Articles Posted in Motorcycle Accidents

The Louisiana Supreme Court held that a patient has (1) an implied private right of action for damages against a health care provider under the Health Care and Consumer Billing and Disclosure Protection Act, La. R.S. 22:1871, et seq., “Balance Billing Act”); and (2) an express direct right of action under La. R.S. 22:1874(B) based on the assertion of a statutory medical lien in accordance with La. R.S. 9:4752. Yana Anderson v. Ochsner Health System and Ochsner Clinic Foundation, 2013-2970 (La. 7/1/14).

La.R.S. 22:1874, in pertinent part, prohibits a health care provider from collecting or attempting to collect amounts from an insured patient in excess of the contracted reimbursement rate. The title of the Act, La. R.S. 22:1871, et seq., is the “Health Care Consumer Billing and Disclosure Protection Act.” While it is silent as to a private cause of action for violations of the Balance Billing Act, this language makes clear that the legislature enacted this statutory scheme with protection of the consumer in mind. The Louisiana Supreme Court reasoned that it is difficult to envision a law denying recourse to individuals when that law’s principle aim is individual protection. Further, the Supreme Court found that when taken as a whole, the Balance Billing Act reveals an intent to make the burden on the violator more onerous, not less. The Supreme Court concluded that: “it would be incongruent to rule that a law intended to punish violators and protect consumers would operate in a manner that prohibits an individual’s access to the courts to redress the very violation that is proscribed.”

The Supreme Court also held that the La.R.S. 22:1874 provides an express direct right of action against a healthcare provider who attempts to balance bill by assertion of a medical lien on a patient tort recovery in accordance with La. R.S. 9:4752, which allows for a “medical lien” in favor of health care providers who provide services to an “injured person.”

In Anderson, a personal injury automobile accident victim who was insured by UnitedHealthcare, received medical treatment at an Ochsner facility. Pursuant to a member provider agreement, UnitedHealthcare contracted with Ochsner to secure discounted charges or healthcare rates for its insureds. Despite its contractual agreement with UnitedHealthcare, Ochsner refused to file a claim with the patient’s health insurer. Instead, Ochsner sent a letter to the patient’s personal injury attorney, asserting a statutory medical lien for the full amount of undiscounted charges on any tort recovery the patient received for the underlying automobile accident. The patient filed a putative class action suit against Ochsner for its statutorily prohibited conduct.
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While insurance policies are executed for the benefit of all injured persons, such protection is limited by the terms and limits of the policy. On July 1, 2014, the Louisiana Supreme Court in a 4-3 decision, held that the reporting provision in a claims-made-and-reported policy is a permissible “term and limit” on the insurer’s liability as to third parties and does not violate the Louisiana Direct Action Statute, La.R.S. 22:1269, which affords a victim the right to sue the insurer directly when a liability policy covers a certain risk. Joyce Gorman v. City of Opelousas, 2013-1734 (La.7/1/14). Under a claims-made-and-reported policy, the event and peril insured against is based on making and reporting of the claim within the period specified by the policy.

In Gorman, a personal injury and wrongful death lawsuit arising out of a wrongful act that occurred in September 2009 was timely filed against the City of Opelousas in September 2010. After discovering the identity of the City’s liability insurer in discovery, the plaintiff filed an amended petition for damages in September 2011, naming Lexington Insurance Company as a defendant pursuant to the Louisiana Direct Action Statute. The Lexington liability insurance policy at issue was effective from April 17, 2010 – April 17, 2011, and had a retroactive date of April 17, 2005. The pertinent terms of the policy obligated Lexington to pay claims on behalf of the City if three conditions occur:

1) the wrongful act occurs on or after the retroactive date of the policy, but before the end of the policy period – (this condition was met);
2) the claim for the wrongful act is first made against the City during the policy period – (this condition was met); and 3) the claim is reported to Lexington in writing during the policy period (this condition was not met because the CIty failed to notify Lexington of the claim).

The majority held that the City’s Lexington insurance policy was not effective because the claim had not been reported to Lexington within the applicable policy period. Brushing aside the harsh penalty faced by the City’s personal injury and wrongful death victim due to the City’s blatant failure to timely notify its insurer of the pending claim, the majority reasoned as follows:

We recognize that an injured third party rarely has knowledge of the identity of the insurer of the party responsible for an injury, making it nearly impossible for an injured third party to give notice to the insurer. Rather, the injured third party generally has to rely on the insured, which has an interest in ensuring the availability of the coverage it purchased, to comply with the reporting provision in its policy. Although we can contemplate no logical reason why the City would not report a claim for which it apparently purchased insurance coverage, we decline, under the facts of this case, to hold the insurer liable for the City’s failure to report the claim as required by the Lexington policy. A contrary finding would, where there is no evidence of fraud or collusion, punish the insurer for the inactions of its insured.

The three dissenters did not believe that a claims-made insurer should be able to raise, in an action by the victim of the insured’s tort, the defense of a non-prejudicial failure of the timely notified insured to give notice to the insurer during the policy period. The dissenters believed that the notice provision was not a “term and limit” of the policy and believed that a third party victim, who is denied coverage under a claims-made policy because the timely notified insured failed to notify the insurer timely, should be able to resort to the public policy provisions of the Direct Action statute to obtain coverage. The notice requirement conflicts with the public policy and intent of the Direct Action statute and effectively restricts the vested rights of injured parties by allowing coverage to be defeated in an otherwise timely and valid claim when an insured without good cause blatantly fails to give notice to its insurer:

The provision in the Direct Action statute prohibiting compliance with terms and limits “in violation of the laws of this State” likewise restricts the ability of the contracting parties to limit the tort victim’s right of action against the insurer. Here, the notice requirement coupled with the insured’s blatant and unjustified failure to provide notice would not only limit, but effectively destroy the tort victim’s right of action in an otherwise timely filed suit, and as such, it should be void as against the public policy provisions of our Direct Action statute.

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The Louisiana Supreme Court in a 4-3 decision held that La. Code Civ. P. art. 596A(3) continues to suspend prescription for putative class members when a class action filed in a Louisiana state court is removed to federal court. Tenesha Smith v. Transport Services Company of Illinois, 2013-2788 (La. 7/1/14). In Smith, a class action was filed in Louisiana state court and then removed to federal court where class certification was denied on June 1, 2004. Notice of the denial of class certification was mailed to the putative class members on September 7, 2004. Another state court suit was filed and around 500 putative class members joined the state court suit on October 4, 2004, less than thirty days from the mailing of notice of the denial of class certification.

The Louisiana Supreme Court held that removal has no effect on the suspension of prescription provided by La. Code Civ. P. art. 596. The filing of a class action petition in a Louisiana state court suspends prescription by operation of Article 596. Even if the case is removed to federal court, prescription cannot recommence until one of Article 596’s exclusive statutory triggering events for re-commencing prescription has occurred: (1) the submission of an election form; (2) notice of the restriction or redefinition of the class to exclude an individual; or (3) notice of the dismissal of the action, of a judgment striking the demand for class relief, or of a judgment denying the motion for class certification or vacating a previous order certifying the class.

Under the facts of the case, the Louisiana Supreme Court held that prescription did not recommence until “thirty days after mailing or other delivery or publication of a notice to the class that the action has been dismissed.” The Smith plaintiffs filed their amended petition within this thirty day period.

The majority found Quinn v. Louisiana Citizens Property Insurance Corp., 12-0152 (La. 11/2/12), 118 So.3d 1011, 1019, inapposite. In Quinn, the Louisiana Supreme Court held that La. Code Civ. P. art. 596 applied to putative class actions filed in Louisiana state court and did not provide cross-jurisdictional tolling in the context of a putative class action “filed in federal court.” The Smith dissenters found no logical basis in which to distinguish Quinn and believed that Quinn‘s rationale applied equally to suits filed in federal court and to suits removed to federal court.
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The Louisiana Supreme Court held that forum selection clauses are not per se violative of public policy in Louisiana. Shelter Mutual Insurance Company v. Rimkus Consulting Group, Inc. of Louisiana, 2013-1977 (La. 7/1/14). Specifically, a plurality of the Louisiana Supreme Court (three Justices agreeing with the opinion and one Justice concurring in the result), enforced a forum selection clause found in the written “Terms and Conditions” of a tacit agreement between Shelter Mutual Insurance Company and Rimkus Consulting Group that required litigation arising out of Rimkus’s engineering evaluation and expert witness services in connection with Shelter’s defense of litigation resulting from a claim for hurricane damages brought by a corporation insured by Shelter be brought in Texas.

The Louisiana Supreme Court held that only specific forum selection clauses declared unenforceable and against public policy by the Louisiana Legislature are invalid and unenforceable. The Louisiana Supreme Court distinguished the specific legislative limitations on forum selection clauses found in La. R.S. 9:2779(A), La. R.S. 51:1407(A) and La. R.S. 23:921(A)(2). The Louisiana Supreme Court rejected a blanket application of the public policy stated in these statutes to every contractual forum selection clause.

La. R.S. 9:2779(A) expressly declares out-of-state forum selection clauses against public policy in a small subset of construction contracts for “public and private works projects, when one of the parties is domiciled in Louisiana, and the work to be done and the equipment and materials to be supplied involve construction projects in this state” and states that “provisions in such agreements requiring disputes arising thereunder to be resolved in a forum outside of this state…are inequitable and against the public policy of this state.”

La. R.S. 51:1407(A) of The Louisiana Unfair Trade Practices Act invalidates contractual selections of venue or jurisdictions involving transactions or interactions between out-of-state, professional telephone solicitors and Louisiana residents.

La. R.S. 23:921(A)(2) prohibits forum selection clauses in employment contracts unless the choice of forum clause “is expressly, knowingly, and voluntarily agreed to and ratified by the employee after the occurrence of the incident which is subject to the civil or administrative action.”

The three dissenters opined that all forum selection clauses are unenforceable because such clauses (1) are prohibited by La.Code Civ. P. art. 44(A), which states: “[a]n objection to the venue may not be waived prior to the institution of the action,” (2) contravene a strong public policy of Louisiana, and (3) are contrary to Louisiana’s comprehensive venue scheme and Louisiana law on forum non conveniens.
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Louisiana Attorney General James “Buddy” Caldwell filed a lawsuit on June 27, 2014 with the 19th Judicial District Court for the Parish of East Baton Rouge against Fresenius Medical Care North America and its Louisiana dialysis clinics over the use of dialysis drugs, GranuFlo and NaturaLyte. The FDA issued a Class I recall on these drugs after it was found that the products could put patients at risk for cardiac arrest when not prescribed appropriately.

The Attorney General’s lawsuit seeks a return of profit made by Fresenius on the sale of these drug in Louisiana and seeks civil penalties of up to $5,000 per violation under Louisiana’s Unfair Trade Practices and Consumer Protection Law, La. R.S. 51:1401, et seq.

A number of class-action lawsuits have also been filed against Fresenius. The federal lawsuits have been consolidated into Multi District Litigation (MDL) 2428: In Re: Fresenius Granuflo/Naturalyte Dialysate Products Liability Litigation in the United States District Court for the District of Massachusetts.
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Louisiana trial lawyers, Paul H. Dué and B. Scott Andrews, of the Baton Rouge, Louisiana personal injury law firm of Dué, Guidry, Piedrahita & Andrews have been selected for 2014 membership in The National Trial Lawyers Top 100 Trial Lawyers.

The National Trial Lawyers is a member-driven organization composed of premier trial lawyers from across the country who meet stringent qualifications. Only top trial lawyers from Louisiana who are actively practicing in civil plaintiff and/or criminal defense law are eligible for invitation. Invitees must demonstrate superior qualifications, leadership skills, and trial results as a legal professional. The selection process for this elite honor is based on a multi-phase process which includes peer nominations combined with third party research.

Prospective members of The National Trial Lawyers are carefully screened prior to receiving an invitation for membership. Membership is not automatically renewed; attorneys are reevaluated annually to determine whether their activities and accomplishments qualify them for continued membership.
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For the second straight year, Louisiana Super Lawyers has selected every member (Paul H. Dué, Kirk A. Guidry, Randy A. Piedrahita and B. Scott Andrews) of the Baton Rouge, Louisiana personal injury law firm of Dué, Guidry, Piedrahita & Andrews.

The reason each member has been selected for inclusions in the 2014 Louisiana Super Lawyers list in the practice area of Personal Injury is clear – more than 27 years of handling referrals of complex and difficult personal injury cases from lawyers around the world. The firm’s success is rooted in academia, with all firm members having graduated at the top of their law school class and having served as members of or as editors of their Law Reviews. The firm boasts two former Louisiana Supreme Court law clerks, a former U.S. Fifth Circuit Court of Appeals law clerk, an Adjunct Professor of Law, two past Presidents of the Louisiana Association for Justice (LAJ), and both a former Louisiana appellate judge and an esteemed University of Texas Law Professor “of counsel”.

This academic background, combined with dedication, hard work and extensive experience, has led to hundreds of millions of dollars in judgments, settlements and verdicts. The firm’s success has been shared with the extensive number of attorneys around the world who have referred complex personal injury cases to the firm – and who find the firm’s experience and funding assistance invaluable in representing their seriously injured clients.

For the fourth consecutive year, the Baton Rouge, Louisiana personal injury law firm of Dué, Guidry, Piedrahita & Andrews has been recognized in the “Best Law Firms” rankings by U.S. News & World Report and Best Lawyers. The firm was recognized for 2014 in the plaintiff practice areas of Personal Injury Litigation, Product Liability Litigation, Medical Malpractice, and Admiralty & Maritime Law.

Firms included in the 2014 “Best Law Firms” list are recognized for professional excellence with persistently impressive ratings from clients and peers. Achieving a tiered ranking signals a unique combination of quality law practice and breadth of legal expertise.

“U.S. News has more than two decades of experience in providing the public with the most accurate and in-depth rankings of a wide range of institutions, including our Best Law Schools rankings,” says Tim Smart, Executive Editor of U.S. News & World Report. “Law firms are an integral part of our rankings and a natural accompaniment to the law school rankings.”

The 2014 rankings are based on the highest number of participating firms and highest number of client ballots on record. To be eligible for a ranking, a firm must have a lawyer listed in The Best Lawyers in America©, which recognizes the top 4 percent of practicing attorneys in the US. Over 12,000 attorneys provided over 330,000 law firm assessments, and almost 7,000 clients provided close to 20,000 evaluations. In addition, to provide personal insight, a new Law Firm Leaders Survey was implemented in the decision-making process.

“Because we combine hard data with peer reviews and client assessments,” says Steven Naifeh, President and Co-Founder of Best Lawyers, “more and more clients inform us ours are the most thorough, accurate, and helpful rankings of law firms ever developed.”

Ranked firms, presented in tiers, are listed on a national and/or metropolitan scale. Receiving a tier designation reflects the high level of respect a firm has earned among other leading lawyers and clients in the same communities and the same practice areas for their abilities, their professionalism and their integrity.
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In McBride v. Estis Well Service, 12-30714 (5th Cir. 10/2/13), the United States Fifth Circuit Court of Appeals held that Jones Act Seamen may recover punitive damages for their employer’s willful and wanton breach of the general maritime law duty to provide a seaworthy vessel. Such breach reflects a reckless disregard for the safety of the crew, who remain “wards of admiralty” deserving special protection under maritime law.

The general maritime law cause of action (unseaworthiness) and remedy (punitive damages) were established before passage of the Jones Act, and the Jones Act did not address that cause of action or remedy. Thus, the Fifth Circuit held that the punitive damages remedy remains available under that unseaworthiness cause of action unless and until Congress intercedes.

The Court concluded as follows: “Like maintenance and cure, unseaworthiness was established as a general maritime claim before the passage of the Jones Act, punitive damages were available under general maritime law, and the Jones Act does not address unseaworthiness or limit its remedies. We conclude, therefore, that punitive damages remain available to seamen as a remedy for the general maritime law claim of unseaworthiness.”

The Fifth Circuit cited as authority three law review and journal articles authored by University of Texas School of Law Distinguished Teaching Professor and W. Page Keeton Chair in Tort Law, David W. Robertson. Professor Robertson is one of the nation’s leading experts in admiralty law and serves of counsel to the Baton Rouge, Louisiana admiralty and maritime law firm of Dué, Guidry, Piedrahita & Andrews.
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