Hulshouser v. Texas Workers Comp. Ins. Fund
| Decision Date | 30 July 2004 |
| Docket Number | No. 05-03-00906-CV.,05-03-00906-CV. |
| Citation | 139 S.W.3d 789 |
| Parties | Michael R. HULSHOUSER, Appellant, v. TEXAS WORKERS' COMPENSATION INSURANCE FUND, Appellee. |
| Court | Texas Court of Appeals |
Appeal from the 162nd District Court, Dallas County, Bill Rhea, J John Robert Howie, Jay K. Gray, Gray Law, LLP, Bedford, for appellant.
David P. Boyce, Austin, for appellee.
Before Justices O'NEILL, FITZGERALD, and FRANCIS.
Michael Hulshouser sued the Texas Workers' Compensation Insurance Fund (the Fund) for bad faith, asserting its denial and delay in compensating him for his initial hernia injury aggravated that condition. The trial court granted summary judgment for the Fund on the ground that any harm resulting from the Fund's delay in accepting compensability of the hernia condition was part of the compensation claim and thus barred by the exclusive remedy provision of the Texas Workers' Compensation Act. We affirm.
On August 25, 1998, Michael Hulshouser injured his lower back at work. The next day he reported to his treating physician that he also suffered from a hernia injury. After further medical evaluation, in May 1999, the Fund denied compensability of the hernia injury, alleging it was unrelated to the initial back injury. On appeal to the Texas Workers' Compensation Commission (TWCC), the Fund agreed to compensate for the hernia condition. In November 1999, Hulshouser had surgery to repair the hernia condition. Thereafter, he developed chronic depression and sought compensation for medical expenses for that condition, asserting it was related to complications from the aggravated hernia condition. The Fund denied compensability of that claim, but the TWCC ultimately ordered the Fund to compensate Hulshouser for the depression disorder.
Hulshouser sued the Fund for bad faith in handling his claims and for statutory causes of action under the Deceptive Trade Practices Act and the Insurance Code. He alleged that the Fund's denial and delay were unreasonable, asserting that the nearly one-year delay in surgery resulted in "permanent disability and pain" that would not have occurred had the medical treatment been timely. He alleged that he "suffered and will continue to suffer severe physical and mental pain, suffering, anguish, impairment and loss of earning capacity." In addition to damages related to the hernia condition, he asserted that the Fund's refusal to pay timely the hospital bill and one doctor bill caused him "a loss of credit."
The trial court granted summary judgment for the Fund on the ground that the exclusivity provision of the Texas Worker's Compensation Act barred the claim for common-law damages related to the hernia condition. In a second order, the trial court dismissed all but one of Hulshouser's remaining claims, on the ground that he had failed to exhaust administrative remedies. Subsequently, Hulshouser nonsuited the one claim remaining after the second order and brought this appeal. Hulshouser does not appeal dismissal of all of his other claims under the second order.
Hulshouser's sole issue on appeal concerns the trial court's unfavorable summary judgment and dismissal of his claims for damages flowing from the allegedly aggravated hernia condition, which states,
Plaintiff cannot recover herein damages for any harm resulting from Defendant's initial denial of compensability of, or delay in accepting compensability of Plaintiff's hernia condition, or for any delay in medical treatment for such hernia condition because, as a matter of law, such harm is part of, and constitutes a compensable injury and recovery of damages for such harm is precluded by the exclusive remedy provisions of the Texas Workers' Compensation Act.
The trial court went on to specify that Hulshouser could not recover any damages for the Fund's denial of, or delay in, accepting compensability for the "hernia condition," including damages for "pain and suffering, mental anguish, lost earning, loss of earning capacity, impairment and disfigurement."1
The standard of review for a summary judgment is well established. The movant must show that there is no genuine issue of material fact and that he is entitled to judgment as a matter of law. Nixon v. Mr. Property Mgmt. Co., 690 S.W.2d 546, 548-49 (Tex.1985). In deciding whether there is a disputed issue of material fact, we take evidence favorable to the nonmovant as true, and we indulge every reasonable inference and resolve any doubt in favor of the nonmovant. Id.
A primary purpose of the Workers' Compensation Act is to relieve employees injured on the job of the burden of proving their employer's negligence and to provide them prompt remuneration for their on-the-job injuries. Payne v. Galen Hosp. Corp., 28 S.W.3d 15, 17 (Tex.2000). Because of this purpose, the courts have liberally construed the Act in the employee's favor. Id.
A "compensable injury" is one that arises out of and in the course and scope of employment. TEX. LAB.CODE ANN. § 401.011(10) (Vernon Supp.2004). To fully effectuate the Act's purpose to provide prompt and certain remuneration to injured employees, "course and scope" has been interpreted expansively to include additional injuries that result from treating on-the-job injuries. Payne, 28 S.W.3d at 18 (). Compensability extends to what has been labeled an "extension injury," which includes "an injury occurring in the probable sequence of events and arising from the actual compensable injury." Duke, 900 S.W.2d at 886 (collecting cases). Where disability or death results from medical treatment instituted to cure or relieve an employee from the effects of his injury, it is regarded as having been proximately caused by the injury and is compensable under a claim for workers' compensation. Id. ().
In exchange for prompt remuneration to the employee with no burden of proof as to negligence, the benefits under the Act provide the exclusive remedy for on-the-job injuries, prohibiting the employee from seeking common-law remedies from his employer, its agents, and co-employees. See Darensburg...
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