Insurance Co. of Pennsylvania v. Hartford Underwriters Insurance Co.

164 S.W.3d 747, 2005 Tex. App. LEXIS 3518, 2005 WL 1089249
CourtCourt of Appeals of Texas
DecidedMay 10, 2005
Docket14-03-01023-CV
StatusPublished
Cited by9 cases

This text of 164 S.W.3d 747 (Insurance Co. of Pennsylvania v. Hartford Underwriters Insurance 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
Insurance Co. of Pennsylvania v. Hartford Underwriters Insurance Co., 164 S.W.3d 747, 2005 Tex. App. LEXIS 3518, 2005 WL 1089249 (Tex. Ct. App. 2005).

Opinion

*748 OPINION

LESLIE BROCK YATES, Justice.

This is an appeal from a summary judgment. Appellant The Insurance Company of the State of Pennsylvania (“ICSP”) argues in four issues that the trial court erred in granting summary judgment in favor of appellee Hartford Underwriters Insurance Company (“Hartford”) and in overruling ICSP’s motion for summary judgment. We reverse and render judgment in favor of ICSP.

Factual and Procedural Background

Tomasa Serpas worked for Tandem Staffing (“Tandem”), a temporary staffing agency. Tandem assigned Serpas to work at an Igloo Products Corporation (“Igloo”) facility, where Serpas sustained a serious injury on January 5, 1999. ICSP provides workers’ compensation insurance to Igloo, and Hartford is the workers’ compensation carrier for Tandem. Hartford received notice of Serpas’s injury on the day it occurred and began paying workers’ compensation benefits to Serpas less than a week later. Hartford has continued to pay workers’ compensation benefits to Serpas.

In May of 2000, Serpas sued Igloo, which moved for and was granted summary judgment. Igloo successfully argued that as an employee, Serpas’s exclusive remedy was through the workers’ compensation scheme. Hartford then filed a notice of disputed claim with the Texas Workers’ Compensation Commission for the first time; this occurred more than three years after the injury. Hartford argued there was newly discovered evidence that Igloo was Serpas’s employer under the borrowed servant doctrine.

A contested case hearing was held, and the hearings division of the commission considered (1) whether Tandem or Igloo was Serpas’s employer for workers’ compensation purposes at the time of the injury and (2) whether Hartford waived its right to contest compensability under section 409.021(c) of the Texas Labor Code. See Tex. Lab.Code Ann. § 409.021(c) (Vernon 1996). The hearing officer determined that Tandem and Igloo were co-employers and that Hartford had waived its right to contest compensability by waiting more than sixty days to dispute the claim. See id. Hartford appealed, and an appeals panel for the commission affirmed the hearing officer’s decision and clarified that Hartford was solely responsible for payment of benefits because it had waived its right to contest compensability.

Hartford again appealed, this time at the district court level. Hartford argued only that it had not waived the right to contest compensability; it did not appeal the co-employer finding. Both Hartford and ICSP filed motions for summary judgment. The district court granted Hartford’s motion, impliedly finding that Hartford had not waived its right to contest compensability by ordering Hartford and ICSP to each pay fifty percent of Serpas’s workers’ compensation benefits. ICSP now brings this appeal from the trial court’s grant of summary judgment and asks this court to reverse and render judgment in ICSP’s favor by concluding that Hartford waived its right to contest com-pensability and is therefore solely responsible for the payment of benefits.

Discussion

When both sides move for summary judgment and the trial court grants one motion and denies the other, the reviewing court should review the summary judgment evidence presented by both sides and determine all questions presented. Comm’rs Court v. Agan, 940 S.W.2d 77, 81 (Tex.1997). The reviewing court should *749 then render the judgment the trial court should have rendered. Id.

As stated above, Hartford sought judicial review of the appeals panel decision. Under section 410.302 of the Labor Code, a trial court is limited to reviewing only those issues decided by the appeals panel. Tex. Lab.Code Ann. § 410.802 (Vernon 1996). The appeals panel resolved two issues and made the following conclusions: (1) Tandem and Igloo were co-employers for workers’ compensation purposes and (2) Hartford had waived its right to contest compensability. Hartford stated in its motion for summary judgment that the co-employer finding was not being contested; accordingly, the only contested issue before the trial court was whether Hartford had waived its right to contest compensability. In its order granting Hartford’s motion for summary judgment, the trial court (1) affirmed the uncontested co-employer finding and (2) reversed the finding that Hartford was solely liable for payment of benefits, thus implicitly holding Hartford had not waived its right to contest compensability. The trial court also ordered each party to pay fifty percent of the workers’ compensation benefits. Because the only contested issue is whether Hartford waived its right to contest compensability, that is the sole issue for our review. See id.

Section 409.021(c) of the Labor Code provides 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 earner is notified of the injury, the insurance carrier waives its right to contest compensability.” Tex. Lajb.Code Ann. § 409.021(c). It is undisputed in this case that Hartford began paying benefits within a week of learning of the injury and did not file a standard form Notice of Refusal/Disputed Claim with the Workers’ Compensation Commission for more than three years after the injury. Because Hartford failed to contest compensability within sixty days of notification, we hold that under the plain language of section 409.021(c), Hartford has waived its right to contest compensa-bility.

Hartford argues that section 409.021(c) does not apply to this case because it is a coverage dispute, not a com-pensability dispute. We disagree. 1 Rule 124.3 of the Texas Administrative Code, enacted by the Texas Workers’ Compensation Commission, provides that a carrier must contest compensability within sixty days in both compensability disputes and liability disputes. See 28 Tex. Admin. Code § 124.3 (2004) (Tex. Workers’ Comp. Comm’n, Investigation of an Injury and Notice of Denial/Dispute). Valid rules and regulations promulgated by an administrative agency acting within its statutory authority have the force and effect of legislation. Lewis v. Jacksonville Bldg. & Loan Ass’n, 540 S.W.2d 307, 310 (Tex.1976).

Subsection (a) of rule 124.3 provides in relevant part that “[i]f the carrier believes that it is not liable for the injury or that the injury was not compensable, the carrier shall file the notice of denial of a claim (notice of denial) in the form and manner required by § 124.2 of this title.” *750 28 Tex. Admin. Code § 124.3(a) (emphasis added). Subsections (b) and (c) address time limits for contesting compensability:

(b) Except as provided by subsection

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
164 S.W.3d 747, 2005 Tex. App. LEXIS 3518, 2005 WL 1089249, Counsel Stack Legal Research, https://law.counselstack.com/opinion/insurance-co-of-pennsylvania-v-hartford-underwriters-insurance-co-texapp-2005.