Lee v. Safemate Life Insurance

737 S.W.2d 84, 1987 Tex. App. LEXIS 8111
CourtCourt of Appeals of Texas
DecidedAugust 19, 1987
Docket08-86-00215-CV
StatusPublished
Cited by6 cases

This text of 737 S.W.2d 84 (Lee v. Safemate Life Insurance) 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
Lee v. Safemate Life Insurance, 737 S.W.2d 84, 1987 Tex. App. LEXIS 8111 (Tex. Ct. App. 1987).

Opinion

OPINION

WOODARD, Justice.

The trial court granted Defendant’s motion for judgment notwithstanding the verdict for want of a cause of action on all matters, except it confirmed the jury’s denial of attorney’s fees on the issue of bad faith and harassment. We reverse and render, except for the matters of attorney’s fees.

The jury found that the Defendant breached its duty of good faith and fair dealing and that it engaged in unfair acts *85 or practices in handling the Plaintiffs claims.

In August of 1983, Plaintiff obtained an automobile loan from a credit union and purchased disability insurance from the Defendant, securing the payment of the loan. In September of 1983, Plaintiff became ill from thrombophlebitis. She terminated her employment without pay and applied to the Defendant insurance company for the loan payments she was unable to make. Her claim was denied on the policy liability exception of a preexisting condition. Plaintiff denied the preexisting condition and brought suit under Tex.Ins.Code Ann. art. 21.21, sec. 16, and alternatively for breach of good faith and fair dealing. The jury awarded $10,300.00 actual damages, $20,-000.00 exemplary damages, and attorney’s fees. The jury further found the suit was not groundless or brought in bad faith, or for the purpose of harassment.

In Special Issue No. One, the jury found the insurance company intentionally breached its duty of exercising good faith and fair dealing in the handling of the Plaintiff’s claims by (1) failing to use due diligence in attempting to determine the nature of her loss, and (2) failing to deal in good faith with her in regard to her insurance claim, and that these were proximate causes of her damages.

The standard of reference given this issue was the instruction setting out the Unfair Claim Settlement Practices Act, Tex.Ins.Code Ann. art. 21.21-2, sec. 2, with its subsections thereunder, stating their violations constitute unfair settlement practices. Section (c) states:

Failing to adopt and implement reasonable standards for prompt investigation of claims arising under its policies; ....

Section (d) states:

Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims submitted in which liability has become reasonably clear; ....

The court instructed that a violation of this Act could be evidence of bad faith. The Defendant objected that there was no definition of the words “good faith.”

A cause of action for breach of the duty of good faith and fair dealing exists when there is no reasonable basis for denial of a claim or delay in payment, or a failure on the part of the insurer to determine whether there is any reasonable basis for the denial or delay. Arnold v. National County Mutual Fire Insurance Company, 725 S.W.2d 165 (Tex.1987).

If Sections (c) and (d) are considered to some degree to be a definition of good faith, the Defendant’s objection of “no definition” is too general. Bellefonte Underwriters Ins. Co. v. Brown, 663 S.W.2d 562 (Tex.App.—Houston [14th Dist.] 1983), aff’d in part, rev’d in part, 704 S.W.2d 742 (Tex.1986); Motor 9, Inc. v. World Tire Corporation, 651 S.W.2d 296 (Tex.App.—Amarillo 1983, writ ref’d n.r.e.). If Sections (c) and (d) are not considered to be definitions of good faith, then it was incumbent upon the Defendant to request a definition in substantially correct form. Rule 279, Tex.R.Civ.P.; State v. Harrington, 407 S.W.2d 467 (Tex.1966). The objection was waived.

In Special Issue No. Two, the jury found that the Defendant negligently breached its duty of good faith and fair dealing by (a) engaging in unreasonable and unjustified delays in paying loss, (b) by failing to use due diligence in attempting to determine nature of loss, and (c) failing to deal in good faith. The Defendant objected to the absence of definitions of “due diligence” and “good faith,” without more, and the same reasoning and rulings applied to the objections on Special Issue No. One apply to these objections. The jury found in Special Issue No. Four that the insurance company engaged in an unfair act or practice in the handling of Plaintiff’s claim by (1) engaging in unreasonable and unjustified delays, (2) failing to use due diligence, and (3) failing to deal in good faith. Article 21.21, sec. 16(a), makes three types of conduct actionable:

(1) Any activity declared in Article 21.21, sec. 4, to be an unfair method of competition and unfair and deceptive trade or practice;
(2) Any activity declared in the rules and regulations lawfully adopted by the State *86 Board of Insurance under Article 21.21 to be an unfair method of competition and unfair and deceptive trade or practice; and
(3) Any activity defined in Tex.Bus. & Com.Code Ann. sec. 17.46 (Vernon Supp. 1968) (Deceptive Trade Practice Act) as an unlawful deceptive trade practice.

Chitsey v. National Lloyds Insurance Company, 738 S.W.2d 641 (1987). Article 21.21, sec. 16(b), provides that a successful plaintiff may obtain treble damages, plus court costs and attorney’s fees.

Article 21.21, sec. 4, contains eight subsections defining unfair practices in the business of insurance, but none of them pertain to unfair claims settlement practices. Plaintiff claimed that Defendant violated Article 21.21, sec. 4(1), but that subsection pertains to false advertising and there is nothing therein that prohibits any conduct alleged by the Plaintiff. Therefore, nothing in Article 21.21, sec. 4, supports a judgment for the Plaintiff based on the jury’s answer to Special Issue No. Four.

Plaintiff alleges that Defendant’s conduct violated State Board of Insurance Orders Nos. 41060, adopted June 4, 1982, and 27085, adopted May 17,1974. Board Order No. 41060 seeks to define and prohibit unfair acts or practices in the insurance industry and was adopted by the Board under Article 21.21. Board Order No. 27085 deals with unfair acts or practices in the settlement of claims. Contrary to the Plaintiff’s assertion, a violation of Board Order No. 27085 is not a per se violation of Article 21.21, sec. 16. Board Order No. 27085 was adopted under the provisions of Tex.Ins.Code Ann. art. 21.21-2 (Vernon 1981), entitled “Unfair Claim Settlement Practices Act.” A violation of Board Order No. 27085 is not necessarily a violation of Article 21.21, sec. 16, because Article 21.21, sec. 16(a), only prohibits practices declared to be unfair or deceptive in “rules or regulations lawfully adopted by the Board under this Article....” [Emphasis added.] The phrase “this Article” clearly refers to Article 21.21, not Article 21.21-2, the provision under which Board Order No. 27085 was adopted.

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Bluebook (online)
737 S.W.2d 84, 1987 Tex. App. LEXIS 8111, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lee-v-safemate-life-insurance-texapp-1987.