Moore v. St. Paul Fire and Marine Insurance Company

203 So. 2d 548, 251 La. 201, 1967 La. LEXIS 2346
CourtSupreme Court of Louisiana
DecidedNovember 6, 1967
Docket48602
StatusPublished
Cited by16 cases

This text of 203 So. 2d 548 (Moore v. St. Paul Fire and Marine Insurance Company) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Moore v. St. Paul Fire and Marine Insurance Company, 203 So. 2d 548, 251 La. 201, 1967 La. LEXIS 2346 (La. 1967).

Opinion

McCALEB, Justice.

Plaintiff, a ranch hand, brought this suit against his employer’s insurer for workmen’s compensation, alleging that he is permanently totally disabled as the result of an injury to the cervical region incurred when he fell from a horse on June 24, 1964 while herding cattle for his employer, J. Austin Davis, at Ragley, Louisiana. Recovery of compensation benefits of $19.50 per week is sought for 400 weeks, less compensation already paid for 18 weeks at $19.05 weekly, plus medical expenses, etc. In addition, plaintiff prayed for recovery of a 12% penalty “ * * * on all compensation payments due at the time the judgment is paid, and for plaintiff’s reasonable attorney’s fees in the amount of $2,500 * * * ”.

Defendant admitted the accident and its liability for workmen’s compensation, but denied that plaintiff had sustained permanent disability. It averred that the payments it had made of $19.05 per week through November 1, 1964 are more than plaintiff was entitled to receive. It also denied liability for the claimed penalty and prayed that plaintiff’s demands be rejected.

After a trial, the district judge dismissed plaintiff’s suit, holding in a well-reasoned opinion that plaintiff had failed to estab *206 lish disability after he was discharged by; his doctor on November 1, 1964 as being able to resume his occupation. Although plaintiff had not claimed in his petition that he was entitled to statutory penalties and attorney’s fees under R.S. 22:658 for the insurer’s delay in payment of the weekly compensation due during the 18 weeks of his disability, the judge considered this matter as one of the issues and, in written reasons for judgment, he commented on these payments as follows:

“The plaintiff was paid workmen’s compensation benefits from the date of the accident through November 1, 1964. However, the weekly benefits were not paid promptly and regularly when due, and the amount of the first draft covering the six weeks period from June 25, 1964, to August 5, 1964, was erroneously computed at the rate of $19.05 per week rather than the correct amount of $19.50. The defendant’s counsel tendered a check for $8.30 at the trial to cover the deficiency (his computation of such sum having been made on the erroneous assumption that the weekly benefits for the entire period of disability had been paid at the rate of $19.05 per week).
The delay in commencement of payment of compensation was occasioned by the insurer’s difficulty in obtaining a written medical report. However, the first draft was mailed immediately upon obtaining such report from the attending physician and receipt of demand from the plaintiff’s attorney. The slight deficiency in amount thereof obviously resulted from a clerical error in transposition of figures — i. e., $19.05 instead of the correct rate of $19.50. It was not shown that the plaintiff or anyone acting in his behalf made any effort to furnish the defendant proof of his disability or to advise it of the incorrect computation of the first draft for workmen’s compensation benefits before suit was filed. Under the circumstances, the court concludes that the insurer’s actions in this respect did not constitute an arbitrary or capricious failure to pay the compensation within sixty days ‘after receipt of satisfactory proofs of loss from the insured, employee or any party in interest * * * and demand therefor,’ within the meaning of R.S. 22:658. Soulier v. Raymond [La.App.], 177 So.2d 651; and Broussard v. Dumas Chevrolet Company, [La.App.], 135 So.2d 614.”

Plaintiff appealed from the adverse decision to the Court of Appeal, Third Circuit, where the judgment was affirmed. See Moore v. St. Paul Fire and Marine Insurance Co., La.App., 193 So.2d 882. Plaintiff then applied for certiorari. The application was granted limited, however, to defendant’s liability for penalities and attorney’s fees. The matter has been argued on this restricted issue, and the case submitted for our decision.

*208 At the outset we feel impelled to note that the question presented for our consideration was never made an issue in plaintiff’s petition, as he simply declared that defendant “arbitrarily, capriciously and without reasonable cause discontinued the payment of compensation benefits to him” and demanded only penalties and attorney’s fees on all compensation payments “due at the time the judgment is paid.” As all compensation had been paid for 18 weeks, except for the clerical error in transposition of figures ($19.05 instead of $19.50), for a portion ,of the 18 weeks that compensation was due, the petition did not assert, as plaintiff has since asserted, that defendant acted arbitrarily and capriciously in failing to make timely payment of weekly compensation benefits from the date of the accident to November 1, 1964 when disability ceased. Nevertheless, in view of the provisions of Art. 862, Code of Civil Procedure, 1 and the fact that the opposing parties and the lower courts have treated the timeliness and the amount of the weekly payments to be at issue, we proceed to a determination of the limited question presented. 2

The trial judge was of the opinion that the insurer did not act arbitrarily in withholding weekly compensation payments on their due date, as it was waiting for the treating physician’s written report in order to determine the length and the nature of plaintiff’s disability. The Court of Appeal disagreed with this holding. It concluded that it was arbitrary for the insurance company to withhold the weekly payments because its adjuster was informed verbally by the doctor during July of 1964 that plaintiff was disabled at that time.

The accident happened on June 24, 1964; and Mr. Robert L. Comeaux, an adjuster for the defendant company, began an investigation on July 1, 1964. Prior to July 23, 1964, the adjuster had communicated with Dr. Cecil W. Clark, the treating physician, and confirmed the disability. He then assured plaintiff that weekly compensation would be forthcoming as soon as Dr. Clark would furnish a medical report stating the probable length of the disability. On September 11 or 12, 1964 a draft was drawn by defendant for the weekly payments due through August 5, but this draft was with *210 held by the adjuster as he had not yet received Dr. Clark’s report. On October 7, 1964 plaintiff employed an attorney, who wrote to plaintiff’s employer, making formal demand for payment of compensation; and, on October 13, defendant paid compensation due through August 5 in the amount of $19.05 a week instead of $19.50 a week, the correct amount.

On October 8 Dr. Clark furnished defendant with his written report, and on October 15 Dr. Stephen E. Carter, who was then treating plaintiff, sent defendant a written report stating that plaintiff would be able to resume his regular work in about two weeks. Based on these reports, defendant paid plaintiff, on October 29, 1964, compensation at $19.50 per week until November 1, 1964. This was the last payment for compensation during 18 weeks which, according to the final judgment in this case, was the length of plaintiff’s disability. Suit was not filed until August 25, 1965.

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Bluebook (online)
203 So. 2d 548, 251 La. 201, 1967 La. LEXIS 2346, Counsel Stack Legal Research, https://law.counselstack.com/opinion/moore-v-st-paul-fire-and-marine-insurance-company-la-1967.