Humana Insurance Company v. Dolores Mueller
04-14-00752-CV
Tex. App.Feb 17, 2015Background
- Mueller worked for SAHA, a local government entity; Humana administered SAHA’s health-benefits program.
- Humana denied Mueller’s health-claims pre-certification, alleging policy exclusions for experimental procedures.
- Mueller amended pleadings to proceed only against Humana after discovering Humana’s outside-the-policy denial actions.
- Humana filed a Plea to the Jurisdiction arguing sovereign/official immunity as an independent contract administrator.
- The trial court denied the Plea to the Jurisdiction; Humana appeals the interlocutory order.
- The appellate issue is whether the court has jurisdiction to review the interlocutory order and whether Humana has immunity.
- Mueller seeks damages and claims under the Texas Insurance Code and contract principles; Humana contends immunity shields it.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is there appellate jurisdiction over the interlocutory order? | Mueller lacks officer/employee status for 51.014(a)(5). | Humana argues it is an independent contractor, not a government employee. | No jurisdiction; 51.014(a)(5) does not apply to Humana. |
| Does Humana have derivative or official immunity for claims handling? | Urges that Humana’s conduct violates the Insurance Code and is ultra vires. | Humana seeks immunity as a private actor performing contracted administrative functions. | Humana has no derivative or official immunity; immunity does not render the appeal mooted. |
Key Cases Cited
- Ben Bolt-Palito Blanco Consol. Indep. Sch. Dist. v. Tex. Political Subdivisions Prop./Cas. Joint Self-Ins. Fund, 212 S.W.3d 320 (Tex. 2006) (loosened immunity bar for local government contracts)
- Cen-Tex Child Care, Inc. v Johnson, 339 S.W.3d 734 (Tex. App.—Fort Worth 2011) (independent contractor under contract not officer immunity under §51.014(a)(5))
- City of El Paso v. Heinrich, 284 S.W.3d 366 (Tex. 2009) (no official immunity for ultra vires acts)
- Klein v. Hernandez, 315 S.W.3d 1 (Tex. 2010) (state employee for purposes of immunity when working at public hospital)
- Tex. A&M Univ. Sys. v. Koseoglu, 233 S.W.3d 835 (Tex. 2007) (statutory construction on immunity/contract claims)
- Tooke v. City of Mexia, 197 S.W.3d 325 (Tex. 2006) (cities have no immunity for proprietary-function torts)