Paramount National Life Insurance Co. v. Williams

772 S.W.2d 255, 1989 Tex. App. LEXIS 1803, 1989 WL 54670
CourtCourt of Appeals of Texas
DecidedJuly 13, 1989
DocketC14-87-00297-CV
StatusPublished
Cited by35 cases

This text of 772 S.W.2d 255 (Paramount National Life Insurance Co. v. Williams) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Paramount National Life Insurance Co. v. Williams, 772 S.W.2d 255, 1989 Tex. App. LEXIS 1803, 1989 WL 54670 (Tex. Ct. App. 1989).

Opinions

OPINION

PAUL PRESSLER, Justice.

Appellee sued after the denial of two claims and the cancellation of her medical insurance policy. The jury found all issues in her favor, and the trial court entered judgment for actual damages of $48,281.94, exemplary damages of $500,000 and attorney’s fees. We modify the judgment to award a twelve percent penalty pursuant to Tex.Ins.Code Ann. art. 3.62 (Vernon 1981). We further order a remittitur of $250,000 in exemplary damages. Otherwise, we affirm the judgment of the trial court.

On March 5, 1981, insurance agent Cliff Cox met with Frankie Williams and her husband Willie and took an application for a hospital insurance policy to be issued by Paramount. Mrs. Williams was sixty-four and had a long history of medical problems which the couple described to Cox. Cox told the Williamses he needed to know only about the preceding five years. He filled out the application and had them read and sign it. Paramount approved the application and issued the policy on March 20, 1981. Mrs. Williams was hospitalized in July 1981 and again in December 1981. She filed two claims totaling over $40,000 in connection with these hospitalizations. Paramount denied the claims and cancelled the policy on the grounds that Mrs. Williams had failed to disclose her full medical history on the insurance application and that the conditions for which she was being treated were preexisting conditions. The company refunded her premiums. Mrs. Williams then sued Paramount for breach of contract, breach of the duty of good faith and fair dealing, fraud and violations of both the Texas Insurance Code and the Texas Deceptive Trade Practices Act. Based on the jury’s answers to thirty-one special issues, the trial court entered judgment on the theory that afforded the greatest recovery. Paramount appeals that judgment with twenty-five points of error.

In its first point of error, Paramount argues that the trial court violated several evidentiary rules in admitting petitions, pleadings and discovery from lawsuits filed against Paramount, as well as complaints to the State Board of Insurance regarding the company’s actions on claims of other insureds. The court admitted the evidence “not for the truth of the matter stated therein, but for the purpose of aiding you, if they do, in determining whether the Defendant has a custom of denying things because of prior existing medical conditions.”

Paramount contends the extraneous,litigation and complaints had no probative value because Mrs. Williams tendered no evidence that in those instances Paramount asserted the defense of prior existing medical conditions without reasonable investigation or without just cause. Paramount maintains such evidence is necessary, citing us to language in Aztec Life Ins. Co. of Texas v. Dellana, a mandamus proceeding. 667 S.W.2d 911, 915 (Tex.App.—Austin 1984, no writ). In Aztec the court ordered the discovery of denied claims of other insureds and made this comment about the relevancy of the denied claims:

On the other hand, this Court knows of no bar to the admission of evidence, if such exists, that Aztec had consistently denied claims upon the basis of the exclusion without reasonable investigation. (emphasis added)

Mrs. Williams, on the other hand, contends the evidence was admissible to prove several of her causes of action. Her argument closely parallels that made by the court in Underwriters Life Ins. Co. v. Cobb, 746 S.W.2d 810, 815 (Tex.App.—Corpus Christi 1988, no writ). That court approved the admission of letters from Underwriters denying other claims about the same time and on the same basis as its denial of the subject claim as well as the [260]*260company’s log of complaints filed against its agents. Although Underwriters contended the evidence was immaterial, irrelevant and highly prejudicial, the court found the following:

Underwriters’ denial of other claims around the same time as its denial of the Cobbs’ claim, and on the same basis, was admissible to show that Underwriters’ refusal to pay the Cobbs’ claim was “ ‘commit[ted] or perforated] with such frequency as to indicate a general business practice.’ ” Chitsey, [v. National Lloyds Ins. Co.] 738 S.W.2d [641] at 643. Such a showing was necessary to recover under the Cobbs’ pleaded cause of action for breach of Underwriters’ duty to reasonably investigate. Id. It is also relevant and material under Arnold to prove the Cobbs’ cause of action for Underwriters’ breach of duty of good faith and fair dealing; these routine denials on the same grounds were sufficiently similar to indicate a failure by Underwriters to determine whether there was any basis to deny the Cobbs’ claim. See Arnold, [v. Nat. County Mut. Fire Ins. Co.] 725 S.W.2d [165] at 167. (additional citations omitted)

Based on the rationale of Cobb and the trial court’s limiting instruction, the evidence was properly admitted. In the Aztec case, the court noted that the evidence in dispute “is generally admissible when the other acts are so closely connected with the act charged so as to disclose a plan or scheme.” 667 S.W.2d at 915. The court also stated that a showing that Aztec consistently followed such a claims practice could be relevant as tending to show that the company had purposely denied the subject claim without reasonable investigation. Id. Furthermore, Paramount had the opportunity to refute or mitigate the evidence of the lawsuits and complaints and show if there had been some favorable resolution. The relevancy of the evidence outweighed any prejudicial effect. Point of error one is overruled.

In point of error two, Paramount challenges the legal and factual sufficiency of the evidence to support the jury's answers to Special Issues Nos. 2 and 4. In addition, it asserts that the trial court erred in submitting Special Issue No. 4 because, as a matter of law, Cliff Cox was Mrs. Williams’ agent, his acts could not bind Paramount and there could be no issue of apparent authority. In reviewing a “no evidence” point, this court must consider only the evidence and the inferences tending to support the finding and disregard all evidence and inferences to the contrary. Garza v. Alviar, 395 S.W.2d 821, 823 (Tex.1965). In deciding an “insufficient evidence” point, we must consider and weigh all the evidence. In re King’s Estate, 150 Tex. 662, 244 S.W.2d 660, 661 (1951).

Paramount denies there was a breach of contract. It alleged that it rejected Mrs. Williams’ two hospital claims on the basis that the conditions for which she was being treated (primarily colon-related) did not comply with the definition of sickness under the policy as well as her failure to disclose preexisting medical conditions. Paramount claims that certain language in the documents relating to the policy puts the applicant on notice that accurate and complete information is required. On her application Mrs. Williams stated she was in good health and free from any physical or mental defects and her only prior medical problems were a kidney stone in 1952 and a cancerous uterus in 1975, both with full recovery. However, the evidence showed Mrs.

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Cite This Page — Counsel Stack

Bluebook (online)
772 S.W.2d 255, 1989 Tex. App. LEXIS 1803, 1989 WL 54670, Counsel Stack Legal Research, https://law.counselstack.com/opinion/paramount-national-life-insurance-co-v-williams-texapp-1989.