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Louisiana evaluations with causation can still end up in litigation as coverage issues Legal Insurance Blog for Real Estate Insurance



Hurricane Laura did indeed cause significant damage. Insurance claims disagreements about these damages and their value can be resolved through assessment.

A Louisiana case, St. Charles Parish Hospital Service District No. 1 against United Fire and Casualty Company . 1 is often cited for the suggestion that Louisiana allows evaluation panels to consider causation. Nevertheless, in the same case, it is clear that such causal links are not binding and can be questioned in court.

Real estate insurance parties in Louisiana believe that appraisal is a definitive way to resolve their property insurance dispute should carefully read and consider the court's discussion of causation, coverage and the non-binding nature of causation provisions in the appraisal before agreeing to invoke appraisal: [1

9659004] questions the award on the grounds that the assessors made incorrect assessments of causation. It refers to the evaluation price, stating that the evaluators have conscientiously prior [sic] the tasks assigned [them] in accordance with the evaluation provisions of the policy and hereby allocate the amounts set out below as the actual cash value of damages due to Wind … & # 39; … The defendant further claims that O & # 39; Leary testified that he made incorrect determinations of causation in his assessment.

Although this is the rule in other states, see e.g. Munn v. Nat & # 39; l Fire Ins. Co. of Hartford 237 Miss. 641, 115 So.2d 54, 58 (1959) (argues that what caused the injury "was not a matter for the assessors to decide"), the defendant has cited no Louisiana authority responsible for the proposal that assessors may not make a causal connection. In fact, Fourchon Docks, Inc. v. National Union Fire Insurance Company the district court ruled that & # 39; & # 39; the assessors and the judge fulfilled their obligation under the policy & # 39; & # 39; despite & # 39; assessors unanimously concluding that damage caused to the reverse osmosis water treatment plant due to high water total [sic] $ 18,940.00. & # 39;

Although it would be inappropriate for appraisers to make causal decisions under Louisiana law, the extent to which the assessors here made such decisions would not invalidate the award. First, the clear language of politics states that "[i] if there is an assessment, [defendant] will still retain [its] the right to deny the claim." Decisions about causation that are included in the price can still be questioned. , and neither the defendant nor the court are bound by them.

In addition, the simple language of the policy requires valuers to determine "the size of the loss." O & # 39; Leary testified that a valuer must take into account causation in order to some extent to determine what the term “amount of loss” refers to. He stated that both he and Provencher "understood that this is the mechanics of how a standard assessment is made." … His testimony makes it clear that an appraiser does not have the task of determining coverage or liability, but that causation must be considered to determine the extent of the loss that must be measured … Again, his determination of causation is not binding and the defendant reserves the right to question them. In view of the presumption of correctness awarded to evaluation awards … and the absence of Louisiana authorities to the contrary, the Court finds that the extent to which O & # 39; Leary considered causation in its assessment does not in itself justify the removal of the award.

The decision is clear that the evaluation panel could decide the causal question. However, either party may question the award based on causation as a matter of coverage. It was clear that "determinations of causation are not binding."

As I have recently said in webinars and my afternoon livestream trainings, the Louisiana Insurance Act is another cat breed. It is more complicated, because while it often recites the same rules as in other states, there are more exceptions to these rules. This does not make Louisiana Insurance Law wrong. It's just a little different, a taste that requires a little deeper study and careful consideration of how these differences affect practical decisions about the treatment of insurance claims.

If you want more information and questions answered about causation and assessment in Louisiana and Mississippi, please join Ashley Harris and me tomorrow at 2pm for Tuesday at 2pm With Chip Merlin .

An afternoon tank

Justice is the great interest of man on earth. It is a ligament that holds civilized beings and civilized nations together.
—Daniel Webster
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1 St. Charles Parish Hospital Service District No. 1 against United Fire and Cas. Co. 681 F.Supp.2d 748 (E.D. Louis. 2010).


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