Provident American Insurance Co. v. Castañeda

988 S.W.2d 189, 1999 WL 2507
CourtTexas Supreme Court
DecidedApril 29, 1999
Docket96-0249
StatusPublished
Cited by169 cases

This text of 988 S.W.2d 189 (Provident American Insurance Co. v. Castañeda) is published on Counsel Stack Legal Research, covering Texas Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Provident American Insurance Co. v. Castañeda, 988 S.W.2d 189, 1999 WL 2507 (Tex. 1999).

Opinions

Justice OWEN

delivered the opinion of the Court,

in which Chief Justice PHILLIPS, Justice HECHT, Justice BAKER, and Justice ABBOTT joined, and in which Justice ENOCH joined in all but part V.

Denise Castañeda seeks damages from Provident American Insurance Company for alleged violations of the Insurance Code and the Deceptive Trade Practices Act arising out of the denial of her claim for benefits under a health insurance policy and the manner in which her claim was handled. Because the evidence is legally insufficient to support the jury’s verdict, we reverse and render judgment that Castañeda take nothing.

I

Denise Castañeda’s father, Guillermo Cas-tañeda, Sr., applied for medical insurance with Provident American Insurance Company in May 1991. He sought a policy that would cover the entire family including his daughter Denise, who was twenty-one years-old at the time, her sister, and their brother Guillermo, Jr. During the application process, Guillermo Castañeda, Sr. failed to disclose that just two days before he applied for the policy, Guillermo, Jr. had received medical attention from a physician for jaundice, anemia, and suspected hepatitis. Denise had received medical treatment for jaundice and hepatitis several years prior to the date her father applied for health insurance.

Provident American issued a policy to the family effective June 17, 1991. The policy contained two limitations that are relevant here: (1) it did not cover expenses resulting from a sickness that “manifests” within thirty days of the policy’s effective date; and (2) it excluded diseases or disorders of certain internal organs, including the gallbladder, unless the loss occurred more than six months after the policy’s effective date.

Less than thirty days after the issuance of the policy, the family learned that Denise’s uncle had been diagnosed with hemolytic spherocytosis (HS), a hereditary condition that causes misshapen blood cells. The spleen destroys these cells, which causes the sufferer to exhibit anemia, jaundice, and, in 90% of the cases, gallstones. The treatment for this condition is to remove the spleen and, if gallstones are present, the gallbladder. Because the disease is hereditary, it was suggested that the Castañedas be tested for HS. Denise and Guillermo, Jr. had exhibited yellow skin all of their lives, and on July 20, 1991, the third day after the thirty-day period expired, they were taken to a physician who diagnosed them that same day with HS and referred them to a blood specialist. They saw the hematologist two days later, and he concurred in the HS diagnosis. Two weeks later, Denise and Guillermo, Jr. each [192]*192had their spleen and gallbladder surgically removed.

The Castañedas submitted claims to Provident American, which were denied. Provident American first asserted the six-month policy exclusion for disorders of the gallbladder but later denied the claims on the basis that HS had manifested within thirty days of the policy’s effective date.

Denise Castañeda sued Provident American, alleging violations of the DTPA and of article 21.21 of the Texas Insurance Code, and Guillermo Castañeda, Sr. sued on behalf of Guillermo, Jr. The two suits were consolidated, but Guillermo Castañeda, Sr. later nonsuited his claims. Denise Castañeda proceeded to trial, and the district court submitted three liability questions based on article 21.21 of the Insurance Code and on the DTPA.1 The jury answered “yes” to each and found that Provident American had engaged in knowing conduct. The jury awarded $50,-000 for Denise Castañeda’s loss of credit reputation and loss of benefits, collectively, but found no mental anguish damages. The jury also awarded reasonable attorney’s fees of 33% of Castañeda’s recovery. The trial court rendered judgment on the verdict, trebling the damages and adding a twelve percent penalty on the lost benefits.

The court of appeals affirmed, except as to the twelve percent penalty.2 Regarding other points of error, the court of appeals concluded that the trial court had erroneously submitted at least one subpart of the first liability question (subpart A)3 but held that this error was harmless because two other subparts (J and H) were properly submitted and supported by legally and factually sufficient evidence.4 The court of appeals also held that the evidence was sufficient to support the award of $50,000 for loss of credit reputation and loss of benefits.5 Provident American filed an application for writ of error with this Court, which we granted. Because there is no evidence to support a finding of liability based on any of the theories submitted to the jury, we do not reach the question of whether a trial court’s judgment may be affirmed if a liability question includes a theory that is not legally cognizable but other viable theories are included within the same question. Likewise, we do not reach Provident American’s complaint that attorney’s fees were improperly based on a percentage of the recovery, an issue that we addressed in Arthur Andersen & Co. v. Perry Equipment Corp.6 after the court of appeals’ decision became final in this case.

II

We begin our review with the first question submitted to the jury.7 The numerous subparts of Question 1 can be distilled into three categories: (1) whether Provident American denied the claim without a reasonable basis or after its liability had become reasonably clear, (2) whether there was a misrepresentation about the policy, and (3) whether Provident American engaged in unfair claims settlement practices. We first consider whether there was any evidence to support a finding that Provident American denied Castañeda’s claim without a reasonable basis or after its liability had become reasonably clear.

III

The trial court submitted two instructions to the jury regarding Provident American’s denial of the claim. Subpart J of Question 1 was based on article 21.21-2, section 2(b)(4)8 and defined an unfair or deceptive act or practice as including: “[n]ot attempting in good faith to effectuate a prompt, fair, and equitable settlement of a claim when [193]*193liability has become reasonably clear.”9 Subpart G of Question 1 was a hybrid theory that defined an unfair or deceptive act or practice as including: “[djenying a claim or delaying payment on a claim without a reasonable basis or fading to determine whether there is any reasonable basis for the denial or delay.”10 This instruction embodied the pre-Giles11 common-law definition of bad faith, but the jury issue included producing cause,12 which is the causation element for an article 21.21 claim.13 However, the parties agree that only statutory claims were tried and that no common-law bad faith claim was submitted. Provident American did not urge the trial court to exclude subpart G from the definitions of an “[ujnfair or deceptive act or practice”14 and contends only that there is no evidence to support a jury finding based on this definition. Our no-evidence review of subpart G is governed by our pre-Giles decisions because this instruction was couched in the same terms as the pre-Giles definition of common-law bad faith. Thus, our decisions in

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Bluebook (online)
988 S.W.2d 189, 1999 WL 2507, Counsel Stack Legal Research, https://law.counselstack.com/opinion/provident-american-insurance-co-v-castaneda-tex-1999.