Author: Nancy Gilbert

Novel Coronavirus Breeds Novel Litigation: Business Interruption Suits in the Age of COVID-19

04.17.2020

The nation’s first suit seeking a declaration of coverage under a commercial property policy for business interruption and extra expenses incurred as a result of COVID-19 was filed in a Louisiana state court on March 20, 2020. Since then, similar suits have been filed across the nation by restaurants, casinos, dentists, dive shops, movie theatres, repertory theatre companies, etc. Clearly, the same coverage issues raised in the Louisiana case will be litigated throughout the nation.

The suit in Cajun Conti, LLC, et al v. Certain Underwriters at Lloyd’s, London, et al, Suit No. 2020-02558, was filed on March 16, 2020, in the Civil District Court for the Parish of Orleans, State of Louisiana. Plaintiffs, doing business as Oceana Grill, a restaurant in the French Quarter, allege coverage should be declared to exist because: 1) the property policy is an “all risks” policy such that all risks are covered unless the insurer can clearly and specifically establish an exclusion from coverage; 2) the policy does not contain any exclusion “for losses from a virus or global pandemic;” 3) the virus has “physically impact[ed] public and private property” as it “physically infects and stays on the surface of objects or materials, ‘fomites,’ for up to twenty-eight days;” 4) such “contamination … [is] a direct physical loss needing remediation;” and, alternatively and in addition, 5) the current and future state orders limiting its operations serve to trigger the civil authority provisions of its policy.

A key issue in Cajun Conti as well as in the other COVID-19 business interruption coverage litigation will be whether the existence of the novel coronavirus constitutes a “direct physical loss or damage” under the intendment of an all risks property policy. The Cajun Conti plaintiffs cite to Widder v. Louisiana Citizens Prop. Ins. Corp., 2011-0196 (La. App. 4 Cir. 8/10/11), 82 So.3d 294, writ denied, 2011-2336 (La. 12/2/11) for the premise that the existence of a hazardous condition that renders the insured property unusable or uninhabitable is sufficient to constitute a “physical loss or damage” sufficient to trigger coverage. Notably, in Widder, the actual presence of inorganic lead in the insured property was confirmed to exist and coverage was therefore available. Because policyholders have the burden to establish the existence of “physical loss or damage,” reliance on Widder may require the Cajun Conti plaintiffs to establish coronavirus was actually present in their property or that its presence otherwise caused their property to be unusable or uninhabitable. Presence in the community may not be sufficient to prove the coronavirus made the insured property uninhabitable or unusable.

One of the items of proof required for the triggering of coverage under the civil authority provisions of a commercial property policy is that the alleged business loss was caused by an action by the civil authority that prohibited access to the insured premises. Relying on out-of-state jurisprudence, one Louisiana federal court has determined this factor requires proof that access to the insured premises be “actually and completely prohibited,” which is not satisfied if the access is merely “limited or hampered.” Kean, Miller v. National Fire Ins. Co. of Hartford, C.A. No. 06-770 (M.D. La. Aug. 29, 2007), 2007 WL 2489711, *4-*6. The state orders expressly referenced in the Cajun Conti suit would appear not to satisfy this standard as they served only to limit occupancy and required earlier closures. Even the subsequent stay-at-home orders [Proclamation Number 33 JBE 2020 and 41 JBE 2020, issued respectively on March 22, 2020 and April 2, 2020], may likely be insufficient to satisfy this requirement as they do not expressly mandate closure of restaurants, but simply require restaurants to “reduce operations to continue minimum contact with members of the public,” expressly allow for curbside delivery, drive-thru, and delivery services, and only prohibit the consumption of food and beverages on site.

The specific facts of each business interruption claim and the terms of the relevant policy should be considered in every occasion. Yet, these suits may face problems of proof generally. For now, we expect the novel suits to continue.

John has been practicing over 30 years and is a Senior Partner with firm where he serves on the Management Committee. He has devoted attention to non-profit boards dedicated to assisting at risk children. He enjoys time with his three children and grandchildren. He also enjoys tennis and hiking.

Nancy B. Gilbert is a partner with Keogh Cox in Baton Rouge, Louisiana. She is a puzzle-solver by nature, and specializes in providing clear and in-depth analysis of complex litigation issues.

Keeping Testimony of Future Medical Expenses “Out of the Gate”

06.17.2019

In a recent case involving Keogh Cox attorneys, the Eastern District of Louisiana in Michael Brander, Jr. v. State Farm Mutual Auto. Ins. Co., Civ. A. No. 18-982 (Feb. 14, 2019), 2019 WL 636423 barred testimony of substantial projected medical expenses because it was not based on a reliable methodology. This ruling stands to impact many other cases where plaintiffs seek to use far-reaching projections of a life-long need for radiofrequency ablations (“RFAs”) or other pain-management modalities to “board” six and even seven-figure numbers for future medical expenses.

In Daubert v. Merrill Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993), the United States Supreme Court recognized the trial judge as the “gatekeeper” of expert opinion testimony and held that only reliable and relevant expert opinions may be admitted. The reliability requirement serves to keep expert opinions “outside the gate” when they constitute unsupported speculation or mere subjective belief; only scientifically valid expert opinions are allowed inside. To ascertain whether an expert opinion is scientifically valid, Daubert instructs the trial court to consider:

∙ whether the expert’s theory can or has been tested;

∙ whether it has been subject to peer review and publication;

∙ the known or potential rate of error when applying the theory;

∙ applicable standards and controls; and,

∙ the degree to which the theory has been generally accepted in the scientific community.

In Brander, the plaintiff advanced medical testimony that he would need RFAs every year of his expected lifetime, a period of 36 years. The court disallowed the testimony, noting that the plaintiff’s physicians had less than ten years personal experience in administering RFAs to patients, the medical literature only considered the effectiveness of RFAs over a span of seven to ten years, and there was no showing that the 36-year treatment plan was in general acceptance by the medical community. According to the court, the expert opinions offered by plaintiff failed Daubert “on all points.” As a result, the plaintiff was permitted to introduce testimony of future RFAs for only a seven-year period.

The reasoning of Brander may be equally applicable to projections of lifetime treatment involving other medical procedures, such as medial branch blocks, Botox injections, or spinal cord stimulators, for which the long-term efficacy has not been firmly established in the medical literature. Opinions unsupported by personal treatment experience and peer-reviewed medical studies are not scientifically valid and are properly halted “at the gate.”

Nancy B. Gilbert is a partner with Keogh Cox in Baton Rouge, Louisiana. She is a puzzle-solver by nature, and specializes in providing clear and in-depth analysis of complex litigation issues.

Past Mistakes: Waiver of Coverage Defenses

07.23.2018

What does it mean to “waive” something? To an insurer in Louisiana, the meaning is clear; a waiver can mean thousands or even millions of dollars in insurance coverage that may otherwise be excluded. Recently, the Louisiana Supreme Court in Forvendel v. State Farm Mutual Automobile Insurance Company, 2017-C-2074 (June 27, 2018) clarified when an insurer will be found to have waived coverage defenses.

Waiver is generally understood as the “intentional relinquishment of a known right, power, or privilege.” Waiver occurs when there is: 1) a right; 2) that is known; and, 3) an actual intention to forego the right or conduct so inconsistent with an intent to enforce the right so as to induce a reasonable belief that it has been relinquished. The waiver rule is generally applied to an insurer who defends itself and its insured without having obtained a nonwaiver agreement to preserve its coverage defense. The joint defense of the insured and the insurer, without asserting a known defense, is deemed to be conduct inconsistent with the enforcement of the coverage defense and therefore a waiver.

In Forvendel, the Louisiana Supreme Court considered whether an insurer’s waiver of a coverage defense in a prior claim served to waive the coverage defense in a subsequent claim involving the same insured and similar circumstances. The key issue in the case was whether the insurer’s conduct in allowing the same insured to “stack” two UM coverages contrary to Louisiana’s “anti-stacking” law (La. R.S. 22:1295 (1)(c)) when adjusting an accident claim in 2007 served as a waiver of the right to assert the anti-stacking law when adjusting a 2013 accident claim.

Luckily for insurers, who could be forever bound by past mistakes in their handling of claims, the Louisiana Supreme Court reversed the two lower courts and found the right was not waived. In so ruling, the Court distinguished prior case law in which a coverage defense was found to have been waived because the insurer’s conduct took place while handing the same claim, not a prior claim. The Louisiana Supreme Court also drew on a line of cases that allowed insurers to recover previously made payments under well-established principles of Louisiana law allowing for the recoupment of payments not due.

The Forvendel case provides a common-sense result by relieving insurers from unintended consequences from past omissions in the handling of an insured’s new claim.

Nancy B. Gilbert is a partner with Keogh Cox. She is a puzzle-solver by nature and uses these skills to provide clear and in-depth analysis of complex litigation issues. Nancy is a devoted grandmother, an avid camper and gardener, and enjoys renovating her 80-year-old home.

Keogh Cox’s Win in Toledo Bend Litigation Could Have National Impact in Flood Hazard Litigation

10.11.2013

In a decision released October 9, 2013, the U.S. Fifth Circuit upheld the grant of the defendants’ Motion to Dismiss by concluding that the Federal Power Act (“FPA”) preempts property damage claims based in Louisiana state tort law where the alleged damage is the result of operations that comply with the FERC-issued license. Simmons v. Sabine River Authority, No. 12-30494, – F.3d – , (5th Cir. 10/09/2013).