Ryan v. Travelers Ins. Co.

• Decision Date: 07 August 1986
• Docket Number: No. 01-86-0200-CV,01-86-0200-CV
• Citation: 715 S.W.2d 172
• Parties: Jack C. RYAN, Appellant, v. TRAVELERS INSURANCE COMPANY, Appellee. (1st Dist.)
• Court: Texas Court of Appeals

Page 172

715 S.W.2d 172

Jack C. RYAN, Appellant, v. TRAVELERS INSURANCE COMPANY, Appellee.

No. 01-86-0200-CV.

Court of Appeals of Texas,

Houston (1st Dist.).

Aug. 7, 1986.

Rehearing Denied Sept. 25, 1986.

Gordon E. Davenport, Roy E. Brown, Brown, Todd, Hagood & Davenport, Alvin, for appellant.

Ervin A. Apffel, Otto D. Hewitt, III, McLeod, Alexander, Powel & Apffel, Galveston, for appellee.

Before LEVY, DUGGAN and HOYT, JJ.

OPINION

LEVY, Justice.

This is an appeal from an order granting appellee's motion for summary judgment and overruling a "successive" award for medical benefits granted appellant by the Industrial Accident Board under the Worker's Compensation Act. We reverse.

In 1977, the appellant, Jack Ryan, received an award from the Industrial Accident Board ("IAB") covering permanent disability caused by an on-the-job injury. This award was set aside by a trial court judgment, not the subject of this appeal, which awarded Ryan $24,925.21 for accrued and unaccrued compensation benefits, and an additional sum of $11,203.44 for past medical expenses. Subsequently, in January, 1983, Ryan incurred additional medical expenses related to his on-the-job injury and filed a claim with the IAB to recover these expenses.

Though the IAB and the appellee, Travelers Insurance Company ("Travelers"), received notice of Ryan's claims in February, June, August, and November of 1983, the IAB did not set a pre-hearing conference until December 23. The conference was then reset to January 12, 1984, because the IAB offices would not be open on December 23. A formal hearing did not occur until April 6, 1984. On April 23, the Board made a final award to Ryan, requiring Travelers to pay certain medical expenses incurred by Ryan during January, 1983.

Travelers appealed the award by filing an action to set it aside in the trial court. Thereafter, Travelers filed a motion for summary judgment alleging that the IAB did not have jurisdiction to enter the April, 1984 award because the award was entered after the Board's jurisdiction had expired. Since the award is considered "successive" in nature, the question is controlled by Tex.Rev.Civ.Stat.Ann. art. 8307, sec. 5 (Vernon Supp.1986) ¹ which provides, in pertinent part, as follows:

After the first such final award or judgment, the Board shall have continuing jurisdiction in the same case to render successive awards to determine the liability of the association for the cost or expense of any such items actually furnished to and received by said employee not more than six (6) months prior to the date of each such successive award, until the association shall have fully discharged its obligation under this law to furnish all such medical aid, hospital services, nursing, chiropractic services, medicines or prosthetic appliances to which said employee may be entitled; provided, each such successive award of the Board shall be subject to a suit to set aside said award by a court of competent jurisdiction, in the same manner as provided in the case of other awards under this law. (Emphasis added.)

In its motion for summary judgment, Travelers argued that the IAB erred in allowing appellant to recover medical expenses incurred in January, 1983, more than six months prior to the award, because sec. 5 expressly limits post-judgment awards to those expenses incurred within six months of the date of the successive award. The trial court granted the summary judgment and discharged Travelers from liability for all medical expenses except those incurred after October 24, 1983, a date six months prior to the date of the IAB successive award on April 24, 1984.

On appeal, Ryan contends that the trial court erred in granting the summary judgment because it incorrectly construed and applied art. 8307, sec. 5. Ryan argues that the trial court's interpretation of the statute would defeat the legislative purpose in enacting the statute because of the lengthy manner in which claims are processed by the IAB. Ryan points out that once a claimant submits a post-judgment claim to the Board, and requests a hearing, he has no control over when a hearing is set or when the final determination is made. Thus, the claimant's right to future medical expenses can expire through no fault of his own. Ryan argues that the trial court's interpretation does not comply with the general rule that the Worker's Compensation Act should be "liberally construed so as to effectuate the remedies which it grants." See Ward v. Charter Oak Fire Insurance Co., 579 S.W.2d 909, 910 (Tex.1979); Texas Employer's Insurance Assn. v. Steadman, 433 S.W.2d 756, 760 (Tex.Civ.App.--Texarkana 1968, no writ); Texas Employee's Insurance Assn. v. Andrews, 130 Tex. 502, 110 S.W.2d 49 (1937).

The narrow issue before this Court is whether, as a matter of law, a claimant who timely submits a claim to the IAB, and gives timely notice to the carrier, is precluded from recovering on those claims under sec. 5, if the IAB does not make an award or otherwise dispose of those claims within six months after the costs are incurred. We hold that the claimant is not so precluded.

As this issue is seemingly one of first impression, we first turn for guidance to the legislative purpose in enacting the Worker's Compensation Act. When the Worker's Compensation Act, Tex.Rev.Civ.Stat.Ann. art. 8306 et seq., was amended in 1969, the legislature identified the purpose of the act as to:

... provide prompt and fair workmen's compensation payments for injured workers, to minimize the expense and delay of court action and the resulting drain on the resources of the claimant; to provide for equitable administration of the law with the goal of channeling the largest possible amount of the premium dollar into the pocket of the injured worker.

See section 1 of Acts 1969, 61st Leg., p. 48, ch. 18.

The courts have frequently interpreted the primary purposes of the Worker's Compensation Act so as to benefit and protect injured employees, and to expedite settlement of meritorious claims. See Stott v. Texas Employers Insurance Assoc., 645 S.W.2d 778 (Tex.1983); Industrial Accident Board v. Parker, 348 S.W.2d 188 (Tex.Civ.App.--Texarkana 1961, writ ref'd n.r.e.). Generally, the Worker's Compensation Act should be liberally construed so as to effectuate the beneficient purposes for which it was enacted. See Travelers Insurance Co. v. Adams, 407 S.W.2d 282, 287 (Tex.Civ.App.--Texarkana 1966, writ ref'd n.r.e.).

It is an elementary rule of construction that all of the provisions of a statute must be construed together and in such manner that, if possible, the provisions will operate in harmony. See, e.g., Travelers Insurance Co., 407 S.W.2d at 287; Industrial Accident Board v. Parker, 348 S.W.2d at 191. One provision will not be given a meaning out of harmony or inconsistent with other provisions, although it might be susceptible of such construction if standing alone. See, generally, Black v. American Bankers Insurance Co., 478 S.W.2d 434, 437 (Tex.1972); cf. Walden v. Royal Globe Insurance Co., 577 S.W.2d 296, 300 (Tex.Civ.App.--Beaumont 1979, writ ref'd n.r.e.).

The Worker's Compensation Act has greatly modified the rights of workers and employers under the English common law, so that the rights and obligations of the parties in a suit brought under this statute are entirely controlled by the statute, except for those matters of form and procedure that are not prescribed. See Truck Insurance Exchange v. Seelbach, 161 Tex. 250, 339 S.W.2d 521 (Tex.1960).

Although section 5 does not provide the procedure for obtaining a final award within six months from the date postjudgment costs and expenses are incurred, section 4a does outline the general method of filing a notice of injury or a claim for compensation.

At the time Ryan filed his claim, sec. 4a required that a claim for compensation with respect to an injury under this statute must be made within six months after the occurrence of the injury. ² Although there are no requirements as to formality in the filing of such claims, a claim must sufficiently identify the injury or condition, and serve as an adequate basis for proper investigation of the claim. See, e.g., Twin City Fire Insurance Co. v. Gibson, 488 S.W.2d 565, 570 (Tex.Civ.App.--Amarillo 1972, writ ref'd n.r.e.); see Harleysville Mutual Insurance Co. v. Frierson, 455 S.W.2d 370 (Tex.Civ.App.--Houston [14th Dist.] 1970, no writ).

A claim has been held sufficient if it gives the name of the injured employee, date and description of accident, description of treatment given, itemized statements of unpaid hospital and doctor bills, the names and addresses of the employer and the carrier, and some indication that the carrier refuses to pay the claim. See, e.g., Harleysville 455 S.W.2d at 370. Under art. 8309a, after an injured employee has filed a claim for compensation and given notice as required by law, the IAB should hear his claim for compensation "within a reasonable time." See Tex.Rev.Civ.Stat.Ann. art. 8309a (Vernon Supp.1986).

Thus, the Act, as we read it, requires only that the IAB hold a hearing within a reasonable time after it has received notice of the claim. If, as suggested by Travelers, we strictly construe sec. 5 to require the IAB to make a final determination on a claim for a successive award every six months, a claimant will bear the heavy burden of requiring the IAB to hold a hearing and make a ruling within a six-month period merely in order to preserve his claim. Moreover, the IAB, responsible for hearing all claims filed, would be greatly overburdened under such an interpretation to schedule such hearings and rulings, or become entangled in countless mandamus actions if it fails to do so.

We conclude that the better construction of sec. 5 is that used by the Court in Texas Employers Insurance Assoc. v. Steadman, 431 S.W.2d 556 (Tex.Civ.App.--Amarillo 1968, writ ref'd n.r.e.). Though the central issue in Steadman was whether...