Guillory v. Trinity Universal Insurance Co.

Citations: 520 So. 2d 1071; 1987 La. App. LEXIS 10893; 1987 WL 2458Docket: Nos. 86-1123, 86-1124

Court: Louisiana Court of Appeal; December 8, 1987; Louisiana; State Appellate Court

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Patsy N. Guillory filed a personal injury lawsuit against Diane D. Reilly, Michael Reilly, and their insurer, Trinity Universal Insurance Company, seeking $120,000 for injuries sustained in an accident on December 9, 1983. The defendants denied the allegations and requested a jury trial, which was granted with a bond filed. After discovering Trinity's policy limit was $10,000, Guillory amended her petition to include her uninsured motorist (UM) carrier, Allstate Insurance Company. A joint motion led to the dismissal of claims against the Reillys, leaving Trinity and Allstate as defendants. Allstate filed a cross-claim against Trinity and the Reillys.

The trial was initially set for February 3, 1986, but was postponed. Guillory later reduced her demand to $9,999.99 and requested a bench trial, leading the court to rescind the jury trial order. Allstate then sought summary judgment, arguing that the Reilly vehicle was not underinsured based on the reduced demand and Trinity's policy limits. The court granted this motion on November 3, 1986.

Additionally, Guillory filed a separate claim against Allstate under the medical payment provisions of her policy, which was consolidated with the original suit. Allstate moved for summary judgment, asserting that medical coverage applied only to expenses incurred within a year of the accident. Since all claimed medical expenses were incurred after December 9, 1984, the court upheld Allstate's motion. The appeals for both cases were consolidated, and the primary issue on appeal in docket number 86-1123 is whether the trial court erred in dismissing Guillory's suit against Allstate after her demand was reduced below the tortfeasor's liability coverage. Trinity's policy limits were established at $10,000 for personal injury per individual.

The trial court accepted the plaintiff's second amending petition, reducing her claim to $9,999.99, which falls within Trinity's liability coverage. Consequently, the defendant, Diane D. Reilly, is not considered an underinsured motorist, and the plaintiff cannot recover under the Underinsured Motorist (UM) provisions of the Allstate policy. The plaintiff contends that the trial judge erred by limiting recovery to the amount prayed for, arguing that a higher award could potentially be justified. The court references established jurisprudence, stating that a litigant cannot recover more than what is requested in their petition, with a noted exception for special damages when certain inadmissible evidence is introduced without objection. Thus, the court upheld the trial court's decision granting Allstate’s motion for summary judgment, asserting that allowing an amendment to seek a greater amount while depriving the defendant of a jury trial would be unjust.

The appeal also addresses whether Allstate must pay medical expenses incurred by the plaintiff over a year after the accident, as specified in the policy. The policy states that Allstate will cover reasonable medical expenses only if they are rendered within one year post-accident, extendable to five years for coverage amounts over $5,000. The plaintiff references cases suggesting that a sufficient connection between the accident and subsequent medical services justifies payment beyond the time limit; however, these cases are deemed distinguishable due to differing policy language. The critical term in this instance is "rendered," as opposed to "incurred," which was pivotal in the cited cases.

The court upheld the time limitation specified in the insurance policy, emphasizing that charges for dental services are only compensable if related to a fractured jaw or accidental dental injury, and must be treated within six months of the accident. The court clarified that the need for additional work does not equate to the performance of services required for compensation. It referenced relevant Louisiana Civil Code Articles, stating that the meanings of contractual terms should be derived from their common usage and contextual phrases. The record indicated that all medical bills submitted by the plaintiff were incurred over a year after the accident, leading to the conclusion that Allstate was not obligated to pay these bills under the medical payment coverage provision. The court reinforced the principle that insurance policies are contracts that must be interpreted according to their explicit terms, as established in previous case law. It found no ambiguity in the policy and confirmed that the insurer's limitation on liability was valid and did not violate public policy. The court rejected the plaintiff's argument that the policy forced unnecessary medical attention within the one-year period. Ultimately, the judgment of the trial court was affirmed, with the plaintiff responsible for the costs of the appeal.