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Appliers Beware: Louisiana Federal Court Voids Insurance Policy, Denies First-Party Hurricane Claim

Published on: November 21, 2022

Many insurance policies contain a Concealment or Fraud provision that provides no coverage where the insured concealed or misrepresented any material fact or circumstance, engaged in fraudulent conduct, or made false statements related to the insurance.

But will a court enforce the Concealment or Fraud provision to deny an insured recovery on an otherwise covered peril? According to a recent decision out of the Eastern District of Louisiana, the answer is YES.

In Fahimipour v. United Property & Casualty Insurance Company, the plaintiffs sought contractual and extra-contractual damages from their insurance carrier for damages to their residential property allegedly sustained during Hurricane Zeta. After a bench trial, Judge Morgan concluded Plaintiffs’ application for insurance included a false statement made with knowledge of its falsity and voided the insurance policy from inception, in its entirety.

Citing Talbert v. State Farm Fire & Cas. Ins. Co., the Fahimipour court noted that “Under Louisiana law, an insurance policy is voided entirely and from its inception when the insured makes a material misrepresentation in the application for insurance with the intent to deceive the insurer.” The insurer must prove by a preponderance of the evidence the following elements in order to succeed on such a claim:

(1) the insured made a false statement;

(2) the false statement was material; and

(3) the false statement was made with intent to deceive.

With regard to the first factor, the Court found the insureds obtained and read an inspection report in connection with their purchase of the property. They “were concerned enough about the findings of the inspectors to contact their real estate agent” about the issues. The insureds represented in their insurance application that the property was well maintained, and free of damage, debris, and liability hazards, despite the extensive contradictory findings in the inspection report.

Regarding the second element, the carrier’s in-house expert testified that the insurer would not have bound coverage if the application contained the information from the inspection report. Therefore, the court found the insured’s false statements were material.

The third element – intent to deceive – “must be determined from the surrounding circumstances indicating the insured’s knowledge of the falsity of the representations made in the application and his recognition of the materiality of his representations, or from circumstances which create a reasonable assumption that the insured recognized the materiality.”

In finding the insurer established the third element, the Court noted the insureds were “sophisticated users of insurance.” Evidence showed the insureds previously purchased houses for renovation and resale, owned multiple properties, submitted insurance applications before, and also submitted claims for coverage on at least three prior occasions.

Ultimately, the Court denied plaintiffs any recovery for alleged hurricane damages because of the misrepresentations they made in their application for insurance coverage.

Prior to Fahimipour,Courts had found that post-loss misrepresentations may also void a policy. In Roach v. Allstate Indem. Co., 476 Fed. App’x 778, 779 (5th Cir. 2012), the plaintiff’s house was damaged in a fire. The Fifth Circuit upheld a summary judgment that voided the plaintiff’s policy after he submitted a falsified claim that included contents not located on inspection following a fire at the residence.

The policy at issue in Roach included a similar Concealment or Fraud provision that stated the policy would provide no coverage if the insured misrepresented any material fact before or after a loss. In granting summary judgment, the district court applied the same three factors used in the Fahimipour case to find the plaintiff made material misrepresentations in his personal property claim when he claimed items not located on inspection.

While the policy in Fahimipour was voided in part because the insureds were “sophisticated users of insurance,” it remains to be seen whether a Louisiana court will void coverage based on a similar provision brought by a less sophisticated insured under a different set of facts.

However, the Fahimipour and Roach decisions show that a court can void a policy, from its inception, because of an insured’s misrepresentations, whether they occur in connection with the application for the policy or after a loss. These rulings also suggest that Louisiana law recognizes an insured also has a reciprocal duty of good faith in its relationship with its insurer.

Case References: Behnaz Fahimipour, et al. v. United Property & Casualty Insurance Company, 2022 WL 16833693 (E.D. La. Nov. 9, 2022); Roach v. Allstate Indem. Co., 476 Fed. App’x 778, 779 (5th Cir. 2012); Talbert v. State Farm Fire & Cas. Ins. Co., 971 So.2d 1206 (La. App. 4 Cir. 2007).

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Keogh Cox & Wilson, Ltd. provides this blog as a public service for general information only. The materials contained herein may not reflect the most current legal developments or even express the opinion of all or even most of Keogh Cox attorneys. Such material does not constitute legal advice or form any attorney-client relationship. Keogh Cox and all contributing author(s) expressly disclaim all liability to any person with respect to the contents of this Web site and Blog and expect that no reliance will be made upon the information provided.

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To Arbitrate or Not to Arbitrate: LA Supreme Court Rejects Federal Court Position

Hurricanes Laura and Delta caused substantial damage in Louisiana, resulting in extensive litigation that continues to develop. In a July 8, 2024 blog post, we reported that the U.S. Fifth Circuit Court of Appeals, in Bufkin Enterprises, LLC v. Indian Harbor Ins. Co., affirmed that equitable estoppel applied to allow domestic insurers to compel arbitration under the New York Convention even where the insured dismissed the foreign insurers with prejudice. Click here to read more.

New case law from the LA Supreme Court warrants supplementation of our prior blog post. The Police Jury of Calcasieu Parish (“Calcasieu”) filed suit in federal court to recover alleged underpaid and untimely insurance claim payments. Various domestic insurers moved to compel arbitration pursuant to arbitration clauses found in two foreign insurers’ policies. The foreign policies required all claims be submitted to arbitration in New York under New York law. The insurers relied upon Bufkin Enterprises, LLC v. Indian Harbor Ins. Co., and Calcasieu moved to certify questions to the LA Supreme Court.

The U.S. District Court for the Western District of LA certified questions to the Louisiana Supreme Court to address this issue. In Police Jury of Calcasieu Parish v. Indian Harbor Insurance Co., the Louisiana Supreme Court held:

  1. Arbitration is prohibited by statute. The case involved the interpretation of La. R.S. 22:868, as amended in 2020. Generally, La. R.S. 22:868(A) prohibits the use of arbitration clauses in insurance policies. The Court held this prohibition is rooted in public policy because compulsory arbitration clauses deprive courts of jurisdiction over actions against insurers. The Court noted it historically has held arbitration clauses within insurance policies are unenforceable, and it did not deviate from its historical position.
  1. As a matter of first impression, an insurance policy with a political subdivision is a “public contract” within meaning of the statute banning any provision in public contracts which requires a suit or arbitration proceeding to be brought in a forum or jurisdiction outside of the state. It was undisputed that Calcasieu is a political subdivision of this state. Also, it was undisputed the Defendants contracted with Calcasieu to provide insurance coverage for approximately 300 properties that Calcasieu owned for the benefit of the public. No private actors involved. Thus, the Court found, “The Defendants’ insurance policies clearly covered public properties owned by Calcasieu, purchased with public funds––taxpayer dollars. As such, we easily find insurance contracts with political subdivisions, like the policies at issue, are public contracts within the meaning of La. R.S. 9:2778.” Thus, the statute precludes arbitration or venue outside of LA, or the application of foreign law, in claims involving the State and its political subdivisions.
  1. A domestic insurer may not use equitable estoppel to enforce arbitration via a foreign insurer's policy. Citing its disagreement with the Federal Court’s ruling in Bufkin Enterprises, L.L.C. v. Indian Harbor Ins., the Court held “[E]quitable estoppel is not available under these circumstances because it conflicts with the positive law of La. R.S. 22:868, which prohibits the use of arbitration clauses in Louisiana-issued insurance policies. As such, domestic insurers may not employ this common law doctrine to compel arbitration through the clause of another insurer's policies, as it clearly contravenes La. R.S. 22:868(A)(2). A contrary finding would (1) violate Louisiana's positive law prohibiting arbitration in Louisiana-issued insurance policies; and (2) invite domestic insurers’ misuse a doctrine of ‘last resort’ to ceaselessly rely on insurance policies of foreign insurers to compel arbitration.”

References:

Police Jury of Calcasieu Parish v. Indian Harbor Insurance Co., 2024 WL 4579035 (La.), 9, 2024-00449 (La. 10/25/24).

Bufkin Enterprises, L.L.C. v. Indian Harbor Ins. Co. 96 F.4th 726 (5th Cir. 2024).

Insight

“Forensic Defendants” Dismissed from Wrongful Conviction Suit

On December 9, 1982, a victim was raped and stabbed multiple times in her Baton Rouge residence. In those harrowing moments, the victim was face-to-face with her assailant and vowed that she would remember the characteristics of her assailant in the unlikely event she survived. A friend arrived at the residence and entered the second-floor room containing the assailant and the wounded victim. Fortunately, at that moment, noise from a postal employee caused the assailant to flee the scene. The investigation began that same day.

Sometime later, Archie Williams became a suspect and was then criminally charged after the victim identified Mr. Williams as her attacker. The victim identified a prominent scar on the assailant which, in an unfortunate twist of fate, tended to match a scar on Mr. Williams. Several of the governmental officers involved in the investigation and the April 1983 criminal trial of Mr. Williams were sued many years later in the case styled Archie Williams v. City of Baton Rouge, ET AL. Keogh Cox attorneys Drew Blanchfield, Collin LeBlanc, Cathy Giering, and Chelsea Payne represented a forensic scientist, a lab technician, and a print examiner in the suit (the “Forensic Defendants.”) In his June 10, 2024 ruling, Judge Brian A. Jackson granted a Motion for Summary Judgment in favor of these defendants, dismissing the claims against them with prejudice.

At the 1983 criminal trial, Forensic Defendants testified that they could not identify Mr. Williams as the attacker. Similarly, both the prosecutor and defense counsel advised the jury that the physical evidence did not implicate Mr. Williams. Nevertheless, Mr. Williams was convicted based upon the passionate but mistaken testimony of the victim. Mr. Williams had not committed these crimes but remained incarcerated until his release decades later.

Mr. Williams consistently denied guilt. In 2008, he hoped DNA testing would help to prove his innocence. However, the DNA evidence was of no assistance. In 1999, The FBI launched its National Fingerprint Database (“IAFIS.”) Yet, a 2009 search generated no matches to fingerprints from the crime scene that had not already been identified. In 2014, Next Generation Identification (NGI) replaced IAFIS. By 2016, NGI held approximately 72,000,000 criminal fingerprints and 50,000,000 civil fingerprints. A 2019 search of this ever-expanding database matched fingerprint evidence taken from the 1983 crime scene to the prints of a convicted rapist who had died in prison years before. Mr. Williams was innocent and was soon released through a joint filing by the State of Louisiana and Mr. Williams. His lawsuit against multiple defendants followed.

In response, the Forensic Defendants filed a Motion that advanced the “qualified immunity” granted to governmental officials. In opposition to the Motion, the plaintiff possessed the burden: 1) to raise a fact dispute on whether his constitutional rights were violated by the defendants’ individual conduct; and 2) to show those rights were “clearly established” at the time of the alleged violation. The Court found that the plaintiff did not meet this burden. Although Plaintiff alleged that certain fingerprint evidence had been “suppressed” in violation of the “Brady Rule,” the Court cited the robust factual record showing that the jury was fully aware that no fingerprint evidence identified Mr. Williams and that unidentified prints were present at the crime scene. The Court also rejected the claim that there was any fabricated exculpatory blood or serology evidence.

The facts in Williams highlight the great technological improvements since the early 1980s which now aid the court system, prosecutors, and defense attorneys to protect against the conviction of an innocent suspect. These facts also tell a sad human story of an individual who spent more than 30 years in jail for a crime he did not commit. While it does not replace the lost years, Louisiana has created a fund which provides some financial resources to wrongfully convicted individuals to help them re-enter society. Williams was able to take advantage of this fund.

References:

Archie Williams v. City of Baton Rouge, ET AL, United States District Court, Middle District of Louisiana, No. 3:20-cv-00162.

Jennifer R. Dietz

Partner
Evidence
Federal Courts
Louisiana
Fraud
Hurricane
Insurance