MacIas v. Schwedler

135 S.W.3d 826, 2004 WL 169792
CourtCourt of Appeals of Texas
DecidedMay 6, 2004
Docket01-02-01251-CV
StatusPublished
Cited by13 cases

This text of 135 S.W.3d 826 (MacIas v. Schwedler) 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
MacIas v. Schwedler, 135 S.W.3d 826, 2004 WL 169792 (Tex. Ct. App. 2004).

Opinion

OPINION

SAM NUCHIA, Justice.

Appellant, Sara Macias, individually, as representative for the Estate of Manuel Macias, and as next friend of Nancy Catalina Macias, Sara Maria Macias, Veronica Macias, Jose Manuel Macias, Anna Macias, and Enrique Macias (collectively, Macias), appeals the dismissal, for lack of subject-matter jurisdiction, of her wrongful death *828 suit against CNA Insurance Company, now known as RSKCo, and Continental Casualty Company, the workers’ compensation insurance carriers for the employer of decedent Manuel Macias; the claim administrator, Crawford & Company and its employees, Josie C. Schwedler, Helen Hardy, and Bobbie J. Badger, R.N.; and those hired to investigate Manuel Macias’s claim, Rehabcorp Inc., Katherine Blanchette, M.D., and William H. Matthews, M.D. We affirm.

BACKGROUND

We present the following facts as alleged in Macias’s fifth amended original petition: Manuel Macias was injured as he was walking into a plant to report to work when his ankle rolled on the edge of the roadway causing him to fall and injure his ankle, knee, buttocks, back, and body in general and aggravating his pre-existing spinal arthritis. He made a claim against his workers’ compensation insurer, which was either CNA or Continental Casualty Company. The carrier filed a notice of disputed claim and hired doctors to provide the carrier with false and fraudulent medical conclusions and refused to consider proper treatment or to perform the necessary diagnostic tests for the injuries to Manuel Macias’s back and the aggravation of his pre-existing arthritis. 1 Upon learning that the carrier was refusing treatment for his back and the aggravated arthritis, Manuel Macias became despondent and committed suicide.

After her husband’s death, Sara Macias, individually and on behalf of her husband’s estate and their children, sued the companies and their employees that were involved in investigation and denial of the workers’ compensation claim. Macias alleged that the defendants:

1.Knowingly violated article 21.21 of the Texas Insurance Code by making false representations regarding the nature of the injury; failed to attempt in good faith to make a prompt, fair, and equitable settlement of the claim; refused to pay the claim without a reasonable investigation; hired biased doctors and medical reviewers whose task was to provide false and misleading conclusions about the injuries; made other untrue statements; and failed to provide necessary facts.
2. Engaged in fraud and unfair settlement practices through defendants Rehabcorp, Inc., Dr. Blanchette, and Dr. Matthews, who, without an examination of Manuel Macias, provided false, misleading, and fraudulent statements that Manuel Macias suffered only a sprained ankle, that an appropriate date for ending treatment should have been 02/12/00, and that there was no direct injury to the spine pertaining to the work incident, despite the fact that the adjuster’s medical records contained information that the pre-existing arthritis had been severely aggravated by the workplace injury.
3. Were liable for intentional infliction of emotional distress by making, publicizing, and stating to Manuel Macias and his family the false and fraudulent statements concerning the injury and medical records; by making these false statements knowingly despite the defendants’ knowledge of the truth of Manuel Macias’s condition; by falsely and fraudulently stating to Manuel Macias that his injury was one of only two percent whole-body impairment, that his benefits were exhausted, and that his injury was limited to his ankle; and by not disclosing that his injury *829 was an aggravation of his pre-exist-ing arthritis.

Schwedler, Hardy, and Crawford & Company filed a motion to dismiss Macias’s suit for lack of jurisdiction on the ground that Macias’s petition did not state facts showing that the decedent or the plaintiff had exhausted their remedies before the Texas Workers’ Compensation Commission, and the trial court had no jurisdiction to adjudicate Manuel Macias’s claim for workers’ compensation benefits. The trial court granted the motion to dismiss. Macias presents five issues attacking the dismissal of her lawsuit. In her first three issues, Macias contends that the trial court erred in granting the dismissal because this is not a suit to recover compensation benefits as damages, there is no determination of benefits or medical treatment for the Commission to make, and therefore, there is no need to exhaust administrative remedies under the Texas Workers’ Compensation Act (the Act). In her fourth issue, Macias contends that the trial court erred by granting a dismissal against the doctor defendants because they are not covered by the Act. In her fifth issue, Macias contends, in the alternative, that the trial court should have granted an abatement rather than a dismissal.

DISCUSSION

Standard of Review

The existence of subject-matter jurisdiction is a matter of law; therefore, we review a trial court’s ruling on a plea to the jurisdiction de novo. Mayhew v. Town of Sunnyvale, 964 S.W.2d 922, 928 (Tex.1998). In reviewing a trial court’s dismissal for lack of subject-matter jurisdiction, we examine the plaintiffs pleadings to determine whether they affirmatively show that the trial court had subject-matter jurisdiction. Continental Cas. Ins. Co. v. Functional Restoration Assoc., 19 S.W.Bd 393, 404 (Tex.2000).

Exhaustion of Remedies

Macias first contends that she is not required to exhaust administrative remedies before filing her wrongful death suit because the suit was not brought to recover compensation benefits as damages, but is a suit for fraud, breach of the duty of good faith and fair dealing, unfair settlement practices, misrepresentation of an insurance policy, and intentional infliction of emotional distress resulting in the wrongful death of her husband. She argues that the calculation of damages under these theories of recovery does not require a benefits determination and that the liability is distinct and separate from the carrier’s liability for benefits or medical treatment under the Act.

Appellees respond that American Motorists Insurance Co. v. Fodge is dispositive of this case. See Am. Motorists Ins. Co. v. Fodge, 63 S.W.3d 801 (Tex.2001). In Fodge, the plaintiff filed a workers’ compensation claim, which was initially denied. Id. at 802. A hearing officer then found a compensable injury and entered an order for the payment of temporary income benefits. Id. The carrier complied with the order. Id. Later, the plaintiff sued the carrier, alleging (1) that compensation benefits were due under the insurance policy, (2) that damages were caused by the bad faith denial of those benefits, and (3) that damages were caused by the bad faith delay in handling the claim and paying the benefits that were determined to be due. Id. at 803.

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Bluebook (online)
135 S.W.3d 826, 2004 WL 169792, Counsel Stack Legal Research, https://law.counselstack.com/opinion/macias-v-schwedler-texapp-2004.