Allstate Insurance Co. v. Perez

783 S.W.2d 779, 1990 WL 1191
CourtCourt of Appeals of Texas
DecidedJanuary 11, 1990
Docket13-89-088-CV
StatusPublished
Cited by10 cases

This text of 783 S.W.2d 779 (Allstate Insurance Co. v. Perez) 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
Allstate Insurance Co. v. Perez, 783 S.W.2d 779, 1990 WL 1191 (Tex. Ct. App. 1990).

Opinion

OPINION

BENAVIDES, Justice.

Rebecca Perez was injured while at work and denied worker’s compensation benefits for part of her injuries. By two points of error, The Allstate Insurance Company’ (Allstate), the worker’s compensation carrier, appeals a judgment in favor of Perez on the ground that Perez elected her remedy when she filed a claim with her group insurance carrier and on the ground of insufficiency of the evidence. We affirm the judgment of the trial court.

I. ELECTION OF REMEDIES

Perez was injured at work when she dropped a Video Cassette Recorder (VCR) on her foot. Initially, she was treated for a foot injury by her employer’s doctor and received worker’s compensation benefits for this injury. Within several days, however, she began to have neck pain and sought medical attention for her neck.

Believing her neck injury to be related to her initial accident, she applied for worker’s compensation benefits for her neck and was denied on the grounds that her injury was not work-related. She was instructed to apply for benefits through her group insurance carrier who then, in turn, told her that her injury was work-related and that she should apply for benefits through her worker’s compensation carrier. She did, and Allstate re-iterated that her neck injury was not work-related. Perez re-submitted the medical expenses for her neck to her group insurance carrier and designated her injury as nonwork-related. She explained that she designated her injury as nonwork-related because she needed surgery and she had been turned down by Allstate. The expenses were then paid.

Evidence regarding the difference between worker’s compensation and group insurance, and Perez’s application for group insurance for her neck was introduced at trial. Perez objected to the evidence to the extent that it applied to the affirmative defense of “election of remedies.” The evidence was admitted as relevant to other issues in the case. Over the objection of Perez, the court submitted two jury issues regarding group insurance benefits which, according to Allstate, established a defense of “election of remedies.” *781 Allstate contended that Perez was precluded from worker’s compensation benefits because she had chosen to receive group insurance benefits.

By its first point of error, Allstate contends that the trial court erred in rendering judgment in favor of Perez under the Worker’s Compensation statute for the reason that Perez made an election of remedies when she applied for and received group medical insurance benefits. Allstate argues that the jury’s answers to the special issues regarding group health insurance benefits were improperly disregarded by the judge when rendering the verdict.

Allstate further argues that the issue of “election of remedies” was tried by consent and that a trial amendment regarding that issue was requested. At trial, Allstate requested that, in the event that the trial judge did not think Allstate’s pleading was sufficient to allow the submission of the two issues on group insurance, it be allowed to make a trial amendment such that the issues could be submitted. The trial judge allowed the two issues in under Allstate’s original answer and, therefore, did not reach Allstate’s request for a trial amendment. No written trial amendment was ever made.

Perez contends that Allstate did not plead the affirmative defense of “election of remedies” and that this issue was not tried by express or implied consent nor was there a written trial amendment regarding this issue. According to Perez, these issues should not have been submitted to the jury in the first place and any disregard of the answers to these issues is harmless.

“Election of remedies” may constitute a bar to relief when: (1) one successfully exercises an informed choice (2) between two or more remedies, rights, or states of facts (3) which are so inconsistent as to (4) constitute manifest injustice. Bocanegra v. Aetna Life Ins. Co., 605 S.W.2d 848, 851 (Tex.1980). In support of its position, Allstate cites Smith v. Home Indem. Co., 683 S.W.2d 559 (Tex.App. — Fort Worth 1985, no writ), a summary judgment case in which Smith was denied worker’s compensation benefits after applying for and receiving group insurance benefits. The court applied the Bocanegra requirements in Smith and found that Smith’s uncontra-dicted admissions that he knew at the time he. applied for group insurance benefits that these benefits were for nonwork-relat-ed injuries and that worker’s compensation benefits were for work-related injuries, and that, nevertheless, he received group insurance benefits, were sufficient to establish that the remedies sought by Smith were inconsistent. Smith, 683 S.W.2d at 563. Allstate used the wording in these findings as the basis for its special issues.

The two questions in issue to which the jury answered affirmatively are as follows:

QUESTION NUMBER 14
Do you find from a preponderance of the evidence that Plaintiff, Rebecca Perez, knew at the time she applied for the group insurance that those benefits were for nonwork related injuries?
QUESTION NUMBER 15
Do you find from a preponderance of the evidence that Plaintiff, Rebecca Perez, received medical and disability benefits under her employer’s group insurance coverage?

Neither of these issues address whether Perez exercised an informed choice between workers’ compensation and her group insurance when she filed her claim for benefits for her neck, or whether she simply did as she was instructed. The issue of choice is an important part of the Bocanegra requirements for sustaining an election of remedies defense. The record indicates that, unlike Smith in which the facts were uncontradicted, the issue of choice was controverted. An affirmative finding on the issue of an informed choice between the policies would have been necessary to sustain relief under the defense of election of remedies.

In Bocanegra, supra, the Supreme Court refused to bar a claim on the theory of election of inconsistent remedies because at the time of the prior claim for insurance *782 (which resulted in settlement) the cause of injury was uncertain. Here, even though the jury found the appellant knew the benefits were for a work related injury, there was no finding that at the time of the election that the cause of injury was certain or known to Perez. The cause of the injury was uncertain at the time of her prior claim. No informed election can occur under such circumstances to bar appellant’s recovery under her worker’s compensation claim.

Appellant did not plead an election of remedies defense. Election of remedies is an affirmative defense which must be specifically pleaded and a general denial is not sufficient to raise such an affirmative defense. France v. American Indem. Co.,

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Bluebook (online)
783 S.W.2d 779, 1990 WL 1191, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-insurance-co-v-perez-texapp-1990.