Court Opinion

ID: 9397996
Source: CourtListenerOpinion
Date Created: 2023-05-28 07:11:21.124755+00
Date Added: 2024-06-11T17:19:29.579706
License: Public Domain

Reversed and Remanded and Memorandum Opinion filed May 25, 2023

                                          In The

                      Fourteenth Court of Appeals

                                 NO. 14-21-00708-CV

  HAFFAN PROPERTIES, LLC, ELVIA BESIL AND EDGAR SPINOSO,
  INDIVIDUALLY AND AS PERSONAL REPRESENTATIVE OF THE
           ESTATE OF CARLOTA SPINOSO, Appellants
                                            V.

    VISTA AGENCY, LLC AND MARIA BARBARA GARCIA, Appellees

                     On Appeal from the 269th District Court
                             Harris County, Texas
                       Trial Court Cause No. 2019-81634

                            MEMORANDUM OPINION

       The trial court granted final summary judgment in favor of appellees, Vista
Agency, LLC and Maria Barbara Garcia, dismissing all of appellants’ claims.1
Appellants appeal the trial court’s judgment arguing the trial court erred in
granting summary judgment on their claims for breach of contract and negligence.
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         Appellants are Haffan Properties, LLC, Elvia Besil, and Edgar Spinoso, Individually
and as Personal Representative of the Estate of Carlota Spinoso.
Concluding there is a genuine issue of material fact on appellants’ claims, we
reverse the judgment of the trial court and remand for further proceedings.

                              STANDARD OF REVIEW

      “We review an order granting summary judgment de novo, taking as true all
evidence favorable to the nonmovant and indulging every reasonable inference in
the nonmovant’s favor.” JLB Builders, L.L.C. v. Hernandez, 622 S.W.3d 860, 864
(Tex. 2021). If there is no evidence of one or more essential elements of a claim or
defense on which the adverse party would have the burden of proof at trial, then
no-evidence summary judgment is proper. Id. “A properly filed no-evidence
motion shifts the burden to the nonmovant to present evidence raising a genuine
issue of material fact supporting each element contested in the motion.” No-
evidence summary judgment is improper if the non-movant brings forth more than
a scintilla of probative evidence to raise a genuine issue of material fact. Id. “To
be entitled to traditional summary judgment, the movant has the burden to prove
that no genuine issue of material fact exists and that the movant is entitled to
judgment as a matter of law.” Id.

      When, as here, “a trial court’s order granting summary judgment does not
specify the grounds on which its order is based, the appealing party must negate
each ground upon which the judgment could have been granted.” Rosetta Res.
Operating, LP v. Martin, 645 S.W.3d 212, 226 (Tex. 2022).

                                    BACKGROUND

      The claims herein are the result of the death of a child, Carlota. Carlota and
her family travelled to Mexico. While in Mexico, Carlota was hospitalized and
treated for cancer. After a lengthy hospital stay, Carlota eventually died. The
litigation herein is over whether appellees, Vista Agency, LLC and Garcia, which

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sold appellants the healthcare insurance policy that covered Carlota, made certain
promises to appellants that appellees were a “full-service” agency that would help
appellants file claims. Appellants allege that appellees undertook and made such
promises and acted in furtherance of the promises.         However, many claims
submitted to the insurer were ultimately denied due to the untimeliness of the
claims filed.

      In their amended petition, appellants alleged that appellees entered into a
contract with appellants to timely submit insurance claims, breached the agreement
by failing to timely submit such claims, and caused appellants to sustain damages
of more than $2 million. Appellants alleged that appellees had a duty of care to
timely submit the insurance claims and to accurately explain the time limitations
for the submission of the claims.

      Appellees moved for traditional and no-evidence summary judgment on
appellants’ claims. Appellees argued that there is no evidence of a contract, no
evidence of breach, no evidence of a meeting of the minds, and no evidence of
consideration. Appellees further argued that there is no legal duty as alleged by
appellants and that appellant Edgar admitted he timely submitted the claims
himself.

      In response, appellants argued that they provided evidence of the elements
of their contract claim and attached exhibits. In his affidavit Edgar testified that
appellees represented themselves as a “‘full-service’ insurance agency that not
only placed insurance but also handled claims for their clients” and that appellees
“agreed to act as agents . . . to procure and manage health insurance coverage.”
Edgar attested that after his daughter became ill in Mexico, he contacted appellees
and requested help in submitting claims and confirming coverage under the
healthcare policy and appellee Garcia stated she would be in contact with the

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healthcare providers to coordinate coverage under the healthcare policy. Edgar
attested that he spoke to appellee Barbara “frequently by phone and she assured me
she was taking care of the insurance coverage and submission of claims.”
Attached to Edgar’s affidavit is an executed authorization designating Barbara as
appellants’ agent for purposes of “international claims.” Additional attachments
include emails from the healthcare insurer directed to both appellant Elvia and
Barbara advising them of the status of the claims. The email indicates that “once
we have this information we will reach out to Blue Cross Blue Shield of TX,
provide them the information (along with the material Barbara provided us this
morning), and request them to approve our covering of the expenses on their
behalf.” In another email addressed to both Elvia and Barbara, the healthcare
insurer representative states “[w]e have been unsuccessful in receiving any
response from [the hospital in Mexico] nor a response from yourselves in assisting
in obtaining information from the hospital.” Lastly, the evidence attached to
appellants’ response shows that at least some of the claims, totaling more than a
hundred thousand dollars, were denied due to missing the claim filing deadline.

      The trial court granted appellees’ summary judgment motion on appellants’
breach of contract claim but denied it as to appellants’ negligence claims.
Appellees again moved for traditional and no-evidence summary judgment on
appellants’ negligence claims. In the second motion appellees argued that there is
no evidence of a legal duty and that Edgar never provided the medical bills for
Barbara to submit. Appellees argued that a letter attached as an exhibit clearly
demonstrates that appellants’ counsel was charged with the duty to prepare and
submit the claims. Appellees also attached an affidavit Edgar submitted in a
federal court case against the healthcare insurer. Appellees argued that the federal
court affidavit and requests for admissions are admissions by appellants in this

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case and argued that the trial court should disregard Edgar’s affidavit in this
lawsuit because it contradicts prior sworn testimony. In responding to requests for
admissions, appellants admitted that Edgar executed the federal court affidavit
under oath and has never retracted, amended, or corrected the federal court
affidavit. When asked to admit that Edgar submitted claims or that Edgar “never
mentioned” appellees in the federal court affidavit, appellants provided an
explanatory response and denied the admission.

      Appellants again responded with the same evidence provided in response to
appellees’ first motion for summary judgment and additional evidence. Appellants
argued that their evidence creates a fact issue on whether a duty exists, again
attesting that appellees undertook and agreed to submit the claims to the insurer,
failed to do so timely, and directed appellants that they had a year to file their
claims when the policy only provided ninety days. Appellants further argued that
they engaged counsel to submit claims only after the deadline had passed and that
it was irrelevant to the claims made against appellees.

      Appellees filed a reply, objecting to appellants’ summary judgment
evidence. The trial court sustained the objections and excluded from consideration
“Exhibits 5a, 5b, and 6.” The trial court then granted summary judgment on
appellants’ negligence claims in favor of appellees.

                            EDGAR’S PRIOR AFFIDAVIT

      As an initial matter, we address the appellees’ contention that we should not
consider Edgar’s affidavit submitted with appellants’ responses to the motions for
summary judgment. Appellees contend in both summary judgment motions and on
appeal that Edgar submitted a contradictory affidavit in a federal lawsuit against
the healthcare insurer, in which appellees were “never mentioned” and Edgar
“admitted that he submitted the claims.” Appellees argue that such statements are
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admissions and that neither the trial court, nor this court, should consider Edgar’s
affidavit submitted with appellants’ responses in determining whether a genuine
issue of material fact has been raised by appellants.

      While appellees made these arguments to the trial court, the trial court did
not rule on their objection to the alleged sham affidavit submitted by Edgar. See
Lujan v. Navistar, Inc., 555 S.W.3d 79, 84–90 (Tex. 2018) (discussing sham
affidavit rule and holding “a trial court may conclude that a party does not raise a
genuine fact issue by submitting sworn testimony that materially conflicts with the
same witness’s prior sworn testimony, unless there is a sufficient explanation for
the conflict.”). An objection that an affidavit constitutes a sham affidavit is an
attack of form, not substance. Hill v. Allstate Fire & Cas. Ins. Co., 652 S.W.3d
516, 524 n.2 (Tex. App.—Houston [14th Dist.] 2022, no pet.); Massey v. DISA
Glob. Sols., Inc., No. 01-21-00355-CV, 2022 WL 3970075, *8 (Tex. App.—
Houston [1st Dist.] Sept. 1, 2022, no pet.) (mem. op.). For a defect of form, a
party must object and obtain a ruling on such objection to preserve error. Hill, 652
S.W.3d at 524 n.2.

      Appellees argue that the federal court affidavit and requests for admissions
are admissions by appellants in this case. In responding to requests for admissions,
appellants admitted that Edgar executed the federal court affidavit under oath and
has never retracted, amended, or corrected the federal court affidavit. When asked
to admit that Edgar submitted claims or that Edgar “never mentioned” appellees in
the federal court affidavit, appellants provided an explanatory response and denied
the admission. The trial court did not rule on appellees’ objection to Edgar’s
affidavit in this case and we cannot imply such a ruling based on the trial court’s
granting of summary judgment in appellees’ favor. See Massey, 2022 WL
3970075, at *8 (“Although the trial court granted summary judgment, it did not

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explicitly rule on DISA’s objection to Massey’s declaration as a sham. Nor did it
implicitly rule on the objection by granting the motion.”); see also Well Sols., Inc.
v. Stafford, 32 S.W.3d 313, 317 (Tex. App.—San Antonio 2000, no pet.) (granting
summary judgment is not implicit ruling that sustains or overrules objections to
summary judgment evidence).

      Without an objection and a ruling, the trial court and this court are required
to “credit evidence favoring the nonmovant, indulging every reasonable inference
and resolving all doubts in his or her favor.” See Lujan, 555 S.W.3d at 84. As a
result, because the trial court dd not make a ruling on appellees’ objection to
Edgar’s affidavit, we take the affidavit as true and indulge every reasonable
inference in appellants’ favor. See JLB Builders, L.L.C., 622 S.W.3d at 864.

                              BREACH OF CONTRACT

      Appellants argue that they submitted sufficient evidence to raise a fact issue
to overcome appellees’ motion for no-evidence and traditional summary judgment
on appellants’ breach of contract claim.

A.    General Legal Principles

      The elements of breach of contract are: (1) a valid contract between the
parties; (2) the plaintiff tendered performance or was excused from doing so; (3)
the defendant breached the terms of the contract; and (4) the plaintiff sustained
damages as a result of the defendant’s breach. Atrium Med. Ctr., LP v. Houston
Red C LLC, 546 S.W.3d 305, 311 (Tex. App.—Houston [14th Dist.] 2017), aff’d,
595 S.W.3d 188 (Tex. 2020). To prove a valid contract exists, “the plaintiff must
establish that (1) an offer was made; (2) the other party accepted in strict
compliance with the terms of the offer; (3) the parties had a meeting of the minds
on the essential terms of the contract (mutual assent); (4) each party consented to

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those terms; and (5) the parties executed and delivered the contract with the intent
that it be mutual and binding.” USAA Tex. Lloyds Co. v. Menchaca, 545 S.W.3d
479, 502 n.21 (Tex. 2018).

B.    Analysis

      In their motion for summary judgment, appellees argued that appellants have
no evidence of a contract, breach, meeting of the minds, or consideration.

      Taking as true all evidence favorable to appellants and indulging every
reasonable inference in appellants’ favor, we conclude the evidence submitted by
appellants is sufficient to raise a genuine issue of material fact.      Appellants
presented evidence of a contract between the parties––the undertaking of filing
claims through the affidavit of Edgar and further supported by the documents
attached to their response. Appellants produced evidence that appellees undertook
to contact Carlota’s healthcare team and coordinate coverage under the policy
through the affidavit and the emails showing that Barbara had provided materials
to the insurer, and later when the insurer complained about a lack of response from
Barbara (and Elvia) in obtaining information from the hospital. Edgar attested that
appellees reassured him that they were taking care of submitting the claims. There
is a reasonable inference of consideration in that Edgar attests that appellees
represented to be a “full-service” agency that would help file and process claims
prior to appellants’ purchase of the policy. There is evidence of breach in that the
claims were not timely filed and the damages include those claims that were so
denied. Further the evidence of a meeting of the minds is shown through the
evidence showing Barbara became an authorized agent to discuss the international
claims with the insurer, as well as the emails evidencing her helping with the
claims process and submitting documentation to the insurer. This is sufficient to

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overcome the relatively minimal burden of defeating a summary judgment
motion.2

       Appellees argue that when a person offers to render a service gratuitously,
there is no consideration. However, appellants provided evidence of consideration
in response to the motion for summary judgment as noted above. Appellees
further contend that they submitted evidence that they did not have any contractual
arrangement to submit or process insurance claims for them, citing to Barbara’s
affidavit in support of summary judgment.                 However, we must credit the
nonmovant’s evidence as true and make all reasonable inferences in the
nonmovants’ favor.

       We conclude that appellants’ evidence raises a genuine issue of material
fact. We sustain appellants’ first issue.

                                        NEGLIGENCE

       Appellants next contend that they provided evidence that appellees agreed to
submit claims on appellants’ behalf, failed to do so, and such failure harmed
appellants.    Appellants also argue that they presented evidence that appellees
advised appellants that they had a year to present claims to the insurer when the
policy provided appellants only ninety days to submit such claims.

A.     General Legal Principles

       “When analyzing a negligence claim, we first ask whether the defendant
owed the plaintiff a duty.” JLB Builders, 622 S.W.3d at 864. “A duty to use
reasonable care may arise when a person undertakes to provide services to another,
       2
         Appellees further argue that appellants waived this issue on appeal because it was not
briefed. However, appellants argued that they brought forth evidence of the elements of their
claims and cited to the record. We construe briefs reasonably, yet liberally to reach and resolve
the merits of the issues and avoid a finding of waiver whenever reasonably possible. See Perry
v. Cohen, 272 S.W.3d 585, 587 (Tex. 2008).

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either gratuitously or for compensation.” Torrington Co. v. Stutzman, 46 S.W.3d
829, 837 (Tex. 2000). Under a negligent undertaking theory, a defendant may be
liable if “(1) the defendant undertook to perform services that it knew or should
have known were necessary for the plaintiff’s protection; (2) the defendant failed
to exercise reasonable care in performing those services; and (3) either (a) the
plaintiff relief on the defendant’s performance, or (b) the defendant’s performance
increased the plaintiff’s risk of harm.” Nall v. Plunkett, 404 S.W.3d 552, 555–56
(Tex. 2013) (per curiam); see also Lifshen v. 20/20 Accounting Sols., L.L.C., 858
Fed. App’x 704, 707 (applying negligent undertaking theory to promise to pay life
insurance premiums).

B.   Analysis

      In the second motion appellees argued that there is no evidence of a legal
duty and that Edgar never provided the medical bills for Barbara to submit.
Appellees argued that a letter attached as an exhibit clearly demonstrates that
appellants’ counsel was charged with the duty to prepare and submit the claims.

      Appellants presented evidence that appellees agreed to submit their
international claims and, as a result, owed appellants’ a reasonable duty of care in
submitting such claims. See Nall, 404 S.W.3d at 555–56; Lifshen, 858 Fed. App’x
at 707–08. As further evidence of this undertaking, appellants’ exhibits showed
that appellees contacted the healthcare team taking care of Carlota to coordinate
coverage under the policy. Edgar attested that after Barbara indicated that she was
going to coordinate care he “assumed that she was taking care of submitting claims
and coordinating payments . . . . spoke to her frequently by phone and she assured
me she was taking care of the insurance coverage and submission of claims.”
Edgar attested that in October 2018, eight months after Carlota died, Barbara
advised appellants to engage counsel to submit such claims. The letter from

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appellants’ counsel requesting information from Barbara is dated November 2018.
Appellants also provided an email from Barbara and attested that in the email
Barbara indicated they had one year to submit claims under the policy.

      Appellees argue that even if they agreed to submit claims, there is no
evidence that appellants provided the claims to submit. However, Edgar’s affidavit
provides that Barbara assured him that she was submitting the claims. Taken as
true, along with the other evidence in the record, this is sufficient to raise a genuine
issue of material fact.

      Taking as true all evidence favorable to appellants and indulging every
reasonable inference in appellants’ favor, we conclude the evidence submitted
raises a fact issue on appellants’ negligence claims.

      We sustain appellants’ second issue.

                                    CONCLUSION

      Having concluded that appellants provided sufficient evidence to raise a
genuine issue of material fact on each element challenged by appellees, we
conclude the trial court erred in granting summary judgment on appellants’ claims
for breach of contract and negligence. Therefore, we reverse the judgment of the
trial court and remand for further proceedings.

                                        /s/    Ken Wise
                                               Justice

Panel consists of Chief Justice Christopher and Justices Wise and Hassan.

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