Texas Mutual Insurance Co. v. Ruttiger

265 S.W.3d 651, 2008 Tex. App. LEXIS 5787, 2008 WL 2930096
CourtCourt of Appeals of Texas
DecidedJuly 31, 2008
Docket01-06-00897-CV
StatusPublished
Cited by31 cases

This text of 265 S.W.3d 651 (Texas Mutual Insurance Co. v. Ruttiger) 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
Texas Mutual Insurance Co. v. Ruttiger, 265 S.W.3d 651, 2008 Tex. App. LEXIS 5787, 2008 WL 2930096 (Tex. Ct. App. 2008).

Opinion

OPINION ON REHEARING

TERRY JENNINGS, Justice.

We grant appellant’s motion for rehearing. See Tex.R.App. P. 49.3. We withdraw our January 17, 2008 opinion, substitute this opinion in its place, and vacate our January 17, 2008 judgment.

Appellant, Texas Mutual Insurance Company (“TMI”), challenges the trial court’s judgment, entered after a jury trial, in favor of appellee, Timothy J. Ruttiger, in Ruttiger’s suit for violations of the Texas Insurance Code, 1 breach of the duty of good faith and fair dealing, and violations of the Texas Deceptive Trade Practices Act (“DTPA”). 2 TMI brings eight issues for our review. In its first three issues, TMI contends that the evidence is legally insufficient to support the jury’s findings that TMI violated the Insurance Code by engaging in unfair and deceptive acts or practices, breached the common law duty of good faith and fair dealing, violated the DTPA, and “knowingly” engaged in unfair and deceptive acts or practices. In its fourth, fifth, and sixth issues, TMI contends that the trial court erred in awarding damages for physical pain and suffering, physical impairment, and mental anguish as “such damages were not separate and independent from the underlying physical injury” and that the evidence is legally insufficient to support the awards for mental anguish and loss of credit reputation. In its seventh issue, TMI contends that the trial court lacked jurisdiction to award damages because Ruttiger “failed to obtain a finding by the Texas Workers’ Compensation Commission [(“TWCC”)] that he was entitled to workers’ compensation benefits.” In its eighth issue, TMI contends that no cause of action exists in Texas for breach of the duty of good faith and fair dealing in the context of a workers’ compensation claim.

We modify the judgment to delete that portion of the judgment awarding Ruttiger damages for his loss of credit reputation. We affirm the judgment of the trial court as modified.

Factual and Procedural Background

In his petition, Ruttiger alleged that, on June 21, 2004, he sustained bilateral inguinal hernias 3 after lifting a heavy bundle of metal conduit while working as an employee of A & H Electric Company (“A & H”). He further alleged that TMI, A & H’s workers’ compensation carrier, denied him timely payment of benefits and necessary medical treatment without a reasonable basis “until finally agreeing to do so, much later in a ‘Benefit Dispute Agreement.’ ” Ruttiger contended that an unbiased inves *656 tigation “would have confirmed” that he sustained his injuries in the workplace and TMI’s wrongful and unreasonable delay in paying medical and income benefits caused him substantial financial hardship and medical problems. Ruttiger attached to his petition a copy of the January 6, 2005 Benefit Dispute Agreement, wherein TMI agreed that Ruttiger sustained a compen-sable injury in the form of a hernia and that Ruttiger suffered a disability for a specific period of time. 4

At the conclusion of trial, the jury found that TMI failed to comply with its duty of good faith and fair dealing, engaged in unfair and deceptive acts or practices, and engaged in these acts and practices knowingly. The jury awarded Ruttiger $37,500 for past physical pain and suffering, $5,000 for future physical pain and suffering, $11,500 for past damage to credit reputation, $5,000 for future damage to credit reputation, $4,500 for past physical impairment, $100,000 for past mental anguish, and $20,000 in additional damages based on its finding that TMI’s conduct was committed knowingly. 5 The trial court rendered judgment in Ruttiger’s favor on his Texas Insurance Code theory of liability, awarded Ruttiger $168,500 in actual damages and $20,000 in additional damages, and stated that in the event the Insurance Code theory failed on appeal, Ruttiger could “elect to recover his damages under the common law for breach of the duty of good faith and fair dealing and/or under the [DTPA].”

Jurisdiction

In its seventh issue, TMI argues that the trial court lacked subject matter jurisdiction because Ruttiger “failed to obtain a finding by the [TWCC] that he was entitled to workers’ compensation benefits.” It asserts that Texas courts have no jurisdiction to award damages against an insurer for a “denial in payment of compensation benefits without a determination by the TWCC that such benefits [are] due.” TMI contends that the Benefit Dispute Agreement was merely a compromise, not a determination by the TWCC as to whether Ruttiger was entitled to workers’ compensation benefits, and treating it as a TWCC determination would permit “the parties to create subject matter jurisdiction” and would result in a “chilling effect” on settlements.

This Court has previously considered, and rejected, similar arguments. In In re Texas Workers’ Compensation Insurance Fund, a claimant sustained an injury in the course and scope of his employment, and the workers’ compensation carrier initially paid him medical and income benefits. 995 S.W.2d 335, 335 (Tex. App.-Houston [1st Dist.] 1999, no pet.). The parties then entered into their first benefit dispute agreement, agreeing that certain medical problems were “causally related” and that the insurer would pay “reasonable and necessary medical.” Id. at 336. However, the insurer subsequently began denying payments, and the parties entered into two additional benefit dispute agreements, with the insurer agreeing to pay the claimant supplemental income benefits for specific amounts. Id. Prior to entering into the third agreement, the claimant sued the insurer, alleging that the insurer failed to timely pay the benefits that it had agreed to pay. Id. *657 The insurer argued that the claimant failed to exhaust his administrative remedies. Id. We disagreed. Id.

We noted that the Texas Workers’ Compensation Act (the “Act”) 6 provides a four-tier system for the disposition of claims by the TWCC. See id. at 336-37. In the first tier, the parties participate in a “benefit review conference” conducted by a “benefit review officer.” Tex. Lab.Code Ann. §§ 410.021-.034 (Vernon 2006 & Supp. 2007). The conference, which is a “nonad-versarial, informal dispute resolution proceeding,” is designed to “mediate and resolve disputed issues by agreement of the parties.” Id. § 410.021(3) (Vernon 2006) (emphasis added). In the second tier, “[i]f issues remain unresolved after a benefit review conference, the parties, by agreement, may elect to engage in arbitration,” and, absent an agreement, a party is entitled to seek relief at a contested case hearing. Id. §§ 410.104, 410.151-.169 (Vernon 2006 & Supp.2007) (emphasis added). In the third tier, a party may seek review by an administrative appeals panel. Id. §§ 410.201-.208 (Vernon 2006 & Supp. 2007). Finally, in the fourth tier, an aggrieved party may seek judicial review. Id.

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Bluebook (online)
265 S.W.3d 651, 2008 Tex. App. LEXIS 5787, 2008 WL 2930096, Counsel Stack Legal Research, https://law.counselstack.com/opinion/texas-mutual-insurance-co-v-ruttiger-texapp-2008.