National Union Fire Insurance Co. v. Dominguez

DOGGETT and GAMMAGE, JJ„

dissenting.

Today’s opinion and the insurance company’s investigation, which forms the basis for this bad faith claim, share much in common — both are perfunctory and both mislead through omission. This decision merely represents a predetermined result in search of a rationale.1

Important to an understanding of this decision is the identity of the parties. Justo L. Dominguez Jr. is a truck driver from Pecos, Texas, who for more than six years earned $5.00 an hour operating a special type of industrial truck for his employer, Petty-Ray Geophysical.2 National Union Fire Insurance is a large national insurance company. A jury in Reeves County found that the insurer had acted in bad faith, the trial judge entered judgment, and the court of appeals sitting in El Paso, in relevant part, unanimously affirmed. 793 S.W.2d 66. Rejecting all of this, the majority adjusts longstanding Texas law to benefit the insurer to the considerable detriment of the truck driver.

The law is well-established that in determining a “no evidence” point, this Court “must consider only the evidence and inferences tending to support the jury’s finding, viewed most favorably in support of the finding, and disregard all contrary evidence and inferences.” Havner v. E-Z Mart Stores, Inc., 825 S.W.2d 456, 458 (Tex.1992); see Garza v. Alviar, 395 S.W.2d 821, 823 (Tex.1965); Cartwright v. Canode, 106 Tex. 502, 171 S.W. 696, 698 (1914). If more than a scintilla of such evidence exists, the claim is sufficient as a matter of law, and any challenges go merely to the weight to be accorded the evidence. Stafford v. Stafford, 726 S.W.2d 14, 16 (Tex.1987); In re King’s Estate, 244 S.W.2d 660, 661 (1951). Although jurors are empowered to qualitatively evaluate the credibility and weight of some evidence and conclude that it constitutes no evidence, the Texas Constitution precludes this Court from performing that task. See Tex.Const. art. V, § 6; Choate v. San Antonio & A.P. Ry. Co., 91 Tex. 406, 44 S.W. 69, 69 (1898).

Dismissing this law as mere “tradition,” the majority asserts, without citation to any authority, that this Court has not only the authority but the duty to make determina--tions as to the “basis an insurance company may have had for denying a claim....” 873 S.W.2d at 376. Empowered by this new, self-bestowed authority, the majority proceeds to reexamine the evidence from the perspective of the insurance company rather than, as required by the Texas Constitution, in the light most favorable to the verdict. This constitutes improper factfinding; it is a review of factual, not legal, sufficiency.

*378Today’s opinion maintains that the only evidence supporting a claim of bad faith was a letter sent by a doctor to Dominguez’s attorney, and it simply categorizes this as evidence solely of coverage, which is declared to constitute no evidence whatsoever of bad faith. But this letter is only a part of the evidence presented to the jury on this issue. The insurer denied Dominguez’s workers compensation claim on the basis that his injury was neither reported within thirty days nor reported as an on-the-job injury. This decision resulted from the recommendation of an investigator, who apparently never interviewed Dominguez’s managing supervisor.3 See State Farm County Mut. Ins. Co. v. Moran, 809 S.W.2d 613, 618 (Tex.App.—Corpus Christi 1991, writ denied) (failure to interview witness to events related to coverage is some evidence of breach of good faith and fair dealing). In apparent disagreement with the jury’s resolution of a disputed issue of material fact, the majority writes that “National Union learned that Dominguez had never reported the injury as work related....” 873 S.W.2d at 376. This judicial finding of fact simply disregards Dominguez’s testimony that he had advised his supervisor almost immediately that the injury was work-related. Indeed, this same supervisor first suggested that Dominguez see a doctor. Although claiming that Dominguez did not say it was work-related, this supervisor later confirmed that he had been promptly advised about the injury, thereby completely eliminating at least one of the insurer’s two grounds for denial.4 A proper no evidence review would acknowledge that because the jury may rightfully have believed Dominguez’s testimony, this Court must treat the contrary National Union report as erroneous. Rejecting the worker’s claim without ever conducting a proper investigation of the basis for the denial certainly constitutes evidence of bad faith. Commonwealth Lloyd’s Ins. Co. v. Thomas, 825 S.W.2d 135, 144 (Tex.App.—Dallas 1992) (evidence of inadequacy of insurer’s investigation is some evidence of breach of the duty of good faith and fair dealing), judgment set aside pursuant to settl’t agr., 843 S.W.2d 486 (Tex.1993).

Contrary to the majority, 873 S.W.2d at 377 & n. 3, this is certainly not the only failing in the insurer’s handling of this matter. Its investigator completely misrepresented the claimant’s post-injury health care. Her report, for example, falsely indicates both that Dominguez did not seek immediate medical treatment from Dr. Zea and that that doctor found no physical impairment. Particularly damaging to Dominguez was the conclusion that he only once saw the doctor who concluded the injury was job-related, when treatment had actually been received on many occasions, as detailed in a four-page written summary of findings. Ironically, the majority fails to note that the doctor whose opinion National Union did rely upon saw Dominguez only once. Additionally, the investigator inaccurately reported that after claiming injury, Dominguez was employed as a body work repairman when he had, in fact, been totally unable to work since his injury.5 Taken in the light most favorable to the judgment, the inaccuracies in this report regarding crucial elements of the claim, in addition to the investigator’s failure to consult the supervisor constitute evidence of bad faith. The majority summarily declares all of this as “no evidence” without even bothering to discuss it.

Today’s opinion then suggests that “Dominguez presented no evidence that casts doubt on National Union’s reliance on the [doctors] who diagnosed the condition as a *379degenerative disease, or on Dominguez’ own statements on insurance forms that his condition was not work related.” 873 S.W.2d at 377. But this is irrelevant in a legal sufficiency inquiry. Under our law, this review must be narrowly focused on what supports the judgment, not what opposes it. Furthermore, at least one doctor did not diagnose the condition as degenerative, but rather as work-related; and there is evidence that the insurer’s consideration of this professional’s findings and opinions was inexcusably defective.

Additional testimony indicated that Dominguez did not understand the difference between disability and workers’ compensation when preparing his insurance forms; he simply accepted the disability forms offered by his employer in order to get a paycheck. This worker, whose formal education ended after the ninth grade, was described by the trial judge as a person of “limited” intelligence. Compare Dresser v. Lee, 1993 WL 433292 *6 (Tex.1993) (Doggett, J., dissenting).

There is no doubt that some evidence of bad faith was presented to justify the jury’s finding. The basis on which the insurer decided to controvert the claim was a slipshod report prepared by an investigator who either did not thoroughly review the case or who manipulated the facts to serve her employer. The majority today continues its practice of wearing blinders when evaluating facts not helpful to insurance companies while violating the constitutional mandate that review by this Court is limited to legal, not factual sufficiency.

Once again, as in Boyles v. Kerr, 855 S.W.2d 593, 606 (Tex.1993) (Doggett, J., dissenting on motion for reh’g), “excessive concern for the effect of every opinion on insurance companies seems to have become the predominant and overriding” concern of this majority. Compare also id. at 603 (Gonzalez, J., concurring on motion for reh’g). Given the determination of the majority to assume for itself the duties and powers of a jury, anyone — a judge, an attorney, a litigant or a legal scholar — will be hard pressed, in any given case, to understand the operative standard of appellate review — whether fundamental rules articulated in existing precedent govern, or whether what’s really at work is some special unwritten standard of review, grounded in an overriding fear that insurers could actually be compelled to pay claims.

. The majority's similar contemporaneous writing in Lyons v. Millers Cas. Ins. Co., 866 S.W.2d 597 (Tex.1993), offers no more support for today’s opinion than the converse.

. As a vibreosis operator, Dominguez ran and maintained a truck that vibrates while exploring for oil and gas.

. Apparently, no contact was made by the insurer with the supervisor until a year after the initial report when he was contacted for a deposition.

. The majority excuses this failing on grounds that it would not have altered National Union’s decision that the injury was not work related. Yet an investigation that is so faulty or perhaps merely a subterfuge for denying coverage shows a lack of good faith and fair dealing. See State Farm. Fire & Cas. Co. v. Simmons, 857 S.W.2d 126, 133 (Tex.App. — Beaumont 1993, writ denied) (evidence that insurer’s investigation was tailored to reach predetermined outcome is some evidence of breach of duty of good faith and fair dealing).

.Apparently the insurance investigator confused a job at which Dominguez had worked with Valley Motor Cadillac before the injury with a job he never held after the injury.