Opinion
14-24-00070-CV
12-12-2024
JOSEPH ANDRE DAVIS, Appellant v. CITY OF HOUSTON, Appellee
On Appeal from the 55th District Court Harris County, Texas Trial Court Cause No. 2023-64640.
Panel consists of Jewell, Bourliot, and Zimmerer, Justices.
MEMORANDUM OPINION
Kevin Jewell, Justice.
Appellant Joseph Andre Davis suffered a compensable on-the-job injury covered by worker's compensation insurance. His employer, the City of Houston, paid temporary income benefits for a period of time, but Davis contends that he is entitled to additional benefits. Because we conclude that there is no enforceable order entitling Davis to additional benefits, we affirm the trial court's judgment dismissing Davis's suit.
Background
Davis was a Firefighter/Paramedic for the City of Houston and sustained a compensable job-related injury on December 11, 2015. He filed a claim for compensation with the City, which is self-insured. The City paid Davis temporary income benefits from the date of his injury through August 2016.
The parties disputed the extent of Davis's compensable injury, the date Davis reached maximum medical improvement ("MMI"), and Davis's impairment rating. A benefit review officer with the Texas Department of Insurance, Division of Workers' Compensation (the "Division") held a benefit review conference on December 8, 2016, to mediate resolution of the disputed issues. The parties were unable to reach agreement. Accordingly, on January 30, 2017, a Division hearing officer held a contested case hearing. In a decision and order signed on February 16, 2017, the hearing officer determined: (1) that Davis's compensable injury included lumbar strain, lumbar radiculitis, a 2 mm disc bulge at L4-L5, and a 3 mm disc bulge at L5-S1 with mild to moderate central canal stenosis and mild neural foramen stenosis; and (2) that Davis reached MMI on August 20, 2016, with a 5% impairment rating. The hearing officer ordered the City to pay benefits in accordance with the decision.
Davis appealed to the Appeals Panel, which did not change the hearing officer's decision. Accordingly, the hearing officer's decision and order became final on May 24, 2017. See Tex. Lab. Code § 410.204(c) ("If the appeals panel does not issue a decision in accordance with this section, the decision of the administrative law judge becomes final and is the final decision of the appeals panel.").
In July 2017, Davis untimely sought judicial review of the appeals panel's decision to district court. Id. § 410.252(a) ("(a) A party may seek judicial review by filing suit not later than the 45th day after the date on which the division mailed the party the decision of the appeals panel."). However, the City did not move to dismiss Davis's appeal. See Tex. Mut. Ins. Co. v. Chicas, 593 S.W.3d 284, 291 (Tex. 2019) ("We conclude that the 45-day deadline to seek review from an appeals-panel decision in section 410.252(a) is not jurisdictional."). In November 2021, the district court granted Davis's motion to return to the designated doctor for a re-examination and re-determination of MMI and impairment rating.
In March 2022, a Division administrative law judge held a contested case hearing to decide the disputed issue of the date of statutory MMI. As relevant here, there are two dates on which a claimant may reach MMI-a clinical date or a statutory date. Clinical MMI is the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated. See 28 Tex. Admin. Code § 130.1(b)(1)(A). Statutory MMI is the expiration of 104 weeks from the date on which income benefits begin to accrue. Id. § 130.1(b)(1)(B). As the supreme court has noted, this definition of statutory MMI "establishes what is in essence a two year cap on temporary income benefits for all claimants," regardless of whether the claimant's condition has actually stabilized. Tex. Worker's Comp. Comm'n v. Garcia, 893 S.W.2d 504, 524-25 (Tex. 1995). The administrative law judge concluded that the date of statutory MMI in this case was December 16, 2017.
The March 2022 order states that the parties "require a determination of the statuto MMI date, which is the purpose of this expedited contested case hearing."
There is a third possible date of MMI specifically for spinal surgeries. See Tex. La Code § 408.104.
In April 2022, the designated doctor, Dr. Kelley Samuel, re-examined Davis. In Dr. Samuel's reports, the doctor noted that there was "difficulty in determining what is currently being disputed." Therefore, the doctor considered the lumbar strain and radiculitis as the compensable injury and the intervertebral disc displacements as disputed conditions. Dr. Samuel certified that Davis reached clinical MMI on June 27, 2016 for the lumbar strain and radiculitis and that Davis reached statutory MMI on December 16, 2017 for the lumbar strain, radiculitis, and other intervertebral disc displacements.
According to the parties, Davis asked the district court to compel the payment of benefits pursuant to Dr. Samuel's re-examination report. (We do not have a copy of Davis's motion, but the parties agree on the nature of the motion.) The district court denied Davis's motion. In July 2022, Davis nonsuited his case in district court, which was for judicial review of the hearing officer's February 2017 decision and order. See Tex. Lab. Code § 410.252(a).
In June 2023, an administrative law judge determined that Davis had disability from August 16, 2016 to December 16, 2017. Davis then filed an original petition for judicial enforcement of the March 2022 and June 2023 decisions, which Davis contends entitle him to additional benefits but with which the City has refused to comply. See id. § 410.208(b) ("If an insurance carrier refuses or fails to comply with an interlocutory order, a final order, or a decision of the commissioner, the claimant may bring suit in the county of the claimant's residence at the time of the injury. . . .").
The City filed a motion for summary judgment, arguing that, because it had complied with all enforceable orders from the Division regarding the payment of benefits to Davis, there is no genuine issue as to any material fact relating to Davis's request for judicial enforcement of any order in the workers' compensation claim. The trial court granted the City's motion and dismissed Davis's suit.
Davis appeals.
Standard of Review
To prevail on a traditional motion for summary judgment, the movant must show that there is no genuine issue of material fact and that it is entitled to judgment as a matter of law. Provident Life & Accident Ins. Co. v. Knott, 128 S.W.3d 211, 215-16 (Tex. 2003). If the movant carries this burden, the burden shifts to the nonmovant to raise a genuine issue of material fact precluding summary judgment. Lujan v. Navistar, Inc., 555 S.W.3d 79, 84 (Tex. 2018) (citing Centeq Realty, Inc. v. Siegler, 899 S.W.2d 195, 197 (Tex. 1995)). We review the summary judgment de novo, construing the evidence in the light most favorable to the nonmovant by crediting evidence favorable to the nonmovant if a reasonable juror could and disregarding contrary evidence unless a reasonable juror could not. Mann Frankfort Stein & Lipp Advisors, Inc. v. Fielding, 289 S.W.3d 844, 848 (Tex. 2009).
Although the City's motion was styled as seeking both traditional and no-evidence summary judgment, the City cited only traditional summary-judgment principles and raised only traditional summary-judgment grounds. Therefore, we construe the motion as one seeking only traditional summary judgment. See Gottwald v. O'Connell, No. 14-19-00626-CV, 2020 WL 6737604, at *1-2 & n.5 (Tex. App.-Houston [14th Dist.] Nov. 17, 2020, pet. denied) (mem. op.).
Analysis
Davis presents four issues. His primary complaint is that the trial court erred in granting the City's motion for summary judgment. Davis also contends that the trial court abused its discretion by permitting the City to disclose confidential information. We begin by summarizing the pertinent statutes that apply in workers' compensation claims before turning to the merits of Davis's arguments.
The Texas Workers' Compensation Act establishes a comprehensive system for resolving workers' compensation claims and provides the exclusive procedures and remedies for disputed issues arising from a worker's claim for benefits. Tex. Mut. Ins. Co. v. Ruttiger, 381 S.W.3d 430, 438 (Tex. 2012). There are four potential stages to the determination and review of disputed issues in a worker's compensation claim. In re Tex. Mut. Ins. Co., 333 S.W.3d 925, 927 (Tex. App.- Waco 2011, orig. proceeding). The first three are within the Division, and the fourth is a judicial review. The three-stage hearing process before the Division consists of: (1) the benefit review conference; (2) the contested case hearing; and (3) the administrative appeal. Garcia, 893 S.W.2d at 514-15. A party who has exhausted his administrative remedies and who is aggrieved by a final decision of the appeals panel has the right to seek judicial review. Tex. Lab. Code §§ 410.251, 410.301.
The benefit review conference is an informal proceeding aimed at resolving the disputed issues by mutual agreement. Id. § 410.021. If the matter is not resolved at the benefit review conference stage, the parties may proceed to a contested case hearing, which is a formal evidentiary proceeding with sworn testimony and prehearing discovery procedures. Id. §§ 410.151-.169. The hearing officer decides the disputed issues by written decision containing factual and legal findings, awarding benefits if they are due. Id. § 410.168(a). The hearing officer's decision is final in the absence of a timely appeal by a party and is binding during the pendency of an appeal to the appeals panel. Id. § 410.169.
Any party may appeal the hearing officer's decision to an appeals panel within the Division. Id. § 410.202. This appeal is not a trial de novo but is limited to review of the contested case hearing record. Id. § 410.203. The request for appeal and the opposing party's response must "clearly and concisely rebut or support the decision of the hearing officer on each issue on which review is sought." Id. § 410.202(c). After considering the parties' briefs and the record from the contested case hearing, the appeals panel may affirm the decision of the hearing officer, reverse and render a new decision, or remand no more than one time to the hearing officer for further consideration and development of the record. Id. § 410.203. If the appeals panel does not issue a decision, the decision of the administrative law judge becomes final and is the final decision of the appeals panel. Id. § 410.204(c).
A party who is aggrieved by a final decision of the appeals panel may seek judicial review of the appeals panel's decision. Id. § 410.251. Issues regarding compensability or eligibility for, and the amount of, income or death benefits may be tried to a jury and are subject to a modified de novo review. Id. § 410.301; Garcia, 893 S.W.2d at 528. Judicial review is limited to issues decided by the Division appeals panel and on which judicial review is sought. Tex. Lab. Code § 410.302(b).
The Act was enacted "to balance the competing interests of providing compensation for injured employees while protecting employers from the costs of litigation." SeaBright Ins. v. Lopez, 465 S.W.3d 637, 642 (Tex. 2015) (internal quotation omitted). The system offers "four levels of income benefits: 1) temporary income benefits; 2) impairment income benefits; 3) supplemental income benefits; and 4) lifetime benefits." Garcia, 893 S.W.2d at 513. At issue in this case is temporary income benefits.
Under section 408.101(a) of the Labor Code, an employee is entitled to temporary income benefits if he or she has a disability and has not attained MMI. See Tex. Lab. Code § 408.101(a); see also 28 Tex. Admin. Code § 129.2. Disability is defined as "the inability because of a compensable injury to obtain and retain employment at wages equivalent to the preinjury wage." Tex. Lab. Code § 401.011(16). MMI is:
(A) the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated [clinical MMI]; [or]
(B) the expiration of 104 weeks from the date on which income benefits begin to accrue [statutory MMI].28 Tex. Admin. Code § 130.1(b)(1)(A)-(B).
In certifying MMI, the doctor reviews medical records, performs a complete medical examination for the purpose of determining MMI, and assigns a specific MMI date. Id. § 130.1(b)(4). The impairment rating for the current compensable injury must be based on the employee's condition as of the MMI date considering the medical record and the certifying examination. Id. § 130.1(c)(3).
A. The City's motion for summary judgment
The City moved for summary judgment on Davis's suit for judicial enforcement of the Division's March 2022 and June 2023 orders. The City argued that it had paid all benefits owing to Davis for his compensable injury. We agree.
Davis is entitled to temporary income benefits if he (i) has a disability and (ii) has not attained MMI. Tex. Lab. Code § 408.101(a). In February 2017, the Division hearing officer concluded that, based on the preponderance of the evidence, Davis reached MMI on August 20, 2016, with an assigned 5% impairment rating. Davis challenged this determination through appeal to the Division appeals panel and then to district court. However, while Davis's judicial review challenge was pending in district court and before the district court made a determination on the merits, Davis nonsuited his case.
A nonsuit "extinguishes a case or controversy from 'the moment the motion is filed' or an oral motion is made in open court; the only requirement is 'the mere filing of the motion with the clerk of the court.'" Univ. of Tex. Med. Branch at Galveston v. Est. of Blackmon ex rel. Shultz, 195 S.W.3d 98, 100 (Tex. 2006) (per curiam) (quoting Shadowbrook Apts. v. Abu-Ahmad, 783 S.W.2d 210, 211 (Tex. 1990) (per curiam)). It renders the merits of the nonsuited case moot. See Villafani v. Trejo, 251 S.W.3d 466, 469 (Tex. 2008) ("One unique effect of a nonsuit is that it can vitiate certain interlocutory orders, rendering them moot and unappealable."); Gen. Land Office v. OXY U.S.A., Inc., 789 S.W.2d 569, 571 (Tex. 1990) ("As a consequence of the trial court's granting the nonsuit, the temporary injunction ceased to exist and the appeal became moot. . . . It was not necessary for the trial court to enter such a separate order because when the underlying action was dismissed, the temporary injunction dissolved automatically.") (internal citation omitted).
Thus, Davis's nonsuit of his case rendered moot any challenge to the Division's February 2017 decision regarding the contested issues relevant to Davis's compensable injury. The underlying decision therefore became final and binding. For purposes of Davis's claim for compensation from his December 11, 2015 injury, he reached clinical MMI on August 20, 2016.
The March 2022 order, in which the administrative law judge held that the statutory MMI date in this case is December 16, 2017, does not alter his entitlement to temporary income benefits. The March 2022 decision merely answered the question of when the statutory MMI date expired. The March 2022 decision did not find or conclude, based on any medical evidence, that Davis had not reached clinical MMI on August 20, 2016 and instead had reached statutory MMI on December 16, 2017.
The June 2023 order, issued after Davis nonsuited his judicial review challenge to the Division's February 2017 decision, likewise is of no consequence. The June 2023 order concluded that Davis had disability from August 16, 2016 to December 16, 2017. This would entitle a claimant to temporary income benefits for that period only if he had not already reached MMI. Because the Division already had concluded that Davis reached MMI on August 20, 2016, that is the last date that factors into his entitlement to temporary income benefits.
"Disability and MMI are different concepts, although both may impact on the payment of temporary income benefits (TIBs)." Appellant v. Respondent, Appeal No. 070139, 2007 WL 1034969, at *1 (Tex. Worker's Comp. Comm'n Mar. 29, 2007). Disability can continue after MMI, but a claimant is not entitled to temporary income benefits after the date of MMI. Id. at *1-2.
We overrule Davis's first, third, and fourth issues.
B. Confidentiality
In his second issue, Davis argues that the City violated the Labor Code's guarantee of confidentiality when it, as part of its summary-judgment proof, submitted and relied upon a November 2023 letter issued by an insurance specialist within the Division. See Tex. Lab. Code § 402.083(a) ("Information in or derived from a claim file regarding an employee is confidential and may not be disclosed by the division except as provided by this subtitle or other law.").
In the investigation letter, the insurance specialist stated that the Division completed an investigation on Davis's compensation claim relating to "[f]ailure to timely comply with a final, or binding contested case hearing (CCH) order or decision." The specialist concluded that Davis reached MMI on August 20, 2016; "therefore, no benefits accrued after this date and no additional benefits, or interest, are owed."
Davis did not object to the City's use of the letter until he filed a motion for new trial. This was too late to preserve any error. "[I]n an appeal from a summary judgment, an objection raised for the first time in a motion for new trial is untimely and insufficient to preserve the alleged error for review." Williamson v. New Times, Inc., 980 S.W.2d 706, 712 (Tex. App.-Fort Worth 1998, no pet.); see also Godoy v. Wells Fargo Bank, N.A., 575 S.W.3d 531, 537 (Tex. 2019); Kelley-Coppedge, Inc. v. Highlands Ins. Co., 980 S.W.2d 462, 467 (Tex. 1998).
We overrule Davis's second issue.
Conclusion
We affirm the trial court's judgment.