Opinion
No. 05-06-00719-CV
Opinion Filed August 22, 2007.
On Appeal from the County Court at Law No. 1 Dallas County, Texas, Trial Court Cause No. 05-05838-A.
Before Justices MOSELEY, O'NEILL, and FITZGERALD.
MEMORANDUM OPINION
Appellant the Centre for Neuro Skills, Inc.-Texas (CNS) appeals a dismissal entered in favor of appellee Association Casualty Insurance Company (ACIC). In two issues, CNS contends the trial court erred in (1) dismissing its claim against ACIC, and (2) failing to grant its motion to compel discovery responses. For the following reasons, we affirm the trial court's judgment.
Mark Young was employed by Simmons Ditching Company, an employer insured for workers' compensation benefits by appellee ACIC. Young sustained a work related injury and received medical treatment by CNS. CNS had a contract with CorVel corporation, an entity that provides cost containment services to insurance carriers. In the CNS/CorVel contract, CNS agreed to charge discounted rates to patients who are covered by insurance carriers that "participate" with CorVel. In return, CorVel agreed to refer patients to CNS and promote CNS as a preferred provider to participating carriers.
CNS subsequently charged ACIC, Young's carrier, a discounted rate for the services provided. ACIC failed to pay a portion of the bill based on its contention that CNS had failed to comply with certain preauthorization requirements of the workers' compensation act. CNS then sued ACIC in county court to recover payment for the unpaid balance. CNS alleged Young had assigned it his benefits under the ACIC policy. It sought recovery from ACIC for medical services provided to Young based on ACIC's breach of duty to "honor" Young's assignment of insurance benefits and breach of duty to make payments to CNS of such "assigned insurance benefits."
ACIC filed a motion to dismiss for want of jurisdiction alleging CNS had failed to exhaust its administrative remedies. Specifically, CNS was seeking to recover for medical services provided to Young pursuant to a workers' compensation policy, a dispute that fell within the jurisdiction of the Texas Department of Insurance, Workers' Compensation Division (the Division). The trial court agreed and dismissed CNS's claim without prejudice.
The authority of the Division was formerly vested in the Worker's Compensation Commission, which was abolished effective September 1, 2005. See Act of May 29, 2005, 79th Leg., R.S., ch. 265, § 8.001, 2005 Tex. Gen. Laws 469, 687.
Whether a court has subject-matter jurisdiction is a question of law which we review de novo. Tex. Natural Res. Conservation Comm'n v. IT-Davy, 74 S.W.3d 849, 855 (Tex. 2002); OHBA Corp. v. City of Carrollton, 203 S.W.3d 1, 4, (Tex.App.-Dallas 2006, pet. denied). In performing this review, we do not look to the merits of the plaintiff's case, but consider only the pleadings and the evidence pertinent to the jurisdictional inquiry. Tex. Dep't of Parks Wildlife v. Miranda, 133 S.W.3d 217, 227 (Tex. 2004); OHBA Corp., 203 S.W.3d at 4.
When the legislature grants an administrative body the sole authority to make an initial determination in a dispute, the agency has exclusive jurisdiction over the dispute. Thomas v. Long, 207 S.W.3d 334, 340 (Tex. 2006). If an administrative body has exclusive jurisdiction, a party must exhaust all administrative remedies before seeking judicial review of the decision. Id. Until the party has satisfied the exhaustion requirement, the trial court lacks subject matter jurisdiction and must dismiss those claims without prejudice to refiling. Id.
The workers' compensation act specifically provides a remedy to heath care providers where the provider is denied payment or paid a reduced amount for the services rendered. See Tex. Lab. Code Ann. § 413.031 (Vernon 2006); Hays Martin, L.L.P. v. Ubinas-Brache, 192 S.W.3d 631, 634 (Tex.App.-Dallas 2006, pet. denied). Thus, the Division has exclusive jurisdiction of disputes concerning reimbursement of medical expenses, including those concerning preauthorization of medical care. See American Motorists Insurance Co. v. Fodge, 63 S.W.3d 801, 803 (Tex. 2001).
In its first issue, CNS asserts the trial court erred in dismissing its case because the Division does not have jurisdiction over independent contractual claims between health care providers and insurance carriers that are not derivative of a patient's workers' compensation claim. It thus asserts it can sue ACIC outside the workers' compensation scheme for breach of contract.
We do not disagree that trial courts have jurisdiction over breach of contract claims between carriers and providers that are not within the jurisdiction of the Division. See e.g., Hays Martin, 192 S.W.3d at 634. However, we disagree that any such claim was alleged in this case. It is undisputed that no contract exists between CNS and ACIC. To show it nevertheless had an independent claim against ACIC, CNS relies on an alleged contract between ACIC and CorVel. It maintains it can sue under this contract as a third party beneficiary.
In its live petition, CNS sought to recover for the payment of medical services provided to Young based on Young's assignment to it of the claim. Nowhere did CNS state that it was a third party beneficiary of ACIC's alleged contract with CorVel. Although CNS later filed a second amended petition alleging it was a third party beneficiary of "any" agreements between ACIC and CorVel, that petition was not before the trial court at the time it dismissed the cause. Although CNS attempts to recharacterize and recast its claim, we conclude CNS's petition makes clear that it is seeking payment for assigned workers' compensation benefits, a claim clearly within the jurisdiction of the Division. We resolve the first issue against CNS.
In its second issue, CNS asserts the trial court erred in failing to compel ACIC to produce its "contracts, agreements, or understandings" with CorVel pertaining to Young's claim. CNS provides no legal argument and cites no authority in support of this issue. We conclude it has waived this issue on appeal. See TEX. R. APP. P. 38.1(h); Moreno v. Reliable Insulation, Inc., 217 S.W.3d 769, 771 (Tex.App.-Dallas 2007, no pet.); Huey v. Huey, 200 S.W.3d 851, 854 (Tex.App.-Dallas 2006, no pet.). We resolve the second issue against CNS.
We affirm the trial court's order.