Yvonne Cooper v. St. Paul Fire and Marine Insurance Company and Texas Mutual Insurance Company

Citation: Not availableDocket: 07-05-00373-CV

Court: Court of Appeals of Texas; June 28, 2006; Texas; State Appellate Court

Original Court Document: View Document

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Yvonne Cooper appealed the denial of her summary judgment and the granting of summary judgments in favor of St. Paul Fire and Marine Insurance Company and Texas Mutual Insurance Company. Cooper sustained a back injury in 1994 while working for NTS Communications, for which Texas Mutual provided workers' compensation benefits. After a second injury in 1996, while St. Paul was the insurer, Cooper filed a second claim. Texas Mutual contested responsibility for the medical expenses related to the second injury, asserting that St. Paul should cover them. Following a benefits review conference, a benefits review officer determined that the 1994 injury was not the cause of Cooper's current back condition, assigning responsibility for the medical expenses to St. Paul.

St. Paul sought a contested case hearing, which concluded that the 1996 injury was indeed a producing cause of Cooper's condition. St. Paul’s appeal to the commission's appeals panel upheld the contested case hearing officer’s decision. St. Paul then sought judicial review, resulting in a jury trial in September 2004. The jury affirmed that Cooper had a 1996 injury but determined that her current back condition was neither solely due to the 1994 injury nor a result of the 1996 injury. Consequently, the trial court ruled in favor of St. Paul, denying Cooper’s request for attorney fees.

Cooper filed counterclaims against St. Paul and Texas Mutual, alleging bad faith, violations of the Deceptive Trade Practices Act (DTPA), and breaches of the Texas Insurance Code, claiming the companies misrepresented an aggravation of his injury and colluded to withhold payment for medical expenses pending trial. These counterclaims were severed from St. Paul's jury trial and abated until its conclusion. Following the jury's verdict, the trial court consolidated Cooper's counterclaims with the previous case and held a hearing on summary judgment motions. The court ruled in favor of St. Paul, granting summary judgment to the insurance companies and denying Cooper's motion for summary judgment.

Cooper raised seven issues on appeal, including the trial court's errors in awarding judgment based on the jury's verdict, denying his motion for attorney fees, granting summary judgment for the insurance companies, excluding evidence, and denying his motion to compel disclosure of an agreement letter between the companies. Cooper argues that if the appeal is remanded, the excluded evidence should be admitted. The trial court's duty is to align its judgment with the jury's answers, and when jury findings are ambiguous, the court can interpret them to uphold the judgment. Cooper contends the trial court misinterpreted the jury's verdict, asserting that St. Paul should not have been absolved of liability given the jury's determination regarding the cause of his back condition. However, the case he references does not support his claim that an insurance carrier is liable for subsequent injuries unless the prior injury is shown to be the sole cause.

The Supreme Court determined that the jury should have been allowed to assess liability in the case. The jury concluded that Cooper's back condition was neither solely caused by the 1994 injury nor a result of the 1996 injury. Consequently, Texas Employers is not applicable because the jury's determination specifically indicated the 1996 injury did not cause Cooper's condition. Despite possible ambiguities in the jury's answers, the trial court harmonized them and issued a judgment consistent with those answers. Cooper's request for attorney fees was denied based on the applicable workers' compensation laws at the time, which did not allow fees for insurance companies that prevail in judicial reviews. The court found no error in this denial. 

Cooper alleged that the insurance companies colluded to delay medical payments, with St. Paul ceasing payments during the appeal and Texas Mutual only covering expenses related to the 1994 injury while disputing 1996-related expenses. She claimed the companies acted in bad faith, violated the Texas Insurance Code, and breached the Texas Deceptive Trade Practices-Consumer Protection Act. St. Paul argued that the jury absolved it of liability for the compensation claim, negating any extra contractual liability. Both companies also cited the statute of limitations as a defense against Cooper's extra contractual claims.

When both parties seek summary judgment on the same issues, the reviewing court assesses the evidence from both sides and renders the judgment the trial court should have issued. Despite Cooper's assertions of bad faith against St. Paul for disputing the aggravation claim, simply disputing a claim does not automatically incur liability for bad faith. To establish a breach of good faith by a workers' compensation carrier, the claimant must demonstrate a lack of reasonable basis for the denial and that the carrier knew or should have known of this lack.

A jury's determination that a party is not covered by an insurance policy absolves the insurer from liability for breach of good faith, violations of the Insurance Code, or the Texas Deceptive Trade Practices-Consumer Protection Act regarding claim denial. In this case, the jury found that Cooper's back condition was not linked to a 1996 injury, thus St. Paul was not liable for any extra contractual claims, and the trial court correctly granted St. Paul's motion for summary judgment while denying Cooper's. 

Texas Mutual argued that Cooper's claims were barred by a two-year statute of limitations, which began when Cooper was notified of the claim denial on August 19, 1996. Cooper's extra contractual claims, raised on February 22, 1999, were therefore time-barred. The trial court properly granted Texas Mutual's motion for summary judgment and denied Cooper's.

Cooper also challenged the trial court's exclusion of certain summary judgment evidence and the denial of a Motion to Compel regarding communications between the insurers. The discretion to admit or exclude evidence lies with the trial court, and to reverse a summary judgment based on evidentiary error, the appellant must demonstrate that the error likely affected the judgment outcome. Cooper did not sufficiently show that the excluded evidence was critical to the judgment.

Cooper alleges evidentiary errors but fails to link any excluded evidence to specific issues or demonstrate that the trial court's judgment relied on this excluded evidence. Consequently, the court does not determine whether an evidentiary error exists but finds Cooper has not met the burden to establish reversible error in the trial court's rulings. Cooper's claims regarding the exclusion of the insurance companies' letter agreement as a party admission and evidence of inconsistency are also rejected. The court applies an abuse of discretion standard and concludes that Cooper did not show how any alleged evidentiary error impacted the judgment. As a result, all of Cooper's issues are overruled, and the trial court's decision is affirmed.