Lee v. Texas Workers' Compensation Commission

272 S.W.3d 806, 2008 Tex. App. LEXIS 9509, 2008 WL 5264877
CourtCourt of Appeals of Texas
DecidedDecember 17, 2008
Docket03-04-00628-CV
StatusPublished
Cited by14 cases

This text of 272 S.W.3d 806 (Lee v. Texas Workers' Compensation Commission) 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
Lee v. Texas Workers' Compensation Commission, 272 S.W.3d 806, 2008 Tex. App. LEXIS 9509, 2008 WL 5264877 (Tex. Ct. App. 2008).

Opinion

OPINION

W. KENNETH LAW, Chief Justice.

Appellant Joon S. Lee, M.D., sought declaratory and injunctive relief in response to an order of the Texas Workers’ Compensation Commission 2 denying him admission to the Commission’s approved doctor list (“ADL”), which prevents him from treating patients under the workers’ compensation system. On cross-motions for summary judgment, the district court *809 granted the Commission’s motion and denied Lee’s. We will affirm the summary judgment in favor of the Commission.

BACKGROUND

To be eligible to treat injured patients and to receive payment under the workers’ compensation system, a doctor must be listed on the ADL. See Tex. Lab.Code Ann. § 408.022(a) (West Supp.2005). 3 Texas Labor Code section 408.023 provides the basis for admitting a doctor to the ADL and establishes the Commission’s authority to adopt rules in furtherance of maintaining the list. Id. § 408.023 (West Supp.2005); see also 28 Tex. Admin. Code § 180.20(a) (2008). Under the version of section 408.023 that was in effect until August 31, 2001, each doctor licensed in Texas was automatically admitted to the ADL “unless subsequently deleted and not reinstated.” See Act of May 22, 1993, 73d Leg., R.S., ch. 269, § 1, 1993 Tex. Gen. Laws 987, 1178 (amended 2001 and 2005) (current version at Tex. Lab.Code Ann. § 408.023).

In 2001, the legislature overhauled the workers’ compensation system and amended section 408.023 of the labor code, ending the practice of automatic admission to the ADL. See Act of June 17, 2001, 77th Leg., R.S., ch. 1456, 2001 Tex. Gen. Laws 5167, 5168 (amended 2005) (current version at Tex. Lab.Code Ann. § 408.023). The 2001 amendment required the Commission to “develop a list of doctors licensed in this state who are approved to provide health care services under this subtitle.” Id. As provided under the amended statute, doctors became eligible for inclusion on the ADL if they “register[ed] with the commission in the manner prescribed by commission rales” and they “complie[d] with the requirements adopted by the commission under this section.” Id. Upon approving a doctor for admission to the ADL, the Commission was required to issue the doctor a certificate of registration. Id. “In determining whether to issue a certificate of registration, the commission may consider and condition its approval on any practice restrictions applicable to the applicant that are relevant to services provided under this subtitle.” Id. The statute further provided that the Commission, by rule, “shall provide a reasonable period, not to exceed 18 months after the adoption of rules under this section, for doctors to comply with the registration and training requirements of this subchapter.” Id.

In addition to authorizing the Commission to “develop” the ADL, the amended statute addressed how the Commission shall “maintain” the list. See id. at 5169 (amended 2005) (current version at Tex. Lab.Code Ann. § 408.0231). Section 408.0231 stated that the Commission by rule shall establish criteria for deleting or suspending a doctor from the ADL and for imposing sanctions. Id. “The criteria for deleting a doctor from the list or for recommending or imposing sanctions may include anything the commission considers relevant,” including “evidence from the commission’s medical records that ... the doctor’s charges, fees, diagnoses, treatments, evaluations, or impairment ratings are substantially different from those the commission finds to be fair' and reasonable based on either a single determination or a pattern of practice.” Id. at 5169-70.

The statute also created the position of “medical advisor,” a doctor employed by the Commission who would consult with the Commission regarding, among other things, “disciplinary actions imposed on a *810 physician ... who applies for registration or is registered with the commission on the list of approved doctors.” Id. at 5171 (current version at Tex. Lab.Code Ann. § 408.0511). The medical advisor was required to establish a medical-quality review panel to make recommendations concerning “the addition or deletion of doctors from the list of approved doctors under Section 408.023” and, more generally, “appropriate action regarding doctors” and other health care providers. Id. (current version at Tex. Lab.Code Ann. § 413.0512).

In response to the labor code amendments, the Commission began the process of amending its rules in order to implement the new legislative scheme. To discharge its statutory duties to develop and maintain the ADL, the Commission adopted rule 180.20. See 28 Tex. Admin. Code § 180.20. Under rule 180.20, doctors who wished to be included on the ADL would have to apply for admission by September 1, 2003. See id. § 180.20(a)(1) (providing that ADL as it exists on August 31, 2003, is “null and void as of September 1, 2003,” and that any doctor on ADL prior to September 1, 2003, who does not reapply or whose application is not approved will no longer be on ADL). Until September 1, 2003, while the Commission was in the process of reviewing the applications, the ADL would automatically include “all doctors licensed in Texas on or after January 1, 1993, and doctors licensed in other jurisdictions who have been added to the list by the commission,” unless the doctor had been deleted from the list by the Commission. Id. § 180.20(b).

Doctors who applied for admission to the ADL by the September 1, 2003 deadline could be granted a “temporary exception” to the requirement that they must be on the ADL in order to treat workers’ compensation patients, allowing those doctors the benefits of inclusion on the ADL while their applications under the new scheme were pending. See id. § 180.20(e) (providing that Commission may grant temporary exception to requirement to be on ADL to ensure that employees have access to health care pending Commission action on doctor’s application); see also Act of June 17, 2001, 77th Leg., R.S., ch. 1456, 2001 Tex. Gen. Laws 5167, 5169 (amended 2005) (current version at Tex. Lab.Code Ann. § 408.023

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Bluebook (online)
272 S.W.3d 806, 2008 Tex. App. LEXIS 9509, 2008 WL 5264877, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lee-v-texas-workers-compensation-commission-texapp-2008.