Frances E. Lerma v. Employees Retirement System of Texas, No. 03-06-00314-CV (Tex.App. - Austin , May 1, 2008)(Opinion by Justice Waldrop )(sicko law, disability denial affirmed, workplace safety, injury) (Before Justices Patterson, Pemberton and Waldrop)
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
Appellant Frances E. Lerma, proceeding pro se, appeals the district court's order affirming a final order by the Board of Trustees for the Employees Retirement System of Texas denying her application for occupational disability benefits. In four points of error, Lerma contends that (1) the Board applied a different legal standard regarding the cause of Lerma's injury than it applied in two previous cases; (2) the Board's interpretation of the statutory definition of occupational disability is inconsistent with the plain language of the statute; (3) the Board engaged in ad hoc rulemaking; and (4) the Board's order is not supported by substantial evidence. We affirm the district court's order.
Lerma worked as a child support officer for the Office of the Attorney General. Her primary job duty was to enforce the collection of child support payments from non-custodial parents. In April 2002, Lerma was meeting with a non-custodial parent when the parent became extremely angry and, according to Lerma, exhibited threatening conduct. After this incident, Lerma continued to work as a child support officer until July 2002, when she was diagnosed with a personality disorder and dismissed from her employment.
After her dismissal, Lerma applied for occupational disability benefits from the Employees Retirement System, which was created by the legislature for the purpose of providing a retirement system for aged and incapacitated state employees. See Act of May 27, 1947, 50th Leg., R.S., ch. 352, 1947 Tex. Gen. Laws 697, 697 (statement of purpose). She claimed that the April 4, 2002 incident with the angry non-custodial parent was the primary cause of her diagnosis of personality disorder. On February 20, 2004, ERS sent Lerma a letter denying her claim for benefits on the ground that her disability did not meet the statutory definition of an occupational disability in section 811.001(12) of the government code. (1) In the letter, ERS explained:
The Medical Board has determined that the primary cause of your incapacity is recurrent, severe, major depression and anxiety disorder that began as early as 1988. You attribute your major depression and anxiety to an increased level of stress on the job that you believe began in January 2000. However, the medical evidence indicates that these are chronic conditions that existed prior to your employment as a Child Support Officer III with the Office of the Attorney General, and were not caused by the job duties.
ERS also stated that Lerma failed to seek reasonable accommodation of her condition at work and that the medical evidence indicated that Lerma should be able to perform her job duties or comparable work.
Lerma appealed ERS's denial of her application for benefits and, after an administrative hearing, the administrative law judge (ALJ) issued a proposal for decision recommending that Lerma's appeal be denied. On April 20, 2005, the ERS Board of Trustees adopted the ALJ's proposal for decision, including the findings of fact and conclusions of law, as its own. Lerma sought judicial review of the Board's decision. On May 5, 2006, the district court held a hearing and issued an order affirming the Board's final order denying Lerma's application for occupational disability benefits.
In her first point of error, Lerma contends that the Board applied a different legal standard regarding the cause of her injury than it applied in two previous cases. Those previous cases concerned two former state employees, Mary L. Dean and Francisca G. Link, who applied for occupational disability benefits with ERS in 1994 and 1998, respectively. (2) ERS denied Dean's and Link's application for benefits, and they both appealed. The Board granted both appeals, finding that both individuals were entitled to occupational disability benefits and that their claims were not barred by preexisting conditions caused solely by natural aging processes.
We review the Board's findings under the substantial evidence rule. Tex. Gov't Code Ann.
Showing posts with label sicko law. Show all posts
Showing posts with label sicko law. Show all posts
Thursday, May 1, 2008
Friday, March 7, 2008
Mediated Settlement Agreement (MSA) Stands
Second thoughts on fairness of divorce property settlement upon realization of effects of divorce on health benefits did provide sufficient grounds to set aside mediated settlement agreement (MSA) that complied with Family Code requirements and entitled either party to judgment. Unconscionability and mutual mistake arguments rejected.
Elsie B. Kott v. Clayton Herman Kott, No. 03-06-00398-CV (Tex.App.- Austin, Feb. 29, 2008) (Opinion by Justice Pemberton ) (family law, divorce, mediated settlement agreement) (Before Justices Patterson, Pemberton and Waldrop)
Appeal from County Court at Law of Bastrop County
M E M O R A N D U M O P I N I O N
Appellant, Elsie B. Kott, appeals from a final decree of divorce that incorporated a mediated settlement agreement between herself and appellee, Clayton Herman Kott. Elsie (1) appeals from the decree, bringing three issues challenging the validity or enforceability of the underlying mediated settlement agreement: (1) the court lacked authority to order mediation; (2) the settlement agreement is so vague that it is incapable of implementation or enforcement; and (3) the settlement agreement is substantively unconscionable. We will affirm the judgment.
Of her three appellate issues, Elsie preserved only her substantive unconscionability complaint by raising it in the trial court. See Tex. R. App. P. 33.1. Regarding her single preserved issue, Elsie asserts that, by divorcing Clayton, she lost her medical coverage as the spouse of a disabled veteran, that neither party had been aware of that implication under federal law when negotiating the mediated settlement agreement, and that she would not have agreed to the property division with that awareness. She urges that the property division, considering her loss of medical benefits, "became substantively unconscionable."
Section 6.602 of the family code provides that, in a suit for dissolution of a marriage, a mediated settlement agreement is binding on the parties if it "(1) provides, in a prominently displayed statement that is in boldfaced type or capital letters or underlined, that the agreement is not subject to revocation; (2) is signed by each party to the agreement; and (3) is signed by the party's attorney, if any, who is present at the time the agreement is signed." Tex. Fam. Code Ann. § 6.602(b) (West 2006). The parties' agreement here meets these requirements. Both parties signed the instrument, both parties' counsel signed it, and the agreement contained the following provision immediately above the signature lines (emphasis as in original):
15. BINDING AGREEMENT
THIS AGREEMENT CONSTITUTES A BINDING MEDIATED SETTLEMENT AGREEMENT. IT HAS BEEN REVIEWED BY BOTH PARTIES AND THEIR ATTORNEYS. THIS AGREEMENT WILL BE FILED WITH THE COURT AND IS NOT SUBJECT TO REVOCATION.
The legislature has mandated that "[i]f a mediated settlement agreement meets the requirements of this section, a party is entitled to judgment on the mediated settlement agreement notwithstanding Rule 11, Texas Rules of Civil Procedure, or another rule of law." Id. § 6.602(c). Thus, settlement agreements complying with section 6.602 are immediately enforceable, are not subject to repudiation by a party, and are binding on the trial court without condition of judicial approval or determination of whether the agreement's terms are just and right. See Cayan v. Cayan, 38 S.W.3d 161, 164-66 (Tex. App.--Houston [14th Dist.] 2000, pet. denied); cf. Tex. Fam. Code. Ann. § 7.006 (West 2006).
On the other hand, courts of appeals, including this Court, have recognized some defenses to the enforceability of section 6.602-compliant mediated settlement agreements. See Spiegel v. KLRU Endowment Fund, 228 S.W.3d 237, 242 (Tex. App.--Austin 2007, pet. denied) (where mediated settlement agreement meets section 6.602's requirements, "it must be enforced in the absence of allegations that the agreement calls for the performance of an illegal act or that it was 'procured by fraud, duress, coercion, or other dishonest means.'") (quoting Boyd v. Boyd, 67 S.W.3d 398, 403 (Tex. App.--Fort Worth 2002, no pet.)); see also Mullins v. Mullins, 202 S.W.3d 869, 877 (Tex. App.--Dallas 2006, pet. denied) (appearing to assume that "mistake" or the absence of a "meeting of the minds" would be a ground for rescinding a mediated settlement agreement).
In the trial court, Elsie complained principally that the mediated settlement agreement was predicated upon mutual mistake. After executing the mediated settlement agreement but prior to entry of judgment, Elsie obtained new counsel and sought to set aside the agreement on the sole ground of mutual mistake.
At the hearing on entry of the decree, Elsie gave brief testimony to the effect that she had been unaware that she would lose her medical coverage as the spouse of a disabled veteran and would not have agreed to the property division had she comprehended those implications. (2) During a short cross-examination, Clayton's counsel elicited Elsie's acknowledgment that she had been represented by counsel during the mediation, that the parties had an experienced mediator, and that the mediation had been "lengthy." (3) Elsie did not assert or present evidence that the agreement called for performance of an illegal act or that it was obtained through fraud, duress, coercion, or dishonesty. At the conclusion of the hearing, the trial court stated on the record that it "finds that the Mediated Settlement Agreement was the result of an arms-length negotiation, and represents their agreement, which will be accepted by the Court," and proceeded to render judgment on the decree.
Elsie subsequently filed a motion for new trial, re-urging her arguments regarding mistake. She added that the "the terms of the property settlement provision of the mediated settlement agreement is not a just and equitable division of the property of the parties unless Mrs. Kott retains her military medical benefits and to require her to live with this 'bargain' would be unconscionable." This new trial motion was overruled by operation of law.
We conclude that Elsie's attempt to challenge the fairness, standing alone, of the terms of a mediated settlement agreement complying with section 6.602 has been foreclosed by the legislature. See Tex. Fam. Code Ann. § 6.602(c) ("If a mediated settlement agreement meets the requirements of this section, a party is entitled to judgment on the mediated settlement agreement notwithstanding Rule 11, Texas Rules of Civil Procedure, or another rule of law."); Cayan, 38 S.W.3d at 164-66 & n.8 (section 6.602 agreements are not subject to a just and right determination by the trial court; to conclude otherwise "would suggest that the trial court retains discretion to reject such an agreement, request the parties to negotiate a different agreement and, if necessary, set the matter for hearing," all contrary to section 6.602(c)); see also Carson v. Carson, No. 03-04-00521-CV, 2005 Tex. App. LEXIS 9250, at *3 (Tex. App.--Austin Nov. 4, 2005, no pet.) (mem. op.) ("To the extent that [the appellant] seeks to disturb the contents of the [mediated settlement] agreement on appeal, these issues are barred by statute and the language of the agreement.").
To the extent Elsie's appellate issue regarding "substantive unconscionability" encompasses her trial-level contention regarding mutual mistake, the evidence is legally and factually sufficient to support the trial court's implied findings that she failed to prove that defense. (4) Mullins, 202 S.W.3d at 877; see also Carson, 2005 Tex. App. LEXIS 9250, at *2-3 (rejecting challenge that party "was not fully informed of the financial implications of the agreed upon distribution of property," observing that party was represented by counsel and the mediated settlement agreement "meets all statutory requirements to be binding on the parties"). We observe again that Elsie has not claimed that the mediated settlement agreement was the product of coercion, duress, or fraud.
For these reasons, we overrule Elsie's appellate issues and affirm the trial court's judgment.
____________________________________________
Bob Pemberton, Justice
Before Justices Patterson, Pemberton and Waldrop
Affirmed
Filed: February 29, 2008
1. To avoid confusion from the common surname, we will refer to the parties by their first names.
2. Elsie's sole direct testimony on this point was:
Q: And in the mediation did you request to be awarded those benefits?
A: No, because I had wanted to hand to my attorney papers stating what I wanted out of the divorce, and he wouldn't take it. So I got so flustered I didn't realize that we had not discussed my benefits being taken away if I got a divorce.
Q: Now, I understand your major concern is with your medical benefits through the military.
A: Yes.
Q: And if you were to retain those, you would be glad to go along with this [property] division?
A: Yes.
Q: But if you were going to lose those rights, then would you like for the court to give you another opportunity to negotiate this property?
A: Yes.
3. The record elsewhere reflects that the mediation had lasted all or most of a day. Clayton's counsel also emphasized that it had been Elsie who first filed for divorce.
4. Neither party requested written findings of fact and conclusions of law, and none were filed.
Elsie B. Kott v. Clayton Herman Kott, No. 03-06-00398-CV (Tex.App.- Austin, Feb. 29, 2008) (Opinion by Justice Pemberton ) (family law, divorce, mediated settlement agreement) (Before Justices Patterson, Pemberton and Waldrop)
Appeal from County Court at Law of Bastrop County
M E M O R A N D U M O P I N I O N
Appellant, Elsie B. Kott, appeals from a final decree of divorce that incorporated a mediated settlement agreement between herself and appellee, Clayton Herman Kott. Elsie (1) appeals from the decree, bringing three issues challenging the validity or enforceability of the underlying mediated settlement agreement: (1) the court lacked authority to order mediation; (2) the settlement agreement is so vague that it is incapable of implementation or enforcement; and (3) the settlement agreement is substantively unconscionable. We will affirm the judgment.
Of her three appellate issues, Elsie preserved only her substantive unconscionability complaint by raising it in the trial court. See Tex. R. App. P. 33.1. Regarding her single preserved issue, Elsie asserts that, by divorcing Clayton, she lost her medical coverage as the spouse of a disabled veteran, that neither party had been aware of that implication under federal law when negotiating the mediated settlement agreement, and that she would not have agreed to the property division with that awareness. She urges that the property division, considering her loss of medical benefits, "became substantively unconscionable."
Section 6.602 of the family code provides that, in a suit for dissolution of a marriage, a mediated settlement agreement is binding on the parties if it "(1) provides, in a prominently displayed statement that is in boldfaced type or capital letters or underlined, that the agreement is not subject to revocation; (2) is signed by each party to the agreement; and (3) is signed by the party's attorney, if any, who is present at the time the agreement is signed." Tex. Fam. Code Ann. § 6.602(b) (West 2006). The parties' agreement here meets these requirements. Both parties signed the instrument, both parties' counsel signed it, and the agreement contained the following provision immediately above the signature lines (emphasis as in original):
15. BINDING AGREEMENT
THIS AGREEMENT CONSTITUTES A BINDING MEDIATED SETTLEMENT AGREEMENT. IT HAS BEEN REVIEWED BY BOTH PARTIES AND THEIR ATTORNEYS. THIS AGREEMENT WILL BE FILED WITH THE COURT AND IS NOT SUBJECT TO REVOCATION.
The legislature has mandated that "[i]f a mediated settlement agreement meets the requirements of this section, a party is entitled to judgment on the mediated settlement agreement notwithstanding Rule 11, Texas Rules of Civil Procedure, or another rule of law." Id. § 6.602(c). Thus, settlement agreements complying with section 6.602 are immediately enforceable, are not subject to repudiation by a party, and are binding on the trial court without condition of judicial approval or determination of whether the agreement's terms are just and right. See Cayan v. Cayan, 38 S.W.3d 161, 164-66 (Tex. App.--Houston [14th Dist.] 2000, pet. denied); cf. Tex. Fam. Code. Ann. § 7.006 (West 2006).
On the other hand, courts of appeals, including this Court, have recognized some defenses to the enforceability of section 6.602-compliant mediated settlement agreements. See Spiegel v. KLRU Endowment Fund, 228 S.W.3d 237, 242 (Tex. App.--Austin 2007, pet. denied) (where mediated settlement agreement meets section 6.602's requirements, "it must be enforced in the absence of allegations that the agreement calls for the performance of an illegal act or that it was 'procured by fraud, duress, coercion, or other dishonest means.'") (quoting Boyd v. Boyd, 67 S.W.3d 398, 403 (Tex. App.--Fort Worth 2002, no pet.)); see also Mullins v. Mullins, 202 S.W.3d 869, 877 (Tex. App.--Dallas 2006, pet. denied) (appearing to assume that "mistake" or the absence of a "meeting of the minds" would be a ground for rescinding a mediated settlement agreement).
In the trial court, Elsie complained principally that the mediated settlement agreement was predicated upon mutual mistake. After executing the mediated settlement agreement but prior to entry of judgment, Elsie obtained new counsel and sought to set aside the agreement on the sole ground of mutual mistake.
At the hearing on entry of the decree, Elsie gave brief testimony to the effect that she had been unaware that she would lose her medical coverage as the spouse of a disabled veteran and would not have agreed to the property division had she comprehended those implications. (2) During a short cross-examination, Clayton's counsel elicited Elsie's acknowledgment that she had been represented by counsel during the mediation, that the parties had an experienced mediator, and that the mediation had been "lengthy." (3) Elsie did not assert or present evidence that the agreement called for performance of an illegal act or that it was obtained through fraud, duress, coercion, or dishonesty. At the conclusion of the hearing, the trial court stated on the record that it "finds that the Mediated Settlement Agreement was the result of an arms-length negotiation, and represents their agreement, which will be accepted by the Court," and proceeded to render judgment on the decree.
Elsie subsequently filed a motion for new trial, re-urging her arguments regarding mistake. She added that the "the terms of the property settlement provision of the mediated settlement agreement is not a just and equitable division of the property of the parties unless Mrs. Kott retains her military medical benefits and to require her to live with this 'bargain' would be unconscionable." This new trial motion was overruled by operation of law.
We conclude that Elsie's attempt to challenge the fairness, standing alone, of the terms of a mediated settlement agreement complying with section 6.602 has been foreclosed by the legislature. See Tex. Fam. Code Ann. § 6.602(c) ("If a mediated settlement agreement meets the requirements of this section, a party is entitled to judgment on the mediated settlement agreement notwithstanding Rule 11, Texas Rules of Civil Procedure, or another rule of law."); Cayan, 38 S.W.3d at 164-66 & n.8 (section 6.602 agreements are not subject to a just and right determination by the trial court; to conclude otherwise "would suggest that the trial court retains discretion to reject such an agreement, request the parties to negotiate a different agreement and, if necessary, set the matter for hearing," all contrary to section 6.602(c)); see also Carson v. Carson, No. 03-04-00521-CV, 2005 Tex. App. LEXIS 9250, at *3 (Tex. App.--Austin Nov. 4, 2005, no pet.) (mem. op.) ("To the extent that [the appellant] seeks to disturb the contents of the [mediated settlement] agreement on appeal, these issues are barred by statute and the language of the agreement.").
To the extent Elsie's appellate issue regarding "substantive unconscionability" encompasses her trial-level contention regarding mutual mistake, the evidence is legally and factually sufficient to support the trial court's implied findings that she failed to prove that defense. (4) Mullins, 202 S.W.3d at 877; see also Carson, 2005 Tex. App. LEXIS 9250, at *2-3 (rejecting challenge that party "was not fully informed of the financial implications of the agreed upon distribution of property," observing that party was represented by counsel and the mediated settlement agreement "meets all statutory requirements to be binding on the parties"). We observe again that Elsie has not claimed that the mediated settlement agreement was the product of coercion, duress, or fraud.
For these reasons, we overrule Elsie's appellate issues and affirm the trial court's judgment.
____________________________________________
Bob Pemberton, Justice
Before Justices Patterson, Pemberton and Waldrop
Affirmed
Filed: February 29, 2008
1. To avoid confusion from the common surname, we will refer to the parties by their first names.
2. Elsie's sole direct testimony on this point was:
Q: And in the mediation did you request to be awarded those benefits?
A: No, because I had wanted to hand to my attorney papers stating what I wanted out of the divorce, and he wouldn't take it. So I got so flustered I didn't realize that we had not discussed my benefits being taken away if I got a divorce.
Q: Now, I understand your major concern is with your medical benefits through the military.
A: Yes.
Q: And if you were to retain those, you would be glad to go along with this [property] division?
A: Yes.
Q: But if you were going to lose those rights, then would you like for the court to give you another opportunity to negotiate this property?
A: Yes.
3. The record elsewhere reflects that the mediation had lasted all or most of a day. Clayton's counsel also emphasized that it had been Elsie who first filed for divorce.
4. Neither party requested written findings of fact and conclusions of law, and none were filed.
Saturday, February 16, 2008
Hartford Ins. Co. v. Crain (Tex.App.- Austin, 2008)
Hartford Insurance Company v. John Crain, No. 03-07-00202-CV (Tex.App. - Austin, Feb. 8, 2008)(Opinion by Justice Henson ) (TWCC judicial review suit, applicable deadline, timeliness) (Before Chief Justice Law, Justices Waldrop and Henson)
Hartford Insurance Company v. John Crain
Appeal from 33rd District Court of Blanco County
FROM THE DISTRICT COURT OF BLANCO COUNTY, 33RD JUDICIAL DISTRICT
NO. CV05952, HONORABLE V. MURRAY JORDAN, JUDGE PRESIDING
O P I N I O N
Hartford Insurance Company appeals from the dismissal of its suit for judicial review of a final decision by the Texas Workers' Compensation Commission (TWCC) appeals panel. (1) Hartford appealed the appeals-panel decision in district court within 40 days after the date the appeals panel filed its decision with the TWCC. Crain subsequently filed a plea to the jurisdiction, arguing that the appeal was untimely because Hartford failed to meet the 30-day deadline for seeking judicial review of a contested case under the Texas Administrative Procedure Act (APA). See Tex. Gov't Code Ann. § 2001.176 (West 2000).
After a hearing, the trial court granted Crain's plea to the jurisdiction. Because we hold that the 40-day deadline provided by section 410.252 of the labor code applies to Hartford's petition for judicial review, we will reverse the trial court's order granting the plea to the jurisdiction and remand for further proceedings consistent with this opinion. See Tex. Lab. Code Ann. § 410.252 (West 2006).
BACKGROUND
The administrative dispute that gave rise to this case involves the necessity of spinal surgery to treat an injury sustained by Crain. The parties agree that Crain's injury is a compensable workers' compensation injury.
Within the workers' compensation system, when a dispute arises over the medical necessity of a health care service, the medical necessity is reviewed by an independent review organization (IRO). Tex. Lab. Code Ann. § 413.031(d), (e) (West 2006 & Supp. 2007). If the dispute remains unresolved after the IRO's review, a party to the dispute has the opportunity to appeal the IRO's decision. Id. § 413.031(k), (l). In all medical-necessity disputes other than those involving spinal surgery, the party may appeal to the State Office of Administrative Hearings, where a hearing is conducted in the manner provided for in the APA. Id. § 413.031(k). However, a party to a medical-necessity dispute regarding spinal surgery that remains unresolved after the IRO's review must follow the dispute-resolution procedures provided by chapter 410 of the labor code. Id. § 413.031(l).
Chapter 410 of the labor code provides a dispute-resolution process that includes a contested-case hearing before a TWCC hearing officer and the opportunity for an appeal of the hearing officer's findings to the TWCC appeals panel. Id. §§ 410.151, 410.202 (West 2006). If a party is dissatisfied with the appeals panel's decision, it may request judicial review by the district court. Id. § 410.251 (West 2006).
On July 27, 2004, an IRO concluded that spinal surgery was reasonable and medically necessary to treat Crain's injury. Hartford timely appealed the IRO's decision and requested a contested-case hearing under chapter 410 of the labor code. After the hearing, a TWCC hearing officer issued a decision and order affirming the IRO decision. Hartford then appealed the hearing officer's findings to the TWCC appeals panel.
On January 18, 2005, the TWCC provided notice to Hartford that the appeals panel had not issued a written decision on Hartford's appeal within 30 days after the response was filed with the TWCC and that therefore the hearing officer's decision and order were final. The notice specifically stated that the hearing officer's decision and order became final on January 18, 2005, and that if the parties were not satisfied with the decision, they could file suit for judicial review of the appeals panel's decision in district court no later than the 40th day after that date. Hartford filed its petition for judicial review within the filing period given on the notice from the TWCC. (2)
Crain filed a plea to the jurisdiction, arguing that Hartford's petition should have been filed within 30 days after the appeals-panel decision was filed with the TWCC, pursuant to the APA. See Tex. Gov't Code Ann. § 2001.176. Hartford argued that petitions for judicial review of appeals-panel decisions involving spinal-surgery disputes are not governed by the 30-day deadline of the APA, and instead must be filed within 40 days after the appeals-panel decision is filed with the TWCC, pursuant to section 410.252 of the labor code. The trial court granted Crain's plea to the jurisdiction, and this appeal followed.
STANDARD OF REVIEW
Whether a court has subject-matter jurisdiction is a question of law reviewed de novo. Texas Dep't of Parks & Wildlife v. Miranda, 133 S.W.3d 217, 226 (Tex. 2004).
The facts of this case are undisputed and the question of whether the trial court had subject-matter jurisdiction turns solely on an issue of statutory construction. Statutory construction is a legal question that we review de novo, ascertaining and giving effect to the legislature's intent as expressed by the plain and common meaning of the statute's words. State v. Schumake, 199 S.W.3d 279, 284 (Tex. 2006). We must read the statute as a whole, rather than just isolated portions, giving meaning to the language that is consistent with other provisions in the statute. Dallas County Cmty. Coll. Dist. v. Bolton, 185 S.W.3d 868, 872-73 (Tex. 2005); Texas Dep't of Transp. v. City of Sunset Valley, 146 S.W.3d 637, 642 (Tex. 2004).
DISCUSSION
This case turns entirely on a determination of whether a petition for judicial review of medical-necessity disputes regarding spinal surgery must be filed in accordance with the 40-day deadline provided in section 410.252 of the labor code or the 30-day deadline provided by the APA.
The parties agree that dispute resolution involving the medical necessity of spinal surgery is governed by chapter 410 of the labor code. Within chapter 410, subchapter F is entitled, "Judicial Review - General Provisions." Subchapter F contains section 410.252, which states, "A party may seek judicial review by filing suit not later than the 40th day after the date on which the decision of the appeals panel was filed with the division." Hartford argues that, based on section 410.252, the 40-day deadline applies in this case and therefore Hartford's petition for judicial review was timely filed.
However, subchapter F also contains section 410.255, which states, "For all issues other than those covered under Section 410.301(a), judicial review shall be conducted in the manner provided for judicial review of a contested case under Subchapter G, Chapter 2001, Government Code." Tex. Lab. Code Ann. § 410.255 (West 2006). This reference to the government code encompasses the judicial-review provisions of the APA. See Tex. Gov't Code §§ 2001.171-.178 (West 2000). The exclusionary language of section 410.255 requires us to look to section 410.301(a), located in subchapter G, which states, "Judicial review of a final decision of the appeals panel regarding compensability or eligibility for or the amount of income or death benefits shall be conducted as provided by this subchapter." Tex. Lab. Code Ann. § 410.301(a) (West 2006). Reading these two provisions together, it becomes clear that appeals-panel decisions regarding compensability or income or death benefits are reviewed as required by subchapter G of chapter 410, while all other decisions are reviewed as provided by the APA.
Crain argues that petitions for judicial review of appeals-panel decisions regarding issues other than compensability or income or death benefits must be filed within the 30-day deadline set forth in the APA. See Tex. Gov't Code Ann. § 2001.176(a) ("A person initiates judicial review in a contested case by filing a petition not later than the 30th day after the day on which the decision that is the subject of the complaint is final and appealable."). Crain further argues that a spinal-surgery dispute does not constitute an issue regarding compensability or income or death benefits, making the decision in this case subject to the 30-day deadline.
Hartford, while contending that a spinal-surgery dispute affects compensability or income or death benefits, asserts that the 30-day deadline created by the APA is inapplicable, regardless of whether judicial review of a spinal-surgery dispute is to be conducted under the APA or subchapter G of chapter 410. Hartford argues that the 40-day deadline provided by section 410.252 applies to all appeals-panel decisions, and that section 410.255, which provides that judicial review should be conducted under the APA, simply refers to the manner in which judicial review is to be conducted, rather than the relevant deadlines. In light of the traditional statutory-construction principle that more specific statutes control over those that are more general, we agree. See Horizon/CMS Healthcare Corp. v. Auld, 34 S.W.3d 887, 901 (Tex. 2000).
Subchapter F of chapter 410 is titled "Judicial Review - General Provisions," while subchapter G is titled "Judicial Review of Issues Regarding Compensability or Income or Death Benefits." Section 410.252 specifically states that a party has 40 days to file suit once an appeals-panel decision has been filed. There is no mention in section 410.252--which is contained in the general provisions of subchapter F--that the 40-day deadline is limited to those decisions that are reviewed under subchapter G. Three provisions later, section 410.255 states that "judicial review shall be conducted in the manner provided for judicial review of a contested case" under the APA (emphasis added). The APA sets forth general procedures for administrative contested cases, including the applicable standard of review and the requirement that the review be conducted without a jury. See Tex. Gov't Code Ann. §§ 2001.171-.178 (West 2000). Because section 410.252 of the labor code specifically creates a deadline applicable to the judicial review of appeals-panel decisions, it controls over the more general provision of section 410.255, which merely provides that judicial review of certain appeals-panel decisions shall be conducted in the manner provided for judicial review under the APA. We read section 410.255's requirement that review of appeals-panel decisions be conducted "in the manner provided for judicial review" under the APA as relating to matters such as the standard of review and the lack of a jury trial, rather than the deadline for filing a petition.
Furthermore, the placement of 410.252 in subchapter F, under "Judicial Review - General Provisions," is further evidence that the legislature intended the 40-day deadline to apply to all appeals-panel decisions. If the legislature intended the 40-day deadline to apply solely to appeals panel decisions regarding compensability or income or death benefits, it could easily have included the deadline provision under subchapter G, which is titled, "Judicial Review of Issues Regarding Compensability or Income or Death Benefits." In construing a statute, we must ascertain the legislative intent by looking to the entire act, including the caption and body. Trawalter v. Schaefer, 179 S.W.2d 765, 767 (Tex. 1944).
Our interpretation of chapter 410 of the labor code is consistent with the language of the notice sent to Hartford by the TWCC, which advises parties that they have 40 days from the date the decision is filed with the TWCC to file a petition for judicial review. While the record does not conclusively establish whether the TWCC has taken an official position on this issue, the language of the notice suggests that the TWCC interprets the labor code to provide a 40-day deadline for filing a petition in cases such as Crain's. An agency's interpretation of its enabling statute is entitled to deference by the courts so long as it is reasonable and does not contradict the plain language of the statute. Public Util. Comm'n v. Gulf States Util. Co., 809 S.W.2d 201, 207 (Tex. 1991).
Crain cites to a number of cases in which courts have noted that the 30-day deadline for filing a petition for review under the APA applies to decisions by the TWCC appeals panel regarding issues other than compensability or income or death benefits. See State Office of Risk Mgmt. v. Herrera, 189 S.W.3d 405, 407 (Tex. App.--Amarillo 2006, no pet.) (stating that "according to all involved," if disputed issues encompass matters of compensability or coverage, "then the 30-day period supposedly applies"); Beaumont Indep. Sch. Dist. v. Parkerson, 105 S.W.3d 761, 763 (Tex. App.--Beaumont 2003, no pet.) (finding that petition for review filed on 39th day was timely because disputed issue fell under 410.301 and therefore 40-day limit applied); Walker v. Argonaut Southwest Ins. Co., 929 S.W.2d 499, 501 (Tex. App.--Texarkana 1996, pet. denied) ("[I]f Walker sought judicial review for any purpose other than the panel's determinations on compensability or eligibility for or the amount of income or death benefits, he was required to file his suit within thirty days of the decision."). We are not persuaded by these cases, however, because any statements to the effect that the APA's 30-day deadline applies to certain decisions by the TWCC appeals panel were dicta; none of the cited cases hold that a trial court lacked subject-matter jurisdiction to review a TWCC appeals-panel decision because a party failed to meet the APA's 30-day deadline. (3)
The parties have exhaustively briefed the issue of whether a spinal-surgery dispute is an issue regarding compensability or income or death benefits, and the resulting standard of review to be applied to appeals-panel decisions regarding spinal surgery. Issues regarding compensability or income or death benefits are to be reviewed using a modified de novo standard, Tex. Lab. Code Ann. § 410.301, while all other issues are reviewed using the substantial evidence rule, Tex. Lab. Code Ann. § 410.255(b). Based on our holding, however, the issues of whether spinal-surgery disputes affect compensability or income or death benefits, and whether such disputes should be reviewed using modified de novo or substantial evidence standards are not relevant to this appeal. Because we hold that the 40-day deadline provided in section 410.252 applies to all appeals-panel decisions, regardless of whether the issue relates to compensability or income or death benefits, the trial court erred in granting Crain's plea to the jurisdiction. (4)
CONCLUSION
Because we have determined that Hartford's petition for judicial review of the appeals panel's decision is governed by the 40-day deadline set forth in section 410.252 of the labor code, we reverse the trial court's order and remand this case for further proceedings consistent with this opinion.
__________________________________________
Diane Henson, Justice
Before Chief Justice Law, Justices Waldrop and Henson
Reversed and Remanded
Filed: February 8, 2008
1. The TWCC was abolished as of September 1, 2005, and its functions were assumed by the division of workers' compensation within the Texas Department of Insurance. Because the majority of the underlying decisions in this case were issued by the TWCC, we will refer to both the TWCC and its successor as the TWCC.
2. The 40th day after January 18, 2005, was Sunday, February 27, 2005. However, title 28, section 102.3(a)(3) of the Texas Administrative Code, which governs the computation of time for TWCC purposes, provides that "unless otherwise specified, if the last day of any period is not a working day, the period is extended to include the next day that is a working day." Therefore, the deadline to appeal the decision was Monday, February 28, 2005. Hartford mailed its petition for judicial review on February 25, 2005, and it was received by the Court on Monday, February 28, 2005.
3. In Morales v. Liberty Mut. Ins. Co., 169 S.W.3d 485 (Tex. App.--El Paso 2005), rev'd, No. 05-0754, 2007 Tex. App. LEXIS 1080 (Tex. Dec. 7, 2007), the court affirmed an order of dismissal for want of jurisdiction because the appellant had filed a petition for judicial review in the employee's county of residence, as required by section 410.252(b) of the labor code, rather than Travis County, the required venue provision of the APA. See Tex. Gov't Code Ann. § 2001.176 (West 2000). However, the supreme court reversed this decision, finding that the appellant's dispute concerned compensability and therefore that the employee's county of residence was not an improper venue. Morales v. Liberty Mut. Ins. Co., No. 05-0754, 2007 Tex. App. LEXIS 1080 (Tex. Dec. 7, 2007). While the supreme court's opinion states in dicta that "[a]n appeal from a decision that does not concern compensability must be filed in Travis County," id. at *6, the holding is that the underlying dispute is an issue regarding compensability and is therefore subject to judicial review under section 410.310. See id. at *15. Like the cases cited by Crain, Morales does not specifically hold that a trial court lacks subject-matter jurisdiction to review a TWCC appeals-panel decision because a party followed the filing deadlines set forth in section 410.252, rather than the APA.
4. We express no opinion regarding the appropriate standard of review for spinal-surgery disputes or whether a spinal-surgery dispute relates to compensability or income or death benefits.
Hartford Insurance Company v. John Crain
Appeal from 33rd District Court of Blanco County
FROM THE DISTRICT COURT OF BLANCO COUNTY, 33RD JUDICIAL DISTRICT
NO. CV05952, HONORABLE V. MURRAY JORDAN, JUDGE PRESIDING
O P I N I O N
Hartford Insurance Company appeals from the dismissal of its suit for judicial review of a final decision by the Texas Workers' Compensation Commission (TWCC) appeals panel. (1) Hartford appealed the appeals-panel decision in district court within 40 days after the date the appeals panel filed its decision with the TWCC. Crain subsequently filed a plea to the jurisdiction, arguing that the appeal was untimely because Hartford failed to meet the 30-day deadline for seeking judicial review of a contested case under the Texas Administrative Procedure Act (APA). See Tex. Gov't Code Ann. § 2001.176 (West 2000).
After a hearing, the trial court granted Crain's plea to the jurisdiction. Because we hold that the 40-day deadline provided by section 410.252 of the labor code applies to Hartford's petition for judicial review, we will reverse the trial court's order granting the plea to the jurisdiction and remand for further proceedings consistent with this opinion. See Tex. Lab. Code Ann. § 410.252 (West 2006).
BACKGROUND
The administrative dispute that gave rise to this case involves the necessity of spinal surgery to treat an injury sustained by Crain. The parties agree that Crain's injury is a compensable workers' compensation injury.
Within the workers' compensation system, when a dispute arises over the medical necessity of a health care service, the medical necessity is reviewed by an independent review organization (IRO). Tex. Lab. Code Ann. § 413.031(d), (e) (West 2006 & Supp. 2007). If the dispute remains unresolved after the IRO's review, a party to the dispute has the opportunity to appeal the IRO's decision. Id. § 413.031(k), (l). In all medical-necessity disputes other than those involving spinal surgery, the party may appeal to the State Office of Administrative Hearings, where a hearing is conducted in the manner provided for in the APA. Id. § 413.031(k). However, a party to a medical-necessity dispute regarding spinal surgery that remains unresolved after the IRO's review must follow the dispute-resolution procedures provided by chapter 410 of the labor code. Id. § 413.031(l).
Chapter 410 of the labor code provides a dispute-resolution process that includes a contested-case hearing before a TWCC hearing officer and the opportunity for an appeal of the hearing officer's findings to the TWCC appeals panel. Id. §§ 410.151, 410.202 (West 2006). If a party is dissatisfied with the appeals panel's decision, it may request judicial review by the district court. Id. § 410.251 (West 2006).
On July 27, 2004, an IRO concluded that spinal surgery was reasonable and medically necessary to treat Crain's injury. Hartford timely appealed the IRO's decision and requested a contested-case hearing under chapter 410 of the labor code. After the hearing, a TWCC hearing officer issued a decision and order affirming the IRO decision. Hartford then appealed the hearing officer's findings to the TWCC appeals panel.
On January 18, 2005, the TWCC provided notice to Hartford that the appeals panel had not issued a written decision on Hartford's appeal within 30 days after the response was filed with the TWCC and that therefore the hearing officer's decision and order were final. The notice specifically stated that the hearing officer's decision and order became final on January 18, 2005, and that if the parties were not satisfied with the decision, they could file suit for judicial review of the appeals panel's decision in district court no later than the 40th day after that date. Hartford filed its petition for judicial review within the filing period given on the notice from the TWCC. (2)
Crain filed a plea to the jurisdiction, arguing that Hartford's petition should have been filed within 30 days after the appeals-panel decision was filed with the TWCC, pursuant to the APA. See Tex. Gov't Code Ann. § 2001.176. Hartford argued that petitions for judicial review of appeals-panel decisions involving spinal-surgery disputes are not governed by the 30-day deadline of the APA, and instead must be filed within 40 days after the appeals-panel decision is filed with the TWCC, pursuant to section 410.252 of the labor code. The trial court granted Crain's plea to the jurisdiction, and this appeal followed.
STANDARD OF REVIEW
Whether a court has subject-matter jurisdiction is a question of law reviewed de novo. Texas Dep't of Parks & Wildlife v. Miranda, 133 S.W.3d 217, 226 (Tex. 2004).
The facts of this case are undisputed and the question of whether the trial court had subject-matter jurisdiction turns solely on an issue of statutory construction. Statutory construction is a legal question that we review de novo, ascertaining and giving effect to the legislature's intent as expressed by the plain and common meaning of the statute's words. State v. Schumake, 199 S.W.3d 279, 284 (Tex. 2006). We must read the statute as a whole, rather than just isolated portions, giving meaning to the language that is consistent with other provisions in the statute. Dallas County Cmty. Coll. Dist. v. Bolton, 185 S.W.3d 868, 872-73 (Tex. 2005); Texas Dep't of Transp. v. City of Sunset Valley, 146 S.W.3d 637, 642 (Tex. 2004).
DISCUSSION
This case turns entirely on a determination of whether a petition for judicial review of medical-necessity disputes regarding spinal surgery must be filed in accordance with the 40-day deadline provided in section 410.252 of the labor code or the 30-day deadline provided by the APA.
The parties agree that dispute resolution involving the medical necessity of spinal surgery is governed by chapter 410 of the labor code. Within chapter 410, subchapter F is entitled, "Judicial Review - General Provisions." Subchapter F contains section 410.252, which states, "A party may seek judicial review by filing suit not later than the 40th day after the date on which the decision of the appeals panel was filed with the division." Hartford argues that, based on section 410.252, the 40-day deadline applies in this case and therefore Hartford's petition for judicial review was timely filed.
However, subchapter F also contains section 410.255, which states, "For all issues other than those covered under Section 410.301(a), judicial review shall be conducted in the manner provided for judicial review of a contested case under Subchapter G, Chapter 2001, Government Code." Tex. Lab. Code Ann. § 410.255 (West 2006). This reference to the government code encompasses the judicial-review provisions of the APA. See Tex. Gov't Code §§ 2001.171-.178 (West 2000). The exclusionary language of section 410.255 requires us to look to section 410.301(a), located in subchapter G, which states, "Judicial review of a final decision of the appeals panel regarding compensability or eligibility for or the amount of income or death benefits shall be conducted as provided by this subchapter." Tex. Lab. Code Ann. § 410.301(a) (West 2006). Reading these two provisions together, it becomes clear that appeals-panel decisions regarding compensability or income or death benefits are reviewed as required by subchapter G of chapter 410, while all other decisions are reviewed as provided by the APA.
Crain argues that petitions for judicial review of appeals-panel decisions regarding issues other than compensability or income or death benefits must be filed within the 30-day deadline set forth in the APA. See Tex. Gov't Code Ann. § 2001.176(a) ("A person initiates judicial review in a contested case by filing a petition not later than the 30th day after the day on which the decision that is the subject of the complaint is final and appealable."). Crain further argues that a spinal-surgery dispute does not constitute an issue regarding compensability or income or death benefits, making the decision in this case subject to the 30-day deadline.
Hartford, while contending that a spinal-surgery dispute affects compensability or income or death benefits, asserts that the 30-day deadline created by the APA is inapplicable, regardless of whether judicial review of a spinal-surgery dispute is to be conducted under the APA or subchapter G of chapter 410. Hartford argues that the 40-day deadline provided by section 410.252 applies to all appeals-panel decisions, and that section 410.255, which provides that judicial review should be conducted under the APA, simply refers to the manner in which judicial review is to be conducted, rather than the relevant deadlines. In light of the traditional statutory-construction principle that more specific statutes control over those that are more general, we agree. See Horizon/CMS Healthcare Corp. v. Auld, 34 S.W.3d 887, 901 (Tex. 2000).
Subchapter F of chapter 410 is titled "Judicial Review - General Provisions," while subchapter G is titled "Judicial Review of Issues Regarding Compensability or Income or Death Benefits." Section 410.252 specifically states that a party has 40 days to file suit once an appeals-panel decision has been filed. There is no mention in section 410.252--which is contained in the general provisions of subchapter F--that the 40-day deadline is limited to those decisions that are reviewed under subchapter G. Three provisions later, section 410.255 states that "judicial review shall be conducted in the manner provided for judicial review of a contested case" under the APA (emphasis added). The APA sets forth general procedures for administrative contested cases, including the applicable standard of review and the requirement that the review be conducted without a jury. See Tex. Gov't Code Ann. §§ 2001.171-.178 (West 2000). Because section 410.252 of the labor code specifically creates a deadline applicable to the judicial review of appeals-panel decisions, it controls over the more general provision of section 410.255, which merely provides that judicial review of certain appeals-panel decisions shall be conducted in the manner provided for judicial review under the APA. We read section 410.255's requirement that review of appeals-panel decisions be conducted "in the manner provided for judicial review" under the APA as relating to matters such as the standard of review and the lack of a jury trial, rather than the deadline for filing a petition.
Furthermore, the placement of 410.252 in subchapter F, under "Judicial Review - General Provisions," is further evidence that the legislature intended the 40-day deadline to apply to all appeals-panel decisions. If the legislature intended the 40-day deadline to apply solely to appeals panel decisions regarding compensability or income or death benefits, it could easily have included the deadline provision under subchapter G, which is titled, "Judicial Review of Issues Regarding Compensability or Income or Death Benefits." In construing a statute, we must ascertain the legislative intent by looking to the entire act, including the caption and body. Trawalter v. Schaefer, 179 S.W.2d 765, 767 (Tex. 1944).
Our interpretation of chapter 410 of the labor code is consistent with the language of the notice sent to Hartford by the TWCC, which advises parties that they have 40 days from the date the decision is filed with the TWCC to file a petition for judicial review. While the record does not conclusively establish whether the TWCC has taken an official position on this issue, the language of the notice suggests that the TWCC interprets the labor code to provide a 40-day deadline for filing a petition in cases such as Crain's. An agency's interpretation of its enabling statute is entitled to deference by the courts so long as it is reasonable and does not contradict the plain language of the statute. Public Util. Comm'n v. Gulf States Util. Co., 809 S.W.2d 201, 207 (Tex. 1991).
Crain cites to a number of cases in which courts have noted that the 30-day deadline for filing a petition for review under the APA applies to decisions by the TWCC appeals panel regarding issues other than compensability or income or death benefits. See State Office of Risk Mgmt. v. Herrera, 189 S.W.3d 405, 407 (Tex. App.--Amarillo 2006, no pet.) (stating that "according to all involved," if disputed issues encompass matters of compensability or coverage, "then the 30-day period supposedly applies"); Beaumont Indep. Sch. Dist. v. Parkerson, 105 S.W.3d 761, 763 (Tex. App.--Beaumont 2003, no pet.) (finding that petition for review filed on 39th day was timely because disputed issue fell under 410.301 and therefore 40-day limit applied); Walker v. Argonaut Southwest Ins. Co., 929 S.W.2d 499, 501 (Tex. App.--Texarkana 1996, pet. denied) ("[I]f Walker sought judicial review for any purpose other than the panel's determinations on compensability or eligibility for or the amount of income or death benefits, he was required to file his suit within thirty days of the decision."). We are not persuaded by these cases, however, because any statements to the effect that the APA's 30-day deadline applies to certain decisions by the TWCC appeals panel were dicta; none of the cited cases hold that a trial court lacked subject-matter jurisdiction to review a TWCC appeals-panel decision because a party failed to meet the APA's 30-day deadline. (3)
The parties have exhaustively briefed the issue of whether a spinal-surgery dispute is an issue regarding compensability or income or death benefits, and the resulting standard of review to be applied to appeals-panel decisions regarding spinal surgery. Issues regarding compensability or income or death benefits are to be reviewed using a modified de novo standard, Tex. Lab. Code Ann. § 410.301, while all other issues are reviewed using the substantial evidence rule, Tex. Lab. Code Ann. § 410.255(b). Based on our holding, however, the issues of whether spinal-surgery disputes affect compensability or income or death benefits, and whether such disputes should be reviewed using modified de novo or substantial evidence standards are not relevant to this appeal. Because we hold that the 40-day deadline provided in section 410.252 applies to all appeals-panel decisions, regardless of whether the issue relates to compensability or income or death benefits, the trial court erred in granting Crain's plea to the jurisdiction. (4)
CONCLUSION
Because we have determined that Hartford's petition for judicial review of the appeals panel's decision is governed by the 40-day deadline set forth in section 410.252 of the labor code, we reverse the trial court's order and remand this case for further proceedings consistent with this opinion.
__________________________________________
Diane Henson, Justice
Before Chief Justice Law, Justices Waldrop and Henson
Reversed and Remanded
Filed: February 8, 2008
1. The TWCC was abolished as of September 1, 2005, and its functions were assumed by the division of workers' compensation within the Texas Department of Insurance. Because the majority of the underlying decisions in this case were issued by the TWCC, we will refer to both the TWCC and its successor as the TWCC.
2. The 40th day after January 18, 2005, was Sunday, February 27, 2005. However, title 28, section 102.3(a)(3) of the Texas Administrative Code, which governs the computation of time for TWCC purposes, provides that "unless otherwise specified, if the last day of any period is not a working day, the period is extended to include the next day that is a working day." Therefore, the deadline to appeal the decision was Monday, February 28, 2005. Hartford mailed its petition for judicial review on February 25, 2005, and it was received by the Court on Monday, February 28, 2005.
3. In Morales v. Liberty Mut. Ins. Co., 169 S.W.3d 485 (Tex. App.--El Paso 2005), rev'd, No. 05-0754, 2007 Tex. App. LEXIS 1080 (Tex. Dec. 7, 2007), the court affirmed an order of dismissal for want of jurisdiction because the appellant had filed a petition for judicial review in the employee's county of residence, as required by section 410.252(b) of the labor code, rather than Travis County, the required venue provision of the APA. See Tex. Gov't Code Ann. § 2001.176 (West 2000). However, the supreme court reversed this decision, finding that the appellant's dispute concerned compensability and therefore that the employee's county of residence was not an improper venue. Morales v. Liberty Mut. Ins. Co., No. 05-0754, 2007 Tex. App. LEXIS 1080 (Tex. Dec. 7, 2007). While the supreme court's opinion states in dicta that "[a]n appeal from a decision that does not concern compensability must be filed in Travis County," id. at *6, the holding is that the underlying dispute is an issue regarding compensability and is therefore subject to judicial review under section 410.310. See id. at *15. Like the cases cited by Crain, Morales does not specifically hold that a trial court lacks subject-matter jurisdiction to review a TWCC appeals-panel decision because a party followed the filing deadlines set forth in section 410.252, rather than the APA.
4. We express no opinion regarding the appropriate standard of review for spinal-surgery disputes or whether a spinal-surgery dispute relates to compensability or income or death benefits.
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