Sanderford v. Lombard

685 So. 2d 1162, 96 La.App. 4 Cir. 1171
CourtLouisiana Court of Appeal
DecidedDecember 11, 1996
Docket96-CA-1171
StatusPublished
Cited by12 cases

This text of 685 So. 2d 1162 (Sanderford v. Lombard) 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
Sanderford v. Lombard, 685 So. 2d 1162, 96 La.App. 4 Cir. 1171 (La. Ct. App. 1996).

Opinion

685 So.2d 1162 (1996)

Sheila SANDERFORD and H. Britton Sanderford, Jr.
v.
Christine LOMBARD, John Menendez, Firemen's Fund Insurance Company, XYZ Insurance Company, Allstate Insurance Company and Axonn, Inc.

No. 96-CA-1171.

Court of Appeal of Louisiana, Fourth Circuit.

December 11, 1996.

*1164 George Pivach, II, Jefferson D. Honeywell, Mark J. Boudreau, Pivach & Pivach, L.L.C., Belle Chasse, for Plaintiff/Appellees.

Glenn B. Adams, Dan Richard Dorsey, Porteous, Hainkel, Johnson & Sarpy, New Orleans, for Defendant/Appellant (Allstate Insurance Company).

Before CIACCIO, PLOTKIN and LANDRIEU, JJ.

LANDRIEU, Judge.

This case arises from an automobile accident that occurred on October 7, 1988. The automobile driven by Sheila Sanderford and owned by Axonn, Inc. was struck from the rear by an automobile owned by John Menendez and driven by Christine Lombard. Sheila and H. Britton Sanderford subsequently filed suit against Lombard; her liability insurer, Fireman's Fund; and Axxon's uninsured motorist carrier, Allstate Insurance Company (Allstate) for personal injuries sustained as a result of the accident. In an amended and supplemental petition for damages, the Sanderfords sued Allstate for handling their claim in an arbitrary and capricious manner and prayed for penalties and attorneys fees.

The trial court granted summary judgment on the issue of liability. At trial, it was stipulated that the plaintiffs had exhausted the underlying policy limits ($19,000.00) of the Fireman's Fund policy. It was further stipulated that Allstate had tendered $5,00.00 in medical payments to Sheila Sanderford and that Allstate was entitled to a credit of $24,000.00 from any and all damages awarded to the Sanderfords.

After a trial on the merits was held on the issue of damages and the arbitrary and capricious claim asserted against Allstate, the jury found for the plaintiffs. They awarded Mrs. Sanderford $105,000.00 for general damages and $30,000.00 for past and future medical expenses and awarded Mr. *1165 Sanderford $10,000.00 for his loss of consortium. The jury also found that Allstate had handled the claim in an arbitrary and capricious manner. The Court awarded attorney's fees of $35,670.45, penalties of $15,000.00, and court costs of $5,971.39.

Allstate asserts that:

(1) The jury verdict finding that Allstate handled the Sanderford's claim in an arbitrary and capricious manner is contrary to the weight of the evidence and the law;

(2) The damages awarded the Sanderfords were excessive; and

(3) The trial court erred in awarding $5,971.39 in court costs.

Plaintiffs also asserted several errors. However, because their answer was not timely filed, their assignments of error are not properly before this Court and will not be addressed.

DISCUSSION

The standard of review of factual findings is manifest error. Rosell v. ESCO, 549 So.2d 840 (La.1989). To reverse a fact finder's determination, the appellate court must find from the record that a reasonable factual basis does not exist for the finding, and must further determine that the record establishes that the record is clearly wrong. Stobart v. Dept. of Transportation and Development, 617 So.2d 880 (La.1993). Where there is conflict in the testimony, reasonable evaluations of credibility and reasonable inferences of fact should not be disturbed upon review. Arceneaux v. Domingue, 365 So.2d 1330 (La.1978).

ASSIGNMENT OF ERROR NO. 1

Allstate asserts that the evidence was insufficient to prove they were arbitrary and capricious in their handling of the Sanderfords' claim. Allstate was Axxon's uninsured motorist carrier. At the time that the Sanderfords' claim arose, La.Rev.Stat. 22:658 stated that "[a]ll insurers issuing any type of contract ... shall pay the amount of any claim due any insured ... within sixty days after receipt of satisfactory proofs of loss from the insured."[1] Failure to make payment shall subject the insurer to penalty if the failure is found to be arbitrary, capricious, or without probable cause. La.Rev. Stat. 22:658(B)(1). A "satisfactory proof of loss" must be sufficient to fully apprise the insurer of the insurer's claim, Hart v. Allstate Ins. Co., 437 So.2d 823 (La.1983), i.e., (1) that the owner or operator of the other vehicle involved in the accident was uninsured or underinsured; (2) that he was at fault; (3) that such fault gave rise to damages; and (4) establish the extent of those damages. McDill v. Utica Mut. Ins. Co., 475 So.2d 1085, 1089 (La.1985).

The Sanderfords made a demand for an unconditional tender to Allstate on or about May 14, 1990. Debbie Skorlich, the Allstate adjuster who evaluated the Sanderfords' claim, testified that it had been agreed that the Sanderfords were free from fault and that the policy limits of the owner and the operator of the vehicle at fault had been exhausted. She stated that because there was insufficient proof of the injuries that the Sanderfords alleged, she requested additional medical information. She admitted, however, that even after the information was received, Allstate did not respond to the Sanderfords' demand for an unconditional tender because Allstate was waiting for depositions to be completed in July.

After the depositions were completed on August 3, 1990, Allstate made a medical payment of $5,000.00 under the medical portion of the policy, not the uninsured motorist portion. Skorlich testified that Allstate never tendered any amount of payment under the underinsured portion of the policy.

Allstate argues that no unconditional tender was made because they questioned whether the bulging disc injury claimed by Mrs. Sanderford was causally related to the automobile accident or to a previous accident in 1986 in which she fell.[2] Skorlich stated *1166 that she had relied on Dr. Courtney Russo's medical records for this information, a doctor that Mrs. Sanderford had not seen in over two years.

Skorlich testified that she also based her decision on Dr. Robert Steiner's independent examination results. Dr. Steiner saw Mrs. Sanderford on August 28, 1990, twentytwo months after her accident and more than sixty days from the demand for unconditional tender. Whether or not refusal to pay benefits is arbitrary, capricious, or without probable cause depends primarily on the facts known to the insurer at the time of its action. Scott v. Insurance Co. of North America, 485 So.2d 50, 52 (La.1986). Therefore, at the time Skorlich made the decision not to respond to the demand within the statutory time frame, she did not have Dr. Steiner's information to influence her decision.

Skorlich testified that the third reason she did not submit a tender was because the submitted information in Dr. Kenneth Adatto and Dr. Robert Lizana's medical reports did not support causality between the accident and Mrs. Sanderford's medical complaint. Skorlich admitted that Dr. Adatto conducted an MRI which indicated a soft tissue injury and that she had received medical documentation from Dr. Adatto that he found a disc bulge. She further testified that she felt the $19,000.00 paid to Mrs. Sanderford was just compensation without reviewing the quantum of any similar cases or discussing quantum with Allstate's attorney.

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Cite This Page — Counsel Stack

Bluebook (online)
685 So. 2d 1162, 96 La.App. 4 Cir. 1171, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sanderford-v-lombard-lactapp-1996.