In re Auth.

• Decision Date: 03 January 2011
• Docket Number: No. 01–10–00752–CV.,01–10–00752–CV.
• Citation: 334 S.W.3d 806
• Parties: In re METROPOLITAN TRANSIT AUTHORITY, Relator.
• Court: Texas Court of Appeals

334 S.W.3d 806

In re METROPOLITAN TRANSIT AUTHORITY, Relator.

No. 01–10–00752–CV.

Court of Appeals of Texas, Houston (1st Dist.).

Jan. 3, 2011.Rehearing and Rehearing En Banc

Overruled Feb. 28, 2011.

Dana M. Gannon, Flahive, Ogden & Latson, Austin, TX, Michael P. Doyle, Doyle Raizner LLP, Houston, TX, for Relator.Robert D. Stokes, Flahive, Ogden & Latson, Austin, TX, for Real Party in Interest.Panel consists of Justices KEYES, HIGLEY, and BLAND.

OPINION

JANE BLAND, Justice.

Metropolitan Transit Authority (“Metro”) filed a petition for writ of mandamus, requesting that this Court compel the trial court to set aside its order denying Metro's plea to the jurisdiction for failure to exhaust administrative remedies and to enter an order granting the plea.¹ We deny the petition.

Background

The underlying case involves a claim for workers' compensation benefits. Metro employed Sharon Wilson as a bus driver. She was hurt in a motor-vehicle accident with another bus. Wilson filed a workers' compensation claim with the Texas Department of Insurance, Division of Workers' Compensation (“DWC”). Metro, which is self-insured, agreed that Wilson had a compensable, work-related lumbar sprain as a result of the accident. But Wilson also claimed that the accident caused a foot injury that, in turn, caused a burn with an infection in her right foot and the auto-amputation of her right great toe. Metro disputed the toe injury.

In the administrative proceedings, Metro denied the compensability of the infection of Wilson's right foot, including the auto-amputation of her right great toe. Wilson responded that medical-care providers had instructed her to treat her injuries, including the trauma to her right foot, with heat therapy and that the heat therapy resulted in an infection of her right foot and auto-amputation of her right great toe. Wilson also responded that Metro had waived its right to challenge compensability because it did not dispute the extent of Wilson's injury within 60 days of receiving notice that her claim included her right foot.

After the parties could not resolve their differences at a benefit review conference, the case proceeded to a contested case hearing on the following three issues:

1. Did the compensable injury of 10/11/06 extend to include an infection of the right foot, including an auto-amputation of the right great toe?

2. Did [Wilson] have disability resulting from the 10/11/06 compensable injury, and if so, for what period(s)?

3. Has [Metro] waived the compensability of an infection of the right foot, including an auto-amputation of the right great toe, by not timely contesting its compensability in accordance with the Texas Labor Code Sections 409.021 and 409.022?

The hearing officer issued a decision favorable to Metro, concluding that it was not liable for medical benefits for the treatment of the infection of Wilson's right foot and auto-amputation of her right great toe. The hearing officer's decision and order included the following findings of fact:

5. The infection of the right foot and auto-amputation of the right great toe did not arise or naturally flow from the compensable injury.

6. Any inability of [Wilson] at any time to obtain and retain employment at wages equivalent to her pre-injury wage is not due to a compensable injury of that date.

7. [Metro], through a reasonable investigation, could not have determined within 60 days following the notice of injury that the right foot infection and auto-amputation of the right great toe was part of the claimed injury.

The decision and order then listed the following relevant conclusions of law:

3. The compensable injury of October 11, 2006, [sic] does not extend to an infection of the right foot, including an auto-amputation of the right great toe.

4. [Wilson] did not have disability through the date of this hearing from the October 11, 2006, compensable injury.

5. [Metro] did not waive the right to contest the compensability of the infection of the right foot and auto-amputation of the right great toe by not contesting compensability in accordance with Texas Labor Code Sections 409.021 and 409.022.

Wilson appealed the hearing officer's decision to the DWC's appeals panel, requesting review of each of these adverse findings of fact and conclusions of law. The appeals panel considered the evidence in the case and reversed the hearing officer's decision. The appeals panel rendered a new decision that Metro “waive[d] the right to contest the compensability of the infection of the right foot and auto-amputation of the right great toe by not timely contesting compensability.” The appeals panel likewise reversed the hearing officer's determination of the extent of Wilson's injury. It concluded that “the compensable injury ... does extend to an infection of the right foot, including an auto-amputation of the right great toe by operation of waiver.” Finally, the appeals panel remanded the case to the hearing officer for a determination of the disability due to Wilson. Although it made findings regarding compensability and extent of injury, the appeals panel did not specifically reverse the hearing officer's fifth finding of fact, i.e., that “[t]he infection of the right foot and auto-amputation of the right great toe did not arise or naturally flow from the compensable injury.”

Metro sought judicial review of the appeals panel's decision. Having obtained a favorable result from the appeals panel, Wilson did not file an appeal in the district court. She filed a general denial of the allegations in Metro's original petition and asserted a counterclaim requesting attorneys' fees.

Metro then filed a plea to the jurisdiction, arguing that the district court's jurisdiction is confined to the waiver issue. Metro asserts that the appeals panel's determination that the infection of Wilson's right foot was compensable “by operation of waiver” precludes any other finding that might support its decision. Under Metro's theory, a decision in its favor on the waiver issue would eliminate the need for a trial on the merits or any further inquiry into its liability.

Wilson responds that she is not an aggrieved party required to seek judicial review in order to defend her claim and the appeals panel's decision against Metro's appeal. She observes that she appealed each of the hearing officer's adverse findings and conclusions to the appeals panel, and the appeals panel decided in favor of her claim. Wilson further notes that the appeals panel decided both issues of compensability and extent of injury, and made no adverse findings by which she is bound in the district court.

After considering the arguments made by Metro and Wilson, the district court denied the plea to the jurisdiction, finding that it could consider the extent of Wilson's injury. Metro's petition for writ of mandamus followed.

Discussion

Metro's petition raises a single issue: whether the trial court has jurisdiction to consider the extent of Wilson's injury.

Standard of Review

To be entitled to the extraordinary relief of a writ of mandamus, the relator must show the trial court clearly abused its discretion and there is no adequate remedy by appeal. In re Laibe Corp., 307 S.W.3d 314, 316 (Tex.2010) (orig.proceeding) (per curiam). A trial court abuses its discretion if it reaches a decision so arbitrary and unreasonable as to constitute a clear and prejudicial error of law, or if it clearly fails to correctly analyze or apply the law. In re Columbia Med. Ctr. of Las Colinas, 306 S.W.3d 246, 248 (Tex.2010) (orig.proceeding) (per curiam); In re Cerberus Capital Mgmt., L.P., 164 S.W.3d 379, 382 (Tex.2005) (orig.proceeding) (per curiam). In determining whether appeal is an adequate remedy, we consider whether the benefits outweigh the detriments of mandamus review. In re BP Prods. N. Am., Inc., 244 S.W.3d 840, 845 (Tex.2008) (orig.proceeding). The failure to grant a plea to the jurisdiction for failure to exhaust administrative remedies with the DWC is subject to mandamus review in order to prevent disruption of the orderly process of government. In re Liberty Mut. Fire Ins. Co., 295 S.W.3d 327, 328 (Tex.2009) (orig.proceeding) (per curiam).

Plea to the Jurisdiction

A plea to the jurisdiction challenging exhaustion of administrative remedies under the workers' compensation scheme is a contest of the trial court's subject matter jurisdiction. Schwartz v. Ins. Co. of State of Pa., 274 S.W.3d 270, 273 (Tex.App.-Houston [1st Dist.] 2008, pet. denied); see Stinson v. Ins. Co. of State of Pa., 286 S.W.3d 77, 83 (Tex.App.-Houston [14th Dist.] 2009, pet. denied) (op. on reh'g). Such a contest may rest on pleadings or on evidence. Stinson, 286 S.W.3d at 83. When a plea to the jurisdiction challenges the pleadings, we determine if the pleader has alleged facts that affirmatively demonstrate the court's jurisdiction to hear the cause. Tex. Dep't of Parks & Wildlife v. Miranda, 133 S.W.3d 217, 226 (Tex.2004). We construe the pleadings liberally and look to the pleader's intent. Id. If the pleadings do not contain sufficient facts to affirmatively demonstrate the trial court's jurisdiction but do not affirmatively demonstrate incurable defects in jurisdiction, the issue is one of pleading sufficiency and the party should be afforded the opportunity to amend. Westbrook v. Penley, 231 S.W.3d 389, 395 (Tex.2007). If the pleadings affirmatively negate the existence of jurisdiction, then a plea to the jurisdiction may be granted without allowing the pleader an opportunity to amend. Cnty. of Cameron v. Brown, 80 S.W.3d 549, 555 (Tex.2002).

Exhaustion of Administration Remedies

“The Workers' Compensation Act vests the Workers' Compensation Division with exclusive jurisdiction to determine a claimant's entitlement to medical benefits.” In re Liberty Mut. Fire Ins. Co., 295 S.W.3d at 328. When an agency has exclusive jurisdiction, a party must exhaust all administrative remedies before seeking judicial...