Opinion
Civil Action No. 3:04-CV-1684-M.
March 16, 2005
MEMORANDUM OPINION AND ORDER
Before the Court is Defendant Dallas County's Motion for Summary Judgment, filed on December 15, 2004. For the reasons stated below, this Motion is GRANTED.
I. BACKGROUND
This case stems from a dispute over insurance payments allegedly due to Plaintiff Bret Martin for medical costs related to the birth of his twin daughters. Plaintiff was an Assistant District Attorney for Dallas County from December 1995 until July 1999. During that time, he was enrolled as a participant in Dallas County's self-funded Healthcare Plan ("Plan"), which was managed by Public Employee Benefits Cooperative ("PEBC") and Defendant North Texas Healthcare Network ("NTHN"). After he left his employment with Dallas County, Plaintiff continued coverage under the Plan as a COBRA participant through December 31, 2000. Plaintiff's wife gave birth to twins on October 1, 2000. All of the medical providers and hospitals completed and processed pre-certification paperwork in anticipation of the twins' birth. Shortly after the twins' birth, Plaintiff called NTHN and notified a claims representative of the birth. Plaintiff alleges that he was assured by the claims representative that all of the necessary paperwork had been received to add the twins to his insurance. Plaintiff also completed a Dallas County Benefit Enrollment Worksheet that he obtained from the District Attorney's Office.
PEBC was named as a defendant in Plaintiff's original suit, but it was never served with process.
Plaintiff submitted claims in excess of $28,000 for the medical expenses related to the twins' birth. Plaintiff's claims were denied. After being advised of the denial of his claims, Plaintiff sent a letter to Gene Gerard, a PEBC Claims Account Executive. On January 15, 2001, Mr. Gerard responded to Plaintiff's letter, stating that "[t]o date, Employer Services has not received notification from PEBC Dallas County that the dependents in question have been added to the plan. As such, no benefits exist." Pl. Resp. to Mot. Summ. J. App. E. The letter further informed the Plaintiff that he could submit additional information if he believed this decision was in error. Id.
Plaintiff filed suit against NTHN on November 1, 2002, in state district court. On October 24, 2003, Plaintiff added claims against PEBC and Dallas County. Plaintiff amended his lawsuit several times. On July 16, 2004, Plaintiff filed his Fourth Amended Petition ("Complaint"), for the first time alleging that Dallas County had violated his federal constitutional rights. Based on the addition of that claim, the case was removed to this Court on August 3, 2004. Plaintiff's Complaint alleges the following causes of action against Dallas County: (1) deprivation of his property interest in violation of the Due Process Clause of the Fourteenth Amendment to the United States Constitution; (2) breach of contract, or in the alternative, promissory estoppel; (3) negligent misrepresentation; (4) breach of good faith and fair dealing; and (5) deceptive insurance practices. Defendant Dallas County seeks summary judgment on all of Plaintiff's claims.
II. ANALYSIS
A movant for summary judgment must prove that there are no genuine issues of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). A genuine issue of material fact exists "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). "The moving party bears the initial burden of showing that there is no genuine issue for trial; it may do so by pointing out `the absence of evidence supporting the nonmoving party's case.'" Duffy v. Leading Edge Prods., Inc., 44 F.3d 308, 312 (5th Cir. 1995) (quoting Skotak v. Tenneco Resins, Inc., 953 F.2d 909, 913 (5th Cir. 1992)). The burden then shifts to the nonmovant to show that summary judgment is not proper. Duckett v. City of Cedar Park, 950 F.2d 272, 276 (5th Cir. 1992). The parties may satisfy their respective burdens by tendering depositions, affidavits, and other competent evidence. Topalian v. Ehrman, 954 F.2d 1125, 1131 (5th Cir. 1992). "However, conclusory statements, hearsay, and testimony based merely on conjecture or subjective belief are not competent summary judgment evidence." Republic W. Ins. Co. v. Rockmore, No. 3-02-CV-1569-K, 2005 U.S. Dist. LEXIS 327, at *17-18 (N.D. Tex. Jan. 10, 2005). To avoid summary judgment, the "opponent must do more than simply show . . . some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). Instead, the nonmovant must present evidence sufficient to support a resolution of the factual issue in its favor. See Anderson, 477 U.S. at 257. All evidence must be viewed in the light most favorable to the nonmovant. Republic W. Ins. Co., 2005 U.S. Dist. LEXIS 327, at *17 (citing Rosado v. Deters, 5 F.3d 119, 122 (5th Cir. 1993)).
A. Due Process
Dallas County contends that Plaintiff's due process claim is barred by the statute of limitations. Plaintiff has filed suit under 42 U.S.C. § 1983, seeking redress for the alleged deprivation of his property, in violation of the Due Process Clause of the Fourteen Amendment. There is no statute of limitations contained within the text of Section 1983 and therefore, this Court is required to apply the appropriate statute of limitations found in Texas law. See Drury v. United States Army Corps of Eng'rs, 359 F.3d 366, 367 (5th Cir. 2004) (citing Braden v. Tex. AM Univ. Sys., 636 F.2d 90, 92 (5th Cir. 1981)). Thus, Texas' two-year statute of limitations for personal injury claims applies. Smith v. Dallas County, No. 3:04-CV-0493-B, 2005 U.S. Dist. LEXIS 2394, at *14 (N.D. Tex. Feb. 11, 2005).
Plaintiff's insurance claims were denied on January 15, 2001. He was required to file suit by January 15, 2003. However, Plaintiff did not file suit against Dallas County until October 24, 2003, and did not assert this claim against Dallas County until July 16, 2004. Plaintiff argues that this claim relates back to the filing of Plaintiff's original suit on November 1, 2002.
Federal Rule of Civil Procedure 15(c) provides that, in certain circumstances, amendments to pleadings relate back to the date of the original pleading. One of those circumstances is when "the claim or defense asserted in the amended pleading arose out of the conduct, transaction, or occurrence set forth or attempted to be set forth in the original pleading." FED. R. CIV. P. 15(c)(2). Thus, the focus is "not . . . the caption given a particular cause of action, but . . . the underlying facts upon which the cause of action is based." Watkins v. Lujan, 922 F.2d 261, 265 (5th Cir. 1991). "The purpose of the rule is accomplished if the initial complaint gives the defendant fair notice that litigation is arising out of a specific factual situation." Longbottom v. Swaby, 397 F.2d 45, 48 (5th Cir. 1968).Johnson v. Crown Enters., No. 03-31083, 2005 U.S. App. LEXIS 1098, at *6 (5th Cir. Jan. 21, 2005). Plaintiff's July 16, 2004 amendment clearly related back to his October 24, 2003 filing because the same set of facts are alleged to have caused the Plaintiff's injury and the Plaintiff merely added another legal theory from which he could recover from Dallas County, which he had already sued. Fed. Deposit Ins. Corp. v. Bennett, 898 F.2d 477, 480 (5th Cir. 1990) ("The fact that an amendment changes the legal theory on which the action initially was brought is of no consequence if the factual situation upon which the action depends remains the same and has been brought to defendant's attention by the original pleading."). However, relation back to the October 24, 2003 pleading does not defeat the limitations defense. To survive that defense, the due process claim against Dallas County must relate back to November 1, 2002, when the Plaintiff filed his original suit.
Dallas County was not named as a defendant in Plaintiff's Original Petition. "[C]laims against [a] new [Defendant] do not relate back unless certain criteria are satisfied. One criterion is that the additional [Defendant] either `knew or should have known' that, but for a mistake about the identity of the [entity] who caused the injury, the claims would have been brought against [it] in a timely manner." Murray v. Town of Mansura, 76 Fed. Appx. 547, 550 (5th Cir. 2003) (citing FED. R. CIV. P. 15(c)(3)). Plaintiff argues that Dallas County was aware of this suit and was not unfairly surprised. In support of this proposition, Plaintiff points out that NTHN was contractually required to "promptly advise [Dallas County] of any dispute, legal action or proceeding . . . which may affect the interests of either [NTHN or Dallas County]." Pl. Resp. to Mot. Summ. J. App. G ¶ 4.5. The Court agrees that this provision required NTHN to alert Dallas County to the existence of this lawsuit. However, Dallas County's knowledge of this suit is not sufficient for relation back. Rule 15(c)(3)(B) clearly requires that the new defendant know that, but for a mistake in identifying the proper party, the new defendant would have been the one sued. No evidence has been presented to show that Dallas County knew or should have known that a mistake was made. Plaintiff's original suit sought relief only from Defendant NTHN, and Plaintiff continues to seek relief from that Defendant. Therefore, Plaintiff apparently did not make a mistake when it filed suit against NTHN. Plaintiff merely failed to identify all of the possible defendants, but seeks to use the relation back concept under Rule 15(c) to allow him to proceed against parties he had not contemplated suing at the time he filed his initial petition. There are no facts to support the argument that Plaintiff made a mistake in identifying the parties to this suit and therefore, the Court grants summary judgment for Defendant Dallas County on the Plaintiff's due process claim, because as a matter of law, it is barred by limitations.
B. Breach of Contract
Plaintiff claims that Dallas County breached its contract with him by failing to pay the medical expenses for the birth of his twins. Dallas County argues that Plaintiff failed to provide evidence to support this claim. Under Texas law, a breach of contract claim requires proof of the following four elements: "1) the existence of a valid contract; 2) performance or tendered performance by the plaintiff; 3) breach of the contract by the defendant; and 4) damages to the plaintiff resulting from the breach." Lewis v. Bank of Am. NA, 343 F.3d 540, 544-45 (5th Cir. 2003) (citing Palmer v. Espey Huston Assocs., 84 S.W.3d 345, 353 (Tex.App.-Corpus Christi 2002, pet. denied)). Even if the Court assumes that there is a valid contract, Plaintiff's claim fails because there is no evidence that he tendered the performance required of him.
In the section entitled "When Coverage Begins," the Plan Booklet states the procedure for adding a new dependent to a participant's insurance coverage.
If you gain a dependent (spouse and/or child) after coverage begins, you must apply to add the new dependent within 31 days after you acquire the dependent. If the dependent is newly born to you or your spouse, coverage will begin on the date of birth. Other dependents' coverage will begin the first of the month following the date they are acquired if you apply within 31 days.
If you fail to enroll a new dependent within 31 days, you cannot enroll them until the next annual reenrollment period. At that time, any new dependent you wish to add will be subject to the preexisting condition limits described on the next page.
Pl. Resp. to Mot. Summ. J. App. H at 53. Similarly for COBRA participants, the Plan Booklet states that "[i]f you gain a new dependent through birth or adoption while you are covered under COBRA, your new dependent may also have COBRA coverage if you enroll them within 31 days of the birth or adoption." Id. at 86.
Plaintiff proffers an interpretation of these provisions that would provide coverage for his twins from their birth until the thirty-first day after their birth, even if Plaintiff never applied for them to be covered. Pl. Resp. to Mot. Summ. J. at 6. The Court finds this interpretation to be erroneous as a matter of law. The Plan requires that new dependents be added within thirty-one days, or else they cannot be added until the next open enrollment period. If a newly born dependent is added within the thirty-one day period, then coverage for that dependent is retroactive to birth, as opposed to any other new dependent, whose coverage begins on the first day of the next month. Plaintiff was a COBRA participant at the time of the twins' birth, and his twins were only eligible for coverage if Plaintiff enrolled them within thirty-one days of their birth. The Court finds that the Plan is not ambiguous, and that in order for the twins to be covered from birth, the Plaintiff was required to apply to add them to his coverage within thirty-one days of their birth. Plaintiff has put forth no evidence that this was timely done. The Dallas County Benefit Enrollment Worksheet tendered by the Plaintiff is not dated. Pl. Resp. to Mot. Summ. J. App. B. Plaintiff also acknowledged that he does not know when it was submitted:
A. . . . I know that the benefits enrollment sheet was submitted and I know that it was undated, so in terms of was it timely or not, I don't — I guess that's up to somebody different than me to decide.
Q. Do you believe it was timely?
A. Again, I have no earthly idea if it was timely or not because I don't — I can't specifically set a date that it was submitted.
Def. Mot. Summ. J. App. at 000002-03. Plaintiff, by his own admission, cannot prove that he tendered the performance that the Court finds is required. Therefore, the Court grants summary judgment for the Defendant Dallas County on the Plaintiff's breach of contract claim.
C. Plaintiff's Tort Claims
Dallas County contends that it has immunity from Plaintiff's promissory estoppel, negligent misrepresentation, breach of good faith and fair dealing, and deceptive insurance practices claims (collectively "tort claims"). "Generally, municipalities and other government entities have governmental or sovereign immunity from private litigation." Barnes v. Dallas Park Rec. Dep't, No. 3:98-CV-1186-G, 1999 U.S. Dist. LEXIS 9370, at * 5 (N.D. Tex. June 7, 1999) (quoting Knowles v. City of Granbury, 953 S.W.2d 19, 23 (Tex.App. — Ft. Worth 1997, writ denied)). Sovereign immunity can only be waived by a statute or legislative resolution that clearly and expressly creates a waiver. See Martin K. Eby Constr. Co. v. DART, 369 F.3d 464, 468 (5th Cir. 2004). The Texas Legislature enacted the Texas Tort Claims Act ("TTCA"), Tex. Civ. Prac. Rem. Code Ann. § 101.021 (Vernon 2004), "to waive sovereign immunity in certain limited circumstances." Harris County v. Cabazos, No. 01-03-00772-CV, 2005 Tex. App. LEXIS 429, at *5 (Tex.App. — Houston [1st Dist.] Jan. 20, 2005, no pet. h.) (citing Dallas County Mental Health Mental Retardation v. Bossley, 968 S.W.2d 339, 343 (Tex. 1998)). The TTCA "waives governmental immunity in three general areas: use of publicly-owned vehicles, premises defects, and injuries arising from conditions or use of property." McCall v. Peters, No. 3:00-CV-2247-D, 2003 U.S. Dist. LEXIS 8038, at *40-41 (N.D. Tex. Feb. 13, 2003) (citing Brown v. Montgomery County Hosp. Dist., 905 S.W.2d 481, 484 (Tex.App.-Beaumont 1995, no writ)). Plaintiff has failed to allege an injury arising under one of the three areas of municipal liability recognized by the TTCA. However, Plaintiff argues that sovereign immunity has been waived because Dallas County is performing a proprietary function. "The judiciary created [an] exception to blanket immunity where it classified any part of the particular function in issue as proprietary." Lawrence v. City of Wichita Falls, 906 S.W.2d 113, 115 (Tex.App.-Fort Worth 1995, writ denied). The exception for proprietary functions does not apply here because counties do not perform proprietary functions. Kesler v. King, 29 F. Supp. 2d 356, 376 (S.D. Tex. 1998). See also Turvey v. City of Houston, 602 S.W.2d 517, 518 (Tex. 1980) ("The distinction between proprietary and governmental functions does not apply to counties."); Jezek v. City of Midland, 605 S.W.2d 544, 547 (Tex. 1980) ("Counties in Texas have no proprietary functions . . ."); Woomer v. Galveston, 765 S.W.2d 836, 838 (Tex.App. — Houston [1st Dist.] 1988, writ denied) ("Counties do not perform proprietary functions and are immune from liability unless the same is waived by the Texas Tort Claims Act."). Therefore as a matter of law, Dallas County cannot perform a proprietary function. Thus, Dallas County is immune from suit on Plaintiff's tort claims.
In addition, Plaintiff has tendered no evidence to support his tort claims against Dallas County. Defendant's Motion was based on the absence of evidence to support Plaintiff's claims. Plaintiff's Response offered no evidence. Once the Defendant pointed out the lack of evidence on these claims, the Plaintiff was required to "come forward with evidence establishing each of the challenged elements of [his] case upon which [he] will bear the burden of proof at trial." Duckett, 950 F.2d at 276. (citing Celotex Corp., 477 U.S. at 323-24).
Further, a two-year statute of limitations applies to Plaintiff's tort claims. See, e.g., Armstrong v. Am. Home Shield Corp., 333 F.3d 566, 570 (5th Cir. 2003) (citing Tex. Civ. Prac. Rem. Code Ann. § 16.003(a) (Vernon 2002)). As noted above, that two-year period expired January 15, 2003, and Plaintiff was required to bring his claims by that date. Supra p. 4. Plaintiff did not file suit against Dallas County until October 24, 2003, and thus his tort claims are time barred. Therefore, the Court grants summary judgment for the Defendant Dallas County on the promissory estoppel, negligent misrepresentation, breach of good faith and fair dealing, and deceptive insurance practices claims.
III. CONCLUSION
This Court GRANTS summary judgment in favor of Defendant Dallas County as to all of Plaintiff's claims.
SO ORDERED.