Jeffries v. Pat A. Madison, Inc.

269 S.W.3d 689, 2008 Tex. App. LEXIS 7536, 2008 WL 4516647
CourtCourt of Appeals of Texas
DecidedOctober 9, 2008
Docket11-07-00185-CV
StatusPublished
Cited by10 cases

This text of 269 S.W.3d 689 (Jeffries v. Pat A. Madison, Inc.) 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
Jeffries v. Pat A. Madison, Inc., 269 S.W.3d 689, 2008 Tex. App. LEXIS 7536, 2008 WL 4516647 (Tex. Ct. App. 2008).

Opinion

OPINION

RICK STRANGE, Justice.

Anna Jeffries filed suit against Pat A. Madison, Inc.; Denis Papasan; Allied National, Inc.; and Guarantee Trust Life Insurance Company alleging several causes of action arising out of the denial of insurance coverage for a surgical procedure. 1 Madison and Papasan filed a traditional motion for summary judgment. The trial court granted the motion and entered a take-nothing judgment in their favor. Jef-fries argues on appeal that this was error because a fact question exists on her negligent misrepresentation claim. We affirm.

I.Background Facts

Jeffries purchased three consecutive short-term medical group insurance policies from Allied and Guarantee Trust through Papasan and Madison. Each policy provided coverage for six months. During the second policy’s period of coverage (July 23, 2004-January 23, 2005), Jeffries was diagnosed with a thyroid condition that required surgery. On December 15, 2004, she met with Papasan and discussed the possibility of changing coverage to a new carrier. Jeffries alleged that Papasan told her not to change carriers because the new carrier would consider her thyroid a preexisting condition and that, when she asked about Allied, he responded that it “wouldn’t be very nice of them but that [she] would have to pay an additional $1,000 deductible if [she had] the surgery after January 23, 2005.” Jeffries purchased a third Allied policy. It covered the period January 23, 2005, through July 23, 2005. Jeffries’s surgery was performed on February 24, 2005, and cost approximately $25,000. Allied denied coverage, contending that the surgery was for a preexisting condition.

II.Issues on Appeal

Jeffries asserted several causes of action in her original petition, but her brief is limited to her negligent misrepresentation claim. Accordingly, the only issue before this court is whether Madison and Papasan were entitled to summary judgment on that claim.

III.Analysis

A. Standard of Review.

When, as here, a party files a traditional motion for summary judgement, the standard of review is well settled. Questions of law are reviewed de novo. St. Paul Ins. Co. v. Tex. Dep’t of Transp., 999 S.W.2d 881, 884 (Tex.App.-Austin 1999, pet. denied). To determine if a fact question exists, we must consider whether reasonable and fair-minded jurors could differ in their conclusions in light of all the evidence presented. Goodyear Tire & Rubber Co. v. Mayes, 236 S.W.3d 754, 755 (Tex.2007). We must consider all the evidence in the light most favorable to the nonmovant, indulging all reasonable inferences in favor of the nonmovant, and determine whether the movant proved that there were no genuine issues of material fact and that it was entitled to judgment as a matter of law. Nixon v. Mr. Prop. Mgmt. Co., 690 S.W.2d 546, 548-49 (Tex.1985).

B. Negligent Misrepresentation.

*691 The elements of a negligent misrepresentation claim are:

(1) the representation is made by a defendant in the course of his business, or in a transaction in which he has a pecuniary interest;
(2) the defendant supplies false information for the guidance of others in their business;
(3) the defendant did not exercise reasonable care or competence in obtaining or communicating the information; and
(4) the plaintiff suffers pecuniary loss by justifiably relying on the representation.

Fed. Land Bank Ass’n of Tyler v. Sloane, 825 S.W.2d 439, 442 (Tex.1991).

Negligent misrepresentation claims frequently arise when the parties have a relationship, but a plaintiff need not prove privity of contract. See Cook Consultants, Inc. v. Larson, 700 S.W.2d 231, 234 (Tex.App.-Dallas 1985, writ ref'd n.r.e.). The duty to avoid making a negligent misrepresentation is separate from any other duty that may exist between the parties and can arise even if the parties’ relationship would otherwise preclude a duty. See, e.g., McCamish, Martin, Brown & Loeffler v. F. E. Appling Interests, 991 S.W.2d 787, 795 (Tex.1999) (privity or an attorney-client relationship is not required to bring a negligent misrepresentation claim against an attorney).

C. The Summary Judgment Evidence.

Madison and Papasan contend that they were entitled to summary judgment because Papasan made no misrepresentation or, alternatively, because Jeffries was charged with knowledge that the third policy would not cover her surgery. Jeffries executed an application on December 15, 2004. For reasons unexplained by the record, a second application was executed on January 17, 2005. The two applications are identical. They are labeled, “Temporary Health Insurance Application”; they provide that the policy is not a continuation of any prior temporary health insurance plan and that the plan will not pay any benefits for preexisting conditions as described in the plan brochure. The brochure included the following provision:

The Horizon’s Temporary Health Plan is a TEMPORARY plan. It is not renewable and not meant to provide long periods of coverage. However, coverage may be rewritten for new and separate coverage periods as long as you meet the eligibility criteria described above and on the application. There is NO CONTINUOUS COVERAGE if the plan is rewritten. This means that a new application must be submitted, a new effective date is given, a new preexisting condition period begins and a new deductible and out-of-pocket expense must be met. Any condition which may have occurred under prior coverage will be treated as a preexisting condition under the rewritten coverage.

Finally, the plan itself specifically excluded coverage for preexisting conditions.

Jeffries filed a response to the motion for summary judgment. Her response included her affidavit in which she stated:

I first met with Denis Papas[a]n in December 2003 to purchase health insurance. He recommended Allied Insurance. He told me Allied was the insurance that he carried and suggested I buy it also.
I met with him again on December 15, 2004 and told him that I had been diagnosed with a thyroid condition and possibly switching to Blue Cross/Blue Shield because Alied’s premiums kept going up. He told me to continue my insurance with Alied because Blue Cross/ Blue Shield would treat my thyroid as a preexisting condition.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
269 S.W.3d 689, 2008 Tex. App. LEXIS 7536, 2008 WL 4516647, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jeffries-v-pat-a-madison-inc-texapp-2008.