Scanlan v. Mutual Benefit Life Insurance

371 So. 2d 356, 1979 La. App. LEXIS 3664
CourtLouisiana Court of Appeal
DecidedMay 4, 1979
DocketNo. 10078
StatusPublished
Cited by2 cases

This text of 371 So. 2d 356 (Scanlan v. Mutual Benefit Life Insurance) 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
Scanlan v. Mutual Benefit Life Insurance, 371 So. 2d 356, 1979 La. App. LEXIS 3664 (La. Ct. App. 1979).

Opinion

GULOTTA, Judge.

Defendant, the disability insurer under a group policy with plaintiff’s employer, Bernard Lumber Company, appeals from a judgment awarding disability payments, penalties, attorney’s fees and interest.

Although belatedly1 tendering to plaintiff the accumulated amount of the monthly designated disability payment under the policy, defendant contends that the trial judge erroneously awarded statutory penalties and attorney’s fees. According to defendant, because plaintiff failed to produce medical evidence from the treating physician to support his claim that the disability commenced subsequent to the effective date of the policy; and because plaintiff failed to submit medical evidence from the treating physician that a disability did, in fact, exist; and because plaintiff refused to acknowledge defendant’s entitlement to reimbursement for workmen compensation received or awarded to plaintiff as provided in the disability policy, defendant contends the delay encountered in the processing of plaintiff’s claim was reasonable.

Defendant further argues, in seeking to be exonerated from the payment of penalties and attorney’s fees, that because the policy states that it was “delivered in Mississippi and is governed by it’s laws” the trial judge erroneously applied the Louisiana Revised Statute R.S. 22:657(A)2 as a [358]*358basis for awarding penalties and attorney’s fees.

Defendant claims also the trial judge erred in ordering disability payments without deducting for workmen’s compensation benefits (in contravention of the provisions of the policy) when plaintiff had been awarded workmen’s compensation benefits which judgment was on appeal.

Finally, defendant contends the trial judge erred in awarding interest on each past monthly disability payment from its due date until payment was tendered (in August 1977) and also erred in awarding interest on penalties since plaintiff had not prayed for such interest.

Considering defendant’s contentions as presented, we find no merit to the claim that the delay for the tender of the disability payments was reasonable. Plaintiff’s attorney testified that *he attached to a November 10, 1976 letter to the insured the completed claim forms, together with the completed medical report from the treating physician. That report establishes the disability as of June 16, 1976 with a date of treatment commencing in the latter part of 1974. As early as January 17, 1977 the defendant insurer was furnished by its insured a copy of plaintiff’s attending physician’s report.

Although defendant claims it had not been furnished with a copy of the report in the attorney’s November 10th letter, they were clearly aware of and had in their possession, a copy of that report by January 17, 1977. Despite defendant’s claim of lack of cooperation on the part of plaintiff’s physician by his failure to respond to repeated requests for information and that this caused the delay in processing the claim, defendant made no attempt to have an examination made of plaintiff by its own physicians.

Furthermore, in the deposition of plaintiff’s attending physician taken as late as June 30, 1977, the doctor reiterated information contained in the earlier report, which was in the possession of defendant. The doctor further added in that deposition that a report had been furnished to defendant on January 27, 1975 setting forth that plaintiff had undergone surgery of the back on November 23, 1974 for a herniated disc. This report was furnished to defendant in connection with a disability claim made by plaintiff in 1974 for which payments were made by defendant. Clearly, information relating to plaintiff’s back problems resulting in his ultimate disability was in possession of defendant in 1974. Although plaintiff testified he received benefits from defendant in 1974 as a result of a disability at that time, the senior group claims examiner for defendant stated that she was not aware that the defendant paid benefits in 1974 to the plaintiff.

In view of the fact that defendant had in its possession the medical report from plaintiff’s attending physician as early as November 1976 and either had knowledge of or was charged with knowledge of plaintiff’s back operation and disability payments in 1974, we conclude, as did the trial judge, that a defense based upon plaintiff’s failure to furnish medical support of his claim, is without merit.

We further find no merit to defendant’s contention that because of plaintiff’s failure to acknowledge defendant’s right to reimbursement for any workmen’s compensation received, defendant’s delay in making disability payments was reasonable. The policy clearly provides for a reduction in the disability payment by the amount of compensation which the employee receives; [359]*359nevertheless, no sound reason exists for defendant to have withheld payment of the difference between the monthly disability payment and plaintiff’s monthly entitlement to workmen’s compensation. Under the policy provisions plaintiff was entitled to receive $689.00 per month. Plaintiff’s entitlement to workmen’s compensation amounted to approximately $384.00 per month, based on a weekly payment of $85.00. Despite the dispute surrounding plaintiff’s failure to acknowledge reimbursement, defendant had the clear responsibility of making payments of the monthly difference after having been placed on notice, in November 1976, of the disability.

The judgment fails to allow defendant credit for the workmen’s compensation benefits awarded to plaintiff. However, plaintiff acknowledges that because the litigated claim for compensation benefits has now resulted in a final judgment3 awarding benefits, defendant is entitled to a credit and the trial court’s judgment in this case should be amended to reflect that credit.

We reject defendant’s further contention that because the policy states that it “is delivered in Mississippi and is governed by its laws” Louisiana statutory penalties and attorney’s fees are inapplicable. In our case defendant, Mutual Benefit, a New Jersey company, issued the master policy to the Trustees of the Biddle Purchasing Company (a multiple employers’ insurance trust, headquartered in Mississippi and administered by Whitney Associates.) The plaintiff’s employer, Bernard Lumber Company, a Louisiana based company, is a participant in the trust’s group insurance coverage. The plaintiff resides and was employed in Louisiana, and more importantly, he sustained his disability during his Louisiana employment.

Furthermore, plaintiff was presumably “issued” only a certificate 4 under the Master Policy by his Louisiana employer and in Louisiana indicating his group long term disability coverage with Mutual. There exists no evidence that this certificate had any reference to the fact that plaintiff would be bound by Mississippi law, nor that he was informed that he could exercise rights only under Mississippi laws.

In Cook v. AAA Worldwide Travel Agency, 360 So.2d 839 (La.1978) Louisiana members of an overseas tour group filed a breach of contract suit in a Louisiana court. Defendant claimed that the language of the travel brochure sent to plaintiffs stated that any claims which may arise under the agreement shall be settled by arbitration in the State of Minnesota. The Supreme Court in rejecting defendant’s argument stated:

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Related

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539 So. 2d 789 (Louisiana Court of Appeal, 1989)
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386 So. 2d 697 (Louisiana Court of Appeal, 1980)

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Bluebook (online)
371 So. 2d 356, 1979 La. App. LEXIS 3664, Counsel Stack Legal Research, https://law.counselstack.com/opinion/scanlan-v-mutual-benefit-life-insurance-lactapp-1979.