City of Carrollton v. Fred Loya Insurance Company

CourtCourt of Appeals of Texas
DecidedJanuary 1, 2015
Docket02-12-00470-CV
StatusPublished

This text of City of Carrollton v. Fred Loya Insurance Company (City of Carrollton v. Fred Loya Insurance Company) 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
City of Carrollton v. Fred Loya Insurance Company, (Tex. Ct. App. 2015).

Opinion

COURT OF APPEALS SECOND DISTRICT OF TEXAS FORT WORTH

NO. 02-12-00470-CV

CITY OF CARROLLTON APPELLANT

V.

FRED LOYA INSURANCE APPELLEE COMPANY

----------

FROM THE 431ST DISTRICT COURT OF DENTON COUNTY TRIAL COURT NO. 2010-40236-362

MEMORANDUM OPINION 1

This case revolves around whether an insured, Danelle Butts, validly

added her daughter, Donna, back to her insurance policy so that the daughter’s

car accident with a pedestrian was covered by the policy. Because we hold that

material issues of fact preclude summary judgment, we reverse and remand.

1 See Tex. R. App. P. 47.4. Facts

Danelle had an automobile insurance policy through Appellee Fred Loya

Insurance. On August 3, 2007, Danelle amended her policy to exclude her

daughter Donna from coverage under the policy because Donna moved out of

the family home.

Less than a month later, Danelle requested that her daughter be added

back onto the policy because she was moving back into the home. The auto

policy change request form was filled out by a Loya employee who wrote at the

bottom of the form, “Added Donna M. Butts as per insured’s request.” Danelle

dated her signature at the bottom of the form “8/30/07.” At the top of the form, in

the blank for “change effective date,” the Loya employee wrote the date of

August 31 but left blank the space for the time. The form was faxed to Loya from

BenefitMall.com at 11:56 a.m. on August 31; Danelle worked for Benefit Mall at

the time. Loya faxed a document entitled “Endorsements” at 12:01 on August 31

to Benefit Mall. It is not clear from the fax stamp whether 12:01 was in the early

morning hours or just after noon. Linda Davila, a Loya employee, testified in

deposition that she assumed that the absence of an “a.m.” or “p.m.” would

indicate that the fax was transmitted after noon. She based that assumption on

military time but conceded that she did not base that assumption on her

knowledge of Loya fax machines.

On August 31, 2007, at approximately 8:35 a.m., Donna, driving Danelle’s

vehicle, struck Appellant City of Carrollton’s employee Diego Salinas.

2 Danelle’s premium payment was processed by Loya after the accident.

Salinas was in the course and scope of his employment when the accident

happened. The City paid workers’ compensation benefits for his medical

expenses and lost wages. The City then sued Donna and Danelle, asserting

equitable subrogation and statutory subrogation under the labor code. 2 Donna

and Danelle tendered the suit to Loya for defense and indemnity under the

policy. Loya denied the claim on the ground that on the date of the accident,

August 31, Donna was excluded from coverage under the policy. Loya concedes

that the endorsement adding Donna back to the policy was issued August 31 but

states that it nevertheless denied coverage after discovering that Danelle had

attempted to add Donna back to the policy after the accident occurred.

The suit proceeded to trial, and the trial court rendered final judgment

against Donna and Danelle, jointly and severally, in the amount of $54,222.92.

Danelle and Donna assigned to the City any claims they had against Loya.

The City then filed this suit against Loya. The City sought a declaration (1)

that Donna and Danelle were both covered under the policy on August 31, 2007;

(2) that Loya was estopped from asserting and had waived any position

otherwise; and (3) that Loya breached its policy obligations by denying coverage.

The City also asserted that the policy and policy forms were ambiguous and that

any ambiguity should be interpreted in favor of coverage. The City asserted that

2 Tex. Labor Code Ann. §§ 417.001–.004 (West 2006).

3 material breach, substantial performance, lack of prejudice, waiver, estoppel,

ratification, and ambiguity precluded Loya from relying upon the exclusion or

policy limits that it had asserted.

Loya’s answer asserted that Donna was a named excluded driver under

the policy and that Danelle had failed to comply with the terms and conditions of

the insurance contract. Loya filed a motion for summary judgment, which the trial

court denied.

The City then moved for partial summary judgment, and Loya filed a

second summary judgment motion. The City sought both a traditional and no-

evidence partial summary judgment on the grounds that

1. The auto policy change request form and the provisions within the

policy related to the change request are ambiguous as a matter of

law;

2. Danelle substantially complied with the policy when she signed the

form on 8/30/07 and paid the additional premium thereafter;

3. Loya is precluded from denying coverage for the accident because it

suffered no prejudice (no-evidence ground);

4. Loya waived any right to deny coverage and was estopped from

denying coverage;

5. Loya could not meet its burden to show that Donna was excluded

from the policy at the exact moment that the accident occurred or

4 that Donna and Danelle had otherwise failed to comply with the

terms and conditions of the policy (no-evidence ground).

Loya asserted in its motion that the City did not make a settlement demand

within the limits of the policy, and therefore the City could not assert a Stowers

claim. It also asserted that the change adding Donna to the policy did not

become effective until several hours after the accident, that she was therefore

not covered under the policy at the time of the accident, and that Loya

consequently did not breach its contract by refusing coverage for the accident. If

the breach of contract claim failed, Loya asserted, it had no liability for extra-

contractual claims under the DTPA or insurance code. Loya further argued that

the City’s equitable arguments all failed because insurance coverage is

contractual and cannot be created through the use of equitable doctrines.

The summary judgment evidence includes deposition excerpts from

Danelle, Donna, and Loya employees, as well as an affidavit from Lana Ruiz,

Loya’s underwriting manager, a copy of the insurance policy, and copies of the

confirmation of the change excluding Donna from the policy as of August 3, the

change request form to add her back to the policy, the receipt for the premium

payment, and the document entitled “Endorsements.”

The policy states that its terms “may not be changed or waived except by

endorsement issued by us” but does not state that an additional premium must

be received before an endorsement is generated. In her affidavit, Ruiz stated

that an endorsement is generated as a result of an automated computer

5 transaction that cannot occur without the payment of the premium and that there

is no way to manually override this process. Ruiz stated that because of this

process, the endorsement adding Donna onto the policy could not have been

issued until payment occurred. In her deposition, however, Ruiz intimated that

the auto policy change request form was the endorsement.

In Donna’s deposition, she stated that at the accident scene, the police

officer asked for proof of insurance, and her mother met her at the scene with an

insurance ID card from Loya that had Donna’s name on it.

Linda Davila, a Loya employee, stated in her deposition that she was not

familiar with all Loya fax machines but that she would assume that the absence

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City of Carrollton v. Fred Loya Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/city-of-carrollton-v-fred-loya-insurance-company-texapp-2015.