Reed v. State Farm Mut. Auto. Ins. Co.

832 So. 2d 1132, 2002 La.App. 3 Cir. 0804, 2002 La. App. LEXIS 3741, 2002 WL 31758740
CourtLouisiana Court of Appeal
DecidedDecember 11, 2002
Docket02-804
StatusPublished
Cited by2 cases

This text of 832 So. 2d 1132 (Reed v. State Farm Mut. Auto. Ins. Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Reed v. State Farm Mut. Auto. Ins. Co., 832 So. 2d 1132, 2002 La.App. 3 Cir. 0804, 2002 La. App. LEXIS 3741, 2002 WL 31758740 (La. Ct. App. 2002).

Opinion

832 So.2d 1132 (2002)

Bonnie D. REED
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY.

No. 02-804.

Court of Appeal of Louisiana, Third Circuit.

December 11, 2002.

*1134 Anne E. Watson, Attorney at Law, Opelousas, LA, for Plaintiff/Appellee, Bonnie D. Reed.

Katherine P. Martin, Attorney at Law, Lafayette, LA, for Defendant/Appellant, State Farm Mutual Automobile Insurance Company.

Court composed of HENRY L. YELVERTON, OSWALD A. DECUIR and ELIZABETH A. PICKETT, Judges.

PICKETT, Judge.

FACTS

This suit arises from an automobile accident that occurred in Ville Platte, Louisiana, on February 27, 2001. This accident involved a 1997 Ford Taurus being driven by Bonnie Reed.

Both parties' vehicles were insured by State Farm Mutual Automobile Insurance Company (State Farm). Ms. Fontenot had a liability policy with a $10,000.00 per person liability limit. Ms. Reed had a policy which afforded $25,000.00 per person in uninsured motorist benefits. It was stipulated that Ms. Fontenot was 100% liable in the cause of the accident.

On April 27, 2001, Ms. Reed signed an authorization giving State Farm permission to obtain her medical records.

On June 22, 2001, Ms. Reed called her State Farm claims representative, Shawn Smith, and told Mr. Smith she was going to need a knee replacement and was making a claim for uninsured motorists (UM) benefits.

On July 23, 2001, Ms. Reed settled with State Farm for Ms. Fontenot's policy limits of $10,000.00.

When notified by Ms. Reed that she intended to make a UM claim, Mr. Smith contacted the State Farm representative who handled Ms. Fontenot's policy, Cedric Roy. Mr. Roy informed Mr. Smith that Ms. Reed had a four-month-old injury which did not exceed policy limits. Monica Domingue subsequently took over the handling of the UM claim. Ms. Domingue secured the records from State Farm's file involving the liability policy, which reflected medical bills totaling $3,272.32 and treatment through May 21, 2001. Ms. Domingue *1135 did not find, at that time, that any UM tender was warranted as she did not believe the claim exceeded the underlying policy limits.

Ms. Domingue further investigated the claim, requesting complete medical records from Dr. Barry Henry and Dr. Chuck Aswell. Dr. Henry's records reflected a pre-existing knee condition for which Ms. Reed had undergone surgery on her knee several months prior to the accident, with pain and mild swelling reported on December 7, 2000, a little less than three months before the accident at issue. Ms. Domingue re-evaluated the claim and, again, determined that Ms. Reed had not proven a claim which exceeded policy limits. Because Ms. Reed was claiming she needed a knee replacement because of the accident, Ms. Domingue specifically inquired of Dr. Henry as to what extent the accident had aggravated Ms. Reed's preexisting condition. Ms. Domingue had received complete medical records on July 30, 2001, one week after State Farm settled the liability issue at policy limits under Ms. Fontenot's policy. Ms. Domingue sent her inquiry to Dr. Henry on August 4, 2001.

State Farm received a reply from Dr. Henry on August 28, 2001. Dr. Henry acknowledged he had recommended a total knee replacement prior to the accident, but that Ms. Reed's condition had been aggravated by the accident. He noted the surgery would be sooner than otherwise necessary as a result of the accident.

By September 7, 2001, State Farm had Bonnie Reed's complete medical records before it reflecting treatment through July 20, 2001, total medical bills of $5,333.47, and an opinion from the treating physician that Ms. Reed's pre-existing knee condition was aggravated by the accident which accelerated the need for knee replacement surgery. At this point, Ms. Domingue increased her evaluation of Ms. Reed's claim, ranging it from $17,500 to $18,500.00. After giving State Farm a credit for the underlying $10,000.00 liability limit, she issued a tender to Ms. Reed for $7,500.00. She advised Ms. Reed that she would continue to evaluate her claim and pay accordingly as any additional documentation was received.

On October 3, 2001, Ms. Reed filed suit against State Farm alleging that State Farm acted arbitrarily and capriciously in failing to timely tender the policy limits and/or a reasonable amount under the policy as required by La.R.S. 22:658 and 22:1220. The plaintiff sought damages, attorney fees, penalties and court costs.

On November 1, 2001, Ms. Reed's attorney, by letter to Ms. Domingue, requested the policy limits of the UM policy be paid to Ms. Reed.

Ms. Reed was seen by Dr. Charles Johnson, an orthopaedic surgeon, on January 29, 2002. He also recommended a total knee replacement, and surgery was scheduled for February 25, 2002. State Farm took Ms. Reed's deposition on February 18, 2002, at which time she told State Farm the date of the scheduled surgery. State Farm had requested, but not yet received, the medical records from Dr. Johnson.

State Farm received Dr. Johnson's medical records on February 26, 2002, which reflected the January appointment and his recommendations. Dr. Johnson's deposition was taken on March 4, 2002. At the deposition, Dr. Johnson testified that the damage to Ms. Reed's knee was caused by the motor vehicle accident. Following this deposition, State Farm tendered the balance of the policy limits in the amount of *1136 $17,500.00. Although a settlement offer was made, Ms. Reed rejected it because it did not include attorney fees and penalties.

State Farm issued its check on April 3, 2002, in the amount of $18,128.87 which included the policy limits of $17,500.00 and legal interest in the amount of $628.87.

A trial on the merits was held on May 20, 2002. Judgment was rendered in favor of the plaintiff, Bonnie Reed, and against the defendant, State Farm, awarding the plaintiff $1,800.00 in penalties with legal interest, $15,000.00 in attorney fees plus legal interest, costs of the proceeding, and a $350.00 expert witness fee assessed for Timothy Fontenot, the physical therapist. Written judgment was executed on May 22, 2002. It is from this judgment the defendant appeals.

ASSIGNMENTS OF ERROR

ASSIGNMENTS OF ERROR BY THE DEFENDANT

(1) The trial court committed manifest error in concluding that State Farm failed to make a reasonable tender within thirty days from proof of loss as the evidence established that Ms. Reed did not make satisfactory proof of a loss mandating a UM tender more than thirty days prior to September 7, 2001 nor did Ms. Reed provide any proof to State Farm that the value of Ms. Reed's claims must have exceeded $17,500.00 at that time.

(2) The trial court committed manifest error in concluding that a second UM tender was mandated more than thirty days prior to April 3, 2002 when no additional satisfactory proof of loss was submitted during that time-frame.

(3) The trial court committed manifest error in concluding that State Farm was arbitrary and capricious in failing to make a reasonable investigation where the evidence clearly showed that State Farm actively investigated the plaintiff's claims throughout the handling of this matter.

(4) The trial court committed manifest error in concluding that State Farm was arbitrary and capricious in failing to properly evaluate the claim when the evidence clearly established that Ms.

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Related

Reed v. State Farm Mut. Auto. Ins. Co.
857 So. 2d 1012 (Supreme Court of Louisiana, 2003)
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845 So. 2d 471 (Louisiana Court of Appeal, 2003)

Cite This Page — Counsel Stack

Bluebook (online)
832 So. 2d 1132, 2002 La.App. 3 Cir. 0804, 2002 La. App. LEXIS 3741, 2002 WL 31758740, Counsel Stack Legal Research, https://law.counselstack.com/opinion/reed-v-state-farm-mut-auto-ins-co-lactapp-2002.