Chester Humphrey v. AIG Life Insurance Company

• Court: Court of Appeals of Texas
• Decided: July 1, 2010
• Docket: 14-08-00973-CV
• Status: Published

Opinion

Affirmed and Memorandum Opinion filed July ___, 2010

Affirmed and Memorandum Opinion filed July 1, 2010.

In The

Fourteenth Court of Appeals

NO. 14-08-00973-CV

Chester Humphrey, Appellant

v.

AIG  Life Insurance Company, Appellee

On Appeal from the 55th District Court

Harris County, Texas

Trial Court Cause No. 2006-48246

MEMORANDUM OPINION

Appellant, Chester Humphrey, sought continuous total disability benefits from his employer’s insurance company, AIG Life Insurance Company (“AIG”) following an on-the-job injury.  Because AIG denied Humphrey’s claim, he sued AIG for breach of contract, violations of the Texas Insurance Code and the Texas Deceptive Trade Practices Act (“DTPA”), and breach of the duty of good faith and fair dealing. 

AIG moved for summary judgment, asserting there was no evidence that AIG breached the terms of the policy because Humphrey could not establish any coverage obligation under the terms of the policy.  The trial court granted summary judgment to AIG, specifically holding that Humphrey failed to present legally sufficient evidence to controvert AIG’s no-evidence motion.  In multiple issues, Humphrey asserts the trial court erroneously concluded that expert testimony was necessary to establish his total disability and contends the trial court should have treated AIG’s motion as a traditional rather than a no-evidence summary-judgment motion.  We affirm.

I.  Background

Humphrey was employed by Pacific Motor Transport Company (“Pacific Motor”) as a truck driver in 2001.  In June 2001, he injured his back while attempting to lift a tarp to cover a load on his truck.  Humphrey sought medical attention for his back pain a few days after the incident; a physician examined him and prescribed medication and physical therapy.  Humphrey underwent physical therapy for three to four months, but his pain was not resolved.  His physician then sent him for an MRI, which showed he had “multiple herniated disks” in his back. 

At the time of his injury, Pacific Motor had a “special risk” policy through AIG.  This policy provides a “weekly accident indemnity” when a covered employee, such as Humphrey, suffered an injury that “totally and continuously disabled and prevented [the employee] from performing” his job duties.  The following policy conditions must be fulfilled to receive these weekly payments:

a.         Such period of disability commences within thirty days after the date of the accident causing such injury; and

b.         Benefits shall commence beginning with the day of continuous disability; and

c.         Such indemnity shall be payable at the rate of $350.00 per week not to exceed 70 percent of basic earnings; and

d.         The maximum period for which such indemnity shall be payable for any one such period of disability shall not exceed 104 weeks.

After his injury, Humphrey sought and received weekly accident disability payments through the AIG policy.[1] 

Pursuant to the policy terms, his weekly disability benefits expired in June 2003, two years (104 weeks) after his injury.  AIG notified Humphrey he could seek “continuous total disability benefits” if he could provide “due proof” that, inter alia, he was totally disabled and that such total disability “resulted solely and directly” from the June 2001 on-the-job injury.  This requirement arose from the following policy rider:

CONTINUOUS TOTAL DISABILITY INDEMNITY

I.          After weekly Accident Indemnity benefits have been paid for 104 weeks, the Company shall pay a weekly Total Disability Indemnity if the Insured Person is totally and continuously disabled and prevented from engaging in any occupation for which he is or could become qualified by reason of his education, training or experience. We will pay the benefit described to an Insured Person when we receive due proof that:

1.         he is totally disabled and under age 70; and

2.         the Insured Person has been granted a Social Security Disability Award for such disability; and

3.         injury occurred while the Insured Person was performing the duties of his occupation; and

4.         such Total Disability:

a.         resulted solely and directly from injury;

b.         began within the Disability Commencement Period shown in Section III, 4 item (A);

c.         continued without interruption for at least the waiting period of 104 weeks, and

d.         is reasonably expected to continue without interruption until the Insured Person dies.

(emphasis added).

AIG ultimately denied Humphrey’s claim for total disability benefits, prompting him to sue AIG for breach of contract, violations of the Texas Insurance Code and DTPA, and breach of the duty of good faith and fair dealing.  As the case neared the trial setting, AIG moved for no-evidence summary judgment, arguing there was no evidence of any coverage obligation because, inter alia, Humphrey could not prove, per the terms of the policy, that his total disability “resulted solely and directly” from the lifting injury.  In response, Humphrey submitted his affidavit and his wife’s, both non-medical laypersons, purporting to link his physical symptoms to the back injury he had suffered on the job.

In his affidavit, Humphrey stated that his pain began contemporaneously with the on-the-job injury and worsened afterwards, leading to weakness in his leg and necessitating occasional use of a walking cane.  He stated that he had not suffered any injuries subsequent to the on-the-job lifting injury.  He also claimed he had no problems with “severe back pain, nor problems with pain in [his] legs or thighs,” before the injury, although he acknowledged that, around 1980, he suffered a back injury, which resulted in “a spinal fusion.”  Finally, he declared that he had completely recovered from his 1980 back injury and surgery and had no back problems or pain before his on-the-job injury in June 2001. 

Humphrey’s wife stated in her affidavit that Humphrey was fine before the on-the-job injury and did not sustain subsequent injuries.  She further stated that Humphrey had no other health problems before the accident, but that he has gained weight, been diagnosed with high blood pressure and diabetes, and his leg that was affected by the back injury has “caused him more problems.” 

Humphrey additionally filed his own motion for partial summary judgment, to which he attached various documentation.  This documentation included copies of several medical reports, which indicated he suffered from lumbar radiculopathy secondary to herniated disc, edema and cellulitis of the lower extremities, congestive heart failure, hypertension, morbid obesity, and diabetes mellitus.  None of these reports indicated that his medical issues resulted from his on-the-job injury.

The trial court granted summary judgment in favor of AIG and denied Humphrey’s summary-judgment motion.  In its summary-judgment order, it specifically ruled Humphrey failed to present at least “a scintilla of evidence that Plaintiff’s total disability resulted solely and directly from the injury.”  The court refused to consider the unqualified lay opinions of Humphrey and his wife.  Because all of Humphrey’s causes of action were premised upon the existence of insurance coverage, and the trial court concluded there was no coverage, the court additionally ruled that “none of the Plaintiff’s causes of action can survive.”  Humphrey filed a motion for new trial, which was denied by the trial court.  This appeal timely ensued.

II.  Analysis

Humphrey has challenged the summary judgment on four grounds:  (1) the trial court erred in granting summary judgment by requiring expert testimony on medical causation; (2) the trial court erroneously treated AIG’s motion as a no-evidence, rather than traditional, motion for summary judgment; (3) the trial court erred in granting summary judgment because AIG failed to carry its summary-judgment burden; and (4) the trial court abused its discretion in denying Humphrey’s motion for new trial.  Because Humphrey’s second and third issues relate to the type of summary judgment motion AIG filed, we consolidate and discuss them first as they govern the applicable standard of review.

A.        AIG’s Motion

            In his second issue in his original appellate brief, Humphrey argues the trial court should have treated AIG’s no-evidence motion as a traditional summary-judgment motion because AIG attached evidence to the motion.[2]  However, the Texas Supreme Court has rejected this argument:  “[I]f a motion brought solely under subsection (i) attaches evidence, that evidence should not be considered unless it creates a fact question, but such a motion should not be disregarded or treated as a motion under subsection (a) or (b).”  Binur v. Jacobo, 135 S.W.3d 646, 651 (Tex. 2004).  In other words, attaching evidence to an otherwise valid no-evidence motion for summary judgment does not transform it into a traditional summary-judgment motion.  See id.  We therefore overrule Humphrey’s second issue.

Similarly, in his third issue, Humphrey asserts that the trial court improperly shifted the burden of proof to him because AIG’s summary-judgment motion should have been treated as a traditional, rather than a no-evidence, motion.  But because attaching evidence to a no-evidence motion does not transform it into a traditional motion for summary judgment, this issue likewise has no merit.  See id.  Thus, we overrule Humphrey’s third issue, and turn to the merits of his first and fourth issues.

B.        Summary Judgment for Failure to Provide Expert Testimony

            In his first issue, Humphrey asserts that the trial court erred in granting AIG summary judgment because he provided controverting lay testimony—his and his wife’s affidavits—within the general experience and scope of common understanding that established a causal connection between his on-the-job injury and his permanent disability.  Stated differently, Humphrey contends that the trial court should not have granted AIG summary judgment because he did not need to provide expert testimony to establish that his total disability resulted “solely and directly” from his injury.  In his fourth issue, Humphrey argues that the trial court abused its discretion in denying his motion for new trial on this same basis. 

1.  Standard of Review

We review a no-evidence summary judgment by the same legal-sufficiency standard used to review directed verdicts.  See Mathis v. Restoration Builders, Inc., 231 S.W.3d 47, 50 (Tex. App.—Houston [14th Dist.] 2007, no pet.).  Under this familiar standard, we review the entire record in the light most favorable to the nonmovant, indulging every reasonable inference and resolving any doubts in his favor.  City of Keller v. Wilson, 168 S.W.3d 802, 824 (Tex. 2005).  A no-evidence motion for summary judgment must be granted if (1) the moving party asserts that there is no evidence of one or more essential elements of a claim or defense on which the adverse party would have the burden of proof at trial, and (2) the respondent produces no summary-judgment evidence raising a genuine issue of material fact on those elements.  See Tex. R. Civ. P. 166a(i).  

We must affirm the summary judgment if the evidence offered to prove a vital fact is no more than a scintilla or the rules of law or evidence preclude the court from giving weight to the only evidence offered to prove a vital fact.  See Walker v. Thomasson Lumber Co., 203 S.W.3d 470, 474 (Tex. App.—Houston [14th Dist.] 2006, no pet.).  More than a scintilla of evidence exists when the evidence rises to a level that would permit “‘reasonable and fair-minded people to differ in their conclusions.’”  Ford Motor Co. v. Ridgway, 135 S.W.3d 598, 601 (Tex. 2004) (quoting Merrell Dow Pharms., Inc. v. Havner, 953 S.W.2d 706, 711 (Tex. 1997)).  However, we must not consider the evidence attached to a no-evidence summary judgment motion except to the extent, if any, it creates a fact issue precluding summary judgment.  See Binur, 135 S.W.3d at 651.  Finally, when both sides move for summary judgment, as they did here, and the trial court grants one motion and denies the other, we consider both sides’ summary-judgment evidence, determine all questions presented, and render the judgment the trial court should have rendered.  Embrey v. Royal Ins. Co. of Am., 22 S.W.3d 414, 415–16 (Tex. 2000).

2.  Necessity of Expert Testimony to Support Humphrey’s Claim

Here, the trial court granted summary judgment on the specific ground that Humphrey’s lay opinion could not be used to establish that his total disability (and not merely his pain) “resulted solely and directly from injury,” a necessary showing before coverage was owed under the AIG policy.  We agree with the trial court.

Generally, expert testimony is necessary to establish causation of medical conditions that are “outside the common knowledge and experience of jurors.”  See Guevara v. Ferrer, 247 S.W.3d 662, 665 (Tex. 2007).  However, under limited circumstances, non-expert evidence may sufficiently support a causation finding that links an event with one’s physical condition.  Id. at 666.  This exception applies only in certain cases in which general experience and common sense enable a layman to determine the causal relationship with reasonable probability.  See id.; Morgan v. Compugraphic Corp., 675 S.W.2d 729, 733 (Tex. 1984).  In such cases, “lay testimony establishing a sequence of events which provides a strong, logically traceable connection between the event and the condition is sufficient proof of causation.”  Morgan, 675 S.W.2d at 733.

Typically, proof of causation by lay testimony may be appropriate for common injuries like broken bones or pain following a car accident.  See Guevara, 247 S.W.3d at 668 (“[C]ausation as to certain types of pain, bone fractures, and similar basic conditions following an automobile collision can be within the common experience of lay jurors.”).  The Texas Supreme Court elaborated with the following hypothetical:

For example, if [the plaintiff] had been pulled from a damaged automobile with overt injuries such as broken bones or lacerations, and undisputed evidence which reasonable jurors could not disbelieve showed that he did not have such injuries before the accident, then the physical conditions and causal relationship between the accident and the conditions would ordinarily be within the general experience and common knowledge of laypersons.

Guevara, 247 S.W.3d at 667; cf. Metro. Transit Auth. v. Harris County, No. 14-06-00513-CV, 2008 WL 4354503, at *8 (Tex. App.—Houston [14th Dist.] Aug. 26, 2008, no pet.) (mem. op.) (affirming judgment on lay testimony linking medical expenses to automobile collision).  Thus, a fact-finder could fairly find a causal link between an automobile collision and a person’s “immediate post-accident condition which resulted in his being transported to an emergency room and examined in the emergency room.”  Guevara, 247 S.W.3d at 669. 

Here, however, Humphrey’s medical issues are neither common nor basic.  See id. at 669–70; City of Laredo v. Garza, 293 S.W.3d 625, 632–33 (Tex. App.—San Antonio 2009, no pet.) (rejecting sufficiency of lay testimony alone to prove medical causation of disc herniations and radiculopathy).  The record reflects that Humphrey suffers from multilevel disc herniation at the L1-L2 and L2-L3 levels, with additional non-contiguous “posterocentral spondylitic subligamentous herniation” at the L5-S1 level, and additional disc bulges at several other levels.  According to one of Humphrey’s treating physicians, these disc herniations have resulted in lumbar radiculopathy. 

Further, although some of Humphrey’s disc complaints are located in the lumbar region, they are not readily traceable to the lifting injury alone because Humphrey has had previous spinal fusion surgery.   The record also reflects that Humphrey is morbidly obese and suffers from edema and cellulitis of the lower extremities, which renders him unable to walk without assistance.  He produced a letter from another physician, E.K. Gaston, M.D., who opined Humphrey is totally and permanently disabled.  But Dr. Gaston linked that condition to a combination of several medical ailments unrelated to his 2001 back injury:  “[B]ecause [Humphrey] suffers from Congestive Heart Failure, Hypertension, Morbid Obesity, Lumbar Radiculopathy and Diabetes Mellitus, I feel that he is total[ly] and permanently disabled and cannot return to any type of gainful employment.” 

In sum, given (1) the complex nature of Humphrey’s purported back injury; (2) the combination of medical ailments unrelated to his 2001 back injury that were identified by Dr. Gaston as contributing to Humphrey’s permanent disability; and (3) his prior spinal fusion surgery, we conclude that the task of evaluating whether his “total disability” was caused “solely and directly” by his 2001 back injury—as required by the terms of the policy at issue here—is not within the general experience and common sense of a layman.  Cf. Garza, 293 S.W.3d at 632–33; Tex. Employers’ Ins. Ass’n v. Ramirez, 770 S.W.2d 896, 900 (Tex. App.—Corpus Christi 1989, writ denied) (“We agree that in cases in which a layman would not, from his common knowledge, understand a causal connection between the employment or injury and the medical condition, expert testimony may be required.”).  We therefore agree with the trial court that expert testimony was necessary under the facts of this case to establish a causal link between Humphrey’s 2001 back injury and his disability.[3]  Because he provided no such expert testimony, he failed to produce at least a scintilla of evidence as to a necessary element of his cause of action.  See Walker, 203 S.W.3d at 473–74.

We hold the trial court did not err by granting summary judgment in favor of AIG.  Accordingly, we overrule Humphrey’s first issue.  Likewise, we overrule Humphrey’s fourth issue.  The trial court did not abuse its discretion by denying Humphrey’s motion for new trial because summary judgment was proper in this case.[4]

III.  Conclusion

We conclude that the trial court properly granted summary judgment in favor of AIG on Humphrey’s claims.  Having overruled his four issues, we affirm the trial court’s order granting AIG’s motion for summary judgment.

                                                                        /s/        Kent C. Sullivan

                                                                                    Justice

Panel consists of Chief Justice Hedges and Justices Seymore and Sullivan.

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[1] Humphrey’s medical expenses were also covered by AIG under the policy. 

[2] AIG filed an original no-evidence summary judgment motion and a combined response to Humphrey’s motion for partial summary judgment and “first amended counter-motion for summary judgment.”  Although only the first motion was titled, “Motion for No-Evidence Summary Judgment,” both clearly argue there is no evidence AIG breached its contract because no coverage was owed to Humphrey. 

[3] We note that the insurance provision at issue in this case—that an insured must provide “due proof” that his disability resulted “solely and directly” from his on-the-job injury—requires proof of causation particularly rigorous relative to coverage available through other types of insurance, such as worker’s compensation insurance.  Cf. Ins. Co. of N. Am. v. Myers, 411 S.W.2d 710, 712–13 (Tex. 1966) (“Workmen compensation benefits are recoverable notwithstanding such [pre-existing] condition if there was shown a causal relation between the injury and death, i.e., the . . . injury . . . was a contributing or producing cause of death.” (emphasis added)); State Office of Risk Mgmt. v. Escalante, 162 S.W.3d 619, 623 (Tex. App.—El Paso 2005, pet. dism’d) (noting in worker’s compensation case that jury determined work-related injury was “producing cause” of disability); Tex. Workers’ Comp. Ins. Fund. v. Simon, 980 S.W.2d 730, 736 (Tex. App.—San Antonio 1998, no pet.) (explaining in a worker’s compensation case that employment must be a “producing cause” of the injury; thus, even if there are other causes for the injury, the employment need only be “a” cause). 

[4] As noted above, the trial court also concluded that, because Humphrey did not establish coverage under the policy, his extra-contractual claims failed as well.  See, e.g., Tivoli Corp. v. Jewelers Mut. Ins. Co., 932 S.W.2d 704, 712 (Tex. App.—San Antonio 1996, writ denied) (holding that extra-contractual claims fail if denial of claim is appropriate).  Humphrey has not appealed this ruling.