Succession of Coddington v. Time Insurance Co.

658 So. 2d 1326, 1995 La. App. LEXIS 1379, 1995 WL 320618
CourtLouisiana Court of Appeal
DecidedMay 10, 1995
DocketNo. 26992-CA
StatusPublished
Cited by1 cases

This text of 658 So. 2d 1326 (Succession of Coddington v. Time Insurance 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
Succession of Coddington v. Time Insurance Co., 658 So. 2d 1326, 1995 La. App. LEXIS 1379, 1995 WL 320618 (La. Ct. App. 1995).

Opinion

lxMARVIN, Chief Judge.

The daughter of decedent, as administrator of his succession, and decedent’s employer’s worker’s compensation insurer who paid benefits including medical expenses, appeal a judgment rejecting their respective demands for benefits provided in the defendant’s major medical policy that became effective at 12:01 a.m. July 26, 1986.

The issues are primarily factual: Did the decedent’s injury that resulted in his death about ten months later occur before or after [1328]*1328July 26, 1986, and was the decedent’s injury [or sickness, as the policy also provides] covered by the Louisiana worker’s compensation law? On circumstantial evidence, the trial court decided both issues against the appellants.

PREFACE

We shall emphasize the pertinent policy language. The coverage clause in the major medical policy obligates the defendant insurer (Time) to pay “for Covered Charges which result from injury or sickness based on the policy provisions.”

Injury is defined as “accidental bodily injury sustained while this policy is in force,” meaning, as Louisiana case law on insurance coverage issues has consistently held, “accidental from the insured’s standpoint.” Schonberg v. New York Life Insurance Company, 235 La. 461, 104 So.2d 171 (1958); Willis v. Tipton, 593 So.2d 435 (La.App.2d Cir.1992).

Sickness is defined as “a condition which manifests itself while this policy is in force.”

_JjA pre-existing condition, which is excluded from coverage, is defined as “a sickness, injury, disease or physical condition ...” which was either diagnosed or medically treated before the effective date of coverage, or which caused symptoms before the effective date of coverage “clear enough to cause an ordinarily prudent person to seek medical care or treatment.”

The policy also excludes from coverage “injury or sickness covered by any Worker’s Compensation ... Law.”

We review the record factually in the light that most favorably supports the trial court judgment. Theriot v. Allstate Ins. Co., 625 So.2d 1337 (La.1993); Harrison v. Myers, 25,902 (La.App.2d Cir. 6/22/94), 639 So.2d 402.

Before discussing the facts, we note appellants argue that the injury which this decedent suffered was a sickness that manifested itself after 12:01 a.m. on July 26, 1986. Appellants reason that the above policy definitions state that sickness is a condition which includes, by the definition of pre-exist-ing condition, an “injury ... or physical condition” that was either manifest or diagnosed, or which caused symptoms that would have been “clear enough to cause a ordinarily prudent person to seek medical care or treatment.” At this juncture we emphasize that a pre-existing condition, including an injury, is defined in the policy to exclude coverage of an injury sustained or sickness that manifested itself which would be covered by the policy except when the injury was sustained or sickness manifested itself before the policy became effective.

Interpreting the above policy language as requiring proof that the decedent’s injury occurred during the policy period, and finding as a fact thatjjthe injury more probably than not predated the effective date of the policy, the trial court found that appellants failed to carry their threshold burden of establishing that their claim was covered under the policy. Even assuming that burden was met, the court found the policy exclusion for work-related injuries applicable.

Appellants’ assignments of error on appeal track their arguments in the trial court. Our review of the record leads us to agree with the trial court that appellants had, and failed to carry, the burden of proving that decedent’s injury occurred during the policy period.

Finding no error, legal or factual, in the trial court’s ruling that the claim was not covered under the policy, we affirm the judgment without addressing the applicability of the policy exclusion for work-related injuries.

FACTS

The decedent was John F. Coddington, a 51-year-old frugal Shreveport businessman who, as an executive officer and principal shareholder, was engaged in several corporate ventures, one of which Louisiana Waterproofing, Inc. (LWP). He may be described [1329]*1329as a “workaholic” and a “phoneaholic” who arose early and worked late, devoted to keeping in touch with business associates and employees and family. For LWP, he left from Shreveport on Saturday, July 17, 1986, to go to Cheyenne, Wyoming, to oversee an LWP job, intending to return to Dallas on July 23 to meet an LWP job foreman, James Bartish, who was to accompany Coddington to another LWP job site in Miami on Thursday, July 24.

LCoddington spent the night of Tuesday, July 22, in Fort Collins, Colorado, with his adult daughter, Kathy Lightfoot, who drove him to the Denver airport on July 23 to board an afternoon flight to Dallas. He wore jeans and a black shirt with zippers. Shortly after his flight from Denver arrived in Dallas about 5:30 p.m., he telephoned Bartish at 5:40 p.m., asking him to meet him at 8:00 a.m. the next morning at the Howard Johnson motel on the North Central Expressway where he would be staying. They were to discuss plans for the Florida job and for boarding the flight together to Miami that Thursday afternoon. On business trips Cod-dington usually stayed at moderately priced hotels such as Howard Johnson’s.

The cab driver who drove Coddington from the Dallas airport on Wednesday said that Coddington inquired about a hotel or motel that offered exercise equipment or facilities to its guests. The cab driver suggested the Fairmont Hotel, a higher priced downtown hotel where Coddington and his wife sometimes stayed when celebrating an anniversary or birthday. Coddington checked into the Fairmont at 6:40 p.m. on Wednesday, July 23.

He apparently had no trouble filling out his registration card or getting to his room, where he began making long distance phone calls about ten minutes later. Coddington attempted or made eight telephone calls in 35 minutes between 6:49 and 7:24 p.m.: three to his wife, whom he was unable to reach either at home or at her place of work, one to the home of his daughter, Jeanne Marie Light-foot Smith, LWP’s office secretary, who gave him the messages she had taken for him at the office that day, and four to various LWP business associates.

IsTo all who had personal or telephone contact with Coddington on Wednesday, July 23, including his Colorado daughter, Bartish, the cab driver, hotel employees and others, Coddington was coherent, normal, and gave no indication of having been injured or impaired in any way. The recipients of the telephone calls Coddington made from his hotel room said he “sounded like himself.”

Coddington apparently did not tell any of his family members or business associates where he was staying while in Dallas. According to his phone records, he made no more phone calls on any day after 7:24 p.m. on Wednesday, July 23. His reputation as a “phoneaholic” was verified by evidence that he had made almost 40 long distance calls in the 24 hours preceding his last call on July 23, and had made over 100 calls after he left Shreveport for Wyoming on July 17, some as early as 5:00 a.m. and as late as 10:00 p.m. during those six days.

Coddington missed his 8:00 a.m.

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658 So. 2d 1326, 1995 La. App. LEXIS 1379, 1995 WL 320618, Counsel Stack Legal Research, https://law.counselstack.com/opinion/succession-of-coddington-v-time-insurance-co-lactapp-1995.