Royal MacCabees Life Insurance Co. v. James

146 S.W.3d 340, 2004 Tex. App. LEXIS 9025, 2004 WL 2294424
Court of Appeals of Texas·Decided October 12, 2004·No. 05-01-01372-CV·Published·Cited by 45 cases

Opinion

OPINION ON REHEARING

Opinion by Justice WRIGHT.

Before us is Royal Maccabees’s June 4, 2004 second motion for rehearing. We grant appellant’s second motion for rehearing. We withdraw the opinion and vacate the judgment of May 21, 2004. The following is now the opinion of the Court.

Royal Maccabees Life Insurance Company appeals a jury verdict and judgment in favor of Vicki James and the City of Mesquite. In sixteen points of error, Royal Maccabees complains of the legal and factual sufficiency of the evidence to support the jury’s findings; asserts there was no breach of contract or breach of the duty of good faith and fair dealing; complains of error in the award of damages, attorneys’ fees, and costs; asserts error in the jury charge; and complains of the admission of the testimony of plaintiffs’ expert witness. We affirm in part and reverse and remand in part. We sustain Royal Maccabee’s third, sixth, and tenth points of error complaining of the award of mental anguish damages, exemplary damages, and attorney’s fees. We remand those issues and the tort causes of action to the trial court for proceedings consistent with this opinion. In all other respects, the trial court’s judgment is affirmed.

Background

Vicki James, plaintiff/appellee, is the surviving spouse of Donnie James, who *344 died on June 5, 1998. Donnie James was employed as a police officer for plain-tiffiappellee City of Mesquite. This dispute arises out of a group life insurance policy issued by appellant Royal Maccabees for City of Mesquite employees, including Donnie James. Under this policy, an eligible employee could elect coverage in incremental amounts up to $100,000. Appellees contend Donnie James was eligible for, elected, and paid premiums for $100,000 in benefits. There is no dispute between the parties as to the first $50,000 in benefits. Royal Maccabees paid a total of $50,000 ($25,000 to plaintiff Vicki James and $25,000 to her daughter Julie James) after Donnie James’s death. 2 The lawsuit and trial arose out of Royal Maccabees’s denial of the additional $50,000 in benefits for which Donnie James had paid premiums (through deductions from his paycheck) for four years and ten months prior to his death.

Many of the facts leading up to Royal Maccabees’s denial are not disputed. The insurance policy was selected by the City of Mesquite and was in place at the time of Donnie James’s death. Donnie James filled out and submitted an application for the disputed benefits. He also filled out and submitted authorization for his employer to withhold premium payments from his paycheck for the disputed benefits. Those premium payments, lumped with payments from other City of Mesquite employees, were .submitted to Royal Maccabees. It is undisputed that Royal Maccabees received the payments each and every month for a period of four years and ten months. However, Royal Maccabees never sent a letter approving the disputed benefits. Royal Maccabees paid the first $50,000 of benefits to Donnie James’s beneficiaries and denied payment of the remaining $50,000 claimed. After Donnie James’s death, Royal Maccabees refunded the premiums it had collected over a four-year period on the claim denied.

The parties also offered evidence on a number of disputed facts. While Royal Maccabees contended it had requested additional medical information about Donnie James from a doctor, but had received no response, the custodian of records for that doctor testified no such requests could be found in the doctor’s files. Further, while Royal Maccabees offered a copy of an unsigned letter purportedly sent to the City of Mesquite disapproving Donnie James’s application for lack of requested information, appellees offered testimony that no such letter was in the City’s files. Further, appellees offered the testimony of Thomas Pinho, the Royal Maccabees employee whose name appeared as signatory on the unsigned letter. Mr. Pinho testified he did not recall writing the letter and would not have written such a letter as part of his employment duties at the time. Finally, appellees offered testimony of representations by Royal Maccabees that eligible full-time employees (including Donnie James) would be covered under the supplemental life insurance policy for amounts over $50,000 without written approval or review of evidence of insurability by Royal Maccabees. Royal Maccabees denied any such representations were made.

At trial, the jury found Royal Maccabees breached the contract, violated the Deceptive Trade Practices-Consumer Protection Act, 3 violated the Insurance Code, breach *345 ed its duty of good faith and fair dealing, and committed fraud. The jury also found Royal Maccabees timely denied the insurance claim and conducted a reasonable investigation. The jury answered “no” to questions relating to the liability of Charles Carter, 4 Royal Maccabees’s agent, for deceptive acts or practices or misrepresentations. The jury also found Royal Maccabees acted knowingly, and awarded punitive damages after a bifurcated proceeding. The trial court entered judgment in the amount of $665,450.25, which amount included insurance benefits, mental anguish damages, damages for violation of Texas Insurance Code article 21.55, punitive damages, attorneys’ fees, and interest.

STANDARDS OF REVIEW

An appellant attacking the legal sufficiency of an adverse finding on an issue on which he did not have the burden of proof must demonstrate on appeal that there is no evidence to support the adverse finding. Croucher v. Croucher, 660 S.W.2d 55, 58 (Tex.1983). In conducting a no evidence review, we consider only the evidence and inferences that tend to support the finding and disregard all evidence and inferences to the contrary. Weirich v. Weirich, 833 S.W.2d 942, 945 (Tex.1992). If there is more than a scintilla of evidence to support the finding, we uphold the judgment. Sutton v. Hisaw & Assocs. Gen. Contractors, Inc., 65 S.W.3d 281, 284 (Tex.App.-Dallas 2001, pet. denied). In contrast, when we review a challenge to the factual sufficiency of the evidence, we consider all the evidence. Plas-Tex, Inc. v. U.S. Steel Corp., 772 S.W.2d 442, 445 (Tex.1989). We set aside the verdict only if it is so contrary to the overwhelming weight of the evidence as to be clearly wrong and unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex.1986) (per curiam).

The construction of a contract is a question of law for the court. Coker v. Coker, 650 S.W.2d 391, 393 (Tex.1983); Edwards v. Lone Star Gas Co., a Div. of Enserch Corp., 782 S.W.2d 840, 841 (Tex.1990). The general rules of contract construction govern insurance policy interpretation. Tex. Farmers Ins. Co. v. Murphy, 996 S.W.2d 873, 879 (Tex.1999); State Farm Life Ins. Co. v.

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Royal MacCabees Life Insurance Co. v. James, 146 S.W.3d 340, 2004 Tex. App. LEXIS 9025, 2004 WL 2294424 (Tex. Ct. App. 2004).

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