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Confusion Amongst Texas Courts: When Can Insureds Recover Policy Benefits for Statutory Violations?

While first-party bad faith claims may appear to be a dying notion in other jurisdictions, the tort-based claim in Texas is alive and well. Throughout the years, courts have continued to search for ways to define the common-law standard and balance it with public interest due to the unequal bargaining power in the insured-insurer relationship.1 For this reason, the law of bad faith in Texas is constantly evolving.

Texas imposes a common law duty on insurers to “deal fairly and in good faith with their insureds.”2 A breach of the duty of good faith and fair dealing gives rise to a tort cause of action that is separate from any action for breach of the underlying insurance policy.3 If an insurer breaches its duty of good faith and fair dealing, in addition to interest, court costs and attorney’s fees, the insured can recover actual, i.e. extra-contractual, damages for economic or personal injuries and exemplary damages if: (1) actual damages were awarded for an injury independent of the loss of policy benefits and (2) the insurer’s conduct was fraudulent, malicious, intentional or grossly negligent.4 Exemplary damages are within the jury’s discretion and “must be reasonably proportioned to actual damages.”5

Texas also provides a statutory scheme for bad-faith claims that allows recovery of extra-contractual damages through a private cause of action against an insurer. The statutory bad-faith tort is governed by Chapter 541 of the Texas Insurance Code (“Code”).6 The statutory claim is in addition, and a supplement, to the contractual cause of action against an insurer for breach of an insurance policy. Similar to the common law claim, for Code violations the insured may recover economic damages, but only up to three times the amount of economic damages, i.e. treble damages, for violations committed “knowingly.”7

It is not uncommon in first party bad-faith cases for the insured to assert a breach of contract claim against the insurer for breaching the insurance policy and a tort cause of action against the insurer for violations of the Code. However, extra-contractual tort claims brought pursuant to the Code require the same predicate for recovery as a bad faith claim under a good faith and fair dealing violation.8 Because the frameworks of the statutory and common law claims are so similar, most Texas courts have treated common law claims as redundant.

When considering the damages available under the policy and under the statute, there have been some inconsistencies amongst Texas courts regarding the recovery of policy benefits when there have been statutory violations of the Code. As such, in USAA Texas Lloyds Company v. Gail Menchaca, the Texas Supreme Court seized the opportunity clear up the confusion by addressing the issue of whether an insured can recover policy benefits for Code violations when there has been no breach of the insurance policy.9

USAA v Menchacha 

In Menchaca, the Texas Supreme Court acknowledges, “When our decisions create such uncertainties, ‘it is our duty to settle conflicts in order that the confusion will as nearly as possible be set at rest.’”10 Thus, the goal in Menchaca was “to provide clarity regarding the relationship between claims for an insurance policy breach and Insurance Code violations.”11 The primary question was “whether an insured can recover policy benefits as actual damages caused by an insurer’s statutory violation absent a finding that the insured had a contractual right to the benefits under the insurance policy.”12

Following Hurricane Ike in September 2008, Gail Menchaca contacted her homeowner’s insurance company, USAA Texas Lloyds (“USAA”), and reported storm damage to her home.13 The USAA adjuster who inspected Menchaca’s claim found only minimal damage.14 USAA determined that the damage was covered under Menchaca’s policy but declined to pay benefits because the total repair costs did not exceed the deductible under Menchaca’s policy.15 Five months later, at Menchaca’s request, another USAA adjuster re-inspected Menchaca’s home.16 The second adjuster confirmed the first adjuster’s findings and again USAA declined to pay any policy benefits.17 Menchaca filed suit against USAA for breach of the insurance policy and for unfair settlement practices in violation of the Texas Insurance Code. Menchaca sought policy benefits for both claims.18 For the alleged breach of the insurance policy, she sought benefit of the bargain damages, i.e. the amount of her claim for policy benefits and attorney’s fees. For the statutory violations, she sought actual damages, i.e. the loss of the benefits that should have been paid pursuant to the policy, court courts and attorney’s fees.19

The case proceeded to a jury trial and three questions were submitted to the jury.20 Question 1 addressed Menchaca’s breach of contract claim and asked whether USAA failed “to comply with the terms of the insurance policy with respect to the claim for damages filed by Gail Menchaca resulting from Hurricane Ike” and the jury answered “No.” Question 2 addressed Menchaca’s claim for statutory violations and asked “whether USAA engaged in various unfair or deceptive practices, including whether USAA refused to “pay a claim without conducting a reasonable investigation with respect to that claim” and the jury answered “Yes.” Question 3 asked the jury to determine Menchaca’s damages that resulted from either USAA’s failure to comply with the policy or its statutory violations, calculated as “the difference, if any, between the amount USAA should have paid Gail Menchaca for her Hurricane Ike damages and the amount that was actually paid” and the jury answered “$11,350.”21

Both parties moved for judgment in their favor. USAA argued that Menchaca was not entitled to recover for bad faith or extra-contractual liability because the jury found that it did not breach the insurance policy. Menchaca argued that the jury answered Questions 2 and 3 in her favor and neither were dependent on a favorable answer to Question 1. The trial court disregarded Question 1 and entered judgment in Menchaca’s favor. The court of appeals affirmed and the Texas Supreme Court granted USAA’s petition for review.22

In analyzing whether an insured can recover policy benefits as actual damages caused by an insurer’s statutory violation absent a finding that the insured had a contractual right to benefits under the insurance policy, the Court set forth “five distinct but interrelated rules that govern the relationship between contractual and extra-contractual claims in the insurance context.”23 Following the Court’s analysis of these rules, it determined that the court of appeals erred by affirming the trial court’s decision to disregard the jury’s answer to Question 1. The Court further stated, “In light of the parties’ obvious and understandable confusion over our relevant precedent and the effect of that confusion on their arguments in this case, we conclude that a remand is necessary here in the interest of justice.”24 The rules outlined by the Court are as follows:

Rule 1:

General Rule: An insured cannot recover policy benefits for an insurer’s statutory violation if the insured does not have a right to those benefits under the policy.25 This rule is derived from the Court’s rule in that “there can be no claim for bad faith when an insurer has promptly denied a claim that is in fact not covered.”26 Although the fact pattern in Stoker was limited to the bad faith denial of a claim, the Court has since applied the general rule to other types of extra-contractual violations, i.e. failing to properly pay a claim, failing to fairly investigate a claim and failing to effectuate a prompt and fair settlement of the claim.27 The general rule is derived from the fact that Code “only allows an insured to recover actual damages ‘caused by’ the insurer’s statutory violation.”28 In determining whether the insured has to establish a right to benefits and then a breach of the policy to recover policy benefits for statutory violations, the Court stated, “While an insured cannot recover policy benefits for a statutory violation unless the jury finds that the insured had a right to the benefits under the policy, the insured does not also have to establish that the insurer breached the policy by refusing to pay those benefits.”29

Rule 2:

Entitled to Benefits Rule: An insured who establishes a right to receive benefits under an insurance policy can recover policy benefits as “actual damages” under the statute if the insurer’s statutory violation causes the loss of the benefits.30 “If an insurer’s ‘wrongful’ denial of a ‘valid’ claim results from or constitutes a statutory violation, the resulting damages will necessarily include ‘at least the amount of the policy benefits wrongfully withheld.’”31

Rule 3:

Benefits Loss Rule: An insured can recover policy benefits as actual damages under the Insurance Code even if the insured has no right to those benefits under the policy, if the insurer’s conduct caused the insured to lose that contractual right. 32 The Court has recognized this principle in cases alleging claims against an insurer for misrepresenting a policy’s coverage, statutory violations by the insurer which prejudice the insured by waiving its right to deny coverage or is estopped from doing so, and statutory violations that cause the insured to lose a contractual right to benefits that it otherwise would have been entitled to.33 “[A]n insurer that commits a statutory violation that eliminates or reduces its contractual obligations cannot then avail itself of the general rule.”34

Rule 4:

Independent Injury Rule: The first aspect of the rule is that if an insurer’s statutory violation causes an injury independent of the insured’s right to recover policy benefits, the insured may recover damages for that injury even if the policy does not entitle the insured to receive benefits.35 This rule takes into account that there may be some extra-contractual claims that may not “relate to the insurer’s breach of contractual duties to pay covered claims” and recognizes that there may be compensatory damages different from policy benefits that result from the tort of bad faith under common law.36

The second aspect of the independent-injury rule is that an insurer’s violation does not allow the insured to recover any damages beyond policy benefits unless the violation causes an injury that is independent from the loss of the benefits.37 For instance, the Court held in Twin City Fire Ins. Co. v. Davis that “an insured who prevails on a statutory claim cannot recover punitive damages for bad-faith conduct in the absence of independent actual damages arising from that conduct.38 Notably, as it relates to the independent-injury rule, the Court states that an independent-injury claim would be rare, they have yet to encounter one, and “have no occasion to speculate what would constitute a recoverable independent injury.”39

Rule 5:

No-Recovery Rule: An insured cannot recover any damages based on an insurer’s statutory violation unless the insured establishes a right to receive benefits under the policy or an injury independent of a right to benefits.40.

Conclusion

“It is the beginning of wisdom when you recognize that the best you can do is choose which rules you want to live by, and it’s persistent and aggravated imbecility to pretend you can live without any.”41 The Texas Supreme Court has attempted to clear up the confusion caused by its precedent by adopting five rules on the issue of recovery of policy benefits for statutory violations. While the rules appear fairly simplistic and undoubtedly will provide guidance, it remains to be seen whether the opinion actually brings clarity to the situation or simply a lesser degree of confusion for the courts to follow. In any event, the rules in Menchaca appear to weigh in favor of insurers because the law is settled, i.e. there must be a right to receive benefits or a (rare, but possible) independent injury to receive policy benefits for statutory violations.


[1] Universal Life Ins. Co. v. Giles, 950 S.W.2d 48, 53 (Tex. 1997).

[2] Arnold v. Nat’l Cty. Mut. Fire Ins. Co., 725 S.W.2d 165, 167 (Tex. 1987).

[3]Viles v. Sec. Nat’l Ins. Co., 788 S.W.2d 566, 567 (Tex. 1990).

[4] Pena v. State Farm Lloyds, 980 S.W.2d 949, 958 (Tex. App.—Corpus Christi 1998, no pet.); Giles, 950 S.W.2d at 54. See also Arnold, 757 S.W.2d at 168 (stating, “[E]xemplary damages and mental anguish damages are recoverable for a breach of the duty of good faith and fair dealing under the same principles allowing recovery of those damages in other tort actions.”).

[5] Pa Preston Carter Co. v. Tatum, 708 S.W.2d 23, 25 (Tex. App.—Dallas 1985, no writ). There is no set rule or ratio between the amount of actual damages and exemplary damages which will be considered reasonable and the determination is made on a case-by-case basis. Alamo Nat’l Bank v. Kraus, 616 S.W.2d 908, 910 (Tex. 1981).

[6] Texas does not adhere to the Uniform Deceptive Trade Practices Act adopted by many other states, but has its own set of laws, known as the Texas Deceptive Trade Practices Act (“DTPA”). Chapter 541 of the Texas Insurance Code addresses the protection of consumer interests against deceptive, unfair, and prohibited practices within the context of insurance. Chapter 17.50(a)(4) of the DTPA incorporates Chapter 541 of the Texas Insurance Code in its entirety.

[7] TEX. INS. CODE § 541.152

[8] National Sec. Fire & Cas. Co. v. Hurst, 523 S.W.3d 840, 840 (Tex. App.—Houston 14th Dist. 2017, no pet.).

[9] No. 14-0721, 2017 WL 1311752, at *1 (Tex. 2017).

[10] 2017 WL 1311752, at *1.

[11] Id. at *3.

[12[ Id. at *1.

[13] Id. 

[14] Id. 

[15] Id. 

[16] Id. 

[17] Id. 

[18] Id. 

[19] Id. at *3.

[20] Id. at *2.

[21] Id.

[22] Id.

[23] Id. at *4.

[24] Id. at *14

[25] TEX. INS. CODE § 541.151; Stoker, 903 S.W.2d at 341.

[26] Republic Ins. Co. v. Stoker, 903 S.W.2d 338, 341 (Tex. 1995).

[27] Menchaca, 2017 WL 1311752, at *5.

[28] Id. (citing TEX. INS. CODE § 541.151).

[29] Menchaca, 2017 WL 1311752, at *7.

[30] Id

[31] Id. (citing Vail v. Texas Farm Bureau Mut. Ins. Co. v. Castaneda, 988 S.W.2d 189, 188 (Tex. 1998).

[32] Menchaca, 2017 WL 1311752, at *10 (emphasis in original).

[33] Id.

[34] Id.

[35] Id. at *11.

[36] Id.. ; see also Twin City Fire Ins. Co. v. Davis, 904 S.W.2d 663, 666 (Tex. 1995) (identifying mental anguish damages as an example).

[37] Menchaca, 2017 WL 1311752, at *11 (emphasis added).

[38] 904 S.W.2d 663, 666 (Tex. 1995) (citing Federal Express Corp. v. Dutschmann, 846 S.W.2d 282, 284 (Tex. 1993) (stating that “[r]ecovery of punitive damages requires a finding of an independent tort with accompanying actual damages.”). Therefore, insurers are not liable for punitive damages if there is not an independent injury resulting in extra-contractual damages.

[39] Menchaca, 2017 WL 1311752, at *12.

[40].Menchaca, 2017 WL 1311752, at *12; Casteneda, 988 S.W.2d at 198.

[41] WALLACE STEGNER, ALL THE LITTLE LIVE THINGS (PENGUIN BOOKS 1991).

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About this Author

Dawn Holiday, Representation, Licensed Professionals, Steptoe Johnson Law FIrm
Member

Dawn Holiday’s primary focus is the representation of licensed professionals and their organizations.  Within the firm's Professional Liability Practice Group, she represents lawyers, accountants, insurance adjusters, real estate professionals, and others facing malpractice claims brought by former clients and adversaries. As a litigator, she handles a variety of multi-party lawsuits in the areas of commercial litigation, personal injury, complex civil litigation, and general liability defense.  As a trial and appellate lawyer, she often advises trial lawyers on issues that arise in trial...

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