State News : Texas

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  


Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.


Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.


Texas

STONE LOUGHLIN & SWANSON, LLP

  512-343-1385

OCIP agreement did not prevent worker from suing property owner who failed to show that agreement was with worker’s employer, a subsidiary of a parent company.


It is a common misperception in the industry that the exclusive remedy defense prevents an employee of a subsidiary company from suing the parent company. It does not. The Dallas Court of Appeals makes this clear in Olivares v. Chevron, issued March 14, 2023. 

For a defendant to assert the exclusive remedy defense, the defendant must be the plaintiff’s employer.  However, the Dallas Court explains that employees of a subsidiary company are not by default also employees of the parent company and in fact, there is a strong presumption that a parent corporation is not the employer of its subsidiary employees. The court’s decision continues:

“An injured employee of a subsidiary corporation, who is estopped under an exclusive remedy provision in his state's workers’ compensation act from suing his employer, may nonetheless bring a third-party claim against the subsidiary's parent or sibling corporation.” Sims v. W. Waste Indus., 918 S.W.2d 682, 684 (Tex. App.—Beaumont 1996, writ denied) (cleaned up). “We are not persuaded that the legislature ever intended parent corporations, who deliberately chose to establish a subsidiary corporation, to be allowed to assert immunity under the Texas Workers’ Compensation Act by reverse piercing of the corporate veil they themselves established.” Id. at 686. 

The plaintiff in Olivares v. Chevron was employed by Apache Global, a subsidiary of Apache Industrial Services, Inc. Chevron sought to show that it had an owner-controlled insurance program (OCIP) with the plaintiff’s employer meaning that Chevron would also be considered his employer and therefore, could not be sued for his work injury.  The court held that Chevron failed to show that the OCIP was with Apache Global, the subsidiary company, rather than Apache Industrial, the parent company and because employees of a subsidiary company are not also employees of the parent company, the exclusive remedy defense did not prevent the plaintiff from suing Chevron.

Chevron presumably spent a lot of money to put this OCIP together to prevent it from being sued for work injuries on its premises and it was for naught. This case provides some good practice pointers for anyone working with OCIPs to make sure they are set up and administered properly.  


Copyright 2023, Stone Loughlin & Swanson, LLP  

SOAH ALJ rejects claimant’s argument that filing deadline is not fair.


There are not many new SOAH decisions these days because there are not nearly as many medical fee disputes as there used to be.  Therefore, when a new SOAH decision comes out it bears mention.  

In SOAH Docket No. 454-22-09437, the Administrative Law Judge held that the claimant was not entitled to reimbursement for his out-of-pocket medical expenses because he did not file his request for medical fee dispute resolution with the Division until about ten months after the filing deadline:  

[Claimant] argues that he has much experience in workers’ compensation—having even written a book on it—and “if someone as well versed in the workers’ compensation system cannot prevail in this matter, what hope does the average injured worker have?” Although the fairness of a labyrinthine workers’ compensation system can be questioned, ultimately its existence and structure is a question for the Texas Legislature and for the Commissioner of Insurance. The ALJ only applies the law as it is. Because [claimant’s] request for resolution was untimely, he is not entitled to reimbursement of his out-of-pocket medical expenses involved in this appeal.

The ALJ’s decision to strictly enforce the Division’s filing deadline should come as no surprise.  As the Texas Supreme Court put it, “A deadline is not something one can substantially comply with. A miss is as good as a mile.” Edwards Aquifer Auth. v. Chemical Lime, Ltd., 291 S.W.3d 392, 403 (Tex. 2009).  The U.S. Supreme Court has explained why filing deadlines must be strictly enforced:

The notion that a filing deadline can be complied with by filing sometime after the deadline falls due is, to say the least, a surprising notion, and it is a notion without limiting principle. If 1–day late filings are acceptable, 10–day late filings might be equally acceptable, and so on in a cascade of exceptions that would engulf the rule erected by the filing deadline; yet regardless of where the cutoff line is set, some individuals will always fall just on the other side of it. Filing deadlines, like statutes of limitations, necessarily operate harshly and arbitrarily with respect to individuals who fall just on the other side of them, but if the concept of a filing deadline is to have any content, the deadline must be enforced. Any less rigid standard would risk encouraging a lax attitude toward filing dates. A filing deadline cannot be complied with, substantially or otherwise, by filing late—even by one day.

United States v. Locke, 471 U.S. 84, 100–101 (1985).

The Supreme Court’s words are important to remember. The Texas workers’ compensation system is replete with deadlines that must be strictly enforced to keep the system running smoothly.  
 

Copyright 2023, Stone Loughlin & Swanson, LLP 



What has the Division’s enforcement section been up to lately?


The Division expends a great deal of effort to ensure compliance with its deadlines and in fact, most of its enforcement actions involve a missed deadline. Here is an overview of some of the most recent workers’ compensation disciplinary orders:

Fine: $14,000. Violation: Carrier paid IIBs on a DD report 186 days late.  
No. 2023-7845 03/15/23 Security National Ins. Co.

Fine: $1,500.  Violation: Carrier took action on a medical bill 159 days late. 
No. 2023-7842 03/10/23 Travelers Property Cas. Co. of Am.

Fine: $800.  Violation: Carrier reported the true death benefit termination 5,536 days late.  
No. 2023-7831 03/01/23 West American Insurance Co.

Fine: $11,000.  Violation: Carrier failed to timely make IIBs payments from 6 to 111 days late.  
No. 2023-7830 03/01/23 LM Insurance Corp.

Fine: $2,500.  Violation: Carrier paid a medical bill 198 days late.  
No. 2023-7829 02/28/23 National Interstate Ins. Co.

Fine: $10,000.  Violation: Carrier failed to timely pay SIBs.
No. 2023-7827 02/28/23 Safety National Cas. Corp.

Fine: $10,000.  Violation:  Carrier paid IIBs on a DD report 175 days late. 
No. 2023-7824 02/28/23 New Hampshire Ins. Co. 

Fine: $5,500.  Violation: Carrier paid benefits on a CCH decision 52 days late. 
No. 2023-7823 02/28/23 New Hampshire Ins. Co.

Fine: $8,000.  Violation: Carrier took action on a medical bill 35 days late. 
No. 2023-7820 02/24/23 Chubb Indem. Ins. Co.

Fine: $700.  Violation: Carrier paid medical bill 97 days late. 
No. 2023-7815 02/21/23 Montgomery County

Fine: $3,500.  Violation: Carrier started death benefits 57 days late. 
No. 2023-7814 02/21/23 TASB Risk Mgmt. Fund 

Fine: $4,000.  Violation: Carrier paid benefits on a CCH decision 16 days late. 
No. 2023-7812 02/21/23 TASB Risk Mgmt. Fund
 

Copyright 2023, Stone Loughlin & Swanson, LLP

How the burden of proof determines the outcome of a case.

 

In Appeal No. 230067 issued March 3, 2023, the Appeal Panel reversed the ALJ’s decision that the carrier is entitled to reduce the claimant’s IIBs by 50% based on contribution from an earlier compensable injury and rendered a new decision that the carrier is not entitled to a reduction of the claimant’s IIBs.  The Appeals Panel held that the carrier still bore the burden of proof at the hearing even though the Division issued an order approving the carrier’s application for contribution which the claimant appealed.  The Appeals Panel held that because the carrier failed to present a cumulative impact analysis, it did not meet its burden of proof.  The Appeals Panel analogized the case to the situation in which the Division determines a claimant is entitled to first quarter SIBs and the carrier appeals the determination.  In that situation, the employee still has the burden of proof at the hearing.  The decision was authored by Appeals Panel Judge Carisa Space-Beam. Appeal No. 230067, filed March 3, 2023.


Copyright 2023, Stone Loughlin & Swanson, LLP

Non-subscribers, do not forget to file the DWC-Form 005!

For all you non-subscribers not enjoying the many benefits of the Texas workers’ compensation system, it is that time of year again when you must tell DWC that you do not care enough to provide your employees with workers’ compensation coverage.  Employers must use the DWC-Form 005 to let DWC know they have opted out of the workers’ compensation system.  According to the Division’s Biennial Report to the 88th Legislature, “In 2022, the percentage of employers that were non-subscribers (25%) was the lowest in six years” and “The percentage of Texas employees working for non-subscribers (17%) was the lowest in 12 years.” In other words, three out of four employers have decided that it is in the best interest of them and their employees to carry workers’ compensation coverage.  Check out this link for more information for non-subscribers including a coverage comparison and analysis of alternative coverages: https://www.tdi.texas.gov/wc/employer/cb007.html


Copyright 2023, Stone Loughlin & Swanson, LLP


“No shot, no money”

 
Judging by those annoying television commercials from personal injury attorneys – especially during Sunday afternoon NFL football games – a car wreck In Texas can mean a BIG payday. Now we may know why. 

Two insurance companies have filed suit against a San Antonio doctor for allegedly prescribing unnecessary and expensive spinal procedures for the sole purpose of artificially inflating the value of his patients’ personal injury claims. The complaint, first filed in San Antonio federal court last July, alleges that San Antonio orthopedic surgeon Sanjay Misra, M.D. falsely purported to legitimately examine patients reporting neck or back pain and prescribed medically unnecessary epidural steroid injections for nearly all of them. 

The complaint describes one 16-year-old patient who told Dr. Misra that she was not comfortable with his recommendation that she receive an injection. He allegedly told her “Well, no shot, no money” -- or words to that effect. 

In the latest twist to the case, the San Antonio Express News reports this month that the insurers have subpoenaed communications between Dr. Misra and two personal injury attorneys that football fans know all too well – Jim Adler, who bills himself as the “Texas Hammer” and appears in television ads wielding a sledgehammer, and Jeff Davis, who appears in ads repeating his telephone number “444-4444!” ad nauseum. The subpoenas reportedly seek records of more than 185 of Dr. Misra’s patients, including documents reflecting the referral of those patients to Dr. Misra by Adler and Davis. The “Texas Hammer” is balking at turning over those records and has filed a motion to quash the subpoenas. 

In the Texas workers’ compensation system, the Official Disability Guidelines – Treatment in Workers’ Comp has gone a long way toward curbing unnecessary treatment. But the ODG does not govern treatment in personal injury cases. 

Treating victims of car wrecks appears to be treating Dr. Misra well. Bexar County Appraisal District records show that he owns a mansion in San Antonio which Redfin describes as being “built specifically for a high-profile NBA star” with 9 bedrooms, 9 bathrooms, a pool, a tennis court, and an estimated value of $4,163,165.

We’ve got a new BRO on the way 


We’ve learned that the Division has selected Louis Sanchez to be a Benefit Review Officer in Houston. Louis currently serves as an Ombudsman with the Office of Employee Counsel. It has been our pleasure to work with him in that capacity, and we look forward to working with him in his new role. 

Congratulations, Louis! 

Copyright 2023, Stone Loughlin & Swanson, LLP 

Dirk Johnson appointed as Injured Employee Public Counsel


This month Governor Greg Abbott appointed Dirk Johnson to serve as Injured Employee Public Counsel. In that role, he will oversee the Office of Injured Employee Counsel which, among other things, provides ombudsmen to assist injured employees at Benefit Review Conferences and Contested Case Hearings. Dirk has a wealth of experience in the industry and has previously served as general counsel to the Texas Department of Insurance, Division of Workers’ Compensation. 

His newest appointment is subject to Senate confirmation. Congratulations, Dirk!
 


To interpret the current LIBs statute, appeals court approves definition of “imbecility” from dictionary published when William Howard Taft was President  


The El Paso court of appeals has provided new guidance for interpreting the term “incurable imbecility” in Texas Labor Code section 408.161 pertaining to eligibility for Lifetime Income Benefits. In El Paso Independent School District v. Portillo, the court approved of a definition of imbecility from a 1910 edition of Black’s Law Dictionary.

The dispute arose when Alejandro Portillo, who worked for EPISD as a heating and air conditioning technician, climbed a ladder to assist a coworker and the coworker fell on top of him, causing Portillo to suffer a head injury. He received medical treatment at a rehabilitation facility for five months and thereafter experienced continuing headaches and dizziness which caused him to lose his balance and fall. Although he was eventually released to return to work in a semi-sedentary position at EPISD, he was not able to return to his prior job as an HVAC technician and subsequently chose to retire from the school district. He applied for LIBs on the ground that the injury left him with incurable imbecility. He lost at the Division but appealed to district court where a jury agreed that he was entitled to LIBs and the trial court entered judgment in his favor. 

On appeal, EPISD argued (among other things) that the jury charge contained an erroneous definition of “imbecility” because (1) it was based on an excerpt of the definition of that term in the dictionary from 1910 and (2) it was different than the definition used by the Administrative Law Judge at the Division, thereby changing the issue to be decided by the jury and “moving the goalposts” in Portillo’s favor. The court of appeals rejected both arguments and affirmed the trial court’s judgment that he suffers from “incurable imbecility.” 

In doing so, the court of appeals explained why it approved of a definition from 1910. It noted that words can change meaning over time – a concept known as “semantic drift” – so to construe the Legislature’s intent in using a statutorily undefined term it is appropriate to consider how the term was defined in dictionaries published as close in time to the enactment of the statute as possible. Since the Legislature added the term “imbecility” to the statute in 1917, the use of a dictionary from 1910, it said, is appropriate.  

The definition of “imbecility” given by the trial court and approved by the court of appeals is the following:
A more or less advanced decay and feebleness of the intellectual faculties; that weakness of mind which, without depriving the person entirely of the use of his reason, leaves only the faculty of conceiving the most common and ordinary ideas and such as relate almost always to physical wants and habits. 
Ahem . . . apparently, people talked differently in 1910. It was, after all, a different time. William Howard Taft was President and the maximum speed limit in most cities was 10 – 12 mph.

It may be time for the Legislature to update the statute. 

Right on cue: Bill proposes to remove the term “incurable imbecility” from LIBs statute


The El Paso court of appeals released its decision in Portillo on January 31, 2023, and nine days later, Texas Senator Drew Springer (R – Weatherford) filed a bill to delete the term “incurable insanity or imbecility” from the LIBs statute. Springer’s bill, SB 799, proposes to replace that archaic term with the phrase “a permanent major neurocognitive disorder or a psychotic disorder.” 

SB 799 would make other changes to the LIB statute as well. Of significance, the bill also would permit first responders to receive LIBs when they suffer a “serious bodily injury . . . that permanently prevents [them] from performing any gainful work.”