Downs v. Continental Casualty Co.

32 S.W.3d 260, 2000 WL 1210839
CourtCourt of Appeals of Texas
DecidedNovember 15, 2000
Docket04-99-00111-CV
StatusPublished
Cited by11 cases

This text of 32 S.W.3d 260 (Downs v. Continental Casualty Co.) 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
Downs v. Continental Casualty Co., 32 S.W.3d 260, 2000 WL 1210839 (Tex. Ct. App. 2000).

Opinion

OPINION

Opinion by:

SARAH B. DUNCAN, Justice.

We grant Continental Casualty Co.’s and Mary Ann Downs’ motions for rehearing, withdraw our opinion and judgment issued January 26, 2000, and in their place issue this opinion and a revised judgment.

After the Texas Workers’ Compensation Commission found Raymond Downs’ death was not compensable, it denied the timely claim for death benefits filed by his widow, Mary Ann Downs. Downs appealed, contending Continental Casualty Co. waived its right to deny compensability by failing to either begin the payment of benefits or send notice of its refusal to pay within seven days of the date it received written notice of injury, as required by section 409.021(a) of the Texas Labor Code. The trial court granted Continental Casualty’s no-evidence motion for summary judgment and denied Downs’ motion, and she appeals. We hold Continental Casualty waived its right to deny compensability, reverse the trial court’s judgment, render judgment reversing the decision of the Texas Workers’ Compensation Commission, and remand the cause to the trial court for further proceedings consistent with this opinion.

Factual and Procedural Background

The material facts are not disputed. Downs made a timely claim for death benefits and established her beneficiary status. However, Continental Casualty did not either begin to pay benefits or notify Downs of its refusal to pay until forty-eight days after the date it received the notice of injury.

Standard of Review

“Interpretation of a statute is a pure question of law. over which the [trial] judge has no discretion.” Mitchell Energy Corp. v. Ashworth, 943 S.W.2d 436, 437 (Tex.1997).

*262 The Parties’ Arguments

The relevant statutory provisions are sections 409.021 and 409.022 of the Texas Labor Code. Under section 409.021(a), the carrier “shall” either “begin the payment of benefits” or “notify the commission and the employee in writing of its refusal to pay and advise the employee of: (A) the right to request a benefit review conference; and (B) the means to obtain additional information from the commission” “[n]ot later than the seventh day after the date on which an insurance carrier receives written notice of an injury.” Tex. Lab.Code Ann. § 409.021(a) (Vernon 1996). 1 If the carrier opts to refuse to pay, its “notice of refusal to pay benefits under Section 409.021 must specify the grounds for the refusal,” and “[t]he grounds for the refusal specified in the notice constitute the only basis for the insurance carrier’s defense on the issue of compensability in a subsequent proceeding, unless the defense is based on newly discovered evidence that could not reasonably have been discovered at an earlier date.” Id. § 409.022(a)-(b). 2 From this provision, Downs argues that a carrier that does not either begin paying benefits or send a notice of refusal within the seven day period waives its right to later deny compensability. Continental Casualty argues the contrary, relying upon section 409.021(c), which provides in part that “[i]f an insurance carrier does not contest the compensability of an injury on or before the 60th day after the date on which the insurance carrier is notified of the injury, the insurance carrier waives its right to contest compensability.” Id. § 409.021(c). This is in fact the construction adopted by the Texas Workers’ Compensation Commission. See Tex. Worker’s Compensation Comm’n, Appeal No. 960949, 1996 WL 367060, at *4 (June 28, 1996); Tex. Worker’s Compensation Comm’n, Appeal No. 950944, 1995 WL 481670, at *5 (July 24, 1995); Tex. Worker’s Compensation Comm’n, Appeal No. 92532, 1992 WL *263 373451, at *3-*4 (Nov. 13, 1992); Tex. Worker’s Compensation Comm’n, Appeal No. 92122,1992 WL 358230, at *5-*6 (May 4,1992). Under this construction, the only consequence of a carrier’s failure to comply with section 409.021(a) is the assessment of the administrative penalty provided for in section 409.021(e).

Waiver

In construing a statute, our objective is to ascertain and give effect to the underlying legislative intent. Texas Water Comm’n v. Brushy Creek Mun. Util. Dist., 917 S.W.2d 19, 21 (Tex.1996). When the language is clear and unambiguous, legislative intent may be determined from the plain and ordinary meaning of the words used. Albertson’s, Inc. v. Sinclair, 984 S.W.2d 958, 960 (Tex.1999). But even if the statute is unambiguous, we may consider the legislature’s objective, the consequences of particular constructions of the statute, and any administrative constructions. Tex. Gov’t Code Ann. § 311.023 (Vernon 1998); see Atascosa County v. Atascosa County Appraisal Dist., 990 S.W.2d 255, 258-59 (Tex.1999). Therefore, to resolve whether a statutory provision is intended “to be mandatory or directory, we consider the plain meaning of the words used, as well as the entire act, its nature and object, and the consequences that would follow from each construction.” Sinclair, 984 S.W.2d at 961. “[Ujnless legislative intent suggests otherwise,” “[w]e generally construe the word ‘shall’ as mandatory.” Id.

The purpose of sections 409.021 and 409.022 is clear. With these provisions, the Legislature sought to encourage a earner uncertain of the compensability of an injury to pay the benefits pending a full investigation of the claim. Thus, it provided the carrier “shall” either pay the benefits or give notice of its refusal to pay within the seven-day period, Tex. Lab. Code Ann. § 409.021(a); and, perhaps most importantly, it provided that the payment of benefits is without prejudice to a determination of noncompensability within the sixty-day period following notice of an injury, id. § 409.021(c), but the carrier is bound by the grounds stated in a premature notice of refusal to pay. Id. § 409.022(a). The legislative purpose is thus advanced if we construe “shall” as mandatory. But what if we do not, as Continental Casualty argues? Not only is the legislative purpose underlying sections 409.021 and 409.022 not advanced, but the carrier is encouraged to do precisely what section 409.021(a) says it shall not do— nothing. Then and only then could the carrier escape paying benefits without the risk of being bound by a premature notice of refusal.

On rehearing, Continental argues that our construction of section 409.021(a) requires a carrier to begin paying benefits before the benefits have accrued and before Continental can make this determination. We disagree.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Southwestern Bell Telephone Co., LP v. Mitchell
276 S.W.3d 443 (Texas Supreme Court, 2008)
Southern Insurance Co. v. Brewster
249 S.W.3d 6 (Court of Appeals of Texas, 2007)
Southwestern Bell Telephone Co. v. Mitchell
276 S.W.3d 452 (Court of Appeals of Texas, 2005)
Hefley v. Sentry Insurance Co.
131 S.W.3d 63 (Court of Appeals of Texas, 2004)
Continental Casualty Co. v. Downs
81 S.W.3d 803 (Texas Supreme Court, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
32 S.W.3d 260, 2000 WL 1210839, Counsel Stack Legal Research, https://law.counselstack.com/opinion/downs-v-continental-casualty-co-texapp-2000.