Texas Mutual Insurance Co. v. Sara Care Child Care Center, Inc.

324 S.W.3d 305, 2010 Tex. App. LEXIS 7588, 2010 WL 3567094
CourtCourt of Appeals of Texas
DecidedSeptember 15, 2010
Docket08-08-00192-CV
StatusPublished
Cited by22 cases

This text of 324 S.W.3d 305 (Texas Mutual Insurance Co. v. Sara Care Child Care Center, Inc.) 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. Sara Care Child Care Center, Inc., 324 S.W.3d 305, 2010 Tex. App. LEXIS 7588, 2010 WL 3567094 (Tex. Ct. App. 2010).

Opinion

OPINION

DAVID WELLINGTON CHEW, Chief Justice.

Texas Mutual Insurance Company appeals from two summary judgment orders, and a final judgment following a bench trial, all in favor of its insured, Sara Care Child Care Center, Inc. (“Sara Care”), and the insured’s employee, Martha Martinez. The insurer argues the first summary judgment, affirming the Texas Workers’ Compensation Commission Appeals Panel decision in the claimant’s favor was in error, due to the panel’s reliance on Texas Labor Code Section 406.008. Texas Mutual continues by challenging the trial court’s partial summary judgment on the issue of its liability to Sara Care for the insured’s extra-contractual claims for affirmative relief. The insurer concludes that the trial court’s final judgment, including attorney’s fees, and statutory additional damages must be reversed, and judgment rendered in its favor, due primarily to errors in the summary judgments. In support of its request for reversal, Texas Mutual also raises an issue challenging the trial court’s rulings on Sara Care’s objections to the carrier’s summary judgment evidence. We reverse and remand in part and affirmed in part.

Sara Care Child Care Center, Inc. operated the child care center at the University of Texas at El Paso. In July 2001, Sara Care purchased a one year workers’ compensation insurance policy from Texas Mutual Insurance Company (“TMI”). The policy provided Sara Care with coverage for workers’ compensation claims August 4, 2001 to August 4, 2002. By letter dated June 6, 2002, TMI notified Sara Care that its policy was scheduled to expire on August 4. The letter specifically stated, in bold typeface, that it was “not a cancellation,” and that the insurer “look[ed] forward to continuing to serve as [Sara Care’s] worker’s compensation carrier” in the next policy term. TMI’s agent, The Treiber Group, sent Sara Care a premium quote for the 2002-2003 policy year sometime prior to the 2001-2002 policy’s expiration. However, due to a mis-communication with the insurance agent, Sara Care failed to pay its 2002-2003 premium until August 24, 2002.

In 2002, Martha Martinez was one of Sara Care’s employees. She suffered a work-related injury on August 20, 2002. TMI denied that Sara Care was covered on the date of the injury, and refused to cover Ms. Martinez’s claim. Sara Care paid Ms. Martinez’s medical bills in the amount of $30,020.48. On May 13, 2004, *308 Sara Care filed suit against TMI, alleging the insurer wrongfully denied coverage for Ms. Martinez’s injuries. The employer asserted causes of action for breach of contract, negligence, violations of the Texas Insurance Code, the Texas Deceptive Trade Practices Act, and promissory es-toppel. Following TMI’s original answer, in which it asserted the trial court lacked jurisdiction over the case due to Sara Care’s failure to exhaust its administrative remedies, the parties entered into a Rule 11 agreement, in which they agreed to abate the case in the trial court pending a final decision from the Texas Workers’ Compensation Commission (“the Commission”).

The Commission held a contested case hearing on April 8, 2005. The hearing officer determined: (1) that TMI did not provide workers’ compensation coverage for Sara Care on August 20, 2002; (2) that TMI did not waive its right to contest compensability of the claimed injury; and (3) that Ms. Martinez did not sustain a compensable injury. Sara Care appealed the hearing officer’s decision to the Commission appeals panel. The appeals panel reversed the hearing officer’s decision, finding that due to TMI’s failure to comply with the cancellation or nonrenewal notice requirements of Section 406.008 of the Texas Labor Code, Sara Care’s workers’ compensation coverage under the 2001-2002 policy was extended, and provided coverage on the date Ms, Martinez was injured. The panel noted that on June 6, 2002, the Commission received a notice of intent to cancel or non-renew Sara Care’s policy, and that it was unclear whether this notice was included with TMI’s June 5 letter to Sara Care. Based on this evidence, the panel determined that TMI had not complied with the notice requirements for policy cancellation, and concluded Sara Care’s policy was statutorily extended due to that failure. The appeals panel also determined that TMI waived its right to contest the compensability of Ms. Martinez’s injury by failing to notify the Commission and the claimant of its refusal to provide coverage within the seven-day limitations period of Labor Code Section 409.021. Accordingly, the appeals panel reversed the hearing officer’s decision, and rendered a new decision in Sara Care’s favor.

On July 22, 2005, TMI filed a Petition for Judicial Review of the appeals panel decision in the trial court where the parties had previously agreed to abate the case. In the petition, TMI contested the appeals panel’s findings that Sara Care was covered by its policy on August 20, 2002, and that it waived its right to contest compensability. The parties proceeded with discovery on both Sara Care’s original petition, and TMI’s petition for judicial review until March 2006.

On March 21, 2006, Sara Care filed a hybrid motion for summary judgment, seeking an affirmance of the appeals panel’s decision on both contested issues. In large part, the motion relied on the policy extension provision of Section 406.008, and the lack of evidence that TMI complied with the notice requirements for policy cancellation or nonrenewal. TMI responded primarily, and for the first time, that summary judgment was improper because the basis of the appeals panel decision, Section 406.008 was inapplicable in this case. In the alternative, TMI argued that a fact issue remained regarding its compliance with the statute. Sara Care replied to TMI’s response with numerous objections to the insurer’s summary judgment evidence, and by arguing that TMI had waived the argument that Section 406.008 was not applicable, because the issue was not raised in the administrative proceedings. The trial court sustained Sara Care’s evidentiary objections, and granted *309 Sara Care’s motion on June 13, 2006 (“the preliminary” or “judicial review” summary judgment).

Approximately a month after the trial court’s judicial review summary judgment, Sara Care filed another hybrid summary judgment motion, requesting summary judgment as to TMI’s liability to the employer for the causes of action raised in its original petition. 1 TMI responded with its own hybrid motion for summary judgment, arguing that Sara Care could not establish TMI’s liability as a matter of law. The insurer also moved for summary judgment on the basis that Sara Care’s request for attorney’s fees was legally unsupported. The trial court granted Sara Care’s second motion for summary judgment as to TMI’s liability for breach of contract, violations of the Texas Insurance Code, violations of the Texas DTPA, and promissory estoppel on December 12, 2006. 2 The court also noted that the only fact issues remaining in the case were: (1) whether TMI acted knowingly with respect to its statutory violations; and (2) the amount of attorney’s fees due to the claimants.

The parties proceeded to a bench trial on November 19, 2007. On March 3, 2008, the trial court entered its final judgment in favor of Sara Care.

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Bluebook (online)
324 S.W.3d 305, 2010 Tex. App. LEXIS 7588, 2010 WL 3567094, Counsel Stack Legal Research, https://law.counselstack.com/opinion/texas-mutual-insurance-co-v-sara-care-child-care-center-inc-texapp-2010.