the Aetna Casualty & Surety Company v. Texas Workers' Compensation Insurance Facility

CourtCourt of Appeals of Texas
DecidedApril 2, 1998
Docket03-97-00285-CV
StatusPublished

This text of the Aetna Casualty & Surety Company v. Texas Workers' Compensation Insurance Facility (the Aetna Casualty & Surety Company v. Texas Workers' Compensation Insurance Facility) 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
the Aetna Casualty & Surety Company v. Texas Workers' Compensation Insurance Facility, (Tex. Ct. App. 1998).

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN




NO. 03-97-00285-CV

The Aetna Casualty & Surety Company, Appellant


v.



Texas Workers' Compensation Insurance Facility, Appellee



FROM THE DISTRICT COURT OF TRAVIS COUNTY, 353RD JUDICIAL DISTRICT

NO. 95-04437, HONORABLE PETE LOWRY, JUDGE PRESIDING

The Aetna Casualty and Surety Company appeals from a declaratory judgment favoring the Texas Workers' Compensation Insurance Facility. The Facility sought the judgment after Aetna requested indemnification from the Facility for sums Aetna paid to defend and to settle Jane Craft's claims that Aetna mishandled her workers' compensation claim. The judgment declares the indemnification provision in the servicing agreement between Aetna and the Facility "unenforceable as to bad faith, gross negligence, punitive damages, and other matters asserted in the underlying lawsuit" by Craft. Aetna contends by three points of error the trial court should have declared the provision valid, enforceable, and applicable. We will affirm the judgment.

BACKGROUND

The relationship of Aetna and the Facility

The Facility is a private association created by the State to provide workers' compensation insurance to those otherwise unable to obtain that insurance. It is the successor to the Texas Workers' Compensation Assigned Risk Pool. All providers of workers' compensation insurance were required to join the Pool and the Facility. See former Tex. Ins. Code Ann. art. 5.76-2, § 2.01. (1) The member insurance companies reinsure policies the Facility issues. Their liability is determined by their share of the workers' compensation market. Id. at § 4.02(b).

Though Aetna is a Facility member by statutory requirement, it is a servicing company by contract. The Pool and Facility contracted with companies, including member insurers, to service the policies sold. See id. at § 4.08. The servicing-company agreement and the Pool bylaws in effect when Aetna became a servicing company call for the servicing companies to receive a share of premiums in exchange for issuing policies in their names and processing claims. The agreement classifies Aetna as an independent contractor that "retains the right to control the means, manner and details of fulfilling its obligations under this Agreement." It obligates Aetna to bear all costs and expenses incident to servicing the policies except "authorized legal expenses." The agreement calls for Aetna to be indemnified as set forth in the following Pool bylaws:



Any person or insurer made or threatened to be made a party to any action, suit, or proceeding, because such person or insurer was a member, or a servicing carrier . . . shall be indemnified against all judgments, fines, amounts paid in settlement, reasonable costs and expenses including attorney's fees and any other liabilities that may be incurred as a result of such action, suit or proceeding . . . except in relation to matters as to which he or it shall be adjudged in such action, suit or proceeding to be liable by reason of willful misconduct in the performance of his or its duties or obligations to the Agency . . . . If any such action, suit or proceeding is compromised, it must be with the approval of the Governing Committee of the Agency.



. . .



In each instance in which a question of indemnification arises, entitlement thereto, pursuant to the conditions set forth herein, shall be determined by the Governing committee which shall also determine the time and manner of payment of such indemnification; provided, however, that a person or insurer who or which has been wholly successful, on the merits or otherwise, in the defense of a civil or criminal action, suit or proceeding of the character herein above described, shall be entitled to indemnification as authorized herein.



Despite the bylaw requiring governing committee approval of settlements, in practice, servicing companies handled litigation as they saw fit, including payments pursuant to settlement agreements. If they applied for reimbursement, the Facility assessed the merits of the claim. The Facility reimbursed some servicing carriers for defending and settling bad-faith claims the Facility deemed lacking in merit.



Trial-court action

This case was tried on stipulated facts. Craft was hurt in April 1989, in the course and scope of her employment at Hidden Oaks, when a desk collapsed and seriously injured her foot. Hidden Oaks had a workers' compensation policy through the Facility. Aetna was the servicing company for her claim.

Aetna's decision not to settle the claim early was costly. Though Aetna initially made weekly compensation and medical-benefits payments to Craft, it stopped and refused to resume. Aetna rejected Craft's offer to settle for $15,000 and two years of medical benefits. The Industrial Accident Board awarded Craft compensation for her injuries and lifetime medical benefits. Aetna appealed. A jury found Craft totally and permanently disabled and awarded her 401 weeks of compensation and lifetime medical benefits for treatment of her injuries. Craft then sued Aetna, alleging deceptive trade practices, failure to process the claim in good faith, and similar misdeeds. Although Aetna claims it had a tenable defense, it settled with Craft for $1.5 million because it feared further legal expenses. Pursuant to a standard practice, Aetna settled the case without consulting the Facility's governing committee.

Aetna requested the Facility to indemnify Aetna for the $1.5 million settlement plus $1,062,117.73 in attorney's fees incurred in defending the suit. The Facility denied the request on grounds that Aetna violated its duty of good faith and fair dealing and committed gross negligence in handling Craft's claim.

The Facility filed the present suit for declaratory judgment that Aetna is not entitled to indemnity on five grounds. Without citing a particular ground, the trial court held the indemnity provision "is unenforceable as to bad faith, gross negligence, punitive damages, and the other matters asserted" in Craft's suit.



DISCUSSION

By three points of error, Aetna contends the trial court erred in rendering judgment for the Facility. Aetna contends the court erred by holding the indemnity clause unenforceable and argues the Facility's suit for declaratory judgment was at least partly barred by res judicata or collateral estoppel.

Aetna's first two points of error are opposite sides of the same issue: whether the trial court should have required the Facility to indemnify Aetna for the payment and attorney's fees incurred in defending and settling Craft's claims of bad faith, gross negligence, and violations of the Deceptive Trade Practices Act and Insurance Code. Because the trial court did not specify the basis of its judgment, we must affirm the judgment if any of the grounds the Facility asserted supports the judgment. See Rogers v. Ricane Enterprises

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