B & S Welding LLC Work Related Injury Plan v. Juan Pedro Oliva-Barron and Avelina Oliva

447 S.W.3d 425, 2014 Tex. App. LEXIS 10303, 2014 WL 5488159
CourtCourt of Appeals of Texas
DecidedSeptember 15, 2014
Docket05-13-00394-CV
StatusPublished
Cited by3 cases

This text of 447 S.W.3d 425 (B & S Welding LLC Work Related Injury Plan v. Juan Pedro Oliva-Barron and Avelina Oliva) 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.

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B & S Welding LLC Work Related Injury Plan v. Juan Pedro Oliva-Barron and Avelina Oliva, 447 S.W.3d 425, 2014 Tex. App. LEXIS 10303, 2014 WL 5488159 (Tex. Ct. App. 2014).

Opinion

OPINION

Opinion by Justice O’Neill

After concluding that appellant B & S Welding LLC Work Related Injury Plan (the Plan) wrongfully denied benefits to appellee Juan Pedro Oliva-Barron (Oliva), the trial court rendered judgment in Oli-va’s favor. The Plan appeals, alleging the trial court erred in its review of the Plan’s decision to terminate Oliva’s benefits and in its award of attorney’s fees to Oliva. We conclude the Plan’s decision to terminate Oliva’s benefits was not supported by substantial evidence. We further conclude that there was no evidence to support one of the damage awards made by the trial court. We therefore affirm the trial court’s judgment in part and reverse in part.

Background

Oliva was injured at work on June 24, 2009, and received medical and indemnity benefits from the Plan. Three months after the injury, the Plan brought this suit against Oliva and his wife Avelina Oliva for fraud, conspiracy to commit fraud, and unjust enrichment. The Olivas then filed a third-party claim against Oliva’s former employer, B & S Welding, LLC (Employer), and counterclaimed against the Plan for unpaid medical and indemnity benefits.

The trial court tried the case in two phases. The Plan’s claims against the Oli-vas and the Olivas’ claims against the Plan under the Employee Retirement Income Security Act of 1975 (ERISA), 29 U.S.C. §§ 1001-1461 (2012), were tried to the court. The Olivas’ claims against Employer were tried to a jury. The jury made findings in favor of Employer. The trial court found in favor of Oliva on his claims against the Plan, and dismissed the Plan’s claims against the Olivas. The trial court rendered judgment in favor of the Olivas *429 and Employer. The trial court also made findings of fact and conclusions of law in support of its judgment.

In this appeal, the Plan alleges error with respect to the trial court’s rulings on the Olivas’ claims against it. The Plan does not appeal the portion of the trial court’s judgment dismissing its claims against the Olivas, and the Olivas do not appeal the portion of the judgment dismissing their claims against Employer.

Discussion

In its first issue, the Plan contends that the Olivas failed to exhaust their administrative remedies before asserting their claims in the trial court. In its second issue, the Plan complains of the trial court’s conclusion that the Plan’s administrator abused its discretion in terminating Oliva’s benefits. In its third issue, the Plan argues that there is no evidence to support the trial court’s award of damages and attorney’s fees to the Olivas. Two different standards of review apply to the Plan’s issues. We discuss the applicable standards of review in our consideration of each issue.

A. Exhaustion of Remedies

In general, a claimant seeking benefits from an ERISA plan must first exhaust available administrative remedies under the plan before bringing suit to recover benefits. Bourgeois v. Pension Plan for Emps. of Santa Fe Int’l Corps., 215 F.3d 475, 479 (5th Cir.2000). However, a plaintiff may be excused from exhausting administrative remedies under ERISA if it would have been futile to do so. See Denton v. First Nat’l Bank of Waco, Texas, 765 F.2d 1295, 1302 (5th Cir.1985). In Finding of Fact 27, the trial court found, “Oliva was not required to exhaust administrative remedies under the Plan because, among other reasons, the Plan’s actions in suing the Olivas exhibited baseless hostility; any administrative appeal for the denial of benefits would have been futile. Furthermore, by its actions the Plan waived, or is estopped from asserting, any exhaustion requirements.”

In its first issue, the Plan argues that there was no evidence to support the trial court’s finding. In an appeal from a bench trial, we review a trial court’s findings of fact under the same legal and factual sufficiency of the evidence standards used when determining if sufficient evidence exists to support an answer to a jury question. Fulgham v. Fischer, 349 S.W.3d 153, 157 (Tex.App.-Dallas 2011, no pet.). When the appellate record contains a reporter’s record as it does in this case, findings of fact are not conclusive on appeal if the contrary is established as a matter of law or if there is no evidence to support the findings. Brockie v. Webb, 244 S.W.3d 905, 908 (Tex.App.-Dallas 2008, pet. denied)! Similarly, unchallenged findings of fact are binding on an appellate court unless the contrary is established as a matter of law or if there is no evidence to support the finding. McGalliard v. Kuhlmann, 722 S.W.2d 694, 696 (Tex.1986).

When an appellant challenges the factual sufficiency of the evidence on an issue, we consider all the evidence supporting and contradicting the finding. Fulgham, 349 S.W.3d at 157 (citing Plas-Tex., Inc. v. U.S. Steel Corp., 772 S.W.2d 442, 445 (Tex.1989)). We set aside the finding for factual insufficiency only if the finding is so contrary to the evidence as to be clearly wrong and manifestly unjust. Id. (citing Cain v. Bain, 709 S.W.2d 175, 176 (Tex.1986) (per curiam)). In a bench trial, the trial -court, as factfinder, is the sole judge of the credibility of the witnesses. Id. As long as the evidence falls “within the zone of reasonable disagreement,” we will not substitute our judgment *430 for that of the fact-fínder. City of Keller v. Wilson, 168 S.W.3d 802, 822 (Tex.2005). A challenge to the legal sufficiency of the evidence fails if more than a scintilla of evidence exists to support the finding. Brockie, 244 S.W.3d at 909.

We review the trial court’s conclusions of law de novo. Fulgham, 349 S.W.3d at 157. We are not bound by the trial court’s legal conclusions, but the conclusions of law will be upheld on appeal if the judgment can be sustained on any legal theory supported by the evidence. Id. at 157-58.- Incorrect conclusions of law will not require reversal if the controlling findings of fact will support a correct legal theory. Id. Conclusions of law may not be reversed unless they are erroneous as a matter of law.' Id.

The Plan makes several arguments in support of its challenge to the sufficiency of the evidence to support the trial court’s finding of futility. The Plan argues there is no evidence of the hostility, bitterness, or bias necessary to establish futility.

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447 S.W.3d 425, 2014 Tex. App. LEXIS 10303, 2014 WL 5488159, Counsel Stack Legal Research, https://law.counselstack.com/opinion/b-s-welding-llc-work-related-injury-plan-v-juan-pedro-oliva-barron-and-texapp-2014.