Celtic Life Ins. Co. v. Coats

• Decision Date: 22 June 1994
• Docket Number: No. D-2775,D-2775
• Citation: 885 S.W.2d 96
• Parties: 38 Tex. Sup. Ct. J. 63 CELTIC LIFE INSURANCE COMPANY, Petitioner, v. John D. COATS, Jr., Respondent.
• Court: Texas Supreme Court

Page 96

885 S.W.2d 96

38 Tex. Sup. Ct. J. 63

CELTIC LIFE INSURANCE COMPANY, Petitioner, v. John D. COATS, Jr., Respondent.

No. D-2775.

Supreme Court of Texas.

June 22, 1994.

Opinion Concurring on Rehearing by

Chief Justice Phillips Nov. 3, 1994.

Alice M. Giessel and James E. Ebanks, Houston, for petitioner.

Joe K. Longley, Tim Labadie and Philip K. Maxwell, Austin, for respondent.

SPECTOR, Justice, delivered the opinion of the Court, in which PHILLIPS, Chief Justice, and GONZALEZ, HIGHTOWER, HECHT, DOGGETT, CORNYN and GAMMAGE, Justices, join.

We grant John D. Coats' motion for rehearing and withdraw our prior opinion and judgment. The following is now the opinion of the Court.

This case presents three issues relating to an insurance company's liability for its agent's representations: first, whether the company's liability depends on its authorization of misrepresentations; second, whether reliance on the representations is an element of recovery; and third, whether the insured's damages should be trebled when the misrepresentations were not committed "knowingly." The court of appeals affirmed the trial court's judgment on a jury verdict against the insurer. 831 S.W.2d 592. We likewise affirm, but modify the court of appeals' judgment by deleting the award of trebled damages.

I.

Kenneth Harrell, a duly-appointed agent for Celtic Life Insurance Co., ¹ visited Aloha Pools in September 1984 and met with its owner, John Coats, to discuss health insurance for Aloha's employees and their families. Coats stated that he wanted a policy providing benefits for psychiatric care that would be equal to or better than the $20,000 coverage provided by his current policy. Coats explained that he needed such coverage because his oldest son had previously required psychiatric care, and he was concerned that his younger son might require similar care. Harrell responded that he understood Coats' needs fully, having experienced similar financial difficulties in providing psychiatric care for his own son.

Harrell subsequently proposed that Coats purchase a specific policy written by Celtic--a policy that provided a maximum lifetime hospitalization benefit of $1 million. Harrell did not point out that psychiatric benefits under the policy were limited to $10,000.

Coats asked his business manager, Paula Englemann, to review Celtic's brochure and discuss the matter further with Harrell. Englemann noticed the $10,000 limit on benefits for psychiatric care, and questioned Harrell about its meaning. Harrell assured her that the $10,000 limit applied only to out-patient psychiatric care. Based on that representation, Englemann recommended to Coats that he purchase the Celtic policy, and Coats agreed.

In January of 1985, Kenneth Harrell obtained enrollment cards, filled out an application, and collected an initial premium in order to obtain Celtic coverage for Aloha's employees. He then forwarded the enrollment cards, the application, and the premium check to Celtic. Celtic then sent an insurance policy to Harrell, who delivered it to Coats.

During the following August, Coats' son was admitted to Shoal Creek Hospital for psychiatric care. Coats filed a claim for his son's treatment; but despite Harrell's continued assurances that the in-hospital psychiatric treatment was covered by the $1 million hospitalization limit, Celtic paid only $10,000 of the $27,000 in medical expenses.

Coats filed this suit seeking relief under article 21.21 of the Texas Insurance Code and the Texas Deceptive Trade Practices-Consumer Protection Act (DTPA), TEX.BUS. & COM.CODE § 17.41-.63. After hearing the evidence, the jury made the following findings:

(1) Harrell made misrepresentations concerning the terms, benefits, provisions, or conditions of the insurance policy such as to be a producing cause of damages to Coats, but he did not do so knowingly;

(2) Harrell had authority to explain, on Celtic's behalf, the benefits of the insurance policy; and

(3) Harrell did not have the authority of Celtic to make representations concerning the insurance policy's terms, benefits, provisions, or conditions which were outside the scope of the written document.

The jury also found that $17,000 would fairly and reasonably compensate Coats for his damages. ²

The trial court rendered judgment on the verdict in favor of Coats, and the court of appeals affirmed. 831 S.W.2d 592.

II.

Celtic argues that it should not be held responsible for Harrell's representations for two reasons: first, Harrell was a mere soliciting agent, and as such lacked authority to bind Celtic; and second, the jury's answer to the third question--which was submitted over Coats' objection--establishes that Harrell was acting outside of his authority as Celtic's agent. We reject both arguments.

In the contexts of life, health, and accident insurance, the Texas Insurance Code makes no distinction between recording agents and soliciting agents. See May v. United Serv. Ass'n of America, 844 S.W.2d 666, 669 n. 8 (Tex.1992) (discussing TEX.INS.CODE art. 21.14, § 20). Rather, agents are defined generally: section 21.02 of the Code lists various acts performed in the ordinary course of providing insurance, ³ and states that any person who performs these acts "shall be held to be the agent of the company for which the act is done, or the risk is taken, as far as relates to all liabilities, duties, requirements and penalties set forth in this chapter."

There is no dispute that Harrell performed, on Celtic's behalf, at least some of the acts listed in section 21.02. Thus, under that provision, Harrell was clearly Celtic's agent.

An insurance company is generally liable for any misconduct by an agent that is within the actual or apparent scope of the agent's authority. See, e.g., Royal Globe Ins. Co. v. Bar Consultants, 577 S.W.2d 688, 693-94 (Tex.1979); Grand Lodge Free and Accepted Masons v. Walker, 110 S.W.2d 945, 949 (Tex.Civ.App.--Dallas 1937, no writ); see generally George J. Couch et al., COUCH ON INSURANCE 2D § 26A:265, at 506 (rev. ed 1984). This rule is based on notions of fairness: "since the principal has selected the agent to act in a venture in which the principal is interested, it is fair, as between him and a third person, to impose upon him the risk that the agent may exceed his instructions." Royal Globe, 577 S.W.2d at 694 (quoting Standard Distributors v. FTC, 211 F.2d 7, 15 (2d Cir.1954) (Hand, J.)).

In the present case, the jury was asked whether Harrell had authority to explain, on Celtic's behalf, the benefits of the insurance policy. The instructions accompanying this question explained that "authority" of an insurance agent can be actual or apparent; and in defining apparent authority, the instructions explained, among other things, that "[a]n insurance company may so clothe the agent with signs or indications of authority so as to lead a reasonably prudent person to believe that the agent actually has such authority." The jury answered the question affirmatively.

Celtic does not contend that Harrell's representations were so absurd that no reasonable person could have believed Harrell was acting within the scope of his authority. ⁴ Nor does Celtic assert any other challenge to the jury's finding that Coats had authority to explain the policy. Thus, under common-law rules of agency, Celtic is liable for the representations Harrell made in explaining the policy.

Celtic's liability is not affected by the finding that Harrell lacked authority to make representations outside the scope of the written document. In determining a principal's vicarious liability, the proper question is not whether the principal authorized the specific wrongful act; if that were the case, principals would seldom be liable for their agents' misconduct. Rather, the proper inquiry is whether the agent was acting within the scope of the agency relationship at the time of committing the act. See Leonard Lakin and Martin Schiff, THE LAW OF AGENCY 144-45 (1984). The misrepresentation in the present case was made in the course of explaining the terms of the policy--a task the jury specifically found to be within the scope of Harrell's authority. Thus, Celtic cannot escape liability on the basis that it did not authorize particular representations concerning the policy.

III.

Celtic asserts that Harrell is not entitled to recover under the DTPA because there has been no showing that Coats relied on Harrell's representations. The trial court refused Celtic's requested issue on reliance after Coats objected on the basis of Weitzel v. Barnes, 691 S.W.2d 598 (Tex.1985).

In Weitzel, we determined that the legislature had specifically rejected reliance as an element of recovery under the DTPA. 691 S.W.2d at 600. The legislature chose, instead, to allow recovery when there is proof of a deceptive act or practice that is a "producing cause" of the consumer's actual damages. Id. (discussing TEX.BUS. & COM.CODE § 17.50(a)).

In the present case, the trial court submitted a question asking whether Harrell made any misrepresentations that were a "producing cause of damages" to Coats. This question, we hold, fairly presented the issue of producing cause to the jury. We decline Celtic's invitation to overrule Weitzel.

IV.

Finally, Celtic argues that the trebling of actual damages was erroneous in view of the jury's finding that Harrell's misrepresentations were not made "knowingly." Celtic points out that since 1979, the DTPA has required that conduct be committed knowingly before damages may be trebled. TEX.BUS. & COM.CODE § 17.50(b)(1). Additionally, by amendment effective April 4, 1985, article 21.21 of the Texas Insurance Code has included a similar requirement of knowing conduct before damages may be trebled. TEX.INS.CODE art. 21.21 § 16(b)(1). Celtic argues that Coats' cause of action did not accrue until August 1985, when his benefits were denied, so that knowing conduct is required for trebling of...