Methodist Hospital v. Zurich American Insurance Co.

329 S.W.3d 510, 2009 WL 3003251
CourtCourt of Appeals of Texas
DecidedSeptember 24, 2009
Docket14-07-00663-CV
StatusPublished
Cited by23 cases

This text of 329 S.W.3d 510 (Methodist Hospital v. Zurich American Insurance Co.) 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
Methodist Hospital v. Zurich American Insurance Co., 329 S.W.3d 510, 2009 WL 3003251 (Tex. Ct. App. 2009).

Opinions

OPINION

CHARLES W. SEYMORE, Justice.

Appellant, The Methodist Hospital (“Methodist”), sued appellees, Zurich American Insurance Company (“Zurich”), Tamera McKenney, and Mary Vu, asserting various causes of action based on ap-pellees’ allegedly improper handling and payment of workers’ compensation claims filed by two Methodist employees. In a single issue encompassing several arguments, Methodist contends the trial court erred by granting summary judgment on Methodist’s (1) breach-of-contract action against Zurich, (2) negligence action against all appellees, and (3) breach-of-express-warranty action against Zurich. We affirm.

I. Background

Zurich issued workers’ compensation insurance policies (“the policy”) to Methodist for various successive periods.1 Workers’ compensation claims were subject to a $1 million deductible per each accident. The parties executed a document entitled “Deductible Agreement,” which outlined “the scope, description and structure” of the “Deductible Program” and “the duties and obligations of each party with respect to this Program.” The Deductible Agreement consisted of the “Terms and Conditions” outlined therein and separate documents entitled “Specifications to Deductible Agreement” executed by the parties.

We will later discuss in more detail pertinent provisions of the Deductible Agreement. However, in general, Zurich agreed to handle and pay workers’ compensation claims and then bill Methodist for payments within the deductible. Methodist agreed to remit all such amounts when due. To accomplish this billing and remittance, Methodist deposited a certain amount into an escrow fund and Zurich initiated a weekly electronic transfer from the fund to obtain payment for losses adjusted within the deductible.

Judith Riegert and Ana Fulton-Perez, Methodist employees, were injured during two applicable policy periods. Both employees filed workers’ compensation claims. Vu was the Zurich adjuster who handled these claims, and McKenney was Vu’s supervisor. The total benefits paid [514]*514for each claim were within the $1 million deductible.

Methodist eventually sued Zurich, McKenney, and Vu. In its live petition, Methodist pleaded (1) breach of contract against Zurich only, (2) negligence against all appellees, (3) breach of express warranty against Zurich only, and (4) a request for declaratory judgment. Methodist alleged Zurich, McKenney, and Vu improperly handled the Riegert and Fulton-Perez claims. Methodist alleged portions of the claimed injuries were not compensable because of pre-existing conditions, but appel-lees failed to dispute compensability within the deadline prescribed by the Texas Workers’ Compensation Act (“the act”) and improperly approved payment of these benefits. Because the amounts paid for each claim were within the $1 million deductible, Methodist contended it sustained damages as a direct consequence of Zurich’s allegedly improper payments.

Zurich filed a traditional and no-evidence motion for summary judgment on Methodist’s claim for breach of express warranty. On July 27, 2007, the trial court signed an order granting the motion and ruling that Methodist take nothing on this cause of action.

Appellees filed a traditional motion for partial summary judgment on the negligence and breach-of-contract actions. On September 20, 2007, the trial court signed an “Amended Order Granting Final Summary Judgment, Partial Dismissal Without Prejudice, and Dismissal Without Prejudice of Defendants’ Counterclaims,” ruling that Methodist take nothing on its (1) breach-of-contract action against Zurich and (2) negligence action against all appel-lees.2 The court further stated the order disposed of all claims and was final and appealable.3

II. Traditional Summary Judgment on Breach-of-Contract and Negligence Actions

A party moving for traditional summary judgment must establish no genuine issue of material fact exists and it is entitled to judgment as a matter of law. See Tex.R. Civ. P. 166a(c); Provident Life & Accident Ins. Co. v. Knott, 128 S.W.3d 211, 215-16 (Tex.2003). A defendant moving for summary judgment must conclusively negate at least one element of the plaintiffs theory of recovery or plead and conclusively establish each element of an affirmative defense. Centeq Realty, Inc. v. Siegler, 899 S.W.2d 195, 197 (Tex.1995). If the defendant establishes its right to summary [515]*515judgment, the burden shifts to the plaintiff to raise a genuine issue of material fact. Id. We review a summary judgment de novo. Knott, 128 S.W.3d at 215. We take all evidence favorable to the nonmovant as true and indulge every reasonable inference and resolve any doubts in favor of the nonmovant. Id.

A.Appellees’ Summary-Judgment Grounds

Appellees presented separate grounds for summary judgment on the breach-of-contract and negligence actions but relied on the same case to support both grounds. To understand the parties’ positions, it is helpful to first explain both grounds and Methodist’s general response.4

1. Breach of Contract

In its live petition, Methodist alleged Zurich breached the parties’ contract by failing to timely contest compensability of the Riegert and Fulton-Perez injuries and paying claims that were invalid because of pre-existing conditions.5 Specifically, Methodist asserted Zurich breached the “duty to defend” set forth in the policy. Methodist also asserted Zurich breached the Deductible Agreement; Methodist did not specify a particular provision of this agreement allegedly violated but seemed to allege Zurich breached a general contractual obligation to properly handle claims.

Zurich moved for summary judgment on the ground that the policy gave Zurich complete discretion in handling and paying workers’ compensation claims; consequently, its decisions to pay the claims at issue were not actionable in breach of contract. In particular, Zurich cited the following portion of the policy:

B. We Will Pay
We will pay promptly when due the benefits required of you by the workers’ compensation law.
C. We Will Defend
We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the [516]*516right to investigate and settle these claims, proceedings or suits.
We have no duty to defend a claim, proceeding or suit that is not covered by this insurance.

Zurich also relied on Wayne Duddlesten, Inc. v. Highland Insurance Co., 110 S.W.3d 85 (Tex.App.-Houston [1st Dist.] 2003, pet. denied). In Duddlesten, the employer’s workers’ compensation policies included a retrospective premium payment plan, under which the standard annual premium would be adjusted based on amounts the insurer had paid for claims under the policy. Id. at 88-89. The insured sued the carrier, alleging it improperly paid several workers’ compensation claims that were not covered under the policy. Id. at 89-90.

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Cite This Page — Counsel Stack

Bluebook (online)
329 S.W.3d 510, 2009 WL 3003251, Counsel Stack Legal Research, https://law.counselstack.com/opinion/methodist-hospital-v-zurich-american-insurance-co-texapp-2009.