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92-3918Court of Appeals for the Fifth Circuit25 mar 2004

Testo completo

*Local Rule 47.5 provides: "The publication of opinions
that have no precedential value and merely decide particular
cases on the basis of well-settled principles of law imposes
needless expense on the public and burdens on the legal
profession." Pursuant to that Rule, the Court has determined
that this opinion should not be published.
IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
_____________________________
No. 92-3918
(Summary Calendar)
_____________________________
SHERI GOLDBERG,
Plaintiff-Appellant,
versus
JOHN P. GUFFNEY, JR., ET AL.,
Defendants,
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY,
Defendant-Appellee.
_________________________________________________
Appeal from the United States District Court
for the Eastern District of Louisiana
(CA 91 3900 D)
_________________________________________________
June 3, 1993
Before KING, DAVIS, and WIENER, Circuit Judges.
PER CURIAM*:
In this diversity case, Plaintiff-Appellant Sheri Goldberg
contends that her insurer, Defendant-Appellee State Farm Mutual
Automobile Insurance Company (State Farm), acted arbitrarily and
capriciously by not unconditionally tendering compensation to her
when State Farm first learned of the possibility that it may have

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2
had some liability under her uninsured/underinsured motorist (UM)
policy. On appeal, Goldberg asserts that the district court erred
in granting judgment in favor of State Farm after a bench trial.
Finding no reversible error in the decision of the district court,
we affirm.
I
FACTS
Goldberg was involved in an automobile accident with John
Guffney, who all parties agree was at fault, on August 3, 1989.
She suffered injuries to her cervical spine, left wrist, left
ankle, and left knee.
Guffney maintained a liability insurance policy that would pay
a maximum of $10,000 to the person or persons whom he injured while
driving. Goldberg was insured by State Farm and maintained a UM
policy that would pay her up to $100,000 if she were injured by
someone who, like Guffney, did not have adequate insurance.
Beginning immediately after the accident, State Farm promptly
paid all of Goldberg's medical bills, which had totaled $14,613.20
by the time this case came to trial. Some of Goldberg's injuries
were severe, and she apparently has not fully recovered. On March
5, 1990, Goldberg's attorney wrote to State Farm advising it of
Goldberg's legal representation. In that letter, the attorney
"stat[ed] [his] understanding that State Farm provided uninsured
motorist insurance." As a result of its receipt of the attorney's
letter, State Farm assigned Goldberg's file to an adjuster and

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1 See LA. REV. STAT. ANN. §§ 22:658, 22:1220 (West Supp.
1993).
3
opened an internal account to provide payment for Goldberg's
injuries. That took place at the end of March 1990.
On July 30, 1990, three days before the prescriptive period
(statute of limitations) on Goldberg's tort suit would have run,
she filed suit in state court against Guffney, his insurer, and
State Farm. After Guffney's insurer paid Goldberg the limits of
its policy, she released both Guffney and the insurer. State Farm
then removed the lawsuit to federal court.
Goldberg made a demand for payment from State Farm under her
UM policy on September 19, 1990. On October 18, 1990, Goldberg's
attorney provided State Farm with affidavits to demonstrate that
the limit of Guffney's only liability insurance policy was $10,000.
In response to Goldberg's demand, on November 11, 1990, State Farm
unconditionally tendered her a payment of $35,000. After Goldberg
underwent more treatment and it became clear that her injuries were
more extensive than first appeared, State Farm unconditionally
tendered an additional $10,000. That was on August 7, 1991.
Nonetheless, Goldberg proceeded with her lawsuit against State
Farm, claiming that, under Louisiana insurance regulations,1 State
Farm's delay in paying the claims was unreasonable, and that the
company acted arbitrarily and capriciously in not making
sufficiently large payments. Under Louisiana law, an insurance
company that denies or delays payment of a claim in an arbitrary
and capricious manner is subject to penalties and attorneys fees.

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2 The case was tried to a U.S. magistrate on the consent of
both parties. See 28 U.S.C. § 636(c).
3 See FED. R. CIV. P. 52(a).
4
After the non-jury trial,2 the district court held against
Goldberg on her claim that State Farm had acted in an arbitrary and
capricious manner in not paying her claim until November 1990. The
court specifically found that "[t]here was no arbitrary or
capricious failure of State Farm to pay under the UM provisions of
its policy." The court also found that "[n]o demand was made for
payment under the UM provisions of the policy until plaintiff's
attorney did so by letter on September 19, 1990," and that
Goldberg's claims were timely paid under the provisions of
Louisiana law regulating insurance companies' payments of claims
and possible penalties.
The court set Goldberg's total damages from the accident at
$69,000. As she had been paid a total of $54,000 by State Farm and
Guffney's insurance company, State Farm was ordered to pay her the
difference plus interest from the date of her demand. Goldberg
timely appealed the court's decision that State Farm had not acted
in an arbitrary and capricious manner.
II
ANALYSIS
As noted above, this is an appeal of a judgment rendered in a
bench trial. In such cases, we review findings of fact for clear
error.3 As we do in other contexts, however, we review conclusions

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4 See Pullman Standard v. Swint, 456 U.S. 273, 287 (1982).
5 McDill v. Utica Mut. Ins. Co., 475 So. 2d 1085, 1089 (La.
1985).
6 Id. (citing Hart v. Allstate Ins. Co., 437 So. 2d 823 (La.
1983))(emphasis added).
7 Id. (citing Hart, 437 So. 2d at 828).
5
of law de novo.4
Louisiana regulates insurance companies to ensure that
insureds receive prompt payment of claims. Describing the
procedures that insurance companies must follow, the Louisiana
Supreme Court has stated:
A claimant for penalties and attorneys fees under the
statute has the burden of proving that the insurer failed
to pay the claim within 60 days after receiving
"satisfactory proof of loss" of the claim, and that the
insurer was arbitrary and capricious in failing to pay.5
A "satisfactory proof of loss" under § 22:658 "is that which is
sufficient to fully apprise the insurer of the insured's claim."6
An insured fully apprises the insurer of a claim))i.e., establishes
a "satisfactory proof of the loss"))for purposes of an uninsured/
underinsured motorists claim by establishing that
the insurer received sufficient facts which fully apprise
the insurer that (1) the owner or operator of the other
vehicle involved in the accident was uninsured or
underinsured; (2) that [sic] he was at fault; (3) that
[sic] such fault gave rise to damages; and (4) establish
the extent of those damages.7
The McDill court stated that when a plaintiff seeks penalties
and attorneys fees under § 22:658, "[t]he general issue . . . is
whether the plaintiff carried his burden of providing [the insurer]

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8 Id.
6
with 'sufficient proofs of loss' under the statute."8 The
controlling issue in the instant case, as asserted by Goldberg, is
whether her attorney's March 5, 1990 letter, and State Farm's
preliminary investigation in response to that letter, fully
apprised State Farm of its obligation to tender payments
unconditionally under the UM policy such that State Farm had an
immediate obligation to pay.
It cannot be seriously questioned that responsible persons at
State Farm realized with a high degree of certainty that the
company would be subject to some liability under Goldberg's UM
policy. The March 5, 1990 letter triggered State Farm's inquiry,
and that inquiry produced State Farm's belief that Guffney's
insurance ceiling was $10,000. As State Farm paid more than that
amount in medical payments alone, it surely knew of its impending
liability; it is inconceivable that the quantum of Goldberg's
personal injury damages would be less than her medical payments in
this situation.
Nevertheless, the simple fact remains that, as found by the
district court, Goldberg made no demand for payment on State Farm
until September 19, 1990. The March 5, 1990 letter, which merely
informed State Farm of Goldberg's legal representation and
mentioned the UM policy, cannot be construed as a demand (or even
a request) for payment. Making a demand or request for payment was
not a purpose expressed or implied in the March 5, 1990 letter.
That letter did not assert that Guffney was underinsured; it did

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9 Hart, 437 So. 2d at 828.
10 We agree with the district court that when the affidavits
were proffered by Goldberg, she satisfied her burden as to all
the criteria listed in Hart and McDill.
11 An amendment to § 22:658, which changed the period in
which a payment must be made from sixty to thirty days, became
effective July 4, 1990))just before the demand in this case. See
7
not discuss or even hint at the quantum of damages; and it did not
mention the other two criteria listed in the Hart and McGill cases.
Goldberg argues that if the March 5, 1990 letter was not
sufficient, surely the filing of the lawsuit on July 30, 1990, gave
State Farm adequate notice. Even if we grant arguendo that the
lawsuit constituted notice, that is not the equivalent of a demand
for payment sufficient to implicate § 22:658. True, every lawsuit
for a money judgment is a demand for payment in the broadest sense
of the phrase, but here that is not enough to satisfy that
component as contemplated in Hart and McGill. Goldberg sued all
possible defendants to interrupt (toll) the prescriptive period.
Preserving her right to sue State Farm and the other defendants was
simply not the equivalent of making a demand for payment.
The district court's finding that Goldberg's first demand for
payment was made on September 19, 1990 was not clearly erroneous;
neither was it legal error. Moreover, in response to this letter,
State Farm timely requested "evidence sufficient to fully apprise
[it] of the insured's claim"9))i.e., evidence of Guffney's insurance
limits. Once Goldberg's affidavits concerning those limits were
provided to State Farm10))on October 18, 1990))payment in a bona
fide amount was tendered within thirty days.11

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LA. REV. STAT. ANN. § 22:658 (West Supp. 1993)(noted in the
historical and statutory notes under "1990 Legislation").
12 LA. REV. STAT. ANN. § 22:658(A)(1).
13 It is clear that procedures that insureds follow in order
to give notice of an accident to an insurer, such as the filing
of a "proof of loss" form, do not trigger the running of the
thirty day clock. Although the State Farm was given notice of
the accident))and in fact paid all of Goldberg's medical
bills))nothing was filed that gave State Farm notice of
Goldberg's demand for payment until September.
8
We note that the statute in question does not speak in terms
of the insured making a "demand," but merely employs the terms
"within thirty days after receipt of satisfactory proofs of loss."12
We see no sensible way to read this statute, however, that does not
necessitate at least a request for payment by the insured to begin
the running of the thirty day clock.13 In the instant case,
Goldberg did nothing that would constitute a demand or request for
payment as contemplated by the applicable Louisiana law until
September; and after that demand was completed by the submission of
requisite proof in the form of the affidavits, payment was timely
tendered.
III
CONCLUSION
The district court found the payments that State Farm tendered
unconditionally to Goldberg to have been timely in the context of
§ 22:658 and that any delay experienced was not due to arbitrary
and capricious activity on the part of State Farm. After a
thorough review of the record before us, the Louisiana statute at

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issue, and the cases interpreting that statute, we discern no
reversible error in the factual findings or legal interpretations
of the district court.
AFFIRMED.

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