Continental Cas. Ins. Co. v. Functional Restoration Associates

• Decision Date: 12 March 1998
• Docket Number: No. 03-97-00103-CV,03-97-00103-CV
• Citation: 964 S.W.2d 776
• Parties: CONTINENTAL CASUALTY INSURANCE COMPANY, Appellant, v. FUNCTIONAL RESTORATION ASSOCIATES; Texas Workers' Compensation Commission; and Productive Rehabilitation Institute of Dallas for Ergonomics, Appellees.
• Court: Texas Court of Appeals

Page 776

964 S.W.2d 776

CONTINENTAL CASUALTY INSURANCE COMPANY, Appellant, v. FUNCTIONAL RESTORATION ASSOCIATES; Texas Workers'

Compensation Commission; and Productive

Rehabilitation Institute of Dallas for

Ergonomics, Appellees.

No. 03-97-00103-CV.

Court of Appeals of Texas,

Austin.

March 12, 1998.

Rehearing Overruled April 9, 1998.

Jane Stone O'Neil, Wilson Grosenheider Moore & Jacobs, L.L.P., for Appellant.

John D. Pringle, Law Offices of John D. Pringle, Austin, Dan Morales, Atty. Gen., for Functional & Productive.

Dewey E. Helmcamp, III, Asst. Atty. Gen., Administrative Law Division, Austin, for Texas Worker's.

Before CARROLL, C.J., and JONES and KIDD, JJ.

JONES, Justice.

Appellant Continental Casualty Insurance Company ("Continental") sued appellees Functional Restoration Associates ("FRA"), Productive Rehabilitation Institute of Dallas for Ergonomics ("PRIDE"), and the Texas Workers' Compensation Commission ("Commission") seeking judicial review of the Commission's decision in a medical-benefits dispute. The trial court dismissed the suit on the Commission's plea to the jurisdiction. On appeal, Continental challenges the dismissal, asserting both statutory and inherent bases for jurisdiction. ¹ We will reverse.

FACTUAL AND PROCEDURAL BACKGROUND

On February 20, 1992, James Hood was injured while in the course of his employment with Baylor Health Care. At that time, Continental was the workers' compensation insurance carrier for Baylor Health Care. Hood sought and received medical treatment for his injuries from FRA and PRIDE. Continental denied requests by FRA and PRIDE for preauthorization, and a medical-payment dispute was subsequently filed with the Commission's Division of Medical Review ("DMR"). See Tex. Lab.Code Ann. § 413.031(a) (West 1996) ("Labor Code"). After reviewing the medical service provided, the DMR concluded that the treatment by FRA and PRIDE for Hood's injuries was appropriate and that Continental, as the employer's carrier, was liable for the cost of his health care in the amount of $13,670.61 for PRIDE and $2,421.78 for FRA. Continental then requested a hearing pursuant to Labor Code § 413.031(d) to review the DMR decision. The result of that hearing was an affirmance of the DMR decision that Continental was liable for the cost of the medical treatment provided by FRA and PRIDE. Continental then sought review in a Travis County district court, asserting that the Commission's decision was not supported by substantial evidence and was arbitrary and capricious. The Commission filed a plea to the jurisdiction asserting that the Labor Code did not provide for judicial review of

DMR decisions. The trial court granted the plea and dismissed the suit, which Continental, FRA, and PRIDE now challenge.

DISCUSSION

The Commission is required to maintain a division of medical review to monitor compliance with rules relating to health care, including medical policies and fee guidelines. Labor Code § 413.002. A health care provider is entitled to review by the DMR if the provider is denied payment or authorization for medical services rendered or to be rendered. Labor Code § 413.031(a); see §§ 408.021, .027. If the dispute remains unresolved after the DMR decision, a party to the dispute is entitled to a hearing. ² Labor Code § 413.031(d). The review hearing is conducted "in the manner provided for a contested case under Chapter 2001, Government Code (the administrative procedure law [sic] )." Id. The question presented here is whether a party to a review hearing has a right to have a court review the decision resulting from that hearing.

I. Statutory Right to Judicial Review

In its first point of error, Continental asserts that the trial court erred in failing to find a statutory grant of judicial review of DMR decisions. No right of judicial review of agency action exists unless a statute provides for such review, the action violates a constitutional right, or the action adversely affects a vested property right. Stone v. Texas Liquor Control Bd., 417 S.W.2d 385, 386 (Tex.1967). Legislative consent for suit must be by "clear and unambiguous language." Federal Sign v. Texas Southern Univ., 951 S.W.2d 401, 405 (Tex.1997). Because this Court has already held that the Administrative Procedure Act, Tex. Gov't Code Ann. ch. 2001 (West 1998), does not itself grant a right of judicial review, Continental must identify another statutory source for that entitlement. See Southwest Airlines Co. v. Texas High-Speed Rail Auth., 867 S.W.2d 154, 158 (Tex.App.-- Austin 1993, writ denied).

Continental contends that Labor Code § 410.251 grants judicial review of the Commission's decisions in medical-benefits disputes. In that section, however, the legislature granted a right of judicial review only to parties who have exhausted their administrative remedies and are "aggrieved by a final decision of the appeals panel." ³ Labor Code § 410.251. But the Labor Code does not provide for--and Continental does not assert that it has requested or received--review of the DMR decision by an appeals panel. Continental asks us instead to treat the language referring to a decision of the appeals panel as merely duplicative of the exhaustion requirement. However, this Court does not, if possible, treat any statutory language as surplusage. See Chevron Corp. v. Redmon, 745 S.W.2d 314, 316 (Tex.1987). We conclude, therefore, that section 410.251, which grants judicial review of appeals-panel decisions, does not grant judicial review of the DMR decision in the present case.

The legislature expressly created an entitlement to judicial review for several issues in which no appeals-panel decision is involved. First, for disputes that involve decisions of the director of the Commission concerning security deposits required for employers who desire to self-insure for workers' compensation, "a party aggrieved by a decision of the director is entitled to judicial review." Labor Code § 407.066(b). Second, for disputes concerning findings of the Commission concerning designation as an extra-hazardous employer, an employer may request a hearing to contest such findings, and "[t]he hearing shall be conducted ... in the manner provided for a contested case under Chapter 2001, Government Code (the administrative procedure law) and is subject to judicial review as provided by that chapter." Labor Code § 411.049(b) Although an express grant of judicial review is generally required, this Court has occasionally found judicial review to be necessarily implied by statutory language that would otherwise be meaningless without such an implication. See Beyer v. Employees Retirement Sys., 808 S.W.2d 622, 626 (Tex.App.--Austin 1991, writ denied); Texas State Dep't of Human Resources v. Silver Threads Co., 569 S.W.2d 49, 51 (Tex.Civ.App.--Austin 1978, writ ref'd n.r.e.). The appeal in Beyer concerned a decision made by State Board of Trustees for the Employees Retirement System of Texas. Beyer, 808 S.W.2d at 624. The relevant statute in Beyer did not explicitly grant a right to judicial review, but did state that "on appeal of a decision made by the trustee ... the standard of review is by substantial evidence." Id. at 625. This Court concluded that in declaring the standard of review to be applied, the statute "authorized by necessary implication a suit for judicial review" because the expression of the standard of review would otherwise be meaningless. Id. at 626. This is consistent with the principle that courts generally give effect to all words in a statute and, if possible, do not treat any statutory language as surplusage. Chevron Corp., 745 S.W.2d at 316.

(emphasis added). Third, for disputes that concern administrative violations, a charged party may request a hearing, and any decision resulting from that hearing "is subject to judicial review in the manner provided for judicial review under Chapter 2001, Government Code." Labor Code §§ 415.034, .035. In sum, the Legislature explicitly created a right to judicial review for self-insurance security deposits, extrahazardous employer designation, and administrative violations. However, there is no language in the chapter on medical review (chapter 413) or elsewhere that expressly grants judicial review of DMR decisions. Although not conclusive, the axiom that express inclusion of one thing is tantamount to express exclusion of all others for purposes of statutory construction weighs against finding a statutory grant of judicial review of DMR decisions. See Johnson v. Second Injury Fund, 688 S.W.2d 107, 108 (Tex.1985); State v. Mauritz-Wells Co., 141 Tex. 634, 175 S.W.2d 238, 241 (1943).

On a similar theory, Continental asserts that a right to judicial review of DMR decisions is implied by Labor Code § 410.255, which states:

(a) For all issues other than those covered under Section 410.301(a), judicial review shall be conducted in the manner provided for judicial review of a contested case under Subchapter G, Chapter 2001, Government Code.

(b) Judicial review conducted under this section is governed by the substantial evidence rule.

Labor Code § 410.255. Section 410.301(a) covers Commission appeals-panel decisions regarding compensability or eligibility for or the amount of income or death benefits. Therefore, since the issues in DMR decisions are not covered under section 410.301(a), an appeal from a DMR decision, if permitted, would fall under section 410.255. Continental suggests that, just as the declaration of the standard of judicial review discussed in Beyer implied a right to judicial review, section 410.255 likewise implies a right of judicial review of DMR decisions. Unlike the statute in Beyer, however, section 410.255 is not rendered meaningless absent judicial review of a DMR decision. Disputes concerning self-insurance security deposits, extrahazardous employer designation, and administrative violations are governed by section 410.255 and, as discussed above, ...