Craig Carpenter v. Southwest Medical Examination Services, Inc.
381 S.W.3d 583
Tex. App.2012Background
- Carpenter suffered a job-related knee injury on November 30, 2007.
- Liberty Insurance Corporation denied knee surgery in January 2008 as related to a preexisting condition.
- Division appointed Dr. Stumhoffer as designated doctor after Liberty’s request; Stumhoffer examined Carpenter on May 9, 2008.
- Southwest Medical Examination Services provided administrative services for Liberty and Dr. Stumhoffer, including scheduling and documentation; a nurse affiliated with Southwest supplied Dr. Stumhoffer with a medical condition analysis for Liberty.
- A BRC raised a potential conflict of interest due to Southwest’s role; the parties agreed that a second designated doctor should be appointed and that Stumhoffer’s report would not be used; Dr. Zeeck was later appointed and found the surgery related to the injury.
- Carpenter filed suit in March 2009 asserting common-law bad faith, statutory bad faith, fraud, Insurance Code, DTPA claims, and conspiracy; Southwest moved for summary judgment and the trial court granted it, severing its claims.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Preclusion of common-law bad faith and related claims | Carpenter argues Ruttiger allows independent bad-faith claims. | Southwest contends the Act precludes such claims. | Yes; Ruttiger precludes these claims under the Act. |
| Disclosures and regulatory duties under the Act and regulations | Carpenter asserts Southwest had a duty to disclose its relationships. | Southwest argues the Act’s comprehensive disclosure regime governs; no independent duty. | Yes; Act provides exclusive dispute procedures, precluding independent duties. |
| Liability of Southwest given no contract with Carpenter | Carpenter claims Southwest as an adjuster owed duties. | Southwest had no contractual relationship; analogous to independent adjuster liability. | Yes; no liability due to lack of contract; independent-adjuster reasoning applies. |
Key Cases Cited
- Arnold v. National County Mutual Fire Insurance Co., 725 S.W.2d 165 (Tex. 1987) (duty of good faith and fair dealing extended to carriers (story adopted))
- Aranda v. Insurance Co. of North America, 748 S.W.2d 210 (Tex. 1988) (extension of good-faith duty rejected for workers’ comp claims)
- Natividad v. Alexis, Inc., 875 S.W.2d 695 (Tex. 1994) (independent adjusting firms owe no duty to insured; good-faith duty limited)
- Dear v. Scottsdale Ins. Co., 947 S.W.2d 908 (Tex. App.—Dallas 1997) (independent adjuster not liable for improper investigation/settlement)
- Dagley v. Haag Eng’g Co., 18 S.W.3d 787 (Tex. App.—Houston [14th Dist.] 2000) (independent adjuster cannot be liable under Insurance Code)
- Crocker v. Am. Nat’l Gen. Ins. Co., 211 S.W.3d 928 (Tex. App.—Dallas 2007) (strengthens independent-adjuster non-liability reasoning)