Natividad v. Alexsis, Inc.

833 S.W.2d 545, 1992 WL 82144
CourtCourt of Appeals of Texas
DecidedJuly 8, 1992
Docket08-91-00344-CV
StatusPublished
Cited by9 cases

This text of 833 S.W.2d 545 (Natividad v. Alexsis, 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
Natividad v. Alexsis, Inc., 833 S.W.2d 545, 1992 WL 82144 (Tex. Ct. App. 1992).

Opinions

OPINION

OSBORN, Chief Justice.

This is an appeal from a take-nothing summary judgment in a suit filed by a workers’ compensation claimant against a party hired to adjust claims for the compensation carrier. The appeal raises, for the first time in Texas, the question of whether an adjusting firm has the same duty of good faith and fair dealing that the insurance company has to a workers’ compensation claimant. Having concluded that such a duty does exist, we reverse and remand to the trial court.

Facts

Rosa Natividad, while an employee of Reveo, sustained accidental injuries in the course of her employment on October 27, 1987 and on June 14, 1988. Both claims were settled following appeals of board awards to the district court.

Reveo had workers’ compensation insurance with National Union Fire Insurance [547]*547Company. Alexsis, Inc. entered into an agreement to provide the services of investigating, adjusting and handling all claims of Reveo employees. This suit was filed against National Union Fire Insurance Company of Pittsburgh, Pennsylvania, Alexsis, Inc. and its adjuster, William Steen and Reveo. Settlements were made with National Union and Reveo and they were dismissed from the suit.1 The claims against the Appellees in this case were disposed of by summary judgment.

Pleading

In Plaintiffs Fifth Amended Petition, it was alleged that after her injuries, payments were not timely made of compensation benefits to which the claimant was entitled. The pleading asserted against these Appellees the following causes of action: (1) breach of the duty of good faith and fair dealing; (2) fraud; (3) economic duress, oppression and outrage; (4) negligent infliction of emotional distress; and (5) extreme and outrageous conduct which causes severe emotional distress as set forth in Restatement (Second) of Torts § 46 (1965).

Breach of Duty of Good Faith and Fair Dealing

In Arnold v. National County Mutual Fire Insurance Company, 725 S.W.2d 165 (Tex.1987), the Court held that insurers have a duty of good faith and fair dealing to their insureds. The Court recognized this duty because “[a]n insurance company has exclusive control over the evaluation, processing and denial of claims.” Arnold, 725 S.W.2d at 167. In his concurring opinion, Justice Gonzalez indicated that one of the elements of the cause of action was a contract between the insurer and the insured.

Just over a year later, the Court in Aranda v. Insurance Co. of North America, 748 S.W.2d 210 (Tex.1988) applied that same duty in a case between a compensation claimant and the compensation carrier. The Court said: “The contract between a compensation carrier and an employee creates the same type of special relationship that arises under other insurance contracts.” Id. at 212. Of course, there is no contract between the carrier and the employee. The contract is between the carrier and the employer who selects the carrier, the term of the policy and agrees as to the premium to be paid. But, the employee is certainly the beneficiary of what Justice Spears said was “a three-party agreement entered into by the employer, the employee, and the compensation carrier.” Id. at 212. The employee establishes a breach of that duty by showing that the carrier has refused to pay or delayed payment of the benefits of the policy without a reasonable basis and that the carrier knew or should have known that there was no reasonable basis for denying the claim or delaying payment of the claim.

Apparently, no Texas court has considered the question of whether the duty which the Supreme Court applied in the Arnold and Aranda cases should apply to a company which does not issue insurance policies but only does the adjusting of claims for an insurance company which provides the compensation coverage. In this case, there is no contract between Rosa Natividad and Alexsis, Inc., and there is no contract between her employer, Reveo and Alexsis, Inc., but, there is a contract whereby Alexsis, Inc. agreed to handle the claims of Reveo employees under the policy issued by National Union. Rosa Natividad was just as much a beneficiary under that contract as was Mr. Aranda under the insurance policy issued by Insurance Company of North America. She was to receive whatever benefits the law provided for an employee injured on the job from the carrier who provided the compensation coverage. In this case, the actual funds may have been provided by National Union (as opposed to INA which both wrote the coverage and provided the adjusting services in the Aranda case) but the responsibility [548]*548to see that those funds were properly and timely paid rested upon Alexsis, Inc. under its contractual obligation to adjust the claims of Reveo employees.

This issue was recently considered by the Supreme Court of Colorado in Scott Wetzel Services, Inc. v. Johnson, 821 P.2d 804 (Colo.1991). In that case, suit was against an independent adjusting company acting on behalf of a self-insured employer, Safeway Stores, Inc. The trial court entered a directed verdict on the grounds that there had to be an insurance contract between the parties, or at least the plaintiff had to be a beneficiary of an insurance contract issued by the defendant. Neither Scott Wetzel Services, Inc. in that case, nor Alex-sis, Inc. in this case issue any insurance policies. In the Court’s opinion, Justice Lohr noted that the self-insured employer could not relieve itself of its obligation of good faith and fair dealing by contracting out its responsibilities. We agree, and in this case, National Union’s duty was not changed by its hiring an adjusting firm to settle claims of Reveo employees. The Colorado Court held that its compensation act “was intended to supply every employee within its protection with a more or less summary and speedy procedure ... to recover compensation for any injury from an industrial accident....” Johnson, 821 P.2d at 812. Thus, the duty of good faith and fair dealing was held to be applicable to the independent adjusting firm. The Court noted that without such an obligation, claims adjusting services could create obstacles to prompt payments. In a dissenting opinion, Chief Justice Rovira stated that the duty should not be extended to the adjusting firm and noted that if the adjusting firm improperly handles claims of Safeway employees that they would have a remedy against Safeway which had the non-delegable duty of good faith and fair dealing.

In Aranda, the Court said: “The purpose of the Workers’ Compensation Act is to provide speedy, equitable relief to an employee injured in the course of his employment.” Aranda, 748 S.W.2d at 212. We conclude that purpose can best be served by requiring those firms which are to provide that “speedy, equitable relief” have the duty to do so in good faith and fair dealing even though there exists a duty upon the part of the insurance carrier to also fulfill that duty.

In the plaintiff’s petition, it is alleged that compensation payments were not promptly and timely sent to the claimant. There is no proof to the contrary.

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Haines v. National Union Fire Insurance
812 F. Supp. 93 (S.D. Texas, 1993)
Natividad v. Alexsis, Inc.
833 S.W.2d 545 (Court of Appeals of Texas, 1992)

Cite This Page — Counsel Stack

Bluebook (online)
833 S.W.2d 545, 1992 WL 82144, Counsel Stack Legal Research, https://law.counselstack.com/opinion/natividad-v-alexsis-inc-texapp-1992.