Insurer Immune from Suit for Good Faith Report to Louisiana Department of Insurance of Suspected Fraud
Post 5224

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Appellate Court Gives Plaintiff a Second Chance to Sue Insurer Who Reported Suspected Fraud

In Solon E. Smith v. State Of Louisiana By And Through The Louisiana Department Of Insurance, Cuna Mutual Group, And CMFG Life Insurance Company, No. 2024 CA 0735, Court of Appeals of Louisiana, First Circuit (October 23, 2025) the appeal addressed whether an insurance company (CMFG Life Insurance Company d/b/a TruStage) is immune from civil liability under Louisiana's Insurance Code for reporting suspected fraud to the Louisiana Department of Insurance (LDI).

FACTS

On December 22, 2022, LDI issued a Suspension Order, ordering Mr. Smith to "cease and desist conducting any business of insurance in the state of Louisiana[.]" On February 8, 2023, LDI issued the Revocation Order permanently revoking Mr. Smith's license to sell insurance and issuing a fine.

On April 19, 2022, the Suspension Order and Revocation Order issued by LDI were reversed by the ALJ as the ALJ determined, "the evidence does not support a finding that [Mr. Smith] violated the relevant statutes." Specifically, the ALJ determined that Mr. Smith having made a typographical error on the application is a much more probable explanation than the alleged act of fraud.

Procedural History

On July 31, 2023 Smith filed a Petition for Damages against LDI, CMFG, and TruStage Financial Group, Inc., alleging defamation, malicious prosecution, abuse of process, and unfair trade practices. CMFG claimed no civil liability for good-faith fraud reports. The trial court sustained the exception and dismissed CMFG with prejudice.

Relevant Law

Peremptory Exception of No Cause of Action (La. Code Civ. P. art. 927(A)(5)):

The statute tests the legal sufficiency of the petition and assumes all well-pleaded facts true, but conclusory statements insufficient. For affirmative defenses like immunity, the exception will be overruled unless facts exclude all reasonable hypotheses supporting defense.

Mandatory Fraud Reporting (La. R.S. 22:1926(A)):

Insurers (and others in insurance business) must report suspected fraud to LDI's Office of Insurance Fraud within 60 days of notice.

Immunity from Liability (La. R.S. 22:1928(A)):

No civil suit (e.g., defamation, torts) exists for required reports or information shared with LDI/NAIC/law enforcement unless malice, fraudulent intent, or bad faith. Plaintiff bears burden to allege facts defeating immunity; conclusory claims (e.g., "reckless disregard" ) insufficient.

Court's Analysis and Holding

CMFG qualifies as a mandatory reporter because it is engaged in the insurance business. The Petition facts show CMFG reported based on Broussard's credible affidavit (her belief of fraud due to non-receipt of policy). There was no duty for CMFG to investigate further because the statute shifts that duty to LDI.

Immunity applies because there were no viable causes of action stated.

CONCLUSION

The Court of Appeals affirmed the trial court's January 18, 2024 judgment insofar as it sustained CMFG's peremptory exception raising the objection of no cause of action. However, it reversed the portion of the judgment dismissing CMFG from Mr. Smith's suit and remand this matter to the trial court to allow Mr. Smith an opportunity to amend his petition with specific facts showing malice. The Court of Appeals concluded that the trial court abused its discretion by not allowing amendment of the Petition.  The decision balanced mandatory fraud-reporting duties with protections against malicious reports, emphasizing that conclusory allegations alone cannot defeat immunity.

Dissent (Chief J. McClendon):

The Chief Justice concluded that there was no abuse of discretion because an amendment would be futile given facts of the case. The statute protects insurers from retaliatory suits for good-faith compliance but preserves amendment rights to prevent premature dismissal.

ZALMA OPINION

The statute that requires an insurer to report suspected fraud to the LDI also includes immunity for the insurer's good faith report unless the insurer makes the report with malice. The decision on appeal gives the plaintiff the chance to amend his pleading to find some way to sue the insurer that was not immunized. The Chief Justice's dissent is convincing since an amendment would be futile and defeat the purpose of the immunity statute by making the insurer defend a second time the futile attempt to allege fraud or malice with more than the mere conclusory allegations.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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