Maintenance, Inc. v. ITT Hartford Group, Inc.

895 S.W.2d 816, 1995 WL 64272
CourtCourt of Appeals of Texas
DecidedMarch 10, 1995
Docket06-94-00046-CV
StatusPublished
Cited by22 cases

This text of 895 S.W.2d 816 (Maintenance, Inc. v. ITT Hartford Group, 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
Maintenance, Inc. v. ITT Hartford Group, Inc., 895 S.W.2d 816, 1995 WL 64272 (Tex. Ct. App. 1995).

Opinion

OPINION

CORNELIUS, Chief Justice.

Maintenance, Inc. and others brought this suit against ITT Hartford Insurance Group, Inc. to recover damages caused by Hartford’s alleged breach of a covenant of good faith and fair dealing and certain provisions of the Deceptive Trade Practices Act. 1 Maintenance had obtained workers’ compensation insurance through the Texas Workers’ Compensation Assigned Risk Pool, and it alleged that Hartford, as the servicing company for the pool, had settled workers’ compensation claims too quickly and by paying too much, causing Maintenance’s experience rating and insurance premiums to rise to an intolerable level and forcing it to cancel its coverage. The trial court rendered a take-nothing summary judgment against Maintenance on the bases that Hartford was not its insurer but only the serving company for the *818 pool, and that Texas did not recognize a cause of action against a workers’ compensation insurer or its agent for paying workers’ claims excessively or too quickly. Because we believe the trial court correctly rendered summary judgment, we affirm.

Maintenance is a group of nine companies providing janitorial services to building owners. Until 1990 it purchased workers’ compensation insurance on its employees from private earners. In 1990 it was forced to apply for its insurance through the assigned risk pool because it was no longer able to obtain voluntary coverage. The Pool appointed Hartford as the servicing company, and as required by statute, Hartford issued a policy to Maintenance on behalf of the Pool.

Maintenance alleged that Hartford’s overly lenient handling and payment of workers’ compensation claims caused the number of claims to rise by 70% and the amount of money paid on the claims to rise by 183% in one year. This experience rating caused Maintenance’s premium modifiers to increase for the year 1991 to the point that it could not afford to purchase workers’ compensation insurance for the years 1991 and thereafter. Maintenance contended that Hartford was the insurer in its policy, and that its affirmative and negligent acts violated its covenant of good faith and fair dealing, as well as certain provisions of the DTPA. Hartford filed a sworn denial that it was liable in the capacity in which it was sued. Tex.R.Cxv.P. 93.

The trial court correctly concluded that Hartford was not the insurer. At the time this action arose, Tex.Ins.Code Ann. art. 5.76 governed the purchase of assigned risk workers’ compensation insurance policies. 2 Among other things, the Act provided that an employer whose application for insurance had been rejected could apply to the assigned risk pool for coverage. On approval of the application for insurance the pool was required to designate one of its members as the servicing company to issue a policy to the applicant. The Act further provided:

[T]he undertakings of such policy shall be entirely reinsured by all members of the pool, and the liability of the member issuing said policy shall be limited to its liability as a reinsurer.

Tex.Ins.Code Ann. art. 5.76(d) 3 (emphasis added). In other portions, the Act provided that the policy issued by the servicing company “evidences the insurance coverages provided by the pool to a rejected risk” and that “it shall be the duty of the pool to provide insurance” for the applicant. Tex.Ins.Code Ann. art. 5.76(a)(8), 4 art. 5.76(c) 5 (emphasis added).

By the explicit terms of the statute, the pool and not the servicing company is the insurer. The servicing company — in this case Hartford — is merely the agent to issue a policy for the pool, and the servicing company is not liable as an insurer, but only as a reinsurer. This conclusion is supported not only by the plain terms of the statute but is also confirmed, we think, by the language of the recent amendment to the statute. The amendment generally follows the plan set out in the former article, but it made some changes and added some consistent language that better defines the responsibilities of the pool and the servicing company. For example, the amendment provides that the servicing company need not be a member of the pool and need not even be an insurance company. See Tex.Ins.Code Ann. art. 5.76-2, § 4.08(a), (d) (Vernon Supp.1994). The fact that the servicing company is not even required to be an insurance company confirms the fact that the Legislature did not intend for it to be the insurer, but only the agent for the pool. The only case we have found involving this issue supports this conclusion. In Farm Air Service v. Houston Fire & *819 Casualty Ins. Co., 309 S.W.2d 510 (Tex.Civ.App.-Austin 1958, no writ), the court held:

The Binder issued by the Pool, and the Assigned Risk Pool Reinsurance Endorsement attached to the policies show that the contract [of insurance] is between [the insured] and the Pool. Appellee is the servicing carrier acting on behalf of, at the direction of and as a member of the Pool. .... Losses occurring under the policies are paid by the Pool out of its Fund in Austin.

Maintenance points to various places on the policy form issued by Hartford that designate Hartford as the insurer. It says these prove that Hartford is the insurer rather than a mere agent. Those provisions, however, are contradicted and superseded by other more specific provisions in the policy and the endorsements to the policy, all of which clearly indicate that the pool is the insurer and Hartford is only liable as a reinsurer.

In an insurance context, a duty of good faith and fair dealing is imposed on an insurance company to its insured when there is a special contract — normally an insurance policy — between them. Natividad v. Alexsis, Inc., 875 S.W.2d 695 (Tex.1994). But when an insurance company breaches its duty of good faith and fair dealing in the handling and payment of claims, and if it has contracted with an agent to perform such claim handling services for it, only the company and not the agent is liable for the breach. Natividad v. Alexsis, Inc., supra, As Hartford here is the agent for claims servicing purposes and is not an insurer, it has no liability to Maintenance for breach of a covenant of good faith and fair dealing.

The employer, though, does have a remedy. The statute provides that an insured aggrieved by any act of the pool may appeal to the State Board of Insurance and obtain relief from any acts that are found to be improper. Tex.Ins.Code Ann. art. 5.76(j). 6

Maintenance argues in its brief that Hartford, even if it is not the insurer, can be liable in its capacity as agent for its own negligence or violations of the Deceptive Trade Practices Act and the Insurance Code. We agree that Hartford may be liable in its individual capacity for such torts or wrongs, if committed.

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Bluebook (online)
895 S.W.2d 816, 1995 WL 64272, Counsel Stack Legal Research, https://law.counselstack.com/opinion/maintenance-inc-v-itt-hartford-group-inc-texapp-1995.