Benefit Trust Life Insurance Co. v. Littles

869 S.W.2d 453, 1993 Tex. App. LEXIS 3492, 1993 WL 437192
CourtCourt of Appeals of Texas
DecidedOctober 29, 1993
Docket04-91-00673-CV
StatusPublished
Cited by11 cases

This text of 869 S.W.2d 453 (Benefit Trust Life Insurance Co. v. Littles) 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
Benefit Trust Life Insurance Co. v. Littles, 869 S.W.2d 453, 1993 Tex. App. LEXIS 3492, 1993 WL 437192 (Tex. Ct. App. 1993).

Opinion

ON APPELLANT’S MOTION FOR REHEARING & MOTION FOR REHEARING EN BANC AND ON AP-PELLEES’ MOTIONS FOR REHEARING

OPINION

CHAPA, Chief Justice.

Appellant’s motion for rehearing and motion for rehearing en banc are denied. Ap-pellees’ motions for rehearing are similarly denied. Our previous opinion of August 31, 1993 is withdrawn, and the following is substituted.

This is an appeal from a judgment rendered against appellant, Benefit Trust Life Insurance Company, who was sued by Leslie Littles and the City of Victoria, appellees, for bad faith in the handling of a claim for the cost of Leslie Littles’ medical treatment.

Benefit Trust has raised numerous grounds of error on appeal, of which we have identified the following dispositive issues:

1) whether Littles had standing to sue under the Texas Insurance Code;
2) whether judgment could be entered against Benefit Trust based on the jury’s responses to the special issues;
3) whether sufficient evidence exists to support the actual damage awards for both Leslie Littles and the City of Victoria;
4) whether sufficient evidence exists to support the trial court’s award of attorney fees to Leslie Littles; and
5) whether the trial court erred in its calculation of attorney fees and prejudgment interest.

Regarding the City of Victoria’s cross-claim against Benefit Trust Life Insurance Company, the single issue on appeal is whether the trial court abused its discretion in refusing to allow the City to make a trial amendment to increase exemplary damages. We find the trial court made several errors in its calculation of prejudgment interest and attorney fees and thus hold that the judgment award must be modified. Otherwise, we affirm the judgment in all other respects.

I. FACTUAL BACKGROUND

Leslie Littles was employed by the City of Victoria and medically insured by the City’s self-funded employee health insurance plan. On January 16, 1988, Littles tried to start a fire for a barbecue with gasoline. He was accidentally burned over twenty-one percent of his body and sent to St. Luke’s Lutheran Hospital in San Antonio for treatment. Doctors, working for Burn Care Associates, operated on Littles at least four times while he was in the hospital, using new techniques to treat his injuries. The multiple surgeries performed by Burn Care amounted to $37,-142.25 in costs.

Littles’ legal problems began when Burn Care Associates was only paid $12,093.60 by the City’s employee health plan for his treatment, leaving a balance of $25,048.65. The City did not directly refuse to pay Bum Care. Instead, Benefit Trust Life Insurance, which was hired by the City of Victoria to administer its claims, made the decision to refuse payment. Under a contract signed by Benefit Trust and the City of Victoria, Benefit Trust was hired by the City to process claims, make payment on claims, and conduct other administrative tasks involving the settlement of claims. It was not personally liable to any claimant for benefits owed by the health plan. Payments made by Benefit Trust were disbursed from an account maintained by the City of Victoria.

Benefit Trust was obligated to pay claims on behalf of the City only to the extent they did not exceed the “prevailing fee” for care provided. The employee health plan handbook provided in part, “No Benefits are paid for ... charges in excess of the Prevailing Fee for the service or supply....” The handbook defined prevailing fee as “[t]he lesser of (1) the fee most often charged by the provider for the same service or supply; or (2) the fee most often charged in the same *461 area by providers with similar training and experience for comparable services or supply.” Meanwhile, the City of Victoria purchased a separate excess risk insurance policy with Benefit Trust Life Insurance to protect its employee health plan. The policy sheltered the City’s health care plan from extraordinarily high medical claims by having Benefit Trust reimburse the City for claims exceeding $50,000 for any single employee in a one year period.

Benefit Trust. explained to Littles in a letter dated November 15,1988 that it would only pay part of the costs he incurred while undergoing treatment with Bum Care Associates. It decided to limit its payment after an independent reconstructive surgery consultant claimed Burn Care’s fee exceeded the “usual and customary allowable fee” for its treatment, hence exceeding the “prevailing fee” limitation of the group health plan. Bum Care, however, sent a written demand for payment of the balance on June 29, 1989.

After an unsuccessful attempt to recover the full payment, Burn Care sued Littles and Benefit Trust. Littles subsequently filed a cross action against Benefit Trust and a third-party claim against the City of Victoria. The various defendants filed additional claims against each other. The City eventually paid Burn Care for the unpaid balance, and Benefit Trust reimbursed the City under the excess risk insurance policy for the amount of the cost of Littles’ medical treatment exceeding $50,000.

Bum Care won a summary judgment against Littles, nonsuited the other defendants, and dropped out of the lawsuit. Leslie Littles and the City of Victoria were realigned as plaintiffs against Benefit Trust. 2 The ease went to trial on June 25,1991. The jury found that Benefit Trust was liable to Littles and the City of Victoria for committing violations of the Insurance Code, either knowingly or with conscious indifference. The jury also found that Benefit Trust breached its administrative agreement and the excess risk insurance contract with the City of Victoria. The jury assessed actual damages, exemplary damages, and attorney fees.

The judgment entered by the trial court held Benefit Trust liable to Littles for $1,674,132.80. This figure included actual damages, prejudgment interest on actual damages, statutory damages under the Insurance Code, and attorney fees. The court also ordered an award of postjudgment interest at ten percent per year until paid. The court also held Benefit Trust liable to the City of Victoria for $116,767.31, which included actual damages, prejudgment interest, and statutory damages under the Insurance Code. The court additionally granted a separate award of attorney fees and post-judgment interest at ten percent per year until paid. Both Benefit Trust and the City *462 were found liable to Littles for $250,308.26, plus postjudgment interest, of which the City obtained a judgment for contribution against Benefit Trust. The court declined to enter a judgment for exemplary damages.

II. STANDING UNDER THE INSURANCE CODE

In its first point of error, Benefit Trust contends that Littles has no standing to bring a cause of action under article 21.21 of the Texas Insurance Code, which forbids unfair competition and practices in the insurance industry. The final judgment granted Littles statutory damages and attorney fees based on the Insurance Code by stating:

It ... appears to the Court that Plaintiff LESLIE LITTLES is entitled to an award of ...

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869 S.W.2d 453, 1993 Tex. App. LEXIS 3492, 1993 WL 437192, Counsel Stack Legal Research, https://law.counselstack.com/opinion/benefit-trust-life-insurance-co-v-littles-texapp-1993.