Continental Casualty Co. v. Gullett

253 B.R. 796, 1999 U.S. Dist. LEXIS 22333, 1999 WL 33214132
CourtDistrict Court, S.D. Texas
DecidedAugust 24, 1999
DocketCiv.A. H-99-0862
StatusPublished
Cited by9 cases

This text of 253 B.R. 796 (Continental Casualty Co. v. Gullett) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Continental Casualty Co. v. Gullett, 253 B.R. 796, 1999 U.S. Dist. LEXIS 22333, 1999 WL 33214132 (S.D. Tex. 1999).

Opinion

MEMORANDUM AND ORDER

ATLAS, District Judge.

Pending before the Court is Appellant Continental Casualty Company’s appeal of the Bankruptcy Court’s January 6, 1999 Amended Order. See Notice of Appeal [Doc. # 1]. Pursuant to this appeal, both Appellant Continental Casualty Company *798 (“Continental”) and Appellees Richard Gullett and Sandra K. Gullett (collectively, the “Gulletts”) have submitted briefs and other pertinent matters. See Corrected Appellant’s Brief [Doc. # 13] (“Appellant’s Brief’); Appellee’s Brief [Doc. # 11]; Appellant’s Reply Brief [Doc. # 14], The Court has considered all pleadings submitted, all matters of record, and the applicable authorities, and concludes that the Bankruptcy Court’s Amended Order should be reversed.

I. FACTUAL BACKGROUND

This bankruptcy appeal stems from various legal proceedings involving Appel-lee/Debtor Richard Gullett (“Gullett”). Gullett filed a workers’ compensation claim for injuries he received on his job. During the pendency of his claim, he also filed for Chapter 13 bankruptcy. Appellant Continental is the workers’ compensation insurance carrier for Gullett’s employer. Gul-lett also filed an adversary proceeding against Continental in connection with his bankruptcy case alleging that Continental’s actions in the workers’ compensation proceedings violated the terms of the automatic stay. The Bankruptcy Court not only agreed with Gullett’s positions, it granted relief beyond that sought by Gul-lett. The Bankruptcy Court imposed severe monetary sanctions upon Continental, and awarded attorney’s fees and costs to Gullett. Continental appeals these Bankruptcy Court rulings.

A. Worker Compensation Statutory Scheme in Texas

To appreciate the issues raised by the parties in the adversary proceeding and this appeal, a description of the workers’ compensation laws in Texas is necessary.

Benefit Structure. — A person injured on the job can file a workers’ compensation claim against the employer’s workers’ compensation insurance carrier. The claimant is entitled to receive two types of benefit, medical benefits and monetary benefits. See Tex.Lab.Code Ann. §§ 408.021, 408.081 (Vernon 1996). There are three types of monetary benefits: temporary income benefits, impairment income benefits, and supplemental benefits. These benefits are distributed sequentially.

After missing seven days from work, the claimant can automatically claim temporary income benefits (“TIB”). Id. § 408.101. TIB are paid during the time the claimant is off work or is working at a lower than pre-injury wage. The carrier stops paying TIB when either a doctor determines that the claimant has reached maximum medical improvement (“MMI”) or the employee returns to work at pre-injury wages. Id. § 408.102.

When MMI is reached, the claimant may be eligible for impairment income benefits. Id. § 408.122. In order to qualify for such benefits, the claimant must present evidence of physical impairment that is based on “an objective clinical or laboratory” findings. Id. § 408.122. If the claimant is eligible for impairment income benefits he is assigned an impairment rating. Id. § 408.123. That rating is stated as a percentage. After reaching MMI, a claimant begins receiving impairment income benefits. These payments continue for three weeks for every percentage point of impairment rating. Thus, if an employee is assigned a 10% impairment rating, he would receive thirty weeks of impairment income benefits.

An employee may be eligible for supplemental benefits after the expiration of impairment income benefits. Id. § 408.142. Any employee whose impairment rating is higher than 15% may apply for supplemental benefits. Id. If the request for supplemental benefits is contested, Texas Workers’ Compensation Commission (“TWCC”) holds a hearing where it decides whether the claimant may receive these extra benefits. Id. § 408.147. Even if the TWCC finds that supplemental benefits are proper, a claimant can receive these benefits for only three months. At the end of the three month period, the claimant must re-apply for supplemental benefits.

*799 Administrative Process. — The legislature has established a four-tier system for disposition of claims by the TWCC under the Texas Workers’ Compensation Act. Id. §§ 410.021, 410.308. Each step is a prerequisite to the succeeding one. See id. §§ 410.024, 410.169, 410.205. The process begins with an informal resolution of claims through a non-adversarial “benefit review conference” conducted by a “benefit review officer.” Id. §§ 410.021-.034. The benefit review officer has the authority to order or decline to order benefits. See id. § 410.032. If the officer orders payments of benefits, an insurance carrier must begin making payments at that time. See id. § 410.032. From the benefit review conference, the parties may proceed, by agreement, to arbitration from the benefit review conference. See id. § 410.104. If there is no agreement to arbitrate, a party may seek relief at a contested case hearing. See id. §§ 410.151-.169.

At the third tier of the disposition process, a party may seek review of the outcome of the contested case hearing by an administrative appeals panel. See id. §§ 410.201-.208. To do this, a party must file a written request not later than the fifteenth day after the contested case decision is entered. See id. § 410.202. The decision of the appeals panel is considered final unless judicial review is sought. See id. § 410.205.

An aggrieved party may seek judicial review of the appeals panel decision. See id. §§ 410.251-.308. Suit must be filed “not later than the 40th day after the date on which the decision of the appeals panel was filed.” See id. § 410.252. If a court of last resort reverses or modifies an appeals panel award, then the insurance carrier may seek reimbursement for any overpayments from the Subsequent Injury Fund (“SIF”) 1 . See id. § 410.205(c).

B. Gullett’s Workers’ Compensation Claim

On January 8, 1996, Gullett was injured at work. He filed a workers’ ■ compensation claim with Continental. From July 1996 to November 1996, Continental paid Gullett TIB. Gullett returned to work with some restrictions on his activity on July 8, 1996. For a time, therefore, Gul-lett was receiving both pre-injury wage and TIB. A representative at Continental, Carmen Munoz, testified that she mistakenly thought that the medical work restrictions caused a reduction in Gullett’s income. Continental overpaid benefits to Gullett between July 1996 and November 1996, totaling $8,619.54.

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Bluebook (online)
253 B.R. 796, 1999 U.S. Dist. LEXIS 22333, 1999 WL 33214132, Counsel Stack Legal Research, https://law.counselstack.com/opinion/continental-casualty-co-v-gullett-txsd-1999.