State Farm Fire & Casualty Co. v. Wade

DORSEY, Justice,

concurring.

This is a declaratory judgment action in which appellant, State Farm Fire and Casualty, seeks a declaration that it does not have to defend an insured on a policy of liability insurance. Special exceptions to the company’s live pleadings were sustained and the cause dismissed. This appeal resulted.

The majority holds that the trial court erred in sustaining the special exceptions and dismissing the declaratory judgment action.1 I concur with that holding. I disagree with the majority’s observations in dicta that State Farm may present evidence other than the plaintiff’s pleadings in the underlying lawsuit.

I would hold only the pleadings of the claimant should be allowed as evidence to determine whether the boat trip that was *454the basis of the injuries was business or pleasure. Whether the incident made the basis of the suit against the insured was covered by the policy should be determined solely from the plaintiffs pleadings in the underlying lawsuit.

“An insurer is required to defend only those cases within the policy coverage. Furthermore, the insurer is entitled to rely on the plaintiff’s allegations in determining whether the facts are within the coverage. If the petition only alleges facts excluded by the policy, the insurer is not required to defend.” Fidelity & Guar. Ins. Underwriters, Inc. v. McManus, 633 S.W.2d 787, 788 (Tex.1982); Heyden Newport Chem. Corp. v. Southern Gen. Ins. Co., 387 S.W.2d 22, 24 (Tex.1965).

The allegations must be considered in light of the policy provisions, without determining the truth or falsity of those allegations. Argonaut Southwest Ins. Co. v. Maupin, 500 S.W.2d 633, 635 (Tex.1973); Heyden Newport, 387 S.W.2d at 24. What the parties know or believe the true facts to be, and any reference to the legal determination thereof, should not be considered when discerning the insurance company’s duty to defend. Heyden Newport, 387 S.W.2d at 24.

“The general rule is that the duty to defend is based on the allegations of the plaintiff’s complaint. The duty arises where there is a possibility of coverage. And the allegations are taken as true for the purpose of determining the duty to defend. The allegations must be liberally construed, thereby resolving all doubts in favor of the insured. The duty exists regardless of the outcome of the case.” Couch On Insurance 2d (Rev. ed.) § 51.42 (1982).

Texas courts have allowed facts outside the pleadings to be admitted into evidence to prove the existence of the insurance contract — that is, who or what is insured. No courts have allowed evidence of the specific occurrence to determine whether the occurrence itself is covered by the policy, however. In International Serv. Ins. Co. v. Boll, 392 S.W.2d 158 (Tex.Civ.App.—Houston 1965, writ ref’d n.r.e.), the insured’s son, Roy Hamilton Boll, was driving the insured automobile when he had an accident. The insured’s policy stated that Roy Hamilton Boll was not covered under the policy. The policy did not identify Roy as the insured’s son, however. In the lawsuit, the plaintiff’s pleadings stated that the insured’s son was driving the car, but did not state the son’s name. The parties stipulated, however, that Roy Hamilton Boll was the only son of the insured. The court allowed the stipulated evidence in making the threshold determination that Roy was not an insured under the policy, thereby absolving the insurance company of a duty to defend him in the lawsuit. Id. at 161.

In Cook v. Ohio Casualty Ins. Co., 418 S.W.2d 712 (Tex.Civ.App.—Texarkana 1967, no writ), the court allowed both stipulations and affidavits that Cook, who was driving her mother’s car when she had an accident, was not an insured under her mother’s automobile insurance policy. Id. at 715.

Conversely, this Court refused entry of evidence tending to show that the insured did not own a piece of equipment which injured the plaintiff in Gonzales v. American States Ins. Co., 628 S.W.2d 184 (Tex.App.—Corpus Christi 1982, no writ). This court held that the allegation that the insured owned the piece of equipment conclusively established coverage, and no evidence to the contrary was admitted. Id. at 187.

The Supreme Court has held, “if the petition only alleges facts excluded by the policy, the insurer is not required to defend.” McManus, 633 S.W.2d at 788. Similarly, if the petition only alleges facts that are covered by the policy, a duty to defend exists. Between these two poles, the presumptions of coverage exist.

Extrinsic evidence regarding coverage is admitted in very limited circumstances. The insurance contract is the basis of the obligation to defend. Proof that the named party defendant in the underlying lawsuit is covered by the policy is fundamental, as is whether the property involved is insured. However, when determining whether the *455event giving rise to the insured’s liability is covered, we look only to the pleadings of the claimant.

I concur in the majority’s holding that the dismissal was improper and that the case should be reversed and remanded for trial. I disagree with the majority’s observations that evidence other than the claimant’s pleadings should be allowed to determine if the incident sued upon is within the policy’s coverage.

GILBERTO HINOJOSA, J., joining in concurrence.

. The use of special exceptions to question a declaratory judgment action is unusual. We find special exceptions used in declaratory judgment actions in few cases in Texas, the most recent being Providence Lloyds v. Blevins, 741 S.W.2d 604 (Tex.App. — Austin 1987, no writ). In Blevins, the court held there was no justicia-ble controversy between the parties. Id. at 606. In other cases, special exceptions have been used to challenge the court’s jurisdiction over the matter in controversy. See Hilley v. Hilley, 305 S.W.2d 204 (Tex.Civ.App.—Waco 1957, writ refd n.r.e.); Stecher v. City of Houston, 272 S.W.2d 925 (Tex.Civ.App.—Galveston 1954, writ refd n.r.e.). However, courts have yet to determine the merits of using special exceptions to test pleadings in a declaratory judgment action, when a determination of one’s rights under a contract is the judgment being sought.