The employee of a subcontractor passed away from heat stroke sustained when working on a construction site. The employee’s family brought a wrongful death action against the subcontractor, who raised the exclusive remedy defense under the workers’ compensation law and requested a benefit review conference at the Division of Workers’ Compensation (DWC). The family challenged DWC’s jurisdiction. The subcontractor filed a combined plea to the jurisdiction and motion for abatement pending a final, appealable decision by DWC. The trial court ordered an abatement. The family, however, never filed a claim for workers’ compensation benefits allowing the statute of limitations to expire. They then asked the trial judge to lift the abatement because the issue of DWC’s exclusive jurisdiction no longer existed. The trial court agreed. The subcontractor filed a writ of mandamus with the court of appeals asserting that the trial court abused its discretion.
There are actually two separate mandamus actions in In re Pedro Martinez and Lydia Gonzalez, Individually and on behalf of the estate of Pedro Jovany “Bruno” Martinez (No. 03-21-00233-CV). In addition to the subcontractor’s action to reverse the trial court’s order lifting the abatement, the second action arose when the subcontractor and workers’ comp carrier, Texas Mutual, prevailed in a contested case hearing at the DWC, in which the ALJ ruled that the decedent sustained a compensable injury while in the employment of the subcontractor. The decedent’s family appealed to an appeals panel, claiming that it never filed a claim invoking DWC’s jurisdiction. The appeals panel nevertheless adopted the ALJ’s decision. The family subsequently filed for judicial review of the DWC’s decision in a Travis County district court but then filed a plea to the jurisdiction asking the court to dismiss its own suit because DWC had no jurisdiction. That trial court declined to do so, resulting the family’s mandamus filing with the court of appeals.
The court of appeals sided with the subcontractor and Texas Mutual. In response to the family’s argument that only the covered employee’s actual claim triggers DWC jurisdiction, the court held that DWC had jurisdiction to determine eligibility for benefits regardless of whether the employee’s claim was “actual” or “potential.” The statutory provision for a benefit review conference (§ 410.021, Labor Code) does not specifically address which party must make the “claim,” only that the BRC must resolve “the rights of the respective parties to a workers’ compensation claim and the procedures necessary to protect those rights.” Under agency rules, however, an employee, subclaimant, or insurance carrier may request a BRC, as well as an employer to contest compensability when the insurer has accepted a claim as compensable (28 TAC § 141.1). Thus, the court reasoned, the agency’s rules implementing the statutory provision, in focusing on resolving “issues” rather than “claims,” constitute a reasonable interpretation that does not conflict with the statute. In that case, the court must defer to the agency’s interpretation that the identity of the party who asks for the BRC is irrelevant. Consequently, the trial court did not abuse its discretion in overruling the family’s plea to the jurisdiction. And, based on that decision, the court of appeals held further that the subcontractor was entitled to mandamus relief from the other trial court’s order lifting abatement of the wrongful death claim.
This is a strong opinion that supports the integrity of the workers’ compensation system and its administrative process for resolving disputes over eligibility and benefits. Here an attempt was made to circumvent the exclusive remedy of the comp system by simply not filing a claim for benefits. The court of appeals saw through that strategy and properly applied the law.
