Pansegrau v. National Union Fire Ins. Co. of Pittsburgh, Pa.

• Decision Date: 29 June 1994
• Docket Number: No. 93-1322,93-1322
• Citation: 23 F.3d 960
• Parties: Sue PANSEGRAU, Plaintiff-Appellee Cross-Appellant, v. NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA., Defendant-Appellant Cross-Appellee.
• Court: U.S. Court of Appeals — Fifth Circuit

Page 960

23 F.3d 960

Sue PANSEGRAU, Plaintiff-AppelleeCross-Appellant, v.NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PADefendant-AppellantCross-Appellee.

No. 93-1322.

United States Court of Appeals Fifth Circuit.

June 29, 1994.

Rehearing Denied July 29, 1994.

Charles T. Frazier, Jr., R. Michael Northrup, Julia F. Pendery, Cowles & Thompson, Dallas, TX, for appellant.

Frederick H. Shiver, Dallas, TX, for appellee.

Appeals from the United States District Court for the Northern District of Texas.

Before GOLDBERG, DAVIS, and DeMOSS, Circuit Judges.

GOLDBERG, Circuit Judge:

In this Texas workers' compensation appeal, National Union Fire Insurance Company("National Union") seeks to have a judgment in favor of plaintiffSue Pansegrau("Pansegrau") reversed on various grounds.Pansegrau, for her part, cross-appeals the decision of the district court to reduce the amount of her judgment.Our interpretation of Texas workers' compensation law reveals no basis for reversing the judgment in Pansegrau's favor.It does, however, show that the district court's decision to reduce Pansegrau's benefits was erroneous and should be reversed.

I.FACTS

In the early morning hours of March 8, 1990, Pansegrau, a registered nurse, was on duty at St. Paul Hospital in Dallas, Texas.While speaking with a co-worker, Pansegrau, without warning and without discoverable cause, suddenly lost consciousness and fell to the ground.She took no action to break her fall and the left side of her head hit the hard tile floor.The impact of her fall caused a basal skull fracture and a brain stem injury.

Pansegrau filed a claim for workers' compensation benefits.After the Workers' Compensation Commission awarded her compensation, the workers' compensation carrier, National Union, appealed by filing the instant lawsuit in the federal district court below.The court held separate trials on liability and damages.After a trial on the question of National Union's liability, the jury returned a verdict in favor of Pansegrau.The jury found that Pansegrau's injury was sustained in the course of her employment and that she was therefore entitled to compensation.

By consent of the parties, the question of damages was referred to a magistrate.The district court adopted the magistrate's findings that Pansegrau was only entitled to recover $73,369.78 in damages.Although she had in fact incurred an additional $281,706.78 in fair and reasonable medical expenses, the court reasoned that she could only recover a part of her total medical expenses because the other expenses had either been paid by Pansegrau's health insurance carrier or were written off by the health care providers as a professional courtesy to her husband who is himself a doctor.The magistrate concluded: "Since plaintiff has never been charged for any expenses associated with services rendered ... she is not entitled to recover damages for such medical expenses."

On appeal, National Union disputes the finding of liability and argues that Pansegrau has failed to show her injury occurred "in the course of employment" so as to entitle her to workers' compensation benefits under Texas law.National Union also alleges sundry other legal errors by the district court.Pansegrau, on cross-appeal, claims that she is entitled to recover the additional past medical expenses.

II.ANALYSIS

A.National Union's Allegations of Error

National Union contends that the district court erroneously interpreted the requirements for a valid workers' compensation claim.Initially, National Union alleges that there was not sufficient evidence to support the jury's findings.The disputed findings include that Pansegrau's injury was sustained "in the course of employment" and that Pansegrau did not make an election of remedies when she pursued and accepted benefits from her employer's group health insurance carrier.Further, National Union alleges that the district court erroneously refused to give a jury instruction explaining the "in the course of employment" phrase and erred in awarding lifetime benefits to Pansegrau as a matter of law.As we show below, National Union's contentions do not justify reversal of the trial court.¹

1.Idiopathic Falls

An injured employee in Texas may recover workers' compensation benefits if the injury was sustained "in the course of employment."Tex.Rev.Civ.Stat.Ann. art. 8309, Sec. 1(4), (Vernon 1967)(repealed 1991).²The statute defines "injury sustained in the course of employment," to include:

injuries of every kind and character having to do with and originating in the work, business, trade or profession of the employer received by an employee while engaged in or about the furtherance of the affairs or business of his employer.

Id.Texas courts have culled two essential requirements out of this statutory definition: the injury (1) must have occurred while the claimant was engaged in the business of his or her employer; and (2) must originate in and have to do with the employer's business.Texas Employers Insurance Association v. Page, 553 S.W.2d 98, 99(Tex.1977).

National Union concedes that Pansegrau meets the first requirement; she was on duty and engaged in her employer's business at the time she suffered her injuries.The controversy in this case concerns the interpretation of the requirement that "the injury originated in the employer's work, trade, business or profession."Id.National Union argues that Pansegrau's injury did not originate in the hospital's business or in her profession as a nurse.The evidence shows that she was standing up and talking when she lost consciousness, fell down, and hit her head on the floor.The doctors who testified to Pansegrau's injuries could not identify a particular reason for the original loss of consciousness.They did testify, however, that her current disabilities are a direct result of her head hitting the hard tile floor.

National Union argues that Texas requires a causal connection between the employee's work conditions and the injury.The injury, it asserts, must result "from a risk or hazard which is necessarily or ordinarily or reasonably inherent in or incident to the conduct of such work or business."American General Ins. Co. v. Williams, 149 Tex. 1, 227 S.W.2d 788, 790(1950);see alsoCity of Garland v. Vasquez, 734 S.W.2d 92, 96(Tex.App.--Dallas1987, writ ref'd n.r.e.).Because there was no evidence linking Pansegrau's loss of consciousness to any particular risk or condition inherent to her position as a nurse at St. Paul Hospital, National Union claims that Pansegrau's injuries did not arise out of her employment.

Based upon the causal connection requirement, National Union contends that the district court made two separate errors in the conduct of the trial below.First, it argues that there was insufficient evidence to support the jury's finding that Pansegrau's injury occurred in the course of her employment.Next, National Union contends that the trial court should have issued a jury instruction which embodied National Union's interpretation of the causal connection requirement.We conclude that National Union's interpretation of the causality requirement is jurisprudentially incorrect and therefore find no merit to its allegations of error.

The case law interpreting and implementing the Texas worker's compensation statute has provided compensation to employees who fall on the job for unknown reasons and are injured as a result.SeeGarcia v. Texas Indemnity Ins. Co., 146 Tex. 413, 209 S.W.2d 333, 336(1948)(granting workers' compensation benefits following an idiopathic fall ³);Page, 553 S.W.2d at 102(same).⁴This line of cases extends the principle that a "pre-disposing bodily infirmity will not preclude compensation."INA of Texas v. Howeth, 755 S.W.2d 534, 536(Tex.App.--Houston[1st Dist.]1988, no writ).In idiopathic fall cases, although the condition which caused the fall is unknown, if the worker was injured by the fall itself, he or she can claim compensation for injuries sustained as a result.

Our decision in this case follows a series of Texas decisions in which the employee was allowed to collect for injuries that occurred after an unexplained fall.The principle found its earliest incarnation in Garcia where the Texas Supreme Court allowed an injured employee to recover workers' compensation benefits after he suffered what the court assumed was an epileptic attack and fell and hit his head on a steel post.209 S.W.2d at 336.The court held that even if the fall was precipitated by some underlying idiopathic condition and even if "[t]he risk may be no different in degree or kind than those to which he may be exposed outside of his employment[, t]he injury is compensable, not because of the extent or particular character of the hazard, but because it exists as one of the conditions of the employment."Id. at 337.While it seemed the court considered the presence of a steel post as a key factor in this case, later decisions interpreting Garcia have not emphasized this element in their analysis of idiopathic falls.

Following Garcia, a Texas court of appeals allowed recovery when an employee's idiopathic condition caused him to lose consciousness and fall to the floor where he received a fatal head injury.General Ins. Corp. v. Wickersham, 235 S.W.2d 215, 219(Tex.Civ.App.--1950, writ ref'd n.r.e.).The Wickersham court held that "[w]e can find no sound reason for denying a recovery where the fall is to the floor, when recovery is allowed where the fall is from a ladder, or platform or similar place."Id.;see alsoAmerican General Ins. Co. v. Barrett, 300 S.W.2d 358, 363(Tex.Civ.App.1957, writ ref'd n.r.e.)(idiopathic fall case holding that a "hard-surfaced road was an instrumentality essential to the work of the employer and falling against it was a hazard to which Barrett was exposed because of his employment").

In Page the Texas Supreme Court faced a...