Davis v. Twin City Fire Insurance Co.

865 S.W.2d 231, 1993 WL 387521
CourtCourt of Appeals of Texas
DecidedNovember 2, 1993
Docket06-92-00031-CV
StatusPublished
Cited by8 cases

This text of 865 S.W.2d 231 (Davis v. Twin City Fire Insurance Co.) 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
Davis v. Twin City Fire Insurance Co., 865 S.W.2d 231, 1993 WL 387521 (Tex. Ct. App. 1993).

Opinion

OPINION

GRANT, Justice.

Faith Davis sued Twin City Fire Insurance Company because it refused to buy her a hot tub pursuant to a workers’ compensation settlement agreement. The trial court entered judgment unfavorable in part to each party and both parties appeal.

ISSUES

Davis contends that the trial court erred (1) in disregarding a jury finding awarding her $100,000 in exemplary damages, (2) in refusing to include prejudgment interest in the judgment, and (3) in concluding that the settlement agreement was ambiguous. Davis also contends that if this court deems a retrial of this case necessary, we should find that the trial court erred in excluding her from viewing certain materials produced by Twin City and viewed by the court in camera and in refusing to admit into evidence proof of Twin City’s net worth.

Twin City contends that the award and decision of the Industrial Accident Board bars the present suit and that the jury’s exemplary damages finding was excessive.

DISPOSITION

We modify the judgment of the trial court by reinstating the jury’s award of exemplary damages, by awarding prejudgment interest, and by modifying the attorney’s fees. We affirm the judgment as modified.

FACTS

On October 30, 1986, Faith Davis injured her lower back while lifting a box of files in the course and scope of her employment. As a result of this incident, Davis filed a workers’ compensation claim against Twin City, her employer’s workers’ compensation carrier. In December 1987, the parties entered into a Compromise Settlement Agreement and Release under which Twin City agreed to pay Davis a lump sum of $37,500, in addition to “five years future medical expenses with Dr. Key, or any other mutually agreed upon physician in advance.”

In September 1987, Davis received a prescription from Dr. James Key for a “hot tub or jacuzzi for a large body for life.” On December 4, three days after the parties signed the settlement agreement, Davis’s attorney sent the prescription to Twin City who received it on December 7. The trial court approved the settlement agreement on December 14.

Twin City then sent a letter to Davis’s attorney requesting that Dr. Key provide a letter of medical necessity regarding the hot tub and further stating that Twin City would submit the prescription to an orthopedic consultant at Southwestern Medical School. On April 20, 1988, Davis’s attorney sent Dr. Key’s letter of medical necessity and four estimates for hot tubs to Twin City. On May 10, 1988, Twin City forwarded Dr. Key’s letter to the Texas Medical Foundation (TMF), which Twin City had retained to do medical consultation. Twin City then informed Davis that it expected TMF to perform the review. TMF completed its review and sent a letter dated October 27, 1988, to Twin City summarizing the review and supporting the use of the whirlpool for Davis’s condition. The two Twin City employees who handled Davis’s claim, however, testified *234 that they did not become aware of the results of the review until significantly later.

On October 17, 1988, more than ten months after Twin City received the hot tub prescription, Davis’s attorney sent a letter to the Industrial Accident Board (IAB) requesting a pre-hearing conference regarding Twin City’s failure to pay for the hot tub. The letter stated that Davis had received no communication from Twin City since May 10. Having received a copy of the letter to the IAB, Twin City employees felt it important that they make a determination regarding the hot tub. Having recently received an orthopedist’s review of another patient’s file, which questioned the efficacy of using a hot tub to treat a lower back ailment, Twin City preliminarily denied Davis’s claim.

On October 28, 1988, Twin City sent, a letter to Davis stating that a board certified orthopedist had reviewed the medical necessity for a hot tub, that the orthopedist concluded that an in-ground hot tub was not justified, but that Twin City intended to consult with another orthopedist.

On January 25, 1989, Twin City sent Davis a letter in which it unequivocally denied her claim. The letter stated that an orthopedist had reviewed Davis’s medical file and rejected the hot tub treatment as not medically necessary. The actual review of Davis’s file by the TMF orthopedist supported the use of a hot tub for treating her lower back, stating that “it would be reasonable to attempt use of a portable whirlpool for treatment of this patient’s back problem. However, if inadequate depth of water due to the size of the tub or patient, then a larger tub may be necessary.” TMF dated its review October 27, 1988, but the Twin City employees in charge of Davis’s claim testified that they did not become aware of the review until after Davis filed suit. Although a Twin City employee testified that Davis’s claim was rejected in part because it was believed that she wanted an in-ground unit, Davis never requested an in-ground unit, and Twin City did not suggest an alternative in either of its denial letters. One of the employees further testified that after becoming aware of the TMF review, Twin City offered Davis $150 to purchase an over-the-tub whirlpool unit. The evidence indicates that Davis requires a stand-alone hot tub to obtain the desired results from the treatment. Twin City produced no evidence at trial suggesting that it ever attempted to correct the inaccuracies in the January 25 letter — despite the fact that, as the Twin City supervisor in charge of Davis’s file testified, the letter was “not accurate at all.”

On March 6, 1988, the IAB denied Davis’s claim stating that the evidence submitted failed to bring Davis within the provisions of the Texas Workers’ Compensation Act because the bill for the hot tub had not accrued. Davis then filed suit against Twin City alleging fraud, rescission of contract, breach of contract, intentional and negligent infliction of emotional distress, insurance code and Deceptive Trade Practices Act violations, failure to pay workers’ compensation benefits, and a breach of the duty of good faith and fair dealing.

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Related

Seneca Resources Corp. v. Marsh & McLennan, Inc.
911 S.W.2d 144 (Court of Appeals of Texas, 1995)
Twin City Fire Insurance Co. v. Davis
904 S.W.2d 663 (Texas Supreme Court, 1995)
Armstrong v. Randle
881 S.W.2d 53 (Court of Appeals of Texas, 1994)

Cite This Page — Counsel Stack

Bluebook (online)
865 S.W.2d 231, 1993 WL 387521, Counsel Stack Legal Research, https://law.counselstack.com/opinion/davis-v-twin-city-fire-insurance-co-texapp-1993.