Justia Insurance Law Opinion Summaries

The Supreme Court held that the Texas Insurance Code does not authorize a private cause of action by a physician against an insurer for payment of claims that accrued prior to 2020 and that Plaintiffs' claims for recovery in quantum merit and for unfair settlement practices failed as a matter of law.In each of the consolidated cases before the Supreme Court, Plaintiffs, groups of emergency medicine doctors outside of an insurer's provider network, brought suit against Defendant, the insurer, alleging that it did not pay them at the usual and customary rates for treating its insureds. Defendant moved for dismissal under Fed. R. Civ. P. 12(b)(6) for failure to state a claim. The district court granted the motion with respect to Plaintiff's implied contract and quantum merit claims and with respect to claims brought under the Emergency Care Statutes. On appeal, the court of appeals certified a question to the Supreme Court. The Supreme Court held (1) the Insurance Code does not create a private cause of action for claims under the Emergency Care Statutes; and (2) with respect to one case, the lower courts did not err in dismissing Plaintiffs' quantum merit and unfair settlement practices claims. View "Texas Medicine Resources, LLP v. Molina Healthcare of Texas, Inc." on Justia Law

In this wrongful death and survival action brought against an automobile insurer, the Supreme Court reversed the judgment of the court of appeals reversing the trial court's judgment in favor of the insurer as to Plaintiff's negligence and gross negligence claims, holding that the court of appeals erred.An insured motorist was involved in a single car accident. The motorist's husband later arrived and began taking photos, but while he was engaged in that activity on the side of the road, he was struck by another vehicle and killed. Plaintiff, the motorist, brought this action alleging that the insurer had instructed her to take the photos and that her husband was complying with that instruction when the other driver hit him. Thus, Plaintiff argued, the insurer proximately caused her husband's death. The trial court granted summary judgment for the insurer on the negligence and gross negligence claims. The court of appeals reversed. The Supreme Court reversed, holding that Defendant did not have a duty to exercise reasonable care in providing post-accident guidance so as not to increase the risk of harm to its insured. View "Elephant Insurance Co., LLC v. Kenyon" on Justia Law

The Supreme Court held that the Texas Workers' Compensation Act (TWCA) does not affect the enforceability of an additional-insured provision under the Texas Anti-Indemnity Act (TAIA).A general contractor's employee injured in an accident obtained a negligence judgment in Texas state court against the subcontractor that operated the crane (Berkel) and the company that leased the crane (Maxim). Berkel was an indemnity and Maxim was an indemnity for TAIA purposes because Berkel had provided Maxim with coverage as an additional insured. After the injured worker settled with Maxim, Maxim unsuccessfully sought reimbursement from Berkel's insurer (Zurich). The court of appeals reversed the judgment against Berkel, concluding that Berkel and the injured worker were "statutory co-employees" of the general contractor under the TWCA, and therefore, the TWCA provided the worker's exclusive remedy. In a separate suit in federal court, Maxim and Zurich disputed over whether the additional-insured coverage was enforceable. The Supreme Court answered a certified question by holding that the word "employee" in Tex. Ins. Code 151.103 bears its common meaning, which is not affected by whether the indemnity and injured employee are considered co-employees for purposes of the TWCA. View "Maxim Crane Works, LP v. Zurich American Insurance Co." on Justia Law

In this insurance coverage dispute presenting two certified questions from the United States Court of Appeals for the Fifth Circuit the Supreme Court held that the Northfield exception to the "eight-corners rule" is permissible under Texas law. See Northfield Insurance Co. v. Loving Home Care, Inc., 363 F,3d 523 (5th Cir. 2004).Plaintiff brought the underlying suit alleging that Insured negligently drilled an irrigation well, damaging Plaintiff's land. Insured demanded a defense from its two liability insurers, BITCO General Insurance Corp., which defended under a reservation of rights, and Monroe Guaranty Insurance Company, which refused to defend. BITCO sued Monroe seeking a declaration that Monroe owed a defense to Plaintiff. The certified questions in this case related to the subsidiary issue of whether Texas law permits consideration of stipulated extrinsic evidence to determine whether the duty to defend exists when the plaintiff's pleading is silent about a potentially dispositive coverage fact. The Supreme Court held (1) the Northfield exception is permissible provided that the extrinsic evidence meets three conditions; and (2) the stipulation offered in this case may not be considered because it overlaps with the merits of liability. View "Monroe Guaranty Insurance Co. v. Bitco General Insurance Corp." on Justia Law

The Supreme Court affirmed the judgment of the court of appeals reversing the judgment of the district court concluding that an automobile-liability insurance policy required the insurer to defend and indemnify the insured against claims for damages arising from an accident involving the use of a "golf cart," holding that the insurer had no duty to indemnify the insured.Plaintiff, acting as next friend of her minor daughter, sued the the Pharr-San Juan-Alamo Independent School District and its employee, alleging that her daughter was severely injured after being thrown from a golf cart. The School District, which had obtained automobile-liability insurance from the Texas Political Subdivisions Property/Casualty Joint Self Insurance Fund, requested that the Insurance Fund provide a defense against Plaintiff's claims and indemnify the School District against liability. The Insurance Fund then brought this suit seeking a declaratory judgment that it had no duty to defend the School District. The trial court entered summary judgment in favor of the School District. The court of appeals reversed. The Supreme Court affirmed, holding that the Insurance Fund had no duty to defend the School District because the term "golf cart" did not refer to a "covered auto" as that term was used in the policy. View "Pharr-San Juan-Alamo Independent School District v. Texas Political Subdivisions Property/Casualty Joint Self Insurance Fund" on Justia Law

The Supreme Court granted in part mandamus relief sought by an insurance carrier from the trial court's order compelling the deposition of the carrier's corporate representative, holding that, under the circumstances, the insured was entitled to depose the carrier's corporate representative on certain matters, but some of the noticed deposition topics exceeded the narrow permissible scope of such a deposition.Frank Wearden, the insured, was involved in an accident and sued USAA General Indemnity, the insurance carrier, for breach of contract and a declaratory judgment seeking to recover benefits under his policy's uninsured/underinsured motorist provisions. Wearden served a notice of intent to take the oral deposition of a USAA corporate representative, listing certain areas the deposition would cover. USAA filed a motion to quash the deposition notice. The trial court denied the motion. The Supreme Court granted mandamus relief, holding (1) the discovery rules did not categorically prohibit the deposition of USAA's corporate representative; (2) the proper subject matter of the deposition is limited to the issues in dispute and may not intrude into matters that are privileged or are beyond the scope of those issues; and (3) with respect to Wearden's deposition topics exceeding that proper scope, the trial court abused its discretion in denying USAA's motion to quash. View "In re USAA General Indemnity Co." on Justia Law

The Supreme Court affirmed the determination of the court of appeals that the Uniform Declaratory Judgments Act (UDJA), Tex. Civ. Prac. & Rem. Code 37.001-.011, can be used to establish an insurance carrier's liability for benefits under an underinsured motorist (UIM) policy, holding that a declaratory judgment action can be used for this purpose.On appeal, the Insurer argued that Insured's use of the UDJA to determine Insured's contract rights and to seek attorney's fees in the UIM case impermissibly dodged the Supreme Court's decision in Brainard v. Trinity Universal Insurance Co., 216 S.W.3d 809 (Tex. 2006). The court of appeals affirmed. The Supreme Court affirmed as well, holding (1) a declaratory judgment in the instant case was the proper remedy for resolving this contractual dispute; and (2) attorney's fees may be recovered under the UDJA under the circumstances. View "Allstate Insurance Co. v. Irwin" on Justia Law

In this insurance dispute, the Supreme Court denied a writ of mandamus compelling the trial court to render judgment in favor of Insurer on the jury's verdict, holding that the trial court did not abuse its discretion in declining to render judgment on the verdict.Insured sought underinsured motorist (UIM) benefits from Insurer. Insurer in this case declined to participate in a jury trial to establish the at-fault motorist's liability and demanded a separate trial on its liability under the UIM policy. Before trial on the UIM claim, the court commenced a jury trial on Insured's negligence claim against the at-fault motorist. The parties settled and the claim was dismissed without rendition of judgment on the jury's verdict. Insurer then argued that a separate trial on the UIM claim was no longer necessary because of the jury's findings and the settlement payment. The trial court denied Insurer's motion for judgment based on the jury verdict from the negligence trial. Insurer sought mandamus relief. The Supreme Court denied relief, holding (1) collateral estoppel did not bind Insured to a verdict that was not reduced to judgment; and (2) Insurer's post-dismissal consent to be bound by the negligence suit's outcome did not make the negligence verdict enforceable against Insured in the contract suit. View "In re USAA General Indemnity Co." on Justia Law

The Supreme Court conditionally granted a petition for a writ of mandamus directing the trial court to vacate its order granting a motion to strike a counteraffidavit served under Tex. Civ. Prac. & Rem. Code 18.001 and precluding the offering party from contesting the reasonableness of the subject medical expenses at trial, holding that the trial court abused its discretion.In granting the motion to strike, the trial court concluded that the counteraffidavit failed to comply with the requirements of section 18.001. The court then prohibited the offering party from testifying regarding the reasonableness and necessity of the medical bills. Petitioner petitioned the Supreme Court for a writ of mandamus. The Supreme Court conditionally granted relief, holding that the trial court erred by striking the counteraffidavit and by granting relief that found no legal basis in section 18.001 for the purported failure to comply with the statute. View "In re Allstate Indemnity Co." on Justia Law

The Supreme Court conditionally granted mandamus relief in these actions challenging rulings on a Rule 91a motion to dismiss, holding that the the trial court abused its discretion in denying Insurer's motion to dismiss Insured's claim for negligent failure to settle.A liability insurer (Insurer) settled claims against its insured (Insured) within policy limits but obtained a release that was contingent on Insured paying a portion of the settlement. Insured paid and then brought this action seeking reimbursement, alleging claims for negligent failure to settle and for breach of contract. Insurer filed a motion to dismiss, which the trial court denied. Insurer sought mandamus relief. The court of appeals granted relief as to the breach of contract claim but concluded that the trial court properly refused to dismiss the claim for negligent failure to settle. Both parties sought mandamus relief. The Supreme Court conditionally granted mandamus relief to both parties, holding (1) the trial court abused its discretion in denying Insurer's motion to dismiss Insured's Stowers claim for negligent failure to settle; and (2) the court of appeals erred in ordering the trial court to dismiss Insured's claim for breach of the contractual obligation to indemnify. View "In re Farmers Texas County Mutual Insurance Co." on Justia Law