Bertha Arce, Individually and as Representative of All Others Similarly Situated v. American National Insurance Company

Court of Appeals of Texas·Decided August 24, 2021·No. 07-19-00362-CV·Published

Opinion

In The

Court of Appeals

Seventh District of Texas at Amarillo

No. 07-19-00362-CV

BERTHA ARCE, INDIVIDUALLY AND AS REPRESENTATIVE OF ALL OTHERS SIMILARLY SITUATED, APPELLANT

V.

AMERICAN NATIONAL INSURANCE COMPANY, APPELLEE

On Appeal from the 46th District Court Hardeman County, Texas

Trial Court No. 11529; Honorable Dan Mike Bird, Presiding

August 24, 2021

OPINION

Before PIRTLE and PARKER and DOSS, JJ.

Appellant, Bertha Arce, Individually and as Representative of All Others Similarly Situated challenges the trial court’s rendition of summary judgment in favor of Appellee, American National Insurance Company, on her claims for breach of contract and violations of the Texas Insurance Code, as well as her claim for recovery of attorney’s

fees and class action claims. Through two issues, Arce contends the trial court erred in (1) overruling her objections to American National’s summary judgment evidence, and (2) granting American National summary judgment on her claims. We reverse the judgment of the trial court and remand for further proceedings consistent with this opinion.

BACKGROUND This is a case involving the denial of a claim under a life insurance policy issued by American National. In December 2016, Sergio Arce, Jr., Bertha Arce’s son, applied for a life insurance policy with American National. Arce was the beneficiary of that policy. Part of the application required that he answer the question of whether, in the last ten years, he had been diagnosed, treated, tested positive for, or been given medical advice for any disease or abnormality of the stomach, intestines, rectum, pancreas, or liver, including cirrhosis, hepatitis, and colitis. Sergio answered that question with “no” and signed a statement affirming that his answers in the application were “full, complete and true to the best of [his] knowledge and belief.” However, medical records showed Sergio had been diagnosed with hepatitis C three years earlier, in 2013. At that time, he did not treat that condition or heed medical advice that he seek treatment or assistance in obtaining treatment. Under American National’s underwriting guidelines, it would not have issued the policy to Sergio if he had disclosed his hepatitis C diagnosis.

The agent who sold Sergio the policy stated she asked Sergio all of the application questions and recorded the answers he provided. She did not, however, determine whether he fully understood each question. American National issued a life insurance policy to Sergio based on his application. He also signed a form indicating his understanding that the premium he had been quoted had been modified from the original

amount to a premium of $91 per month and that the accidental death benefit coverage had been denied.

The policy was issued on January 4, 2017. It contained an incontestability provision providing that the policy could not be contested after it had been in force during the insured’s lifetime for a period of two years. Prior to the expiration of that two-year period, American National was entitled to contest the policy for material misstatements made in the application.

Unfortunately, Sergio was in a car accident and died thirteen days after the policy was issued. Arce submitted a claim for benefits. American National denied the claim in July 2017, enclosing the applicable portions of the policy and Sergio’s medical records, as well as refunding the $91 premium paid, with interest. The denial letter explained that while Sergio indicated on his application that he did not suffer from liver disease, including cirrhosis or hepatitis, medical records showed a history of liver disease, untreated hepatitis C, and continued drinking despite counseling that Sergio cease doing so. It also explained that had Sergio provided accurate information on the application, the policy would not have been issued under American National’s underwriting guidelines.

Arce filed suit against American National in November 2017, alleging breach of contract, violations of sections 541.060, 541.061, and 542.060 of the Texas Insurance Code, and seeking recovery of policy benefits, statutory penalties, and attorney’s fees. Arce later amended her petition to add claims for class relief. In February 2019, American National filed a traditional motion for summary judgment, arguing Arce’s claims were barred because Sergio made material misrepresentations in his application for the life insurance policy. The trial court granted American National’s motion in July 2019, stating

it was disposing of all claims and all parties. The trial court subsequently denied Arce’s motion for new trial and for reconsideration and overruled her objections to American National’s summary judgment evidence. Thereafter, Arce timely filed her notice of appeal.

STANDARD OF REVIEW—TRADITIONAL MOTION FOR SUMMARY JUDGMENT We review a trial court’s ruling on a motion for summary judgment under a de novo standard of review. Valence Operating Co. v. Dorsett, 164 S.W.3d 656, 661 (Tex. 2005). To prevail on a traditional motion for summary judgment the movant must “show that, except as to the amount of damages, there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law . . . .” TEX. R. CIV. P. 166a(c); Cmty. Health Sys. Pro’l Servs. Corp. v. Hansen, 525 S.W.3d 671, 681 (Tex. 2017) (citing Provident Life, 128 S.W.3d at 216); Lightning Oil Co. v. Anadarko E&P Onshore, LLC, 520 S.W.3d 39, 45 (Tex. 2017)). A fact is conclusively established if reasonable minds could not differ about the conclusion to be drawn from the record. City of Keller v. Wilson, 168 S.W.3d 802, 816 (Tex. 2005). In our review of a trial court’s grant of summary judgment, we take as true all evidence favorable to the nonmovant and indulge every reasonable inference and resolve any doubts in the nonmovant’s favor. Valence, 164 S.W.3d at 661.

ANALYSIS

ISSUE ONE—ARCE’S OBJECTIONS TO AMERICAN NATIONAL’S SUMMARY JUDGMENT EVIDENCE

Through her first issue, Arce argues the trial court erred in overruling her objections to American National’s summary judgment evidence.1 American National argues the record shows the summary judgment evidence Arce is challenging on appeal was proper and the trial court did not err in overruling the objections.

An appellate court should review a trial court’s decision to admit or exclude summary judgment evidence under an abuse of discretion standard. Van Adrichem v. Agstar Fin. Servs., FLCA, No. 07-13-00432-CV, 2015 Tex. App. LEXIS 11734, at *3 (Tex. App.—Amarillo Nov. 13, 2015, no pet.) (mem. op.) (citing McCraw Materials, L.L.C. v. DivLend Equip. Leasing, L.L.C., No. 07-12-00215-CV, 2013 Tex. App. LEXIS 779, at *11, (Tex. App.—Amarillo Jan. 28, 2013, no pet.) (mem. op.), (citing In re J.P.B., 180 S.W.3d 570, 575 (Tex. 2005)). We must uphold a trial court’s evidentiary ruling if there is any legitimate basis for it. Owens-Corning Fiberglas Corp. v. Malone, 972 S.W.2d 35, 43 (Tex. 1998) (citing State Bar of Tex. v. Evans, 774 S.W.2d 656, 658 n.5 (Tex. 1989)).

An affidavit presented in a summary judgment proceeding must be made on personal knowledge, set forth such facts as would be admissible in evidence, and show affirmatively that the affiant is competent to testify to the matters stated therein. TEX. R. CIV. P. 166a(f). A conclusory statement is “one that does not provide the underlying facts to support the conclusion and, therefore, is not proper summary judgment proof.” Van 1 Arce contends the lack of admissible summary judgment evidence means section 705.005, rather

than section 705.101-.105, of the Texas Insurance Code applied. That, she asserts, means different obligations were imposed on American National. We will address this aspect of her contention in our analysis of Arce’s claims under the Texas Insurance Code.

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Bertha Arce, Individually and as Representative of All Others Similarly Situated v. American National Insurance Company, (Tex. Ct. App. 2021).

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