153 So. 3d 448
La. Ct. App.2014Background
- Student Wilbert Barton (Marksville High) was injured April 24, 2009, during a strength and conditioning PE class taught/supervised by football coaches; he became quadriplegic with >$500,000 in medical bills.
- Avoyelles Parish School Board held an accidental-injury policy for interscholastic athletes issued by National Union effective Aug 1, 2008–July 31, 2009.
- National Union moved for summary judgment asserting the policy only covers injuries occurring during the sport’s “official season” and during a “regularly scheduled and approved” game/practice; Wilbert’s injury was in April and during a PE class.
- Plaintiffs argued the policy language is ambiguous (terms like “official season,” “regularly scheduled,” “approved,” and “practice session” undefined) and that the strength/conditioning class was an approved component of the football program.
- Trial court denied National Union’s summary-judgment motion; the appellate court (majority) affirmed, finding genuine issues of material fact as to coverage and as to whether insurer’s claim handling was arbitrary and capricious. One judge dissented as to penalties/fees.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether injury occurred "during the official season" so policy covers loss | Barton: policy ambiguous; spring strength/conditioning is part of the program and season; LHSAA rules leave room for season interpretation | National Union: "official season" is fall/winter per LHSAA calendar; April is off-season, so no coverage | Denied summary judgment — ambiguity/genuine issue of material fact as to whether April class falls within "official season" |
| Whether injury occurred during a "regularly scheduled and approved" practice/session | Barton: PE strength/conditioning class was approved by principal, taught by coaches, integral to football program, thus an approved practice | National Union: class was a PE course, not a regularly scheduled/approved football practice; LHSAA prohibits practices during class hours; approvals must come from participation organization (school board) | Denied summary judgment — factual dispute exists whether the class was a covered, approved practice session |
| Whether insurer acted arbitrarily and capriciously in denying coverage (penalties/attorney’s fees) | Barton: insurer was on notice of ambiguity; denying payment may be arbitrary; premature to decide on summary judgment | National Union: reasonable dispute about policy meaning; good-faith denial so penalties improper | Denied summary judgment — genuine factual issues over insurer’s reasonableness; penalties/fees premature to resolve |
Key Cases Cited
- Sims v. Mulhearn Funeral Home, Inc., 956 So.2d 583 (La. 2007) (ambiguous insurance provisions construed against insurer)
- Holland v. Golden Rule Ins. Co., 688 So.2d 1186 (La. App. 3 Cir. 1996) (insurer may be penalized where denial rests on ambiguous policy)
- Coker v. American Health & Life Ins. Co., 525 So.2d 130 (La. App. 3 Cir. 1988) (even novel issues do not automatically excuse insurer from penalties)
- Thibodeaux v. Lafayette Gen. Surgical Hosp. L.L.C., 38 So.3d 544 (La. App. 3 Cir. 2010) (summary-judgment review is de novo)
- Hoffpauir v. Time Ins. Co., 536 So.2d 699 (La. App. 3 Cir. 1988) (exclusions must be clear and unmistakable)
- Calogero v. Safeway Ins. Co. of La., 753 So.2d 170 (La. 2000) (insurer with legitimate doubts may litigate claims without penalty, but reasonableness is factual)