578 S.W.3d 98
Tex. App.2018Background
- In Oct. 2007 Beasley (insured) received medical treatment after a car accident; providers billed $2,662.54.
- Beasley’s health insurer (BCBS) paid providers $1,068.90 after contractual discounts; providers accepted that as payment in full.
- Beasley submitted the full $2,662.54 to his PIP insurer, Farmers, who paid $1,068.90 and refused to pay the PIP policy limit of $2,500.
- Beasley alleged Farmers breached the policy and violated the DTPA and Texas Insurance Code, seeking the unpaid PIP balance (~$1,432) in monetary damages.
- Farmers filed a plea to the jurisdiction arguing Beasley lacked standing because he suffered no injury—the providers accepted BCBS payment and he owed nothing more.
- Trial court granted the plea and dismissed; Beasley appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Beasley has standing to sue (plea to the jurisdiction) | Beasley alleged concrete monetary injury: Farmers paid less than PIP limits for reasonable, necessary medical expenses and he seeks the difference. | Farmers argued no actual injury because providers accepted BCBS payment; Beasley incurred no out-of-pocket obligation, so no legally cognizable injury (invoking Allstate v. Forth). | Court reversed: Beasley pleaded an actual, concrete monetary injury (difference between billed/reasonable charges and amount paid); jurisdiction exists and merits questions remain for trial. |
| Whether the dismissal of the breach claim required dismissal of statutory (DTPA/Insurance Code) claims | Beasley contends statutory claims rest on same injury and should survive if breach claim survives. | Farmers argued lack of injury defeats all claims. | Court held trial court erred to dismiss statutory claims tied to the contested injury; remanded for further proceedings. |
Key Cases Cited
- Allstate Indem. Co. v. Forth, 204 S.W.3d 795 (Tex. 2006) (insured lacked standing where she abandoned monetary damages and providers accepted insurer’s reduced payment without showing insured suffered unpaid liability)
- Miranda v. Texas Dep’t of Parks & Wildlife, 133 S.W.3d 217 (Tex. 2004) (when jurisdictional facts are disputed, courts may consider evidence to resolve plea to the jurisdiction)
- Heckman v. Williamson County, 369 S.W.3d 137 (Tex. 2012) (plea to the jurisdiction may require evidentiary review when jurisdictional facts are contested)
- Bland Indep. Sch. Dist. v. Blue, 34 S.W.3d 547 (Tex. 2000) (courts should limit jurisdictional evidence and avoid merits when resolving pleas to the jurisdiction)
- Axtell v. Univ. of Tex., 69 S.W.3d 261 (Tex. App.—Austin 2002) (accept plaintiff’s factual allegations as true when reviewing jurisdictional challenge to pleadings)
- Linegar v. DLA Piper LLP (US), 495 S.W.3d 276 (Tex. 2016) (standing requires a concrete, particularized, actual or imminent injury)
- Stewart v. Basey, 245 S.W.2d 484 (Tex. 1952) (plaintiff must show monetary loss to recover actual damages for breach of contract)