In The
Court of Appeals
Ninth District of Texas at Beaumont
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NO. 09-14-00521-CV
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IN RE TEXAS ALLIANCE OF ENERGY, AKA TEXAS ALLIANCE OF
ENERGY PRODUCERS WORKERS’ COMPENSATION SELF-INSURED
GROUP TRUST
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Original Proceeding
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MEMORANDUM OPINION
Relator, Texas Alliance of Energy a/k/a Texas Alliance of Energy Producers
Workers’ Compensation Self-Insured Group Trust, seeks mandamus relief from
the exercise of jurisdiction by the 253rd District Court of Liberty County, Texas, in
a suit filed by John Bennett. Relator contends the trial court improperly asserted
jurisdiction over Bennett’s extra-contractual claims, and that the trial court
improperly resolved as a matter of law workers’ compensation claims that were not
first adjudicated administratively or that were not timely appealed. We
conditionally grant the writ in part.
1
Background
Bennett sustained a compensable injury on August 30, 2006. In
administrative proceedings before the Division of Workers’ Compensation (DWC),
a contested case hearing resulted in a decision that Bennett reached maximum
medical improvement (MMI) on September 3, 2008, that Bennett’s impairment
rating was nineteen percent, and that he was not entitled to supplemental income
benefits (SIBs) for compensable quarters one through six. The Appeals Panel
notified the parties that the hearing officer’s decision and order became final on
July 18, 2011.
On September 2, 2011, Bennett filed suit for judicial review of the Appeals
Panel’s decision on the impairment rating and date of MMI.1 In September 2011,
Relator filed a plea to the jurisdiction alleging in part that Bennett failed to request
relief from the Appeals Panel decision that he was not entitled to SIBs for the first
through sixth compensable quarters. Bennett added a request for SIBs to his prayer
for relief with a pleading filed on November 28, 2011. In 2013, Bennett amended
his pleadings to allege claims for negligence and intentional infliction of emotional
1
Bennett’s original petition identified the defendant as “Texas Alliance of
Energy Producers.” The defendant’s name varies in Bennett’s subsequent
pleadings, but Relator’s filings in the trial court assert that it is the proper
defendant.
2
distress.2 In the pleading filed in 2013, Bennett’s factual recitations include a
statement that the Appeals Panel decision upholding the hearing officer’s decision
on MMI is incorrect because the actual impairment rating was twenty percent. The
petition does not mention the Appeals Panel’s decision on SIBs.
Relator filed a motion for summary judgment in which it contended Bennett
had no judicial remedy for the extra-contractual claims asserted in his petition. See
Tex. Mut. Ins. Co. v. Ruttiger, 381 S.W.3d 430, 446-56 (Tex. 2012); Am. Motorists
Ins. Co. v. Fodge, 63 S.W.3d 801, 804 (Tex. 2001); see also Tex. Labor Code Ann.
§ 408.001(a) (West 2006). Regarding judicial review of the Appeals Panel’s
decision, Relator asserted that Bennett dropped his request for SIBs in one of the
amended pleadings he filed with the trial court, and his attempted amendment of
his petition to assert a claim for SIBs for the first quarter was not timely filed under
the statute. 3 See Tex. Labor Code Ann. § 410.252(a) (West Supp. 2014). Relator
2
In 2014, Bennett either filed or purported to file Plaintiff’s Third Amended
Petition, alleging Bennett’s entitlement to SIBs for the first compensable quarter
only and asserting claims for negligence and for intentional infliction of emotional
distress. The third amended petition bears an incorrect cause number and Relator
states that the trial court clerk’s office does not have a record of the petition having
been filed.
3
In its motion for summary judgment Relator also asserted that it was
entitled to judgment because Bennett originally sued the wrong defendant, that the
correct defendant was not sued until November 28, 2011, and that a subsequent
amendment to Bennett’s pleadings again named the wrong defendant, effectively
dismissing Relator from the suit. Relator contended it was entitled to judgment as a
3
asserted that the issue of its failure to request a benefit review hearing on SIBs for
the first compensable quarter was not subject to judicial review because the issue
had not been presented to the Appeals Panel.
Bennett filed a motion for summary judgment asserting that he was entitled
to judgment as a matter of law because Relator failed to request a benefit review
conference within ten days of the date the DWC issued a notice of entitlement to
SIBs for the first quarter. In response, Relator asserted that, having allowed the
issue of the first quarter of SIBs to be litigated before the Appeals Panel without
objection, Bennett could not obtain judicial review of Relator’s failure to exhaust
its administrative remedies regarding the first quarter of SIBs.
The trial court granted Bennett’s motion for summary judgment and ordered
that Bennett is entitled to receive his benefits for compensable quarters one
through six. The trial court denied Relator’s motion for summary judgment and
Relator’s motion to sever Bennett’s extra-contractual claims. The trial court has
not disposed of all of the issues before that court.
matter of law because Bennett had no evidence that he timely filed suit against a
proper defendant and further amendment would be barred by the statute of
limitations. Relator does not press this argument in its mandamus petition, and we
do not consider it here.
4
Issues
The issues in dispute in this mandamus proceeding concern whether Bennett
exhausted his remedies at the administrative level and whether he properly pleaded
his claims. Relator contends: (1) the trial court abused its discretion by asserting
jurisdiction over Bennett’s claims for extra-contractual damages allegedly arising
out of the claims handling process; (2) Bennett failed to exhaust administrative
remedies on his workers’ compensation claims, with respect to the issue of
entitlement to SIBs; and (3) Bennett failed to exhaust his administrative remedies
with respect to the issue of whether Relator waived its right to contest the first
compensable quarter of SIBs by failing to request a benefit review conference
when the DWC issued its August 12, 2008 notice of entitlement to SIBs for the
first quarter.
Only the DWC can determine entitlement to particular benefits. See
Ruttiger, 381 S.W.3d at 437. When a claimant has failed to exhaust administrative
remedies, the trial court’s exercise of jurisdiction is “correctable by mandamus to
prevent a disruption of the orderly processes of government.” See In re Liberty
Mut. Fire Ins. Co., 295 S.W.3d 327, 328 (Tex. 2009). “If a claim is not within a
court’s jurisdiction, and the impediment to jurisdiction cannot be removed, then it
must be dismissed; but if the impediment to jurisdiction could be removed, then
5
the court may abate proceedings to allow a reasonable opportunity for the
jurisdictional problem to be cured.” Fodge, 63 S.W.3d at 805.
Judicial review of a workers’ compensation case “is limited to issues
decided by the appeals panel and on which judicial review is sought.” Tex. Labor
Code Ann. § 410.302(b) (West 2006). The DWC determined that Bennett reached
statutory MMI with a nineteen percent impairment rating and that he was not
entitled to SIBs for the first six compensable quarters, but Bennett challenged only
the impairment rating in his original petition for judicial review. No claims-
handling complaints were addressed by the Appeals Panel.4 Because the trial
court’s subject-matter jurisdiction is limited to the issues addressed by the Appeals
Panel, the trial court abused its discretion by denying Relator’s plea to the
jurisdiction as to Bennett’s claims-handling complaints. See Ruttiger, 381 S.W.3d
at 451-56; Fodge, 63 S.W.3d at 804; Bean v. Tex. Mut. Ins. Co., 09-11-00123-CV,
2012 WL 5450826, at *2 (Tex. App.—Beaumont Nov. 8, 2012, no pet.) (mem.
op.). We sustain issue one.
The Appeals Panel ruled that Bennett was not entitled to SIBs for
compensable quarters one through six. Notwithstanding the Appeals Panel
4
The Workers’ Compensation Act addresses claims-handling abuses through
a sanctions process that includes judicial review of administrative violations. See
Tex. Labor Code Ann. §§ 415.001-.036 (West 2006 & Supp. 2014). Those
procedures were not implemented in this case and are not at issue here.
6
decision, Relator argues that the record demonstrates that Bennett failed to exhaust
his administrative remedies with regard to his right to SIBs. Relator claims
Bennett’s failure to exhaust occurred when he failed to specifically plead that he
was challenging that ruling in his original petition, and again when he filed an
amended petition that did not include allegations specifically requesting that he
recover a judgment for SIBs.
Several of the Courts of Appeals have held the time limit for filing suit
contained in section 410.252 of the Texas Labor Code is mandatory and
jurisdictional. See Fire & Cas. Ins. Co. of Conn. v. Miranda, 293 S.W.3d 620, 624
(Tex. App.—San Antonio 2009, no pet.); Texas Mun. League v. Burns, 209 S.W.3d
806, 812 (Tex. App.—Fort Worth 2006, no pet.); LeBlanc v. Everest Nat’l Ins. Co.,
98 S.W.3d 786, 787 (Tex. App.—Corpus Christi 2003, no pet.); Johnson v. United
Parcel Serv., 36 S.W.3d 918, 921 (Tex. App.—Dallas 2001, pet. denied). Here, it
is undisputed that Bennett filed suit within forty-five days of the date on which the
DWC mailed the notice of its decision. See Tex. Labor Code Ann. § 410.252(a).
He complied with section 410.252(a).
For its jurisdictional argument, Relator relies upon section 410.302(b) of the
Texas Labor Code. See id. § 410.302(b). The issues that may be determined by the
trial court are limited to issues decided by the Appeals Panel. Id. “The pleadings
7
must specifically set forth the determinations of the appeals panel by which the
party is aggrieved.” Id. Section 410.302(b) defines the scope of the issues that may
be judicially reviewed after an appeals panel decision but the pleading requirement
is not itself jurisdictional. Old Republic Ins. Co. v. Warren, 33 S.W.3d 428, 432
(Tex. App.—Fort Worth 2000, pet. denied).
Because courts presume in favor of jurisdiction, unless the petition
affirmatively demonstrates a lack of jurisdiction, the trial court will assume
jurisdiction until it is proven otherwise. Peek v. Equip. Serv. Co. of San Antonio,
779 S.W.2d 802, 804 (Tex.1989); see also Tex. Dep’t of Transp. v. Beckner, 74
S.W.3d 98, 104 (Tex. App.—Waco 2002, no pet.). Relator suggests Bennett’s live
pleading is his Second Amended Petition, and argues that pleading exclusively
presented claims-handling complaints over which the trial court lacks subject
matter jurisdiction. Bennett’s pleadings are somewhat confusing, and from the
mandamus record it is unclear which petition is Bennett’s live pleading. The trial
court did not abuse its discretion in denying Relator’s plea to the jurisdiction as it
relates to Bennett’s claim for SIBs. 5 The trial court may require Bennett to amend
5
This is an original mandamus proceeding limited to the trial court’s subject
matter jurisdiction. Except where the trial court’s subject matter jurisdiction is
implicated, we express no opinion regarding the motions for summary judgment,
the responses to the motions and the objections to the summary judgment evidence,
or the trial court’s rulings on the motions for summary judgment.
8
his pleadings to comply with section 410.302(b) of the Texas Labor Code. See
Beckner, 74 S.W.3d at 104. The mandamus record does not establish that Bennett
affirmatively pleaded himself out of court with regard to his appeal of the Appeals
Panel’s decision that he is not entitled to SIBs for compensable quarters one
through six. We overrule issue two.
Relator contends that the trial court abused its discretion in exercising
jurisdiction over the issue of whether Relator exhausted its administrative remedies
regarding Bennett’s entitlement to SIBs for the first quarter. The trial court’s
subject matter jurisdiction is limited to issues decided by the Appeals Panel. See
Tex. Labor Code Ann. § 410.302(b). A trial court lacks subject-matter jurisdiction
over any issue that was not properly presented to the Appeals Panel. Frank v.
Liberty Ins. Corp., 255 S.W.3d 314, 320 (Tex. App.—Austin 2008, pet. denied).
The trial court cannot consider an issue of waiver that was not presented for
consideration in the administrative review process. Zurich Am. Ins. Co. v. Debose,
No. 01-13-00344-CV, 2014 WL 3512769, at *7 (Tex. App.—Houston [1st Dist.]
July 15, 2014, no pet.) (mem. op.). The mandamus record does not indicate that the
Appeals Panel considered whether Relator waived its right to challenge the first
quarter SIBs either in the contested case hearing or the Appeals Panel because it
failed to request a benefit review conference after a notice of entitlement to SIBs
9
for the first quarter issued on August 12, 2008. In the absence of evidence
demonstrating that the Appeals Panel considered the issue of waiver, the trial court
abused its discretion by considering an issue that was not presented to the Appeals
Panel. Id. We sustain issue three.
Conclusion
The mandamus record demonstrates that the trial court failed to limit itself to
issues considered by the Appeals Panel. See Tex. Labor Code Ann. § 410.302(b).
Bennett exhausted his administrative remedies with regard to his entitlement to
SIBs, however, and Relator has not demonstrated that the trial court could not
exercise jurisdiction over a properly pleaded dispute concerning SIBs. If the
impediment to jurisdiction could be removed, then the trial court may abate
proceedings to allow a reasonable opportunity for the jurisdictional problem to be
cured. See Fodge, 63 S.W.3d at 805.
We are confident that the trial court will reconsider its rulings in light of this
opinion, and that after giving the plaintiff an opportunity to replead, the trial court
will grant a plea to the jurisdiction as to any issues that were not brought before the
Appeals Panel. The writ of mandamus shall issue only if the trial court fails to
comply within a reasonable time.
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PETITION CONDITIONALLY GRANTED IN PART.
PER CURIAM
Submitted on December 17, 2014
Opinion Delivered January 22, 2015
Before McKeithen, C.J., Kreger and Johnson, JJ.
11
in Re Texas Alliance of Energy, AKA Texas Alliance of Energy Producers Workers' Compensation Self-Insured Group Trust
Combined Opinion