NANCY K. JOHNSON, United States Magistrate Judge.
Plaintiff Karen England ("Plaintiff") filed the present action against Liberty Insurance Corporation, Liberty Mutual Insurance Company ("Defendant"), and Linda Evans ("Evans"), alleging four causes of action predicated on a bad faith delay or denial of benefits: (1) violation of the Texas Insurance Code ("Insurance Code"); (2) violation of the Deceptive Trade Practices Act ("DTPA"); (3) breach of the common law duty of good faith and fair dealing; and (4) punitive damages for bad faith.
Plaintiff filed this action against Liberty Insurance Company and Linda Evans in state court on April 19, 2010.
With the court's leave, Plaintiff filed her First Amended Complaint, which added Liberty Mutual Insurance Company as a defendant in the suit, on October 7, 2010.
Defendant filed the pending motion for summary judgment on May 6, 2011.
Plaintiff, an employee of Insurance Services Office, Inc. (ISO)
A magnetic resonance imaging scan ("MRI") conducted at Seton Northwest Hospital on March 1, 2008, confirmed Dr. Lay's diagnosis of a herniated disc and showed advanced degenerative disc disease of the lower spine.
Plaintiff retained counsel on or about March 16, 2008, and filed an Employee's Claim for Compensation for Work-Related Injury or Occupational Disease form ("DWC Form-041") with the Texas Department of Insurance's Division of Workers' Compensation ("DWC") two days later, on March 18, 2008.
On referral from Dr. Lay, Plaintiff had an orthopedic consultation with Dr. Marshall on April 14, 2008.
Following Defendant's denial of benefits, Plaintiff returned to Dr. Marshall on May 12, 2008, on which date Dr. Marshall recommended that Plaintiff undergo a surgical discectomy of her L4-5 vertebrae.
On June 9, 2008, having obtained additional medical records regarding Plaintiff's claimed injury, Defendant accepted Plaintiff's workers' compensation claim as to Plaintiff's "Lumbar Sprain/Strain" and awarded benefits from March 11, 2008, until Plaintiff began a new job on June 14, 2008.
Three months later, on September 8, 2008, a second Designated Doctor, Richard Neel, M.D., ("Dr. Neel"), examined Plaintiff.
Over a year after Plaintiff sustained her injury, on March 10, 2009, the parties entered into a Benefit Dispute Agreement ("BDA"), agreeing that Plaintiff's "compensable injury of 2/20/08, consisting of a lumbar strain/sprain, extends to include a herniated disc at the L4-5 level."
Summary judgment is warranted when the evidence reveals that no genuine dispute exists regarding any material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986); Brown v. City of Houston, Tex., 337 F.3d 539, 540-41 (5th Cir.2003). A material fact is a fact that is identified by applicable substantive law as critical to the outcome of the suit. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Ameristar Jet Charter, Inc. v. Signal Composites, Inc., 271 F.3d 624, 626 (5th Cir.2001). To be genuine, the dispute regarding a material fact must be supported by evidence such that a reasonable jury could resolve the issue in favor of either party. Anderson, 477 U.S. at 250, 106 S.Ct. 2505; TIG Ins. Co. v. Sedgwick James of Wash., 276 F.3d 754, 759 (5th Cir.2002).
The movant must inform the court of the basis for the summary judgment motion and must point to relevant excerpts from pleadings, depositions, answers to interrogatories, admissions, or affidavits that demonstrate the absence of genuine factual issues. Celotex Corp., 477 U.S. at 323, 106 S.Ct. 2548; Topalian v. Ehrman, 954 F.2d 1125, 1131 (5th Cir.1992). If the moving party can show an absence of record evidence in support of one or more elements of the case for which the nonmoving party bears the burden, the movant will be entitled to summary judgment. Celotex Corp., 477 U.S. at 322, 106 S.Ct. 2548. In response to a showing of lack of evidence, the party opposing summary judgment must go beyond the pleadings and proffer evidence that establishes each of the challenged elements of the case, demonstrating that genuine issues of material fact do exist that must be resolved at trial. Id. at 324, 106 S.Ct. 2548.
When considering the evidence, "[d]oubts are to be resolved in favor of the nonmoving party, and any reasonable inferences are to be drawn in favor of that party." Evans v. City of Houston, 246 F.3d 344, 348 (5th Cir.2001); see also Boston Old Colony Ins. Co. v. Tiner Assocs. Inc., 288 F.3d 222, 227 (5th Cir.2002). The court should not "weigh evidence, assess credibility, or determine the most reasonable inference to be drawn from the evidence."
However, the nonmoving party must show more than "some metaphysical doubt as to the material facts." Meinecke v. H & R Block of Houston, 66 F.3d 77, 81 (5th Cir.1995). Conclusory allegations, unsubstantiated assertions, improbable inferences, unsupported speculation, or only a scintilla of evidence will not carry this burden. Brown, 337 F.3d at 541; Ramsey v. Henderson, 286 F.3d 264, 269 (5th Cir. 2002). The court must grant summary judgment if, after an adequate period of discovery, the nonmovant fails "to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex Corp., 477 U.S. at 322, 106 S.Ct. 2548.
Plaintiff identified the following causes of action in her amended complaint: (1) breach of the duty of good faith and fair dealing; (2) violations of §§ 541.060(a)(2)(A), 541.060(a)(7), 541.061(1)(3), 541.002(1) of the Insurance Code; (3) violation of the DTPA; and (4) punitive damages for bad faith. Defendant seeks summary judgment in its favor on all of Plaintiff's claims. Defendant contends that: (1) Plaintiff failed to exhaust administrative remedies in challenging the denial of workers' compensation benefits; (2) certain statutory claims made by Plaintiff under the Insurance Code do not authorize private causes of action; (3) Plaintiff has produced no evidence of misrepresentations made by Defendant to Plaintiff; (4) the existence of a bona fide dispute over the compensability and the extent of Plaintiff's injury precludes bad-faith liability for Plaintiff's statutory and common law claims; and (5) Plaintiff did not suffer an injury independent of her compensable injury. The parties agree that Texas law is applicable to the present dispute. The court considers the merits of Defendant's motion.
Defendant argues that the court lacks jurisdiction over Plaintiff's claims because Plaintiff failed to exhaust administrative remedies through the DWC. The court considered the same argument in Defendant's Motion to Dismiss for Lack of Subject Matter Jurisdiction and denied the motion on August 12, 2011, 2011 WL 3567084. Defendant presents no additional facts for the court's consideration in the present motion. Therefore, summary judgment is denied for the same reasons the motion to dismiss was denied.
Sections 541.060 and 542.003 of the Insurance Code define and prohibit unfair settlement practices by an insurer "with respect to a claim by an insured." Tex. Ins. Code § 541.060(a); see also Tex. Ins. Code § 542.003 (prohibiting unfair claim settlement practices). Relevant to Plaintiff's claims, § 541.060 prohibits an insurer from:
Tex. Ins. Code §§ 541.060(a)(2)(A), (a)(3), (a)(7). Section 542.003, for purposes of this suit, specifies that an insurer's "fail[ure] to adopt and implement reasonable standards for the prompt investigation of claims arising under the insurer's policy" constitutes an unfair claim settlement practice under the Insurance Code. Tex. Ins. Code § 542.003(b)(3).
In Defendant's supplement to its motion for summary judgment, Defendant cites the Texas Supreme Court's recent decision in Tex. Mut. Ins. Co. v. Ruttiger, ___ S.W.3d ___, 2011 WL 3796353 (Tex. 2011)
The insurer initially denied Ruttiger's claim on the ground that the injury was not sustained at work. Id. at ___ - ___, at *1-2. About three months after the denial, Ruttiger requested a Benefits Review Conference and the parties entered into a BDA. Id. at ___, at *2. The parties agreed that Ruttiger had sustained a compensable injury and, upon the approval of the agreement by the DWC, the insurer paid benefits to Ruttiger, including temporary income, surgery, and associated medical expenses, for the agreed period of disability. Id. Ruttiger alleged, inter alia, that the insurer violated the Insurance Code by failing to: (1) employ reasonable standards for promptly investigating claims; (2) conduct a reasonable investigation; (3) provide a reasonable explanation for denial of the claim; and (4) effect a prompt, equitable settlement of the claim when liability was reasonably clear. Id. at ___, at *3; see Tex. Ins. Code §§ 541.060(a)(2)(A), (a)(3), (a)(7); Tex. Ins. Code §§ 541.003(b)(3).
The Texas Supreme Court considered Ruttiger's claims under §§ 541.060 and 541.002 of the Insurance Code in light of the procedures and provisions detailed by the amended Texas Workers' Compensation Act ("TWCA") and the DWC.
Here, Plaintiff asserts various violations of § 541.060 and § 542.003 of the Insurance Code.
Under the Insurance Code, an insurer commits an unfair or deceptive act or practice when it misrepresents an insurance policy by:
Tex. Ins. Code § 541.061. Defendant argues that Plaintiff has no evidence to support her claim that Defendant misrepresented its insurance policy in violation of § 541.061 of the Insurance Code.
In support of her misrepresentation claim, Plaintiff alleges that:
As the court understands these allegations, Plaintiff asserts that Defendant's denial of Plaintiff's workers' compensation claim constituted a material misrepresentation of
As pled in her amended complaint, Plaintiff alleged that "Defendants' violations of the Texas Insurance Code create a cause of action under the DTPA." As in Ruttiger, the viability of Plaintiff's DTPA claims hinge on Defendant's violation of the Insurance Code. See ___ S.W.3d at ___, 2011 WL 3796353 at *14. Because Plaintiff cannot recover on her Insurance Code claims, her contingent DTPA claims must necessarily fail. Summary judgment in favor of Defendant is thus granted as to Plaintiff's DTPA claims.
For over twenty years, Aranda v. Ins. Co. of North America, 748 S.W.2d 210, 215 (Tex.1988), has allowed employees to assert claims for the breach of the duty of good faith and fair dealing against workers' compensation insurers. Defendant argues that the Texas Supreme Court's recent decision in Ruttiger, however, calls the holding of Aranda into question. See Ruttiger, ___ S.W.3d at ___ - ___, 2011 WL 3796353 at *14-19. The court first considers the potential effect of Ruttiger on claims of this type.
In addition to resolving the incompatibility between provisions of the Insurance Code and the amended TWCA, the Texas Supreme Court addressed the continued viability of the extra-statutory cause of action accorded to workers' compensation claimants by Aranda. See Ruttiger, ___ S.W.3d at ___, ___ - ___, 2011 WL 3796353 at *1, *14-23; id. at ___ - ___, at 26-27 (Jefferson, J., dissenting). Seven of the nine Texas Supreme Court justices were willing to consider "whether Aranda should be overruled even though the court of appeals did not reach the issues involving the cause of action for breach of the duty of good faith and fair dealing." Id. at ___, at *1. The two remaining justices declined to consider the issue until it could first be addressed by the court of appeals. See id. at ___, at *23 (Willett, J., concurring). Of the seven justices willing to consider the Aranda issues raised in Ruttiger's claims, four would overrule Aranda while three would not. See id. at ___, at *1.
In Aranda, the Texas Supreme Court held that an employee may assert a cause of action outside of the dispute resolution procedures established by the TWCA against a workers' compensation insurer for a breach the duty of good faith and fair dealing. 748 S.W.2d at 212-13. That
The three dissenting justices, on the other hand, contended that the Legislature did not intend "to abrogate entirely a common law bad faith remedy when it enacted the [TWCA]," but instead intended merely to limit such suits in the workers' compensation system. Id. at ___, at *26. Supporting this position, the dissenters cited § 416.001 of the TWCA, which provides that:
Tex. Lab.Code § 416.001; see Ruttiger, ___ S.W.3d at ___, 2011 WL 3796353 at *26. The logical inference from § 416.001, the justices asserted, was that certain other claims against an insurer for the breach of the duty of good faith and fair dealing remained available to workers' compensation claimants. Ruttiger, ___ S.W.3d at ___, 2011 WL 3796353 at *26. The justices noted that the TWCA limited exemplary damages "[i]n an action against an insurance carrier for a breach of the duty of good faith and fair dealing," thus suggesting that other damages were available for such claims. Tex. Lab.Code § 416.002(b); see Ruttiger, ___ S.W.3d at ___, 2011 WL 3796353 at *26. These provisions, in conjunction with inferences drawn by the dissenting justices from the plain language of the TWCA, militated against overruling Aranda. Ruttiger, ___ S.W.3d at ___ - ___, 2011 WL 3796353 at *26-27.
The justices in favor of overruling Aranda conceded that the language of the TWCA provisions cited by the dissenters indicated a clear intent of the Legislature to limit Aranda claims. Id. at ___, at *20. Considering the dissenters' analysis, however, they stated that the dissenters went beyond the plain language of the TWCA, arguing that "the absence of language abolishing the Aranda action does not reflect legislative intent to do the opposite and keep it available to litigants." Id. at ___ at *22. The four justices concluded by noting that it was the Texas Supreme Court's prerogative to determine whether the common law claim under Aranda remained viable given the Legislature's revamping of the TWCA and its "continual supervision, monitoring, improving, and managing of the [workers' compensation] system." Id. at ___, at *23.
Under Texas law, a workers' compensation insurer owes its insured's employees a duty to deal fairly and in good faith in processing claims. Higginbotham v. State Farm Mut. Auto. Ins. Co., 103 F.3d 456, 459 (5th Cir.1997) (applying Texas law); (extending Arnold v. Nat'l County Mut. Fire Ins. Co., 725 S.W.2d 165, 167 (Tex.1987) to the workers' compensation system). Whether raised under the DTPA and the Insurance Code or under Texas common law, the insurer's duty is the same. See id. at 460. The insurer breaches this duty in denying a claim if "the insurer knew or should have known that it was reasonably clear that the claim was covered." U.S. Fire Ins. Co. v. Williams, 955 S.W.2d 267, 268 (Tex.1997). Even if the insurer is found to be wrong in denying a claim, it may not be liable for bad faith if it can establish the existence of a bona fide dispute. Id. Whether an insurer has a reasonable basis for a denial is to be judged according to the facts before the insurer at the time. Harbor Ins. Co. v. Urban Constr. Co., 990 F.2d 195, 202 (5th Cir.1993) (applying Texas law); Viles v. Sec. Nat'l Ins. Co., 788 S.W.2d 566, 567 (Tex.1990). In order to support a claim of bad faith, the insured must offer evidence that the insurer had no facts to support a denial. Higginbotham, 103 F.3d at 459.
Within the insurer's duty to deal fairly and in good faith falls the obligation to "reasonably investigate a claim." Universe Life Ins. Co. v. Giles, 950 S.W.2d 48, 56 n. 5 (Tex.1997). That is to say, if a full, unbiased investigation would have made coverage reasonably clear, the insurer cannot avoid bad faith liability by conducting an outcome determinative investigation. See id. ("[a]n insurer will not escape liability merely by failing to investigate a claim so that it can contend that liability was never reasonably clear.").
Defendant in this case argues the existence of a bona fide dispute as to the compensability and extent of Plaintiff's injury on the ground that there was no evidence that the injury was work-related when it denied benefits. In support, Defendant first directs the court's attention to summary judgment evidence of: (1) Plaintiff's failure to immediately report her alleged work-related injury to her employer,
In response, Plaintiff argues that Defendant failed to conduct a reasonable investigation and created a bona fide dispute
The summary judgment evidence shows that on or about April 18, 2008, ten days before its denial of benefits, Defendant was aware that Plaintiff had been treated by health care providers other than Dr. Marshall since the date of the alleged injury.
Given this evidence, the court finds that questions of fact exist as to whether Defendant breached its duty of good faith and fair dealing by failing to conduct a reasonable investigation, including: (1) whether Defendant acted reasonably in failing to obtain medical records of Plaintiff's injury under § 408.025(d) of the TWCA when it knew such records existed; and (2) whether Defendant acted reasonably in relying on the limited information in its possession when it knew about the existence of additional records. Because the viability of Defendant's claim of a bona fide dispute hinges on these fact questions, summary judgment on this ground is denied.
In a claim against an insurer for the breach of the duty of good faith and fair dealing, a workers' compensation claimant may recover damages for injuries independent of the compensable injury. Aranda, 748 S.W.2d at 214 ("A claimant is permitted to recover when he shows that the carrier's breach of the duty of good faith and fair dealing or the carrier's intentional act is separate from the compensation claim and produced an independent injury."); see United Serv. Auto. Ass'n v. Gordon, 103 S.W.3d 436, 442 (Tex.App.-San Antonio 2002, no pet.) ("An insured is not entitled to recover extra-contractual damages unless the complained of actions or omissions cause injury independent of the injury resulting from a wrongful denial of policy benefits.").
An exacerbation of the original compensable injury, or an injury stemming directly therefrom, does not constitute a recoverable independent injury for the breach of the duty of good faith and fair dealing. See Hulshouser v. Tex. Workers' Comp. Ins. Fund, 139 S.W.3d 789, 793 (Tex.App.-Dallas 2004, no pet.). Rather,
Here, Defendant argues that Plaintiff cannot sustain a claim for breach of the duty of good faith and fair dealing because she has offered no evidence of having sustained an injury independent of her compensable injury. In response, Plaintiff offers summary judgment evidence in the form of deposition and affidavit testimony that, as a direct result of Defendant's conduct, Plaintiff sustained independent injuries recoverable under the common law, including damages to her credit reputation and mental anguish.
The court finds that Plaintiff's evidence is sufficient to raise a fact dispute as to the existence and extent of independent injuries sustained as a result of Defendant's conduct.
Based on the foregoing, the court