Fulton v. Associated Indemnity Corp.

46 S.W.3d 364, 2001 Tex. App. LEXIS 2347, 2001 WL 359622
CourtCourt of Appeals of Texas
DecidedApril 12, 2001
Docket03-00-00449-CV
StatusPublished
Cited by31 cases

This text of 46 S.W.3d 364 (Fulton v. Associated Indemnity Corp.) 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
Fulton v. Associated Indemnity Corp., 46 S.W.3d 364, 2001 Tex. App. LEXIS 2347, 2001 WL 359622 (Tex. Ct. App. 2001).

Opinion

BEA ANN SMITH, Justice.

Donald Fulton suffered a back injury while on the job and after several months of treatment was assessed at maximum medical improvement (MMI) with an impairment rating of seven percent. Six months later his symptoms resurfaced, and Fulton and his doctors asked the Workers’ Compensation Commission to amend his MMI certification date and impairment rating. The Commission determined that Fulton’s first MMI assessment and impairment rating had become final because he failed to dispute that rating within ninety days of its assignment, as required by Commission Rule 130.5(e) (the 90-day Rule). That rule states: “The first impairment rating assigned to an employee is considered final if the rating is not disputed within 90 days after the rating is assigned.” 28 Tex. Admin. Code § 130.5(e) (2000). Fulton sought judicial review of the Commission’s decision and order, challenging the validity of the 90-day Rule. The district court affirmed the Commission’s decision. On appeal, Fulton complains that the 90-day Rule contravenes the Workers’ Compensation Act (the Act) by implicitly finalizing an MMI certification within ninety days if it is not disputed. We hold that the 90-day Rule is invalid; therefore, we reverse the order of the district court and render judgment granting Fulton’s motion for summary judgment.

FACTS AND PROCEDURAL BACKGROUND

After Fulton was injured on the job in June 1995, he was initially treated by Dr. Fred Arnold, a chiropractor. In September 1995, Dr. Arnold referred Fulton to Dr. Jacob Rosenstein, a neurosurgeon, who diagnosed Fulton with a cervical spine injury, which involved a disc bulge and protrusion. In October 1995, Dr. Rosen-stein noted that surgery might be required if Fulton’s condition did not improve, but no surgery was performed at that time. Although a small central disc bulge was confirmed by a CT scan on November 21, Dr. Arnold released Fulton to work without restrictions on November 27,1995.

In January 1996, Dr. Arnold referred Fulton to another doctor to determine whether Fulton had reached MMI, the point when a certifying doctor determines that no further recovery can be reasonably anticipated and assigns an impairment rating. See Tex. Lab.Code Ann. § 401.011(30) (West Supp.2001) & § 408.123 (West 1996). On January 11, 1996, a certifying doctor ascertained that Fulton had reached MMI with an impairment rating of seven percent.

To determine the impairment rating, the certifying doctor evaluated the permanent effect of Fulton’s injury according to statutory guidelines. 1 See id. § 408.124 (West Supp.2001); Rodriguez v. Serv. Lloyds Ins. Co., 997 S.W.2d 248, 253 (Tex.1999). The impairment rating represents the percentage of permanent impairment to the whole body. Tex. Lab.Code Ann. § 401.011(24) (West Supp.2001); Rodriguez, 997 S.W.2d at 253. The greater the percentage, the longer the employee receives impairment income benefits. Rodriguez, 997 S.W.2d at 253.

*366 An injured worker qualifying for impairment income benefits receives seventy percent of his average weekly wage. Tex. Lab.Code Ann. § 408.126 (West 1996). These benefits are available from the date MMI is certified and continue for three weeks for every percentage point of impairment. Id. § 408.121(a). The impairment rating may also qualify an employee for supplemental income benefits, which provide long-term disability compensation, if the impairment rating is fifteen percent or higher. Id. § 408.142(a); Rodriguez, 997 S.W.2d at 253. Medical benefits continue whatever the impairment rating. See Tex.Lab.Code Ann. § 408.021(a) (West 1996) (providing medical benefits for health care “as and when needed”).

Fulton’s seven-percent impairment rating entitled him to twenty-one weeks of impairment income benefits; he did not qualify for supplemental income benefits. Dr. Arnold discussed the significance of the impairment rating with Fulton on January 25, 1996. Fulton acknowledged receiving a copy of his MMI and impairment rating certification on February 24, 1996.

In May 1996, Fulton began working for a new employer. After three days, he developed intense neck pain and headaches. Fulton returned to Dr. Arnold for treatment, who again referred Fulton to Dr. Rosenstein. A cervical myleogram revealed a disc herniation with bilateral nerve root compression; on September 11, 1996, Dr. Rosenstein determined that Fulton’s condition had deteriorated so seriously that he now required surgery. Dr. Rosenstein operated on Fulton on October 4, 1996. In December 1996, Drs. Rosen-stein and Arnold wrote to Fulton’s certifying doctor asking him to reconsider Fulton’s MMI date and impairment rating. The certifying doctor filed an amendment with the Commission rescinding the prior certification. The doctor made a new determination that Fulton reached MMI on January 10, 1997, and assessed a new impairment rating of twelve percent.

On May 14, 1997, a contested case hearing was held and the hearing officer found that under the 90-day Rule, the MMI and seven-percent impairment rating became final on January 11, 1996. See 28 Tex. Admin. Code § 130.5(e). Fulton appealed to the Commission, which affirmed that decision. Fulton then sued Associated Indemnity Corporation, 2 his employer’s insurance carrier for workers’ compensation, challenging the validity of Rule 130.5(e). Both parties filed motions for summary judgment. The trial court granted Associated Indemnity’s motion for summary judgment and denied Fulton’s motion. Fulton appeals that judgment to this Court.

STANDARD OF REVIEW

The propriety of summary judgment in this case is a question of law; therefore, we review the trial court’s decision de novo. See McCarthy Bros. Co. v. Cont’l Lloyds Ins. Co., 7 S.W.3d 725, 728 (Tex.App.—Austin 1999, no pet.). When both sides move for summary judgment and the trial court grants one motion and denies the other, we review the summary-judgment proof presented by both sides and determine all questions presented. Comm’rs Court v. Agan, 940 S.W.2d 77, 81 (Tex.1997). If we find error, we must render the judgment the trial court should have rendered. Id.

DISCUSSION

Fulton complains that the trial court erred in granting Associated Indemnity’s motion for summary judgment and in denying his motion because the Commission *367

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46 S.W.3d 364, 2001 Tex. App. LEXIS 2347, 2001 WL 359622, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fulton-v-associated-indemnity-corp-texapp-2001.