Fortis Benefits v. Cantu

234 S.W.3d 642, 50 Tex. Sup. Ct. J. 965, 2007 Tex. LEXIS 603, 2007 WL 1861000
CourtTexas Supreme Court
DecidedJune 29, 2007
Docket05-0791
StatusPublished
Cited by192 cases

This text of 234 S.W.3d 642 (Fortis Benefits v. Cantu) 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
Fortis Benefits v. Cantu, 234 S.W.3d 642, 50 Tex. Sup. Ct. J. 965, 2007 Tex. LEXIS 603, 2007 WL 1861000 (Tex. 2007).

Opinion

*644 Justice WILLETT

delivered the opinion of the Court.

The issue in this insurance subrogation case is whether the equitable “made whole” doctrine — the rule that an insurer is not entitled to subrogation of medical benefits unless the insured has been “made whole” — trumps an insurer’s contract-based subrogation right.

After respondent Vanessa Cantu sued multiple parties for severe injuries she sustained in an auto accident, her medical insurer, petitioner Fortis Benefits, intervened, claiming a subrogation right under the policy. The various defendants settled with Cantu, and Fortis looked only to Cantu for its recovery. A divided court of appeals upheld a trial court finding that because Cantu’s medical expenses exceeded the settlement amount plus the benefits Fortis had paid, Fortis’s subrogation claim was barred by the equitable “made whole” doctrine. We hold that the “made whole” doctrine must yield to Fortis’s right to contractual subrogation under the plain terms of the insurance policy.

I. Background

Cantu suffered severe injuries in a car wreck and later sued the driver of the vehicle in which she was riding, his employer, the vehicle seller, and the vehicle manufacturer (Ford). Fortis intervened and asserted contractual subrogation and reimbursement rights to recoup from Cantu’s tort recovery the amount of medical benefits it had paid under the policy. At a pretrial conference, Fortis agreed with all parties on the record that Fortis was excused from participating in the pretrial and trial proceedings and that Fortis at the post-verdict phase would look only to Cantu to resolve its subrogation and reimbursement claims.

Cantu settled her claims with the defendants before trial for $1,445 million. Cantu and Fortis disputed what portion of the settlement proceeds, if any, should go to Fortis, and Cantu moved for summary judgment, arguing she had not been “made whole” by the settlement. Cantu’s past medical expenses totaled $378,500 (of which Fortis claimed to have paid $247,534.14), and her summary judgment evidence included two “life care plans” estimating her future medical expenses at roughly $1.7 million and $5.3 million. She argued that her past and future medical expenses, exclusive of other amounts like pain and suffering, exceeded the amount of the settlement plus what Fortis had already paid. Cantu argued that the “made whole” doctrine precluded Fortis’s contractual claims of subrogation and reimbursement. The trial court granted summary judgment in favor of Cantu, and a divided court of appeals affirmed. 1

II. Subrogation and the “Made Whole” Doctrine

This Court recognized the “made whole” doctrine twenty-seven years ago in Ortiz v. Great Southern Fire & Casualty Insurance Co. 2 The Ortiz family had a fire insurance policy from Great Southern on their home, but not the contents. 3 A fire caused damages of $4,000 to the home and $11,614 to personal property, and Great Southern paid $4,000 for home repairs. 4 The Ortizes then sued Stacy-Mason, Inc., alleging that one of its employees negligently started the fire. Great Southern intervened, claiming a right of equitable *645 subrogation. 5 After the Ortizes settled with Stacy-Mason for $10,000, the trial court awarded, and the court of appeals affirmed, $4,000 of that settlement to Great Southern. 6

We reversed, holding, “An insurer is not entitled to subrogation if the insured’s loss is in excess of the amounts recovered from the insurer and the third party causing the loss.” 7 We reasoned that one justification for equitable subrogation is to prevent the insured from receiving a double recovery, first from the insurer, then from the third party. 8 We also recognized, however, that if the insured’s total recovery is less than his or her losses, equity cuts the other way: “when ‘either the insurer or the insured must to some extent go unpaid, the loss should be borne by the insurer for that is a risk the insured has paid it to assume.’ ” 9 Because the settlement in Ortiz encompassed both covered and noncov-ered items, we remanded for a determination of how much of the $10,000 related to house damage. 10

Ortiz would govern if Fortis were merely asserting a claim for equitable sub-rogation. But Fortis is not citing principles of equity to recover its money; its policy with Cantu conferred on Fortis two separate contractual rights of recovery, one styled “subrogation” and one styled “reimbursement.” 11 Fortis argues that these provisions authorize recovery from Cantu’s $1,445 million settlement with the defendants, and that neither provision is displaced by the “made whole” doctrine. We agree.

A. Equitable Subrogation v. Contractual Subrogation

Our Ortiz decision addressed the “made whole” doctrine in the context of equitable subrogation, but it did not discuss how the doctrine applies, if at all, to contractual subrogation. Other courts, however, have discussed whether the doctrine applies in the face of a contract that grants the insurer greater subrogation rights. For example, in Oss v. United Services Automobile *646 Ass' n, 12 the Fifth Circuit, applying Texas law in a diversity case, was confronted with facts similar to those in this case. The insured was not made whole by the settlement following a car wreck, yet insurer USAA sought enforcement of its contractual subrogation rights under the policy. 13 Like Fortis, USAA urged the Fifth Circuit to reject the “made whole” doctrine by distinguishing Ortiz as involving equitable rather than contractual sub-rogation. 14 The Fifth Circuit, relying on the El Paso Court of Appeals’ decision in Means v. United Fidelity Life Insurance Co., refused because it believed that, in Texas, “the same principles govern both equitable and contractual subrogation.” 15

In Means, the insureds had challenged the validity of United Fidelity’s contractual subrogation right to foreclose on their 200-acre property. 16 The court noted, “Whether we have a purely equitable sub-rogation or, as here, a purely contractual one where both Mr. and Mrs.

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Cite This Page — Counsel Stack

Bluebook (online)
234 S.W.3d 642, 50 Tex. Sup. Ct. J. 965, 2007 Tex. LEXIS 603, 2007 WL 1861000, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fortis-benefits-v-cantu-tex-2007.