Texas Casualty Insurance Company v. Beasley

CALVERT, Chief Justice.

This is a workmen’s compensation case. In response to special issues the jury found that Miles Clifford Beasley, the claimant, sustained an accidental injury in the course of his employment which produced permanent, total incapacity. The trial court rendered judgment on the verdict for Beasley for 401 weeks of compensation at $35.00 per week, less benefits previously paid. The Court of Civil Appeals affirmed. 381 S.W.2d 236. We reverse the judgments of the trial court and the Court of Civil Appeals and render judgment that the claimant take nothing.

Beasley sustained a back injury on April 11, 1961, while in the course of his employment for Premier Granite Quarries, Texas Casualty’s assured. He filed his claim for compensation benefits with the Industrial Accident Board on November 13,1962, nineteen months after the date of his injury. Under the provisions of Sec. 4a of Art. 8307, Vernon’s Texas Civil Statutes, his right to compensation benefits is barred because of his failure to file his claim within six months from the day of his injury, unless he had good cause for his delay. The only question to be decided here is whether the evidence adduced at the trial fails as a matter of law to show good cause.

It is not enough to satisfy the statutory requirement to prove that good cause for failure to file existed during the six-month period; an injured workman owes a duty of continuing diligence in the prosecution of his claim, and must prove that good cause for failure to file continued up to the date of filing. Texas Employers Insurance Ass’n v. Hancox, 162 Tex. 565, 349 S.W.2d 102; Consolidated Casualty Insurance Co. v. Perkins, 154 Tex. 424, 279 S.W.2d 299; Petroleum Casualty Co. v. Dean, 132 Tex. 320, 122 S.W.2d 1053; Williamson v. Texas Indemnity Ins. Co., 127 Tex. 71, 90 S.W.2d 1088. Beasley’s proof on the issue must be tested by that rule.

Beasley consulted and was examined by three different doctors within a brief period of time following his injury. Acting upon their advice, he submitted to surgery on May 8, 1961, for the removal of a herniated disc. He returned to his work for Premier some eight weeks later and, in spite of almost constant pain in the area of the operation, continued in that employment until February 10, 1962. He quit his job with Premier on advice of his doctor and obtained employment on a ranch on February 15,1962, where he was still working at the time of trial. He strained or wrenched his back in July, 1962, and was hospitalized in traction for five days. He was released from the hospital on July 23, 1962.

On June 20,1962, the owner of the ranch, who was also an attorney, wrote a letter to Premier Granite Quarries about a possible compensation claim for Beasley. Premier referred the letter to the claims manager of Texas Casualty Company. The claims manager replied to the letter on July 8, 1962, and suggested that he would be pleased to receive any kind of compromise offer with regard to Beasley’s claim. Between July 8, 1962, and the middle of August of that year, Beasley’s employer made one or two telephone calls *35to the claims manager of Texas Casualty, probably one before and one after his hospitalization. Near the middle of August, a conflict of interest arose between Texas Casualty and the compensation carrier of Beasley’s employer. In the latter part of August, Beasley’s employer notified Beasley of the conflict, advised him that he could no longer continue negotiations with Texas Casualty, and referred him to another attorney. Around October 1, 1962, Beasley consulted the attorney to whom he had been referred and who thereafter filed the claim.

The claimant’s reason for delaying the filing of his claim is to be found principally in his own testimony. He testified that he was assured by the doctors before his operation on May 11,1961, that the surgery would make him “as good as new”; and in spite of the fact that he continued to have pain in his back and leg, he continued to believe that he would get well up to the time that he had to go back to the hospital in July, 1962, at which time he realized that he was not going to get well and would have to file a claim. He testified further that he did not want to assert a claim if he was going “to be all right.”

For the purpose of deciding the question before us, we will assume, without deciding, that good cause for failure to file a claim existed until Beasley was hospitalized in July, 1962. See Hawkins v. Safety Casualty Co., 146 Tex. 381, 207 S.W.2d 370. The question then narrows to this: Did good cause for failure to file the claim continue to exist from the middle of July, 1962, until the claim was filed on November 13, 1962? The answer to the question turns on the degree of diligence used to get the claim filed. Beasley was charged with the duty of prosecuting his claim with that degree of diligence which a reasonably prudent person would have exercised under the same or similar circumstances. Watson v. Texas Indemnity Ins. Co., 147 Tex. 40, 210 S.W.2d 989; Hawkins v. Safety Casualty Co., 146 Tex. 381, 207 S.W.2d 370; Hartford Accident & Indemnity Co. v. Hardin, Tex.Civ.App., 252 S.W.2d 752, writ refused. Ordinarily, whether a claimant has used that degree of diligence is a question of fact to be determined by a jury or trial judge. Texas Employers’ Ins. Ass’n v. McDonald, Tex.Civ.App., 238 S.W.2d 817, writ refused. However, the evidence in a particular case may lead to lack of diligence as the only reasonable conclusion, in which event the question is to be decided as a matter of law. Hawkins v. Safety Casualty Co., 146 Tex. 381, 207 S.W.2d 370, 372. We hold that the evidence in this case requires a conclusion, as a matter of law, that the claimant did not exercise the degree of diligence in the filing of his claim which a reasonably prudent person would have exercised under the same or similar circumstances.

The evidence reflects that Beasley knew he should file a claim. Texas Casualty paid him weekly compensation benefits for eleven or twelve weeks following his injury. During this period Beasley went to see a lawyer with reference to the filing of a claim, and was advised that he did not need to file one as long as he was drawing compensation. However erroneous the advice may otherwise have been, it certainly confirmed the necessity for filing a claim when compensation payments ceased, if he should be disabled. In spite of his knowledge, there is in the record no evidence that he or his employer-attorney took any steps to get a claim filed from the middle of July, 1962, at which time he concluded he was not going to get well, to the latter part of August, and no evidence that he did anything toward filing one during the month of September. There is no evidence that Beasley advised his employer-attorney that a claim had not been filed, or discussed with him the necessity or advisability of filing a claim. The evidence is conflicting as to whether in dealing with Texas Casualty’s claim agent the employer was acting as a friend or as Beasley’s attorney. The relationship is immaterial; he was Beasley’s agent. There is no evidence that Beasley was prevented by his physical condition or by the duties of his employment from filing his claim during the month of *36September. The controlling fact is that no steps were taken to get a claim filed for two and a half months. That is too long for a reasonably prudent person to do nothing. See Jones v. Texas Employers Ins. Ass’n, 128 Tex. 437, 99 S.W.2d 903. It becomes unnecessary to decide whether under the circumstances five to six weeks was an unreasonable period of time for investigation and filing of the claim by the attorney who filed it.

The Court of Civil Appeals held that the evidence presented a fact issue on the issue of diligence. In making the holding, that court relied primarily on Texas Employers’ Ins. Ass’n v. McDonald, Tex.Civ.App., 238 S.W.2d 817, writ refused. While the evidence of good cause in that case is in some respects similar to the evidence in this case, it is in other respects distinctly dissimilar. In that case the claimant thought papers he had filed with the Industrial Accident Board within thirty days of his injury was a claim for compensation; here, the claimant knew he had not filed a claim. In that case a claim for compensation was filed promptly upon the termination of settlement negotiations ; here, the claimant took no steps whatever to prosecute his claim until some thirty days after termination of settlement negotiations, and offered no evidence to excuse his failure to do so. We conclude that this case is not ruled by McDonald.

Texas Casualty’s motion for an instructed verdict and its subsequent motion for judgment notwithstanding the verdict should have been granted. The judgments of the Court of Civil Appeals and trial court are reversed, and judgment is here rendered that the plaintiff take nothing.