Evanston Insurance Co. v. Legacy of Life, Inc.

370 S.W.3d 377, 55 Tex. Sup. Ct. J. 1102, 2012 WL 2476935, 2012 Tex. LEXIS 569
CourtTexas Supreme Court
DecidedJune 29, 2012
DocketNo. 11-0519
StatusPublished
Cited by74 cases

This text of 370 S.W.3d 377 (Evanston Insurance Co. v. Legacy of Life, Inc.) is published on Counsel Stack Legal Research, covering Texas Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Evanston Insurance Co. v. Legacy of Life, Inc., 370 S.W.3d 377, 55 Tex. Sup. Ct. J. 1102, 2012 WL 2476935, 2012 Tex. LEXIS 569 (Tex. 2012).

Opinion

Justice GUZMAN delivered the opinion of the Court.

This case comes to us on two certified questions from the Fifth Circuit Court of Appeals. The certified questions arise from a suit filed by a daughter against an organ donation charity when she discovered that the charity — contrary to an earlier representation to her — would allegedly profit from harvesting her deceased mother’s tissues. The charity requested a defense from its insurer and the insurer denied a defense. The insurer’s subsequent suit against the charity resulted in the following certified questions from the Fifth Circuit Court of Appeals:

1. Does the insurance policy provision for coverage of “personal injury,” defined therein as “bodily injury, sickness, or disease including death resulting therefrom sustained by any person,” include coverage for mental anguish, unrelated to physical damage to or disease of the plaintiffs body?
2. Does the insurance policy provision for coverage of “property damage,” defined therein as “physical injury to or destruction of tangible property, including consequential loss of use thereof, or loss of use of tangible property which has not been physically injured or destroyed,” include coverage for the underlying plaintiffs loss of use of her deceased mother’s tissues, organs, bones, and body parts?

Evanston Ins. Co. v. Legacy of Life, Inc., 645 F.3d 739, 751 (5th Cir.2011). We answer both questions in the negative.

I. Factual Background

Legacy of Life, Inc. (Legacy) is an organ donation charity. Debra Alvarez consented for Legacy to harvest some of her terminally ill mother’s tissues after she died. Alvarez alleges in her suit against Legacy that she only consented because Legacy represented the tissues would be distributed on a nonprofit basis but that Legacy instead transferred them to companies 1 that sold the tissues for a profit.2 Alvarez brought various claims against Legacy, seeking compensatory damages, mental anguish damages, restitution, exemplary damages, and attorney’s fees. Importantly, Alvarez did not allege that she or her mother suffered a physical injury. Instead, Alvarez alleged that her mother’s estate as the legal and rightful owner of the remains was wrongfully deprived of them, causing restitution damages to the estate and mental anguish damages to Alvarez.

Legacy had a combined medical professional and general liability insurance policy through Evanston Insurance Company (Evanston). Legacy demanded that Ev-anston defend the Alvarez suit. Evanston, [380]*380645 F.3d at 741. Evanston denied the request and filed suit in federal court seeking a declaratory judgment that it had no duty to defend because Alvarez did not claim damages for personal injury or property damage. Id. at 742-43. Legacy counterclaimed, asserting various insurance claims and requesting a declaratory judgment in its favor. Id. at 743.

Evanston and Legacy both moved for summary judgment. Id. The district court granted Legacy’s motion for partial summary judgment on the duty to defend and denied Evanston’s motion for summary judgment. Id. The court entered a declaratory judgment that Evanston had a duty to defend, holding that personal injury covers extreme mental and emotional distress and that a Texas court could potentially find human tissues to be property. Id. Tellingly, the district court referred to the duty to defend question as “exceedingly close.” Id. at 744. The Fifth Circuit certified the personal injury and property damage questions to this Court and noted that if Alvarez’s claims involve either personal injury or property damage under the policy, Evanston has a duty to defend the entire Alvarez suit. Id. at 745, 751.

II. The Duty to Defend

When determining whether an insurer has a duty to defend, we follow the eight corners rule by looking at the four corners of the complaint for alleged facts that could possibly come within the scope of coverage in the four corners of the insurance policy. GuideOne Elite Ins. v. Fielder Rd. Baptist Church, 197 S.W.3d 305, 307 (Tex.2006). Our precedent favors insureds when examining both the complaint and the policy. As to the complaint, if it includes even one covered claim, the insurer must defend the entire suit.3 Zurich Am. Ins. Co. v. Nokia, Inc., 268 S.W.3d 487, 491 (Tex.2008). However, we only defer to a complaint’s characterization of factual allegations, not legal theories or conclusions. Nat’l Union Fire Ins. Co. of Pittsburgh, Pa. v. Merchs. Fast Motor Lines, Inc., 939 S.W.2d 139, 141 (Tex.1997) (per curiam). As to the policy, if a term is susceptible to more than one reasonable interpretation, we must resolve that uncertainty in favor of the insured. Fiess v. State Farm Lloyds, 202 S.W.3d 744, 746 (Tex.2006).

III. Personal Injury

With these principles in mind, we first determine whether Alvarez’s suit seeks damages for personal injury under Legacy’s policy with Evanston. Specifically, the first certified question asks: “Does the insurance policy provision for coverage of ‘personal injury,’ defined therein as ‘bodily injury, sickness, or disease including death resulting therefrom sustained by any person,’ include coverage for mental anguish, unrelated to physical damage to or disease of the plaintiff’s body?” Evans-ton, 645 F.3d at 751. The policy defines “personal injury” as:

(a) bodily injury, sickness or disease including death resulting therefrom sustained by any person;
[381]*381(b) false arrest, detention or imprisonment, •wrongful entry or eviction or other invasion of private occupancy, malicious prosecution or humiliation, except when maliciously inflicted by, at the direction of, or with the consent or acquiescence of the insured;
(c) the publication or utterance of libel or slander or other defamatory or disparaging material, or a publication or utterance in violation of an individual’s right of privacy except when maliciously published or uttered by, at the direction of, or with the consent or acquiescence of the insured, (emphasis added).

When an insurance policy defines its terms, those definitions control. Trinity Universal Ins. Co. v. Cowan, 945 S.W.2d 819, 828 (Tex.1997). Legacy claims “bodily” only modifies “injury” and that Alvarez’s mental anguish qualifies as sickness under the policy. Evanston maintains that “bodily” modifies “injury,” “sickness” and “disease” and that an accompanying physical injury is required.

We agree with Evanston. In Trinity, we examined a homeowner’s policy that defined “bodily injury” as “bodily harm, sickness of disease.” Id. at 820.

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Bluebook (online)
370 S.W.3d 377, 55 Tex. Sup. Ct. J. 1102, 2012 WL 2476935, 2012 Tex. LEXIS 569, Counsel Stack Legal Research, https://law.counselstack.com/opinion/evanston-insurance-co-v-legacy-of-life-inc-tex-2012.