the United Healthcare Choice Plus Plan for City of Austin Employees and the City of Austin v. Charles Lesniak

Court of Appeals of Texas·Decided July 15, 2015·No. 03-15-00309-CV·Published

Opinion

ACCEPTED

03-15-00309-CV

6070665

THIRD COURT OF APPEALS

AUSTIN, TEXAS

7/15/2015 9:39:20 AM

JEFFREY D. KYLE

CLERK

No. 03-15-00309-CV

FILED IN

3rd COURT OF APPEALS

IN THE THIRD COURT OF APPEALS AUSTIN, TEXAS IN AUSTIN, TEXAS 7/15/2015 9:39:20 AM ____________________ JEFFREY D. KYLE Clerk

City of Austin and The United Healthcare Choice Plus Plan for City of Austin Employees

Appellants,

v.

Charles Lesniak

Appellee

On Appeal From the 419th District Court, Travis County, Texas

APPELLEE BRIEF

James C. Plummer (16075700)

Amar Raval (24046682)

Plummer | Raval

4203 Montrose Blvd., Suite 270 Houston, TX 77006

(713) 522-2887

(713) 522-3605 Fax

jplummer@plummerlawyers.com araval@plummerlawyers.com

COUNSEL FOR APPELLEE CHARLES LESNIAK ORAL ARGUMENT REQUESTED

IDENTITIES OF PARTIES AND COUNSEL City of Austin Appellant

Andralee Cain Lloyd (24071577) Megan Mosby (24073392) City of Austin - Law Department P.O. Box 1546 Austin, TX 78767-1546 (512) 974-2918 andralee.lloyd@austintexas.gov megan.mosby@austintexas.gov Counsel for Appellant

The United Healthcare Choice Plus Plan for City of Austin Employees Appellant

Andrew G. Jubinsky (11043000) Lance V. Clack (24040694) Figari & Davenport, LLP 901 Main St., Suite 3400 Dallas, TX 75202 (214) 939-2000 andy.jubinsky@figdav.com lance.clack@figdav.com Counsel for Appellant

Charles Lesniak Appellee

James C. Plummer (16075700) Amar Raval (24046682) Plummer | Raval 4203 Montrose Blvd., Suite 270 Houston, TX 77006 (713) 522-2887 jplummer@plummerlawyers.com araval@plummerlawyers.com Counsel for Appellee

i

TABLE OF CONTENTS

Page

IDENTITIES OF PARTIES AND COUNSEL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . i INDEX OF AUTHORITIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii STATEMENT OF THE CASE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v STATEMENT REGARDING ORAL ARGUMENT. . . . . . . . . . . . . . . . . . . . . . . . v STATEMENT OF FACTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ARGUMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Standard of Review:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Issue 1: Providing health insurance to city employees is a purely proprietary function for which governmental immunity does not exist. . . . . 3

Issue 2: Governmental Immunity was Waived by T EXAS L OCAL G OVT C ODE §271.152. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

PRAYER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 CERTIFICATE OF SERVICE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 CERTIFICATE OF COMPLIANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

ii

INDEX OF AUTHORITIES

Pages

Bailey v. City of Austin 972 S.W.2d 180, 192-93 (Tex.App.-Austin 1998, pet. denied). . . . . . . . . . . . . . . 5,7

Ben Bolt-Palito Blanco Consol. Indep. Sch. Dist. v. Texas Political Subdivisions Prop. 212 S.W.3d 320 (Tex. 2006). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,12

City of El Paso v. Henrich 284 S.W.3d 366, 371-72 (Tex. 2009). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,4

City of Galveston v. Posnainsky 62 Tex. 118 (1884).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

City of Georgetown v. Lower Colorado River Authority 413 S.W.3d 803, 811 (Tex.App.-Austin 2013, pet. dism’d). . . . . . . . . . . 5,13,14,15

City of Houston v. Williams 353 S.W.3d 128, 134 (Tex. 2011). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,7

City of Terrell v. McFarland 766 S.W.2d 809, 813 (Tex.App.-Dallas 1988, writ denied). . . . . . . . . . . . . . . . . . . 4

City of Mexia v. Tooke 197 S.W.3d 328 (Tex. 2006). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,5,6,12,13,14

Dillard v. Austin Indep. Sch. Dist. 806 S.W.2d 589, 594-595 (Tex.App.-Austin 1991, writ denied). . . . . . . . . . . . . . . 4

East Houston Estate Apartments, L.L.C. v. City of Houston 294 S.W.3d 723, 731-32 (Tex.App.-Houston [1st Dist.] 2009, no pet.).. . . . . . . . . . 5

Entergy Gulf States, Inc. v. Summers 282 S.W.3d 433, 437 (Tex. 2009). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

First Am. Title Ins. Co. v. Combs iii 258 S.W.3d 627, 631-32 (Tex. 2008). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Foster v. Teacher Ret. Sys. 273 S.W.3d 883, 886 (Tex.App.-Austin 2008, no pet.). . . . . . . . . . . . . . . . . . . . . . 11

Gates v. City of Dallas 704 S.W.2d 737, 738-39 (Tex. 1986). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Gay v. City of Wichita Falls 2014 WL 393141 (Tex.App.-El Paso Aug. 13, 2014, no pet.). . . . . . . . . . . . . 12,13

Houston Mun. Empls. Pension Sys. v. Ferrell 248 S.W.3d 151 (Tex. 2007). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Richardson Hosp. Auth. v. Duru 387 S.W.3d 109, 113 (Tex.App-Dallas 2012, no pet.). . . . . . . . . . . . . . . . . . . . . . 11

Texas Dept. of Parks and Wildlife v. Miranda 133 S.W.3d 217, 226 (Tex. 2004). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Tex. Natural Res. Conservation Comm’n v. IT-Davy 74 S.W.3d 849, 854 (Tex. 2002). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

VanDevender v. Woods 222 S.W.3d 430, 433 (Tex.2007).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

STATUTES T EX. INS. C ODE §1575. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 T EX. L OCAL G OVT. C ODE §51.075. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 T EX. L OCAL G OVT. C ODE §271.152. . . . . . . . . . . . . . . . . . . 7,8,9,10,11,12,13,14,15 T EX. L OCAL G OVT. C ODE §271.151. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,8,9 T EX. L OCAL G OVT. C ODE §271.158. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

iv

STATEMENT OF THE CASE

This is an interlocutory appeal of a denial of a plea to the jurisdiction. The suit involves the denial of medical treatment at an eating disorder facility for the dependent of a City of Austin employee. Appellants City of Austin and The United Healthcare Choice Plus Plan for City of Austin Employees contend that governmental immunity shields them both from suit and liability. Appellee contends that governmental immunity does not exist or has been waived by statute.

STATEMENT REGARDING ORAL ARGUMENT

Appellee believes that oral argument will be helpful to the Court because (a) this case involves a claim for benefits under the City of Austin’s health benefit plan, with technical terms that may require assistance from counsel, and (b) the Court will be able to question Appellants on their position that City of Austin employees should have no access to the judicial system if their health insurance claims are denied.

v

STATEMENT OF FACTS

1. This is a lawsuit for health benefits by a City of Austin employee against the City of Austin (“Austin”) and the United HealthCare Choice Plan for City of Austin Employees (“Plan”). Mr. Lesniak works for Austin as an environmental policy program manager. C.R. 186. He enrolled in the Plan in 2013 and 2014 to obtain health insurance for himself and his eligible dependents. Id.

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Related

Texas Department of Parks & Wildlife v. Miranda
133 S.W.3d 217 (Texas Supreme Court, 2004)
VanDevender v. Woods
222 S.W.3d 430 (Texas Supreme Court, 2007)
Houston Municipal Employees Pension System v. Ferrell
248 S.W.3d 151 (Texas Supreme Court, 2007)
First American Title Insurance Co. v. Combs
258 S.W.3d 627 (Texas Supreme Court, 2008)
Entergy Gulf States, Inc. v. Summers
282 S.W.3d 433 (Texas Supreme Court, 2009)
The City of El Paso v. Lilli M. Heinrich
284 S.W.3d 366 (Texas Supreme Court, 2009)
The City of Houston v. Steve Williams
353 S.W.3d 128 (Texas Supreme Court, 2011)
Texas Natural Resource Conservation Commission v. IT-Davy
74 S.W.3d 849 (Texas Supreme Court, 2002)
Tooke v. City of Mexia
197 S.W.3d 325 (Texas Supreme Court, 2006)
City of Terrell v. McFarland
766 S.W.2d 809 (Court of Appeals of Texas, 1988)
Dillard v. Austin Independent School District
806 S.W.2d 589 (Court of Appeals of Texas, 1991)
East Houston Estate Apartments, L.L.C. v. City of Houston
294 S.W.3d 723 (Court of Appeals of Texas, 2009)
Foster v. Teacher Retirement System
273 S.W.3d 883 (Court of Appeals of Texas, 2008)
Gates v. City of Dallas
704 S.W.2d 737 (Texas Supreme Court, 1986)
Bailey v. City of Austin
972 S.W.2d 180 (Court of Appeals of Texas, 1998)
City of Georgetown, Texas v. Lower Colorado River Authority
413 S.W.3d 803 (Court of Appeals of Texas, 2013)
Richardson Hospital Authority v. Pacidus Nnamdi Duru
387 S.W.3d 109 (Court of Appeals of Texas, 2012)
City of Galveston v. Posnainsky
62 Tex. 118 (Texas Supreme Court, 1884)