Underwriters Life Insurance Co. v. Cobb

746 S.W.2d 810, 1988 Tex. App. LEXIS 96, 1988 WL 3242
CourtCourt of Appeals of Texas
DecidedJanuary 21, 1988
Docket13-86-456-CV
StatusPublished
Cited by48 cases

This text of 746 S.W.2d 810 (Underwriters Life Insurance Co. v. Cobb) 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
Underwriters Life Insurance Co. v. Cobb, 746 S.W.2d 810, 1988 Tex. App. LEXIS 96, 1988 WL 3242 (Tex. Ct. App. 1988).

Opinion

OPINION

DORSEY, Justice.

The Underwriters Life Insurance Company appeals the judgment for Terrell and Edith Cobb arising from Underwriters’ refusal to pay Edith Cobb’s medical claim under a medical insurance contract. After trial before a jury, the Cobbs recovered $1,088,230.00, including $1,000,000.00 in punitive damages. We order a remittitur of $500,000.00 of exemplary damages, but otherwise affirm.

In 1982, Roy Fowler became an insurance agent for Underwriters. An employee of his, Donovan Cherrette, contacted Terrell and Edith Cobb and persuaded them to cancel their existing medical insurance policy with another company and purchase accident and sickness insurance from Underwriters on August 81, 1982. When Cherrette sold the policy to the Cobbs, he was not licensed to sell insurance in the state.

Mrs. Cobb was hospitalized in 1984 and incurred expenses for medical services covered by the Underwriters policy in the amount of $6,249.69. Underwriters refused to pay her claims on the basis that she had failed to fully disclose her medical history on the policy application. This refusal gave rise to the litigation resulting in this appeal.

According to the Cobbs, Cherrette filled out the insurance application for them after receiving their truthful answers to questions concerning Mrs. Cobb’s medical history. Roy Fowler signed the policy application as agent and forwarded the application to Underwriters, which subsequently issued the policy. The Cobbs testified that Cherrette failed to write on the application the medical information that they had given him concerning Mrs. Cobb’s medical history and that they signed the application without reading it.

The Cobbs sued Underwriters for breach of the insurance contract, breach of the duty of good faith and fair dealing, negligence, and for violations of the Texas Insurance Code and the Deceptive Trade Practices Act. The jury found all issues in favor of the Cobbs, who were awarded damages in the amount of their original claim, $6,249.69, plus a statutory twelve percent penalty under the Insurance Code, $25,000.00 each for mental anguish, $1,000,000.00 in exemplary damages, and attorney’s fees.

*814 In its answers to special issues, the jury found that:

1. (S.I. 1) Donovan Cherrette had authority to deal with the Cobbs on behalf of Underwriters;

2. (S.I. 2, 3, & 4) Underwriters knowingly misrepresented the terms and requirements of its insurance policy to the Cobbs, and that such was the producing cause of damages to the Cobbs;

3. (S.I. 5 & 6) Underwriters refused to pay the Cobb’s claim without conducting a reasonable investigation, and that such refusal was a producing cause of damages;

4. (S.I. 7 & 8) Underwriters failed to act in good faith to effectuate a prompt, fair, and equitable settlement of the plaintiffs’ claims and that such was a producing cause of damages;

5. (S.I. 9) Such a failure was a breach of the duty of good faith and fair dealing and a proximate cause of damages;

6. (S.I. 11) Underwriters failed to instruct, supervise, or scrutinize the character of Fowler and Cherrette and that such constituted negligence and the proximate cause of damages to the Cobbs;

7. (S.I. 14 & 15) Such negligence was an unfair practice in the business of insurance and a producing cause of damages to the Cobbs;

8. (S.I. 16) The conduct found in issues 5, 7, or 11 exhibited such an entire want of care to raise the belief that its conduct was the result of conscious indifference to the rights or welfare of the Cobbs.

By its first four points of error, Underwriters challenges the legal theories supporting the Cobbs’ recovery. By points of error two and three, Underwriters charges that there is no private cause of action by an insured against her insurer for a breach of the duty of good faith and fair dealing for the company’s failure to act in good faith to effectuate a prompt, fair, and equitable settlement.

The Supreme Court has recognized a common law duty of insurers to deal fairly and in good faith with their insureds; a cause of action exists when no reasonable basis for denial of the claim or delay in payment exists, or the insurer fails to determine whether there is any basis for the denial or delay. Arnold, v. National County Mutual Fire Insurance Co., 725 S.W.2d 165 (Tex.1987). Underwriters argues that the Arnold holding is limited and that a suit for breach of this duty may only be brought after a separate suit for breach of the underlying contract has been successful, citing Linkenhoger v. American Fidelity & Casualty Co., 152 Tex. 534, 260 S.W.2d 884, 887 (1953). However, in a footnote in Arnold during a discussion of Linkenhoger, the Supreme Court noted, “This does not mean that a contract claim and a claim of the duty of good faith and fair dealing may not be tried together when possible." Arnold, 725 S.W.2d at 168 n. 1. We find this language persuasive. The doctrine of judicial economy mandates the joinder whenever possible of related claims when it may be done without undue prejudice to the rights of the parties. Points of error two and three are overruled.

By its point of error number one, Underwriters maintains that there is no private cause of action for an insurance company’s failure to conduct a reasonable investigation of a policy claim.

Tex.Ins.Code Ann. art. 21.21, § 16 (Vernon Supp.1987) grants a private right of action to any person who has sustained actual damages as a result of another’s engaging in an act or practice: (1) declared in Section 4 of Article 21.21; (2) declared in rules or regulations lawfully adopted by the State Board of Insurance to be unfair or deceptive acts or practices in the business of insurance; or (8) defined by Section 17.46 of the Business Commerce Code (Deceptive Trade Practices Act).

The Cobbs argue that the State Board of Insurance has adopted rules concerning unfair claims settlement practices by adoption of Board Orders 41060 and 41454, the latter of which in Section 1.003 provides:

*815 “Unfair Claim Settlement Practices. No insurer shall engage in unfair claim settlement practices. Unfair claim settlement practices means committing or performing with such frequency as to indicate a general business practice any of the following: ... (15) Refusing to pay claims without conducting a reasonable investigation based upon all available information.” (Emphasis added).

Chitsey v. National Lloyds Insurance Co., 738 S.W.2d 641, 643 (Tex.1987) held that such a cause of action for damages exists, and the failure to investigate must be done with such frequency as to indicate a general business practice.

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Bluebook (online)
746 S.W.2d 810, 1988 Tex. App. LEXIS 96, 1988 WL 3242, Counsel Stack Legal Research, https://law.counselstack.com/opinion/underwriters-life-insurance-co-v-cobb-texapp-1988.