Old American Insurance Company v. Lincoln Factoring, LLC
This text of Old American Insurance Company v. Lincoln Factoring, LLC (Old American Insurance Company v. Lincoln Factoring, LLC) 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.
Opinion
ACCEPTED 02-17-00186-CV SECOND COURT OF APPEALS FORT WORTH, TEXAS 12/21/2017 5:50 PM DEBRA SPISAK CLERK
02-17-00186-CV FILED IN 2nd COURT OF APPEALS __________________________________________________________________ FORT WORTH, TEXAS 12/21/2017 5:50:29 PM COURT OF APPEALS DEBRA SPISAK Clerk SECOND DISTRICT OF TEXAS AT FORT WORTH __________________________________________________________________
OLD AMERICAN INSURANCE COMPANY
Appellant
v.
LINCOLN FACTORING, LLC
Appellee __________________________________________________________________
Appeal from County Court at Law No. 1, Tarrant County, Texas Hon. Don Pierson presiding (2015-005979-1) __________________________________________________________________
APPELLEE’S BRIEF __________________________________________________________________
MICHAEL G. ENGFER FRANK GILSTRAP Texas Bar No. 24085296 Texas Bar No. 07964000 6145 Wedgwood Drive Hill Gilstrap, PC Fort Worth, Texas 76133 1400 West Abram Street 817-850-9800 Arlington, Texas 76013 817-850-9801 fax 817-261-2222 mike@sryp.net 817-861-4685 fax fgilstrap@hillgilstrap.com
ATTORNEYS FOR APPELLEE
ORAL ARGUMENT REQUESTED PARTIES AND COUNSEL
Appellant Old American Insurance Co.
David R. Sweat (appeal) 3705 West Green Oaks Blvd., Suite C Arlington, Texas 76016
Andrew W. Seibert (trial) Seibert Law Firm PC 6001 W. I20, Suite 205 Arlington, Texas 76017
Appellee Lincoln Factoring, LLC
Frank Gilstrap (appeal) Hill Gilstrap, PC 1400 West Abram Street Arlington, Texas 76013
Michael Engfer (trial and appeal) 6145 Wedgwood Drive Fort Worth, Texas 76133
Judges Hon. Sergio L. DeLeon Justice of the Peace, Place 5 350 West Belknap, Suite 112 Fort Worth, Texas 76196-0247
Hon. Don Pierson, Judge County Court at Law No. 1 100 W. Weatherford St., Room 490 Fort Worth, Texas 76196-0240
1 TABLE OF CONTENTS
PARTIES AND COUNSEL ......................................................................................1
TABLE OF CONTENTS ...........................................................................................2
INDEX OF AUTHORITIES......................................................................................6
STATEMENT OF THE CASE ................................................................................13
FACTS .....................................................................................................................14
The “death benefit” and the suicide exclusion ..............................................14
The ADB and the additional exclusions ........................................................14
The death and the assignment ........................................................................15
Lincoln makes a claim ...................................................................................15
The three claims .............................................................................................16
Old American delays payment ......................................................................17
Lincoln sues and Old American pays ............................................................18
The litigation ..................................................................................................18
The judgment .................................................................................................19
SUMMARY OF THE ARGUMENT ......................................................................19
Merits .............................................................................................................20
Coverage ..............................................................................................20
Insurance Code ....................................................................................20
2 Bad faith ..............................................................................................21
Treble damages....................................................................................21
Prompt payment ..................................................................................21
Misrepresentation ................................................................................22
Declaratory Judgment..........................................................................22
Forfeiture .............................................................................................23
Preservation .........................................................................................23
Capacity” and “standing” ..............................................................................23
a. Old American’s complaints involve capacity, not standing. .......24
b. The claims were assigned, and they were assignable. .................24
c. Direct standing under the Insurance Code. ..................................25
ARGUMENT PART ONE: MERITS.....................................................................25
1. Old American was required to pay the $10,000 “death benefit” when it received proof that the insured had died, regardless of cause-of-death. ...............................................................................................25
2. Bad faith: Old American’s obligation to pay the $10,000 death benefit was “reasonably clear” when Lincoln first made its claim. .................................27
3. Prompt payment: Lincoln was entitled to recover 18% interest and attorney’s fees. ........................................................................................32
The statute. ..........................................................................................32
No “good faith” defense. .....................................................................33
Application. .........................................................................................34
4. Old American has waived any error as to the misrepresentation claims. .....34
3 The statute: ..........................................................................................35
Facts:....................................................................................................35
5. Old American also waived any error as to the award of attorney’s fees under the Declaratory Judgments Act. .............................38
6. Old American waived any defense under Section 1103.51 of the Insurance Code. ...................................................................................40
7. Lincoln is entitled to recover attorney’s fees. ...............................................43
8. Treble damages: Old American acted “knowingly.”...................................44
9. Old American failed to preserve error as to the calculation of interest, calculation of damages, or the award of treble damages. ................45
ARGUMENT PART TWO: STANDING .............................................................47
10. Old American waived any error as to the assignment of claims by failing to raise it in the trial court. ............................................................47
11. Alternatively, Lincoln has standing to assert its own claims for “bad faith” and misrepresentation under Section 541.151 of the Code. .............................................................................................................52
12. Lincoln has standing to assert a “prompt payment” claim under section 542.060 of the Code. ...............................................................58
13. Alternatively, the Insurance Code claims were assigned and they were assignable.
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ACCEPTED 02-17-00186-CV SECOND COURT OF APPEALS FORT WORTH, TEXAS 12/21/2017 5:50 PM DEBRA SPISAK CLERK
02-17-00186-CV FILED IN 2nd COURT OF APPEALS __________________________________________________________________ FORT WORTH, TEXAS 12/21/2017 5:50:29 PM COURT OF APPEALS DEBRA SPISAK Clerk SECOND DISTRICT OF TEXAS AT FORT WORTH __________________________________________________________________
OLD AMERICAN INSURANCE COMPANY
Appellant
v.
LINCOLN FACTORING, LLC
Appellee __________________________________________________________________
Appeal from County Court at Law No. 1, Tarrant County, Texas Hon. Don Pierson presiding (2015-005979-1) __________________________________________________________________
APPELLEE’S BRIEF __________________________________________________________________
MICHAEL G. ENGFER FRANK GILSTRAP Texas Bar No. 24085296 Texas Bar No. 07964000 6145 Wedgwood Drive Hill Gilstrap, PC Fort Worth, Texas 76133 1400 West Abram Street 817-850-9800 Arlington, Texas 76013 817-850-9801 fax 817-261-2222 mike@sryp.net 817-861-4685 fax fgilstrap@hillgilstrap.com
ATTORNEYS FOR APPELLEE
ORAL ARGUMENT REQUESTED PARTIES AND COUNSEL
Appellant Old American Insurance Co.
David R. Sweat (appeal) 3705 West Green Oaks Blvd., Suite C Arlington, Texas 76016
Andrew W. Seibert (trial) Seibert Law Firm PC 6001 W. I20, Suite 205 Arlington, Texas 76017
Appellee Lincoln Factoring, LLC
Frank Gilstrap (appeal) Hill Gilstrap, PC 1400 West Abram Street Arlington, Texas 76013
Michael Engfer (trial and appeal) 6145 Wedgwood Drive Fort Worth, Texas 76133
Judges Hon. Sergio L. DeLeon Justice of the Peace, Place 5 350 West Belknap, Suite 112 Fort Worth, Texas 76196-0247
Hon. Don Pierson, Judge County Court at Law No. 1 100 W. Weatherford St., Room 490 Fort Worth, Texas 76196-0240
1 TABLE OF CONTENTS
PARTIES AND COUNSEL ......................................................................................1
TABLE OF CONTENTS ...........................................................................................2
INDEX OF AUTHORITIES......................................................................................6
STATEMENT OF THE CASE ................................................................................13
FACTS .....................................................................................................................14
The “death benefit” and the suicide exclusion ..............................................14
The ADB and the additional exclusions ........................................................14
The death and the assignment ........................................................................15
Lincoln makes a claim ...................................................................................15
The three claims .............................................................................................16
Old American delays payment ......................................................................17
Lincoln sues and Old American pays ............................................................18
The litigation ..................................................................................................18
The judgment .................................................................................................19
SUMMARY OF THE ARGUMENT ......................................................................19
Merits .............................................................................................................20
Coverage ..............................................................................................20
Insurance Code ....................................................................................20
2 Bad faith ..............................................................................................21
Treble damages....................................................................................21
Prompt payment ..................................................................................21
Misrepresentation ................................................................................22
Declaratory Judgment..........................................................................22
Forfeiture .............................................................................................23
Preservation .........................................................................................23
Capacity” and “standing” ..............................................................................23
a. Old American’s complaints involve capacity, not standing. .......24
b. The claims were assigned, and they were assignable. .................24
c. Direct standing under the Insurance Code. ..................................25
ARGUMENT PART ONE: MERITS.....................................................................25
1. Old American was required to pay the $10,000 “death benefit” when it received proof that the insured had died, regardless of cause-of-death. ...............................................................................................25
2. Bad faith: Old American’s obligation to pay the $10,000 death benefit was “reasonably clear” when Lincoln first made its claim. .................................27
3. Prompt payment: Lincoln was entitled to recover 18% interest and attorney’s fees. ........................................................................................32
The statute. ..........................................................................................32
No “good faith” defense. .....................................................................33
Application. .........................................................................................34
4. Old American has waived any error as to the misrepresentation claims. .....34
3 The statute: ..........................................................................................35
Facts:....................................................................................................35
5. Old American also waived any error as to the award of attorney’s fees under the Declaratory Judgments Act. .............................38
6. Old American waived any defense under Section 1103.51 of the Insurance Code. ...................................................................................40
7. Lincoln is entitled to recover attorney’s fees. ...............................................43
8. Treble damages: Old American acted “knowingly.”...................................44
9. Old American failed to preserve error as to the calculation of interest, calculation of damages, or the award of treble damages. ................45
ARGUMENT PART TWO: STANDING .............................................................47
10. Old American waived any error as to the assignment of claims by failing to raise it in the trial court. ............................................................47
11. Alternatively, Lincoln has standing to assert its own claims for “bad faith” and misrepresentation under Section 541.151 of the Code. .............................................................................................................52
12. Lincoln has standing to assert a “prompt payment” claim under section 542.060 of the Code. ...............................................................58
13. Alternatively, the Insurance Code claims were assigned and they were assignable. .....................................................................................60
Were the claims assigned? ...........................................................60
Were the claims assignable?.........................................................60
14. Lincoln does not have standing as to the claim under Section 542.003 of the Code..........................................................................64
PRAYER ..................................................................................................................65
CERTIFICATE OF SERVICE ................................................................................66 4 CERTIFICATE OF COMPLIANCE .......................................................................66
5 INDEX OF AUTHORITIES
Cases Aleman v. Zenith Ins. Co., 343 S.W.3d 817 (Tex.App.--El Paso 2011, no pet.)......................................29
Allstate Ins. Co. v. Watson, 876 S.W.2d 145 (Tex.1994) ..........................................................................58
Amanda v. Ins. Co. of North Am., 748 S.W.2d 210 (Tex.1998) ..........................................................................29
American Southern Ins. Co. v. Buckley, 748 F.Supp.2d 610 (E.D.Tex.2010) ..............................................................64
Apex Fin. Corp. v. Garza, 155 S.W.3d 230 (Tex.App.--Dallas 2004, pet. denied) .................................40
Barshop v. Medina County Underground Water Conservation Dist., 925 S.W.2d 618 (Tex.1996) ..........................................................................40
Basic Energy Service, Inc. v. D-S-B Properties, Inc., 367 S.W.3d 254 (Tex.App.--Tyler 2011) ......................................................47
Berkley Regional Ins. Co. v. Philadelphia Indem. Ins. Co., No. A-10-CA-3662-SS, 2011 WL 9879170, 2011 U.S.Dist. LEXIS 155 (W.D.Tex. Apr. 27, 2011) .................................64
Brown & Brown of Texas, Inc. v. Omni Metals, Inc., 317 S.W.3d 361 (Tex.App.--Houston [1st Dist.] 2010, pet. denied) ............58
Cash Rent-a-Car, Inc. v. Old American County Mut. Fire Ins. Co., No. 01-09-00021-CV, 2010 WL 143482, 2010 Tex.App. LEXIS 250 (Tex.App.--Houston [1st Dist.] Jan. 4, 2010, no pet.) ...................................60
Casso v. Brand, 776 S.W.2d 551 (Tex.1989) ..........................................................................42
Cater v. United Servs. Auto. Ass’n, 27 S.W.3d 81 (Tex.App.--San Antonio 2000, pet. denied) ...........................35
6 Ceshker v. Bankers Commercial Life Ins. Co., 558 S.W.2d 102 (Tex.Civ.App.--Tyler 1977) ...............................................57
Ceshker v. Bankers Commercial Life Ins. Co., 568 S.W.2d 128 (Tex.1978) ..........................................................................57
Chapparal Operating Co. v. EnergyPro, Inc., No. 02-16-00471-CV, 2017 Tex. App. LEXIS 10091 (Tex.App.--Fort Worth, Oct. 26, 2017, pet. filed) .........................................39
Coastal Liquids Transp., L.P. v. Harris County Appraisal Dist., 46 S.W.3d 880 (Tex.2001) ............................................................................25
Conley v. Tex. Bd. of Crim. Justice, No. 03-08-00293-CV, 2010 WL 163292, 2010 Tex.App.LEXIS 3011 (Tex.App.--Austin Apr. 2, 2010, no pet.) ........39
Conn. State Dental v. Anthem Health Plans, 591 F.3d 1337 (11th Cir.2009) ......................................................................61
Countrywide Home Loans, Inc. v. Howard, 240 S.W.3d 1 (Tex.App.--Austin 2007, pet. denied) ....................................40
Cybiz, Inc. v. Gaskill, No. 14-16-00405-CV, 2017 WL 1015560, 2017 Tex.App. LEXIS 2147 (Tex.App.--Houston [14th Dist.] March 14, 2017, no pet.) .....47
DamilerChrysler Corp. v. Enron, 252 S.W.2d 299 (Tex.2008) ..........................................................................20
Dean Vivian Homes, Inc. v. Sabera’s Plumbing and Appliances, Inc., 615 S.W.2d 921 (Tex.Civ.App.--Waco 1981, no pet.)..................................41
Douglas-Peters v. Choe & Holen P.C., No. 05-15-01538-CV, 2017 WL 836848, 2017 Tex.App.LEXIS 1836 (Tex.App.--Dallas March 13, 2017, no pet.) ............... 48, 50, 52, 61, 62
Encompass Office Solutions, Inc. v. Ingenix, Inc., 775 F.Supp. 938 (E.D.Tex.2011)............................................................ 59, 61
First Nat. Life Ins. Co. v. Vititow, 323 S.W.2d 313 (Tex.Civ.App.--Texarkana 1959, writ dism’d) ..................35
7 Fitness Evolution, L.P. v. Headhunter Fitness, L.L.C., No. 05-13-00506-CV, 2015 WL 6750047, 2015 Tex.App. LEXIS (Tex.App.--Dallas Nov. 4, 2015, no pet.) .................................... 25, 48-53, 61
Gillespie v. Nat’l Collegiate Student Loan Trust 2005-3, No. 02-16-00124-CV, 2017 WL 2806780, 2017 Tex.App.LEXIS 5957 (Tex.App.--Fort Worth, June 29, 2017, no pet.)............................................24
Great Am. Ins. Co. v. Fed. Ins. Co., No. 3:04-CV-2267-H, 2006 WL 2263312, 2006 U.S.Dist. LEXIS 55038 (N.D.Tex. Aug. 8, 2006) ................................................................................64
Guinn Invs. v. Ridge Oil Co., 73 S.W.3d 523 (Tex.App.--Fort Worth 2002, pet. denied) ...........................40
Gumpp v. Philadelphia Life Ins. Co., 562 S.W.2d 885 (Tex.Civ.App.--San Antonio 1978, no writ) ......................35
Gusma Props., L.P. v. Travelers Lloyds Ins. Co., 514 S.W.3d 319 (Tex.App.--Houston [14th Dist.] 2016, no pet.).................34
Harris v. American Protection Ins., 158 S.W.3d 614 (Tex.App.--Fort Worth 2005, no pet.) ................................34
Hazlewood v. Werley, No. 07-12-00166-CV, 2014 WL 2810215, 2014 Tex.App. LEXIS 6698 (Tex.App.--Amarillo, June 18, 2014, pet. denied) ........................................41
Hermann Hosp. v. Nat. Standard Ins. Co., 776 S.W.2d 249 (Tex.App.--Houston [1st Dist.] 1989, writ denied) ...... 56-58
Higginbotham v. State Farm Mut. Auto Ins. Co., 103 F.3d 456 (5th Cir.1967) ..........................................................................35
Hixson v. Pride of Texas Dist. Co., Inc., 683 S.W.2d 173 (Tex.App.--Fort Worth 1985, no writ.) ..............................39
Hydroscience Technologies, Inc. v. Hydroscience, Inc., 401 S.W.3d 783 (Tex.App.--Dallas 2013, pet. denied) .................................20
Jarvis v. Rocanville Corp., 298 S.W.3d 305 (Tex. App.—Dallas 2009, pet. denied) ..............................39
8 John C. Flood of DC, Inc. v. SuperMedia, LLC, 408 S.W.3d 645 (Tex.App.--Dallas 2013, pet. denied) .......................... 51, 53
Key Life Ins. Co. v. Davis, 519 S.W.2d 403 (Tex.Civ.App.--Beaumont 1974, no writ) ..........................35
King-Mays v. Nationwide Mut. Ins. Co., 194 S.W.3d 143 (Tex.App.--Dallas 2006, pet. denied) .................................51
KLZ Diamond Tools, Inc. v. TKG Gen. Agency, Inc., 2016 Tex.App.LEXIS 7639 (Tex.App.--Dallas July 18, 2016, no pet.) .......66
Lamar Homes, Inc. v. Mid-Continent Cas. Co., 242 S.W.3d 1 (Tex.2007) ..............................................................................33
Launius v. Allstate Ins. Co., No. 03-06-CV-0579-B, 2007 WL 113547, 2007 U.S.Dist. 28286 (N.D.Tex. Apr. 17, 2007) ..........................................64
Lee v. Rogers Agency, 517 S.W.3d 137 (Tex.App.--Texarkana 2017, no pet.) .................................63
MBM Fin. Corp. v. Woodlands Operating Co., 292 S.W.3d 660 (Tex.2009) ................................................................... 39, 40
Montoya v. State Farm Mut. Auto Ins. Co., No. 16-00005 (RCL), 2016 WL 5942327, 2016 U.S.Dist. LEXIS 141 (W.D.Tex. Oct. 12, 2016) ..............................................................................64
Nootsie Ltd. v. Williamson Cty. Appraisal Dist., 925 S.W.2d 659 (Tex.1996) ..........................................................................53
PPG Industries, Inc. v. JMB/Houston Centers Partners, Ltd., 146 S.W.3d 79 (Tex.2004) ................................................................ 26, 62-64
Ramin’ Corp. v. Wills, No. 09-14-00168-CV, 2015 WL 612602, 2015 Tex.App. LEXIS 10612 (Tex.App.--Beaumont Oct. 15, 2015, no pet.)...............................................41
Republic Nat. Life Ins. Co. v. Spillars, 363 S.W.2d 373, 376 (Tex.Civ.App.--Waco 1962) ......................................59
9 Ressler v. Gen. Am. Life Ins. Co., 561 F.Supp.2d 691 (E.D.Tex. 2007) ....................................................... 29-31
Royal Globe Ins. Co. v. Bar Consultants, Inc., 566 S.W.2d 724 (Tex.Civ.App.--Austin 1978) ....................................... 56-58
Samedan Oil Corp. v. Intrastate Gas Gathering, Inc., 78 S.W.3d 428 (Tex.App.--Tyler 2001, pet. granted, judgm’t vacated w.r.m.) .................................................................................47
Scottsdale Ins. Co. v. Travis, 68 S.W.3d 72 (Tex.App.--Dallas 2001, pet. denied) .....................................40
Star-Telegram, Inc. v. Doe, 915 S.W.2d 471 (Tex.1995) ..........................................................................39
State and County Mut. Fire Ins. Co. v. Walker, 228 S.W.3d 404 (Tex.App.--Fort Worth 2007, no pet.) ................................45
State Farm Life Ins. Co. v. Martinez, 216 S.W.3d 799 (Tex.2007) ..........................................................................33
Sullivan, In re, 157 S.W.3d 911 (Tex.App.--Houston [14th Dist.] 2005, no pet.).................54
Tango Transport v. Healthcare Financial Services, LLC, 322 F.3d 888 (5th Cir.2003) ..........................................................................60
Texas Farmers Ins. Co. v. Gerdes, 880 S.W.2d 215 (Tex.App.--Fort Worth 1994, writ denied).........................50
Town Ctr. Mall v. Dyer, No. 02-14-00268-CV, 2015 Tex.App. LEXIS 10213 (Tex.App.--Fort Worth Oct. 1, 2015, pet. denied) ........................................53
U.S. Bank, N.A. v. Prestige Ford Garland, Ltd. Partnership, 170 S.W.3d 272 (Tex.App.--Dallas 2005, no pet.) .......................................42
Umar v. Scott, 991 S.W.2d 512 (Tex.App.--Fort Worth 1999, no pet.) ................................39
United States v. United Servs. Auto Ass’n, 431 F.2d 735 (5th Cir.1970), cert. denied, 400 U.S. 992 (1971) ..................59
10 Universe Life Ins. Co. v. Giles, 950 S.W.2d 48 (Tex.1997) ..................................................................... 28, 33
Vail v. Texas Farm Bureau Mut. Ins. Co., 754 S.W.2d 129 (Tex.1988) ..........................................................................57
Vandeveter v. All American Life & Cas. Co., 101 S.W.3d 763 (Tex.App[.--Fort Worth 2003, no pet.) ..............................29
Vertical N. Am., Inc. v. Vopak Terminal Deer Park, Inc., No. 14-15-01088-CV, 2017 Tex.App. LEXIS 8944 (Tex.App.--Houston [14th Dist.] Sept. 21, 2017, no pet.).............................51
Walker v. Federal Kemper Life Ins. Co., 828 S.W.2d 442 (Tex.App.--San Antonio, Jan. 29, 1992, writ denied) ........41
Watts v. Oliver, 396 S.W.3d 124 (Tex.App.--Houston [14th Dist.] 2013, no pet.).................47
Webb v. Int’l Trucking Co., 909 S.W.2d 220 (Tex.App.--San Antonio 1995, no writ) .............................58
Statutes 29 U.S.C. §1132(a)(1) ........................................................................................60
TEX.CIV.PRAC. & REM. CODE §37.009 ....................................................................40
TEX.INS. CODE §541.001 ........................................................................................58 §541.008 ........................................................................................58 §541.002(2) ........................................................................................55 §541.051(1)(A) ........................................................................................36 §541.052(a) ........................................................................................36 §541.052(b)(5) ........................................................................................36 §541.060(a)(1) ........................................................................................36 §541.060(a)(2)(A) ........................................................................................28 §541.061(1) ........................................................................................36 §541.152(a) ........................................................................................36 §541.152(a)(1) ........................................................................................45 §541.152(b) ................................................................................. 36, 45 §542.003(b)(1) ........................................................................................65 §542.005 ........................................................................................65 11 §542.006 ........................................................................................65 §542.010 ........................................................................................65 §542.012 ........................................................................................65 §542.051(2) ........................................................................................60 §542.054 ........................................................................................33 §542.055(a)(2) & (3) .....................................................................................34 §542.058(a) ........................................................................................34 §542.060 ................................................................................. 34, 59 §1103.151 ................................................................................. 41, 42 §3.62 (repealed) ........................................................................................59 art. 21.21 §16(a) (repealed) .................................................................... 55, 56
Acts 1951, 52nd Leg., ch. 491, amended by Acts 1957, 55th Leg., p.401, ch. 198 56
Acts 1969, 61st Leg., p.2051, ch. 706, §1 eff. June 12, 1989..................................56
Acts 1973, 63rd Leg., p.335, ch. 143, §§2(a)-2(c), eff. May 21, 1973....................56
Acts 1973, 63rd Leg., R.S., ch. 319 §1, 1973 TEX.GEN.LAWS 735.........................36
Acts 2003, 78th Leg., ch.1274 §2 (eff. April 11, 2005) ..........................................55
Rules
TEX.R.APP.P. Rule 33.1 ........................................................................................51 Rule 33.1(a)(1)(A) ........................................................................................47 Rule 33.1(b) ........................................................................................47
TEX.R.CIV.P. Rule 93(2) ........................................................................................51 Rule 329b(g) ........................................................................................47
12 STATEMENT OF THE CASE
This case arises from an eight month delay in paying life insurance
proceeds. The policy was issued by Old American Life Insurance Co., the
Appellant. When the insured died, the beneficiary assigned his claim for $4,725
in policy proceeds to the funeral home, which, in turn, assigned it to Lincoln
Factoring, LLC, the Appellee.
In October of 2014, Lincoln requested payment, but Old American
refused to pay until it had a “completed” death certificate showing cause-of-death.
However, under the policy, payment did not depend on cause-of-death. Five
months later, in March of 2015, Lincoln sued Old American in Justice Court.
Three months after that, in June of 2015, Old American said that it
had received a “completed death certificate” showing cause-of-death, and it paid
the $4,725 to Lincoln. Thus, Old American delayed payment for eight months.
Lincoln continued its suit. The Justice Court ruled for Old American,
and Lincoln took a de novo appeal. In the County Court at Law, Lincoln asserted
Insurance Code claims for failure to make “prompt payment,” for “bad faith,” and
for misrepresentation. Old American counterclaimed for declaratory judgment.
The court rendered summary judgment for Lincoln awarding multiple damages,
interest and attorney’s fees. Old American has appealed.
13 FACTS
The “death benefit” and the suicide exclusion
On August 13, 2011, Rebecca Barnes of Washington, D.C. applied for
a life insurance policy with Old American Ins. Co., of Kansas City.1 Old
American issued a policy two days later.2 It was a “whole life policy” in the
“Initial Face Amount” of $10,000. See Policy, p.3 § 4.4, p.7 §4.6 (250, 254).3
The “death benefit” was defined as the “face amount” of $10,000. Id.
According to the policy, this initial $10,000 “death benefit” was
payable “when we receive proof of the Insured’s covered death.” Id., p.7 §5
(emphasis added). There was one cause-of-death exclusion: suicide was
“excluded from coverage for two years after the effective date.” Id., p.8 §8.3 (255).
The ADB and the additional exclusions
The policy also provided for an “Accidental Death Benefit” (or
“ADB”) for an additional $10,000. See Benefit and Premium Schedule (251).
This ADB was payable “upon receiving proof that an insured’s death . . .
resulted directly and independently of all other causes from accidental bodily
1 See interview sheet (266). 2 See Ropp aff., p.1 (607); cover letter (242). 3 This citation is to the Clerk’s Record.
14 injury.” (257) (emphasis added). There was also a list of “Risks Not Covered,”
which excluded death from war, suicide, infection, disease, committing a felony,
drugs, flying, etc. (257). But these cause-of-death provisions applied only to the
$10,000 ADB. Id. They did not apply to the initial $10,000 “death benefit.” Id.
The death and the assignment
Rebecca Barnes, the insured, died in Washington, D.C. on September
28, 2014, three years after the policy was issued. The death certificate stated that
cause-of-death was “pending” (272). However, the funeral director signed an
affidavit stating that the “cause of death was natural or accidental” (466) (emphasis
added).
The beneficiary of the policy was named Frank Howard (323). As
fiancé of the deceased, he purchased the funeral for $4,725 (465). He paid for the
funeral by assigning $4,725 in policy proceeds to the funeral home, which in turn
assigned them to Lincoln Factoring, LLC, of Fort Worth, the Appellee (269-270).
Howard also assigned an additional $1,884.75 in policy proceeds to the cemetery,
which assigned them to American Capital Funding (352-353).
Lincoln makes a claim
On October 21, 2014 Lincoln Factoring delivered the assignments, a
claim form, the death certificate, a published announcement of death, the funeral
bill, and the funeral director’s affidavit to Old American and requested payment of
15 the $4,725. The death certificate was issued by the Department of Health of the
District of Columbia. It showed that Rebecca Barnes had died on September 28,
2014, and showed cause-of-death as “pending.” (463). American Capital Funding
also made a claim (636-638).
The three claims
At this point, there were three claims to the initial $10,000 “death
benefit.” See Ropp. aff., p.2 (324).4 Lincoln was claiming $4,725 and American
Funding was claiming $1,884.75. Id. (324, 352-353). These two claims totaled
$6,609.75. The third claimant was Frank Howard, the beneficiary, who was owed
the balance of the “death benefit” ($10,000.00 - $6,609.75 = $3,390.25). Also,
Howard had a claim to the entire $10,000 ADB (257).
Again, as to the initial $10,000 “death benefit,” there was only one
cause-of-death exclusion--suicide (255). But that exclusion had expired a year
before the death. The policy was issued on August 13, 2011; the suicide exclusion
expired two years later, on August 13, 2013; and Rebecca Barnes died a year after
that, on September 28, 2014. Accordingly, the initial $10,000 death benefit was
payable immediately, and Old American was required to distribute it as follows:
4 See also Defendant’s Resp. to Plaintiff’s Motion for Summary Judgment, p.2 ¶ 2 (595).
16 (i) $4,475 to Lincoln (ii) $1,884.75 to American Capital Funding and (iii)
$3,390.25 to Frank Howard, the beneficiary.
Matters were different as to the $10,000 ADB, which was owed solely
to Frank Howard, the beneficiary. Unlike the initial $10,000 “death benefit,”
payment of the ADB was subject to cause-of-death exclusions. See supra, p.14.
Therefore, under the policy, Old American had a right to delay payment of the
ADB until it received evidence of cause-of-death. But Old American had no right
to delay payment of the initial $10,000 “death benefit.” Even so, as we shall see,
Old American withheld both payments--the $10,000 “death benefit” and the
$10,000 ADB--until it finally received a “completed” death certificate showing
cause-of-death.
Old American delays payment
On October 23, 2014, Old American advised Lincoln that “we still
need a copy of the death certificate” (360). Specifically, it wanted “a complete
death certificate with cause and manner of death included.” Ropp aff., p.2 (608).
On December 18, 2014, Lincoln’s attorney wrote to Old American. He explained
that “[p]roof of the cause of death is not required to pay on the above policy.”
(362) (emphasis added). Old American ignored this obvious fact. Instead, on
December 30, 2014, it replied as follows:
Thank you for providing the death certificate for this claim. However, because the cause of death is listed as being “under 17 investigation,” we cannot conclude our claim investigation at this time. The policy has an Accidental Death Benefit rider and the cause of death is required information to determine if the ADB claim is payable. Further, the underlying claim may be affected if the cause of death is homicide or suicide.
Letter (648) (emphasis added).
The underlined language was simply wrong. The suicide exclusion
had expired, and while homicide was an excluded cause-of-death for the ADB, that
exclusion was not applicable to the initial $10,000 “death benefit.”
Lincoln sues and Old American pays
On March 16, 2015, five months after demand, Lincoln sued Old
American in Justice Court (6). On June 19, 2015, eight months after demand, Old
American emailed Lincoln that “We have the death certificate!” (374). The email
continued: “By the way--cause of death Hypertensive Cardiovascular Disease”
(374). On June 22, Old American delivered its check for $4,725 to Lincoln (375).
Old American also paid American Corporate Funding and Frank Howard.5
The litigation
The Justice Court heard the case on September 29, 2015, and it
rendered judgment that Lincoln take nothing (96). Lincoln appealed to the County
Court at Law (97). It alleged Insurance Code claims for failure to make “prompt
5 See Old American’s summary judgment response, p.4 (597).
18 payment,” for “bad faith,” and for misrepresentation (125-135, 137-140).6 Old
American counterclaimed for declaratory judgment and attorney’s fees (101).
The judgment
The parties filed cross-motions for summary judgment and responses
(179, 311, 377, 594).7 The County Court at Law granted Lincoln’s motion, denied
Old American’s motion, and awarded $9,450 in “treble damages,” $1,050 in
interest, and $12,000 in attorney’s fees. See Order (663). It also ordered “that
judgment be entered in favor of Lincoln Factoring, LLC for all its claims, and that
Defendant Old American Insurance Company take nothing by its claims.” Id. The
Order did not state the grounds upon which it was based. Id.
SUMMARY OF THE ARGUMENT
Old American’s issues fall into two groups: “standing” and “merits.”
“Standing” involves jurisdiction, and courts should decide jurisdictional issues
first.8 But Lincoln’s arguments involve “capacity,” rather than “standing.” And in
6 Lincoln alleged both common law and statutory bad faith. See Plaintiff’s Second Amended Petition, pp.6-7 ¶ 33 (126-127) & p.10-11 ¶ 38 (130-131). It also alleged DTPA violations. Id., p.16 ¶¶ 45-46 (136). 7 Lincoln sought summary judgment because Old American “violated the insurance code, breached the contract, and acted in bad faith” (180). It did not seek summary judgment under the DTPA (185-210). 8 See, e.g., Hydroscience Technologies, Inc. v. Hydroscience, Inc., 401 S.W.3d 783, 789 (Tex.App.--Dallas 2013, pet. denied) (“Standing must be resolved before the merits of an issue may be addressed.”) (citing DamilerChrysler Corp. v. Enron, 252 S.W.2d 299, 304 (Tex.2008)).
19 any event, Lincoln has standing directly under the Insurance Code. Both issue are
complicated. So, before venturing into the weeds, we want to show the Court
where we are going. Accordingly, we will argue “merits” first.
Merits
Coverage. As noted above, eight months elapsed from October
2014, when Old American received proof that Rebecca Barnes had died, until June
of 2015, when it paid Lincoln. During this entire period, Old American refused to
pay until it received proof of cause-of-death. But the initial $10,000 “death
benefit” was payable regardless of cause-of-death. All that was needed was proof
that Rebecca Barnes had died, and Old American received that when Lincoln first
submitted its claim. There was only one cause-of-death exclusion, to-wit: suicide.
But it had expired. See Argument, part 1, infra, p.25.
Insurance Code. An insurance policy is a contract, and once Old
American finally paid the $10,000 “death benefit,” Lincoln could not recover for
breach of contract. This is a perennial problem for insurance beneficiaries. The
insurer delays payment and then avoids liability for breach of contract by paying at
the last minute, just as in this case.
Fortunately, the Texas Insurance Code provides extra-contractual
remedies for delay in paying a claim. Specifically, a claimant can recover (i) 18%
interest and attorney’s fees under the “prompt payment” provisions of the Code
20 and (ii) damages and attorney’s fees under the “bad faith” provisions of the Code.
Also, under the Code, a claimant can recover damages and attorney’s fees for the
insurer’s misrepresentations. In this case, Lincoln can recover on all three claims.
Bad faith. The test for “bad faith” is whether the insurer’s liability
under the policy has become “reasonably clear.” In our case, Old American’s
liability was absolutely clear. The suicide exclusion had expired, and the initial
$10,000 “death benefit” was payable as soon as Old American received the claim.
Old American’s stated reason for delaying payment--that it needed evidence of
cause-of-death--was transparently false. Indeed, Old American has never said
why the initial $10,000 “death benefit” was not payable immediately.
Accordingly, Old American is liable under the “bad faith” provisions of the code
(and the common law). See Argument, part 2, infra, p.27.
Treble damages. It was Old American’s policy to delay payment
until it received a “completed” death certificate, even when payment did not
depend on cause-of-death. Lincoln’s attorney told Old American why payment
was due at once, but Old American ignored this explanation. Thus, it is
undisputed that Old American “knowingly” refused to pay, and is liable for treble
damages. See Argument, part 8, infra, p.44.
Prompt payment. Under the “prompt payment” provisions of the
Code, Old American had 60 days to pay the claim, and when it missed that
21 deadline, it became liable for 18% interest and attorney’s fees. Old American says
that there was a “good faith” disagreement over the interpretation of the policy.
But Old American has never offered any interpretation that would let it delay
payment, and in any event, “good faith” is not a defense to a “prompt payment”
claim. Once it was established that the death was covered, Old American
automatically became liable for 18% interest and attorney’s fees. See Argument,
part 3, infra, p.32.
Misrepresentation. There was evidence that, before accepting the
assignment, Lincoln asked for and received assurances from Old American that it
would pay the claim. But Old American did not address Lincoln’s
misrepresentation claim in its summary judgment response, and it has not
addressed them in this Court. Accordingly, Old American has waived any error as
to the misrepresentation claims, and the judgment must be affirmed without regard
to the merits. See Argument, part 4, infra, p.34.
Declaratory Judgment. Old American filed a counterclaim for
declaratory judgment. Under the Declaratory Judgments Act, attorney’s fees can
be awarded to either party, regardless of who prevails. Here again, Old American
has not assigned error and the attorney’s fees award must be affirmed without
reaching the merits. See Argument, part 5, infra, p.38.
22 Forfeiture: In this Court, for the first time, Old American is
invoking an Insurance Code provision allowing forfeiture of life insurance benefits
if the beneficiary intentionally caused the death of the insured. But Old American
did not raise this issue in the trial court, and it has been waived. See Argument,
part 6, infra, p.40.
Preservation: Finally, Old American complains about the
calculation of interest and damages and the trebling of damages. But these issues
were not raised in the trial court, and any error has been waived. See Argument,
part 9, infra, p.45.
“Capacity” and “standing”
Old American is challenging Lincoln’s “standing” to seek relief under
the Insurance Code. See Appellant’s Brief, p.13 (Issues 1-3) & pp.24-32
(Argument, parts 1-5). Of course, “standing is a component of subject matter
jurisdiction that may be raised for the first time on appeal.” 9 But Old American’s
arguments do not involve “standing.” They involve “capacity.”
Old American’s argument is based on Frank Howard’s assignment to
the funeral home. First, it says that, while Howard assigned his right to policy
proceeds, he did not also assign his Insurance Code claims. See Appellant’s brief,
9 Gillespie v. Nat’l Collegiate Student Loan Trust 2005-3, No. 02-16-00124-CV, 2017 WL 2806780, 2017 Tex.App.LEXIS 5957, at *3 n.12 (Tex.App.--Fort Worth, June 29, 2017, no pet.).
23 pp.26-27. Second, Old American says that, for public policy reasons, Howard
could not have assigned his Insurance Code claims. Id., pp.27-32. We have three
alternative responses.
a. Old American’s complaints involve capacity, not standing.
Lack of capacity is waived if it is not raised in the trial court.10 And the Fifth
Court has expressly held that (i) whether a claim has been assigned is a question of
capacity and (ii) whether a claim is assignable also involves a question of capacity.
See Fitness Evolution, L.P. v. Headhunter Fitness, L.L.C., No. 05-13-00506-CV,
2015 WL 6750047, 2015 Tex.App. LEXIS at *42-44 (Tex.App.--Dallas Nov. 4,
2015, no pet.). Because Old American did not raise either of these issues in the
trial court, they have been waived. See Argument, part 10, infra, p.47.
b. The claims were assigned, and they were assignable.
Absent contrary language, an assignment of policy benefits carries
with it an assignment of the Insurance Code claims. Accordingly, when Howard
assigned his policy benefits, he also assigned his Insurance Code claims.
As to assignability, all claims are assignable except for a few kinds of
claims which are non-assignable for public policy reasons. Old American’s
claims do not fall within that narrow group of exceptions. Old American relies on
10 Coastal Liquids Transp., L.P. v. Harris County Appraisal Dist., 46 S.W.3d 880, 884 (Tex.2001) (challenges to lack of capacity can be waived).
24 PPG Industries, Inc. v. JMB/Houston Centers Partners, Ltd., 146 S.W.3d 79
(Tex.2004), which prohibits assignment of DTPA claims to discourage “wealthy
entrepreneurs” from trading in high dollar DTPA claims. These concerns are not
applicable here. Lincoln (and other factoring companies) provide up-front money
so that bereaved persons can afford funerals for their loved ones. In return,
Lincoln receives assignments of policy benefits. Because this business meets an
important public need, acquisition of Insurance Code claims should be facilitated,
not discouraged. See Argument, part 13, infra, p.60.
c. Direct standing under the Insurance Code. In any event,
Lincoln has standing, in its own right, to assert its claims directly under the
Insurance Code. Under section 541.151 of the Code, “bad faith” and
misrepresentation claims may be brought by “[a] person who sustains actual
damages.” And under Section 542.060 “prompt payment” claims may be brought
by the assignee of policy benefits. See Argument, parts 11 & 12, infra, pp.52-58.
ARGUMENT PART ONE: MERITS
1. Old American was required to pay the $10,000 “death benefit” when it received proof that the insured had died, regardless of cause-of-death. As we have seen, Old American said (i) that it could not determine
whether Lincoln’s claim was payable without determining cause-of-death and (ii)
that it could not determine cause-of-death until it received the “completed death
25 certificate.” See supra, p.17.11 But again, the policy had two parts: the initial
$10,000 “death benefit” and the $10,000 ADB. We are only concerned with the
initial $10,000 “death benefit,” and under the policy, that was payable “when we
receive proof of the Insured’s covered death.” Policy, p.7 ¶ 5 (254) (emphasis
Payment of the initial $10,000 “death benefit,” was subject to only
one cause-of-death exclusion. Suicide was “excluded from coverage for two years
after the effective date.” See supra, p.14. But this exclusion had expired.12 From
that point on, death from any cause was a “covered death.”
Accordingly, in order to receive payment, Lincoln merely had to
present proof that the insured was, in fact, dead. And the death certificate
undeniably showed that the insured was dead (even though it did not show cause-
of-death). Still, Old American refused to pay until it received a “completed” death
certificate showing cause-of-death, even though payment of the initial $10,000
“death benefit” did not depend on cause-of-death. See supra, p.16. Using this
transparently false excuse, Old American delayed payment for eight months.
11 See Response to Request for Admission, p.3 ¶ 4 (admitting that the claim would be paid once Old American received a death certificate showing the cause and manner of death). (295). 12 Id., pp.2-3 ¶ 6 (295-296) & p.5 ¶ 17 (297) (admitting the insurance policy had been in force for over two years and that, if the cause of death had been suicide, the life insurance benefit would have had to be paid).
26 Lincoln’s claim was only for $4,725, and it could be satisfied from the
$10,000 “death benefit.” Again, Frank Howard, the beneficiary, was initially
entitled to receive the entire $10,000, but he assigned $4,725 to the funeral home
and $1,884.75 to the cemetery. Both claims could have been satisfied from the
initial $10,000 “death benefit” leaving the balance ($3,390.25) for Frank Howard.
See supra, p.16.
2. Bad faith: Old American’s obligation to pay the $10,000 death benefit was “reasonably clear” when Lincoln first made its claim. At common law, an insurer “violates its duty of good faith and fair
dealing by denying or delaying payment of a claim if the insurer knew or should
have known it was reasonably clear that the claim was covered.” Universe Life Ins.
Co. v. Giles, 950 S.W.2d 48, 49 (Tex.1997) (emphasis added). Similarly, under
the Insurance Code, it is an unfair practice to fail “to attempt in good faith to
effectuate a prompt, fair, and equitable settlement of . . . a claim with respect to
which the insurer’s liability has become reasonably clear.” TEX.INS.CODE
§541.060(a)(2)(A) (emphasis added).13
Old American correctly says that “the standard for statutory and
common law bad faith is the same.” Appellant’s brief, p.39.14 In both kinds of
13 See generally Giles, 950 S.W.2d at 55-56 (Tex.1997) (statutory history). 14 Id. at 55-56 (adopting common-law standard for statutory bad faith actions).
27 cases “an objective standard is utilized to determine whether a reasonable insurer
under similar circumstances would have delayed or denied payment of the claim.”
Id., p.40 (emphasis added).15 And because the standard is “objective” it can be
decided on summary judgment.
Again, it is undisputed that Old American was obligated to pay the
initial $10,000 “death benefit” when it received proof that the insured had died
regardless of cause-of-death. This occurred on October 1, 2014, when Lincoln
delivered the death certificate, the published announcement of death, the funeral
bill and the funeral director’s affidavit. See supra, p.16. At that point, Old
American’s “liability ha[d] become reasonably clear,” and its decision to delay
payment of the $10,000 “death benefit” for eight months is “bad faith” both at
common law and under the Insurance Code.
In Ressler v. Gen. Am. Life Ins. Co., 561 F.Supp.2d 691 (E.D.Tex.
2007), the insured initially purchased a $60,000 life insurance policy. Later the
coverage was increased to $100,000. Under the policy, the insurer could contest
the increased coverage amount ($40,000) if the application contained a
15 citing Amanda v. Ins. Co. of North Am., 748 S.W.2d 210, 213 (Tex.1998); Vandeveter v. All American Life & Cas. Co., 101 S.W.3d 763, 722 (Tex.App[.--Fort Worth 2003, no pet.). See also Appellant’s brief, p.38 (“Old American must be judged by an objective standard to determine whether a reasonable insurer under similar circumstances would have delayed payment of the claim.”) (citing Aleman v. Zenith Ins. Co., 343 S.W.3d 817, 822 (Tex.App.--El Paso 2011, no pet.)).
28 misrepresentation regarding the health of the insured. That provision would
expire after two years, and it did not apply to the original coverage ($60,000). Id. at
693. The insured died a year after the coverage increase, that is, within the two-
year contestability period. Id.
The insurance company paid the $60,000, but it delayed paying the
additional $40,000 because the death certificate showed that the insured had
suffered from “severe atherosclerotic disease,” a condition not shown on the
application for the $40,000 increase in coverage. Id. The insurer asked the widow
(who was also the beneficiary) to authorize release of medical information. She
refused and sued for bad faith. Id. After the insurer obtained medical records via
discovery, it determined that the insured had made no material misrepresent-ation,
and it paid the remaining $40,000. Id. Citing a number of Texas cases, the court
held that, as to the additional $40,000 coverage, liability had not been reasonably
clear, and for this reason, the insurer had not breached its duty of good faith and
fair dealing. Id. at 696.
If Lincoln had acted in good faith--like the insurer in Ressler--it
would have paid the initial $10,000 “death benefit” (including the $4,725 to
Lincoln) and delayed paying the additional $10,000 ADB until it received proof of
cause-of-death. But in our case, Old American delayed payment of both the ADB
and the “death benefit” until it received the “completed” death certificate showing
29 cause-of-death. This would be the same as if the insurer in Ressler had delayed
payment of both the $40,000 coverage increase and the $60,000 initial coverage
until questions regarding the alleged misrepresentation in the application were
resolved. Under those circumstances, that insurer would have been liable for “bad
faith” in delaying payment of the initial $60,000. Similarly, in our case, Old
American is liable for “bad faith” in delaying payment of the initial $10,000.
Old American cites the Ropp affidavit as evidence that its “claim
procedure . . . was consistent with the standards in the insurance industry.”
Appellant’s brief, pp.37-38 (citing Ropp affidavit). But Ropp did
not say that. Rather, he said that:
It is the standard in the insurance industry to require certain information and documentation regarding an insured’s death before paying a claim. Where the Policy does not mention claim forms, they are required in every claim. Additionally, a completed death certificate, while not specifically mentioned in the Policy is also required for all claims by Old American.
Ropp aff., p.3 (325). Thus, Ropp merely said that it is “standard in the insurance
industry” to require “certain information and documentation.” And in this case,
the only “information and documentation” needed to pay the initial $10,000 “death
benefit” was proof that the insured had died. It is undisputed that Old American
had this in October of 2014 when Lincoln first submitted its claim.
Ropp also said that it was Old American’s policy to require “a
completed death certificate . . . for all claims.” (emphasis added). While this
30 might have been Old American’s internal requirement, there is no evidence that it
is “the standard in the insurance industry” to require proof of cause-of-death when
payment does not depend on cause-of-death. On the contrary, this statement
shows that Old American acted “knowingly” thereby making it liable for treble
damages. See infra, p.44.
Old American also says that, “[w]hen the death certificate raises
questions which require further investigation, the insurer is entitled to delay
payment of the claim until a reasonable investigation is concluded.” Appellant’s
brief, p.38. But, in this case, the death certificate did not raise questions “which
require further investigation.” It showed that Rebecca Barnes had died, and that
was all that was needed to pay the initial $10,000 “death benefit.”
Further evidence of Old American’s “bad faith” is found in its
December 18, 2014 letter. We have already quoted the first paragraph of this
letter on page 17 and 18 above. That letter continued as follows:
Please provide a death certificate with the cause of death determined (or other documentation demonstrating the cause of death) as soon as that investigation is concluded. Once we have that information, we can complete our claim investigation.
Letter (648) (emphasis added). Also, Ropp swore that
Lincoln Factoring never provided, or attempted to provide, “other documentation demonstrating the cause of death.” There was no affidavit from a loved one stating the manner of death, no medical records, nothing ever indicating the manner or cause of death.”
31 Ropp aff., p.2 (608) (emphasis added).
This is yet another transparent falsehood. It is undisputed that, from
the outset, Old American had the funeral director’s affidavit, which stated that the
“cause of death was natural or accidental.” See supra, p.15.
3. Prompt payment: Lincoln was entitled to recover 18% interest and attorney’s fees. See Appellant’s brief, pp.35-36.
Because Old American finally paid the claim, it says that it is not
liable for breach of contract. Even so, under the “prompt payment” provisions of
the Insurance Code, it was still liable for 18% interest and attorney’s fees.
The statute. Prompt payment statutes have been around since
Reconstruction.16 The current version, applicable here, is found in Chapter 542,
Subchapter B, of the Insurance Code, entitled “Prompt Payment of Claims.”
Specifically, we are concerned with sections 542.055, 542.058 and 542.060.
These provisions must be liberally construed to promote “the prompt payment of
insurance claims.” Id. §542.054.
Under section 542.055, the insurer has 30 days after “receiv[ing]
notice of a claim” to “commence an investigation of the claim; and request from
the claimant all items, statements, and forms that insurer reasonably believes, at
16 See generally State Farm Life Ins. Co. v. Martinez, 216 S.W.3d 799, 803-804 & nn.14- 20 (Tex.2007); Lamar Homes, Inc. v. Mid-Continent Cas. Co., 242 S.W.3d 1, 24-25 & nn.1-7 (Tex.2007) (Brister, J., dissenting); Universe Life Ins. v. Giles, 950 S.W.2d 48, 55-56 (Tex.1997).
32 that time, will be required.” TEX.INS.CODE §542.055(a)(2) & (3). Then, once the
insurer “receiv[es] all items, statements, and forms reasonably required,” it has 60
days to pay the claim. Id. §542.058(a). If it fails to pay within 60 days, it “shall
pay damages and other items provided n Section 542.060.” Id. §542.058(a). And
under 542.060, an insurer who fails to comply “is liable to pay . . . interest on
the amount of the claim at the rate of 18 percent per annum as damages together
with reasonable attorney’s fees.” Id. §542.060.17
No “good faith” defense. Old American says that the parties
“merely had a good faith disagreement over the wording of the policy and the
importance of having a complete death certificate.” Appellant’s brief, p.37. It’s
difficult to take this assertion seriously since Old American has never offered a
reason as to why it needed a “complete death certificate.” But even if there had
been a “good faith disagreement,” Old American would still be liable because
“good faith” is not a defense to a claim under the “prompt payment” provision.
“An insurance company’s good faith assertion of defense does not
relieve the insurer of liability for penalties for tardy payment, as long as the insurer
is finally adjudged liable.” Higginbotham v. State Farm Mut. Auto Ins. Co., 103
17 See generally Gusma Props., L.P. v. Travelers Lloyds Ins. Co., 514 S.W.3d 319, 322- 323 (Tex.App.--Houston [14th Dist.] 2016, no pet.) (summarizing operation of statute); Harris v. American Protection Ins., 158 S.W.3d 614, 623 (Tex.App.--Fort Worth 2005, no pet.) (same). Cf. Appellant’s brief, p.35 (last paragraph).
33 F.3d 456, 461 (5th Cir.1967).18 Accord Cater v. United Servs. Auto. Ass’n, 27
S.W.3d 81, 84 (Tex.App.--San Antonio 2000, pet. denied) (“an insurance
company’s good faith defense do[es] not relieve the insurer from liability for
damages for late payment, as long as the insurer is finally found liable for the
claim.”).19 Thus, even if Old American had had a “reasonable basis” for
withholding payment, it would still be liable for interest and attorney’s fees under
the “prompt payment” provisions.
Application. Old American withheld payment for eight months, but
ultimately admitted that the $4,725 claim was owed. Therefore, under the
“prompt payment” provisions, Old American is liable for 18% interest on the
amount of the claim for those eight months, plus attorney’s fees.
4. Old American has waived any error as to the misrepresentation claims.
18 citing Key Life Ins. Co. v. Davis, 519 S.W.2d 403, 405 (Tex.Civ.App.--Beaumont 1974, no writ). 19 See also Gumpp v. Philadelphia Life Ins. Co., 562 S.W.2d 885, 888-889 (Tex.Civ.App. --San Antonio 1978, no writ) (“Where the 30-day demand has been made, the penalty is due if the Insurer is ultimately held liable on the policy no matter how justifiable was the basis for its unsuccessful defense of non-liability); First Nat. Life Ins. Co. v. Vititow, 323 S.W.2d 313, 316 (Tex.Civ.App.--Texarkana 1959, writ dism’d) (“[i]f a 30-day demand has been made, the penalty is collectible if the insurer is finally adjudged to be liable on the policy regardless of how justifiable its unsuccessful defense of unaliability may have appeared. The penalty flows from the failure to pay.”) (citations omitted).
34 The statute: Chapter 541, Subchapter B, of the Insurance Code is a
codification the Unfair Claims Settlement Practices Act.20 All together it consists
of eleven sections, each defining an unfair or deceptive act or practice. Under four
of these--Sections 541.051, 541.052, 541.060 and 541.061--it is an unfair practice
to misrepresent the terms or benefits of an insurance policy.21 The remedial
provisions for violation of Chapter 541, Subchapter B--which includes both “bad
faith” and misrepresentation--are found in Chapter 541, Subchapter D. A
violation of any of these sections entitles a plaintiff to the remedies available under
section 541.152, which include actual damages, attorney’s fees and costs.22 And if
the violation is “knowingly committed,” the damages can be trebled.23
Facts: As noted above, Lincoln submitted its claim to Old American
on October 21, 2014. See supra, p.15. Lincoln’s cover letter read as follows:
20 See Acts 1973, 63rd Leg., R.S., ch. 319 §1, 1973 TEX.GEN.LAWS 735 (codified at TEX.INS.CODE art. 21.21), repealed Acts 2003, 78th Leg., ch. 1274 (H.B. 2922), §26(a)(1) (eff. April 1, 2005). 21 See TEX.INS.CODE §541.051(1)(A)(It is an unfair practice to “make [a] state-ment misrepresenting . . . the terms of the policy.”); Id. §541.052(a)(It is an unfair practice to make “[a] statement containing an untrue, deceptive, or misleading . . . representations . . . regarding . . . the conduct of the person’s insurance business.”); Id. §541.060(a)(1)(It is an unfair settlement practice to “misrepresent[] to a claimant a material fact or policy provision relating to coverage at issue.”); Id. §541.061(1)(It is an unfair practice to “misrepresent an insurance policy by . . . making an untrue statement of material fact.”). See also id. §541.052(b)(5) (“This section applies to [a] statement made . . . in any manner.”). 22 Id. §541.152(a). 23 Id. §541.152(b).
35 Enclosed herewith is our assignment of the above-captioned policy duly executed by Frank Howard, the named beneficiary. Leah of your company verified the [following] information to us:
1. That the beneficiary entitled to the policy proceeds is the one named above;
2. That the policy was in full force and effect and had benefits equal to the amount of this assignment at the time of the insured’s demise;
3. That there were no liens or loans except for against the corpus of the insurance; and
4. That you would recognize the assignment to us and remit your check in the payment of the proceeds of our assignment to our office at
6145 WEDGEWOOD DRIVE FORT WORTH, TEXAS 76133
Predicated and relying on the above representations, we have for a valuable consideration accepted this assignment.
Letter (459).24 This letter, which was not objected to, or even controverted, is
evidence of an actionable misrepresentation under the code.
In its First Amended Petition, Lincoln made the following allegation:
Before accepting assignment of the policy proceeds and paying for the decedent’s funeral expenses, Plaintiff contacted Defendant to verify the legitimacy of the assignment of Frank Howard. Defendant through its representatives Leah on October 13, 2014 assured Plaintiff that Frank Howard was entitled to the proceeds of the policy, and Defendant agreed that it would recognize an assignment of $4,725 of the policy proceeds to Plaintiff and remit its check to Plaintiff for that
24 Emphasis added in the opening paragraph. Emphasis in original in closing paragraph.
36 amount. Relying upon the representations and promises of Defendant, Plaintiff paid Payne Funeral Support Services, LLC a check for the funeral services for the decedent.
First Amended Petition, p.2 ¶ 6 (27). Later, Lincoln alleged additional
misrepresentations.25 In the trial court, Lincoln sought summary judgment as to
all of these misrepresentation claims.26 But Old American simply ignored these
misrepresentation claims in its summary judgment response. And, as noted above,
the trial court granted Lincoln’s summary judgment motion as to all claims without
distinguishing or identifying any particular claim. See Judgment (663).
Now, in this Court, Old American has not assigned error to the
misrepresentation claims. Indeed, Sections 541.051, 541.052, 541.060, and
541.061 are not even cited. See Appellant’s Brief, pp.27-29.
“When, as here, a party moves for summary judgment on multiple
grounds and the trial court's summary-judgment order does not specify the ground
(or grounds) on which it is based, the appellant must negate all possible grounds on
which the order could be based.” Chapparal Operating Co. v. EnergyPro, Inc., No.
02-16-00471-CV, 2017 Tex. App. LEXIS 10091, at **2-3 (Tex.App.--Fort Worth,
25 See Plaintiff’s Second Amended Petition ¶¶ 34, 35, 36, 40 & Ex. A (127-129, 132, 143). See also Lincoln’s summary judgment response, p.3 (596). 26 See Lincoln’s summary judgment motion, pp. 15-19, 23-24 (193-198, 201-202).
37 Oct. 26, 2017, pet. filed).27 Similarly, on appeal, “[w]hen an appellant fails to
challenge every ground on which the summary judgment could have been based,
[the appellate court] must affirm, regardless of the unchallenged ground's merit.”
Id.28 Therefore, this Court must affirm the judgment without reaching the merits of
the misrepresentation theory.
5. Old American also waived any error as to the award of attorney’s fees under the Declaratory Judgments Act.
It is common practice for an insurer to sue under the Declaratory
Judgments Act to resolve coverage issues.29 And in our case Old American
counterclaimed for declaratory relief as follows:
Plaintiff knew that Defendant needed to have a completed death certificate and that Defendant cannot require the Tarrant County Medical Examiner’s Office (sic) to proceed more quickly in issuing one. Defendant seeks a declaratory judgment that it was only required to pay Plaintiff the proceeds on this event (sic) and that under Chapter 37 of the Texas Civil Practices and Remedies Code, Plaintiff be required to pay Defendant’s legal fees.
27 citing Star-Telegram, Inc. v. Doe, 915 S.W.2d 471, 473 (Tex.1995); Jarvis v. Rocanville Corp., 298 S.W.3d 305, 313 (Tex. App.—Dallas 2009, pet. denied). 28 Accord Hixson v. Pride of Texas Dist. Co., Inc., 683 S.W.2d 173, 176 (Tex.App.--Fort Worth 1985, no writ.) (“Where a judgment may rest upon more than one ground, the party aggrieved must assign error to each such ground, or he has waived his right to complain of the ruling to which no error was assigned.”). See also Umar v. Scott, 991 S.W.2d 512, 514 (Tex.App.--Fort Worth 1999, no pet.) (citing cases); Conley v. Tex. Bd. of Crim. Justice, No. 03- 08-00293-CV, 2010 WL 163292, 2010 Tex.App.LEXIS 3011, at **3-4 (Tex.App.--Austin Apr. 2, 2010, no pet.). 29 See generally MBM Fin. Corp. v. Woodlands Operating Co., 292 S.W.3d 660, 668 (Tex.2009) (noting that “historically, declarations of non-liability under a contract have been among the most common suits filed under the Act.”).
38 Counterclaim, p.2 ¶ 4 (101) (emphasis added).30 Lincoln answered that
counterclaim and pleaded for “reasonable attorneys’ fees and costs.” (107).
By seeking relief under the Declaratory Judgments Act, Old American
invited being held liable for Lincoln’s attorney’s fees under that Act, which
provides, in part, as follows:
In any proceeding under this chapter, the court may award costs and reasonable attorney’s fees as are equitable and just.
TEX.CIV.PRAC. & REM. CODE §37.009. Under this broad language, attorney’s fees
may be awarded to either party.31 Indeed, attorney’s fees may even “be awarded
to the non-prevailing party.” (emphasis added).32
The trial court awarded attorney’s fees to Lincoln without stating its
grounds (663), and that award can be upheld under the Declaratory Judgments Act.
Once again, Old American has waived any error as to the award of fees under the
30 citing Texas Uniform Declaratory Judgments Act, TEX.CIV.PRAC. & REM. CODE §37.001, et seq. 31 See MBM Fin. Corp., 292 S.W.3d at 669 (The Declaratory Judgments Act “allows fee awards to either party in all cases.”); Apex Fin. Corp. v. Garza, 155 S.W.3d 230, 238 (Tex.App.- -Dallas 2004, pet. denied) (“attorneys’ fees may be awarded to either party regardless of who prevails, as long as the award is equitable and just.”) (citing Barshop v. Medina County Underground Water Conservation Dist., 925 S.W.2d 618, 632 (Tex.1996)). 32 Accord Countrywide Home Loans, Inc. v. Howard, 240 S.W.3d 1, 7 (Tex.App.--Austin 2007, pet. denied) (“A court may even award costs and fees to a party who did not prevail.”) (citing Barshop v. Medina County Underground Water Conservation Dist., 925 S.W.2d 618, 637 (Tex.1996)); Guinn Invs. v. Ridge Oil Co., 73 S.W.3d 523, 527 n.1 (Tex.App.--Fort Worth 2002, pet. denied) (same); Scottsdale Ins. Co. v. Travis, 68 S.W.3d 72, 77 (Tex.App.--Dallas 2001, pet. denied) (“Under the Act, attorney’s fees may be awarded to the non-prevailing party.”).
39 Declaratory judgment Act by failing to make any complaint about that award in the
trial court or in this Court. Indeed, the words “declaratory judgment” do not
appear in Old American’s summary judgment response (594-606), or the
Appellant’s brief.
6. Old American waived any defense under Section 1103.51 of the Insurance Code. In its brief, for the first time, Old American says that “the manner of
death would determine whether there was a possibility of forfeiture of the death
benefit by the named beneficiary under Texas Insurance Code §1103.151.”
Appellant’s Brief, p.37. That provision reads as follows:
A beneficiary of a life insurance policy or contract forfeits the beneficiary’s interest in the policy or contract if the beneficiary is a principal or an accomplice in willfully bringing about the death of the insured.
TEX.INS.CODE §1103.151 (emphasis added). There are three flaws in this
argument.
First, section 1103.151, which provides for “forfeiture,” is an
affirmative defense which must be pleaded,33 and Old American did not plead this
33 See Hazlewood v. Werley, No. 07-12-00166-CV, 2014 WL 2810215, 2014 Tex.App. LEXIS 6698, at *10 (Tex.App.--Amarillo, June 18, 2014, pet. denied) (“Fee Forfeiture as an Affirmative Defense”); Walker v. Federal Kemper Life Ins. Co., 828 S.W.2d 442, 449 (Tex.App. --San Antonio, Jan. 29, 1992, writ denied) (treating policy provision providing for forfeiture for non-payment of premiums as an affirmative defense); Dean Vivian Homes, Inc. v. Sabera’s Plumbing and Appliances, Inc., 615 S.W.2d 921, 927 (Tex.Civ.App.--Waco 1981, no pet.) (holding that statute providing for forfeiture for charging of usurious interest was an affirmative defense); Ramin’ Corp. v. Wills, No. 09-14-00168-CV, 2015 WL 612602, 2015 Tex.App. LEXIS 10612, at *23 (Tex.App.--Beaumont Oct. 15, 2015, no pet.) (“A party may seek forfeiture as a 40 defense (93) 34 or raise it in its summary judgment response (594-606). In an
appeal from a summary judgment ruling, a court may consider “only the theories
that were presented in writing and considered by the trial court.” U.S. Bank, N.A. v.
Prestige Ford Garland, Ltd. Partnership, 170 S.W.3d 272, 275 (Tex.App.--Dallas
2005, no pet.) (citing Casso v. Brand, 776 S.W.2d 551, 553 (Tex.1989)). For that
reason, this defense has been waived.
Second, Old American never had any reason to believe that the
beneficiary had been a “principal or an accomplice in willfully bringing about the
death of [Rebecca Barnes].” 35 Indeed, when it first made a claim, Lincoln
provided an affidavit from the funeral director saying that the “primary cause of
death was natural or accidental” (466) (emphasis added).
Third, Old American admitted that it never called the District of
Columbia police to determine if Frank Howard was under suspicion of causing the
death, and it never had any evidence that he was suspected of causing the death.36
On deposition Richard Ropp, who was in charge of Old American’s claims,
testified as to “whether or not the beneficiary was under suspicion of causing the
remedy for breach of a fiduciary duty, provided the party includes a request for forfeiture in its pleadings.”). 34 Old American did not file an answer in the County Court at Law. 35 TEX.INS.CODE §1103.151. 36 Response to Request for Admissions, p.3 ¶¶ 4-5 (302).
41 death of Rebecca Barnes.” Ropp depo. 43/5-15 (412). As to a December 30 email
from Robin Hall, Id. 36/22 (412), Ropp testified as follows:
Q. [By Mr. Engfer] Okay. Can you read it, the part that says what you’re referring to?
A. (Reading) In an attempt to try to get this resolved I made some phone calls. I tried to locate a number for the beneficiary with no luck. I called the funeral home. I called the coroner’s office and was told that the investigation was still pending. I also called American Capital Funding. They called the cemetery, the cemetery called the coroner’s office. The coroner told them to check back in the middle of January. I’ve seen letters to both the finance companies. At this point it is a waiting game.
Q. Okay. But that doesn’t say anything about whether or not the beneficiary is under suspicion of causing the death of Rebecca Barnes, correct?
A. Correct.
Q. So there was, as far as you can tell, no investigation of whether or not the beneficiary is under suspicion of causing the death when you read those--this e-mail, correct?
A. That e-mail may have indicated that we tried.
Q. Well, where in the e-mail does it say that they inquired on whether the beneficiary was under suspicion of Rebecca Barnes’ death?
A. It doesn’t.
Q. Okay, so as of March 31, 2015 [Old American] had not investigated whether or not the beneficiary is under the suspicion of causing the death of Rebecca Barnes, correct?
42 A. Under--further, on the exhibit, on Page 029, the e-mail between counsel Langland and Robin Hall--
Q. Okay. Can you read the specific part that says there was an investigation by Old American into whether or not the beneficiary is under suspicion of causing the death of Rebecca Barnes? Specifically read that.
A. It doesn’t specifically say that.
Q. It doesn’t say that. It doesn’t say that anywhere on this--on 029; isn’t that correct?
Id. 36/22--38/9 (emphasis added) (412-413).
7. Lincoln is entitled to recover attorney’s fees. See Appellant’s brief, p.43.
Old American’s challenge to the attorney’s fees award is quite
narrow. It says that “Lincoln is not a prevailing party in this litigation” and cannot
recover its attorney’s fees. Appellant’s brief, p.43. But as we have demonstrated,
Lincoln was the prevailing party, and it was entitled to recover attorney’s fees
under the Insurance Code and under the Declaratory Judgments Act.
Aside from arguing that it should be the prevailing party, Old
American has made no complaint about the attorney’s fees award. Lincoln
supported its claim for attorney’s fees with an attorney’s affidavit (306). Old
American did not object to that affidavit or present any evidence to create a fact
issue. Old American does not contend that the attorney’s fees were not
43 “reasonable and necessary” or that they were not “equitable and just.” 37 Nor does
it contend that the evidence of attorney’s fees was not properly segregated.
Indeed, its summary judgment response does not even mention attorney’s fees.
Thus, the attorney’s fees award must be upheld if the court affirms any part of our
Insurance Code claim. Indeed, under the Declaratory Judgments Act, it must be
affirmed even if the court reverses as to all of our claims, since the trial court can
award fees even to the non-prevailing party. See supra, p.38.
8. Treble damages: Old American acted “knowingly.” As previously noted, our statutory bad faith claim is based on Section
541.060 of the Insurance Code. That provision is entitled “Unfair Settlement
Practices,” and it is found in Chapter 541, Subchapter B of the Code. The
remedial provisions are found in Chapter 541, Subchapter D. Under these
provisions “[a] plaintiff who prevails in an action under this subchapter may
obtain: . . . actual damages, plus court costs and reasonable and necessary
attorney’s fees.” TEX.INS.CODE §541.152(a)(1). And if the defendant “knowingly
committed the act complained of,” a court “may award” up to “three times the
amount of actual damages.” Id. §541.152(b).
37 See generally State and County Mut. Fire Ins. Co. v. Walker, 228 S.W.3d 404, 407 (Tex.App.--Fort Worth 2007, no pet.) (“Whether the fees are reasonable and necessary are questions of fact; whether awarding the fees and costs is equitable and just is a question of law.”).
44 As we have seen, the test for “bad faith” is whether the insurer “knew
or should have known” that liability was “reasonably clear.” See supra, n.16. The
test for treble damages is whether the insurer “knew.” Here it is undisputed that
Old American “knew” that the initial $10,000 was payable immediately. Early on,
Lincoln’s lawyer explained why payment of the claim did not depend on cause-of-
death. Even so, Old American expressly refused to pay the claim until it received
evidence of cause-of-death. Indeed, as we have seen, it was Old American’s
policy to require a “completed” death certificate for “all claims,” even in cases
such as our where payment did not depend on cause-of-death. See supra, p.30.
Also, in the trial court, Old American did not even complain about the trebling of
damages, as we shall now demonstrate.
9. Old American failed to preserve error as to calculating damages and as to awarding treble damages. See Appellant’s brief, pp.41-42, 43-45.
As to the award of actual damages, Old American says that it should
receive credit for the $4,725 paid after suit was filed. See Appellant’s brief, p.41-
42. And, as we have seen, it is also complaining about the award of treble
damages. Id., p.42. Finally, it says that the trial court erred in calculating interest
under the prompt payment provisions. Id., pp.43-45.
Old American did not preserve error as to any of this. Its summary
judgment response is completely silent on these issues (594-604). The actions that
Old American is now complaining about were set forth in the judgment (663).
45 That was where the trial court awarded “treble damages” in the amount of $9,450.
This appears to result from the following calculations:
$4,725 x 3 = $14,175 $14,175 - $4,725 = $9,450
It was also there, in the judgment, that the trial court awarded the $1,050 in interest
that Old American now says was excessive.
To preserve error, Old American should have made these complaints
to the trial court. See Rule 33.1(a)(1)(A), TEX.R.APP.P. Old American could have
done this by moving to modify the judgment under Rule 329b(g), TEX.R.CIV.P.38
Old American did not do this. Nor did it make any other complaint about these
rulings. Accordingly, it has waived any error in the calculation of interest,39 the
award of treble damages,40 and the calculation of damages.41
38 See Rule 33.1(b), TEX.R.APP.P. 39 See Watts v. Oliver, 396 S.W.3d 124, 133-134 (Tex.App.--Houston [14th Dist.] 2013, no pet.) (holding that complaint about calculation of interest may not be raised for the first time on appeal). Cybiz, Inc. v. Gaskill, No. 14-16-00405-CV, 2017 WL 1015560, 2017 Tex.App. LEXIS 2147, at *12 (Tex.App.--Houston [14th Dist.] March 14, 2017, no pet.). 40 See Samedan Oil Corp. v. Intrastate Gas Gathering, Inc., 78 S.W.3d 428, 457-458 (Tex.App.--Tyler 2001, pet. granted, judgm’t vacated w.r.m.) (punitive damages). 41 See Basic Energy Service, Inc. v. D-S-B Properties, Inc., 367 S.W.3d 254, 262-264 (Tex.App.--Tyler 2011) (withdrawn pursuant to settlement).
46 ARGUMENT PART TWO: STANDING
10. Old American waived any error as to the assignment of claims by failing to raise it in the trial court. See Appellant’s brief, pp.26-29.
Old American’s “standing” arguments concern Frank Howard’s
assignment to the funeral home. See supra, p.15. First, Old American says that
Howard only assigned his right to the policy proceeds; he did not also assign his
Insurance Code claims.42 Second, Old American says that, for public policy
reasons, Howard could not assign his Insurance Code claims.43
Both issues--whether the claim was assigned and whether it was
assignable--are questions of capacity, not standing. Unlike lack of standing, lack
of capacity is waived if it is not raised in the trial court. And since Old American
did not raise either issue in the trial court, they have been waived. Two recent
cases from the Fifth Court of Appeals are directly in point. See Fitness Evolution,
L.P. v. Headhunter Fitness, LLC, No. 05-13-00506-CV, 2015 Tex.App.LEXIS
11496 (Tex.App.--Dallas Nov. 4, 2015, no pet.), and Douglas-Peters v. Choe &
Holen P.C., No. 05-15-01538-CV, 2017 WL 836848, 2017 Tex.App.LEXIS 1836,
at *23 (Tex.App.--Dallas March 13, 2017, no pet.).
42 See Appellant’s brief, p.27 (“Frank Howard clearly reserved his right . . . to pursue any statutory claims he might have under the Texas Insurance Code.”). 43 Id., p.28 (arguing that any “such assignment would be invalid as a matter of law.”).
47 In the first case, Fitness Evolution leased space in a shopping center
from Gleneagles; and Joseph Mulroy guaranteed the lease. See Fitness Evolution,
2015 Tex.App.LEXIS 11496, at *8. Fitness Evolution assigned the lease to
Headhunter Fitness, which could not pay the rent. Id. at *9-*10. In 2007, Fitness
Evolution sued Headhunter Fitness, and Headhunter Fitness filed a third-party
action against Mulroy. Id. at *10.
While that suit was in progress, Headhunter Fitness negotiated with
Sagebrush Partners to lease space in a different shopping center. Id. at *11-*12.
Headhunter Fitness asked Gleneagles to release it from the original lease, but
Gleneagles refused. Id. at *13-*14. At that point, the suit settled. Id. at *16-*17.
In 2011, Mulroy and Fitness Evolution filed a new suit against
Headhunter Fitness and Sagebrush. Id. at *19-*22. Mulroy, as assignee of
Gleneagles, claimed that Sagebrush had tortiously interfered with the original lease
(between Gleneagles and Fitness Evolution). Id. at *21 & *22 n.13. The trial
court granted summary judgment denying that tortious interference claim. Id. at
*34. Mulroy appealed.
On appeal, Sagebrush argued that Mulroy could not recover as the
assignee of Gleneagles. Id. at *52-*53. In so doing, Sagebrush addressed the
same two issues that we are concerned with in our case. First, Sagebrush argued
that Gleneagles had “not specifically assign[ed]” the tortious interference claim to
48 Mulroy. Id. at *53.44 Second, Sagebrush argued that purported assignment of the
tortious interference claim “is void because it goes against public policy.” Id. at
*55.45 The court of appeals rejected both arguments for the same reason: they
involved question of capacity, not standing; and Sagebrush had not raised these
issues in the trial court. Id. at *54-*56. Therefore, they had been waived.
As to the first issue--“the scope of Gleneagles’s assignment to
Mulroy”--the court noted that, while “Sagebrush . . . referred to this as an issue
of ‘standing,’ it is actually a challenge to whether Mulroy, as assignee of
Gleneagles’s claims, can recover in the capacity in which he sued.” Id. at *57
(emphasis added).
Texas law is clear that a challenge to a party’s privity of contract is a challenge to capacity, not standing. . . . While the question of whether a party is entitled to sue on a contract is often informally referred to as a question of ‘standing’ it is not truly a standing issue because it does not affect jurisdiction.” . . .
Fitness Evolution, 2015 Tex.App.LEXIS 11496, at *42 (citations omitted). 46 But
44 See also, Fitness Evolution, 2015 Tex.App. LEXIS 11496, at 56 (arguing that the purported assignment “does not specifically assign a tortious interference with an existing contract claim.”). 45 Sagebrush argued that “public policy prohibits Mulroy, as assignee of Gleneagles’s claims, from recovering on the assigned causes of action because Gleneagles’s tortious interference with an existing contract claims were not capable of assignment due to the fact that Mulroy, individually, was also the guarantor of the lease.” Fitness Evolution, 2015 Tex.App. LEXIS 11496, at *55 (citing Texas Farmers Ins. Co. v. Gerdes, 880 S.W.2d 215, 218 (Tex.App.- -Fort Worth 1994, writ denied). 46 Accord Douglas Peters, 2017 Tex.App.LEXIS 1836 at 21-22. See also Vertical N. Am., Inc. v. Vopak Terminal Deer Park, Inc., No. 14-15-01088-CV, 2017 Tex.App. LEXIS 8944 49 Sagebrush had
not file[d] a verified pleading challenging the capacity of Mulroy, as assignee of Gleneagles’s claim, to sue on this basis, nor do they brief this lack of capacity on appeal. This issue was not preserved in the trial court. Accordingly, we do not address the merits of this argument . . .
Id. at *56-*57.47 On this point the Court cited its earlier opinion in John C. Flood
of DC, Inc. v. SuperMedia, LLC, 408 S.W.3d 645, 650-652(Tex.App.--Dallas
2013, pet. denied).48
Similarly, as to the second issue, Sagebrush contended “that the
assignment of Gleneagles’s claims is void because it goes against public policy.”
Id. at *54-*55. But here again, the court held that “[t]his argument challenges the
qualifications of Mulroy, as assignee of Gleneagles’s claim, to litigate
Gleneagles’s claim.” Id. at *55.
Although the Sagebrush Group referred to this as an issue of “standing” it is actually a challenge to whether Mulroy, as assignee of Gleneagles’s claim, can recover in the capacity in which he sued.
Id. at 53 (emphasis added).49 Once again, however,
[t]his issue was not preserved in the trial court. Accordingly, we do
at *3 (Tex.App.--Houston [14th Dist.] Sept. 21, 2017, no pet.) (“A challenge to who owns a claim raises the issue of capacity, not standing.”). 47 citing Rule 33.1, TEX.R.APP.P. See also Rule 93(2), TEX.R.CIV.P. (requiring verified plea of lack of capacity). 48 See also King-Mays v. Nationwide Mut. Ins. Co., 194 S.W.3d 143, 145 (Tex.App.-- Dallas 2006, pet. denied) (applying same reasoning to claim of subrogation). 49 citing John C. Flood, 408 S.W.3d at 640.
50 not reach the merits of this argument that the Sagebrush Group labels as “standing.”
Id. at 56.
In Douglas-Peters, a law firm owned a claim against a former client
for unpaid attorney’s fees. 2017 Tex.App. LEXIS 1836, at *5-*6. It assigned the
claim to a new law firm; and the new firm sued the former client for the unpaid
fee. Id. at *6-*7. The former client contended that the assignment
is void because it is against public policy. She argues that the assignment of claims by attorneys against their clients are a “legal corollary” to the assignment of legal malpractice claims, which is against public policy.”
Id. at *27. Here again, the court held that this question--whether assignment of
claims for unpaid attorney’s fees violates public policy--involved a question of
capacity, not standing. Id. at **21-22 (citing cases).
Unlike Fitness Evolution, the court in Douglas-Peters held that the
issue of capacity had been preserved. Therefore, the court could “address
Douglas-Peters’ capacity arguments.” Id. at *25. Even so, the former client had
not adequately briefed the public policy issue, and for this reason, the court
declined the “invitation to invalidate the assignment of claims for attorneys’ fees
on the basis of public policy.” Id. at *28.
In our case, Old American is making these same arguments. It says
(i) that Frank Howard never assigned his Insurance Code claim and (ii) that his
Insurance Code claim could not be assigned on public policy grounds. But, as in 51 Fitness Evolution, these issues were never raised in the trial court.
Old American never filed a verified pleading under Rule 93(2).50
Nor did it raise this issue in its summary judgment response (594-606).51 Old
American did not raise the “capacity” issue--which it erroneously calls a
“standing” issue--until it filed its brief in this Court, and for that reason, both
arguments--whether the claim was assigned and whether it was assignable--have
been waived. See Nootsie Ltd. v. Williamson Cty. Appraisal Dist., 925 S.W.2d
659, 662 (Tex.1996) (holding that “Nootsie first questioned the district’s capacity
in its briefing before this Court. Therefore, Nootsie has waived its complaint
about capacity.”).52
11. Alternatively, Lincoln has standing to assert its own claims for “bad faith” and misrepresentation under Section 541.151 of the Code.
According to Old American, Lincoln is contending (i) that Frank
Howard, the beneficiary, assigned his Insurance Code claims to Lincoln and (ii)
that Lincoln is asserting the assigned claims. And because those claims have not
been assigned (and because they are not assignable), Lincoln has no standing, or so
50 See Defendant’s Original Answer (93). Old American never filed an answer in the County Court at Law. See docket sheet (665). 51 Cf. John C. Flood, 408 S.W.3d at 655 (“The problem with appellant’s argument is that their response to appellee’s summary judgment motions did not raise the issue of SuperMedia’s lack of capacity to bring suit.”). 52 Accord Town Ctr. Mall v. Dyer, No. 02-14-00268-CV, 2015 Tex.App. LEXIS 10213, at **7-8 (Tex.App.--Fort Worth Oct. 1, 2015, pet. denied).
52 the argument goes. See Appellant’s brief, pp.26-27. We have just demonstrated
that both arguments involve lack of capacity, not lack of standing, and they have
been waived. See supra, p.47. Now, in the alternative, we say that Lincoln has
standing to assert its own claims directly under the Code. In other words, standing
is conferred by statute. 53
In this part of the argument, we will address Section 541.151 of the
Insurance Code, which gives Lincoln standing to sue for “bad faith” and
misrepresentation. And in part 12, we will address section 542.060, which gives
Lincoln standing to sue for failure to make “prompt payment.”
As previously noted, the Code provisions prohibiting “bad faith” and
misrepresentation are found in Chapter 541, Subchapter B, of the Code. The
remedial provisions are found in Chapter 541, Subchapter D, entitled “Private
Action for Damages.” Section 541.151, entitled “Private Action for Damages
Authorized,” reads as follows:
A person who sustains actual damages may bring an action against another person for those damages caused by the other person engaging in an act or practice:
(1) defined by [Chapter 541] Subchapter B [of the Insurance
53 See generally In re Sullivan, 157 S.W.3d 911, 915 (Tex.App.--Houston [14th Dist.] 2005, no pet.) (holding that “the judge-made criteria regarding standing do not apply when the Texas Legislature has conferred standing through a statute. In statutory standing cases, such as this, the analysis is a straight statutory construction of the relevant statute to determine upon whom the Texas Legislature has conferred standing and whether the claimant in question falls in that category.”) (internal citations omitted).
53 Code] to be an unfair method of competition or an unfair or deceptive act or practice in the business of insurance; or
(2) specifically enumerated in Section 17.46(b), Business & Commerce Code, as an unlawful deceptive trade practice if the person bringing the action shows that the person relief on the act or practice to other person’s detriment.
TEX.INS. CODE §541.151 (emphasis added). 54 Here we are concerned with sub-
paragraph (1), which provides a remedy for Lincoln’s “bad faith” and
misrepresentation claims.55
To recover for an unfair practice, as defined by Chapter 541,
Subchapter B, of the Code (which includes “bad faith” and misrepresentation), one
must qualify as “a person” under the following statutory definition:
“Person” means an individual, corporation, association, partnership, reciprocal or interinsurance exchange, Lloyd’s plan, fraternal benefits society, or other legal entity engaged in the business of insurance, including an agent, broker, adjuster, or life and health insurance counselor.
TEX.INS.CODE §541.002(2) (emphasis added).
The phrase “engaged in the business of insurance” does not restrict
the definition of “person.” Rather, it expands that definition to include those
54 See Acts 2003, 78th Leg., ch.1274 §2 (eff. April 11, 2005) (repealing TEX.INS.CODE art. 21.21 §16(a)). 55 Again, Lincoln did not seek summary judgment under the DTPA, which is the subject of sub-paragraph (2). See supra, p.10 n.7.
54 “engaged in the business of insurance.” This issue was decided in 1978, when the
statute read as follows:
Any person who has been injured by another’s engaging in any of the practices declared in Section 4 of this Article or in rules or regulations lawfully adopted by the Board [of Insurance] under this Article to be unfair methods of competition and unfair and deceptive acts or practices in the business of insurance or in any practice defined by Section 17.46 of the Business and Commerce Code, as amended, as an unlawful deceptive trade practice may maintain an action against a company or companies engaging in such act or practices.
TEX.INS.CODE art. 21.21 §16(a).56 Under that version of the statute, “person” was
also defined as follows:
“Person” shall mean any individual, corporation, association, partnership, . . . and any other legal entity engaged in the business of insurance . . .
Id. §2(a) (emphasis added).57
Initially, the lower courts held that the phrase “engage in the business
of insurance” limited the scope of “persons” who could sue. For example, one
court held that:
Art. 21.21 does not confer a private cause of action upon individuals for alleged unfair practices. One must be “engaged in the business of insurance” to bring suit under art. 21.21, TEX.INS.CODE.
56 See Acts 1951, 52nd Leg., ch. 491, amended by Acts 1957, 55th Leg., p.401, ch. 198; Acts 1969, 61st Leg., p.2051, ch. 706, §1 eff. June 12, 1989; Acts 1973, 63rd Leg., p.335, ch. 143, §§2(a)-2(c), eff. May 21, 1973 (quoted at Hermann Hosp., 776 S.W.2d at 251). 57 quoted at Royal Globe, 566 S.W.2d at 726.
55 Ceshker v. Bankers Commercial Life Ins. Co., 558 S.W.2d 102, 104 (Tex.Civ.App.
--Tyler 1977) (emphasis added).58 But the Supreme Court disagreed:
We disapprove the [above] holding which construed the Code to limit the term “person” to one who is engaged in the business of insurance.
Ceshker v. Bankers Commercial Life Ins. Co., 568 S.W.2d 128, 129 (Tex.1978).
Accord Royal Globe Ins. Co. v. Bar Consultants, Inc., 566 S.W.2d 724, 726
(Tex.Civ.App.--Austin 1978) (“The Texas Supreme Court in a recent per curiam
opinion disapproved a court of civil appeals’ restrictive reading of the definition of
‘person’ as used in Section 16 of Article 21.21 of the Insurance Code”), aff’d, 577
S.W.2d 688 (Tex.1979); Hermann Hosp. v. Nat. Standard Ins. Co., 776 S.W.2d
249, 251 (Tex.App.--Houston [1st Dist.] 1989, writ denied) (“The Texas Supreme
Court, in 1978, held that this statute does not require that the injured party be a
person who is engaged in the business of insurance.”).
By way of example, an insured party is obviously not “engaged in the
business of insurance.” Even so, in 1988, the Supreme Court held that an insured
party was also a “person” who could sue under article 21.21 §16(a). See Vail v.
Texas Farm Bureau Mut. Ins. Co., 754 S.W.2d 129, 134 (Tex.1988). This issue
has now been decided. Any person or entity has standing to sue for an unfair
practice defined by Chapter 541, Subchapter B, which includes “bad faith” and
58 writ ref’d, n.r.e., 568 S.W.2d 128 (Tex.1978).
56 “misrepresentation.” 59
Despite this broad statutory language, the Supreme Court has limited
the definition of “person” in one kind of case, to-wit: “bad faith” claims brought
by a “third party.” In Allstate Ins. Co. v. Watson, 876 S.W.2d 145 (Tex.
1994), the Court held that a car wreck plaintiff could not sue the defendant’s
liability carrier under article 21.21 §16(a) because the plaintiff was asserting a
“third-party” claim. Watson, 876 S.W.2d at 149-150. There were practical reasons
for this decision. To allow a third-party plaintiff to sue under article 21.21 would
place conflicting duties on the insurer. The insurer would owe one set of duties to
its insured and another set of duties to the third party. Watson, 876 S.W.2d at 150.
Accordingly, a “third-party” claimant asserting a “bad faith” claim did not qualify
as a “person,” despite the broad statutory language.
But Watson applies only to “bad faith” claims. On the other hand, the
courts have allowed third-party claimants to sue for misrepresentation.60 In any
event, Lincoln is not a “third-party” claimant, that is, it is not adverse to the estate
59 See also TEX.INS. CODE §541.001 & 541.008 (Chapter 541 “shall be liberally construed and applied to promote the underlying purposes” which are to prohibit “unfair or deceptive act or practices” in the “business of insurance.”). 60 See generally Royal Globe Ins. Co. v. Bar Consultant, 577 S.W.2d 688 (Tex.1979); Hermann Hosp. v. Nat. Standard Ins. Co., 776 S.W.2d 249 (Tex.App.--Houston [1st Dist.] 1989, writ denied); Webb v. Int’l Trucking Co., 909 S.W.2d 220 (Tex.App.--San Antonio 1995, no writ); Brown & Brown of Tex., Inc. v. Omni Metals, Inc., 317 S.W.3d 361 (Tex.App.--Houston [1st Dist.] (2010, pet. denied).
57 of Clara Barnes, the insured, or to Frank Howard, the beneficiary.
12. Lincoln has standing to assert a “prompt payment” claim under section 542.060 of the Code. See Appellant’s Brief, pp.30-32.
As previously noted, the “prompt payment” claim is based in Sections
542.055 and 542.058 of the Insurance Code. See supra, p.32. The remedy reads
as follows:
If an insurer that is liable for a claim under an insurance policy is not in compliance with this subchapter, the insurer is liable to pay the holder of the policy or the beneficiary making the claim under the policy, in addition to the amount of the claim, interest on the amount of the claim at the rate of 18% a year as damages, together with reasonable attorney’s fees.
TEX.INS.CODE §542.060 (emphasis added). In United States v. United Servs. Auto
Ass’n, 431 F.2d 735 (5th Cir.1970), cert. denied, 400 U.S. 992 (1971), the child of
an Air Force officer received treatment at a government hospital, and “the United
States brought suit on the medical payment provision of the officer’s automobile
insurance policy.” The United States sued the insurance company for penalties and
interest under TEX.INS.CODE §3.62, the predecessor of the current statute. Id. at 2.
In affirming an award against the insurance company, the Fifth Circuit held that
the United States was “a ‘holder’ of the policy within the terms of the Texas
statute.” Id. at 3.61
61 citing Republic Nat. Life Ins. Co. v. Spillars, 363 S.W.2d 373, 376 (Tex.Civ.App.-- Waco 1962), rev’d on other grounds, 368 S.W.2d 92 (Tex.1963). See generally Encompass Office Solutions, Inc. v. Ingenix, Inc., 775 F.Supp.2d 938, 947-948 & n.1 (E.D.Tex.2011).
58 Similarly, under ERISA, “[a] civil action may be brought by a
participant or beneficiary.” 29 U.S.C. §1132(a)(1) (emphasis added), and a health
care provider, or its assignee, can sue under this provision to collect benefits owed
to covered employees. See Tango Transport v. Healthcare Financial Services,
LLC, 322 F.3d 888, 889-890 (5th Cir.2003) (allowing financial service company to
sue on claims assigned by ERISA participant).
In reaching these decisions, courts have reasoned that “granting
derivative standing to the assignee of health care providers helps plan participants
and beneficiaries by encouraging providers to accept participants who are unable to
pay up front.” Id. at 894. Thus, “to bar healthcare providers from assigning their
rights under ERISA . . . would chill health care providers’ willingness to accept
a patient.” Id. Similarly, a lender “will only be willing to purchase an assignment
from a healthcare provider if they can be assured that they will be afforded
standing to sue for reimbursement.” Id.
Old American cites Cash Rent-a-Car, Inc. v. Old American County
Mut. Fire Ins. Co., No. 01-09-00021-CV, 2010 WL 143482, 2010 Tex.App.
LEXIS 250 (Tex.App.--Houston [1st Dist.] Jan. 4, 2010, no pet.), for the
proposition that “only [the] insured could assert a claim under Chapter 542.”
Appellant’s brief, p.31. But that decision was based on a provision denying
“prompt payment” to third-party claimants. See TEX.INS.CODE §542.051(2)
59 (“Claim” means a first party claim that is made by an insured or policy holder”)
(emphasis added). Again, Lincoln is not a third-party claimant. See supra, p.58.
13. Alternatively, the Insurance Code claims were assigned and they were assignable. Were the claims assigned? “Absent specific circumstances, causes
of action in Texas are fully assignable.” Fitness Evolution, 2015 Tex.App. LEXIS
11496, at *43.62 It is undisputed that Howard assigned his benefits under the
policy. and “[a]n assignment to receive payment of benefits necessarily
incorporates the right to seek payment. [T]he right to receive benefits would be
hollow without such enforcement capabilities.” Encompass Office Solutions, Inc. v.
Ingenix, Inc., 775 F.Supp. at 949.63
Were the claims assignable? Most kinds of claims are assignable,
but in a few kinds of cases
an assignment may be invalidated by the courts because it is found to offend public policy. The Texas Supreme Court has held that certain types of assignments are invalid because they violate public policy: (1) an assignment of a cause of action that works to collude against an insurance carrier; (2) an assignment of a legal malpractice claim; (3) an assignment that creates a Mary Carter agreement; (4) an assignment of the Plaintiff’s cause of action to a joint tortfeasor of the defendant; and (5) an assignment of interest in an estate that distorts the true positions of beneficiaries.
62 Accord Douglas-Peters, 2017 Tex.App.LEXIS 1836, at *22. 63 quoting Conn. State Dental v. Anthem Health Plans, 591 F.3d 1337, 1352 (11th Cir. 2009).
60 Douglas-Peters, 2017 Tex.App. LEXIS at *23 (citing PPG Industries, 146 S.W.2d
at 87 n.31.
PPG Industries involved a building, completed in 1978, which
included more than 12,000 windows manufactured and installed by PPG. Id. at 83.
PPG replaced some of the windows in 1982. Id. The building was sold in 1989
and all of the seller’s warranties were assigned to the purchaser. More window
problems appeared in 1991, and the purchaser for breach of warranty. Id. The jury
awarded $4.7 million as damages. Id. “The trial court trebled the award under the
mandatory provisions of the 1973 DTPA.” Id. PPG appealed. The Supreme
Court upheld the award of actual damages for breach of warranty but it reversed
the award of treble damages under the DTPA because the original owner’s DTPA
claim was not assignable on public policy grounds. Id. at 83-84.
In an opinion by Justice Scott Brister, the court distinguished between
“plac[ing] the power of treble damages in the hands of aggrieved parties” and
“plac[ing] it in the hands of those considering litigation for commercial profit.” Id.
at 85 (emphasis added). Thus, the Court held that “the DTPA claim could not be
assigned lest they fall into the hands of “arbitrageurs” or “wealthy entrepreneurs,”
who “buy DTPA claims cheap and sell them dear.” Id. at 86-87 (emphasis added).
These concerns are not applicable to our case.
Lincoln is not an “arbitrageur” or “wealthy entrepreneur” who “buys
61 claims cheap and sell them dear.” Rather, like other factoring companies which
operate in this area, Lincoln merely provides up-front cash to pay for funerals. By
assigning rights under a life insurance policy, a beneficiary can, at a difficult time,
obtain ready cash to provide a funeral for a loved one. The same policy arguments
that underlying “derivative standing” in ERISA cases are also at work here.
Allowing factoring companies to have standing will help provide funerals to those
“who are unable to pay up front.” To bar the beneficiaries of those insurance
policies from assigning their rights under the Insurance Code will chill a factoring
company’s willingness to provide up-front cash for funerals. See supra, p.59.
Moreover, PPG Industries involved a DTPA claim, but in our case
Lincoln did not seek or obtain summary judgment under the DTPA. Old
American says that the court in Lee v. Rogers Agency, 517 S.W.3d 137 (Tex.App.--
Texarkana 2017, no pet.), “held that the owner of a life insurance policy could not
validly assign his [bad faith] claims to a trustee.” Appellant’s brief, p.28. But Lee
did not involve the validity of assignment. Rather, in that case, insurance code
claims were “relinquished when the policies were transferred to [a] Trust.” Id. at
146.
The Lee opinion does contain a lengthy footnote noting that “the
Supreme Court has not addressed whether Insurance Code claims are assignable.”
517 S.W.3d at 146 n.3 (emphasis added). It does, however, note that some federal
62 courts have extended the PPG holding to Insurance Code claims. Two of these
cases involve assignability of “bad faith” claims.64 The footnote also notes that
federal district courts have taken opposite positions as to the assignability of
“prompt payment claims.” 65 Certainly, in this regard, the notion that “wealthy
entrepreneurs” would somehow traffic in claims for 18% interest and attorney’s
fees is ridiculous. In our case, public policy factors weigh in favor of
assignability.
Yet, life insurance companies, like Old American, are obviously
willing to treat factoring companies no differently from the way they treated
beneficiaries before the enactment of the Insurance Code. They hold on to the
money until the last minute, and when they are finally sued, they simply pay up
and say that they have complied with the insurance contract. But they have not
complied with extra contractual duties imposed by the Insurance Code, and this
Court should hold that “prompt payment” claims in this case are assignable.
64 See Great Am. Ins. Co. v. Fed. Ins. Co., No. 3:04-CV-2267-H, 2006 WL 2263312, 2006 U.S.Dist. LEXIS 55038, at *29-*30 (N.D.Tex. Aug. 8, 2006); Launius v. Allstate Ins. Co., No. 03-06-CV-0579-B, 2007 WL 113547, 2007 U.S.Dist. 28286, at *14-*15 (N.D.Tex. Apr. 17, 2007). Old American also cites Montoya v. State Farm Mut. Auto Ins. Co., No. 16-00005 (RCL), 2016 WL 5942327, 2016 U.S.Dist. LEXIS 141, 322, at *18 (W.D.Tex. Oct. 12, 2016). See Appellant’s Brief, p.31. 65 Cf. Berkley Regional Ins. Co. v. Philadelphia Indem. Ins. Co., No. A-10-CA-3662-SS, 2011 WL 9879170, 2011 U.S.Dist. LEXIS 155, 852, at *22-*27 (W.D.Tex. Apr. 27, 2011); with American Southern Ins. Co. v. Buckley, 748 F.Supp.2d 610 (E.D.Tex.2010).
63 14. Lincoln does not have standing as to the claim under Section 542.003 of the Insurance Code. See Appellant’s brief, pp.29-30.
We also alleged that Old American made misrepresentations in
violation of Section 542.003 of the Insurance Code, which prohibits an insurer
from “knowingly misrepresenting to a claimant pertinent facts or policy provisions
relating to coverage at issue.” TEX.INS.CODE §542.003(b)(1). See Motion, pp.25-
340 (203-208). This particular provision is found in Chapter 542, Subchapter A,
which concerns dealings between insurers and the Texas Department of Insurance.
It requires an insurer to keep a record of complaints and to report them to the
Department.66 Also, the Department has authority to investigate handling of
claims and to issue cease and desist orders and to recover attorney’s fees.67 The
remedy for this subchapter in found in Section 542.012, which allows recovery of
attorney’s fees. As it turns out, that remedy is only available to the Department of
Insurance, and we now concede that we do not have standing to assert this
particular claim for misrepresentation.
In this regard, a number of courts have held that there is no private
cause of action under Chapter 542, Subchapter A; and Old American cites those
cases on pages 29 and 30 of its brief. However, one of these cases goes too far,
66 Id. §542.005 & 542.006. 67 Id. §542.010 & 542.012.
64 saying that there is no private cause of action for all of Chapter 542. See KLZ
Diamond Tools, Inc. v. TKG Gen. Agency, Inc., 2016 Tex.App.LEXIS 7639, at *19
(Tex.App.--Dallas July 18, 2016, no pet.) (“Chapter 542 does not provide a private
cause of action for violations of its terms.”). That statement is dicta, and it is
overbroad. Like all of the cases cited by Old American, that case involved Section
542.003. And of course, Section 542.003 falls into Chapter 542, Subchapter A.
By contrast, the law is well settled that there is a private cause of action for bad
faith and misrepresentation claims, which fall under Chapter 542, Subchapter B.
PRAYER
The judgment of the trial court should be affirmed. Costs should be
adjudged against Old American.
Respectfully submitted,
/s/ Frank Gilstrap 07964000
HILL GILSTRAP, P.C. 1400 West Abram Street Arlington, Texas 76013 (817) 261-2222 (817) 274-9724 fax fgilstrap@hillgilstrap.com ATTORNEY FOR APPELLEE
65 CERTIFICATE OF SERVICE
I hereby certify that on December 21, 2017 a copy of the foregoing
Appellee’s Brief was served on the following counsel of record:
David R. Sweat 3705 W. Green Oaks Blvd., Ste. C Arlington, Texas 76016
/s/ Frank Gilstrap
CERTIFICATE OF COMPLIANCE
I certify that this brief was prepared using Microsoft Word 2013, and
that, according to that program’s word-count function, the sections covered by
TRAP 9.4(i)(1) contain 12,667 words.
Related
Cite This Page — Counsel Stack
Old American Insurance Company v. Lincoln Factoring, LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/old-american-insurance-company-v-lincoln-factoring-llc-texapp-2017.