Source: https://case-law.vlex.com/vid/823-f-3d-344-683706413
Timestamp: 2019-04-20 15:16:39+00:00

Document:
823 F.3d 344 (5th Cir. 2016), 15-50559, Crose v. Humana Ins. Co.
For ELEANOR CROSE, Individually and as Permanent Guardian of Ronald Crose, Plaintiff - Appellant: Elizabeth Rose von Kreisler, George Brothers Kincaid & Horton, L.L.P., Austin, TX.
For HUMANA INSURANCE COMPANY, Defendant - Appellee: Carlos Ramon Soltero, Ellen Burkholder Cochran, Rachael Kelly Padgett, McGinnis, Lochridge & Kilgore, L.L.P., Austin, TX.
Eleanor Crose appeals the district court's summary judgment for Humana Insurance Company on her claims for breach of contract and unfair insurance practices. Because summary judgment was warranted, we AFFIRM.
told the operator that she believed that Mr. Crose had overdosed. Emergency services transported him to a nearby hospital.
The emergency room doctor who initially treated Mr. Crose, Dr. Bogitch, provided an assessment, stating: This is [a] gentleman who unfortunately, with very little past medical history, used [ecstasy] last night and was found down today with a large intraparenchymal hemorrhage with an unusual subarachnoid component as well as an entrapped ventricle and early uncal herniation.
Dr. Bogitch also ordered a urine drug screen, which came back positive for amphetamines (ecstasy), benzodiazepines (a prescription tranquilizer), and cannabinoids (marijuana).
Another physician, Dr. Hinze, examined Mr. Crose; his report stated: I suspect that [Mr. Crose's stroke] is due to uncontrolled hypertension likely from his ecstasy ingestion . . . . [Ecstasy ingestion] would account for his diaphoresis, nausea, vomiting, diarrhea and could produce a hypertensive state, which would exacerbate if not initiate his [stroke].
Dr. Hinze's report also noted that Mr. Crose rarely drinks alcohol and has a history of smoking marijuana and taking ecstasy, but using ecstasy was an " unusual event."
At all times relevant to this appeal, Mr. Crose had an individual health insurance policy with Humana. Mr. Crose submitted a claim with Humana under the policy to cover the cost of medical services and treatments provided to Mr. Crose as a result of his stroke. Humana denied the claim, citing the following exclusion in the policy: " Causation Exclusions . .. Loss due to being intoxicated or under the influence of any narcotic unless administered on the advice of a health care practitioner."
Ms. Crose filed suit claiming breach of contract, unfair insurance practices, and prompt payment violations under the Texas Insurance Code. Humana filed a motion for summary judgment, which the district court granted. Ms. Crose now appeals.
" We review a district court's summary judgment de novo." Health Care Serv. Corp. v. Methodist Hosps. of Dallas, 814 F.3d 242, 247 (5th Cir. 2016). We review the facts in a " light most favorable to the non-moving party." Cannon v. Jacobs Field Servs. N. Am., Inc., 813 F.3d 586, 590 (5th Cir. 2016). Summary judgment is appropriate if the moving party shows " that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Cass v. City of Abilene, 814 F.3d 721, 728 (5th Cir. 2016) (citing Fed.R.Civ.P. 56(a)). " A genuine issue of material fact exists when the evidence is such that a reasonable jury could return a verdict for the non-moving party." Crownover v. Mid-Continent Cas. Co., 772 F.3d 197, 201 (5th Cir. 2014).
The parties agree that Texas law governs this case. Under Texas law, the elements of a breach of contract claim are: " (1) the existence of a valid contract; (2) performance or tendered performance by the plaintiff; (3) breach of the contract by the defendant; and (4) damages to the plaintiff resulting from that breach." Hunn v. Dan Wilson Homes, Inc., 789 F.3d 573, 579 (5th Cir. 2015) (citing Foley v. Daniel, 346 S.W.3d 687, 690 (Tex.App.--El Paso 2009, no pet.)), cert. denied, 136 S.Ct. 592, 193 L.Ed.2d 470 (2015).

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