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American Motorists Insurance Co. v. Fodge

The trial court does not have jurisdiction over a claimant's suit against a carrier to recover workers' compensation benefits and damages resulting from a denial of benefits without a prior determination by the Texas Workers' Compensation Commission that benefits are due.

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

The important issue in this case is whether a compensation claimant can prosecute a lawsuit against a carrier to recover benefits and damages resulting from a denial of benefits without a prior determination by the Texas Workers’ Compensation Commission that benefits are due her. We hold that she cannot do so, and that her claims must be dismissed or abated, as appropriate. We also hold, however, that she can prosecute her claim that payment of benefits awarded by the Commission was improperly delayed. Accordingly, we reverse the judgment of the court of appeals *fn1 and remand the case to the trial court.

Barbara Anne Fodge, a data entry operator for Dallas Diagnostic Association, claimed compensation benefits for a back injury she suffered at work on May 31, 1994. The carrier, American Motorists Insurance Co., denied Fodge’s claim on two grounds: that her injury was not work-related, and that she did not timely notify her employer of the injury. *fn2 A Commission benefit review officer determined on April 25, 1995, that Fodge had no disability, but at a benefit contested case hearing on June 20, 1995, the hearing officer found that Fodge had suffered a compensable back injury of which she had timely notified her employer. Fodge and American Motorists stipulated that her disability had lasted twenty days, and the hearing officer ordered payment of temporary income benefits for that period. American Motorists complied. Never in the proceedings at the Commission did Fodge claim medical benefits or complain that American Motorists had denied medical benefits, nor did any medical provider claim payment for medical services provided to Fodge. Neither Fodge nor American Motorists appealed the hearing officer’s order.

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