Court Opinion

ID: 9772441
Source: CourtListenerOpinion
Date Created: 2023-08-29 17:17:49.89495+00
Date Added: 2024-06-11T07:31:44.424530
License: Public Domain

GONZALEZ, Justice,
dissenting.
My opinion dated January 21, 1987 is withdrawn, and the following is substituted.
I dissent. I cannot believe that the Legislature ever intended for court judgments (particularly a judgment in a Workers’ Compensation Act case) to be the basis of a DTPA action nor an action as an unfair insurance practice. In order to avoid the machinations and contortions that would have been necessary in order to torture a judgment into a “good” or “service,” the court, out of thin air, without any authority, reasoning or analysis, states that article 21.21 does not incorporate the entire DTPA. I do not agree with these conclusions.
*773Marshall sustained an on the job injury. This gave rise to a workers’ compensation claim and an award by the Industrial Accident Board. The case was appealed to District Court where the parties entered into a settlement agreement which was incorporated into the judgment. The judgment contains an open-ended future medical provision that gave rise to this lawsuit.
Marshall alleged Aetna violated § 17.-46(b)(5) of the Bus. & Comm.Code by representing to Marshall that Aetna would provide benefits and then failing to provide those benefits. Tex.Bus. & Comm.Code Ann. § 17.46(b)(5) makes actionable: “representing that goods or services have ... benefits ... which they do not have_ The terms “goods” or “services” as used in § 17.46(b)(5) are defined in § 17.45(1) and (2) as: (1) “Goods” means tangible chattels or real property purchased or leased for use, and (2) “services” means work, labor, or service purchased or leased for use including services furnished in connection with sale or repair of goods. Clearly, an agreed judgment is not contemplated within the definition of a “good” or “service.” Therefore Marshall has no basis for his claim for relief under either the DTPA or the Insurance Code.
An agreed judgment is a contract and is enforced as a contract. The fact that the judgment was entered into by consent of the parties gives it neither less nor greater force than if it had been the result of a hotly contested trial. Wagner v. Warnasch, 156 Tex. 334, 295 S.W.2d 890, 893 (1956). Furthermore, an allegation of mere breach of contract, without more, does not constitute a false, misleading, or deceptive act in violation of the DTPA. Ashford Development, Inc. v. Uslife Real Estate Services Corp., 661 S.W.2d 933 (Tex.1983). See also American Ins. Companies v. Reed, 626 S.W.2d 898 (Tex.App.—Eastland 1981, no writ); General Accident, Fire and Life Assurance Corp., Ltd. v. Legate, 578 S.W.2d 505 (Tex.Civ.App.—Texarkana 1979, writ ref d n.r.e.); Bennett v. Imperial Insurance Co., 606 S.W.2d 7 (Tex.Civ.App.—Dallas 1980, writ ref’d n.r.e.).
Our courts recognize that article 21.21 of the Insurance Code permits a cause of action on an insurance policy. However, there is no authority to support the bringing of a cause of action under article 21.21 to enforce the open medical provision of a compromise settlement agreement incorporated into a court judgment in a workers’ compensation case.
The purpose of article 21.21, as declared in section 1, is “to regulate trade practices in the business of insurance in accordance with the intent of Congress as expressed in the Act of Congress of March 9, 1945.” The Act of Congress referred to is commonly known as the McCarran-Ferguson Act. 15 U.S.C. §§ 1011-1015 (1945). The core meaning of the phrase “business of insurance” centers on the relationship between the insurer and insured, the type of policy which can be issued, and the insurance policy’s interpretation. Validity, Construction, and Application of McCarran-Ferguson Act Dealing with Regulation of Insurance Business by State or Federal Law, 21 L.Ed.2d 938, 955-56 (1969). Moreover, federal courts have determined that the term “business of insurance” as used in the McCarran-Ferguson Act involves the underwriting or spreading of risks in a relationship between an insurer and insured. Group Life & Health Ins. Co. v. Royal Drug Co., Inc., 440 U.S. 205, 99 S.Ct. 1067, 59 L.Ed.2d 261 (1979).
Section 16 of article 21.21 allows a cause of action to be brought by a person injured by another’s engaging in one of the following:
(1) Practices declared in section 4 of article 21.21 to be unfair or deceptive; or
(2) practices declared in the rules and regulations lawfully adopted by the State Board of Insurance pursuant to article 21.21 as being unfair and deceptive acts or practices or unfair methods of competition in the business of insurance; or
(3) practices defined by section 17.46 of the Business and Commerce Code as being unlawful deceptive trade practices.
*774Royal Globe Ins. Co. v. Bar Consultants, Inc., 577 S.W.2d 688 (Tex.1979). (emphasis added).
Under section 4, the following conduct is proscribed:
(1) misrepresentation and false advertising of policy contracts; (2) false information in advertising in general; (3) defamation; (4) boycott, coercion and intimidation resulting in or tending to result in unreasonable restraint of the business of insurance; (5) false financial information; (6) issuing or delivering stock operations or advisory board contracts; (7) unfair discrimination in rates, benefits or terms of contracts; and (8) granting of rebates in certain cases. These acts and practices, declared by section 4 of article 21.21 to be unfair and deceptive, are clearly concerned with the sale and advertising of insurance.
This court has held many times that the court must construe a statute as written, and if possible, ascertain its intention from the language used without using extraneous matters as a basis for reading into the statute an intention not expressed or intended to be expressed therein. Government Personnel Mut. Life Ins. Co. v. Wear, 151 Tex. 454, 251 S.W.2d 525 (1952). More recently this court reiterated in Seay v. Hall, 677 S.W.2d 19 (Tex.1984), that courts should carefully search out a statute’s intent, giving full effect to all its terms and find the intent in the language of the statute and not elsewhere.
When giving full effect to all the terms in sections 4 and 16 of article 21.21 and ascertaining the Legislature’s intent from the language used therein, it is clear that this statute was never meant to be applied to enforce a judgment. Nowhere in the McCarran-Ferguson Act, the cases interpreting the Act, or in the clear and unambiguous language of article 21.21, does there appear the slightest suggestion that it was intended to enforce an open medical provision in a judgment in a workers’ compensation case.
In summary, article 21.21, section 16 was intended to protect the insurance consumer at the time of purchasing a policy. There is no allegation of any misconduct at the time the insurance policy was sold. Representations made by the insurance company after the purchase of the policy cannot constitute the basis of a DTPA claim. See Royal Globe Ins. Co. v. Bar Consultants, Inc., 577 S.W.2d at 694; Rosell v. Farmers Texas County Mut. Ins. Co., 642 S.W.2d 278, 279 (Tex.App.—Texarkana 1982, no writ). The Legislature could easily have made express provisions for post-sale and post-loss conduct; their failure to do so evidences an intent to not allow recovery of treble damages for such conduct.
As shown by the facts of this case, Aet-na’s conduct cannot be condoned. However, Marshall is not without a remedy. He can sue for breach of contract, for execution on the judgment, or bring suit under Tex.Rev.Civ.Stat.Ann. art. 8307, § 5(a).1 Our opinion that these remedies are inadequate does not give us the right to rewrite the statute under the guise of interpreting it. I would hold that because a judgment is neither a “good” nor a “service,” Marshall does not have a DTPA cause of action nor an action under article 21.21, section 16 of the Insurance Code.2

. The court does not cite nor attempt to distinguish our holding in Reed Tool Co. v. Copelin, 689 S.W.2d 404, 406 (Tex.1985), where we reaffirmed the fact that the Texas Workers' Compensation Act is the exclusive remedy for work-related injuries with the exception of intentional injury. Here, there are no findings of an intentional tort. See also Paradissis v. Royal Indemnity Company, 507 S.W.2d 526 (Tex.1974).

. The irony is that in the long run, the majority opinion will hurt rather than help consumers. Cases will be more difficult to settle and we may have seen the end of agreed judgments in workers’ compensation cases that leave future medical open.