Court Opinion

ID: 9760935
Source: CourtListenerOpinion
Date Created: 2023-08-29 01:24:38.248247+00
Date Added: 2024-06-11T07:29:18.849064
License: Public Domain

BARAJAS, Justice,
concurring.
While I find myself in agreement with the majority’s holding, I find it necessary to concur with the majority opinion. The decision to write separately, however, in no way reflects disagreement with the reasoning inherent in the opinion of the majority. Instead, my concurrence results only from a desire to expand upon the policy reasons that support the majority’s holding.
As the majority correctly states, an independent claims adjusting company, entrusted to administer an employer’s workers’ compensation plan, does have a duty of good faith and fair dealing to the employer’s claimants. Indeed, such a duty exists even though there is no contractual privity between the independent claims adjusting company and the claimant. Aside from being legally sound, the imposition of such a duty is dictated by public policy.
In the context of workers’ compensation, the duty of an insurance carrier is to provide speedy, equitable relief to those employees injured in the course of their employment. See Aranda v. Insurance Co. of North America, 748 S.W.2d 210 (Tex.1988). Significantly, fulfillment of this duty necessarily entails the exercise of a great deal of discretion.
At the outset, it is generally within the discretion of an insurance carrier to act as its own claims adjuster or, in the alternative, contract with an independent claims adjusting company. If an insurance carrier chooses to adjust its own claims, Aranda unequivocally imposes the duty of good faith and fair dealing. Id. However, prior to the majority’s decision in the instant case, Texas law had not directly addressed the legal ramifications that would result if an insurance carrier exercised its discretion by delegating the adjustment of claims to an outside entity. Despite this fact, there was and is a strong public policy argument against a “discretionary avoidance” of the duty of good faith and fair dealing.
If independent claims adjusting companies are not governed by the holding in Aranda, insurance carriers would be able to exercise their discretion in such a way as to avoid the duty of good faith and fair dealing. That is not to say that under the law prior to the majority’s decision a claimant could not sue an insurance carrier if the carrier’s adjuster acted in “bad faith.” Instead, such a statement suggests that the rationale behind the duty of good faith and fair dealing could effectively be avoided because independent claims adjusting companies would not be required to “provide speedy, equitable relief to an employee injured in the course of his employment.” Aranda, 748 S.W.2d at 212. Such a result is clearly contrary to public policy.
The duty of an independent claims adjusting company, engaged by an employer or carrier to administer the employer’s workers’ compensation plan, is distinct from that of an insurance carrier. An independent claims adjusting company is entrusted to make the initial determination of a claimant's eligibility for benefits, to investigate any employee disability claims, to obtain pertinent medical reports, to pay any medical bills and equally as important, to insure that employee compensation is properly and timely paid. Through the performance of the above services on behalf of the insurer, Appellee Alexsis, Inc. was obligated to effectively deliver workers’ compensation benefits and take the steps necessary to perform the carrier’s duty of good faith and fair dealing owed to its claimants.