ADJ9078233 · October 16, 2023

The arbitrator and Appeals Board found the insurance policy lacked clear and unambiguous exclusions for out-of-state injuries, thus coverage extended to injuries sustained out-of-state by the applicant.

From the decision · page 9The exclusion had to be clearly stated not merely open to interpretation. This is especially true in light of the fact the employer was a football team that played one-half of its games out-of-state. The Louisiana Workers' Compensation Corporation relies on the out-of-state provision which is stated above is unclear as to its intent. If the Louisiana Workers' Compensation Corporation intended an exclusion for extraterritorial injuries, they should have set forth that exclusion in clear and unambiguous language. There is no language or endorsement contained in the insurance policy issued by the Louisiana Workers' Compensation Corporation of an express limitation of extraterritorial injuries and jurisdiction. There is no express exclusion in the insurance policy for injuries in another state and filed in another state and not defending or paying benefits based on an award issued by another state having jurisdiction. In the opinion of the Arbitrator, in the absence of such express language excluding such injuries and fillings in another state and in light of the know business of the insured, the fact that the Shreveport Pirates played approximately one-half their games out-of-state, it is found by the Arbitrator that the insurance policy issued by the Louisiana Workers' Compensation Corporation to the Shreveport Pirates covers applicant's claim in California.

The insurance policy did not contain clear and unambiguous exclusions for out-of-state injuries.

Favours Applicant prevailed

This ambiguity led the arbitrator and Appeals Board to interpret the policy as covering the applicant's injuries sustained out-of-state.

From the decision · page 9The exclusion had to be clearly stated not merely open to interpretation. This is especially true in light of the fact the employer was a football team that played one-half of its games out-of-state. The Louisiana Workers' Compensation Corporation relies on the out-of-state provision which is stated above is unclear as to its intent. If the Louisiana Workers' Compensation Corporation intended an exclusion for extraterritorial injuries, they should have set forth that exclusion in clear and unambiguous language. There is no language or endorsement contained in the insurance policy issued by the Louisiana Workers' Compensation Corporation of an express limitation of extraterritorial injuries and jurisdiction. There is no express exclusion in the insurance policy for injuries in another state and filed in another state and not defending or paying benefits based on an award issued by another state having jurisdiction. In the opinion of the Arbitrator, in the absence of such express language excluding such injuries and fillings in another state and in light of the know business of the insured, the fact that the Shreveport Pirates played approximately one-half their games out-of-state, it is found by the Arbitrator that the insurance policy issued by the Louisiana Workers' Compensation Corporation to the Shreveport Pirates covers applicant's claim in California.

Watkins et al. v. New York Giants (2015)

An insurance policy must clearly describe exclusions and limitations on coverage; lack of clarity results in coverage being read broadly in favor of the insured.

The arbitrator relied on Watkins to interpret the policy's ambiguous exclusions as extending coverage to the applicant's injuries.

From the decision · page 8The arbitrator determined that the changes made at p. 15 created ambiguity in the nature and scope of the coverage, rather than clarifying it. The arbitrator concluded that just as in Watkins, supra, a failure of clarity in the purported policy exclusions resulting in ambiguity as to the nature of the coverage extended resulted in the policy being read to extend coverage:

The insurance policy language was ambiguous and lacked clear exclusions for out-of-state injuries, favoring coverage for the applicant's injuries.

From the decision · page 8The arbitrator determined that the changes made at p. 15 created ambiguity in the nature and scope of the coverage, rather than clarifying it. The arbitrator concluded that just as in Watkins, supra, a failure of clarity in the purported policy exclusions resulting in ambiguity as to the nature of the coverage extended resulted in the policy being read to extend coverage: