East Texas Educational Insurance Association v. Sanford Jones and James Thomas Lyle, as Independent of the Estate of Mary Louise Jones, and Next Friend of J.L., a Minor
This text of East Texas Educational Insurance Association v. Sanford Jones and James Thomas Lyle, as Independent of the Estate of Mary Louise Jones, and Next Friend of J.L., a Minor (East Texas Educational Insurance Association v. Sanford Jones and James Thomas Lyle, as Independent of the Estate of Mary Louise Jones, and Next Friend of J.L., a Minor) is published on Counsel Stack Legal Research, covering Texas Court of Appeals, 9th District (Beaumont) primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
Opinion
In The
Court of Appeals
Ninth District of Texas at Beaumont
________________
NO. 09-24-00191-CV ________________
EAST TEXAS EDUCATIONAL INSURANCE ASSOCIATION, Appellant
V.
SANFORD JONES AND JAMES THOMAS LYLE, AS INDEPENDENT EXECUTOR OF THE ESTATE OF MARY LOUISE JONES, DECEASED, AND NEXT FRIEND OF J.L., A MINOR, Appellees ________________________________________________________________________
On Appeal from the 60th District Court Jefferson County, Texas Trial Cause No. 24DCCV0369 ________________________________________________________________________
MEMORANDUM OPINION
East Texas Educational Insurance Association (“ETEIA” or “carrier”), a
workers’ compensation carrier, appeals the trial court’s Orders to Determine Lien
Amounts and Severance Order awarding it funds for its subrogation interest after
paying benefits on behalf of Mary Louise Jones (individually, “Jones” or
“Decedent”), who later died. Sanford Jones and James Thomas Lyle, as Independent
Executor of the Estate of Mary Louise Jones, Deceased, and Next Friend of J.L., a
1 Minor (collectively, the “Jones Plaintiffs” or “Appellees”) intervened in a lawsuit
initiated by other plaintiffs who were injured in the same accident and sued Toyota
for products liability, among other things. In the lawsuit against Toyota, ETEIA also
intervened seeking subrogation for various workers’ compensation indemnity and
medical benefits it paid to or on behalf of Jones. The Jones Plaintiffs acknowledge
in their First Amended Petition in Intervention that “various workers compensation
and medical benefits have been paid to or for plaintiff-intervenors.”
The Jones Plaintiffs filed two motions central to this appeal: (1) Motion to
Approve Apportionment of Global Settlement Offer; and (2) Motion to Determine
Amount of Workers’ Compensation Lien. Later, the trial court signed an Order
granting the Jones Plaintiffs Motion to Sever Claims in Intervention and for Entry
of Final Judgment in Severed Action. In seven issues, ETEIA asserts that the trial
court’s award failed to include $350,000.00 in medical benefits it paid to Jones’s
medical insurance carrier that had been established as a matter of law, or in the
alternative, that the trial court improperly adjudicated ETEIA’s subrogation interest
at a hearing rather than a trial on the merits and summarily put ETEIA to trial. ETEIA
asks us to reverse the trial court’s judgment and render judgment awarding it the
additional $350,000 for the medical benefits paid, or alternatively, to reverse the trial
court’s judgment and remand the matter for a new trial on the amount of its
subrogation interest paid.
2 We hold the trial court abused its discretion by misapplying the law to the
facts of this case when it summarily adjudicated ETEIA’s subrogation claim during
a settlement hearing and effectively denied its right to “first money” reimbursement
of medical benefits paid without a trial on the merits or summary-judgment
proceedings. We reverse and remand the matter for further proceedings consistent
with this opinion as discussed below.
BACKGROUND AND PROCEDURAL HISTORY
Automobile Accident
Jones worked as a teacher for Little Cypress-Mauriceville Consolidated
Independent School District (LCM). In May 2008, she was part of a group of
teachers who traveled to Mexico for a Spanish immersion program. While in
Mexico, she and others were seriously injured in an automobile accident on an
excursion when a Mexican national driving the Toyota Hiace van they were in left a
mountain roadway. In November 2008, Jones died because of her injuries; several
other teachers also died. Other members of the group sued Toyota in District Court
in Jefferson County, Texas in cause number B-184,121 (“Jefferson County
Lawsuit”), and the Jones Plaintiffs intervened in that lawsuit. We outlined the
background facts leading to the underlying products liability litigation in an earlier
opinion involving a separate appeal. See Toyota Motor Co. v. Cook, 581 S.W.3d 278,
281–82 (Tex. App.—Beaumont 2019, no pet.).
3 Orange County Lawsuit: Workers’ Compensation Dispute
Initially, ETEIA challenged the compensability of Jones’s injuries, asserting
she was on an excursion and left the course and scope of her employment. The
Division of Workers’ Compensation (“DWC”) ruled against ETEIA on its
compensability challenge and determined that Jones’s injuries were compensable.
ETEIA appealed the DWC compensability determination by filing a lawsuit in
Orange County District Court numbered B-090427-C (“Orange County Lawsuit”).
In the Orange County lawsuit, TRS-Active Life as managed by Blue Cross Blue
Shield (BCBS), which was Jones’s health insurer, and ETEIA entered into a written
settlement agreement that called for ETEIA to pay the Jones Plaintiffs indemnity
benefits and to reimburse TRS-ActiveCare $350,000 for medical benefits paid
related to the accident.
Ultimately, the parties submitted an Agreed Judgment in the Orange County
Lawsuit, which ETEIA signed, and the Jones Plaintiffs’ counsel signed based on the
parties’ settlement agreement. 1 On October 25, 2008, the trial court signed the
1 The Jones Plaintiffs make much of the fact in their Brief that the copy of the settlement agreement in the record was not signed by all parties. Even so, the copy in the record shows that both Sanford Jones and James Thomas Lyle signed it, along with a representative of Blue Cross Blue Shield (BCBS). Additionally, the Agreed Judgment the trial court signed, was also signed by ETEIA and attorneys for the Jones Plaintiffs and referenced the settlement agreement. 4 Agreed Final Judgment in the Orange County Lawsuit. As relevant here, that Agreed
Final Judgment provided that
ETEIA’s payment in the amount of $350,000 to TRS-ActiveCare and $50,000 to Roebuck & Thomas, PLLC for attorney fees satisfies ETEIA’s obligation to reimburse the Teachers Retirement System of Texas (TRS) and Blue Cross Blue Shield (BCBS) for the medical bills and expenses that they paid to the health care providers who rendered and provided medical treatment to [Jones] for her May 22, 2008 compensable injury. TRS and BCBS will be entitled to no other monies for the medical bills it paid or for any other medical bills submitted to it for medical treatment received by [Jones] as a result of her May 22, 2008 compensable injury.
Jefferson County Lawsuit and ETEIA’s Subrogation Claim
The record before us shows that on January 23, 2017, the Jones Plaintiffs filed
their First Amended Petition in Intervention in the Jefferson County Lawsuit, and on
June 28, 2021, ETEIA filed its Second Amended Petition in that same lawsuit. 2 The
Jones Plaintiffs assert that Intervenor ETEIA should be required to prove all the
benefit payments, and if the Jones Plaintiffs recover anything as a result of the
lawsuit, that Intervenor ETEIA “should pay an attorney fee up to 33 and 1/3% of
such recovery to plaintiffs’ counsel, and pay a proportionate share of expenses
incurred by plaintiff in prosecution of this suit, as permitted by the Texas Labor
Code.” In its Second Amended Petition in Intervention, ETEIA pleads that its total
lien amount is $820,065.59, which includes: $17,221.45 in temporary income
2 These are the only petitions in intervention in the record. 5 benefits (TIBs) to Jones’s estate; $402,594.14 in death income benefits (DIBs) to
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In The
Court of Appeals
Ninth District of Texas at Beaumont
________________
NO. 09-24-00191-CV ________________
EAST TEXAS EDUCATIONAL INSURANCE ASSOCIATION, Appellant
V.
SANFORD JONES AND JAMES THOMAS LYLE, AS INDEPENDENT EXECUTOR OF THE ESTATE OF MARY LOUISE JONES, DECEASED, AND NEXT FRIEND OF J.L., A MINOR, Appellees ________________________________________________________________________
On Appeal from the 60th District Court Jefferson County, Texas Trial Cause No. 24DCCV0369 ________________________________________________________________________
MEMORANDUM OPINION
East Texas Educational Insurance Association (“ETEIA” or “carrier”), a
workers’ compensation carrier, appeals the trial court’s Orders to Determine Lien
Amounts and Severance Order awarding it funds for its subrogation interest after
paying benefits on behalf of Mary Louise Jones (individually, “Jones” or
“Decedent”), who later died. Sanford Jones and James Thomas Lyle, as Independent
Executor of the Estate of Mary Louise Jones, Deceased, and Next Friend of J.L., a
1 Minor (collectively, the “Jones Plaintiffs” or “Appellees”) intervened in a lawsuit
initiated by other plaintiffs who were injured in the same accident and sued Toyota
for products liability, among other things. In the lawsuit against Toyota, ETEIA also
intervened seeking subrogation for various workers’ compensation indemnity and
medical benefits it paid to or on behalf of Jones. The Jones Plaintiffs acknowledge
in their First Amended Petition in Intervention that “various workers compensation
and medical benefits have been paid to or for plaintiff-intervenors.”
The Jones Plaintiffs filed two motions central to this appeal: (1) Motion to
Approve Apportionment of Global Settlement Offer; and (2) Motion to Determine
Amount of Workers’ Compensation Lien. Later, the trial court signed an Order
granting the Jones Plaintiffs Motion to Sever Claims in Intervention and for Entry
of Final Judgment in Severed Action. In seven issues, ETEIA asserts that the trial
court’s award failed to include $350,000.00 in medical benefits it paid to Jones’s
medical insurance carrier that had been established as a matter of law, or in the
alternative, that the trial court improperly adjudicated ETEIA’s subrogation interest
at a hearing rather than a trial on the merits and summarily put ETEIA to trial. ETEIA
asks us to reverse the trial court’s judgment and render judgment awarding it the
additional $350,000 for the medical benefits paid, or alternatively, to reverse the trial
court’s judgment and remand the matter for a new trial on the amount of its
subrogation interest paid.
2 We hold the trial court abused its discretion by misapplying the law to the
facts of this case when it summarily adjudicated ETEIA’s subrogation claim during
a settlement hearing and effectively denied its right to “first money” reimbursement
of medical benefits paid without a trial on the merits or summary-judgment
proceedings. We reverse and remand the matter for further proceedings consistent
with this opinion as discussed below.
BACKGROUND AND PROCEDURAL HISTORY
Automobile Accident
Jones worked as a teacher for Little Cypress-Mauriceville Consolidated
Independent School District (LCM). In May 2008, she was part of a group of
teachers who traveled to Mexico for a Spanish immersion program. While in
Mexico, she and others were seriously injured in an automobile accident on an
excursion when a Mexican national driving the Toyota Hiace van they were in left a
mountain roadway. In November 2008, Jones died because of her injuries; several
other teachers also died. Other members of the group sued Toyota in District Court
in Jefferson County, Texas in cause number B-184,121 (“Jefferson County
Lawsuit”), and the Jones Plaintiffs intervened in that lawsuit. We outlined the
background facts leading to the underlying products liability litigation in an earlier
opinion involving a separate appeal. See Toyota Motor Co. v. Cook, 581 S.W.3d 278,
281–82 (Tex. App.—Beaumont 2019, no pet.).
3 Orange County Lawsuit: Workers’ Compensation Dispute
Initially, ETEIA challenged the compensability of Jones’s injuries, asserting
she was on an excursion and left the course and scope of her employment. The
Division of Workers’ Compensation (“DWC”) ruled against ETEIA on its
compensability challenge and determined that Jones’s injuries were compensable.
ETEIA appealed the DWC compensability determination by filing a lawsuit in
Orange County District Court numbered B-090427-C (“Orange County Lawsuit”).
In the Orange County lawsuit, TRS-Active Life as managed by Blue Cross Blue
Shield (BCBS), which was Jones’s health insurer, and ETEIA entered into a written
settlement agreement that called for ETEIA to pay the Jones Plaintiffs indemnity
benefits and to reimburse TRS-ActiveCare $350,000 for medical benefits paid
related to the accident.
Ultimately, the parties submitted an Agreed Judgment in the Orange County
Lawsuit, which ETEIA signed, and the Jones Plaintiffs’ counsel signed based on the
parties’ settlement agreement. 1 On October 25, 2008, the trial court signed the
1 The Jones Plaintiffs make much of the fact in their Brief that the copy of the settlement agreement in the record was not signed by all parties. Even so, the copy in the record shows that both Sanford Jones and James Thomas Lyle signed it, along with a representative of Blue Cross Blue Shield (BCBS). Additionally, the Agreed Judgment the trial court signed, was also signed by ETEIA and attorneys for the Jones Plaintiffs and referenced the settlement agreement. 4 Agreed Final Judgment in the Orange County Lawsuit. As relevant here, that Agreed
Final Judgment provided that
ETEIA’s payment in the amount of $350,000 to TRS-ActiveCare and $50,000 to Roebuck & Thomas, PLLC for attorney fees satisfies ETEIA’s obligation to reimburse the Teachers Retirement System of Texas (TRS) and Blue Cross Blue Shield (BCBS) for the medical bills and expenses that they paid to the health care providers who rendered and provided medical treatment to [Jones] for her May 22, 2008 compensable injury. TRS and BCBS will be entitled to no other monies for the medical bills it paid or for any other medical bills submitted to it for medical treatment received by [Jones] as a result of her May 22, 2008 compensable injury.
Jefferson County Lawsuit and ETEIA’s Subrogation Claim
The record before us shows that on January 23, 2017, the Jones Plaintiffs filed
their First Amended Petition in Intervention in the Jefferson County Lawsuit, and on
June 28, 2021, ETEIA filed its Second Amended Petition in that same lawsuit. 2 The
Jones Plaintiffs assert that Intervenor ETEIA should be required to prove all the
benefit payments, and if the Jones Plaintiffs recover anything as a result of the
lawsuit, that Intervenor ETEIA “should pay an attorney fee up to 33 and 1/3% of
such recovery to plaintiffs’ counsel, and pay a proportionate share of expenses
incurred by plaintiff in prosecution of this suit, as permitted by the Texas Labor
Code.” In its Second Amended Petition in Intervention, ETEIA pleads that its total
lien amount is $820,065.59, which includes: $17,221.45 in temporary income
2 These are the only petitions in intervention in the record. 5 benefits (TIBs) to Jones’s estate; $402,594.14 in death income benefits (DIBs) to
Sanford Jones and J.L.; and $400,250.00 in medical benefits for medical treatment
rendered to Jones following her May 22, 2008, injury. Among other things, it asks
that it “be reimbursed for its entire subrogation lien and that from Plaintiffs’ recovery
of damages from Defendants . . . that the Court further enforce ETEIA’s right of
subrogation by awarding it a future offset in the amount of Plaintiffs’ net recovery
in accordance with TEXAS LABOR CODE §417.001-417.003.”
Plaintiffs’ Motion to Approve Apportionment of Global Settlement
On November 8, 2023, the Jones Plaintiffs and other Plaintiffs filed their
Motion to Approve Apportionment of Global Settlement, and the next day, they filed
a Notice of Oral Hearing for the Motion, which stated that the hearing was set for
November 20, 2023 at 9:15 a.m. In the Motion to Approve, the Plaintiffs assert that
settlement negotiations “resulted in a confidential global settlement offer to resolve
all pending claims arising out of the above-described incident against Defendant in
return for releases.” The Plaintiffs’ attorneys assert that the offer was apportioned
by Reaud, Morgan & Quinn LLP, the law firm representing them. They request that
the trial court approve the apportioned amounts, so the law firm could convey the
offers and explain the net recovery to them.
6 Jones Plaintiffs’ Motion to Determine Amounts of Workers’ Compensation Lien
Six days after filing the Motion to Approve, on November 14, 2023, the Jones
Plaintiffs filed a Motion to Determine Amounts of Workers’ Compensation Liens,
followed by a Notice of Oral Hearing on the Motion filed on Thursday, November
16, 2023, which set the hearing on Monday, November 20, 2023, at 9:30 a.m. This
hearing was set the same day but fifteen minutes after the hearing on the Motion to
Approve. In the Motion to Determine Amounts, the Jones Plaintiffs assert that “to
evaluate the allocated offer and determine if they are willing to accept the settlement
offer or not, Plaintiffs need to know the exact amount of workers’ compensation
benefits for which Intervenors are requesting reimbursement.” In the Motion to
Approve Amounts, the Jones Plaintiffs agree that they and Jones received workers’
compensation benefits because of the accident and that “ETEIA claims to have paid
monies on [Jones’s] behalf for which they are seeking reimbursement.” The Jones
Plaintiffs ask that Intervenor ETEIA appear at the hearing on the Motion to Approve
and “be made to present evidence as to the benefits actually paid and for which they
seek reimbursement to enable the Court to determine the proper amount of each
lien.”3
The Jones Plaintiffs also ask that Region 5 Education Service Center, another 3
Intervenor, appear, but that Intervenor is not a party to this appeal. 7 ETEIA’s Response and Affidavit of Patricia Blackshear
On November 16, 2023, ETEIA filed the affidavit of records custodian
Patricia Blackshear who averred she oversees records of Claims Administrative
Services, Inc., a third-party administrator for workers’ compensation benefits for
ETEIA. She states that the total amount of benefits paid was $820,065.59, which
included DIBs of $402,564.14, TIBs of $17,221.45, and medical bills and funeral
expenses of $400,250.00. Blackshear also attached the “Payment Detail Report” for
Jones’s claim. The attached report includes payment breakdown notes showing, a
“Total for IND” paid of $419,815.29. It shows the “Total for MED” listed as
$400,250.00, which included: $350,000.00 paid to TRS-ActiveCare; $50,000.00 to
Roebuck & Thomas PLLC, the Jones Plaintiffs’ attorneys in the Orange County
lawsuit; and two separate $125.00 payments totaling $250.00 to Cunningham
Lindsey.4
Later the same day, ETEIA also filed Intervenors’ Response to Plaintiffs’
Motion to Approve the Apportionment of a Global Settlement Offer, attaching as an
exhibit Blackshear’s earlier filed affidavit and “Payment Detail Report.” ETEIA
stated in its Response that it “was not invited to participate in the discussions of the
On appeal, ETEIA does not challenge the trial court’s refusal to award the 4
$50,000.00 paid to the Jones Plaintiffs’ counsel in the Orange County Lawsuit or the $250.00; it seeks reimbursement for the $350,000.00 payment for medical benefits to TRS-ActiveCare plus the amounts paid for TIBs and DIBs. 8 Defendants and Plaintiffs’ counsel, which led to The Settlements between the
Defendants and the Plaintiffs.” ETEIA asserted that it was notified of the settlement
in May 2023, and the workers’ compensation lien needed to be discussed, but they
had not reached an agreement on the workers’ compensation lien. In its Response,
and consistent with Blackshear’s affidavit, ETEIA again asserted a total final
subrogation amount of $820,065.59 and that it paid: $400,250.00 in medical bills
and expenses for the medical treatment received and rendered to Jones following her
injury; total amounts of DIBs paid was $419,815.59 (broken down into $17,221.45
in TIBs and $402,594.14 in DIBs). It also claimed it became obligated to pay and
did pay workers’ compensation benefits to and on behalf of the Jones Plaintiffs
totaling $820,065.59.
ETEIA contends that the Motion to Approve the Apportionment of a Global
Settlement Offer does not address ETEIA’s statutory workers’ compensation liens
and only asks that it approve the allocation among the Plaintiffs. ETEIA argues that
Plaintiffs’ Motion to Approve cannot be ruled on, and no allocation can be approved
by the Court until the statutory workers’ compensation liens held by the workers’
compensation parties, who have intervened, are properly addressed pursuant to the
Labor Code, which controls this issue. ETEIA asserts that Labor Code section
417.002 controls, which among other things, requires that a plaintiff’s net proceeds
in a third-party action shall be used to reimburse the insurance carrier for benefits,
9 including medical benefits, that have been paid for the injury. See Tex. Labor Code
Ann. § 417.002(a). ETEIA contends that under Labor Code section 417.002, it is
entitled to “first money” from the tortfeasor, and until the carrier is reimbursed in
full, neither the employee nor his representatives are entitled to any of the third-party
recovery. It also asserts that under section 417.003(c), the Jones Plaintiffs’ attorneys
are not entitled to their attorney’s fees out of the workers’ compensation lien,
because ETEIA has been “actively represented” by its own counsel. Additionally,
ETEIA argues that because the Jones Plaintiffs’ attorneys have acted contrary to a
carrier’s subrogation interests, by attempting to eliminate the lien or convince the
carrier they are entitled to nothing, they are not aiding in the carrier’s recovery. It
also disputes that the statutory scheme allows for the award of expenses out of the
subrogation lien funds.
The Jones Plaintiffs did not file a reply or any affidavits contesting ETEIA’s
lien amounts before the hearing.
Hearing and Trial Court’s Orders
There is no reporter’s record of the November 20, 2023, hearings, but that
day, the trial court signed two orders. The first was an Order Granting Motion to
Approve the Apportionment of a Global Settlement Offer. This Order did not contain
any dollar amounts and only allocated percentages among the various Plaintiffs. It
allocated 16.67% to the Jones Plaintiffs. The second order the trial court signed was
10 the Order on Motion to Determine Amounts of Workers’ Compensation Liens. In
the Order on Motion to Determine Amounts, the trial court showed that it considered
the Motion, “and the responses and replies thereto, and the arguments of counsel[.]”
The Order added that ETEIA “has established that it has paid $419,785.59 in benefits
for the compensable injury as contemplated by Tex. Lab. Code Ann. § 417.022[,]”
that Plaintiffs’ counsel is entitled to a one-third attorneys’ fee and reimbursement of
its proportionate share of expenses under 417.023, and that ETEIA shall receive as
provided by section 417.023 an amount corresponding to the court’s finding that it
has established that it has paid $419,785.59 in benefits. This amount mirrored the
DIBs and TIBs. The Order did not address the $350,000.00 in medical benefits
ETEIA reimbursed TRS-ActiveCare in the Orange County Lawsuit. One week later,
on November 27, 2023, the Jones Plaintiffs submitted an Amended Order on Motion
to Determine Amount of Workers’ Compensation Liens without any Motion or
attached document explaining the need for Amended Order, which eliminated the
reference to the one-third share of attorney’s fees. The trial court signed the
Amended Order the same day the Jones Plaintiffs submitted it.
ETEIA’s Motion for Reconsideration and Jones Plaintiffs’ Response
On December 1, 2023, ETEIA filed Intervenor’s Motion for Reconsideration
which attached multiple exhibits. In the Motion for Reconsideration, ETEIA again
lays out the amounts it paid. ETEIA argues that with its original response, it filed
11 Blackshear’s sworn business records affidavit that included the total amount of
$820,065.59, including medical bills and funeral expenses of $400,250.00, and the
Jones Plaintiffs never objected to the sworn affidavit nor was there a contravening
affidavit filed. Yet, it contends that the trial court’s Order disregards the medical
benefits paid by ETEIA of $400,250.00. 5 ETEIA argues that during the case, it has
filed multiple affidavits evidencing the medical bills and benefits paid with the
relevant records and attaches those as Exhibits B through D.
ETEIA states that the BCBS medical bills were eventually negotiated down
and ultimately resolved for $400,250.00 and “that it is against the weight of all the
evidence to conclude that there was $0.00 in medical bills and benefits paid” on
Jones’s behalf. It then asserts the original total of the medical bills was $840,479.50
which was reduced via negotiation to $400,250.00 that is subject to reimbursement
under 417.002(a). ETEIA again contends that Jones Plaintiffs’ attorneys are not
entitled to a portion of their fees from the reimbursement amounts under section
417.003, because they never represented ETEIA’s interests. In support of this, it
points to the Jones Plaintiffs’ attorneys’ attempts to reduce or eliminate the lien, and
the fact that ETEIA was represented by its own attorneys. ETEIA also asks the court
to clarify whether 417.003(a) or (c) applies.
5 This amount includes the $350,000.00 reflected on the Payment Detail Report that ETEIA asserts it is entitled to, along with the $50,000.00 and $250.00 payment that ETEIA does not claim on appeal. 12 With its Motion for Reconsideration, ETEIA attached the following exhibits:
Blackshear’s affidavit and Payment Detail Report originally filed on November 16,
2023; ETEIA’s Notice of Filing Second Business Record Affidavit of Crawford
Armstrong III, saying it attached 229 pages of BCBS records originally filed on
October 7, 2021; ETEIA’s Notice of filing Third Business Record & Lien Affidavit
including “Third Affidavit in Support of Subrogation Lien and Business Record
Affidavit” of Crawford Armstrong III attaching 635 pages of insurance related
records and records reported by BCBS and TRS originally filed with court on March
22, 2022; and ETEIA’s “Notice of Filing Second Business Record Affidavit”
containing Crawford Armstrong III’s affidavit originally attaching 229 pages of
insurance related records showing filed October 7, 2021. 6 On January 10, 2024,
ETEIA filed a Notice of Hearing by Submission setting “Intervenor’s Motion for
Reconsideration” to be considered on January 19, 2024.
On January 10, 2024, for the first time in writing, the Jones Plaintiffs
addressed ETEIA’s Motion for Reconsideration by filing their Affidavit in
Opposition to Defendant’s Motion to Reconsider. This was almost two months after
the hearing on the Motion to Approve and Motion to Determine Lien Amounts. The
6 These exhibits do not attach the medical and billing records referenced in each affidavit; the exhibits show that the notices and affidavits were filed, what they purported to attach, and the dates they were originally filed by ETEIA. Additionally, Exhibit D appears to be a duplicate of Exhibit B. 13 attached Business Records Affidavit was executed by an attorney from the Jones
Plaintiffs’ attorneys in the prior Orange County Lawsuit. The affidavit attached
twenty-eight pages of records from the Roebuck & Thomas Law Firm. The records
included the “Release and Settlement Agreement in the Orange County Lawsuit”
which states that BCBS and TRS-ActiveCare were among the Releasors and that
ETEIA was the Releasee. The attorney who represented the Jones Plaintiffs in the
Orange County Lawsuit signed the Release and Settlement Agreement. The Release
and Settlement Agreement outlined the facts of the worker’s compensation
compensability dispute. It also attached the DWC Order determining that Jones’s
injury was compensable. Finally, attached to the Business Records Affidavit was the
Agreed Final Judgment in Orange County Lawsuit signed by the Jones Plaintiffs’
attorney, ETEIA, and the trial court. The Agreed Final Judgment referenced the
parties’ Settlement Agreement and included the following:
IT IS ORDERED, ADJUDGED and DECREED that ETEIA’s payment in the amount of $350,000.00 to TRS-ActiveCare and $50,000 to Roebuck & Thomas, PLLC for attorney fees satisfies ETEIA’s obligation to reimburse the Teachers Retirement System of Texas (TRS) and Blue Cross Blue Shield of Texas (BCBS) for the medical bills and expenses that they paid to the health care providers who rendered and provided medical treatment to MARY JONES for her May 22, 2008 compensable injury. TRS and BCBS will be entitled to no other monies for the medical bills it paid or for any other medical bills submitted to it for medical treatment received by MARY JONES as a result of her May 22, 2008 compensable injury.
14 The Agreed Judgment also reflects that the trial court approved the Settlement
Agreement “as required under Texas Labor Code § 410.256 and § 410.258[.]” It
explained that a copy of the Agreed Judgment and the Settlement Agreement was
served upon the DWC at least thirty-one days before the entry of the Judgment. The
Jones Plaintiffs made no argument; they simply filed the affidavit and attached the
records.
On January 18, 2024, the Jones Plaintiffs filed their Response to Intervenor
ETEIA’s Motion for Reconsideration, which included multiple exhibits. It was the
first time they presented any argument in writing contesting ETEIA’s lien amounts.
The Jones Plaintiffs responded that ETEIA’s proof regarding “medical bills and
funeral expenses” is inadequate. They argued that ETEIA initially denied the claim,
which was later determined to be compensable. They explained that Roebuck was a
law firm and contended that any payments to them and the $250.00 to the claims
adjusting firm were not for medical bills. They also attached a “certified copy of the
judgment” in the Orange County Lawsuit. In sum, the Jones Plaintiffs took the
position that ETEIA did not pay any medical bills, instead all ETEIA did was settle
a lawsuit. They argued that given ETEIA’s denial of the claim and challenge to
compensability, ETEIA “settled a lawsuit in which it likely faced exposure for its
own wrongful denial of the claim.” They then contended that ETEIA’s counsel did
not “actively participate” in the litigation and described the depositions and events
15 ETEIA’s attorneys did not attend. The Jones Plaintiffs argued that the $50,000 paid
to Roebuck & Thomas and $250 paid to its adjusting company should be disallowed.
They asked that ETEIA’s Motion for Reconsideration be denied except that the trial
court should enter an Order Nunc Pro Tunc correcting the references to the Texas
Labor Code sections 417.002 and 417.003.
The Jones Plaintiffs attached the following exhibits to their Response to
Intervenor’s Motion for Reconsideration: Blackshear’s Affidavit and Payment
Detail Report for the claim; Business Records Affidavit from Jeffrey Roebuck with
records including “Release and Settlement Agreement,” DWC Order, Agreed Final
Judgment unsigned by judge but signed by Jones’s Plaintiffs’ attorney; certified
copy of Agreed Final Judgment in Orange County Lawsuit; Sedgwick/Cunningham
Lindsey web announcement; TRS-ActiveCare website; Affidavit of Attorney Curtis
W. Leister outlining all the ways ETEIA did not participate in the recovery from
Toyota; and Affidavit of John G. Werner describing how many depositions he
attended and stating that ETEIA only attended five of seventeen and attaching
appearance sheets for depos.
Amended Order on Motion to Determine Amounts of Workers’ Compensation Liens
On January 22, 2024, the trial court signed another Amended Order on Motion
to Determine Amounts of Workers’ Compensation Liens. The Order did not change
the amounts but changed the Labor Code sections. The Order states that ETEIA has 16 established that it has paid $419,785.59 in benefits for compensable injury as
contemplated by Texas Labor Code section 417.002. It adds that ETEIA should
receive an amount, as provided by the calculations under section 417.003(a) “an
amount corresponding to the Court’s finding that it has established it has paid
$419,785.59 in benefits for the compensable injury as contemplated by Tex. Lab.
Code Ann. § 417.002.”
Jones Plaintiffs’ Motion to Sever Claims in Intervention and for Entry of Final Judgment in Severed Action
On February 28, 2024, the Jones Plaintiffs filed a Motion to Sever and for
Entry of Final Judgment in Severed Action. In the Motion to Sever, the Jones
Plaintiffs assert that a dispute has arisen between them and Intervenor ETEIA. They
note the trial court’s previous rulings “that ETEIA had established entitlement only
to $419,785.59 in benefits, and that Counsel for Plaintiffs was entitled to a 1/3 fee
and proportionate share of expenses as provided by Section 417.003(a).” The Jones
Plaintiffs then provide a calculation for the attorney’s fees, expenses, and net
payment to ETEIA. They contend “the attorneys fee deduction chargeable to ETEIA
is $139,928.53 (1/3 of $419,785.59). The lien being 41.978559% of the gross
recovery, the pro-rata share of expenses to be deducted is $46,869.30. This leads to
a net payment to ETEIA by Plaintiffs of $232[,]987.76.” The Jones Plaintiffs then
argue the trial court’s rulings regarding the lien amount must be made final for there
17 to “be certainty about the disposition of the settlement proceeds.” They then ask the
trial court to enter a severance order of ETEIA’s subrogation claims.
The Jones Plaintiffs set their Motion to Sever Claims in Intervention for
hearing March 6, 2024. The same day of the hearing, the trial court signed the Order
severing ETEIA’s claims in intervention.
Findings of Fact and Conclusions of Law and Motion for New Trial
On March 22, 2024, ETEIA filed its Request for Findings of Fact and
Conclusions of Law under Rule 296. See Tex. R. Civ. P. 296. It filed Proposed
Findings of Fact and Conclusions of Law pertaining to the following trial court
proceedings and orders: (1) the Jones Plaintiffs’ Motion to Determine Amounts of
Workers’ Compensation Lien, filed November 14, 2023; (2) the November 20, 2023,
hearing on the Jones Plaintiffs’ Motion to Determine Amounts of Workers’
Compensation Lien; (3) the Order on Motion to Determine Amounts of Workers’
Compensation Liens, entered on November 20, 2023; (4) the Amended Order on
Motion to Determine Amounts of Workers’ Compensation Liens, entered on
November 27, 2023; (5) ETEIA’s Motion for Reconsideration; (6) the Amended
Order on Motion to Determine Amounts of Workers’ Compensation Liens, entered
on January 22, 2024; and (7) the Severance Order pertaining to ETEIA’s claims,
entered March 7, 2024.
18 On April 4, 2024, ETEIA filed its Motion for New Trial. In the Motion for
New Trial, ETEIA complains that the trial court wrongfully recited the amount of
workers’ compensation benefits paid as $419,785.19 under Texas Labor Code
section 417.002. ETEIA asserts that the trial court’s order “disregarded the $350,000
ETEIA paid to TRS-ActiveCare in settlement of Cause No. B-090427-C, East Texas
Educational Insurance Association v. Beneficiaries of Mary Louise Jones, et al, in
163rd District Court of Orange County, Texas.” ETEIA argues that TRS-
ActiveCare’s claim against ETEIA in the Orange County Lawsuit “was a subclaim
pursuant to TEX. LABOR CODE § 409.009, for reimbursement of medical benefits.”
ETEIA notes that the trial court’s Agreed Final Judgment in that proceeding
determined “that this payment was for reimbursement of medical bills and expenses
that TRS-ActiveCare paid to the health care providers who rendered and provided
medical treatment to Mary Jones for her May 22, 2008 compensable injury.” It
contends that the Jones Plaintiffs presented no evidence that ETEIA’s payments
were for any other claims like Insurance Code violations, DTPA claims, or any
common-law claims, and that regardless, such claims would have been pre-empted
by the Texas Workers’ Compensation Act.
In the Motion for New Trial, ETEIA also specifies that TRS-ActiveCare was
billed $1,771,507.89 and paid $830,630.84 in medical benefits for the compensable
injury. ETEIA contends that under Texas Labor Code section 409.0091(h), it was
19 only required to reimburse TRS-ActiveCare the lesser of the amount payable under
the applicable fee guideline as of the date of service or the actual amount paid by the
health care insurer. Finally, ETEIA argues that its “$350,000 settlement payment to
TRS-ActiveCare constituted payment for medical benefits, as provided for by TEX.
LABOR CODE § 417.002(a).” Ultimately, ETEIA asks that the trial court find it
“paid $769,785.59 in benefits for the compensable injury” under section 417.002.
On April 10, 2024, the Jones Plaintiffs filed their Preliminary Response to
Intervenor ETEIA’s Request for Findings of Fact and Conclusions of Law stating
that they improperly calendared a deadline and asking for more time to respond. On
April 17, 2024, ETEIA filed its Notice of Past Due Findings of Fact and Conclusions
of Law. The next day, ETEIA filed its Amended Proposed Findings of Fact and
Conclusions of Law, which removed its earlier requested findings numbered 13
through 15 but did not add any new findings.
On April 22, 2024, the Jones Plaintiffs filed their Response to ETEIA’s
Request for Findings of Fact and Conclusions of Law. They asserted that ETEIA’s
Proposed Findings of Fact and Conclusions of law “directly conflict with the Court’s
rulings and are wholly incompatible with the Court’s rulings and Judgment.” The
Jones Plaintiffs then submitted their proposed Findings of Fact and Conclusions of
Law.
20 On April 25, 2024, the trial court signed the Findings of Fact and Conclusions
of Law submitted by the Jones Plaintiffs, which contained the following:
I. FINDINGS OF FACT 1. Mary Louise Jones was injured in the accident made the subject of this lawsuit on May 22, 2008. 2. The Texas Department of Insurance, Division of Workers’ Compensation determined that Mary Louise Jones was in the course and scope of her employment with Little Cypress Mauriceville ISD when she was injured in the accident the subject of this lawsuit on May 22, 2008. 3. As a result of the determination of the Texas Department of Insurance, Division of Workers’ Compensation, ETEIA became obligated to pay worker’s compensation benefits to or on behalf of Mary Louise Jones as a result of the accident made the subject of this lawsuit on May 22, 2008. 4. Mary Louise Jones died on November 10, 2008, as a result of her injuries sustained in the accident made the subject of this lawsuit. 5. Sanford Jones was the surviving spouse of Mary Louise Jones. 6. [J.L.] was the surviving minor child of Mary Louise Jones. 7. ETEIA paid workers’ compensation death benefits totaling $402,564.14 to the beneficiaries of Mary Louise Jones. These beneficiaries were Sanford Alvin Jones and [J.L.]. 8. ETEIA paid temporary income benefits totaling $17,221.45. 9. ETEIA originally denied the claims of Mary Louise Jones and her beneficiaries. 10. The beneficiaries appealed the denial, and that appeal was upheld by the Texas Department of Insurance, Division of Workers’ Compensation. 11. ETEIA then appealed the decision of the Texas Department of Insurance, which appeal was docketed as Cause Number B-090427, East Texas Educational Insurance Association v. Beneficiaries of Mary Louise Jones, et al., in the 163rd Judicial District Court of Orange County, Texas. (the “Worker’s Compensation Proceeding”). 12. The Worker’s Compensation Proceeding was settled, pursuant to which ETEIA for itself -- and for its excess insurance company Midwest Employers Casualty Company; and for its third party administrator for workers compensation claims, Claims Administrative Services, Inc.; and for its adjuster handling the claim, Ann Barron, and 21 for “all other persons, firms, corporations [sic] who have any legal obligations, duties, or involvement in Mary Jones’ workers compensation claim – demanded and obtained releases from: a. Blue Cross Blue Shield of Texas (BCBSTX); b. The Teacher Retirement System of Texas (TRS), acting in its capacity of TRS-ActiveCare; c. Sanford Jones; d. James Thomas Lyle, individually; and e. James Thomas Lyle, as next friend of [J.L.], a minor. 13. The releases obtained from these parties are exceptionally broad and comprehensive, and include releases of the following specifically enumerated claims: a. Claims for violations of the Texas Labor Code; b. Claims for violations of the Texas Deceptive Trade Practices Act; c. Breach of any common law duty, including the duty of good faith and fair dealing; d. Claims of intentional or negligent infliction of emotional distress; and e. “Any other claim or damage which may related, either directly or indirectly,” to the workers’ compensation claim of Mary Jones. 14. The settlement agreement further notes that “RELEASEE [ETEIA] denies any liability and allegations that could be made by RELEASORS BCBSTX and TRS-ActiveCare for claims of reimbursement and payment of [medical bills].” 15. Pursuant to the settlement, ETEIA did not release any party from any claim, but instead purportedly paid $350,000 to TRS-ActiveCare, and $50,000 to the attorneys representing the family of Mary Jones. 16. Of the total amount recovered by all Plaintiffs in Cause No. B- 184,121, 16.67% was allocated to Sanford Jones and James Thomas Lyle, as Independent Executor of the Estate of Mary Louise Jones, Deceased, and as Next Friend of [J.L.], a Minor. As such, 16.67% of the total litigation expenses incurred by all plaintiffs is allocated to the settlement made by Sanford Jones and James Thomas Lyle, as Independent Executor of the Estate of Mary Louise Jones, Deceased, and as Next Friend of [J.L.], a Minor, for determining a proportionate share of the litigation expenses to be awarded under Texas Labor Code Section 417.003(a)(2). 17. With respect to Cause No. B-184,121: a. ETEIA did not retain any experts; 22 b. ETEIA did not participate in any hearings against Toyota; c. ETEIA had no involvement in negotiating the settlement against Toyota; d. ETEIA “attended” only a minority of the depositions conducted in the case, during which its counsel did not ask any questions of any witness; e. Reaud, Morgan & Quinn took the lead on deposing all Defendant experts; f. Reaud, Morgan & Quinn selected and presented for deposition various experts in fields such as mechanical engineering (two), seat belts, accident reconstruction, biomechanics, and human factors; g. Reaud, Morgan & Quinn attorneys traveled to various states, and also in one instance to Mexico; h. Reaud, Morgan & Quinn located and purchased two exemplar vehicles for use by the experts; i. Reaud, Morgan & Quinn located (in Mexico) the driver of the subject van, and arranged for his deposition to be taken in Mexico; j. Reaud, Morgan & Quinn retained research entities to research the technical data on the subject vehicle and similar vehicles; k. Reaud, Morgan & Quinn retained foreign-language translators not only for Mexican documents, but also for Toyota product literature which was originally published in languages such as German or Dutch; and l. Reaud, Morgan & Quinn handled all aspects of the appeal in Toyota Motor Co. v. Cook, 581 S.W.3d 278 (Tex. App.- Beaumont 2019, no pet). II. CONCLUSIONS OF LAW 18. In reaching its decision, this Court accepted and considered all of the filings recited in the introductory part of this Order, including but not limited to the affidavits of Patricia Blacks[h]ear, Roebuck & Thomas, PLLC, John Werner, and Curtis Leister, with the attachments thereto. 19. ETEIA’s arguments regarding Texas Labor Code Section 409.009 and 409.0091 were not presented to the Court prior to its ruling and thus have been waived. 20. ETEIA has not established that any of the money paid in settlement of the lawsuit Cause Number B-090427, East Texas Educational Insurance Association v. Beneficiaries of Mary Louise Jones, et al., in 23 the 163rd Judicial District Court of Orange County, Texas was “medical benefits that have been paid for the compensable injury” under Tex. Lab. Code Section 417.002. 21. ETEIA did not “actively participate in obtaining a recovery” in the case as contemplated by Texas Labor Code Section 417.003(c). 22. Under Texas Labor Code Section 417.003(a), Reaud, Morgan & Quinn is entitled to a fee of one-third of the insurance carrier’s recovery. Since the insurance carrier’s recovery is $419,785.59, the amount to be deducted as attorney’s fees is $139,928.53. 23. The subrogation interest of ETEIA is 41.978559% of the gross recovery by Sanford Jones and James Thomas Lyle, as Independent Executor of the Estate of Mary Louise Jones, Deceased, and as Next Friend of [J.L.], a Minor. As such, ETEIA’s proportionate share of the litigation expenses apportioned to the recovery is $46,845.37, to be awarded out of ETEIA’s recovery pursuant to Texas Labor Code Section 417.003(a)(2). 24. The net recovery for ETEIA, based on $419,785.59 in benefits paid, minus $139,928.53 in attorneys fee, and minus $46,845.37 as a proportionate share of expenses, is $233,011.69, to be paid by Sanford Jones and James Thomas Lyle, as Independent Executor of the Estate of Mary Louise Jones, Deceased, and as Next Friend of [J.L.], a Minor from the settlement proceeds obtained from Toyota.
On April 26, 2024, after the trial court signed the Jones Plaintiffs’ Findings of
Fact and Conclusions of Law, ETEIA filed its Request for Additional Findings of
Fact and Conclusions of Law with proposed Additional Findings of Fact and
Conclusions of Law attached. ETEIA’s additional requested findings address that
Plaintiffs’ Findings of Fact and Conclusions of Law signed by the trial court omits
language from the settlement agreement, and the signed Findings of Fact and
Conclusions of Law do not accurately reflect the agreement. The additional
requested findings and conclusions notes that the “settlement agreement clearly
reflected that the $350,000 settlement payment was for reimbursement of medical 24 payments made by TRS-ActiveCare” then cites the portions of the settlement
agreement with the applicable language. ETEIA also points to language in the
Agreed Final Judgment from the Orange County Lawsuit. It includes a conclusion
of law that TRS-ActiveCare’s claim against ETEIA in the Orange County Lawsuit
was a “subclaim pursuant to Tex. Labor Code § 409.009, for reimbursement of
medical benefits.” Additional conclusions of law cite to Labor Code section 417.002
and state that the Jones Plaintiffs “would receive a windfall, and would be unjustly
enriched if they are not required to provide any reimbursement out of the settlement
for the medical benefits that were paid by TRS-ActiveCare and/or ETEIA.” The
additional proposed conclusions reflect that: the subrogation lien was improperly
adjudicated at a hearing and should have been adjudicated at a trial; ETEIA was only
given five days’ notice of the November 20, 2023 hearing, which included two
weekend days; no notice of a trial setting or of an evidentiary hearing was given to
ETEIA where it would have to prove the amount of its subrogation claim; to the
extent that the November 20, 2023 hearing could be considered a “trial,” pursuant
to Texas Rule of Civil Procedure 245, the Plaintiffs did not give timely and/or proper
notice of the trial setting or timely file a responsive pleading under Rule 63; and that
the trial court’s conclusion of law should be withdrawn as ETEIA was not provided
adequate notice or time to fully brief all issues pertaining to its subrogation before
the November 20 hearing. The trial court did not sign ETEIA’s Requested
25 Additional Findings of Fact and Conclusions of Law. On May 21, 2024, ETEIA
appealed.
ISSUES ON APPEAL
In seven issues, ETEIA complains the trial court erred: (1) in failing to award
reimbursement to ETEIA for its $350,000.00 settlement payment to TRS-
ActiveCare, which constituted reimbursement of medical benefits recoverable under
Labor Code section 417.002(a); (2) by adjudicating ETEIA’s subrogation interest at
a hearing when it should have been adjudicated at a trial; (3) in putting ETEIA to
trial summarily, if the November 20, 2023, hearing could be considered a “trial;” (4)
by allowing a “trial” to proceed, if the hearing could have been considered a trial,
where the Jones Plaintiffs failed to timely file a responsive pleading to ETEIA’s
intervention at least seven days before trial under Texas Rule of Civil Procedure 63;
(5) by adjudicating ETEIA’s subrogation interest, as the issue was not ripe until there
was a third-party recovery, and Appellees’ motion was an improper request for an
advisory opinion; (6) by not requiring the court reporter to make a record of the
November 20, 2023 hearing; and (7) in holding that ETEIA’s arguments about Texas
Labor Code sections 409.009 and 409.0091 were waived, as the conclusion of law
was vague, and ETEIA was not given proper notice from Appellees’ motion that
these sections would be at issue. In answer to issues two and three, we hold that the
trial court erred by adjudicating ETEIA’s subrogation interest at a hearing and
26 summarily putting ETEIA to trial in violation of Texas Rule of Civil Procedure 245.
We therefore reverse and remand this matter for a new trial as discussed below.
INITIAL MATTER: WAIVER
In their Brief, the Jones Plaintiffs’ refrain is that ETEIA has waived
everything – particularly its complaints about the lack of a jury trial by participating
in hearings without objection. Neither motion the Jones Plaintiffs filed would have
given ETEIA any indication they were contesting the subrogation claim or
reimbursement amounts or that ETEIA would need to brief every conceivable issue
in support of its subrogation and reimbursement claims before the hearings.
Seemingly, the Jones Plaintiffs want us to affirm the trial court’s determination of
the lien amounts and calculations, implying that the process afforded was sufficient
for ETEIA to be meaningfully heard. ETEIA appeared at hearings noticed on
motions not for a trial. These distinctions matter, especially here, where the trial
court—unbound by the rules of evidence and a conventional trial on the merits—
disregarded the only evidence on file at the time of the hearing, which was
Blackshear’s affidavit and records that ETEIA filed before the hearing.
Elsewhere in their Brief, the Jones Plaintiffs assert that “there is no suggestion
that any evidence was introduced at the November 20, 2023 hearing[,]” and
“ETEIA’s appellate counsel wisely does not assert that anything took place at the
hearing other than attorney argument.” Despite the Jones Plaintiffs’ argument to the
27 contrary, the record reflects that ETEIA did complain about a lack of notice and the
fact that their subrogation claims were summarily decided in their Request for
Additional Findings of Fact and Conclusions of Law within ten days of the trial court
having signed the original Findings of Fact and Conclusions of Law submitted by
the Jones Plaintiffs. See Tex. R. Civ. P. 298 (permitting a party to request additional
findings within ten days after the trial court files its original).7 We conclude that
ETEIA has preserved its complaint about the trial court summarily adjudicating its
right to reimbursement and subrogation claim at a hearing.
ANALYSIS
This case is a procedural quagmire given the orders, amended orders, and
absence of a reporter’s record. To distinguish case authority, the Jones Plaintiffs
assert in their Brief that they “responded in good faith and did not engage in any
chicanery, let alone the egregious conduct which led up to the Ledbetter decision.”
See Tex. Mut. Ins. Co. v. Ledbetter, 251 S.W.3d 31, 34–35 (Tex. 2008). While some
differences exist between these facts and Ledbetter, a significant similarity is the
effort to subvert the express language of the Workers’ Compensation Act without a
trial on the merits.
7 ETEIA’s Second Amended Petition in Intervention also reflects that they adopted portions of the Plaintiffs’ pleadings, and that the Plaintiffs’ pleadings demanded a jury trial. Additionally, a docket notation indicates the jury fee had been paid, although it does not specify which party paid the fee.
28 We turn to issues one through three. In issue one, ETEIA complains that the
trial court erred by refusing to award reimbursement to ETEIA for its $350,000
settlement payment to TRS-ActiveCare, which constituted reimbursement of
medical benefits recoverable under Labor Code section 417.002(a). In conjunction
with issue one, it asks us to render judgment awarding that amount since the
undisputed evidence in the record establishes ETEIA paid $350,000 as
reimbursement for medical expenses. In issues two and three, however, ETEIA
complains that the trial court erred by adjudicating ETEIA’s subrogation interest at
a hearing when it should have been adjudicated at a trial and in putting ETEIA to
trial summarily, if the November 20, 2023, hearing could be considered a “trial.”
Since a lack of due process likely resulted in the rendition of an improper judgment,
remand rather than rendition is the appropriate remedy, as we discuss below. We
turn to issues two and three.
Standard of Review
Although neither party provides us with a standard of review, in Ledbetter,
the Court explained that where a trial court approved a settlement that did not give
the workers’ compensation carrier first money, it constituted an abuse of discretion.
See id. at 36. Thus, we will review the trial court’s determination of lien amounts
that failed to reimburse the carrier with the first money of any recovery up to the
amount of benefits paid, including medical benefits, for an abuse of discretion. See
29 id. This reflects the premise that one way a trial court abuses its discretion is by
misapplying the law to the established facts of the case. See Diamond Hydraulics,
Inc. v. GAC Equip., LLC, No. 24-1049, 2026 WL 844386, at *2 (Tex. Mar. 27, 2026)
(quoting Huynh v. Blanchard, 694 S.W.3d 648, 674 (Tex. 2024)).
Applicable Law
The Texas Supreme Court has repeatedly recognized the principle that “the
compensation carrier gets the first money a worker receives from a tortfeasor.”
Ledbetter, 251 S.W.3d at 35 (collecting cases) (citations omitted). The Court has
also explained the importance of “[f]irst-money reimbursement” as it “is crucial to
the worker’s compensation system because it reduces costs for carriers (and thus
employers, and thus the public) and prevents double recovery by workers.” Id.
(citing Capitol Aggregates, Inc. v. Great Am. Ins. Co., 408 S.W.2d 922, 924 (Tex.
1966); Fort Worth Lloyds v. Haygood, 246 S.W.2d 865, 868 (1952)). From any
recovery by the injured worker or her beneficiaries, “‘the carrier is first entitled to
the money up to the total amount of benefits it has paid[.]’” Id. (quoting Argonaut
Ins. Co. v. Baker, 87 S.W.3d 526, 530 (Tex. 2002)).
How much a beneficiary receives as part of a settlement matters, as it
implicates how the money is paid. See id. As part of the statutory plan, any net
recovery up to the amount of past benefits goes to the carrier. See id.; see also Tex.
Lab. Code Ann. § 417.002(a). Any recovery greater than past benefits but less than
30 all future benefits goes to the beneficiary but releases the carrier from future
payments to that extent. See Tex. Lab. Code Ann. § 417.002(b); Ledbetter, 251
S.W.3d at 35–36. Any recovery greater than past and future benefits combined goes
to the beneficiary. See Tex. Lab. Code Ann. § 417.002(c); Ledbetter, 251 S.W.3d at
36. “The net amount recovered by a claimant in a third-party action shall be used to
reimburse the insurance carrier for benefits, including medical benefits, that have
been paid for the compensable injury.” Tex. Lab. Code Ann. § 417.002(a) (emphasis
added). “There is nothing discretionary about this statute; a carrier’s right to
reimbursement is mandatory.” Ledbetter, 251 S.W.3d at 36. Said another way, “until
a carrier is reimbursed in full, ‘the employee or his representatives have no right to
any of such funds.’” Id. (quoting Capitol Aggregates, Inc., 408 S.W.2d at 923) (other
citations omitted). “When an injured worker settles a case without reimbursing a
compensation carrier, everyone involved is liable to the carrier for conversion—the
plaintiffs, the plaintiffs’ attorney, and the defendants.” Id. at 38. (citations omitted).
A carrier’s claim for reimbursement is treated as an affirmative claim, and
“[t]here is no requirement that a carrier plead the precise amount of reimbursement
it seeks.” Id. at 37. “[L]itigants cannot be put to trial summarily.” Id. (citing Tex. R.
Civ. P. 245). Texas Rule of Civil Procedure 245 provides that a trial court:
may set contested cases on written request of any party, or on the court’s own motion, with reasonable notice of not less than forty-five days to the parties of a first setting for trial, or by agreement of the parties; provided, however, that when a case previously has been set for 31 trial, the Court may reset said contested case to a later date on any reasonable notice to the parties or by agreement of the parties.
Tex. R. Civ. P. 245. “The notice required by Rule 245 ‘is mandatory and involves
the constitutionally protected right of due process.’” In re B.C., 579 S.W.3d 432,
435 (Tex. App.—Corpus Christi–Edinburg 2019), aff’d, 592 S.W.3d 133 (Tex.
2019) (quoting In re I.L.S., 339 S.W.3d 156, 159 (Tex. App.—Dallas 2011, no pet.)).
Importantly, “a lack of notice violates basic principles of due process.” Highsmith v.
Highsmith, 587 S.W.3d 771, 778 (Tex. 2019) (citation omitted). “Due process
demands that a party be afforded ‘an opportunity to be heard at a meaningful time
and in a meaningful manner.’” Id. (quoting Univ. of Tex. Med. Sch. at Hous. v. Than,
901 S.W.2d 926, 930 (Tex. 1995)).
The Texas Rules of Civil Procedure provide different procedural vehicles that
may be used to resolve the parties’ dispute. See In re Park Mem’l Condo. Ass’n, Inc.,
322 S.W.3d 447, 451 (Tex. App.—Houston [14th Dist.] 2010, orig. proceeding).
“Those options include, among other things, the following: trial on the merits, either
to a jury or the bench, motions for summary judgment, or agreements by the parties
to compromise some or all of a party’s claims.” Id. (citing Tex. R. Civ. P.
11 (agreements between parties), 166a (summary judgment), 216 (jury trial), 262
(bench trial)). “Except by these methods, however, a trial court cannot resolve a
disputed issue.” Id. (citing Unitrust, Inc. v. Jet Fleet Corp., 673 S.W.2d 619, 623
(Tex. App.—Dallas 1984, no writ) (“A dismissal, when issues are disputed, without 32 affording the parties a right to a full trial on the merits, should only be invoked if the
summary-judgment procedure is invoked or if the parties come to an agreement on
the issues.”)). Parties cannot resolve disputed fact issues “‘simply on motion and
hearing’ without any of the procedural protections provided by a trial on the merits
before a factfinder.” Aguilar v. Aguilar, No. 04-24-00161-CV, 2025 WL 1512197,
at *5 (Tex. App.—San Antonio May 28, 2025, no pet.) (mem. op.) (quoting Gamboa
v. Gamboa, 383 S.W.3d 263, 269 (Tex. App.—San Antonio 2012, no
pet.) (discussing in context of Rule 11 enforcement in divorce proceeding)).
Since claimants should already know how much they have received in benefits,
and a carrier is entitled to reimbursement for medical payments without proof they
were reasonable and necessary, “a carrier’s subrogation claim should hardly ever be
contested.” Ledbetter, 251 S.W.3d at 37. That said, on the rare occasion a claimant
wants to contest the amounts, “they could not insist on a summary trial.” Id. A carrier
must prove its case at trial. See id.; Lege v. Jones, 919 S.W.2d 870, 874 (Tex. App.—
Houston [14th Dist.] 1996, no writ). A settlement hearing is not a trial. See Ledbetter,
251 S.W.3d at 37. Likewise, the failure to hold a jury trial on factual issues is harmful
error. See Mercedes-Benz Credit Corp. v. Rhyne, 925 S.W.2d 664, 665 (Tex. 1996).
33 Application
Here, the record reflects a protracted dispute among multiple parties involving
serious injuries, fatalities, and workers’ compensation benefits being paid to the
Jones Plaintiffs and on behalf of Jones. We realize the need to bring this decades-
long litigation to an end, but we cannot do so by permitting the trial court to
summarily adjudicate the right of the workers’ compensation carrier seeking
reimbursement. See Ledbetter, 251 S.W.3d at 36–37. That is what happened here.
The statutory scheme governing reimbursement to workers’ compensation
carriers for benefits paid for a compensable injury is clear: the carrier has the right
to “first money.” Id. at 36; Tex. Lab. Code Ann. § 417.002(a). Unlike most claimants,
the Jones Plaintiffs have decided to contest the subrogation claim amounts, which
they may do. See Ledbetter, 251 S.W.3d at 36. Even so, they cannot have the
adjudicated fact issue of the reimbursement amounts for medical benefits decided
“‘simply on motion and hearing’ without any of the procedural protections provided
by a trial on the merits before a factfinder.” Aguilar, 2025 WL 1512197, at *5
(quoting Gamboa, 383 S.W.3d at 269). In other words, ETEIA “cannot be put to trial
summarily[,]” and the Jones Plaintiffs “could not insist on a summary trial” simply
because they decided they wanted to contest the reimbursement amounts ETEIA
paid for medical benefits. See Ledbetter, 251 S.W.3d at 36 (citing Tex. R. Civ. P.
245).
34 The trial court cannot adjudicate disputed fact issues in any way it sees fit. It
may do so by the parties’ settlement agreement, a bench trial, a jury trial, or a motion
for summary judgment, which adhere to certain rules of procedure and evidence. See
In re Park Mem’l Condo. Ass’n, Inc., 322 S.W.3d at 451; see also Tex. R. Civ. P.
11 (agreements between parties), 166a (summary judgment), 216 (jury trial), 262
(bench trial). The record shows that the Jones Plaintiffs failed to provide the requisite
notice required for a trial under Rule 245. See Tex. R. Civ. P. 245. They also did not
move for summary judgment, as the governing rule provides procedural protections
by outlining the time of filing evidence, responses, and notice requirements. See id.
166a. Rather than providing the requisite notice required by rules 166a or 245, the
Jones Plaintiffs provided less than a week’s notice. See id. 166a, 245. Further, neither
the Motion to Approve nor Motion to Determine Lien Amounts indicated or alerted
ETEIA that the Jones Plaintiffs were contesting the reimbursement amounts for
medical benefits paid by the carrier. Instead, the Motion to Determine Lien Amounts
asked that the carrier appear and present evidence, which ETEIA did when it filed
Blackshear’s Affidavit and attached the Payment Detail Report for the claim. The
record reflects that the Jones Plaintiffs filed no evidence before the hearing, and they
concede no evidence was introduced at the hearing. Despite this, the trial court
entered multiple orders disregarding ETEIA’s evidence and permitting the Jones
35 Plaintiffs to submit evidence after the fact, which at least in part, substantiates
ETEIA’s claim for the medical reimbursement benefits paid on behalf of Jones. 8
We briefly turn to the Jones Plaintiffs’ claims that they did not know “what
the amount was” for the subrogation lien and reimbursement amounts due to the
passage of time and complicated procedural history. They point to ETEIA’s failure
to state amounts in the affidavits it filed before November 2023, yet ETEIA was not
required to “plead the precise amount of reimbursement it seeks.” Ledbetter, 251
S.W.3d at 37. The Jones Plaintiffs themselves knew the amounts before the hearing,
given Blackshear’s Affidavit and the Payment Detail Report showing the amounts
paid. Additionally, the same amounts stated in Blackshear’s Affidavit were pleaded
in ETEIA’s Second Amended Petition in Intervention, which had been on file since
2021. The fact that they signed a Settlement Agreement and their previous attorney
signed an Agreed Final Judgment in the Orange County Lawsuit based on that
Agreement specifying ETEIA reimbursed $350,000.00 to TRS-ActiveCare for
medical bills it paid because of the compensable injury undermines this assertion.
See id. (noting claimants should know the amounts of benefits paid).
8 Indeed, the evidence filed after the fact included Blackshear’s affidavit with the Payment Detail Report, a business records affidavit from the Jones Plaintiffs’ counsel in the Orange County Lawsuit, the Settlement Agreement in the Orange County Lawsuit, and Agreed Judgment in that suit. The remaining evidence filed consisted of the Jones Plaintiffs’ attorneys trying to explain why they should be entitled to a fee from the subrogation lien amount owed to the carrier, even though ETEIA was represented by its own attorneys. 36 We hold the trial court abused its discretion by misapplying the law to the
facts of this case when it summarily adjudicated ETEIA’s subrogation claim during
a settlement hearing and effectively denied its right to “first money” reimbursement
of medical benefits paid without a trial on the merits or summary-judgment
proceedings. See id.; In re Park Mem’l Condo. Ass’n, Inc., 322 S.W.3d at 451; see
also Tex. R. Civ. P. 166a, 216, 245, 262. Accordingly, we sustain issues two and
three. “[T]he remedy for a denial of due process is due process,” so rather than
rendition, remand for an adjudication of the merits of ETEIA’s claims by trial,
summary-judgment, or other method allowable under the rules, is the appropriate
remedy. See Mosley v. Tex. Health & Hum. Servs. Comm’n, 593 S.W.3d 250, 268
(Tex. 2019); Than, 901 S.W.2d at 933; see also In re Park Mem’l Condo. Ass’n, Inc.,
322 S.W.3d at 451. Given our resolution of issues two and three, we need not address
ETEIA’s remaining issues. See Tex. R. App. P. 47.1.
Courts have held that generally those who received the funds unlawfully (the
plaintiffs and their attorney) should disgorge them rather than making the tortfeasors
pay twice. See Ledbetter, 251 S.W.3d at 39. The parties have not asked us to set
aside the Jones Plaintiffs’ settlement with Toyota, and we do not hold it is necessary.
We are confident the trial court can protect both the carrier’s and the Jones Plaintiffs’
interests without undoing the settlement entirely. See id.
37 CONCLUSION
Having determined that the trial court summarily and erroneously resolved the
merits of ETEIA’s subrogation claim and reimbursement amount for benefits paid
without a jury trial, bench trial, or motions for summary judgment, we reverse the
following orders entered by the trial court: (1) Order on Motion to Determine
Amounts of Workers’ Compensation Liens, signed November 20, 2023; (2)
Amended Order on Motion to Determine Amounts of Workers’ Compensation
Liens, signed November 27, 2023; (3) Amended Order on Motion to Determine
Amounts of Workers’ Compensation Liens, signed January 22, 2024; and (4)
Severance Order pertaining to ETEIA’s claims, signed March 7, 2024. We also
vacate the trial court’s Findings of Fact and Conclusions of Law, signed April 25,
2024, as they were filed to explain the Orders we have already determined were
improperly entered. We remand this matter for proceedings consistent with this
opinion.
REVERSED AND REMANDED.
W. SCOTT GOLEMON Chief Justice
Submitted on February 10, 2026 Opinion Delivered May 28, 2026
Before Golemon, C.J., Wright and Chambers, JJ.
Related
Cite This Page — Counsel Stack
East Texas Educational Insurance Association v. Sanford Jones and James Thomas Lyle, as Independent of the Estate of Mary Louise Jones, and Next Friend of J.L., a Minor, Counsel Stack Legal Research, https://law.counselstack.com/opinion/east-texas-educational-insurance-association-v-sanford-jones-and-james-txctapp9-2026.