Beasley v. Farmers Tex. Cnty. Mut. Ins. Co.
| Decision Date | 25 April 2018 |
| Docket Number | NO. 12-17-00150-CV,12-17-00150-CV |
| Parties | Rodney BEASLEY, Appellant v. FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANY, Appellee |
| Court | Texas Court of Appeals |
Gregory D. Smith, Midland, for Appellant.
Thomas F. Loose, Dallas, for Appellee.
Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.
Rodney Beasley appeals from the trial court's grant of a plea to the jurisdiction dismissing his case against Farmers Texas County Mutual Insurance Company (Farmers). He presents two issues on appeal. We reverse and remand.
Beasley was involved in a motor vehicle accident in October 2007. At the time of the incident, he was a covered person under an automobile insurance policy issued by Farmers which included personal injury protection (PIP) benefits with a $2,500 limit. Subsequently, Beasley sought medical care from health care providers for treatment of injuries he sustained who submitted their bills totaling $2,662.54 to Beasley's medical health care insurer, Blue Cross-Blue Shield of Texas (BCBS). Pursuant to its contractual agreement with the providers, BCBS discounted the charges and paid a total of $1,068.90 to the providers who accepted the monies as payment in full for the medical services provided.
In 2010, Beasley made a claim for PIP benefits and submitted the medical provider's bills totaling $2,662.54 to Farmers for payment under the policy. In response, Farmers paid Beasley the amount that BCBS paid the providers ($1,068.90) advising Beasley that this amount represented the medical expenses incurred, per the insurance policy, because it was the amount his medical providers agreed to accept in full payment of the medical services rendered. Thereafter, Beasley submitted a provider affidavit stating the charges of $2,662.54 were reasonable for the medical services provided and requested that Farmers reconsider his claim and pay him PIP limits of $2,500. Farmers refused to pay any additional monies.
Beasley sued Farmers alleging breach of the insurance contract, violations of the Texas Deceptive Trade Practices Act (DTPA), and violations of the Texas Insurance Code. According to Beasley, Farmers was contractually obligated to pay him $2,500 under the policy because the medical charges of $2,662.54 exceeded the PIP policy limits and were both reasonable in amount and necessary to treat the injuries he received in the motor vehicle incident. Because Farmers paid less than the reasonable charges for this necessary treatment, Beasley alleged Farmer's breached the insurance contract and violated the DTPA and insurance code.
Farmers filed a plea to the jurisdiction contending that Beasley lacked standing because he suffered no injury. According to Farmers, Beasley failed to allege an actual injury because he is not legally responsible for any remaining payment on his medical bills which were discounted pursuant to the provider's contracts with BCBS and those discounts are not collateral sources under the PIP statute. The trial court granted the plea to the jurisdiction and dismissed Beasley's lawsuit. This appeal followed.
In his first issue, Beasley argues that the trial court should not have granted the plea to the jurisdiction. He contends that (1) in granting the motion, the trial court impermissibly considered the merits of the case, and (2) that he pleaded allegations establishing standing to pursue his claims against Farmers. In his second issue, Beasley argues that the trial court erred by dismissing his DTPA claim when it granted the plea to the jurisdiction on his breach of contract claim. Farmers responds that Beasley failed to allege an actual injury and, therefore, lacks standing to pursue either his breach of contract or statutory claims.
A plea to the jurisdiction is proper to challenge a party's lack of standing. See Vernco Constr., Inc. v. Nelson , 460 S.W.3d 145, 149 (Tex. 2015). Standing is a component of subject matter jurisdiction. See West Orange-Cove Consol. ISD v. Alanis , 107 S.W.3d 558, 583 (Tex. 2003). Whether a court can exercise subject matter jurisdiction over a claim is a question of law that is reviewed de novo. City of Ingleside v. City of Corpus Christi , 469 S.W.3d 589, 590 (Tex. 2015). In the appeal of a case involving a jurisdictional challenge to the pleadings, the appellate court must accept as true all the factual allegations in the plaintiff's petition. See Axtell v. Univ. of Tex. , 69 S.W.3d 261, 264 (Tex. App.—Austin 2002, no pet.). If the case involves a challenge to the existence of jurisdictional facts, the appellate court must consider relevant evidence submitted by the parties when necessary to resolve the jurisdictional issues raised. See Tex. Dep't of Parks & Wildlife v. Miranda , 133 S.W.3d 217, 227 (Tex. 2004).
Evidence is not necessary to resolve a plea to the jurisdiction when the plaintiff's petition (1) affirmatively demonstrates the court's jurisdiction, (2) affirmatively negates the court's jurisdiction, or (3) is insufficient to determine jurisdiction but does not affirmatively demonstrate incurable defects. Miranda , 133 S.W.3d at 226–27. The trial court must consider evidence on a plea to the jurisdiction when evidence is necessary to determine jurisdictional facts. Heckman v. Williamson Cty. , 369 S.W.3d 137, 150 (Tex. 2012).
In most pleas to the jurisdiction, the court should limit the evidence to only what is relevant to the jurisdictional issue and avoid considering evidence that goes to the merits of the case. Bland ISD v. Blue , 34 S.W.3d 547, 555 (Tex. 2000). However, in some cases, jurisdiction involves the merits of the case. In those types of cases, the trial court must review the evidence to determine whether there is a fact issue. Suarez v. City of Tex. City , 465 S.W.3d 623, 632–33 (Tex. 2015). This standard mirrors the traditional summary judgment standard procedure under Texas Rule of Civil Procedure 166a(c).
Sampson v. Univ. of Tex. at Austin , 500 S.W.3d 380, 384 (Tex. 2016) ; see TEX. R. CIV. P. 166a(c). That is, the defendant must first present evidence to show that the court lacks subject matter jurisdiction; if the defendant does so, the plaintiff must then show there is a disputed material fact on the jurisdictional issue. Mission Consol. ISD v. Garcia , 372 S.W.3d 629, 635 (Tex. 2012). If the facts are disputed, the court cannot grant the plea to the jurisdiction, and the issue must be resolved by the factfinder at trial; however, if the evidence is undisputed or if there is no fact question on the jurisdictional issue, the trial court will rule on the plea to the jurisdiction as a matter of law. Suarez , 465 S.W.3d at 633 ; Mission Consol. , 372 S.W.3d at 635.
If a claim is not within a court's jurisdiction and the impediment to jurisdiction cannot be removed, the claim must be dismissed; but if the impediment to jurisdiction can be removed, the court should abate the proceedings to allow the plaintiff a reasonable opportunity to cure the jurisdictional problem. Am. Motorists Ins. Co. v. Fodge , 63 S.W.3d 801, 805 (Tex. 2001). A petition containing multiple claims should not be dismissed just because the court lacks jurisdiction over one of the claims. See Thomas v. Long , 207 S.W.3d 334, 338–39 (Tex. 2006). The court may dismiss or abate the claims over which it does not have subject matter jurisdiction and retain the claims over which it does have jurisdiction. See id.
Generally, for a plaintiff to have standing, there must be a concrete injury to the plaintiff and a real controversy between the parties that will be resolved by the court. Linegar v. DLA Piper LLP (US) , 495 S.W.3d 276, 279 (Tex. 2016). The plaintiff must show he is suffering or has suffered an actual or threatened injury. Heckman , 369 S.W.3d at 155. The injury must be concrete, particularized, and actual or imminent; it cannot be hypothetical. Linegar , 495 S.W.3d at 279 ; Heckman , 369 S.W.3d at 155. The injury must also be personal to the plaintiff, rather than suffered by a third party or the public at large. Linegar , 495 S.W.3d at 279.
The Texas Insurance Code mandates that automobile insurers provide a minimal level of PIP coverage. TEX. INS. CODE ANN. § 1952.152 (West 2009). PIP coverage provides for the recovery of the reasonable amount of necessary medical, surgical, x-ray or dental expenses that arise from an accident and incurred within three years from the date of the accident. Id. § 1952.151 (West 2009). PIP benefits are payable without regard to the fault or nonfault of the claimant and any collateral source of medical, hospital, or wage continuation benefits. Id. § 1952.155(a) (West 2009).
To prove an action for breach of contract, the plaintiff must establish that the defendant's breach caused injury. Southwell v. Univ. of the Incarnate Word , 974 S.W.2d 351, 354–55 (Tex. App.—San Antonio 1998, pet. denied). To recover actual damages, the plaintiff must prove he suffered some monetary loss as a result of the breach. See Stewart v. Basey , 150 Tex. 666, 245 S.W.2d 484, 486 (1952).
In both its plea to the jurisdiction and on appeal, Farmers takes the position that Beasley lacks standing because he has not suffered an actual injury. It relies heavily on the Texas Supreme Court's holding in Allstate Indem. Co. v. Forth to support this position. 204 S.W.3d 795 (Tex. 2006). Beasley responds that the holding in Forth is distinguishable and that he alleged an actual injury and, therefore, has standing.
Forth dealt with whether the plaintiff had standing to sue her PIP insurer for settling her submitted medical bills directly with the medical providers for an amount less than the amount charged by the providers. Id. at 795. Forth's daughter was injured in a motor vehicle accident and required medical care to treat those injuries. Id. Forth filed a claim for payment of the medical expenses with her PIP insurer, ...
To continue reading
Request your trial
-
Allen v. United Servs. Auto. Ass'n
...terms of the PIP policy was sufficient to invoke the trial court's jurisdiction." Id. at 238 (citing Beasley v. Farmers Tex. Cty. Mut. Ins. Co.,578 S.W.3d 98, 106-06 (Tex. App.—Tyler 2018), rev'd, 598 S.W.3d 237 (Tex. 2020)). In the Texas Supreme Court, Beasley asserted that his case was di......
-
Farmers Tex. Cnty. Mut. Ins. Co. v. Beasley
...that the PIP insurer breached the terms of the PIP policy was sufficient to invoke the trial court's jurisdiction. 578 S.W.3d 98, 105–06 (Tex. App.—Tyler 2018, pet. granted). We disagree with the court of appeals and conclude that the plaintiff is unable to show that he suffered any actual ......