Ortiz v. A.N.P., Inc.

768 F. Supp. 2d 896, 2011 U.S. Dist. LEXIS 22307, 2011 WL 782035
CourtDistrict Court, S.D. Texas
DecidedMarch 7, 2011
Docket5:10-po-00917
StatusPublished

This text of 768 F. Supp. 2d 896 (Ortiz v. A.N.P., Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ortiz v. A.N.P., Inc., 768 F. Supp. 2d 896, 2011 U.S. Dist. LEXIS 22307, 2011 WL 782035 (S.D. Tex. 2011).

Opinion

MEMORANDUM AND ORDER

KEITH P. ELLISON, District Judge.

Before the Court is Third-Party Defendant’s Motion for Summary Judgment (Doc. No. 18). After considering the parties’ filings and the applicable law, the Court finds that the Motion for Summary Judgment should be granted in part and denied in part.

I.FACTUAL BACKGROUND

This case arises out of a workplace injury sustained by Plaintiff Aicia Ortiz (“Ortiz”) while working for her employer A.N.P., Inc. (“A.N.P.”). The following are undisputed facts proffered by Union Central.

Union Central issued a group insurance policy (the “Policy”), in which A.N.P. was a participating employer, providing occupational accident insurance to A.N.P.’s employees. (Burke Decl. Ex. A.) The Policy provided that it was governed, to the extent applicable, by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1101-1461, and its amendments. (Id. at 9.) Under the Policy, an eligible employee who suffered a covered accident could apply for and receive reimbursement of medical expenses, benefits for accidental death or dismemberment, and weekly benefit payments based on the level of disability. (Id. at 12-20.)

In its application to Union Central’s predecessor, Combined Insurance Company of America, for the Policy, A.N.P. signed an addendum acknowledging that it fully understood the following items:

1. This is not Worker’s Compensation Insurance, nor is it a replacement for Workers’ Compensation Insurance. Combined Insurance Company of America does not sell, nor is it authorized to sell, Workers’ Compensation Insurance.
2. This coverage is an employee benefit and does not insure any casualty or general liability risk.
3. This coverage nor the Combined Insurance Company of America does not indemnify or protect the Employer from any losses or damages from employees on account of accidental injury or death of an employee.
4. This coverage is not intended to, nor will it provide the Policyholder with any protection or defense against any suit which may be brought by anyone for any reason.
5. The Combined Insurance Company of America, nor its agent has not represented the coverage as anything other than an employee benefit which offers no indemnity for Policyholder liability.
6. THIS IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. WE DO NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THIS COVERAGE, AND IF WE ARE A NON-SUBSCRIBER, WE LOSE CERTAIN COMMON LAW DEFENSES TO SUIT AS WELL AS CERTAIN LIMITATIONS ON LIABILITY THAT WOULD OTHERWISE BE AVAILABLE UNDER THE WORKERS’ COMPENSATION LAWS. WE MUST COMPLY *900 WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

(Burke Decl. Ex. B at 5.)

By virtue of Ortiz’s employment with A.N.P., she was covered by the Policy. In April 2009, Ortiz suffered first and second degree burns on her right arm while working at A.N.P.’s dry cleaning operation. (Burke Deck Ex. C at 15, 53.) She filed a claim with Union Central for benefits under the Policy. (Id.) Over the course of several months, Union Central paid approximately $2,037.50 to or for the benefit of Ortiz for the injuries she sustained in the accident. (Burke Deck Ex. D.) Union Central stopped weekly benefit payments to Ortiz after she visited an independent physician, Ronald Buczek. Dr. Buczek concluded that Ortiz could return to work with restrictions on the use of her left arm. (Burke Deck Ex. C at 53.) Union Central’s third-party administrator, Verity National Group Group, Inc., sent Ortiz a letter advising her that, as a result of Buczek’s determination, it was ceasing payment of future weekly disability benefits. (Id. at 57.) The letter advised Ortiz that she could appeal the decision to cease benefits. (Id.) Neither Ortiz nor her counsel ever appealed this decision.

Ortiz subsequently filed suit against A.N.P., Lee’s One Hour Cleaners, Nizar, Inc., and Palm Portfolio Management, Inc. (collectively, “Defendants”), all of whom allegedly controlled the business where she worked. She asserted common law claims of negligence and defective premises and sought damages for medical expenses, physical pain, mental anguish, loss of earnings, and physical impairment and disfigurement. Defendant A.N.P. and Defendant Lee’s One Hour Cleaners (collectively, “A.N.P.”) filed a third-party petition (the “Third-Party Petition”) against Union Central. The Third-Party Petition’s cause of action is “contractual contribution/indemnity for any amounts that may be recoverable or payable from the occupational accident insurance policy for the lost wages, medical expenses and other personal injury damages the subject of [Ortiz’s] claims against A.N.P., which are being asserted against A.N.P., and which claims are in whole or in part insured against in the above referenced Policy.” (Doc. No. 1-1 at 16.) Union Central removed the case to this Court and counterclaimed for a declaratory judgment that: (a) the Policy is governed by ERISA; (b) all of AN.P.’s claims are preempted by ERISA; (c) the Policy does not insure against casualty or general liability risks, does not require indemnification or protection from loss or damages, and does not provide for defense against Ortiz’s claims; (d) Union Central has complied with all of its obligations to A.N.P. and Ortiz; and (e) Union Central is entitled to recover attorney’s fees from A.N.P. (Doc. No. 4.)

In our prior Memorandum and Order, we held that Ortiz’s state law negligence claims against A.N.P. were separate and independent from A.N.P.’s claims arising under ERISA against Union Central. We severed Ortiz’s claims against A.N.P. from A.N.P.’s claims against Union Central and remanded the former to state court. Union Central has now moved for summary judgment on A.N.P.’s claims against it and its request for a declaratory judgment. The motion has been briefed and is ripe for disposition.

II. SUBJECT MATTER JURISDICTION

Federal courts are courts of limited jurisdiction and possess an independent obligation to examine the basis of *901 jurisdiction. Save the Bay, Inc. v. U.S. Army, 639 F.2d 1100, 1102 (5th Cir.1981). A court must dismiss an action if it determines “at any time” that it lacks subject-matter jurisdiction. Fed. R. Civ. P. 12(h)(3); Stockman v. Fed. Election Comm’n, 138 F.3d 144, 151 (5th Cir.1998) (“It is incumbent on all federal courts to dismiss an action whenever it appears that subject matter jurisdiction is lacking.”). A ease is properly dismissed for lack of subject matter jurisdiction when the court lacks the statutory or constitutional power to adjudicate the case. Home Builders Ass’n of Mississippi Inc. v. City of Madison, Miss.,

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Bluebook (online)
768 F. Supp. 2d 896, 2011 U.S. Dist. LEXIS 22307, 2011 WL 782035, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ortiz-v-anp-inc-txsd-2011.