Texas Hunting Regulations Overview–Fort Worth, Texas Civil Litigation Lawyers

Hunting Regulations Overview — Texas Parks & Wildlife Department

Hunting License

A hunting license is required of any person, regardless of age, who hunts any animal, bird, frog or turtle in Texas (except furbearers, if the hunter possesses a trapper’s license.) See Hunting Licenses and Permits.

  • No license is required for nuisance fur-bearing animals, depredating hogs or coyotes.
  • Non-residents under 17 years of age may purchase and hunt with the Youth Hunting License.

Closed Season

For any species, the period of time, if any, when hunting that species is not permitted.

Hunter Orange

No hunter orange is required while hunting on private property, but it is recommended. Public hunting lands require 400 square inches of daylight florescent orange with 144 square inches appearing on both chest and back, and daylight florescent orange headwear must be worn. (See Prohibited Acts on Public Hunting Lands offering Hunts by Special or Regular Permit.)

Legal Shooting Hours for All Game Animals and Nonmigratory Game Birds

The period from one-half hour before sunrise to one-half hour after sunset. Look up sunrise/sunset hours.

Open Season

Dates shown are opening and closing dates for the open season. The open season includes both dates and all days between. Unless otherwise specified, the open season is a “general” season and all legal means, as specified in this guide, may be used in taking the species. Where the open season is designated as “archery,” only legal archery equipment/crossbow as specified, may be used. Where the open season is designated as “muzzleloader only” only muzzleloaders as defined may be used. When a season is designated as a “youth-only,” special regulations apply. See definition of “youth.”

There is no open season for any wild animal, wild bird, or exotic animal on public roads or the right-of-way of public roads, except that the holder of a Reptile and Amphibian Stamp may capture indigenous reptiles or amphibians on the shoulder of a public road or any unpaved area of a public right of way.

Sale of Inedible Wildlife Parts

The following inedible wildlife parts may be purchased or sold provided the part was lawfully taken or possessed:

  • Hair, hide, antlers, bones, horns, skull, hooves, or sinew from the following game animals: mule deer, white-tailed deer, pronghorn antelope, desert bighorn sheep, gray or cat squirrels, fox squirrels or red squirrels, and collared peccary or javelina.
  • Feathers from ducks, geese, and brant may be used, purchased, or sold for making fishing flies, pillows, mattresses, and similar commercial uses.
  • Feathers from migratory birds may not be purchased or sold for hats or ornamental purposes nor may a person purchase or sell mounted migratory game bird specimens taken by hunting.
  • Feathers, bones, or feet of game birds other than migratory game birds (turkey, grouse, pheasant, partridge, quail, and chachalaca).

Possession of Deer Hit by Motor Vehicle

It is unlawful to possess a deer or any part of a deer that has been hit by a motor vehicle.

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

Letter of James Fannin to Acting Governor James W. Robinson During Texas Revolution

Head Quarters Army of Texas Fort Defiance Goliad Feby 28 1836 6 o’c P.M. To the Acting Governor, & Council of the Provisional Govt. of Texas  I have to inform you that I have just received the unpleasant intelligence that Colo. Johnsons command were yesterday morning before day light surprised by the Enemy at San Patricio- I received my intelligence by express from Edwd. Gritten in the Mission del Refugio, who reports that Col. Johnson with two men had arrivd, on foot at a Rancho near that place- I also learn that two others had arrived at the Mission—Capt Pearson was shot down & others when asking for Quarters- From those who have escaped it is impossible to learn the strength of the army or the loss sustained by our countrymen

 

Mr. Gritten writes that Col. Johnson and his Companions will as soon as fresh horses can be procured proceed to this place  They will probably arrive tomorrow morning This morning Col. Ferris left this post with a communication from me informing you of the return of the Troops to this place after crossing the River on the way to Bexar. The propriety of their retrogade movement will now be apparent.  It is now obvious that the Enemy have entered Texas at two points, for the purpose of attacking Bexar & this place- The first has been attacked and we may expect the enemy here momentarily- Both places are importent- and this at this time particularly so- All our provisions are at Matagorda Dewitts Landing Coxes point & on the way here- We have not in the garrison supplies of Bread Stuff for a single day and as yet but little Beef and should our Supplies be cut off our situation will be, to say the least disagreeable- & in case we are not reinforced and a sufficient force sent to convey the provisions (as we have no means of transportation) when famine begins to look us in the face, we shall be compelled to cut our way through the enemy leaving the artillery & munitions of war in their hands- We hope, however for the best we hope that before this time the people have risen and are marching to the relief of Bexar & this post- but should the worst happen- on whose head should the burthen of censure fall- not on the heads of those brave men who have left their homes in the United States to aid us in our struggle for Liberty -but on those whose all is in Texas & who notwithstanding the repeated calls have remained at home without raising a finger to keep the Enemy from their thresholds- What must be the feelings of the Volunteers now shut in Bexar- & what will be those of this command if a sufficient force of the enemy should appear to besiege us here without provisions- Will not curses be heaped on the heads of the sluggards who remained at home with a knowledge of our situation

 

Our present force in Garrison is about four Hundred & twenty, including Guerra’s company of Mexicans—(about five white citizens of Texas in this number   I omitted to mention that the force on the Nueces was divided into two parties one under Col. Johnson—in the Village of San Patricio & the other under Col. Grant & Maj. Morris on the road above- of the fate of the latter party we know nothing—as yet.  I am with respect & Consideration Yr. obt. servt.  J. W. Fannin Jr. Col. Comt. &c.  Superscription:  If this can be fowd early, so as to overtake the Express sent off this morning, it will save much time—Col. Ferris went by Dimmitts landing with it—Speed—go at speed  Forward with all dispatch and spread the alarm & call out the whole people to arms—to arms.  [Addressed: To/His Excellency James W. Robinson Actg Govr and Genl. Council of Texas Washington   Express

 

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

The Texas Declaration of Independence of March 2, 1836

 

The Texas Declaration of Independence
(March 2, 1836)

 

The Texas Declaration of Independence was produced, literally, overnight. Its urgency was paramount, because while it was being prepared, the Alamo in San Antonio was under seige by Santa Anna’s army of Mexico.Immediately upon the assemblage of the Convention of 1836 on March 1, a committee of five of its delegates were appointed to draft the document. The committee, consisting of George C. Childress, Edward Conrad, James Gaines, Bailey Hardeman, and Collin McKinney, prepared the declaration in record time. It was briefly reviewed, then adopted by the delegates of the convention the following day.

As seen from the transcription below, the document parallels somewhat that of the United States, signed almost sixty years earlier. It contains statements on the function and responsibility of government, followed by a list of grievances. Finally, it concludes by declaring Texas a free and independent republic.

The full text of the document is as follows:


 

The Unanimous
Declaration of Independence
made by the
Delegates of the People of Texas
in General Convention
at the town of Washington
on the 2nd day of March 1836.

When a government has ceased to protect the lives, liberty and property of the people, from whom its legitimate powers are derived, and for the advancement of whose happiness it was instituted, and so far from being a guarantee for the enjoyment of those inestimable and inalienable rights, becomes an instrument in the hands of evil rulers for their oppression.

When the Federal Republican Constitution of their country, which they have sworn to support, no longer has a substantial existence, and the whole nature of their government has been forcibly changed, without their consent, from a restricted federative republic, composed of sovereign states, to a consolidated central military despotism, in which every interest is disregarded but that of the army and the priesthood, both the eternal enemies of civil liberty, the everready minions of power, and the usual instruments of tyrants.

When, long after the spirit of the constitution has departed, moderation is at length so far lost by those in power, that even the semblance of freedom is removed, and the forms themselves of the constitution discontinued, and so far from their petitions and remonstrances being regarded, the agents who bear them are thrown into dungeons, and mercenary armies sent forth to force a new government upon them at the point of the bayonet.

When, in consequence of such acts of malfeasance and abdication on the part of the government, anarchy prevails, and civil society is dissolved into its original elements. In such a crisis, the first law of nature, the right of self-preservation, the inherent and inalienable rights of the people to appeal to first principles, and take their political affairs into their own hands in extreme cases, enjoins it as a right towards themselves, and a sacred obligation to their posterity, to abolish such government, and create another in its stead, calculated to rescue them from impending dangers, and to secure their future welfare and happiness.

Nations, as well as individuals, are amenable for their acts to the public opinion of mankind. A statement of a part of our grievances is therefore submitted to an impartial world, in justification of the hazardous but unavoidable step now taken, of severing our political connection with the Mexican people, and assuming an independent attitude among the nations of the earth.

The Mexican government, by its colonization laws, invited and induced the Anglo-American population of Texas to colonize its wilderness under the pledged faith of a written constitution, that they should continue to enjoy that constitutional liberty and republican government to which they had been habituated in the land of their birth, the United States of America.

In this expectation they have been cruelly disappointed, inasmuch as the Mexican nation has acquiesced in the late changes made in the government by General Antonio Lopez de Santa Anna, who having overturned the constitution of his country, now offers us the cruel alternative, either to abandon our homes, acquired by so many privations, or submit to the most intolerable of all tyranny, the combined despotism of the sword and the priesthood.

It has sacrificed our welfare to the state of Coahuila, by which our interests have been continually depressed through a jealous and partial course of legislation, carried on at a far distant seat of government, by a hostile majority, in an unknown tongue, and this too, notwithstanding we have petitioned in the humblest terms for the establishment of a separate state government, and have, in accordance with the provisions of the national constitution, presented to the general Congress a republican constitution, which was, without just cause, contemptuously rejected.

It incarcerated in a dungeon, for a long time, one of our citizens, for no other cause but a zealous endeavor to procure the acceptance of our constitution, and the establishment of a state government.

It has failed and refused to secure, on a firm basis, the right of trial by jury, that palladium of civil liberty, and only safe guarantee for the life, liberty, and property of the citizen.

It has failed to establish any public system of education, although possessed of almost boundless resources, (the public domain,) and although it is an axiom in political science, that unless a people are educated and enlightened, it is idle to expect the continuance of civil liberty, or the capacity for self government.

It has suffered the military commandants, stationed among us, to exercise arbitrary acts of oppression and tyrrany, thus trampling upon the most sacred rights of the citizens, and rendering the military superior to the civil power.

It has dissolved, by force of arms, the state Congress of Coahuila and Texas, and obliged our representatives to fly for their lives from the seat of government, thus depriving us of the fundamental political right of representation.

It has demanded the surrender of a number of our citizens, and ordered military detachments to seize and carry them into the Interior for trial, in contempt of the civil authorities, and in defiance of the laws and the constitution.

It has made piratical attacks upon our commerce, by commissioning foreign desperadoes, and authorizing them to seize our vessels, and convey the property of our citizens to far distant ports for confiscation.

It denies us the right of worshipping the Almighty according to the dictates of our own conscience, by the support of a national religion, calculated to promote the temporal interest of its human functionaries, rather than the glory of the true and living God.

It has demanded us to deliver up our arms, which are essential to our defence, the rightful property of freemen, and formidable only to tyrannical governments.

It has invaded our country both by sea and by land, with intent to lay waste our territory, and drive us from our homes; and has now a large mercenary army advancing, to carry on against us a war of extermination.

It has, through its emissaries, incited the merciless savage, with the tomahawk and scalping knife, to massacre the inhabitants of our defenseless frontiers.

It hath been, during the whole time of our connection with it, the contemptible sport and victim of successive military revolutions, and hath continually exhibited every characteristic of a weak, corrupt, and tyrranical government.

These, and other grievances, were patiently borne by the people of Texas, untill they reached that point at which forbearance ceases to be a virtue. We then took up arms in defence of the national constitution. We appealed to our Mexican brethren for assistance. Our appeal has been made in vain. Though months have elapsed, no sympathetic response has yet been heard from the Interior. We are, therefore, forced to the melancholy conclusion, that the Mexican people have acquiesced in the destruction of their liberty, and the substitution therfor of a military government; that they are unfit to be free, and incapable of self government.

The necessity of self-preservation, therefore, now decrees our eternal political separation.

We, therefore, the delegates with plenary powers of the people of Texas, in solemn convention assembled, appealing to a candid world for the necessities of our condition, do hereby resolve and declare, that our political connection with the Mexican nation has forever ended, and that the people of Texas do now constitute a free, Sovereign, and independent republic, and are fully invested with all the rights and attributes which properly belong to independent nations; and, conscious of the rectitude of our intentions, we fearlessly and confidently commit the issue to the decision of the Supreme arbiter of the destinies of nations.

Richard Ellis, President
of the Convention and Delegate
from Red River.
Charles B. Stewart
Tho. Barnett
John S. D. Byrom
Francis Ruis
J. Antonio Navarro
Jesse B. Badgett
Wm D. Lacy
William Menifee
Jn. Fisher
Matthew Caldwell
William Motley
Lorenzo de Zavala
Stephen H. Everett
George W. Smyth
Elijah Stapp
Claiborne West
Wm. B. Scates
M. B. Menard
A. B. Hardin
J. W. Burton
Thos. J. Gazley
R. M. Coleman
Sterling C. Robertson James Collinsworth
Edwin Waller
Asa Brigham
Geo. C. Childress
Bailey Hardeman
Rob. Potter
Thomas Jefferson Rusk
Chas. S. Taylor
John S. Roberts
Robert Hamilton
Collin McKinney
Albert H. Latimer
James Power
Sam Houston
David Thomas
Edwd. Conrad
Martin Parmer
Edwin O. Legrand
Stephen W. Blount
Jms. Gaines
Wm. Clark, Jr.
Sydney O. Pennington
Wm. Carrol Crawford
Jno. TurnerBenj. Briggs Goodrich
G. W. Barnett
James G. Swisher
Jesse Grimes
S. Rhoads Fisher
John W. Moore
John W. Bower
Saml. A. Maverick (from Bejar)
Sam P. Carson
A. Briscoe
J. B. Woods
H. S. Kimble, Secretary

 

 

 

Signers of the Texas Decl. of Ind.
http://www.lsjunction.com/docs/tdoi.htm

 

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

Few Things Help an Individual More Than to Place Responsibility Upon Him–Fort Worth, Texas Civil Litigation Lawyers

QUOTES ON LIBERTY AND JUSTICE, TRUTH AND DUTY:

 

 

“Few things help an individual more than to place responsibility upon him.” Up from Slavery

-Booker T. Washington

 

“The true meaning of America, you ask? It’s in a Texas rodeo, in a policeman’s badge, in the sound of laughing children, in a political rally, in a newspaper… In all these things, and many more, you’ll find America. In all these things, you’ll find freedom. And freedom is what America means to the world. And to me.”

-Audie Murphy

 

“The enemy has demanded a surrender at discretion, otherwise, the garrison are to be put to the sword, if the fort is taken — I have answered the demand with a cannon shot, & our flag still waves proudly from the walls — I shall never surrender or retreat.  Then, I call on you in the name of Liberty, of patriotism & everything dear to the American character, to come to our aid, with all dispatch — The enemy is receiving reinforcements daily & will no doubt increase to three or four thousand in four or five days.  If this call is neglected, I am determined to sustain myself as long as possible & die like a soldier who never forgets what is due to his own honor & that of his country — Victory or Death. P.S. The Lord is on our side…”

-William Barrett Travis

 

“If, from the more wretched parts of the old world, we look at those which are in an advanced stage of improvement, we still find the greedy hand of government thrusting itself into every corner and crevice of industry, and grasping the spoil of the multitude. Invention is continually exercised, to furnish new pretenses for revenue and taxation. It watches prosperity as its prey and permits none to escape without tribute.” Rights of Man, 1791

-Thomas Paine

 

“If the federal government should overpass the just bounds of its authority and make a tyrannical use of its powers, the people, whose creature it is, must appeal to the standard they have formed, and take such measures to redress the injury done to the Constitution as the exigency may suggest and prudence justify.” The Federalist Papers Federalist No. 33,  January 3, 1788

-Alexander Hamilton

 

“It is only when the people become ignorant and corrupt, when they degenerate into a populace, that they are incapable of exercising their sovereignty.” Inaugural Address, March 4, 1817

-James Monroe

 

“I love my country, I love my guns, I love my family. I love the way it is now, and anybody that tries to change it has to come through me. That should be all our attitudes because this is America….”

-Charles Daniels

 

“But when a long train of abuses and usurpations, pursuing invariably the same Object, evinces a design to reduce them under absolute Despotism, it is their rights, it is their duty, to throw off such Government.”  April 4, 1776

– Declaration of Independence

 

“It is much to be wished that slavery may be abolished. The honour of the States, as well as justice and humanity, in my opinion, loudly call upon them to emancipate these unhappy people. To contend for our own liberty, and to deny that blessing to others, involves an inconsistency not to be excused. Letter to R. Lushington, March 15, 1786

-John Jay

 

“In such a performance you may lay the foundation of national happiness only in religion, not by leaving it doubtful “whether morals can exist without it,” but by asserting that without religion morals are the effects of causes as purely physical as pleasant breezes and fruitful seasons.” Letter to John Adams, August 20, 1811

-Benjamin Rush 

 

“Man is not free unless government is limited. There’s a clear cause and effect here that is as neat and predictable as a law of physics: As government expands, liberty contracts.” Farewell Address, The Oval Office, January 11, 1989

-Ronald Reagan

 

“I prefer to be true to myself, even at the hazard of incurring the ridicule of others, rather than to be false, and incur my own abhorrence.” Narrative of the Life of Frederick Douglass

-Frederick Douglass

 

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

Pregnancy Discrimination and Workplace Laws–EEOC–Ft. Worth, Texas Employment Defense Attorneys

Pregnancy Discrimination & Work Situations

The Pregnancy Discrimination Act (PDA) forbids discrimination based on pregnancy when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, such as leave and health insurance, and any other term or condition of employment.

Pregnancy Discrimination & Temporary Disability

If a woman is temporarily unable to perform her job due to a medical condition related to pregnancy or childbirth, the employer or other covered entity must treat her in the same way as it treats any other temporarily disabled employee. For example, the employer may have to provide light duty, alternative assignments, disability leave, or unpaid leave to pregnant employees if it does so for other temporarily disabled employees.

Additionally, impairments resulting from pregnancy (for example, gestational diabetes or preeclampsia, a condition characterized by pregnancy-induced hypertension and protein in the urine) may be disabilities under the Americans with Disabilities Act (ADA).  An employer may have to provide a reasonable accommodation (such as leave or modifications that enable an employee to perform her job) for a disability related to pregnancy, absent undue hardship (significant difficulty or expense).  The ADA Amendments Act of 2008 makes it much easier to show that a medical condition is a covered disability.  For more information about the ADA, see http://www.eeoc.gov/laws/types/disability.cfm.  For information about the ADA Amendments Act, see http://www.eeoc.gov/laws/types/disability_regulations.cfm.

Pregnancy Discrimination & Harassment

It is unlawful to harass a woman because of pregnancy, childbirth, or a medical condition related to pregnancy or childbirth. Harassment is illegal when it is so frequent or severe that it creates a hostile or offensive work environment or when it results in an adverse employment decision (such as the victim being fired or demoted). The harasser can be the victim’s supervisor, a supervisor in another area, a co-worker, or someone who is not an employee of the employer, such as a client or customer.

Pregnancy, Maternity & Parental Leave

Under the PDA, an employer that allows temporarily disabled employees to take disability leave or leave without pay, must allow an employee who is temporarily disabled due to pregnancy to do the same.

An employer may not single out pregnancy-related conditions for special procedures to determine an employee’s ability to work. However, if an employer requires its employees to submit a doctor’s statement concerning their ability to work before granting leave or paying sick benefits, the employer may require employees affected by pregnancy-related conditions to submit such statements.

Further, under the Family and Medical Leave Act (FMLA) of 1993, a new parent (including foster and adoptive parents) may be eligible for 12 weeks of leave (unpaid or paid if the employee has earned or accrued it) that may be used for care of the new child. To be eligible, the employee must have worked for the employer for 12 months prior to taking the leave and the employer must have a specified number of employees.  See http://www.dol.gov/whd/regs/compliance/whdfs28.htm.

Pregnancy & Workplace Laws

Pregnant employees may have additional rights under the Family and Medical Leave Act (FMLA), which is enforced by the U.S. Department of Labor.  Nursing mothers may also have the right to express milk in the workplace under a provision of the Fair Labor Standards Act enforced by the U.S. Department of Labor’s Wage and Hour Division.  See http://www.dol.gov/whd/regs/compliance/whdfs73.htm.

For more information about the Family Medical Leave Act or break time for nursing mothers, go to http://www.dol.gov/whd, or call 202-693-0051 or 1-866-487-9243 (voice), 202-693-7755 (TTY).

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

Duty to Indemnify Under Texas Law: Ruled Determination Premature Until Underlying Lawsuit Resolved– Fort Worth, Texas Insurance Defense Attorneys

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF TEXAS
HOUSTON DIVISION
CHARTIS SPECIALTY INSURANCE CO., §
§
Plaintiff, §
§
v. § CIVIL ACTION H-14-1527
§
JSW STEEL (USA), INC., §
§
Defendant. §
ORDER
Pending before the court are plaintiff Chartis Specialty Insurance Company’s (“Chartis”)
motion for summary judgment (Dkt. 20), defendant JSW Steel Inc.’s (“JSW”) motion for partial
summary judgment (Dkt. 22), JSW’s motion to abate (Dkt. 23), and Chartis’s motion to strike (Dkt.
29). After considering the motions, responses, and applicable law, the court finds that Chartis’s
motion for summary judgment (Dkt. 20) should be GRANTED IN PART and DENIED IN PART,
JSW’s motion for summary judgment (Dkt. 22) should be DENIED, JSW’s motion to abate (Dkt.
23) should be GRANTED, and Chartis’s motion to strike (Dkt. 29) should be DENIED AS MOOT.
I. BACKGROUND
In this case, an insurer, Chartis, seeks a declaration that it does not owe indemnity or defense
for an underlying lawsuit against its insured, JSW. Dkt. 1 at 1. Chartis issued commercial general
liability and commercial umbrella policies to JSW in September 2010. Dkt. 20 at 7-8. Among other
things, the policies provide coverage for “personal and advertising injury,” which includes “oral or
written publication, in any manner, of material that slanders or libels a person or organization or
disparages a person’s or organization’s goods, products or services.” Dkt. 20-3 at 49. However, the
policy excludes (1) “personal and advertising injury caused by or at the direction of the insured with
Case 4:14-cv-01527 Document 39 Filed in TXSD on 07/08/15 Page 1 of 7
the knowledge that the act would violate the rights of another and would inflict personal and
advertising injury,” (2) “personal and advertising injury arising out of oral or written publication of
material, if done by or at the direction of the insured with knowledge of its falsity,” and (3) “personal
and advertising injury arising out of a breach of contract, except an implied contract to use another’s
advertising idea in your advertisement.” Dkt. 7-1 at 11.
On April 19, 2012, MM Steel filed an original complaint alleging that JSW and others
arranged a “group boycott” to drive MM Steel out of business (the “Underlying Lawsuit”). Dkt. 1-1.
MM Steel’s original complaint included claims for violation of the Sherman Act, breach of contract,
tortious interference, business disparagement, and conspiracy. Dkt. 20 at 9. JSW tendered the
Underlying Lawsuit to Chartis for defense and indemnity. Id. Chartis maintained that the only
potentially covered claim was MM Steel’s claim for business disparagement. Id. Even though the
original complaint did not contain allegations that JSW made any disparaging statements, Chartis
agreed to defend JSW in the Underlying Lawsuit with a full reservation of rights. Id. Prior to trial,
MM Steel abandoned all of its state law claims against JSW except for breach of contract. Id.
On March 25, 2014, the jury returned a verdict in MM Steel’s favor on its antitrust and
breach of contract claims against JSW. Id at 10. MM Steel advised the court that it did not intend
to pursue recovery of its breach of contract verdict, and the court entered a final judgment in the
Underlying Lawsuit against JSW and its co-defendants for $156 million. Id. Following judgment,
JSW turned to Chartis for indemnity and post-verdict defense costs while the Underlying Lawsuit
is on appeal. Id. Chartis denied coverage because the verdict rendered against JSW was for claims
that were not covered by the Chartis policies. Id. Chartis then filed this lawsuit seeking a
declaration that it has no duty to defend JSW on appeal or indemnify JSW for the judgment. JSW
2
Case 4:14-cv-01527 Document 39 Filed in TXSD on 07/08/15 Page 2 of 7
presented breach of contract claims for Chartis’s failure to defend and indemnify JSW. JSW and
Chartis now both move for summary judgment.
II. LEGAL STANDARD
A court shall grant summary judgment when a “movant shows that there is no genuine
dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R.
Civ. P. 56(c). “[A] fact is genuinely in dispute only if a reasonable jury could return a verdict for
the non-moving party.” Fordoche, Inc. v. Texaco, Inc., 463 F.3d 388, 392 (5th Cir. 2006). The
moving party bears the initial burden of demonstrating the absence of a genuine issue of material
fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S. Ct. 2548 (1986). If the party meets its
burden, the burden shifts to the non-moving party to set forth specific facts showing a genuine issue
for trial. Fed. R. Civ. P. 56(e). The court must view the evidence in the light most favorable to the
non-movant and draw all justifiable inferences in favor of the non-movant. Envtl. Conservation Org.
v. City of Dallas, Tex., 529 F.3d 519, 524 (5th Cir. 2008).
III. ANALYSIS
A. Duty to Defend
Under Texas law, courts follow the “eight corners” rule to determine whether a party has a
duty to defend. Federated Mut. Ins. Co. v. Grapevine Excavation Inc., 197 F.3d 720, 723 (5th Cir.
1999). “Under this rule, courts compare the words of the insurance policy with the allegations of
the plaintiff’s complaint to determine whether any claim asserted in the pleading is potentially within
the policy’s coverage.” Id. “The duty to defend analysis is not influenced by facts ascertained before
the suit, developed in the process of litigation, or by the ultimate outcome of the suit.” Primrose
Operating Co. v. Nat’l Am. Ins. Co., 382 F.3d 546, 552 (5th Cir. 2004). All doubts with regard to
the duty to defend are resolved in favor of the duty. Id. Courts applying the eight corners rule “give
3
Case 4:14-cv-01527 Document 39 Filed in TXSD on 07/08/15 Page 3 of 7
the allegations in the petition a liberal interpretation.” Nat’l Union Fire Ins. Co. of Pittsburgh, Pa.
v. Merchants Fast Motor Lines, Inc., 939 S.W.2d 139, 141 (Tex. 1997).
JSW argues that the court should consider the original complaint in the Underlying Lawsuit
in conducting its analysis. Dkt. 24 at 19-20. However, none of the allegations concerning JSW in
MM Steel’s original complaint in the Underlying Lawsuit trigger coverage under the policy. MM
Steel alleges that several of its competitors convinced JSW to breach the contract between MM Steel
and JSW by refusing to sell steel to MM Steel. According to the original complaint:
at a meeting in October 2011, JSW’s President, Mike Fitch, and Rajesh Khosla, a
JSW salesman, told Plaintiff MM Steel that JSW would no longer honor its contract.
This was because, according to Fitch, multiple persons had made “unsolicited” visits
to JSW to disparage Hume, Schultz1, and MM Steel. Because of those unsolicited
visits, JSW cut off supply to MM Steel. Hume told Fitch that he was effectively
putting MM Steel out of business. When Hume told Fitch that he (Hume) sensed
Fitch and JSW had been threatened, Fitch’s only response was this: “I understand the
gravity of the situation,” but “I have to do what’s best for my business.” The end
result was that despite an existing contract and an established business relationship
with Hume and Shultz, JSW was going to enter into a conspiracy to shut down MM
Steel, not to mention breach its contract. Plaintiff has recently learned that
Defendants Alloy and Moore threatened JSW.
Dkt. 20-7 at 15-16. These are the only facts alleged against JSW, and they are excluded from
coverage, as analyzed below. The complaint also contains the following allegations applicable to
all defendants:
Defendants published disparaging words about Plaintiff MM Steel’s economic
interests, and those words were false. Defendants published the words with malice
and without privilege.
Defendant’s tortious conduct caused Plaintiff MM Steel to suffer actual damages and
other special damages.
Id. at 25.
1Hume and Shultz are the owners of MM Steel. Dkt. 20-7 at 13.
4
Case 4:14-cv-01527 Document 39 Filed in TXSD on 07/08/15 Page 4 of 7
While the policies at issue cover statements that disparage a person’s or organization’s goods,
products or services, certain statements are excluded. Dkt. 1 at ¶ 4.7. Specifically excluded from
coverage is “personal or advertising injury caused by or at the direction of the insured with the
knowledge that the act would violate the rights of another and would inflict personal and advertising
injury.” The complaint seems to allege that all of the disparagement was actually committed by
parties other than JSW, and JSW’s wrongdoing was limited to its breach of contract (also excluded
from coverage) in aid of the conspirators’ antitrust violations. However, even if the disparagement
were alleged against or imputed to JSW, it would not be covered as it was a knowing attempt to
violate MM Steel’s rights and inflict personal and advertising injury. See Burlington Ins. Co. v.
Superior Nationwide Logistics, Ltd., 783 F. Supp. 2d 958, 964-65 (S.D. Tex. 2010) aff’d 427 F.
App’x 299 (5th Cir. 2011) (finding that allegations of an organized campaign to destroy a competing
business did not trigger a duty to defend where policy language was identical to the Chartis policy);
see also Rose Acre Farms, Inc. v . Columbia Cas. Co., 662 F.3d 765, 769 (7th Cir. 2011); Trailer
Bridge, Inc. v. Ill. Nat’l Ins. Co., 657 F.3d 1135 (11th Cir. 2011). Additionally, the policies exclude
personal or advertising injury where the publication was made with knowledge of its falsity. Dkt.
7-1 at 11. The disparagement alleged in the complaint consists of false statements made with malice.
These allegations are clearly excluded from coverage. Because the complaint alleges only knowing
violations of MM Steel’s rights and deliberate publication of false material, policy coverage is not
implicated, and there is no duty to defend. 2 Because Chartis has no duty to defend JSW in the
Underlying Lawsuit, JSW cannot recover on its breach of contract claim predicated on Chartis’s
2 The conclusion is the same when the court considers the pre-trial order, which alleges basically the
same facts, but asserts only antitrust claims.
5
Case 4:14-cv-01527 Document 39 Filed in TXSD on 07/08/15 Page 5 of 7
failure to defend. Likewise, JSW is not entitled to interest on any unpaid defense fees as alleged in
JSW’s counterclaim. Dkt. 8 at 17-18.
B. Duty to Indemnify
A decision on whether Chartis has a duty to indemnify is premature. “Generally, Texas law
only considers the duty-to-indemnify question justiciable after the underlying suit is concluded,
unless ‘the same reasons that negate the duty to defend likewise negate any possibility the insurer
will ever have a duty to indemnify.’” Northfield Ins. Co. v. Loving Home Care, Inc., 363 F.3d 523,
529 (5th Cir. 2004) (quoting Farmers Tex. Cnty. Mut. Ins. Co. v. Griffin, 955 S.W.2d 81, 84 (Tex.
1997)). Although the evidence presented at trial and the findings of the jury do not appear to trigger
coverage, the Underlying Lawsuit is on appeal, and this court finds it prudent to stay this action until
the Underlying Lawsuit is fully and finally resolved. Upon final resolution of the Underlying
Lawsuit, the parties can move this court for a final determination on indemnity.
C. Motion to Strike
Also before the court is Chartis’s motion to strike an expert report submitted by JSW in
support of its claim for breach of contract for failure to defend. Because that claim is being
dismissed by this order, the motion to strike is moot.
IV. CONCLUSION
Chartis has no duty to defend JSW in the Underlying Lawsuit. However, a decision on the
duty to indemnify is premature. Accordingly, Chartis’s motion for summary judgment (Dkt. 20) is
GRANTED IN PART and DENIED IN PART, JSW’s motion for summary judgment on duty to
6
Case 4:14-cv-01527 Document 39 Filed in TXSD on 07/08/15 Page 6 of 7
defend (Dkt. 22) is DENIED, and JSW’s motion to abate (Dkt. 23) is GRANTED. Chartis’s motion
to strike (Dkt. 29) is DENIED AS MOOT. The remainder of this case is STAYED pending final
resolution of the Underlying Lawsuit. JSW’s claims for breach of contract based on a failure to
defend and interest on unpaid defense fees are DISMISSED WITH PREJUDICE.
It is so ORDERED.
Signed at Houston, Texas on July 8, 2015.
___________________________________
Gray H. Miller
United States District Judge

 

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

Claim By Insured Against Insurance Adjuster in Texas Property Damage Lawsuit– Ft. Worth, Texas Insurance Defense Lawyers

ZIMMERMAN v. TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANY by XAVIER RODRIGUEZ, District Judge

Civil Action No. 5:15-CV-325.

RONALD ZIMMERMAN, Plaintiff, v. TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANY AND COREY KRONK, Defendants.

United States District Court, W.D. Texas, San Antonio Division.
June 30, 2015.

ORDER

XAVIER RODRIGUEZ, District Judge.

On this date the Court considered Plaintiff’s motion to remand and for leave to amend the complaint (docket no. 2). For the following reasons, the Court DENIES the motion to remand and the motion to amend.

I. Background

Plaintiff Ronald Zimmerman owns a residence located at 111 Routt Street, San Antonio, Bexar County, Texas. (Docket no. 1-4 at 3). Defendant Travelers Lloyds of Texas Insurance Company (“Travelers”) is an insurance company that employs Defendant Corey Kronk as a claims adjuster. (Docket no. 2 at 1). Zimmerman maintains insurance on his residence with Travelers. (Docket no. 1-4 at 4). Zimmerman alleges the roofs of his house and separate cabana were damaged by hail. (Id. at 3). Zimmerman made a claim with Travelers Insurance for the loss on or about March 31, 2013. (Id.) Kronk was the claims adjuster assigned to handle Plaintiff’s claim. “EFI Global (a forensic engineering firm) was hired by [Travelers] to investigate the roof damage, ultimately stating that they did not observe hail damage to the cabana roof.” (Id.) Kronk adjusted the loss, and Travelers paid for the damage to the roof of the main home, but denied the cabana portion of the claim. (Id.)

Zimmerman alleges that a tree branch fell on a vent on the roof of the cabana, allowing water to enter and cause more damage to the cabana after Kronk and Travelers denied his initial claim on the cabana. (Id. at 3-4). Kronk re-inspected the cabana. (Id. at 4). Zimmerman alleges Kronk initially acknowledged the damage and agreed to cover the repair. (Id.) Zimmerman alleges Kronk told him that Kronk’s supervisor instructed him to do so. (Id.)

Zimmerman filed a state court petition in the 407th Judicial District Court in Bexar County, Texas, on March 19, 2015. (Docket no. 1 at 1). Defendants removed to federal court on April 23, 2015, based on diversity jurisdiction. (Id. at 2). Zimmerman filed this opposed motion to remand to state court and an incomplete motion for leave to amend his complaint on May 22, 2015.1 (Docket no. 2 at 1). Defendants responded on June 4, 2015. (Docket no. 3 at 14). Zimmerman filed again for leave to amend, this time attaching the proposed amended complaint, on June 9, 2015. (Docket no. 4).

II. Legal Standard

A party may remove an action from state court to federal court if the action is one over which the federal court possesses subject matter jurisdiction. See 28 U.S.C. § 1441(a). On a motion to remand, the court must consider whether removal was proper. Removal is proper in any case in which the federal court would have had original jurisdiction. Id. A federal court originally has subject matter jurisdiction over controversies involving disputes between citizens of different states where the amount in controversy exceeds $75,000. 28 U.S.C. § 1332. Citizenship of the parties and amount in controversy are based on the facts as they existed at the time of removal. Louisiana v. Am. Nat. Prop. Cas. Co., 746 F.3d 633, 636 (5th Cir. 2014). The court considers only the allegations in the state court petition; any amended complaints filed after removal are not considered. Cavallini, 44 F.3d at 264 (citing Pullman Co. v. Jenkins, 305 U.S. 534, 537 (1939) (“The second amended complaint should not have been considered in determining the right to remove . . . [removal] was to be determined according to the plaintiffs’ pleading at the time of the petition for removal.”)).

The removing party bears the burden of showing that federal jurisdiction exists and that removal was proper. De Aguilar v. Boeing Co., 47 F.3d 1404, 1408 (5th Cir. 1995). The removal statute is strictly construed in favor of remand. Vantage Drilling Co. v. Hsin-Chi Su, 741 F.3d 535, 537 (5th Cir. 2014) (citing Acuna v. Brown & Root, Inc., 200 F.3d 335, 339 (5th Cir. 2000)).

III. Analysis — Motion to Remand

A court only has diversity jurisdiction when the parties are completely diverse, i.e. when no plaintiff is a citizen of the same state as any defendant. Wisconsin Dep’t of Corr. v. Schacht, 524 U.S. 381, 388 (1998). Here, Zimmerman and Defendant Kronk are both citizens of Texas. Travelers, being a citizen of Connecticut for diversity purposes, is diverse from Plaintiff. The amount in controversy exceeds $75,000. (Docket no. 3 at 5). Defendants argue that Kronk is improperly joined. If Kronk is stricken from the suit, complete diversity exists and removal was proper. Therefore, the Court must determine if Kronk was improperly joined.

A removing party can establish federal jurisdiction based on 28 U.S.C. § 1332 by demonstrating that an in-state defendant has been “improperly joined.” Smallwood v. Illinois Cent. R. Co., 385 F.3d 568, 573 (5th Cir. 2004). To establish improper joinder, a removing party must show a plaintiff cannot “establish a cause of action against the non-diverse party in state court.” Id. (quoting Travis v. Irby, 326 F.3d 644, 646-47 (5th Cir. 2003)). A plaintiff cannot establish a cause of action against an in-state defendant if there is “no reasonable basis for the district court to predict that the plaintiff might be able to recover” on the claims asserted against an in-state defendant. Smallwood, 385 F.3d at 573.

The improper joinder analysis closely resembles a Rule 12(b)(6) analysis. Id. However, unlike in a traditional Rule 12(b)(6) analysis, the Court has discretion to review evidence on whether plaintiff has a viable cause of action against the non-diverse defendant under state law. Id. (citing Badon v. RJR Nabisco, Inc., 236 F.3d 282, 389 n. 10. (5th Cir. 2000)). “The burden is on the removing party; and the burden of demonstrating improper joinder is a heavy one.” Cuevas v. BAC Home Loans Servicing, LP, 648 F.3d 242, 249 (5th Cir. 2011) (citing Griggs v. State Farm Lloyds, 181 F.3d 694, 699 (5th Cir. 1999)). As a preliminary matter, pursuant to Cavallini and Pullman, the Court only considers Zimmerman’s state court petition on this motion for remand because the amended pleading (docket no. 4-1) was not on file before removal.

To prevent remand, Defendants must meet their heavy burden showing Zimmerman has no reasonable basis for any of his claims against Kronk. Zimmerman asserts eight causes of action in his state court petition: (1) breach of contract, (2) violations of section 17.50(a) of the Deceptive Trade Practices — Consumer Protection Act, (3) violations of section 17.46(b) of the DTPA, (4) violations of Chapter 541 of the Texas Insurance Code, (5) violations of Chapter 542 of the TIC, (6) breach of duty of good faith and fair dealing, (7) negligence and gross negligence, and (8) negligent misrepresentation. (Docket no. 1-4 at 4-11). Of these causes of action, Zimmerman only clearly asserts the breach of duty of good faith and fair dealing, and the negligence and gross negligence claims against Kronk.

A. Breach of Duty of Good Faith and Fair Dealing

Zimmerman’s claim for breach of duty of good faith and fair dealing states, in relevant part:

. . . Plaintiff would show that a special relationship exists between Defendants and Plaintiff such that Defendant owed its insured a duty to deal fairly and in good faith. Plaintiff would further show that Defendants breached this duty owed to Plaintiff and as such, he is entitled to damages.(Doc. 1-4, 9). Despite the inconsistent use of plural and singular constructions in the petition, the Court construes this as a claim for breach of duty of good faith and fair dealing against both Travelers and Kronk. (See docket no. 3 at 7; Docket no. 1-4 at 9-10) (both Zimmerman and Travelers agree that this cause of action has been stated against Kronk).

In Texas, a duty of good faith and fair dealing does not exist in the insurance context without a contract creating a special relationship between the parties. Natividad v. Alexsis, Inc., 875 S.W.2d 675, 678 (Tex. 1994) (“[I]n an insurance context, the duty of good faith and fair dealing arises only when there is a contract giving rise to a `special relationship.'” And “without such a contract there would be no special relationship and hence, no duty of good faith and fair dealing.” (emphasis original)); Cavallini v. State Farm Mut. Auto Ins. Co., 44 F.3d 256, 262 (5th Cir. 1995) (under Texas Law, “the existence of a contract, giving rise to a special relationship, is a necessary element of the duty of good faith and fair dealing.” (internal quotations omitted)). Insurance adjusters typically do not sign any contract with the insured; therefore, adjusters do not typically owe a duty of good faith and fair dealing to the insured. Great W. Inn v. Certain Underwriters at Lloyds of London, No. CIV.A. H-11-320, 2011 WL 1157620, at *5 (S.D. Tex. Mar. 24, 2011) (“Under Texas law, an independent insurance adjuster owes no duty of good faith and fair dealing to the insured.”). Thus, Texas generally does not recognize a cause of action for breach of good faith and fair dealing against insurance adjusters. Crocker v. Am. Nat’l Gen. Ins. Co., 211 S.W.3d 928, 937 (Tex.App.-Dallas 2007, no pet.); see also Natividad, 875 S.W.2d at 678.

Here, there are neither allegations nor indications in the record that Kronk signed the insurance contract between Zimmerman and Travelers. (See docket no. 2-2 at 2-3, 8-9). Zimmerman does not allege he and Kronk are both signatories to any contract. No privity of contract exists between Zimmerman and Kronk, so there is no special relationship between them and no duty owed by Kronk. See Natividad, 875 S.W.2d at 678. Therefore, Zimmerman has no reasonable basis for a claim for breach of duty of good faith and fair dealing against Kronk. Id.; see also Great W. Inn, 2011 WL 1157620 at *5.

B. Negligence and Gross Negligence

Zimmerman’s claim for negligence and gross negligence states, in relevant part:

. . . Defendant TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANY and COREY KRONK’s actions surrounding the denial of coverage for Plaintiff’s claim, which loss was covered by the insurance policy purchased by Plaintiff, resulted in the aforementioned damages.With every contract, there is a common-law duty to perform it with care, skill, reasonable expedience, and faithfulness. Accordingly, Defendants were under a duty to act with reasonable skill and diligence in performing pursuant to the insurance contract so as not to injure Plaintiff by their performance. Here, Defendants failed to act with reasonable skill and diligence in performing their duties under the insurance agreement, which resulted in Plaintiff’s damages.Finally, the duty not to make misrepresentations or to make certain disclosures during the contract formation stage is imposed by law independent of a contract and thus, is actionable. Here, Defendants failed to disclose various material facts. For example, Defendants failed to disclose that Plaintiff would limit payment of Plaintiff’s claim under false pretenses for a claim that supposedly was covered under the policy.Defendants breached the above described duties and . . . [a]s a result of Defendant’s negligence and gross negligence, Plaintiff has suffered damages.(Docket no. 1-4 at 9-10) (emphasis original). As Kronk is specifically named in this cause of action (unlike all others) and “Defendants,” plural, is consistently used throughout, this cause of action is definitely asserted against Kronk. The Court identifies three possible theories of negligence that Zimmerman may be asserting against Kronk, though Zimmerman does not specify them in the petition or motion for remand: (1) a claim of negligence for violation of contractual duties, (2) a claim of negligent claims handling, or (3) a claim of negligence based on some other duty from common or other law. There is no reasonable basis for any of these three versions of the claim.

1. Negligence for Violation of Contractual Duties

In the second paragraph of Zimmerman’s negligence claim, he states that “Defendants failed to act with reasonable skill and diligence in performing their duties under the insurance agreement (contract).” (Docket no. 1-4 at 10). Therefore, Zimmerman’s claim against Kronk may be construed as one for negligence for violation of duties imposed by contract. However, as stated above, no contract exists to which Zimmerman and Kronk are both parties. Without privity of contract, Kronk had no contractual duties to Zimmerman. Kronk cannot be held liable for negligently violating duties he did not have. See Natividad, 875 S.W.2d at 678; see also Great W. Inn, 2011 WL 1157620 at *5.

Next, in the third paragraph of this section, Zimmerman claims that Defendants violated “the duty not to make misrepresentations or to make certain disclosures during the contract formation stage.” (Id.) First, even if an independent insurance adjuster could be held liable for the violation of such a duty, Zimmerman has pled no set of facts on which such a theory may be upheld. Jewel v. City of Covington, GA., 425 F.2d 459, 460 (5th Cir. 1970) (“General [conclusory] allegations unsupported by facts are insufficient to constitute a cause of action.”); Waters v. State Farm Mut. Auto Ins. Co., 154 F.R.D 107, 108 (S.D. Tex. 1994) (“Failure to specify a factual basis for recovery against a non-diverse party constitutes a failure to state a claim and fraudulent joinder of that party.”). Zimmerman has not alleged that Kronk was in any way personally involved during the “contract formation stage.” (Docket no. 1-4 at 10). And given the opportunity to elaborate or more clearly argue Kronk’s involvement in the contract’s formation in his motion for remand,2 Zimmerman failed to do so. (See docket no. 2 at 6-8). Further, Zimmerman’s allegations in that paragraph are made against “Defendants” generally and do not identify any specific conduct against Kronk individually. See Holmes v. Acceptance Cas. Ins. Co., 942 F.Supp.2d 637, 648 (E.D. Tex. 2013) (“[P]laintiff’s general allegations against `Defendants,’ without inserting facts attributed to the adjuster individually, d[o] not provide a reasonable basis for recovery from the adjuster.”). As such, Zimmerman’s allegations are entirely conclusory in nature and do not provide a reasonable basis on which he may recover against Kronk for negligently violating a contractual duty.

2. Negligent Claims Handling

In the first paragraph of Zimmerman’s negligence complaint, he mentions “COREY KRONK’s actions surrounding the denial of coverage for Plaintiff’s claim.” (Docket no. 1-4 at 9-10) (capitalization original). Based on this language, Zimmerman’s negligence claim against Kronk may be construed as one for negligent claims handling because all of Kronk’s “actions surround the denial of coverage” involve his handling of Zimmerman’s claim. (See docket no. 2-2 at 2-3). However, Texas law does not recognize a cause of action for negligent insurance claims handling. Bui v. St. Paul Mercury Ins. Co., 981 F.2d 209, 210 (5th Cir. 1994) (stating there is no negligent insurance adjusting claim in Texas); Rooters v. State Farm Lloyds, 428 F. App’x 441, 448 (5th Cir. 2011) (“Texas law does not recognize a cause of action for negligent claims handling.”) (citing Higginbotham v. State Farm Mut. Auto Ins. Co., 103 F.3d 456, 460 (5th Cir. 1997)). This rule has been applied both to insurance companies and to insurance adjusters. See Rooters, 428 F. App’x at 448 (holding that an insurance company could not be found liable for negligent claims handling); see also French v. State Farm Ins. Co., 156 F.R.D. 159, 162 (S.D. Tex. 1994) (holding that an insurance adjuster could not be held individually liable for negligent claims handling); Dear v. Scottsdale Ins. Co., 947 S.W.2d 908, 916 (Tex. App.-Dallas 1997) (Claims that an independent adjusting firm negligently investigated a claim against an insured “must also fail as a matter of law.”), overruled on other grounds by Apex Towing Co. v. Tolin, 41 S.W.3d 118 (Tex. 2001). Because there is no cause of action in Texas for negligent claims handling by adjusters, there is no reasonable basis on which Zimmerman could recover against Kronk for negligent claims handling.

3. Common Law Negligence

Finally, Zimmerman’s negligence claim may be construed as a simple common law negligence claim. “Although the Texas Supreme Court has not addressed the issue of whether an independent adjuster could be held liable for negligence separate from good faith and fair dealings, the Fifth Circuit has spoken to this issue.” Universal Cas. Co. v. Gilbert Plumbing Co., Inc., No. 4:08-2759, 2009 WL 1158844, at *5 (5th Cir. Apr. 29, 2009) (citing Bui, 981 F.2d at 209). In Bui, a boat owner alleged that the insurance adjuster who handled the owner’s claim for boat damage acted negligently in preparing the claim. 981 F.2d at 210. The Fifth Circuit upheld the district court’s dismissal of the common law negligence claim, holding that the adjuster “owed no duty to [the insured] under Texas law.” Id.; see also Universal, 2009 WL 1158844, at *5 (“[Since] the independent adjuster owes no duty to the claimant, [he] cannot be held liable for common law negligence”). The existence of a legal duty owed by the defendant to the plaintiff is one of the necessary elements of common law negligence in Texas. Van Horn v. Chambers, 970 S.W.2d 542, 544 (Tex. 1998) (“A negligence cause of action has three elements: 1) a legal duty; 2) breach of that duty; and 3) damages proximately resulting from the breach.”). Because independent adjusters, absent a contract or other special circumstances, owe no duty to the insured in Texas, they cannot be held liable for common law negligence. Bui, 981 F.2d at 210; see also Universal, 2009 WL 1158844, at *5. Texas law does not recognize a cause of action for common law negligence by the insured against independent insurance adjusters — including Kronk.

No matter how Zimmerman’s negligence claim is construed — negligent violation of contractual duties, negligent claims handling, or common law negligence — Texas does not recognize the cause of action against insurance adjusters like Kronk. As such, there is no reasonable basis for a negligence claim against Kronk. See Smallwood, 385 F.3d at 573.

C. All of Zimmerman’s Other Causes of Action

Zimmerman’s state court petition lists six other causes of action: (1) breach of contract, (2) violations of section 17.50(a) of the Deceptive Trade Practices — Consumer Protection Act (“DTPA”), (3) violations of section 17.46(b) of the DTPA, (4) violations of Chapter 541 of the Texas Insurance Code (“TIC”), (5) violations of Chapter 542 of the TIC, and (6) negligent misrepresentation. (Docket no. 1-4 at 4-11). None of these are stated against Kronk in the petition.

Zimmerman’s first cause of action for breach of contract specifically states that “TRAVELERS has committed breach of contract of insurance between the parties.” (Id. at 4). Zimmerman consistently uses “Defendant,” in the singular, to refer to Travelers throughout the breach of contract section. (Id.) Kronk is not named in that section. (Id.) In addition, the remaining five causes of action refer only to “Defendant” in the singular. Kronk is not specifically named in any of those causes of action, and Zimmerman does not argue that the singular “Defendant” refers to Kronk, not to Travelers. Instead, “Defendant,” which clearly is used to refer to Travelers from the outset of the petition in the breach of contract claim, continues to refer only to Travelers. Further, Zimmerman’s proposed amended complaint, submitted after removal, clearly recognizes the error and attempts to assert these claims against Kronk with the use of “Defendants” in the plural. (Docket no. 4-1 at 6-9). Zimmerman thereby affirms that the remaining six causes of action were not asserted against Kronk in the state court petition. For all these reasons, the Court finds that those causes of action were asserted only against Travelers, not Kronk.

Zimmerman disagrees, contending in his Opposed Motion for Remand and Motion to Amend that he asserted the TIC and DTPA claims against Kronk in the state court petition without pointing to any specific language in his petition to support his argument. (Doc. 2, 1). Instead, Zimmerman explains that, under Texas law, an insurance adjuster such as Kronk may be held liable for violations of the TIC and DTPA. (Doc. 2, 2-3). But even if insurance adjusters may be held individually liable for violating the TIC and DTPA, see Gasch v. Hartford Acc. & Indem. Co., 491 F.3d 278, 282-84 (5th Cir. 2007) (holding an independent insurance adjuster individually liable for violations of the TIC); Tex. Ins. Code Ann. § 541.151(2) (a “tie-in statute” expressly incorporating liability for violations of the DTPA into the TIC), the mere theoretical possibility that a cause of action may be asserted against a non-diverse defendant is not enough to require remand. Griggs v. State Farm Lloyds, 181 F.3d 694, 701 (5th Cir. 1999) (“While the burden of demonstrating fraudulent joinder is a heavy one, we have never held that a particular plaintiff might possibly establish liability by the mere hypothetical possibility that such an action could exist.”). The cause of action that might plausibly be stated must actually be asserted against the non-diverse defendant in the live petition at the time of removal. Id. Thus, though TIC and DTPA claims against Kronk are hypothetically possible, that fact is irrelevant. As shown above, Zimmerman did not actually assert those claims against Kronk in his state court petition, and Zimmerman fails to point to any language in the petition that might indicate the claims were alleged against Kronk. As the DTPA and TIC claims were not asserted against Kronk, there is no reasonable basis in the state court petition for the Court to conclude that Zimmerman might be able to recover against Kronk on those causes of action. See Griggs, 181 F.3d at 701.

Because Zimmerman cannot establish any cause of action against Kronk in the state court petition, the non-diverse party in this action, there is no reasonable basis to predict that the plaintiff might be able to recover against an in-state defendant. See Smallwood, 385 F.3d at 573. Therefore, the Court finds that Kronk was improperly joined and that this Court has diversity jurisdiction over this suit.

IV. Analysis — Motion for Leave to Amend

A court’s subject matter jurisdiction may be defeated by the addition of a non-diverse defendant.3 See Doleac ex rel. Doleac v. Michalson, 264 F.3d 470, 477 (5th Cir. 2001) (explaining that generally jurisdiction is determined at the time a suit is removed and postremoval developments to lower the amount in controversy or change the citizenship of a party will not divest jurisdiction; however, the addition of a non-diverse defendant will defeat jurisdiction). Since joinder of a non-diverse defendant has such a drastic consequence on jurisdiction, a court has discretion to permit or deny joinder. See 28 U.S.C. § 1447(e) (“If after removal the plaintiff seeks to join additional defendants whose joinder would destroy subject matter jurisdiction, the court may deny joinder, or permit joinder and remand the action to the State court.”).

While Federal Rule of Civil Procedure 15(a)(2) requires a court to “freely give leave to amend when justice so requires,” a district court should scrutinize a proposed amendment to add a non-diverse defendant more closely than an ordinary amendment. Hensgens v. Deere & Co., 833 F.2d 1179, 1182 (5th Cir. 1987). When an amendment will defeat jurisdiction, the court must balance the defendant’s right in “maintaining the federal forum with the competing interest of not having parallel lawsuits.” Id. at 1182. Among the factors a court should consider are: (1) the extent to which the purpose of the amendment is to defeat federal jurisdiction; (2) whether the plaintiff has been dilatory in asking for the amendment; (3) whether the plaintiff will be significantly injured if amendment is not allowed; and (4) any other factor bearing on the equities. Id. “As a plaintiff will not be `significantly injured’ by the denial of a clearly meritless claim, it is within the district court’s discretion to deny the amendment as futile if there is no reasonable basis to predict that the plaintiff will be able to recover against the non-diverse, nonindispensable party sought to be added as a defendant.” Wilson v. Bruks-Klockner, Inc., 602 F.3d 363, 368 (5th Cir. 2010). If the court permits the amendment, then it must remand to state court. Hensgens, 833 F.2d at 1182.

A. Extent to which the Purpose of the Amendment is to Defeat Federal Jurisdiction

The first Hensgens factor requires the Court to examine “the extent to which the purpose of the amendment is to defeat federal jurisdiction.” Hensgens, 833 F.2d at 1182. Bearing on this factor is whether the plaintiff knew or should have known the identity of the non-diverse defendant when the state court petition was filed. See, e.g., Rouf v. Cricket Communications, Inc., NO. H-13-2778, 2013 WL 6079255, at *2 (S.D. Tex. Nov. 19, 2013) (denying amendment after finding that plaintiffs knew about the proposed non-diverse defendants when suit was filed). If a plaintiff moves to amend shortly after removal, some courts have viewed that as evidence of a primary purpose to defeat jurisdiction. See, e.g., Gallegos v. Safeco Ins. Co. of Indiana, NO. H-09-2777, 2009 WL 4730570, at *4 (S.D. Tex. Dec. 7, 2009) (finding that a plaintiff’s filing of a motion for leave to amend and a motion for remand less than a month after removal evidenced the amendment’s principal purpose of defeating jurisdiction). Additionally, if the amendment seeks to add additional defendants after an original non-diverse defendant was found to be improperly joined, or seeks to add new claims against the improperly joined non-diverse defendant, some courts have viewed that as evidence of a primary purpose to defeat jurisdiction. E.g. Smith v. Robin America Inc., NO. H-08-3565, 2009 WL 2485589, at *5 (S.D. Tex. Aug. 7, 2009) (“Plaintiff’s efforts to avoid a federal forum by filing in state court and naming a nondiverse party against which there was no reasonable possibility of recovery, then moving to remand when the case was removed, provide some evidence that she filed the motion to add new parties who would destroy federal jurisdiction for that purpose.”). “This is an especially strong inference to make when the motion to remand is made within the same pleading as the motion for leave to amend” or after the motion to remand. Id.

Here, Zimmerman definitely knew Kronk’s identity when the state court petition was filed. Kronk was named in that petition, but for unsupportable claims. (See docket no. 1-4). The claims that Zimmerman attempts to newly assert against Kronk were available at the time of the state court petition — nothing in the proposed amendment provides new facts or legal bases unavailable to Zimmerman at the time of his initial petition. (See docket no. 4-1). Zimmerman’s motion to amend also comes shortly after the removal. The court in Gallegos considered a motion to amend that was filed less than a month after removal to be evidence of a primary purpose to defeat jurisdiction. Gallegos, 2009 WL 4730570, at *4. Zimmerman’s “Motion for Remand and Motion to Amend” was filed exactly one day short of a month from the date of removal. (Docket no. 1; Docket no. 2). His properly filed motion to amend was filed 45 days after removal and only after Travelers’ response to the motion for remand, (Docket no. 4), which the court sees as even stronger evidence that the purpose of the amendment is to defeat jurisdiction than if the motion for leave to amend had come at the same time as the motion for remand. Therefore, the inference that Zimmerman’s primary purpose in submitting his motion to amend is to defeat jurisdiction and avoid federal court is very strong. See Smith, 2009 WL 2485589, at *5.

Once it was finally attached to the motion to amend, the amended petition differed very little from the original petition except to change “Defendant” to “Defendants” in almost all cases and to address Travelers’ jurisdictional arguments. (See generally docket no. 4-1). Zimmerman’s state court petition also improperly joined Kronk initially because Zimmerman had no reasonable possibility of recovery against Kronk on the claims asserted. See Smith, 2009 WL 2485589, at *5. The first Hensgens factor therefore weighs heavily against granting Zimmerman’s motion to amend as it appears the purpose of the amendment is to defeat diversity jurisdiction.

B. Whether Zimmerman Has Been Dilatory in Asking for the Amendment

The second Hensgens factor requires the court to consider whether Zimmerman was dilatory in asking for the amendment. Hensgens, 833 F.2d at 1182. Generally, a plaintiff is not dilatory in seeking to amend a complaint when “no trial or pre-trial dates [have been] scheduled and no significant activity beyond the pleading stage has occurred.” Herzog v. Johns Manville Products Corp., NO. 02-1110, 2002 WL 31556352, at *2 (E.D. La. Nov. 15, 2002); Smith v. Robin America Inc., NO. H-08-3565, 2009 WL 2485589, at *5 (S.D. Tex. Aug. 7, 2009). Here, no scheduling order had been entered when Mr. Zimmerman sought to amend to make his additional allegations against Kronk. Nevertheless, when, as is the case here, a plaintiff’s true motive in seeking to add a defendant is to defeat jurisdiction, speed is not terribly relevant. See Adey/Vandling, Ltd. V. Am. First Ins. Co., NO. A-11-CV-1007-LY, 2012 WL 534838, at *4 (W.D. Tex. Feb. 17, 2012). Therefore, Zimmerman’s speed in attempting to amend weighs only slightly in favor of allowing his amendment.

C. Whether Zimmerman Will Be Significantly Injured if Amendment Is Not Allowed

The third Hensgens factor is whether a plaintiff will be significantly injured if amendment is not allowed. Hensgens, 833 F.2d at 1182. When considering this factor, courts look to “whether a plaintiff can be afforded complete relief in the absence of the amendment.” Lowe v. Singh, No. H10-1811, 2010 WL 3359525, at *2 (S.D. Tex. Aug. 23, 2010). Courts also consider “whether the plaintiff will be forced to litigate their action against the non-diverse defendants in a different court system, on a different timetable, subject to different procedural rules and conflicting results, and under the weight of additional financial burden.” Adey/Vandling, 2012 WL 534838, at *4. Here, assuming that Zimmerman can assert the DTPA and TIC claims against Kronk, Zimmerman may be forced to litigate in two different court systems if leave to amend is denied. This burden is mitigated, however, by the fact that Zimmerman can likely obtain full relief from Travelers alone because he seeks money damages on claims for which both Travelers and Kronk are defendants and Travelers has the deeper pockets. See Boyce v. CitiMortgage, Inc., 992 F.Supp.2d 709, 721 (W.D. Tex. 2014) (finding that this factor was neutral where the plaintiff could obtain full relief from those defendants already in the suit because no claims were unique to the new defendant). Therefore, inability to litigate against Kronk in federal court likely will not harm Zimmerman. As such, though Zimmerman may voluntarily assume litigating in multiple forums, he likely can obtain full relief without doing so. The third Hensgens factor, therefore, is neutral.

D. Any Other Factor Bearing on the Equities

Finally, the fourth Hensgens factor requires the Court to consider any other factors bearing on the equities. Hensgens, 833 F.2d at 1182. There are no other factors relevant in this case.

Examining all of the factors, the Court finds that the primary purpose of Zimmerman’s proposed amendment is to defeat jurisdiction. The first and fourth factors weigh heavily in favor of denying leave. The second factor weighs only slightly in Zimmerman’s favor. The third factor is neutral. The balance is clearly in favor of denial. Therefore, the Court denies Zimmerman’s motion for leave to amend his original petition, thus retaining jurisdiction over this case.

V. Conclusion

For the above reasons, the Court DENIES Plaintiff’s motion for remand (docket no. 2) and motion for leave to amend (docket no. 4). The Court has jurisdiction over this removed case and denies remand. Defendant Kronk is dismissed as improperly joined.

It is so ORDERED.

FootNotes

1. Zimmerman’s May 22, 2015 submission to the court contained a section entitled “Motion for Leave to Amend,” but did not attach an actual amendment. (Docket no. 2 at 8-9). According to Rule CV-7(b) of the Local Court Rules for the United States District Court for the Western District of Texas, “When a motion for leave to file a pleading, motion, or other submission is required, an executed copy of the proposed pleading, motion, or other submission shall be filed as an exhibit to the motion for leave.” Because Zimmerman did not attach an executed copy of the amended petition as an exhibit to his motion, his motion for leave to amend was improper. Zimmerman did not make a proper motion for leave to amend, with a proposed amendment included as an exhibit to the motion, until June 9, 2015. (Docket no. 4 & 4-1).

2. Or even the proposed amended complaint.

3. Zimmerman argues his amendment “merely clarifies or corrects allegations against Kronk” and thus is not “attempting to add new Defendants.” (Docket no. 4 at 6, 8). However, Kronk was improperly joined in the state court petition. Therefore, Zimmerman is adding a new defendant with his proposed amendment, which definitively asserts additional claims against Kronk.

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

Insurance Coverage in Texas Long-Term Disability Plan Lawsuit– Fort Worth, Texas Insurance Defense Attorneys

IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
No. 14-10052
JUDY B. KILLEN,
Plaintiff-Appellant,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY,
Defendant-Appellee.
Appeal from the United States District Court for the Northern District of Texas
Before STEWART, Chief Judge, OWEN, Circuit Judge, and MORGAN, District Judge.∗
CARL E. STEWART, Chief Judge:
Plaintiff-Appellant Judy Killen (“Killen”) worked as an ultrasound technician for Covenant Health Systems (“Covenant”) beginning in 2002. She ceased working in March 2009 due to neck, shoulder, and upper back pain. She was awarded 24 months of benefits from Covenant’s long-term disability insurance plan, which Defendant-Appellee Reliance Standard Life Insurance Company (“Reliance Standard”) administered. After three internal decisions by Reliance Standard rejecting Killen’s request for extended long-term disability benefits, she brought suit in federal court. The district court held
∗ District Judge of the Eastern District of Louisiana, sitting by designation.
United States Court of Appeals
Fifth Circuit
FILED
January 8, 2015
Lyle W. Cayce
Clerk
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that Reliance Standard did not abuse its discretion in finding that Killen could perform sedentary work, and granted summary judgment to Reliance Standard. For the reasons discussed herein, we AFFIRM.
I. Factual and Procedural Background
Killen worked for Covenant from 2002 until March 2009, when she claimed that neck, shoulder and upper back pain made it too difficult for her to continue. Reliance Standard administered Covenant’s long-term disability plan (the “Plan”)—which is governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.—and also paid benefits under the Plan if it found an employee disabled.
Killen collected benefits from June 2009 to June 2011. During this time, Killen separately qualified for Social Security disability benefits. To continue receiving benefits under the Plan after two years, a claimant must be “totally disabled” such that she is incapable of performing the material duties of any occupation for which she is qualified by way of education, training, or experience. Under the contract, an insured is totally disabled if “due to an Injury or Sickness he or she is capable of only performing the material duties on a part-time basis or part of the material duties on a Full-time basis.”
At the outset, Killen’s primary care physician—Dr. Steven Crow (“Dr. Crow”)—treated her. Dr. Crow treated Killen on over twenty separate occasions over the next four years and addressed a variety of maladies she experienced beginning in late 2008. In August 2010, Killen seriously injured her right shoulder by exacerbating an apparently pre-existing tear in the rotator cuff. Dr. Crow found in September 2010 that Killen “had severe pain in the shoulder since that time,” and that she was experiencing “[s]hooting pain towards her neck.” Shortly thereafter, Dr. Crow referred her to Dr. Kevin Crawford (“Dr. Crawford”), an orthopedic surgeon who determined in October 2010 that Killen had a “high-grade full-thickness rotator cuff tear” in her right 2
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shoulder. The tear was further corroborated by a radiologist’s report. In a follow-up appointment in January 2011, however, Dr. Crawford found that Killen’s “function is good, even though she has some discomfort.”
In May 2011, Reliance Standard’s internal vocational staff—evaluating the reports outlined above after Killen requested continued benefits—performed a residual employability analysis and listed five sedentary occupations appropriate for Killen. Consequently, Reliance Standard determined that, while Killen could no longer work as an ultrasound technician, she “appear[ed] capable of sedentary work activity.” Reliance Standard thereafter decided to discontinue Killen’s benefits.
This first denial apparently crossed in the mail with additional documents Killen sent to Reliance Standard, among them a treatment report from Dr. Crow and a letter from Dr. Crawford. Dr. Crow’s letter noted Killen’s “severe anxiety.” Dr. Crawford’s June 2011 letter, however, is the subject of dispute by the parties and is ambiguous about Killen’s condition. He wrote that Killen was “reasonably functional despite the findings on MRI,” but elaborated that “[w]hen I say functional, I mean that she still can get by with activities of daily living and can get her hand to her mouth and fix the back of her hair to some extent.” Reliance Standard evaluated these additional documents apparently as a courtesy; it would otherwise have had to open up a more probing internal appeal. The company again denied continued coverage.
Subsequently, through her attorney, Killen filed an internal appeal with Reliance Standard, relying on an August 2011 letter from Dr. Crow that repeatedly emphasized how she was “incapable of holding down a job” due to her medical issues. At Reliance Standard’s urging, she submitted to an in-person evaluation and independent review conducted in February 2012 by Dr. Mary Burgesser (“Dr. Burgesser”), a physical medicine and rehabilitation specialist. Dr. Burgesser, while crediting Killen’s chronic, irreparable right 3
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shoulder pain and acknowledging Dr. Crawford’s diagnosis, concluded in a detailed report that the injury did not prevent her from performing sedentary work. A subsequent (second) residual employability analysis conducted in March 2012 by Reliance Standard, this time taking into account Dr. Burgesser’s report, came to a similar conclusion as the first: Killen was capable of performing sedentary work in at least three alternative occupations. Relying on these reports, Reliance Standard denied Killen’s appeal in March 2012. In its letter, Reliance Standard noted that Killen had been receiving disability benefits from the Social Security Administration (“SSA”)—benefits which offset Reliance Standard’s own obligations to Killen—but explained that the SSA may have used a different standard in evaluating benefits decisions and also did not have Dr. Burgesser’s report when it awarded Killen benefits.
Nearly four months later, Killen sought to supplement the record with a letter from Dr. Crow adhering to the contents of his August 2011 letter: he still believed, he wrote, that Killen was “unable to work due to her medical issues.” Reliance Standard responded, notifying Killen that it had closed her file and would not supplement it with the letter.
After Killen exhausted her administrative appeals, she filed suit in August 2012 in federal court under 29 U.S.C. § 1132(a)(1)(B). In December 2013, the district court granted summary judgment to Reliance Standard.
Killen timely appealed, arguing that Reliance Standard: (1) lacked substantial evidence supporting its denial; (2) failed to give Killen a full and fair review of her claim; (3); issued a decision tainted by a conflict of interest because it both administers and pays benefits; and (4) inappropriately refused to allow Killen to introduce the letter from Dr. Crow after it made a final decision to terminate her benefits.
4
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II. Standard of Review
Review of summary judgment decisions in the ERISA context is de novo, and we apply the same standard as the district court. Schexnayder v. Hartford Life & Accident Ins. Co., 600 F.3d 465, 468 (5th Cir. 2010). Because the Plan gave Reliance Standard discretion to determine benefit eligibility as well as to construe the Plan’s terms, the court reviews Reliance Standard’s denial under the Plan for abuse of discretion. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); Holland v. Int’l Paper Co. Ret. Plan, 576 F.3d 240, 246 (5th Cir. 2009). “A plan administrator abuses its discretion where the decision is not based on evidence, even if disputable, that clearly supports the basis for its denial.” Holland, 576 F.3d at 246 (internal quotation marks and citations omitted). “If the plan fiduciary’s decision is supported by substantial evidence and is not arbitrary and capricious, it must prevail.” Ellis v. Liberty Life Assurance Co. of Boston, 394 F.3d 262, 273 (5th Cir. 2004).
Killen argues in her briefs repeatedly that the summary judgment standard requires that the evidence and inferences drawn from that evidence be viewed in the light most favorable to her since she is the nonmovant. She points to cases reciting the boilerplate language of the summary judgment standard. However, she misapprehends the nature of appellate review of summary judgment decisions on ERISA benefits cases where the plan at issue vests discretion, as this one does, in a plan administrator.1 In that case, “[t]he fact that the evidence is disputable will not invalidate the decision; the evidence need only assure that the administrator’s decision fall [sic] somewhere on the continuum of reasonableness—even if on the low end.”
1 The parties do not dispute that the Plan vests discretionary authority with Reliance Standard. The Plan states that Reliance Standard “has the discretionary authority to interpret the Plan and the insurance policy and to determine eligibility for benefits.” 5
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Porter v. Lowe’s Cos., Inc.’s Bus. Travel Acc. Ins. Plan, 731 F.3d 360, 363–64 (5th Cir. 2013) (internal quotation marks and citation omitted).
The case on which Killen primarily relies, Baker v. Metropolitan Life Ins. Co., 364 F.3d 624 (5th Cir. 2004), is inapposite. While Baker does explain that appellate courts review district court decisions in the ERISA context de novo and draw all inferences in favor of the nonmovant, id. at 627–28, Killen’s selective citation to the case leaves out Baker’s later clarification: “when an administrator has discretionary authority with respect to the decision at issue, the standard of review should be one of abuse of discretion.” Id. at 627. A court must “give deference to the decision of the plan administrator and may not substitute its judgment for the decision of the fiduciary.” 1A Couch on Ins. § 7:59 (3d ed. 2014).
III. Discussion
A.
Killen first challenges the district court’s finding that substantial evidence supported the plan’s denial of benefits. Substantial evidence is “more than a scintilla, less than a preponderance, and is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Id. (internal quotation marks and citation omitted). Killen claims that the Plan language requires Reliance Standard to show that she can perform all of the job duties of a sedentary vocation on a full-time basis before discontinuing benefits. While it might have shown she could perform sedentary work, she argues, Reliance Standard never showed she could do so full time. Additionally, she claims the district court misconstrued the medical evidence and ignored objective documentation of her pain.
“[M]ost disputed claims for disability insurance benefits are awash in a sea of medical evidence, often of contradictory nature,” 10A Couch on Ins. § 147:33, and this case is no different. Indeed, counsel for Killen admitted as
6
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much at oral argument. Courts frequently hear cases, like this one, where the plaintiff’s own treating physicians generally support a finding of disability and the defendant’s vocational specialists and independent medical examiners disagree.
In Holland, for example, a former paper machine specialist who had experienced a heart attack sought long-term disability benefits. See 576 F.3d at 243. The Plan’s language closely tracked the applicable language in this case. See id. at 244. The employee’s primary care physician equivocated, but supported a finding of total disability, and a specialist’s statements about his health were ambiguous: the specialist noted that the plaintiff had serious airway damage, but was improving. Id. The administrator had a third and fourth doctor conduct a paper review of the medical records, and a fifth doctor conducted a physical examination: all three agreed that the employee was not totally disabled. See id. at 244–45. The administrator never consulted a vocational expert. Id. at 249. The internal claim for benefits was denied twice. This court held that there had been no abuse of discretion; the existence of contradictory evidence, the court noted, “does not . . . make the administrator’s decision arbitrary. Indeed, the job of weighing valid, conflicting professional medical opinions is not the job of the courts; that job has been given to the administrators of ERISA plans.” Id. at 250 (internal quotation marks and citation omitted); accord Wade v. Hewlett-Packard Dev. Co., 493 F.3d 533, 540–41 (5th Cir. 2007), abrogated on other grounds by Hardt v. Reliance Standard Life Ins. Co., 560 U.S. 242 (2010) (upholding a denial of benefits where plaintiff’s two treating physicians supported a disability finding but an examining neurophysiologist in a separate assessment found otherwise).2
2 There is no obligation to weigh treating physicians’ opinions any differently than those of other doctors or specialists. The Supreme Court recently clarified that “courts have 7
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When we find an abuse of discretion, the discrepancies between the facts and the administrator’s findings are often stark. In Lain v. UNUM Life Ins. Co. of Am., a claimant had experienced serious chest pains and esophageal problems documented by multiple treating physicians. See 279 F.3d 337, 340–42 (5th Cir. 2002), overruled on other grounds by Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 115–19 (2008). Based on two internal reviews of the claimant’s medical files—one of which seemed to actually substantiate the individual’s complaints—and without an independent physical examination,3 the administrator denied benefits. See id. at 341–42. This court found an abuse of discretion, noting that there was a “complete absence in the record of any ‘concrete evidence’ supporting [the administrator’s] determination.” Id. at 347.
In this case, substantial evidence supported Reliance Standard’s decision to deny long-term disability benefits to Killen. While there is evidence in the record to support Killen’s claim for disability—which the district court recognized—there is also more than enough evidence supporting a denial to insulate the decision from reversal, particularly under our narrow review for abuse of discretion.
First, Reliance Standard’s vocational expert and examining physician provided sufficient evidence—including evidence of Killen’s ability to perform full-time sedentary work—to justify the denial. A vocational expert employed by Reliance Standard identified between three and five sedentary jobs Killen could perform. Additionally, Dr. Burgesser wrote in her report that Killen was
no warrant to require administrators automatically to accord special weight to the opinions of a claimant’s physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician’s evaluation.” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003).
3 ERISA does not mandate an independent medical examination prior to a denial. See, e.g., Hobson v. Metro. Life Ins. Co., 574 F.3d 75, 91 & n.3 (2d Cir. 2009) (collecting cases). 8
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“capable of performing at a sedentary work capacity . . . . The sedentary work would involve sitting most of the time and walking or standing for brief periods.” On a separate form, Dr. Burgesser listed a series of activities that Killen could perform “on a regular basis in an 8-hour workday.” The form noted that Killen could sit “frequent[ly],” and that she could “occasional[ly]” stand, walk, climb stairs, and drive. Contrary to Killen’s position that Reliance Standard never showed she could perform full-time work, these findings—taken together—demonstrate that Killen could perform full-time work.
Second, Killen’s own treating physicians equivocated at different times about the extent of her disability, even after the rotator cuff tear. Though her primary care physician ultimately concluded that she was totally disabled, her orthopedic surgeon’s reports are ambiguous at best on the issue. Indeed, in a follow-up appointment to address her right shoulder rotator cuff tear, he stated that her “function is good, even though she has some discomfort.”
The evidence in this case is comparable to that presented in Holland and Wade. In both of those cases—as in this one—there were conflicting medical opinions, with the plaintiffs’ treating physicians generally supportive of a finding of disability and the defendants’ internal reviews or independent examining physicians determining otherwise. See Holland, 576 F.3d at 244–45; Wade, 493 F.3d at 535–37. As the district court here acknowledged, it is the role of the ERISA administrator, not the reviewing court, to weigh valid medical opinions. See Holland, 576 F.3d at 250; Wade, 493 F.3d at 541. And unlike in Lain, it cannot be said in this case that there is a “complete absence in the record of any ‘concrete evidence’” supporting a denial. Lain, 279 F.3d at 347. Reliance Standard’s decision was supported by substantial evidence.4
4 Killen argues also that some of the district court’s discussion of statements she made to her physicians—for example, telling Dr. Crow that she wanted to get on disability—
9
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B.
Killen next argues that Reliance Standard failed to provide a full and fair review of her claim because (1) the company did not provide sufficient evidence in support of its initial May 2011 denial of benefits and (2) the company brought forward its strongest evidence of Killen’s continued ability to perform full-time sedentary work during the final appeal without giving her a meaningful opportunity to respond.5
When denying claims, ERISA-covered employee benefit plans must: (1) provide adequate notice; (2) in writing; (3) setting forth the specific reasons for such denial; (4) written in a manner calculated to be understood by the participant; and (5) afford a reasonable opportunity for a full and fair review by the administrator. Wade, 493 F.3d at 540 (citing 29 U.S.C. § 1133).
Killen’s first argument is foreclosed by our decision in Wade. In Wade, the administrator failed to comply even with the basic requirements of § 1133 during its initial internal review. While we found that the administrator’s errors at least arguably reflected a failure to substantially comply with ERISA and its accompanying regulations, we stated that “[t]he statute and regulations do not require compliance with Section 1133 at each and every level
improperly contributed to its substantial evidence finding. Killen is correct that some of these statements are not especially germane to the substantial evidence inquiry, but the district court’s mere mention of those details, particularly in light of its recognition of the importance of the opinions of Dr. Burgesser and the vocational analyst to Reliance Standard’s denial, does not disturb our holding that substantial evidence supported the denial. Killen’s argument that neither Reliance Standard nor the district court considered the objective reports of her pain are also belied by the record. Both the district court and Reliance Standard’s independent medical examiner acknowledged Killen’s pain.
5 Killen, in her briefing, alternatively characterizes these alleged ERISA violations as “procedurally unreasonable.” But the doctrine of procedural unreasonableness is a “separate concept that is a subset of our conflict of interest analysis.” Truitt v. Unum Life Ins. Co. of Am., 729 F.3d 497, 509 n.4 (5th Cir. 2013). 10
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of review of a Plan’s internal claims processing,” and found that the claimant had been provided a full and fair review. See id.
Here, by contrast, Reliance Standard substantially complied with ERISA at every step, including its initial denial. In its May 2011 initial written denial, Reliance Standard addressed: (1) medical records about Killen’s right shoulder injury, crediting her right rotator cuff tear but highlighting Dr. Crawford’s observation that her function was “good even though you have discomfort”; (2) the myriad medical issues—unrelated to the right shoulder problem—that Killen experienced, including those related to her neck and shoulder pain, heart problems, and depression; and (3) the internal vocational rehabilitation specialist’s finding based on submitted records that “while unable to work in your normal occupation, you appear capable of sedentary work activity.” Killen’s view that these findings do not permit the inference that she could perform full-time sedentary work takes too narrow a view of the evidence.
Killen also argues that Reliance Standard unfairly brought forward its strongest evidence—the independent medical examiner’s report—only in the final stage of her appeal, thereby preventing her from engaging in the “meaningful dialogue” contemplated by § 1133. See Lafleur v. La. Health Serv. & Indem. Co., 563 F.3d 148, 154 (5th Cir. 2009).
Circuits that have addressed the issue have generally determined that ERISA does not guarantee claimants an opportunity to rebut an independent medical examination report generated during an appeal prior to a denial of benefits. See Metzger v. UNUM Life Ins. Co. of Am., 476 F.3d 1161, 1167 (10th Cir. 2007) (holding that ERISA and its implementing regulations do “not require a plan administrator to provide a claimant with access to the medical opinion reports of appeal-level reviewers prior to a final decision on appeal”); see also Pettaway v. Teachers Ins. & Annuity Ass’n of Am., 644 F.3d 427, 436 (D.C. Cir. 2011) (same); Midgett v. Washington Grp. Int’l Long Term Disability 11
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Plan, 561 F.3d 887, 895–96 (8th Cir. 2009) (same); Glazer v. Reliance Standard Life Ins. Co., 524 F.3d 1241, 1245–46 (11th Cir. 2008) (same).
Citing Metzger, this court in an unpublished opinion adopted a similar stance. Shedrick v. Marriott Int’l, Inc., 500 F. App’x 331, 339 (5th Cir. 2012) (“Further, there does not appear to be relevant case law or regulations for the proposition that Aetna violated ERISA’s full and fair review requirement by failing to consider evidence submitted after [the claimant’s] appeal was closed or by not allowing [the claimant] to rebut the report by Dr. Wallquist.”).
Killen does not dispute the force of this precedent. Rather, she contends that it is inapplicable where the first-stage denial did not provide evidence that she could call into question. But here, even assuming arguendo that Reliance Standard did not provide Killen with sufficient evidence justifying the initial denial for her to rebut, the underlying justification for each denial remained constant. Each letter rejected Killen’s claim for benefits on the same ground: her ability to perform sedentary work. This takes the facts out of our line of cases where the insurer impermissibly uses a “bait-and-switch” tactic, providing one justification at the first stage and then, during the review, changing the grounds for the denial. See, e.g., Rossi v. Precision Drilling Oilfield Servs. Corp. Emp. Benefits Plan, 704 F.3d 362, 366 (5th Cir. 2013); Robinson v. Aetna Life Ins. Co., 443 F.3d 389, 394 (5th Cir. 2006) (“Aetna’s shifting justification for its decision and failure to identify its vocational expert meant that Robinson was unable to challenge Aetna’s information or to obtain meaningful review of the reason his benefits were terminated.”).
While the information provided in Dr. Burgesser’s report might have further bolstered Reliance Standard’s position, there was nothing in the report that altered the company’s original position. Therefore, Killen was not “sandbagged” by a report containing unanticipated factual findings. She was on notice beginning with the initial May 2011 denial that she needed to bring 12
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forward evidence of her inability to perform sedentary work. Reliance Standard provided her an adequate opportunity to do so.
C.
We turn to Killen’s argument that Reliance Standard’s decision was “procedurally unreasonable”—that is, that the company’s conflict of interest as both the administrator of the Plan and the payor of benefits tainted its denial—because of its failure to adequately distinguish the SSA’s disability finding.
The Supreme Court has held that a “plan administrator [who] both evaluates claims for benefits and pays benefits claims,” as Reliance Standard does here, has a conflict of interest. See Glenn, 554 U.S. at 112. But the Court purposefully avoided enunciating a precise standard for evaluation of the impact of the conflict. See id at 119. In Glenn, and in a post-Glenn case in this court with similar facts, Schexnayder, the defendant-administrators denied disability benefits, but not before the claimants successfully applied for disability benefits before the SSA. See Glenn, 554 U.S. at 118; Schexnayder 600 F.3d at 471. The administrators financially benefitted from those decisions (payments from the SSA offset their own obligations) and then ignored the agency’s findings of total disability entirely; the result was a reversal of those benefits decisions. See Glenn, 554 U.S. at 118; Schexnayder 600 F.3d at 471.
Here, by contrast, Reliance Standard twice addressed the SSA benefits awarded to Killen, once distinguishing its denial in detail. Compare Schexnayder, 600 F.3d at 471 n.3 (“It is the lack of any acknowledgement which leads us to conclude that Hartford’s decision was procedurally unreasonable.”). We find no procedural unreasonableness on these facts suggesting that we should accord the conflict of interest factor any special weight.
13
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D.
Killen’s final argument is that Reliance Standard improperly failed to allow her to supplement the administrative record with a letter from Dr. Crow submitted four months after the third denial.
When assessing factual questions in benefits cases, “a long line of Fifth Circuit cases stands for the proposition that . . . the district court is constrained to the evidence before the plan administrator.” Vega v. Nat’l Life Ins. Servs., Inc., 188 F.3d 287, 299 (5th Cir. 1999) (collecting cases), overruled on other grounds by Glenn, 554 U.S. at 112. Before filing suit, “the claimant’s lawyer can add additional evidence to the administrative record simply by submitting it to the administrator in a manner that gives the administrator a fair opportunity to consider it.” Id. at 300. Such a “fair opportunity” must come in time for the administrator to “reconsider his decision.” Id.
Here, the file was already closed and Killen had exhausted two internal appeals. We cannot say that such a late submission of evidence, only four weeks before Killen filed suit, gave Reliance Standard the “fair opportunity” contemplated by Vega. Although Dr. Crow rebuts Dr. Burgesser’s opinion directly in the letter, he does so by repeating a position he had already taken. Indeed, he explained in the supplemental letter that “nothing has really changed in her condition.” The letter, therefore, would not have changed the outcome here. Cf. Keele v. JP Morgan Chase Long Term Disability Plan, 221 F. App’x 316, 320 (5th Cir. 2007) (“We need not decide this question of Vega’s precise requirements today, because we conclude that the documents in dispute do not change the disposition of the case.”). We decline to find an abuse of discretion in Reliance Standard’s decision not to supplement the record, and we find no fault in the district court’s choice not to consider the letter.
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IV. Conclusion
For the foregoing reasons, we AFFIRM the district court’s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying Killen long-term disability benefits. 15
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Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

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Biennial Report of the Texas Department of Insurance Non Subscriber Statistics–Fort Worth, Texas Non Subscriber Lawyers

The Biennial Report of the Texas Department of Insurance to the 83rd Legislature , released December 2012 by the Texas Department of Insurance, reports fewer Texas employers are currently opting to leave the state’s workers’ compensation system. According to the report prepared for the Texas legislature, lower workers compensation insurance premiums and an increased availability of workers compensation health care networks have led to fewer employers opting out of the system. “The percentage of Texas employers that are nonsubscribers to the workers compensation system decreased to 33 percent in 2012 — the second-lowest percentage since 1993 (an estimated 113,000 employers in 2012).” In 1993, 44 percent of Texas employers were non-subscribers. The report also noted a reversal of the trend of larger employers choosing to opt out of the Texas workers’ compensation system after 2008. The non-subscription rates among large employers fell from 26 percent in 2008 to 15 percent in 2010 and 17 percent in 2012.

 

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]

The Enforcement Program of EEOC–Fort Worth, Texas Employment Law Attorneys

Private Sector Enforcement Program: Providing quality services that are fair and prompt for both employees and employers in our administrative processing system is vital to our mission. In FY 2009, we received 93,277 private sector charges of discrimination. We also received 2,728 charges through net transfers from state and local Fair Employment Practices Agencies (FEPAs). We achieved 85,980 resolutions, with a merit factor resolution rate of 20.3%. (Merit factor resolutions include mediation and other settlements and cause findings, which, if not successfully conciliated, are considered for litigation.) Through our administrative enforcement activities, we also secured more than $294.2 million in monetary benefits. Overall, we secured both monetary and non-monetary benefits for more than 17,491people through our charge processing. We had a pending inventory of 85,768 charges at the end of the fiscal year. [See Enforcement and Litigation Statistics]

Federal Sector Enforcement Program: In our federal sector enforcement role, the EEOC is responsible for providing hearings and appeals after the initial processing of the complaints by each individual federal agency. Unlike our responsibilities in the private sector, we do not process complaints of discrimination for federal employees. In the federal sector, individuals file complaints with their own federal agencies and those agencies conduct a full and appropriate investigation of the claims raised in the complaints. Complainants can then request a hearing before an EEOC administrative judge. In FY 2009, we received a total of 7,277 requests for hearings. Additionally, we resolved a total of 6,779 complaints and secured more than $44.5 million in relief for parties in these complaints.

The EEOC also adjudicates appeals of federal agency actions on discrimination complaints and ensures agency compliance with decisions issued on those appeals. During FY 2009, the EEOC received 4,745 requests for appeals of final agency actions in the federal sector.  [See Annual Report on the Federal Work Force]

Mediation

Private Sector Mediation Program: The EEOC’s mediation program has been very successful and has contributed to the ability, over the past few years, to better manage our growing inventory and resolve charges in 180 days or fewer. In FY 2009, the EEOC’s National Mediation Program secured 8,498 resolutions, and we obtained more than $121.6 million in monetary benefits for complainants from mediation resolutions.

Participant confidence in our program is high, with our FY 2009 figures reflecting that 96% of all participants would return to EEOC’s Mediation Program in the future. We believe this high confidence level helps with our continuing efforts to convince parties to charges, particularly employer representatives, of the value of the mediation approach.

Although participants almost uniformly view the mediation program favorably, the percentage of employers agreeing to mediate is considerably lower than the percentage of charging parties agreeing to mediate. As part of our effort to increase the participation of employers in the mediation program, we have encouraged employers to enter into Universal Agreements to Mediate (UAMs). These agreements reflect the employer’s commitment to utilize the mediation process to resolve charges.

Many employers entered into these agreements in FY 2009, resulting in a cumulative multi-year total of 1,603 UAMs (192 National/Regional UAMS and 1,411 Local UAMs).

Federal Sector Mediation Program: Using Alternative Dispute Resolution (ADR) techniques to resolve workplace disputes throughout the federal government can have a powerful impact on agencies’ EEO complaint inventories and, in turn, the Commission’s hearings and appeals inventories. Resolving disputes as early as possible in the federal sector EEO process improves the work environment and reduces the number of formal complaints, allowing all agencies, including the EEOC, to redeploy resources that otherwise would be devoted to these activities. In addition, a growing number of agencies have incorporated dispute prevention techniques into their ADR programs, further increasing productivity and reducing the overall number of employment disputes.

Data submitted by federal agencies at the close of FY 2008, the most recent data available, indicate that there were 38,898 instances of pre-complaint EEO counseling across the federal government. Of that number, the parties participated in ADR in 19,267 cases, or 49.5% of the time.

The Commission’s efforts in promoting and expanding mediation/ADR at all stages of the federal EEO complaint process also appear to be having a positive effect on federal agencies’ EEO complaint inventories.  As more agencies expand their efforts to offer ADR during the informal process, we expect to see continued decreases in the number of formal complaints filed, which will reduce costs for complainants and all federal agencies, and enable agencies to focus resources on their primary missions.

EEOC continues to actively pursue a variety of ways to assist federal agencies in improving alternative dispute resolution by identifying and sharing best practices, providing assistance in program development and improvements, providing training to federal employees and managers on the benefits of ADR, and maintaining a web page that serves as a clearinghouse for information related to federal sector ADR. We will continue to expand technical assistance efforts with agencies to encourage the development of effective ADR programs and promote ADR training among government managers and staff.

Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.

Martindale AVtexas[2]