Beacon National Insurance Co. v. Montemayor

86 S.W.3d 260, 2002 Tex. App. LEXIS 5425, 2002 WL 1728439
CourtCourt of Appeals of Texas
DecidedJuly 26, 2002
Docket03-01-00499-CV
StatusPublished
Cited by133 cases

This text of 86 S.W.3d 260 (Beacon National Insurance Co. v. Montemayor) 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
Beacon National Insurance Co. v. Montemayor, 86 S.W.3d 260, 2002 Tex. App. LEXIS 5425, 2002 WL 1728439 (Tex. Ct. App. 2002).

Opinion

MARILYN ABOUSSIE, Chief Justice.

Appellants Beacon National Insurance Company, First Preferred Insurance Company, and Petrolia Insurance Company (collectively “Beacon”) appeal the district court’s order granting the Texas Department of Insurance’s (“TDI”) plea to the jurisdiction and dismissing the cause. 1 Beacon contends the district court erred because (1) Beacon is entitled to pursue declaratory relief to construe a contract; (2) its action presents a justiciable contro *264 versy with TDI and is not barred by sovereign immunity; (3) Beacon is not required to exhaust its administrative remedies before seeking this declaratory relief on a purely legal question; and (4) primary jurisdiction does not bar Beacon’s request for declaratory relief. We will affirm the judgment of the district court.

BACKGROUND

This controversy stems from Beacon’s treatment of its insureds’ claims for roof repairs. When replacing a roof, some homeowners elect to lay new shingles over the damaged layer of shingles rather than pay the cost of having the old layer removed. Repeating this practice over time can result in the loss of a “nailable surface,” ie., a surface to which a new roof may adequately be affixed. Subsequent roof repairs eventually require removing the underlying layers in order to obtain a nailable surface.

The crux of this controversy concerns the Texas Standard Homeowers Insurance Policy-Form B (“Form B”), a standard insurance policy form promulgated by TDI, the terms of which are incorporated into the insurance policy contracts between Beacon and its policy holders. Form B provides, “If a Peril Insured Against causes the loss, we will pay the reasonable cost you incur for necessary repairs.” Form B requires an insurer to pay its insured “the cost to repair or replace that part of the building structure(s) damaged, with material of like kind and quality and for the same use and occupancy on the same premises; or the amount actually and necessarily spent to repair or replace the damaged building structure(s).” 2 Form B excludes from coverage “loss caused by wear and tear, deterioration or loss caused by any quality in property that causes it to damage or destroy itself.”

Beacon acknowledges that Form B requires it to pay for roof damage caused by covered perils, such as hail. However, Beacon contends that Form B does not require it to pay for repairs or replacement of roofing layers damaged by excluded perils, such as wear and tear. Thus, as Beacon concludes in a memo to its agents dated January 27, 2000, “on those claims requiring replacement of damaged roofs, our company will only figure to tear off one layer of roofing and replace it with like kind and quality.”

Beacon asserts that TDI expressly approved Beacon’s interpretation of Form B in a letter to Beacon dated February 15, 2000. 3 However, Beacon complains that TDI reversed its position in a letter to Beacon dated October 5, 2000, informing Beacon that regardless of whether underlying roof layers were damaged by excluded perils, Beacon was responsible for pro *265 viding a nailable surface for a new roof covering:

One such situation [not addressed in the February 15, 2000 letter] exists if during the removal of the damaged roof covering it is discovered the underlayment (shingles or decking) is an unsuitable nailing surface for the new roof covering. ... To attach the new roof covering, there must be a nailable surface; therefore, it may be necessary to either (i) replace wood shingles/shakes with new wood shingles/shakes, or (ii) remove the wood shingles/shakes and redeck the affected area before installing the new roof covering.

A generous reading of these letters suggests that TDI agreed with Beacon’s assertion that it was not responsible for replacing underlying layers of roofing when those underlying layers were damaged by excluded perils. However, that statement, and TDI’s acquiescence to it, does not address situations where the cause of damage to the underlying layers of roofing is unknown, or where there are so many underlying damaged layers (some caused by excluded perils, some by covered perils) that a nailable surface cannot be obtained without removing the underlying layers.

Beacon claims that TDI “announced its intention” to: (1) fine Beacon a total of $12,000; (2) require Beacon to review its policy files to locate specific claims in which Beacon refused to pay for tear off necessary to obtain a “nailable surface”; and (3) require Beacon to pay past roof repair claims in accordance with the October 5, 2000 letter. Beacon expresses concern that TDI will institute an administrative enforcement action against it. On May 23, 2001, Beacon filed suit against TDI, seeking declaratory relief that

(1) [i]n light of both the “like kind and quality” language in the settlement portion of Form B and the specific exclusions listed in the policy, [Beacon is] not obligated to repair or replace portions of a multi-layer roof that are damaged as a result of an excluded peril; (2) TDI may not periodically interpret an insurance contract in a manner that is contrary to the plain terms of the contract and that in doing so it is exceeding its statutory authority; (3) TDI cannot retroactively impose a new interpretation of a policy form in order to punish an insurer who took actions consistent with the agency’s previous interpretation; and (4) Beacon’s treatment of roof repair claims consistent with the terms of Form B and the agency’s interpretation of such form cannot constitute “bad faith” claims settlement practices as a matter of law....

Beacon founded its request for declaratory relief on the Uniform Declaratory Judgments Act (“the UDJA”). See Tex. Civ. Prac. & Rem.Code Ann. § 37.003 (West 1997). It characterizes its suit as an effort to obtain a court declaration of purely legal questions regarding its contract rights and obligations under Form B with respect to claims settlement with its policy holders. See Tex. Civ. Prac. & Rem.Code Ann. § 37.004 (West 1997). In response, TDI filed a plea to the jurisdiction based on, among other things, sovereign immunity, Beacon’s failure to exhaust its administrative remedies, and the primary jurisdiction of TDI over the issues presented. The district court granted TDI’s plea to the jurisdiction without specifying the grounds, and Beacon appeals.

STANDARD OF REVIEW

A plea to the jurisdiction challenges the district court's authority to determine the subject matter of the cause of action. Bland Indep. Sch. Dist. v. Blue, 34 S.W.3d 547, 554 (Tex.2000). Subject matter jurisdiction raises a question of law, which we review de novo. See Mayhew v. Town *266 of Sunnyvale, 964 S.W.2d 922, 928 (Tex.1998). The plaintiff bears the burden of pleading facts that show the district court has subject matter jurisdiction. Texas Ass’n of Bus. v. Texas Air Control Bd.,

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Bluebook (online)
86 S.W.3d 260, 2002 Tex. App. LEXIS 5425, 2002 WL 1728439, Counsel Stack Legal Research, https://law.counselstack.com/opinion/beacon-national-insurance-co-v-montemayor-texapp-2002.