Baker v. Argonaut Insurance Co.

36 S.W.3d 587, 2000 Tex. App. LEXIS 7072, 2000 WL 1539054
Court of Appeals of Texas·Decided October 19, 2000·No. No. 05-98-00391-CV·Published·Cited by 5 cases

Opinion

OPINION

MORRIS, Justice.

In this case of first impression, we address an insurance company’s right to be reimbursed for workers’ compensation benefits paid to an injured employee. Specifically, we decide the extent of an insurance company’s right to reimbursement from an injured employee who receives benefits under a deductible plan insurance policy. Debbie Baker, individually and as next friend of both Anthony Baker and Mandy Baker, together with Leighla and Rockey Baker, contend the trial court erred in allowing Argonaut Insurance Company to recover from them all the compensation benefits it paid to Anthony Baker for injuries he suffered in an on-the-job accident. Argonaut’s recovery was taken out of settlement funds the Baker family received from a third party. The Bakers argue that Argonaut’s recovery included the insurance policy’s deductible amount owed by Anthony Baker’s employer and, under Texas law, they cannot be made to pay the deductible on the employer’s behalf. The Bakers also challenge the trial court’s award of attorney’s fees, arguing the award was improper based on the summary judgment evidence. We agree with the Bakers on both issues. We modify the trial court’s order to reduce the award to Argonaut by the amount of the deductible. We reverse the remainder of the trial court’s order and remand the cause for further proceedings.

I.

The facts of the case are largely undisputed. Argonaut Insurance Company provides employers with workers’ compensation insurance coverage. Pursuant to a statutory requirement, Argonaut offers Texas employers that subscribe to workers’ compensation coverage the option of [589]*589choosing a self-insured deductible plan. A deductible plan allows an employer to reduce its insurance premiums by agreeing to reimburse the carrier for benefits it pays to injured employees up to the deductible amount. Flowers Construction Company elected to take advantage of Argonaut’s deductible plan and signed an endorsement to its insurance policy agreeing to reimburse Argonaut up to $250,000 for each employee accident. Flowers’s insurance premiums were consequently lowered.

Anthony Baker, an employee of Flowers, was severely injured when a van in which he was riding was hit by a large truck. At the time of the accident, Baker was in the course and scope of his employment. Baker filed a claim for workers’ compensation benefits with Argonaut. Argonaut accepted the claim and paid benefits totaling $352,596.13.

Baker’s family sued the driver of the truck involved in the accident, claiming his negligence caused Baker’s injuries. In the same suit, the Bakers also sued the driver’s employers. Argonaut intervened in the suit, claiming it was statutorily subro-gated to Anthony Baker’s rights of recovery to the extent of the workers’ compensation benefits Baker had received. In other words, Argonaut claimed it was entitled under Texas law to recover the insurance benefits it had paid to Anthony Baker out of any damages awarded to the Baker family. The Bakers eventually settled their claims for $882,000.

A dispute arose between Argonaut and the Bakers about the amount Argonaut was entitled to receive out of the settlement funds. Argonaut claimed the Bakers were required to reimburse it for the full $352,596.13 in benefits Anthony Baker had received. The Bakers responded that, because Flowers’s insurance policy included a $250,000 deductible, Argonaut could look to the settlement proceeds only for reimbursement of those benefits paid in excess of the deductible amount. Therefore, according to the Bakers, Argonaut was enti-tied to only $102,596.13 of the settlement money.

Argonaut and the Bakers further disagreed about whether the Bakers’ attorney was entitled to receive fees from Argonaut for his work in obtaining the settlement. The Bakers contended that, under Texas law, their lawyer was entitled to one-third of Argonaut’s subrogated recovery. Argonaut disputed this, claiming the Bakers’ counsel did not represent Argonaut’s interests but instead sought to undermine its recovery rights.

Both sides filed motions for summary judgment. After considering the motions and evidence presented, the trial court signed an order allowing Argonaut to recover the full amount of the benefits it paid to Baker out of the settlement proceeds. The court further ordered Argonaut to pay the Bakers’ attorney $25,649 in attorney’s fees, the equivalent of twenty-five percent of the amount the Bakers concede was owed to Argonaut. The Baker family timely appealed, challenging both Argonaut’s award and the amount of attorney’s fees awarded to their lawyer.

II.

Argonaut’s efforts to recoup its benefit payments are based upon its entitlement to reimbursement once Baker received payment for his injuries from another source. In general, a compensation carrier is statutorily subrogated to the rights of an injured employee to the extent of the compensation benefits paid. See Tex.Lab.Code Ann. § 417.001(b) (Vernon Supp.2000). Furthermore, the insurance company is entitled to reimbursement for the full amount of benefits paid to the employee from any damages he receives for his injuries. See Tex.Lab.Code Ann. § 417.002(a) (Vernon 1996). The purpose of reimbursing the insurer out of the employee’s third-party recovery is to reduce the burden of insurance on the employer and the public and to prevent the employee from obtaining a double recovery. Fos[590]*590ter v. Truck Ins. Exck, 933 S.W.2d 207, 212 (Tex.App.—Dallas 1996, writ denied). Argonaut argues that, by virtue of its statutory rights, it is entitled to be reimbursed from the Bakers’ settlement proceeds for all the benefits it paid to compensate Baker for his injuries. In making this argument, Argonaut disregards the effect of a separate set of statutes applicable to the deductible plan it entered into with Flowers.

In 1989, the Texas Legislature adopted article 5.55C of the Texas Insurance Code. See Tex.Ins.Code Ann. art. 5.55C (Vernon Supp.2000). Article 5.55C requires workers’ compensation insurance carriers to offer deductible plans that allow employers to self-insure for a deductible amount. Id. art. 5.550(a). A deductible policy must provide that the insurance carrier “will make all payments for benefits that are payable from the deductible amount and that reimbursement by the policyholder shall be made periodically.” Id. art. 5.55C(d). Article 5.55C also provides that “a person who is employed by a policyholder who self-insures the deductible amount as provided under this article may not be required to pay any of the deductible amount.” Id. art. 5.55C(f).

Although article 5.55C does not directly address an insurance company’s right to reimbursement under section 417.002(a) of the labor code, it does specifically address the carrier’s right to reimbursement for the deductible amount. When construing statutory provisions, we must attempt to give effect to the intent of the legislature, avoid conflicts, and give each provision effect. Hollingsworth v. City of Dallas, 931 S.W.2d 699, 702 (Tex.App.—Dallas 1996, writ denied); Matherson v. Pope,

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Baker v. Argonaut Insurance Co., 36 S.W.3d 587, 2000 Tex. App. LEXIS 7072, 2000 WL 1539054 (Tex. Ct. App. 2000).

36 S.W.3d 587 (Baker v. Argonaut Insurance Co.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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