Court Opinion

ID: 9778513
Source: CourtListenerOpinion
Date Created: 2023-08-29 21:10:36.849498+00
Date Added: 2024-06-11T11:19:22.546167
License: Public Domain

HECHT, Justice,
concurring.
I join in the Court’s judgment but not in its opinion, which goes further than it must or should to resolve the dispositive issue before us. That issue, precisely, is whether the Viles are entitled to recover against their insurers without a jury finding that the insurers waived the verified proof of loss required by the insurance policies. I agree that this issue must be resolved in favor of the Viles, but not for the expansive reasons chosen by the Court.
As a rule, whether an insurer has waived the proof of loss required by its insurance policy is a question to be answered by the fact-finder, and the duty to request a finding is upon the insured claiming waiver. American Teachers Life Ins. Co. v. Brugette, 728 S.W.2d 763 (Tex.1987). However, an insurer’s denial of a claim before the deadline for presenting the required proof of loss waives that requirement as a matter of law. See Sanders v. Aetna Life Ins. Co., 146 Tex. 169, 205 S.W.2d 43, 44-45 (1947); Hazlitt v. Provident Life & Accident Ins. Co., 212 S.W.2d 1012, 1013 (Tex.Civ.App.—San Antonio 1948), aff'd, 216 S.W.2d 805, 807 (Tex.1949); Angelo State University v. International Ins. Co. of New York, 491 S.W.2d 700, 701-02 (Tex.Civ.App.—Austin 1973, no writ). In this case, the testimony of the insurers’ authorized adjuster that he decided first to deny the Viles’ claim and then to offer them a fraction of the amount claimed as a compromise, all before the required proof of loss was due under the policies, establishes waiver of the requirement as a matter of law. Consequently, the Viles were not obliged to obtain a jury finding on this issue, and the court of appeals erred in holding to the contrary.
These reasons, supported by settled authority, are sufficient to resolve the issue presented in this case. It is therefore unnecessary, unwise and improper for the Court to hold, as it does, “that a breach of the duty of good faith and fair dealing will give rise to a cause of action in tort that is separate from any cause of action for breach of the underlying insurance contract.” 788 S.W.2d at 567. This holding suggests, at least, that a breach of the duty of good faith and fair dealing may occur even when there has been no breach of contract. The Court cites no authority for this statement. In both cases to which the Court refers, Arnold v. National *569County Mut. Fire Ins. Co., 725 S.W.2d 165 (Tex.1987), and Chitsey v. National Lloyds Ins. Co., 738 S.W.2d 641 (Tex.1987), a breach of the contract of insurance accompanied the alleged breach of the duty of good faith and fair dealing. The concurring opinion in Arnold stated that a breach of contract was an element of a cause of action for breach of the duty of good faith and fair dealing. Arnold, 725 S.W.2d at 168 (Gonzalez, J., concurring). I agree that the Viles’ failure to present a timely proof of loss could not preclude them from recovering because the insurers had already decided before the proof of loss was due to deny the Viles’ claim. The circumstances of this case, however, neither require nor support a general proposition that tort claims for breach of the duty of good faith and fair dealing are always “separate” from contract claims for breach of the underlying insurance policy.
Equally improvident is the Court’s statement: "Whether there is a reasonable basis for denial [of a claim] ... must be judged by the facts before the insurer at the time the claim was denied.” 788 S.W.2d 567. The statement is true in the context of this case: the Viles’ failure to file a proof of loss could not have been a basis for the insurers’ denial of the Viles’ claim because it had not occurred at the time the claim was denied. In other contexts, however, the Court’s statement is highly doubtful. For example, there may be a reasonable basis for denying a claim even if the adjuster who actually makes the decision is not aware of it and denies the claim for some other reason, even an invalid one. In this regard, the Court’s statement appears to conflict with, if not contradict, the holding of Aranda v. Insurance Company of North America, 748 S.W.2d 210, 213 (Tex.1988), that one element of a cause of action for breach of the duty of good faith and fair dealing is “the absence of a reasonable basis for denying or delaying payment of the benefits of the policy”. This element requires an “objective determination of whether a reasonable insurer under similar circumstances would have delayed or denied the claimant’s benefits”, id., not a subjective determination of whether the particular adjuster’s denial of the claim was reasonable.
The Court attempts to contrive a profound case from a simple one, almost impatient to address issues not raised, as if this Court could set its own agenda. Its resulting discursive should be no obstacle to full consideration of the issues when properly presented in future cases.
PHILLIPS, C.J., and GONZALEZ and COOK, JJ., join in this concurring opinion.