Aetna Casualty & Surety Co. v. Moseley

975 S.W.2d 728, 1998 Tex. App. LEXIS 5211, 1998 WL 536734
CourtCourt of Appeals of Texas
DecidedAugust 20, 1998
DocketNo. 13-97-180-CV
StatusPublished

This text of 975 S.W.2d 728 (Aetna Casualty & Surety Co. v. Moseley) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aetna Casualty & Surety Co. v. Moseley, 975 S.W.2d 728, 1998 Tex. App. LEXIS 5211, 1998 WL 536734 (Tex. Ct. App. 1998).

Opinion

OPINION

HINOJOSA, Justice.

This is an appeal from the trial court’s decision to set aside a worker’s compensation compromise settlement agreement (“CSA”). By twelve points of error the worker’s compensation carrier, Aetna Casualty & Surety Company, challenges the legal and factual sufficiency of the evidence supporting the trial court’s findings of fact. By two additional points, Aetna contends the trial court erred in falling to find that appellee, James B. Moseley, should return benefits received under the CSA We affirm.

Moseley was employed by Hall Real Estate Company to perform maintenance duties at the Beechtree Apartments in Corpus Christi. On November 2, 1989, as he was admonishing another employee and bending to lift an object, Moseley heard a pop in his right ear. He immediately lost the hearing in that ear and began to experience roaring tinnitus1 and vertigo. An examination revealed that Moseley was suffering from a fistula in the cochlea.2 Dr. James Motes performed inner ear surgery on November 3 to close the fistula. Although Moseley’s hearing improved to a degree after the surgery, the tinnitus and vertigo continued. In April 1990, Moseley was referred to Dr. Claude MeLelland, an ear, nose, and throat specialist.

Dr. MeLelland found the initial surgery to patch the fistula was not successful and that fluid was leaking into the middle ear. On June 14, 1990, Dr. MeLelland performed a second surgery inserting an endolpymphatic shunt to drain the fluid from the inner ear. Within a month after the surgery, Moseley was again complaining of tinnitus, headaches, lethargy, and increased vertigo. Medications were not successful in alleviating these symptoms, and a third surgery was performed in October 1990 to sever the right vestibular, or balance nerve, which is located on the brain stem. Dr. Marco Eugenio, a neurosurgeon, assisted Dr. MeLelland with this surgery.

Dr. McLelland’s medical records indicate outstanding results from the surgery as of November 7, 1990. On November 12, Aetna claims representative Michael Gutierrez re[730]*730ceived a letter from Dr. McLelland stating that Moseley had a gratifying result from the surgery and that “he should be able to resume nearly full activity in the near future.” The letter also placed Moseley’s hearing handicap at 3.13%. As a result of this letter, Aetna calculated that Moseley was entitled to a lump sum payment for the specific injury of hearing loss. Aetna sent Moseley a letter informing him that he was entitled to a lump sum payment of $1,013 and lifelong medical benefits. Moseley did not believe the lump sum payment was sufficient for the three surgeries he had endured and their effects, but he did not want to relinquish the lifelong medical benefits. He spoke with Gutierrez and asked if there was an alternative to the lump sum payment. After a discussion with Ross Dunn, Jr., an Aetna claims supervisor, Moseley signed a CSA on December 3, 1990, for $4,000 and twenty years of medical benefits. The CSA was approved by the Industrial Accident Board in January 1991.

On November 18, 1991, Moseley returned to Dr. MeLelland’s office complaining of visual disturbances and dizziness. Moseley was referred to Dr. Juan Bahamon for neurological testing. Moseley complained to Dr. Ba-hamon that he had periods of disorientation, chronic tinnitus, chronic headaches, chronic light-headedness, and the irresistible desire to walk in circles. He also complained of poor concentration, memory loss, low stamina, irritability, aggressiveness, depression and mood swings. The tests failed to reveal an objective basis for Moseley’s complaints. Dr. Bahamon referred Moseley to Dr. Philip Gasquoine for psychological testing in September 1992. These tests confirmed Moseley’s complaints of memory loss, low stamina, poor concentration, hostility, and depression. Dr. Gasquoine began psychotherapy designed to help Moseley accept that his symptoms are permanent and to provide coping techniques.

In January 1993, Moseley commenced this lawsuit to set aside the CSA. After a bench trial, the trial court found that: (1) Aetna’s representatives, and the doctors they relied on, had misrepresented the extent of Moseley’s injuries, (2) Moseley had relied on the misrepresentations when he signed the CSA, and (3) Moseley had a meritorious claim for additional benefits. Based on these and other findings, the trial court concluded the CSA should be set aside and the case remanded to the Industrial Accident Board. Aetna appeals from these findings and conclusions.

By its first twelve points of error, Aetna complains the evidence is legally and factually insufficient to support certain findings of fact made by the trial court.

Findings of fact in a case tried to the court have the same force and dignity as a jury’s verdict upon questions. Anderson v. City of Seven Points, 806 S.W.2d 791, 794 (Tex.1991); Taiwan Shrimp Farm Village Ass’n, Inc. v. U.S.A. Shrimp Farm Dev., Inc., 915 S.W.2d 61, 70 (Tex.App.—Corpus Christi 1996, writ denied). We review a trial court’s findings of fact for legal and factual sufficiency of the evidence by the same standards that we apply when we review the sufficiency of the evidence supporting a jury’s finding. Anderson, 806 S.W.2d at 794; Taiwan Shrimp Farm, 915 S.W.2d at 70.

When we review a “no evidence” or legal sufficiency of the evidence point of error, we consider only the evidence and reasonable inferences that tend to support the jury’s finding, and we disregard all evidence and inferences to the contrary. Responsive Terminal Sys. Inc. v. Boy Scouts of Am., 774 S.W.2d 666, 668 (Tex.1989). If there is more than a scintilla of evidence to support the finding, the legal sufficiency challenge fails. Stafford v. Stafford, 726 S.W.2d 14, 16 (Tex. 1987).

When we review an “insufficient evidence” or factual sufficiency of the evidence point of error, we consider, weigh, and examine all of the evidence which supports or undermines the jury’s finding. Plas-Tex, Inc. v. United States Steel Corp., 772 S.W.2d 442, 445 (Tex. 1989). We set aside the verdict only when we find that the evidence, standing alone, is too weak to support the finding or that the finding is so against the overwhelming weight of the evidence that it is manifestly unjust and clearly wrong. Cain v. Bain, 709 S.W.2d 175, 176 (Tex.1986); Garza v. Alviar, 395 S.W.2d 821, 823 (Tex.1965).

[731]*731To set aside a compromise agreement, a worker must show that misrepresentations concerning the injuries were made by the employer or compensation carrier; that the worker relied on those misrepresentations in making the settlement; and that there was a meritorious claim for more compensation than had been paid. Rodriguez v. American Home Assurance Co., 735 S.W.2d 241, 242 (Tex.1987);

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Related

Stafford v. Stafford
726 S.W.2d 14 (Texas Supreme Court, 1987)
Anderson v. City of Seven Points
806 S.W.2d 791 (Texas Supreme Court, 1991)
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772 S.W.2d 442 (Texas Supreme Court, 1989)
Saenz v. Fidelity & Guaranty Insurance Underwriters
925 S.W.2d 607 (Texas Supreme Court, 1996)
Garza v. Alviar
395 S.W.2d 821 (Texas Supreme Court, 1965)
Responsive Terminal Systems, Inc. v. Boy Scouts of America
774 S.W.2d 666 (Texas Supreme Court, 1989)
TEXAS EMPLOYERS'INSURANCE ASSOCIATION v. Maynard
362 S.W.2d 128 (Court of Appeals of Texas, 1962)
Rodriguez v. American Home Assurance Co.
735 S.W.2d 241 (Texas Supreme Court, 1987)
Cain v. Bain
709 S.W.2d 175 (Texas Supreme Court, 1986)
Graves v. Hartford Accident & Indemnity Co.
161 S.W.2d 464 (Texas Supreme Court, 1942)
Texas Employers Insurance v. Kennedy
143 S.W.2d 583 (Texas Supreme Court, 1940)
Brannon v. Pacific Employers Insurance
224 S.W.2d 466 (Texas Supreme Court, 1949)
Brannon v. Pacific Employers Ins. Co.
224 S.W.2d 466 (Texas Supreme Court, 1949)
Yarbrough v. Texas Employers' Insurance Ass'n
591 S.W.2d 556 (Court of Appeals of Texas, 1979)

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Bluebook (online)
975 S.W.2d 728, 1998 Tex. App. LEXIS 5211, 1998 WL 536734, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aetna-casualty-surety-co-v-moseley-texapp-1998.