Continental Cas. Ins. v. Functn'l Restor. Assoc.

• Decision Date: 06 July 2000
• Citation: 19 S.W.3d 393
• Parties: (Tex. 2000) CONTINENTAL CASUALTY INSURANCE COMPANY, PETITIONER v. FUNCTIONAL RESTORATION ASSOCIATES, PRODUCTIVE REHABILITATION INSTITUTE OF DALLAS FOR ERGONOMICS, AND THE TEXAS WORKERS' COMPENSATION COMMISSION, RESPONDENTS NO. 98-0479
• Court: Texas Supreme Court

Page 393

19 S.W.3d 393 (Tex. 2000)

CONTINENTAL CASUALTY INSURANCE COMPANY, PETITIONER v. FUNCTIONAL RESTORATION ASSOCIATES, PRODUCTIVE REHABILITATION INSTITUTE OF DALLAS FOR ERGONOMICS, AND THE TEXAS WORKERS' COMPENSATION COMMISSION, RESPONDENTS

NO. 98-0479

IN THE SUPREME COURT OF TEXAS

Argued January 13, 1999

Decided April 6, 2000

Rehearing Overruled July 6, 2000

On Petition for Review from the Court of Appeals for the Third District of Texas

Court of Appeals reversed.

[Copyrighted Material Omitted] JUSTICE ABBOTT delivered the opinion of the Court, in which JUSTICE ENOCH, JUSTICE BAKER, JUSTICE HANKINSON and JUSTICE O'NEILL joined, and in Part III of which JUSTICE GONZALES joined.

CHIEF JUSTICE PHILLIPS filed a dissenting opinion in which JUSTICE GONZALES joined, and in which JUSTICE HECHT joined in Parts I, II, and III , and in which JUSTICE OWEN joined in Part II.

JUSTICE OWEN filed a dissenting opinion in which JUSTICE HECHT joined.

In this case we determine whether Continental Casualty Insurance Co. ("Continental") is entitled to judicial review of a medical benefits decision by the Texas Workers' Compensation Commission's Hearings Division. The trial court dismissed Continental's suit for want of jurisdiction. The court of appeals reversed, holding that although the Texas Workers' Compensation Act does not confer a statutory right to judicial review of medical benefits disputes, Continental has an inherent right to judicial review. 964 S.W.2d 776. Because we conclude that Continental has no statutory right to judicial review and failed to plead a right to inherent judicial review, we reverse the court of appeals' judgment and affirm the district court's judgment dismissing the suit.

I

James Hood suffered an on-the-job injury compensable under the Workers' Compensation Act. At the time, Continental was the workers' compensation insurance carrier for Hood's employer. Hood received medical treatment for his injury from Functional Restoration Associates ("FRA") and Productive Rehabilitation Institute of Dallas for Ergonomics ("PRIDE"). Continental returned a request-for-preauthorization form to PRIDE, stating "[reasonable and] necessary as related to injury will defer to MEO Dr. to determine necessity."¹. After treatment began, Continental received a medical opinion that the treatments were not necessary. Continental then informed FRA and PRIDE that it would not authorize treatment, and refused payment.

In response, FRA and PRIDE requested medical dispute resolution from the commission. See TEX. LAB. CODE 413.031(a). The commission's Division of Medical Review issued a decision that Continental was liable for the cost of the health care. Continental then requested a hearing before the commission's Hearings Division. See TEX. LAB. CODE 408.027(d), 413.031(d). The hearing officer ordered Continental to pay the medical bills.

Continental filed suit in Travis County district court seeking judicial review of the commission's decision. After the trial court requested briefing on jurisdiction, the commission entered a plea to the jurisdiction. The trial court granted the plea and dismissed the suit. The court of appeals reversed, holding that, although the Workers' Compensation Act does not confer a right to judicial review of medical benefits disputes, Continental has an inherent right to judicial review of the agency decision because the commission proceedings affected a vested property right. 964 S.W.2d 776. Both Continental and the commission filed petitions for review.

II

There are four types of benefits available to injured workers under the Texas Workers' Compensation Act: medical, income, death, and burial. See TEX. LAB. CODE 401.011(5). Generally, disputes concerning a carrier's liability for benefits are resolved through the dispute resolution procedures of Chapter 410, entitled "Adjudication of Disputes." See id. 410.002. These procedures usually involve a benefit review conference, a contested case hearing, and an appeal to the commission appeals panel. See Lumbermens Mut. Cas. Co. v. Manasco, 971 S.W.2d 60, 61 (Tex. 1998).

Although these procedures generally govern benefits dispute resolution, the Act also provides a different dispute resolution procedure for certain types of medical benefits disputes. These procedures are described in Chapter 413, entitled "Medical Review." Section 413.031 provides that a health care provider has a right to commission review of a medical service provided if the health care provider is denied payment or authorization for the service. TEX. LAB. CODE 413.031(a)(1),(2). Thus, section 413.031 review covers fee disputes and preauthorization disputes.². Review is conducted by the commission's Division of Medical Review in Austin, unless the health care provider or the commission requests that the review be conducted by a professional review organization. See id. 413.031(c). A party to a medical dispute that remains unresolved after a medical benefits review is entitled to a hearing conducted in accordance with Chapter 2001 of the Government Code, the Administrative Procedure Act ("APA").³. See id. 413.031(d); see also id. 408.027(d).

An APA hearing is an adversarial, trial-type proceeding. The decision of the hearing officer in a section 413.031 hearing is final. See id. 402.073(b). Chapter 413 does not state whether a hearing officer's decision is subject to judicial review. The question presented is whether Continental is entitled to judicial review of the hearing officer's decision regarding its medical benefits dispute. Continental, joined by FRA and PRIDE,⁴. argues that it has such a right under the Workers' Compensation Act, or, alternatively, that it has an inherent right to judicial review. The commission, on the other hand, contends that Continental has neither a statutory nor an inherent right to judicial review. We hold that Continental does not have a statutory right to judicial review. Further, without deciding whether Continental has a constitutional due process right to judicial review of the commission's order, we conclude that Continental failed to plead such a right in the district court. Therefore, we hold that the district court properly granted the plea to the jurisdiction.

III

It is well recognized under Texas law that there is no right to judicial review of an administrative order unless a statute provides a right or unless the order adversely affects a vested property right or otherwise violates a constitutional right. See Stone v. Texas Liquor Control Bd., 417 S.W.2d 385, 385-86 (Tex. 1967); see also Firemen's & Policemen's Civil Serv. Comm'n of Fort Worth v. Kennedy, 514 S.W.2d 237, 239 (Tex. 1974). Therefore, the first inquiry is whether the Texas Workers' Compensation Act provides Continental a statutory right to judicial review. Although such a determination would seem to be easy, its difficulty is revealed by the fact that, until this litigation arose, the commission itself believed that judicial review was available.⁵. The lower courts concluded that the Act does not provide a statutory right to judicial review in this case. We agree.

A

Continental initially contends that section 410.255 grants a right to judicial review. Section 410.255 is entitled "Judicial Review of Issues Other Than Compensability or Income or Death Benefits," and states that:

(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 [the APA].

TEX. LAB. CODE 410.255(a). Continental contends that this dispute involves an issue other than those covered under section 410.301(a) (which covers "compensability or eligibility for or the amount of income or death benefits"), and therefore section 410.255 grants it a right to judicial review to be conducted in the manner provided for judicial review of a contested case under the APA.

Our objective in construing a statute is to determine and give effect to the Legislature's intent. See Liberty Mut. Ins. Co. v. Garrison Contractors, Inc., 966 S.W.2d 482, 484 (Tex. 1998). In so doing, we look first to the plain and common meaning of the statute's words. See id.; see also Fitzgerald v. Advanced Spine Fixation Sys., Inc., 996 S.W.2d 864, 865 (Tex. 1999). We consider the entire statute, not simply the disputed portions. See State v. Terrell, 588 S.W.2d 784, 786 (Tex. 1979). Each provision must be construed in the context of the entire statute of which it is a part. See Bridgestone/Firestone, Inc. v. Glyn-Jones, 878 S.W.2d 132, 133 (Tex. 1994) ("Only in the context of the remainder of the statute can the true meaning of a single provision be made clear."). Applying these principles, we hold that section 410.255 does not grant Continental a right to judicial review; instead, we agree with the courts below that section 410.255 simply prescribes the manner of judicial review.

Continental argues that the plain language of section 410.255 grants a right of judicial review. But the commission urges that, viewed in context, the function of 410.255 is much more limited. We thus begin by looking at the structure of Chapter 410 and the placement of section 410.255 within it. See Manasco, 971 S.W.2d at 63; see also Fitzgerald, 996 S.W.2d at 866 (in construing a statute, "we look at the entire act, and not a single section in isolation"). Subchapter A, which contains "General Provisions," states that "[a] proceeding before the commission to determine the liability of an insurance carrier for compensation for an injury or death under [the Workers' Compensation Act] is governed by this chapter." TEX. LAB. CODE 410.002. It further provides that, except as otherwise provided by Chapter 410, the APA does not apply to Chapter 410. See id. 410.003. Subchapters B, C, D, and E govern benefit review conferences, arbitration, contested case hearings, and appeals panel...