Harleysville Mutual Insurance Co. v. Frierson

455 S.W.2d 370, 1970 Tex. App. LEXIS 2632
CourtCourt of Appeals of Texas
DecidedMay 6, 1970
Docket357
StatusPublished
Cited by13 cases

This text of 455 S.W.2d 370 (Harleysville Mutual Insurance Co. v. Frierson) 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
Harleysville Mutual Insurance Co. v. Frierson, 455 S.W.2d 370, 1970 Tex. App. LEXIS 2632 (Tex. Ct. App. 1970).

Opinion

*372 TUNKS, Chief Justice.

On January 2, 1967, Jessie Paul, in the course of his employment by Foremost Supermarket, sustained an accidental injury. The appellant, Harleysville Mutual Insurance Company, was the workmen’s compensation carrier for Foremost Supermarket. On January 8, 1967, Jessie Paul went to Memorial Baptist Hospital in Houston seeking treatment for his accidental injury. Dr. J. N. Frierson was called by a nurse to administer the requested treatment. Jessie Paul was admitted to the hospital and remained there under treatment until he was discharged on February 8, 1967. Dr. Frierson treated Jessie Paul during the time he was in the hospital and thereafter continued treating him in his office until April 12, 1967. Jessie Paul’s bill at Memorial Baptist Hospital was $1,474.20 and his bill for the treatment by Dr. Frierson was $429.00.

Both Foremost Supermarket and Har-leysville Mutual Insurance Company had notice of Jessie Paul’s injury within thirty days. Neither the employer nor the carrier requested the treatment that was given to Jessie Paul at the hospital and by the doctor. Dr. Frierson, however, sent to Harleysville agent four written reports concerning the hospitalization and treatment of the employee. Those reports were dated January 12, January 20, February 14 and March 13, 1967. Harleysville did not respond to Dr. Frierson’s reports until March 16, 1967 when it returned the doctor’s March 13th letter and informed him that they were denying that Jessie Paul has sustained an injury while working for Foremost Supermarkets.

On February 10, 1967, two days after Jessie Paul was discharged from the hospital, Harleysville entered into a written settlement agreement with him by which it was agreed that the employee should be paid $525 in full payment of his compensation benefits, including past and future medical treatment. This settlement was submitted to the Industrial Accident Board and was approved on February 20, 1967.

Although Harleysville knew that Jessie Paul had been admitted to Memorial Baptist Hospital for treatment of an injury alleged to have been incurred in the course of his employment (their agent actually visited Paul in the hospital) and that Dr. Frierson had treated him for that injury, they did not notify either the hospital or the doctor before their settlement agreement with Paul and did not advise them of their denial of coverage until March 16, 1967. The doctor and the hospital had no notice of such settlement and denial of coverage from any other source. At no time did either of them authorize Jessie Paul to settle their claims against Harleysville for their bills nor to, in any other manner, represent them as to their said claims.

Upon the insurance company’s refusal to pay for Paul’s treatment, Dr. Frierson, on April 13, 1967, wrote a letter to the Industrial Accident Board giving the name of the injured employee, the date and description of the accident, the names and addresses of the employer and the compensation carrier, the description of the treatment given and itemized statements of the unpaid hospital and doctor bills. The letter also informed the board of the refusal by Harleysville to pay those bills. Ultimately the board accepted that letter as a timely and properly filed claim by the doctor and the hospital and, after hearing, rendered an award allowing recovery by them of the amounts of their bills. Har-leysville timely gave notice of dissatisfaction with that award and filed suit in the district court of Harris County to set it aside. The hospital and the doctor answered and filed cross-actions for their claims. A non-jury trial in the district court resulted in judgment for the doctor and the hospital. Harleysville has perfected its appeal from that judgment.

The apellant’s first three points of error are based on the proposition that *373 the settlement agreement with Jessie Paul and the Industrial Accident Board’s approval thereof are res judicata of the ap-pellees’ rights. Those points are overruled. The settlement agreement and the board’s approval did not constitute an adjudication of the issues of this or any other lawsuit. Lowry v. Anderson-Berney Bldg. Co. (Tex.Comm.App., opinion adopted), 139 Tex. 29, 161 S.W.2d 459.

Findings of fact and conclusions of law were filed by the trial court. They include findings that Jessie Paul sustained an accidental injury in the scope and course of his employment, that his employer and the appellant had notice within thirty days and that after such notice the appellant “refused, failed or neglected” to furnish medical treatment within a reasonable time. Appellant’s fifth and sixth points of error attack this last findings on the no evidence and insufficient evidence grounds. Appellant’s argument in this respect is quoted from its brief as follows:

“ * * * Thus, a finding that the Insurer failed, refused or neglected to provide reasonable medical aid must be predicated on a finding that at the time the Insurer made such refusal it was apprised of whether or not the claimant had suffered a compensable injury.”

It is apparently appellant’s position that so long as it entertained a subjective doubt as to the compensable nature of the injury to Jessie Paul it could avoid its obligation under Art. 8306, Sec. 7, Vernon’s Ann.Tex.Civ.St, to furnish medical aid and hospitalization. Its liability was not so conditioned. The trial court found, on sufficient evidence, that Jessie Paul sustained a compensable injury of which the employer and appellant had timely notice. These facts, under Section 7, imposed upon appellant the obligation to furnish the employee medical and hospital aid. That obligation was not conditioned upon the carrier’s acceptance of the fact that the injury was a compensable one. The trial court’s further finding, on sufficient evidence, that, after notice to the employer and the carrier, the carrier refused, failed or neglected to furnish medical aid established the appellees’ cause of action for the reasonable value of the necessary medical aid furnished the employee by them. Texas General Indemnity Co. v. Hancock, Tex.Civ.App., 422 S.W.2d 565, no writ hist.; Texas Employers’ Ins. Ass’n. v. Steadman, Tex.Civ.App., 415 S.W.2d 211, ref., n. r. e.; Trinity Universal Ins. Co. v. Farley, Tex.Civ.App., 408 S.W.2d 776, no writ hist.

Appellant’s eighth and ninth points of error are to the effect that the appellees failed to prove that they had filed their claims within six months of the date of the injury to Jessie Paul. While there is no serious dispute that Dr. Frierson’s April 13, 1967 letter to the Industrial Accident Board constituted a sufficient claim by the doctor, the appellant contends that the doctor’s letter did not constitute a claim by the hospital because there is no evidence that the doctor was authorized by the hospital to file a claim in its behalf. Those points of error are overruled.

Article 8307, Sec.

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Bluebook (online)
455 S.W.2d 370, 1970 Tex. App. LEXIS 2632, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harleysville-mutual-insurance-co-v-frierson-texapp-1970.