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Herod v. American Service Life Ins. Co.
Citations: 554 So. 2d 783; 1989 WL 155396Docket: 89-CA-431
Court: Louisiana Court of Appeal; December 12, 1989; Louisiana; State Appellate Court
The case concerns Audrey Herod's appeal against American Service Life Insurance Company and Blue Cross of Louisiana regarding the denial of coverage for hospital expenses related to surgery for a ruptured disc. Herod held a Blue Cross policy from 1981 until it lapsed in September 1984, after which she obtained a policy from American Service Life on August 1, 1984. Her surgery, costing approximately $25,000, occurred in early 1985. Both insurers denied coverage: American Service Life based on claims of a pre-existing condition and material misrepresentations on Herod's application, while Blue Cross claimed the surgery resulted from an accident occurring after its policy had lapsed. The trial court granted Blue Cross's motion for summary judgment, which led to Herod's appeal. The court evaluated the summary judgment criteria established in Vermilion Corp. v. Vaughn, emphasizing that the burden lies with the mover to demonstrate the absence of material fact issues. Key findings included Herod's admission to prior back treatments since 1982 and her acknowledgment of various incidents, including a fall in October 1984. However, the court noted ambiguity regarding the timing and severity of Herod's pre-existing conditions and their connection to the subsequent surgery, particularly given the absence of conclusive medical testimony. A letter from her treating physician indicated that her prior issues were not related to the ruptured disc, leaving uncertainty regarding the origins of her medical problems. Consequently, the appellate court reversed the summary judgment, indicating that a genuine issue of material fact existed regarding when Herod's disc problem began. The document clarifies that it is neither an affidavit nor certified, lacking the necessary evidentiary weight as established in Continental Casualty Co. v. McLure, which found such documents insufficient for assessing genuine issues of material fact. Similar reasoning applies here, as dismissing Blue Cross could inadvertently imply a factual finding regarding the absence of a pre-existing condition, thus undermining American Service Life's defenses. If the dismissal is not viewed as a factual determination, and American Service Life proves a pre-existing condition at trial, the plaintiff would have no recourse against Blue Cross, her previous insurer. The overall record may suggest the plaintiff is unlikely to succeed against Blue Cross or that American Service Life may not establish a pre-existing condition; however, this alone does not justify summary judgment. The critical issue is whether genuine material facts remain unresolved. The court concludes that such issues do exist, leading to the vacating of the trial judge's summary judgment and remanding the case for further proceedings.