Dallas National Insurance Company v. Gilbert Morales

CourtCourt of Appeals of Texas
DecidedDecember 27, 2012
Docket08-11-00197-CV
StatusPublished

This text of Dallas National Insurance Company v. Gilbert Morales (Dallas National Insurance Company v. Gilbert Morales) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dallas National Insurance Company v. Gilbert Morales, (Tex. Ct. App. 2012).

Opinion

COURT OF APPEALS EIGHTH DISTRICT OF TEXAS EL PASO, TEXAS

DALLAS NATIONAL INSURANCE § COMPANY, No. 08-11-00197-CV § Appellant, Appeal from the § v. 210th Judicial District Court § GILBERTO MORALES, of El Paso County, Texas § Appellee. (TC# 2008-935) §

OPINION

Appellant Dallas National Insurance Company (“Dallas National”) appeals a judgment and

two orders entered in favor of Appellee Gilberto Morales (“Morales”). Dallas National raises five

issues: (1) and (2) the trial court abused its discretion by finding legally and factually sufficient

evidence that Morales’s injury fell into the narrow class of injuries/conditions that entitle injured

workers to receive Lifetime Income Benefits (“LIBS”); (3) and (4) the trial court erred in finding

legally and factually sufficient evidence that Morales is entitled to recover Supplemental Income

Benefits (“SIBS”); and (5) the court erred in awarding attorney’s fees for the recovery of LIBS and

SIBS. For the reasons that follow, we affirm.

PROCEDURAL BACKGROUND

Morales filed a Contested Case Hearing with the Texas Department of Insurance, Workers’

Compensation Division1 (“the Division”) to determine his entitlement to SIBS for the quarter of

April 2007 through July 2007 (“the fifth quarter”).2 The Division issued an adverse ruling,

1 Effective September 1, 2005, the Texas Workers’ Compensation Commission is now the Texas Department of Insurance, Workers’ Compensation Division. See TEX.LAB.CODE ANN. § 402.001 (West 2006 and Supp. 2012). 2 As noted in Plaintiff’s Exhibit 1, the “qualifying period” for the fifth quarter was April 12, 2007 through July 11, holding that Morales was not entitled to SIBS for the fifth quarter. Morales appealed to the

Worker’s Compensation Appeals Panel (“the Panel”), which affirmed the Division’s ruling

denying SIBS. In January of 2008 a Contested Case Hearing was held regarding Morales’s

claims for LIBS. The Division again issued an adverse ruling and Morales again appealed to the

Panel, which affirmed the Division’s denial of LIBS.

Morales filed suit against Dallas National on March 3, 2008, contesting the Division’s

ruling denying Morales SIBS. Morales also sought an award of attorney’s fees. Morales then

filed a Second Amended petition adding a cause of action seeking to overturn the Division’s denial

of LIBS, and seeking attorney’s fees for that cause of action as well. Dallas National filed its First

Amended Original Answer asserting a general denial. At trial, Dallas National sought to admit

into evidence the Division’s decisions denying LIBs and SIBs to Morales.

The case was tried to a jury on December 6, 2010. The jury determined that Morales was

entitled to LIBS based on a total and permanent loss of use of his feet, and that he was entitled to

SIBS for the fifth quarter. On December 15, 2010, Morales filed a Motion for Approval of

Attorney’s Fees and Expenses. Dallas National responded on January 25, 2011. The trial court

entered judgment granting LIBS and SIBS to Morales on April 8, 2011, and also executed an order

awarding attorney’s fees to Morales.

Dallas National filed a Motion for New Trial in May, 2011 after which it filed a Motion to

Vacate and New Judgment on May 17, 2011 alleging that the judgment was signed in violation of

Division rules. The court granted the Motion to Vacate on May 24, 2011 and re-dated the

judgment pursuant to the Motion. Dallas National filed a second Motion for New Trial on

2007. The fifth quarter itself dated from July 25, 2007 to October 23, 2007. Morales’ action was in response to Dallas National’s denial of SIBS during the fifth quarter. 2 June 17, 2011 which was overruled by operation of law on August 31, 2011. Dallas National

timely appealed.

FACTUAL BACKGROUND

Morales was employed as a construction worker when, on May 12, 2003, he sustained a

work-related injury by falling from a moving pickup truck. Morales injured his neck, back and

shoulder. He was released to light duty work three days following his injury. Dallas National is

the workers’ compensation insurance carrier for Morales’s injury and while it paid SIBS to

Morales in earlier quarters, it denied payment of SIBS during the fifth quarter.

Morales underwent surgeries to repair his neck and back in 2004. Following his surgeries,

Morales was seen by several doctors for continued back and neck pain. Morales was also given a

27 percent impairment rating: 25 percent ascribed to his neck injury and the remaining 2 percent

to his right shoulder, with 0 percent ratings for his back, feet, and arms.

Morales was diagnosed with circulatory problems in his legs in October of 2007. He

testified that the circulatory problems caused his legs to become discolored, and that at times it was

not possible to even find a pulse in his feet. Morales further testified that during the quarter of

July 25, 2007 through October 23, 2007, he made a number of searches seeking light duty work,

and that had any employers made an offer he would have accepted the job. He also testified that

in February of 2010 he underwent surgery on his back due to the pain in his legs.

In 2008, Morales was diagonsed with a L3-L4 paracentral radial tear with left paracentral

protrusion; L4-L5 central disc protrusion with spur protrusion and L5-S1 left paracentral radial

tear with disc bulge. Deposition testimony of Dr. Zolfoghary3 was presented at trial, where he

3 The deposition testimony appears in the exhibit list of the reporter’s record, marked with an asterisk indicating for “Appellate purposes only.” 3 testified that Morales suffers from “very bad disk with radiculopathy, difficulty with walking and

bending . . .” and that “he cannot go back to do any kind of gainful work.”4 Dr. Zolfoghary

testified that the radiculopathy condition affects both of Morales’s legs, mostly his right, and that is

a condition which will never improve and will affect Morales for the rest of his life. Numerous

physicians, including Morales’s primary treating physicians, have restricted Morales from

returning to work.

DISCUSSION

Dallas National raises five issues: (1) and (2) the trial court abused its discretion by

finding legally and factually sufficient evidence that Morales’s injury fell into the narrow class of

injuries/conditions that entitle injured workers to receive Lifetime Income Benefits (“LIBS”); (3)

and (4) the trial court erred in finding legally and factually sufficient evidence that Morales is

entitled to recover Supplemental Income Benefits (“SIBS”); and (5) the court erred in awarding

Morales his attorney’s fees for the recovery of LIBS and SIBS. We will consider issues one and

two jointly, and three and four jointly, given their interrelationship.

Standard of Review

In determining whether evidence is legally sufficient to support the finding under review (a

“no evidence” challenge), we must consider evidence favorable to the finding if a reasonable fact

finder could and disregard evidence contrary to the finding unless a reasonable fact finder could

not.5 Cent. Ready Mix Concrete Co., Inc. v. Islas, 228 S.W.3d 649, 651 (Tex. 2007); City of

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