Court of Appeals of Texas, Fifth District, Dallas
BARBARA STEGALL, INDIVIDUALLY, AND ON BEHALF OF THE ESTATE OF JOE STEGALL, Appellant
TML MULTISTATE INTERGOVERNMENTAL EMPLOYEE BENEFITS POOL, INC., AND UMR, INC., Appellees
Appeal from the County Court at Law No. 4 Dallas County,
Texas Trial Court Cause No. CC-16-05440-D
Justices Whitehill, Partida-Kipness, and Pedersen, III
PEDERSEN, III JUSTICE
of this Court are vested with the authority to interpret the
law; we possess neither the expertise nor the prerogative to
make policy judgments. Those decisions are entrusted to our .
. . elected leaders, who can be thrown out of office if the
people disagree with them. It is not our job to protect the
people from the consequences of their political
an appeal of the trial court's orders granting the
partial plea to the jurisdiction filed by appellee TML
Multistate Intergovernmental Employee Benefits Pool, Inc. and
the first amended plea to the jurisdiction filed by
appellee UMR, Inc. Appellant Barbara Stegall, Individually,
and on behalf of the Estate of Joe Stegall, asserts that the
trial court erred in granting appellees' pleas to the
jurisdiction. In a single issue, she contends that appellees
have no governmental immunity because her claims pertain to
appellees' proprietary functions, not their governmental
functions. We affirm.
suit underlying this appeal is a health benefits coverage
dispute. Joe Stegall worked as the Chief Financial Officer
for the city of Royse City, Texas. As a city employee, he was
eligible for, and participated in, the city's medical and
prescription drug benefits provided by TML Multistate
Intergovernmental Employee Benefits Pool, Inc. (TML). TML is
an intergovernmental self-insurance risk pool that operates
under the Texas Interlocal Cooperation Act. See Tex.
Gov't Code Ann. §§ 791.001, 791.011. UMR, Inc.
(UMR) is one of TML's third-party administrators.
2014, Mr. Stegall was diagnosed with bile duct cancer and
liver cancer. His oncologist advised him to begin treatment
immediately, using a combination of chemotherapy medications
specifically targeting bile duct cancer. The oncologist
stated that once he saw how Mr. Stegall responded to the
first chemotherapy regimen, additional chemotherapy would be
added to treat the liver cancer. Based on Mr. Stegall's
positive response to the first chemotherapy regimen, on
October 23, 2014, his oncologist prescribed sorafenib (brand
name Nexavar), an FDA-approved drug designed to increase
survival rates and life expectancy for patients with advanced
UMR initially denied coverage for Nexavar for Mr. Stegall.
When the oncologist sought clarification, he learned that the
TML and/or UMR medical representative did not believe that
Mr. Stegall actually had liver cancer. Mr. Stegall's
oncologist attempted to procure Nexavar through other
sources. However, when TML learned of these attempts, a TML
representative called Mr. Stegall's oncologist to warn
that TML would consider terminating Mr. Stegall's health
benefits coverage if Mr. Stegall took Nexavar without
TML's authorization. On November 21, 2014, Mr. Stegall
and his oncologist learned that TML had reversed its position
and would provide coverage for Nexavar. Unfortunately, Mr.
Stegall died several weeks later.
Stegall, individually, and on behalf of the estate of her
deceased husband, sued TML and UMR for wrongful denial of
medical benefits and additional acts of interference with the
decedent's access to prescribed chemotherapy. Stegall
brought suit under tort and contract theories. TML and UMR
filed general denials and, as to the tort claims, both filed
pleas to the jurisdiction on grounds of governmental
immunity. After separate hearings, the trial court granted
both pleas to the jurisdiction, leaving only Stegall's
breach of contract claims against TML. Stegall voluntarily
nonsuited her breach of contract claims against TML and filed
a motion for new trial. After her new trial motion was
overruled by operation of law, Stegall filed this appeal.
contends that the trial court erred in granting
appellees' pleas to the jurisdiction. She does not argue
that this is a case in which governmental immunity was
waived. Instead, she argues that governmental immunity never
existed because appellees' claims-adjusting activities,
including improperly denying coverage, attempting to
intimidate Mr. Stegall into foregoing chemotherapy,
threatening Mr. Stegall's future coverage, and later
reversing their position on coverage without notifying Mr.
Stegall of their decision, were proprietary-not governmental-
to the Jurisdiction
their pleas to the jurisdiction, TML and UMR argued that they
had governmental immunity from Stegall's suit. An
assertion of governmental immunity implicates a court's
subject matter jurisdiction, and such immunity is properly
asserted in a plea to the jurisdiction. Harris Cty. v.
Annab, 547 S.W.3d 609, 612 (Tex. 2018). The existence of
subject matter jurisdiction is a question of law, and we
review the trial court's ruling on a plea to the
jurisdiction de novo. See id.; see also
City of Dallas v. E. Vill. Ass'n, 480 S.W.3d 37, 42
(Tex. App.-Dallas 2015, pet. denied).
to the jurisdiction can be based on the pleadings or on the
evidence. Tex. Dep't of Parks & Wildlife v.
Miranda, 133 S.W.3d 217, 226 (Tex. 2004); City of
Dallas v. Turley, 316 S.W.3d 762, 767 (Tex. App.-Dallas
2010, pet. denied). When a plea to the jurisdiction
challenges the pleadings, we determine if the pleader has
alleged facts that affirmatively demonstrate the court's
jurisdiction to hear the case. Miranda, 133 S.W.3d
at 226, 228. We look to the allegations in the pleadings,
construe them in the plaintiff's favor, and look to the
pleader's intent. See Cty. of Cameron v. Brown,
80 S.W.3d 549, 555 (Tex. 2002); Peek v. Equip. Serv.
Co., 779 S.W.2d 802, 804 (Tex. 1989). The plaintiff
bears the burden to allege facts that affirmatively
demonstrate the trial court's jurisdiction to hear a
case. Miranda, 133 S.W.3d at 226-27;
Turley, 316 S.W.3d at 767.
plea to the jurisdiction challenges the existence of
jurisdictional facts, we consider relevant evidence submitted
by the parties to determine if a fact issue exists.
Miranda, 133 S.W.3d at 227. The standard of review
for a jurisdictional plea based on evidence "generally
mirrors that of a summary judgment under Texas Rule of Civil
Procedure 166a(c)." Id. at 228.
immunity and governmental immunity are related common law
doctrines that protect the government from suit. Hughes
v. Tom Green Cty., 573 S.W.3d 212, 218 (Tex. 2019).
"Sovereign immunity protects the state and its various
divisions, such as agencies and boards, from suit and
liability, whereas governmental immunity provides similar
protection to the political subdivisions of the state, such
as counties, cities, and school districts." Travis
Cent. Appraisal Dist. v. Norman, 342 S.W.3d 54, 57-58
(Tex. 2011) (citing Wichita Falls State Hosp. v.
Taylor, 106 S.W.3d 692, 694 n.3 (Tex. 2003)).
Governmental immunity encompasses both immunity from suit and
immunity from liability. Reata Constr. Corp. v. City of
Dallas, 197 S.W.3d 371, 374 (Tex. 2006); Tooke v.