Hopper v Argonaut Ins Co

November 12, 2013 – Case Report

 

This case makes it clear that there is no legal basis to sue a workers’ compensation insurance carrier outside the administrative processes and other remedies set out in the Texas Workers' Compensation Act.  The Austin Court of Appeals cites to the case of Texas Mutual Insurance Co. v. Ruttiger, 381 S.W.3d 430, 451  (Tex. 2012), for this holding, Brad McClellan a workers’ compensation claimants’ attorney located in Austin, Texas represented the Hoppers. Catherine Hanna and Eric Peabody represented Argonaut Insurance Company.  

 

Robert Hopper suffered a work-related injury to his wrist in July, 2004. Argonaut Insurance Company paid workers' compensation benefits to Mr. Hopper for his wrist injury.  Mr. Hopper died in March, 2007, from a fentanyl overdose.  After Mr. Hopper died, his wife and children (the Hoppers) filed claims for workers' compensation death benefits.  They claimed that Mr. Hopper’s death was compensable because he became addicted to the pain medication that was prescribed for his wrist injury and died from an overdose of that pain medication.

 

Argonaut Insurance Company (Argonaut) disputed the Hoppers' entitlement to death benefits.  First Argonaut claimed the Hoppers were not legal beneficiaries.  Second, Argonaut claimed Mr. Hopper’s death was not related to his wrist injury.  Almost two years after Mr. Hopper's death, the disputed claims were resolved by a Benefit Dispute Agreement (BDA) in which Argonaut agreed that (1) the Hoppers were beneficiaries and (2) Mr. Hopper's compensable wrist injury was a producing cause of his death.

 

After entering into the BDA the Hoppers sued Argonaut for mishandling and unreasonably delaying payment on their claims. In addition to undue delay, the Hoppers alleged that Argonaut made negligent, malicious, and knowingly false statements that the Hoppers were not entitled to coverage under the workers' compensation policy by suggesting that Mr. Hopper intentionally overdosed and that the Hoppers were not true beneficiaries. The Hoppers alleged that Argonaut acted fraudulently, maliciously, and unconscionably in mishandling, delaying, and denying the Hoppers' claims for death benefits.  The Hoppers said Argonaut violated Texas Insurance Code sections 541.060 and 541.061, the Texas Deceptive Trade Practices Act, and the common-law duty of good faith and fair dealing.

 

The Austin Court of Appeals stated the Texas Supreme Court had held that a claim under Insurance Code section 541.061 was compatible with the comprehensive nature of the workers' compensation system because a cause of action under section 541.061 is not limited to the claim settlement context.  Section 541.061 applies to the misrepresentation of an insurance policy’s terms, not misrepresentations about whether a specific claim is factually within a policy's terms. The alleged misrepresentations made by Argonaut were about whether Mr. Hopper's death resulted from a compensable injury and whether the Hoppers were his true beneficiaries, not about the terms of the policy.  Therefore, the Hoppers had no basis to sue Argonaut. 

 

The Hopper v. Argonaut Ins. Co., opinion can be found here: https://www.search.txcourts.gov/Case.aspx?cn=03-12-00734-CV under Case Event: Memorandum Opinion.

JOHN D. PRINGLE, P.C.

ARBORETUM PLAZA ONE
9442 Capital of Texas Highway North, Suite 500
AUSTIN, TEXAS 78759

(512) 472-8742 (TEL)
(512) 472-8745 (FAX)

info@PringleTexasLawyer.com

           

Copyright © 2007-2008 John D. Pringle, P.C.