TDI vs. Insurance Council of Texas

Texas Department of Insurance, Division of Workers' Compensation v. Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, Inc., NO. (Tex. App. -Mar. 21, 2008)( )(affirmed)(we conclude that the Rule is invalid because it is not in harmony with the relevant governing statutes, which allow for judicial review of medical necessity disputes) (Before Justices Patterson, Puryear and Smith)

Full style: Texas Department of Insurance, Division of Workers' Compensation v. Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, Inc.--Appeal from 345th District Court of Travis County

M E M O R A N D U M O P I N I O N
In response to concerns regarding the expense of review procedures utilized in workers' compensation claims concerning the necessity of medical treatment, the Texas Department of Insurance, Division of Workers' Compensation (1)
promulgated a rule creating a less expensive alternative review procedure. See 28 Tex. Admin. Code § 133.309 (2007) (the "Rule"). In 2004, the Insurance Council of Texas ("Council") filed a declaratory judgment action challenging the validity of the Rule. See Tex. Gov't Code Ann. § 2001.038 (West 2000). Texas Mutual Insurance Company ("Texas Mutual"), Texas Property and Casualty Insurance Guaranty Association ("Texas Property"), and Envoy Medical Systems, L.P., ("Envoy") all intervened and supported the Council's contention that the Rule was invalid. (2) The Division and the Joint Appellees filed cross motions for summary judgment, and the district court granted the Joint Appellees' motion and denied the Division's motion. We will affirm the judgment of the district court.