Opinion · Texas Supreme Court
Natividad v. Alexsis, Inc.
875 S.W.2d 695
- Type
- Opinion
- Court
- Texas Supreme Court
- Jurisdiction
- Texas
- Date
- 1994-06-08
- Topic
- general
holding that appellate court reviews de novo whether pleading states legally valid claim in context of suit in which trial court granted summary judgment on ground of pleading deficiency after sustaining special exceptions | noting that the focus of the review is on the non-movant’s pleadings at the time of the summary judgment | providing that an insurance carrier is liable for actions of agent only when agent performs claims handling services | finding that a claims adjustment firm could not be sued in bad faith by the injured employee because it was not part of the special relationship among the employee, the employer, and the insurer | finding that a claims adjustment firm could not be sued in bad faith by the injured employee because it was not part of the special relationship among the employee, the employer, and the insurer | finding that a claims adjustment firm could not be sued in bad faith by the injured employee 20 because it was not part of the special relationship among the employee, the employer, and the insurer | finding that a claims adjustment firm could not be sued in bad faith by the injured employee 20 because it was not part of the special relationship among the employee, the employer, and the insurer | clarifying that “behavior is not outrageous simply because it may be tortious” | explaining that the duty of good faith arises only because of the insurance contract and that claims adjusting firm and adjuster owed no duty of good faith to the insured because they were not parties to the insurance contract | refusing to extend the duty of good faith and fair dealing to an adjuster employed by an insurance company | noting that when an employee has benefit checks delayed, is given the A runaround @ and faces fabricated excuses of lost files and malfunctioning computers, that the employee was treated rudely but that the conduct cannot be regarded as extreme and outrageous | discussing summary judgment of emotional-distress claim properly based on deficiencies of plaintiff's pleadings | stating summary judgment based on pleading deficiency is proper if party has opportunity by special exception to amend and fails to do so, or files further defective pleadings | in evaluating motion for summary judgment on pleadings, court assumes that all allegations and facts in non-movant’s pleadings are true and indulges all inferences in nonmovant's pleadings in light most favorable to nonmovant | appellate court reviews de novo whether pleading states legally baseless claim in context of suit in which trial court granted summary judgment | insurer, not agent, owes insured a duty of good faith and fair dealing because of “special relationship” created by contract between insurer and insured; “[t]his duty is non-delegable” | “Summary judgment based on a pleading deficiency is proper if a party has had an opportunity by special exception to amend and fails to do so, or files a further defective pleading.” | in evaluating motion for summary judgment on pleadings, court assumes that all allegations and facts in nonmovant's pleadings are true and indulges all inferences in nonmovant's pleadings in light most favorable to nonmovant | when appellate court reviews summary judgment premised on pleading deficiencies, court “tak[es] all allegations, facts, and inferences in the pleadings as true and view[s] them in a light most favorable to the pleader” | in evaluating motion for summary judgment on pleadings, court assumes that all allegations and facts in nonmovant's pleadings are true and indulges all inferences in nonmovant's pleadings in light most favorable to nonmovant | “An insurance carrier, not its agents and contractors providing claims handhng services, is hable to the insured for actions by agents or contrac tors that breached the duty of good faith and fair dealing owed by the carrier to the insured.” | no implied covenant in context of employment relationship
Citator
- Cited by
- 360 opinions
Frederick B. Wulff, Sr., Kurt Schwarz, Elizabeth Hosch, Dallas, for respondents.
Alexsis, Inc. and Steen moved for summary judgment on the grounds that they did not owe a duty of good faith and fair dealing to Natividad and that Natividad could not recover for her emotional distress. The trial court rendered a take-nothing summary judgment in favor of the defendants.
The court of appeals reversed the summary judgment in part. Although there were no pleadings and evidence to support the theory, the court of appeals held that Natividad was a third-party beneficiary of a contract between Alexsis, Inc. and National Union, and that Alexsis, Inc. owed Natividad a duty of good faith and fair dealing.3However, the court of appeals held that Steen did not owe a duty of good faith and fair dealing because "[h]e did not issue an insurance policy and did not contract with the carrier . . .Page 697to provide any adjusting services."4The court of appeals upheld summary judgment favoring Alexsis, Inc. and Steen as to Natividad's allegations of fraud, and of economic duress, oppression and outrage, but remanded Natividad's causes of action for negligent and intentional infliction of emotional distress.
On appeal to this Court, Natividad argues that the court of appeals erred in holding that Steen did not owe Natividad a duty of good faith and fair dealing. By cross-application, Alexsis, Inc. and Steen argue that because the duty of good faith and fair dealing must be based on a contract between the parties, neither Alexsis, Inc. nor Steen owed Natividad this duty. Alexsis, Inc. and Steen also argue that the uncontroverted affidavit testimony of Steen was sufficient to support summary judgment on the claims for negligent and intentional infliction of emotional distress, and that summary judgment of Natividad's claim of intentional infliction of emotional distress was otherwise proper because they negated other elements of her claim.
Since its inception, the duty of good faith and fair dealing has only been applied to protect parties who have a special relationship based on trust or unequal bargaining power.See Arnold,725 S.W.2d at 167. In the insurance context, this special relationship arises out of "the parties' unequal bargaining power and the nature of insurance contracts which would allow unscrupulous insurers to take advantage of their insureds. . . ."Id.; see also, Viles v. SecurityNat'l Ins. Co.,788 S.W.2d 566(Tex. 1990);Aranda v.Insurance Co. of N. Am.,748 S.W.2d 210(Tex. 1988);Chitsey v. National Lloyds Ins. Co.,738 S.W.2d 641(Tex. 1987).5
When this Court applied the duty of good faith and fair dealing to the workers' compensation relationship inAranda,748 S.W.2d at 212, we continued to focus on the special relationship created by the contractual relationship of the parties: the employer, the employee, and the insurance carrier. We stated:
The Workers' Compensation Act sets forth a compensation scheme that is based on a three-party agreement entered into by the employer, the employee, and the compensation carrier. . . . As between the compensation carrier and the employee, there is a promise for a promise: the carrier agrees to compensate the employee for injuries sustained in the course of employment, and the employee agrees to relinquish his common law rights against his employer. The employee is thus a party to the contract and therefore entitled to recover in that capacity.
The contract between a compensation carrier and an employee creates the same type of special relationship that arises under other insurance contracts.Id.(citations omitted).
The duty of good faith and fair dealing emanates from the special relationship betweenPage 698the parties and not from the terms of the contract, therefore its breach gives rise to tort damages and not simply to contractual liability.6However, the "special relationship" exists only because the insured and the insurer are parties to a contract that is the result of unequal bargaining power, and by its nature allows unscrupulous insurers to take advantage of their insureds.Arnold,725 S.W.2d at 167. Without such a contract there would be no "special relationship" and hence, no duty of good faith and fair dealing.
The court of appeals and the Dissent look toScott WetzelServices, Inc. v. Johnson,821 P.2d 804(Colo. 1991), to support extending the duty of good faith and fair dealing to the agents of insurance carriers. Their reliance on this case is misplaced. InWetzel,821 P.2d at 812, the court imposed a duty of good faith based on policy goals contained in that state'scompensation act.In contrast, as set out above, we have always recognized that in an insurance context, the duty of good faith and fair dealing arises only when there is acontractgiving rise to a "special relationship."
In the present case, there is no special relationship between Natividad and either Alexsis, Inc. or Steen. Natividad is not a party to a contract with Alexsis, Inc. or Steen. Natividad's contractual privity is only with her employer and National Union. Natividad is owed a duty of good faith and fair dealing from National Union. This duty is non-delegable.7When the insurance carrier has contracted with agents or contractors for the performance of claims handling services, the carrier remains liable for actions by those agents or contractors that breach the duty of good faith and fair dealing owed to the insured by the carrier. Natividad was entitled to and did recover from National Union for actions by its employees, agents or contractors that breached the duty of good faith and fair dealing owed to Natividad by National Union. Alexsis, Inc. and Steen, because they were not parties to a contract with Natividad giving rise to a "special relationship," owed Natividad no duty of good faith and fair dealing. Thus, the court of appeals was correct in affirming the trial court's summary judgment as to Natividad's claim for breach of the duty of good faith and fair dealing against Steen. The court of appeals erred, however, in reversing the trial court's summary judgment as to Natividad's claim for breach of the duty of good faith and fair dealing against Alexsis, Inc.
distress, but the court of appeals reversed the judgment stating that Steen's supporting affidavit "will not support a summary judgment where he is a party to the suit with a vital interest in its outcome." 833 S.W.2d at 549 (citingSpoljaric v. Percival Tours, Inc.,708 S.W.2d 432(Tex. 1986)). Alexsis, Inc. and Steen argue to this Court that summary judgment is proper because Natividad's live pleadings did not allege any "extreme and outrageous" conduct by either Alexsis, Inc. or Steen. Additionally, Alexsis, Inc. and Steen argue that the court of appeals erred in holding that Steen's affidavit that he did not intend to cause Natividad emotional distress does not support summary judgment.
Summary judgment based on a pleading deficiency is proper if a party has had an opportunity by special exception to amend and fails to do so, or files a further defective pleading.Texas Dept. of Corrections v. Herring,513 S.W.2d 6, 10 (Tex. 1974); TIMOTHY PATTON, SUMMARY JUDGMENTS IN TEXAS § 3.07[2] (1992); David Hittner and Lynne Liberato,Summary Judgments in Texas,35 S. TEX.L.REV. 9, 25 (1994). A review of the pleadings in such case isdenovo,with the reviewing court taking all allegations, facts, and inferences in the pleadings as true and viewing them in a light most favorable to the pleader.See Aranda,748 S.W.2d at 213. The reviewing court will affirm the summary judgment only if the pleadings are legally insufficient.
In the present case, Alexsis, Inc. and Steen filed special exceptions to Natividad's pleadings alleging factual and legal insufficiency. The trial court ordered Natividad to file an amended petition to address the deficiencies in her pleadings specially excepted to by Alexsis, Inc. and Steen. In response, Natividad filed her Fifth Amended Petition. Summary judgment is therefore proper if no fact issue exists as to whether the conduct of Alexsis, Inc. and Steen was "`so outrageous in character, and so extreme in degree, as to go beyond all possible bounds of decency, and to be regarded as atrocious, and utterly intolerable in a civilized community.'"Twyman,855 S.W.2d at 621 (quoting RESTATEMENT (SECOND) OF TORTS § 46, cmt. d (1965)). "`It is for the court to determine in the first instance whether the defendant's conduct may reasonably be regarded as so extreme and outrageous as to permit recovery.'"Wornick Co v.Casas,856 S.W.2d 732, 734 (Tex. 1993) (quoting RESTATEMENT (SECOND) OF TORTS § 46, cmt. h). In this case, Natividad has not pleaded sufficient facts concerning the conduct of Alexsis, Inc. and Steen to proceed beyond the summary judgment stage.
Natividad relies on the following allegations to support her claim of outrageous conduct: her benefit checks were delayed and, when issued, were drawn on an out-of-state bank; defendants gave her the "runaround" when she and her lawyer attempted to inquire about the payments, putting her on "hold" and fabricating excuses of lost files and computer malfunctions; and she was treated rudely. These allegations, taken as true, may constitute bad faith, giving rise to a cause of action against the insurer. They cannot, however, reasonably be regarded as so extreme as to "go beyond all possible bounds of decency."SeeRESTATEMENT (SECOND) OF TORTS § 46, cmt. d. Rude behavior does not equate to outrageousness, and behavior is not outrageous simply because it may be tortious.Id.If the conduct involved here can be considered outrageous for the purposes of creating liability for the tort of intentional infliction of emotional distress, then it appears thatanyinstance of insurance bad faith will also raise a fact issue on intentional infliction of emotional distress. Courts in other jurisdictions have properly rejected this approach.See, e.g., Wooley v.Shewbart,569 So.2d 712, 717 (Ala. 1990) (allegation that compensation carrier denied benefits for no reason shortly before insured's surgery does not state a claim of outrageous conduct);Farley v. CNA Ins. Co.,576 So.2d 158, 160 (Ala. 1991) (evidence that compensation carrier gave claimant the "runaround" and did not timely pay her bills did not establish claim for outrageous conduct);Davis v. GulfLife Ins. Co.,502 So.2d 1012(Fla.Dist.Ct.App. 1987) (insurer's arbitrary refusal to pay a valid claim does not constitute outrageous conduct);Roberts v. Auto-OwnersIns. Co.,422 Mich. 594,Page 700374 N.W.2d 905, 911 (1985) (insurer's failure to facilitate filing of claim and denial of valid benefits claim was not outrageous);Hajciar v. Crawford Co.,142 Mich. App. 632,369 N.W.2d 860, 864 (1985) (insurer's termination of benefits in order to coerce a lump sum settlement was not extreme and outrageous for purposes of the intentional infliction tort);Reamsnyder v. Jaskolski,10 Ohio St.3d 150,462 N.E.2d 392, 394 (1984) (insurer's pressuring of insured to accept settlement offer, along with threats of premature termination of benefits, was not outrageous).
It does not appear that any jurisdiction has recognized the element of outrageous conduct as satisfied on allegations as slender as those of Natividad.8Accordingly, we reverse the judgment of the court of appeals and render judgment that Natividad take nothing on her claim for intentional infliction of emotional distress. Our disposition of this issue makes it unnecessary to reach the issue of whether Steen's affidavit supports summary judgment.
The duty of good faith and fair dealing "emanates not from the terms of the insurance contract, but from an obligation imposed in law 'as a result of aspecial relationshipbetween the partiesgoverned or createdby a contract.' "Viles v. Security National Ins. Co.,788 S.W.2d 566, 567 (Tex. 1990). Here, although there is no contract between Natividad and the insurance company's agent, Alexsis, there is a contract whereby Alexsis promised to handle the claims of Revco employees in accordance with the terms of the policy issued by National Union. Consequently, when Alexsis directly dealt with Natividad the relationship wasgovernedby the workers' compensation insurance contract.Page 701In addition, Natividad stands as beneficiary under Alexsis' contract.2Natividad, entitled to timely benefits provided by law to employees injured on the job, may actually have received the funds from National Union, "but the responsibility to see that those funds were properly and timely paid rested upon Alexsis."Natividad,833 S.W.2d at 547. The majority attempts to discount this reality by arguing that Natividad failed to plead a third party beneficiary theory. What is important, however, is not whether Natividad is actually a third party beneficiary, but whether the chain of contracts from National Union to Alexsis, delegating the duties owed to Natividad, created a "special relationship" between Natividad and National Union's agent.See Viles,788 S.W.2d at 567.
A special relationship is one "marked by shared trust or an imbalance in bargaining power."F.D.I.C. v. Coleman,795 S.W.2d 706, 708-709 (Tex. 1990). This court has declared that such a relationship exists between a claimant and the employer's workers' compensation carrier.Aranda v.Insurance Co. of N. America,748 S.W.2d 210, 212 (Tex. 1988). The majority states that this relationship arises from the unequal bargaining power of the parties to the contract. The duty of good faith and fair dealing, however, is meant to protect the insured from that power which is wieldedafterthe contract is made. "[W]ithout such a cause of action insurers can arbitrarily deny coverage and delay payment of a claim with no more penalty than interest on the amount owed."Arnold,725 S.W.2d at 167;Aranda,748 S.W.2d at 212. InArnold,we reasoned that "[a]n insurance company has exclusive control over the evaluation, processing and denial of claims" and can use that control in such a way that would subject the insured to "economic calamity."Arnold,725 S.W.2d at 167;Aranda,748 S.W.2d at 212.
Here, the exclusive control which we found so threatening is held not by the carrier, but by its agent, Alexsis. National Union delegated to Alexsis its own sole authority to handle individual Revco workers' compensation claims not exceeding $50,000. Alexsis exercised exclusive control over the evaluation, processing and denial of Natividad's particular workers' compensation claims. With such control, Alexsis was exclusively empowered to commit acts which could forestall the prompt payment or reasonable denial of claims.See ScottWetzel Services, Inc. v. Johnson,821 P.2d 804, 812 (Colo. 1991). The reasoning for recognizing the duty to the covered employee from the employer's carrier extends as well to the carrier's agent, the adjusting company which deals directly with the employee.See Aranda,748 S.W.2d at 212.
The majority concludes that because a carrier may be held liable for its agent's actions, no cause of action is necessary against the agents themselves.See Wetzel,821 P.2d at 813 (Rovira, C.J., dissenting). The court inWetzel,faced with this argument, acknowledged that to best serve the policy of the compensation act, the cause of action should serve to deter inappropriate conduct of the actor, here the agent who deals directly with the insured.Wetzel,821 P.2d at 812. Attempting to distinguishWetzel,the majority states the decision was based on Colorado's compensation act, which seeks to provide compensation through a "summary and speedy . . . procedure."See Wetzel,821 P.2d at 812. But doesn't our own compensation act seek to provide "speedy, equitable relief" so that injured employees are protected from the "economic calamity of disabling injuries"?Aranda,748 S.W.2d at 212,citing Texas Employers' Insurance Ass'n v.Wright,128 Tex. 242,97 S.W.2d 171, 172 (1936).
Because I believe you must punish the actor to curb the actions, I respectfully dissent.3National UnionandAlexsis have thePage 702duty of good faith and fair dealing, whether the power derives from a contract with the insured or through a delegation of duties under the same contract.
I join that part of the majority opinion which deals with Natividad's claims of intentional infliction of emotional distress, with the following clarification. By this concurrence I give no credence to this court's previous holdings which effectively shield insurance companies from responsibility for their actions. I would allow Natividad her claim for the adjuster's breach of the duty of good faith and fair dealing which is denied by the majority holding. I would also allow Natividad her claims for negligent infliction of emotional distress which this court took away inBoyles v.Kerr,855 S.W.2d 593(Tex. 1993). I concur with the majority only because the specific facts of this case do not rise to the level of "extreme and outrageous conduct" necessary for a claim of intentional infliction of emotional distress. Other insureds suffering the brunt of bad faith insurers, however, may very well be able to allege sufficient facts to meet the demands of this cause of action.
- Payments on the compensation claims totalled $44,589.36 and the settlements totalled $77,500. ↩
- A cause of action for a violation of Section 16 of Article21.21of the Texas Insurance Code was not properly before the trial court.See833 S.W.2d at 549. ↩
- 833 S.W.2d at 547. Alexsis, Inc. employed Steen to perform some of the tasks under Alexsis, Inc.'s contract with AIG. There was no contract between Alexsis, Inc. and National Union. If Alexsis, Inc. and Steen were negligent in processing Natividad's claim for workers' compensation benefits, they breached a contractual duty owed to AIG. If anyone was a third-party beneficiary of the contract between Alexsis, Inc. and AIG, it was National Union. ↩
- 833 S.W.2d at 548. The same can be said about Alexsis, Inc. Alexsis, Inc. did not issue an insurance policy and did not contract with National Union to provide any adjusting services. Thus, under the rationale of the court of appeals, there is no principled reason to extend the duty to Alexsis, Inc. but not to Steen. ↩
- This Court inArnoldstated:
While this court has declined to impose an impliedcovenantof good faith and fair dealing in every contract, we have recognized that a duty of good faith and fair dealing may arise as a result of a special relationship between the parties governed or created by a contract.
Arnold,725 S.W.2d at 167;see also English v.Fischer,660 S.W.2d 521, 524 (Tex. 1983) (Spears, J. concurring) ("I would note . . . that Texas courts have read a duty of good faith and fair dealing into many types ofcontractually based transactions.") (emphasis added). ↩ - See Viles,788 S.W.2d at 567. Contrary to suggestions by the Dissent, our opinion today does not deviate from our earlier opinion inChitsey,738 S.W.2d at 643 n. 1, that the duty of good faith and fair dealing is not an implied covenant, but a duty imposed by law. ↩
- Contrary to the Dissent's suggestion, today's opinion does not shield insurance companies from responsibility for their actions. By imposing a non-delegable duty of good faith and fair dealing on insurance companies we are sending a clear message — the buck stops with them. The insurance companies must answer for the "sins" of their agents. ↩
- The Court is in agreement that, "the specific facts of this case do not rise to the level of 'extreme and outrageous conduct' necessary for a claim of intentional infliction of emotional distress."875 S.W.2d 702(Gammage, J. concurring and dissenting). However, the facts alleged do give rise to a fact issue for breach of the duty of good faith and fair dealing. As noted in footnote 1, Natividad settled that claim with National Union. ↩
- See e.g. Manges v. Guerra,673 S.W.2d 180(1984). There, we held that the special relationship between an executive mineral rights owner and the nonexecutive owners gave rise to the duty of utmost good faith. The contract in that case, however, was between Manges and the Guerrapartnership,not the individual nonexecutive owners.Manges,673 S.W.2d at 181. ↩
- InAranda,we recognized a legal fiction by holding that the insured employee is party to a tripartite agreement and exchanges a "promise for a promise" with the employer's insurance carrier.Aranda v. Insurance Co. ofN. America,748 S.W.2d 210, 212 (Tex. 1988). When the carrier delegates his duty to fulfill that promise, the employee necessarily becomes a third party beneficiary under the delegation contract, here between National Union and AIG. Under the majority's holding, however, Natividad would not even have a cause of action against AIG, the entity which steps directly into the carrier's contractual relationship. ↩
- I would affirm the decision of the court of appeals that Steen, Alexsis' employee, does not owe the insured a personal duty of good faith and fair dealing. The duties under the insurance contract were delegated to Alexsis. Alexsis merely ordered its employee, Steen, to perform the duties held by the adjusting firm. The duties, therefore, including the implied duty of good faith and fair dealing, stop with Alexsis. ↩