Opinion
No. 05-09-00087-CV
Opinion Filed October 19, 2009.
On Appeal from the 95th Judicial District Court, Dallas County, Texas, Trial Court Cause No. DC-08-06022-D.
Before Chief Justice THOMAS and Justices O'NEILL and MURPHY.
MEMORANDUM OPINION
In two issues, appellant Keith Johnson generally appeals the order granting appellee Zurich American Insurance Company's plea to the jurisdiction and motion to dismiss. We affirm.
Background
Appellant filed suit seeking damages against appellee as his workers' compensation carrier for denial of medical care under the Texas Workers' Compensation Act. Appellee filed a plea to the jurisdiction and motion to dismiss based on appellant's failure to exhaust his administrative remedies under the workers' compensation act prior to filing suit. The trial court granted the plea to the jurisdiction and motion to dismiss, and this appeal ensued.
Standard of Review and Applicable Law
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. Lang, 207 S.W.3d 334, 340 (Tex. 2006). If an administrative body has exclusive jurisdiction, courts have no subject matter jurisdiction over the dispute until the party has exhausted all of the administrative remedies within the agency. See Subaru of Am., Inc. v. David McDavid Nissan, Inc., 84 S.W.3d 212, 221 (Tex. 2002).
Through the Texas workers' compensation statutory scheme, the legislature has vested the Division of Workers' Compensation (the Division) with exclusive jurisdiction to determine a claimant's entitlement to medical benefits. See Tex. Lab. Code Ann. § 413.031 (Vernon 2006); Am. Motorists Ins. Co. v. Fodge, 63 S.W.3d 801, 803-04 (Tex. 2001). The workers' compensation act gives the Division jurisdiction to adjudicate medical benefits disputes, including preauthorization of medical care and medical necessity of a health care service. Id.
Effective September 1, 2005, the legislature dissolved the Texas Workers' Compensation Commission, created the Division of Workers' Compensation, and merged the Division with the Texas Department of Insurance. Act of June 1, 2005, 79th Leg., R.S., ch. 265, § 8.001, 2005 Tex. Gen. Laws 469, 607-08.
A party's failure to exhaust administrative remedies under the workers' compensation laws deprives the district court of jurisdiction over the party's request for judicial review. Tex. Lab. Code Ann. § 410.251 (Vernon 2006); Combined Specialty Ins. Co. v. Deese, 266 S.W.3d 653, 658 (Tex. App.-Dallas 2008, no pet.). The exhaustion pre-requisite to judicial review is satisfied only after a party's claims have been reviewed in a contested administrative hearing, followed by a timely appeal to the Division's appeals panel. Deese, 266 S.W.3d at 658.
Analysis
Appellant's lawsuit alleges denial by appellee of medical treatment appellant asserts to be reasonable and necessary following his November 13, 2006 work injury. Under the workers' compensation act, appellant was entitled to contest denial of the medical treatment requests through an administrative dispute resolution procedure. Tex. Lab. Code Ann. § 413.031. Appellant did not, however, submit any disputes concerning the denied requests for administrative review at the Division prior to filing suit. Since appellant's claim against appellee depends on whether he was entitled to the medical care he purports was reasonable and necessary, that issue must first be addressed administratively. See Tex. Lab. Code Ann. § 413.031; Fodge, 63 S.W.3d at 804. Because it was not, the trial court correctly granted appellee's plea to the jurisdiction and dismissed the suit. See id. at 805.
Appellant's failure to exhaust his administrative remedies leaves the trial court without subject matter jurisdiction over the lawsuit. See In re Entergy Corp., 142 S.W.3d 316, 321-22 (Tex. 2004). The trial court properly granted appellee's plea to the jurisdiction and motion to dismiss. We overrule appellant's issues on appeal.
We affirm the trial court's judgment.