The Waco Court of Appeals has reversed a trial court order denying a workers’ compensation carrier’s motion for summary judgment and entering a judgment overturning a decision of TDI appeals panel.
Ace Property & Casualty Insurance Co. v. Homer Ladd (No. 10-17-00273-CV) arose from a workplace back injury in 2000. The worker’s comp carrier, Ace, approved a laminectomy and paid for the surgery. The worker reached maximum medical improvement in October, 2001, with an impairment rating of 20%. Ace paid the appropriate benefits and moved on down the road. In 2010, however, the worker asked Ace to pay for treatment for “post-laminectomy syndrome of the lumbar region.” The carrier denied the claim, and the worker sought administrative review by DWI. Following a contested case hearing, the ALJ ruled that the worker’s post-laminectomy syndrome was not caused or aggravated by the worker’s prior compensable injury. The worker appealed to the appeals panel, which affirmed the ALJ.
The worker appealed to McClennan County district court seeking reversal of the DWI’s decision and claims for declaratory relief against Ace, DWC, and the DWC commissioner. The defendants filed pleas to the jurisdiction asserting sovereign immunity and plaintiff seeking declaratory relief for issues not previously adjudicated by DWC. The trial court dismissed the declaratory judgment claim and plaintiff’s claims against DWC and the commissioner with prejudice, leaving Ace still in the case with respect to the administrative decision. The parties filed competing motions for summary judgment. The trial court denied Ace’s motion, granted plaintiff’s motion, and entered final judgment in favor of plaintiff along with post-judgment interest. Both parties appealed.
In opinion by former Austin Court of Appeals Chief Justice Jeff Rose, the court of appeals affirmed the trial court’s dismissal of plaintiff’s claim against DWC and the commissioner based on sovereign immunity. It further affirmed the trial court’s dismissal of plaintiff’s declaratory judgment claim as (1) raising new issues not considered in the administrative hearing and (2) barred by sovereign immunity as to the DWC and commissioner (no showing of an ultra vires action waiving immunity under the UDJA). As to Ace’s summary judgment motions, however, the court split the baby. It reversed the trial court’s denial of Ace’s traditional summary judgment motion because plaintiff presented no record evidence that he raised the issue of whether Ace waived its defenses in the administrative hearing. Plaintiff thus failed to exhaust his administrative remedies on that issue. But, the court affirmed the trial court’s dismissal of Ace’s no-evidence summary judgment motion because plaintiff raised a fact issue about the cause of his post-laminectomy syndrome (statements by Ace’s expert that “any post-laminectomy syndrome would only be caused by the laminectomy”—oops). Based on this evidence, the court affirmed the trial court and remanded for trial. At the same time, the court did not opine as to the sufficiency of plaintiff’s evidence or whether it rose to the level of meeting the substantial evidence test for judicial review of administrative decisions.
For workers’ compensation insurers and lawyers, this case is worth taking a look at for its discussion of the jurisdictional issues, its rejection of the UDJA action as a route to make claims beyond the scope of the administrative hearing, and its handling of the narrow boundary beyond which a traditional summary judgment motion may succeed but a no-evidence summary judgment may not. The case also illustrates the long tail that workers’ comp claims have under some circumstances and the risks that those claims entail. Though the opinion does not relate the amount of plaintiff’s recovery in the trial court, it (obviously) was significant enough to compel plaintiff to seek judicial review in the first place. We can well imagine how the floodgates will open if proponents of changes in the workers’ comp system to weaken the administrative process are successful.