Jones v. Illinois Employers Insurance of Wausau

136 S.W.3d 728, 2004 WL 1170422
CourtCourt of Appeals of Texas
DecidedJune 29, 2004
Docket06-03-00013-CV
StatusPublished
Cited by18 cases

This text of 136 S.W.3d 728 (Jones v. Illinois Employers Insurance of Wausau) 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
Jones v. Illinois Employers Insurance of Wausau, 136 S.W.3d 728, 2004 WL 1170422 (Tex. Ct. App. 2004).

Opinion

OPINION

Opinion by

Justice ROSS.

This case involves the award of medical expenses to Wood F. Jones by the Texas Workers’ Compensation Commission (the Commission). The Commission ordered Illinois Employers Insurance of Wausau to pay Jones’ various medical expenses incurred since 1997. Wausau appealed the order to the Colorado County District Court, contending Jones’ bacterial heart condition was not caused by a cut finger he incurred on the job in 1978 and was, therefore, not compensable. The trial court agreed and granted Wausau’s motion for summary judgment. Jones appeals the granting of Wausau’s motion and also contends the trial court erred: (1) by sustaining Wausau’s objection to his summary judgment evidence; (2) by denying his motion for new trial and denying a hearing on that motion; and (3) by not granting his cross-motion for summary judgment.

Background

On March 20, 1978, Jones suffered a cut to his finger while in the course of his employment with Jones Engineering and Farming, Inc. Several days later, Jones became ill with chills, fever, joint pain, diarrhea, and severe headache. He was hospitalized and diagnosed with an infection of “staphylococcal aureus.” He was administered antibiotics and recovered. In June 1978, Jones went to the emergency room at a hospital in Wharton with a cough and severe chest pain. He was transferred to Houston with symptoms of congestive heart failure and possible acute pneumonia in both lungs. Under the care of cardiologist Frank Rickman, M.D., Jones underwent surgery for the replacement of an aortic heart valve. It was determined Jones suffered from bacterial endocarditis. 1

Jones sought worker’s compensation benefits for his illness. On March 8, 1979, the Texas Industrial Accident Board (the Board) (predecessor to the Commission) found that Jones sustained a compensable injury in the course of his employment with Jones Engineering and Farming, Inc. The Board ordered Wausau to pay Jones $91.00 per week for 14-5/7 consecutive weeks for his disability and to pay Jones’ medical expenses, including expenses ré- *733 lated to Rickman’s care. The Board left open future medical expenses for Jones’ lifetime. 2 Wausau did not appeal the Board’s order.

Jones later submitted additional medical expenses to the Commission related to his heart problem. On June 18, 1993, the Commission ordered Wausau to pay for medical expenses Jones had incurred since the Board awards in 1979. Wausau appealed the orders of the Commission to the 270th Judicial District Court of Harris County. Jones moved for summary judgment, contending the 1979 Board awards were res judicata on the issue of whether his heart-related problem was caused by his cut finger. In response, Wausau contended a fact question remained on the reasonable necessity of Jones’ medical expenses for his heart-related problem, because the expenses were not naturally related to his cut finger. The trial court granted Jones’ motion for summary judgment and denied Wausau relief on its “collateral attack on the Industrial Accident Board’s prior awards” because such awards “are final awards which have pre-clusive effect and can not be collaterally attacked by Wausau.”

Wausau prematurely appealed to the First District Court of Appeals. The 270th Judicial District Court, however, found there were two tangential issues to be resolved and, accordingly, realigned the parties and conducted a bench trial on Jones’ claims for reimbursement and attorney’s fees. On August 2, 1996, the trial court rendered a final judgment in favor of Jones and ordered Wausau to pay $1,203.73 for medical expenses Jones had incurred since 1979, interest on that judgment, and attorney’s fees. On September 4, 1996, the trial court made detailed findings of fact and found that Wausau had unsuccessfully argued before the Board in 1979 that Jones’ heart infection was not caused by the infection from his cut finger. The court concluded that “[t]he three prior awards of the Industrial Accident Board issued in 1978 and 1979 are res judicata and operate as a bar to Defendant Wau-sau’s efforts to relitigate its own liability for payment of medical expenses for treatment of the heart condition .... ”

Wausau’s appeal to the First District Court of Appeals then moved forward. The parties, however, reached a settlement agreement, and the First District Court of Appeals dismissed the appeal.

Since 1997, the Commission has entered seven orders for Wausau to pay Jones’ medical expenses. Wausau appealed each of these Commission orders in various courts. 3 All seven of these appeals were *734 eventually consolidated into this case and constitute the subject of the summary judgment proceedings below, and now, this appeal.

Summary Judgment Proceedings

On May 28, 2002, Wausau moved for summary judgment on the ground the expert report it provided established that Jones’ claims for heart-related medical expenses were not medically necessary to cure or relieve him from the effects of the finger injury he sustained in 1978. Alternatively, Wausau moved for partial summary judgment on Jones’ affirmative defenses pled in his answer of res judicata and collateral estoppel. Wausau contended the res judicata and collateral estoppel defenses were barred by the workers’ compensation law, specifically Tex.Rev.Civ. Stat. Ann. art. 8307, § 5 (Vernon 1967), repealed by, Act of Dec. 12, 1989, 71st Leg., 2nd C.S., ch. 1, 1990 Tex. Gen. Laws 1. The hearing for Wausau’s motion for summary judgment was set for July 19, 2002.

Jones mailed a response to Wausau’s motion for summary judgment, including a cross-motion for summary judgment, July 12, 2002. The clerk’s file stamp indicated receipt July 15, 2002. Jones based both his response to Wausau’s motion for summary judgment and his own cross-motion for summary judgment on the contention Wausau was barred by res judicata and collateral estoppel from contesting whether his heart ailment was compensable. On the same date, Jones also filed a counterclaim against Wausau for breach of the covenant and duty of good faith and fair dealing. The day before the hearing, Wausau filed a reply to Jones’ response, contending Jones’ cross-motion for summary judgment and supporting proof were untimely. Wausau also contended Exhibit D of Jones’ summary judgment proof, consisting of letters from Jones’ treating physicians, was hearsay and should not be considered.

The hearing took place July 19, 2002, as scheduled, and the trial court heard arguments from both sides and took the matter under advisement. On August 1, 2002, while the matter was still under advisement in the trial court, Jones filed a motion for continuance for additional time to cure the alleged defects in his summary judgment proof. The trial court never ruled on this motion. On September 6, 2002, the trial court granted Wausau’s motion for summary judgment and reversed the Commission awards. Jones moved for a rehearing. On November 15, 2002, the trial court denied Jones’ motion for rehearing and sustained Wausau’s objections to Jones’ cross-motion for summary judgment and summary judgment proof.

Summary Judgment Response and Cross-Motion for Summary Judgment

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Cite This Page — Counsel Stack

Bluebook (online)
136 S.W.3d 728, 2004 WL 1170422, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jones-v-illinois-employers-insurance-of-wausau-texapp-2004.