Macias v. Texas Property & Casualty Insurance Guaranty Ass'n

974 S.W.2d 381, 1998 Tex. App. LEXIS 3642, 1998 WL 315573
CourtCourt of Appeals of Texas
DecidedJune 17, 1998
DocketNo. 04-93-00805-CV
StatusPublished

This text of 974 S.W.2d 381 (Macias v. Texas Property & Casualty Insurance Guaranty Ass'n) 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.

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Macias v. Texas Property & Casualty Insurance Guaranty Ass'n, 974 S.W.2d 381, 1998 Tex. App. LEXIS 3642, 1998 WL 315573 (Tex. Ct. App. 1998).

Opinions

OPINION

RICKHOFF, Justice.

Jose Macias suffered a work-related injury on March 3,1990. On October 3,1990, while participating in a work-hardening program at his employer’s direction, Macias suffered another injury. On May 14, 1991 Macias [382]*382signed a Compromise Settlement Agreement (“CSA”); on August 16,1991 he filed a claim for the October injury. After the Texas Workers’ Compensation Commission denied his claim for the October injury, Macias filed suit. Employers Casualty Co. (“Employers”) 1 sought summary judgment, claiming both that the May agreement settled both the March and October injuries, and that the October injury related back to the March injury and therefore Macias could not maintain a separate action for the October injury. A general summary judgment was granted.

In three points of error Macias argues that he was not estopped from filing a separate claim for the October 3 injury; that the CSA did not include the October injury; and that the summary judgment affidavit relied on by Employers was inadequate.

STANDARD OF REVIEW

The party moving for summary judgment has the burden of showing that no genuine issue of material fact exists and that it is entitled to judgment as a matter of law. Tex.R. Civ. P. 166a(c); Nixon v. Mr. Property Management Co., 690 S.W.2d 646, 548 (Tex.1985). In deciding whether a disputed material fact issue precludes summary judgment, the reviewing court will take as true all evidence favoring the nonmoving; every reasonable inference from the evidence will be indulged in favor of the nonmoving, and any doubts will be resolved in his favor. Nixon, 690 S.W.2d at 549. If the order is general, without specifying the grounds on which the trial court granted summary judgment, the nonmoving party on appeal must negate any grounds on which the trial court could have granted summary judgment. Malooly Brothers, Inc. v. Napier, 461 S.W.2d 119, 121 (Tex.1970); Sipes v. Petry and Stewart, 812 S.W.2d 428 (Tex.App.-San Antonio 1991, no writ).

A defendant who conclusively negates at least one of the essential elements of each of the plaintiffs causes of action is entitled to summary judgment. Wornick Co. v. Casas, 856 S.W.2d 732, 733 (Tex.1993). A defendant may also show entitlement to summary judgment by conclusively proving all elements of an affirmative defense. Montgomery v. Kennedy, 669 S.W.2d 309, 310-11 (Tex.1984); Swilley v. Hughes, 488 S.W.2d 64, 67 (Tex. 1972).

It is well-settled that the Workers’ Compensation Act should be liberally construed in favor of the worker. Lujan v. Houston General Ins. Co., 756 S.W.2d 295, 297 (Tex. 1988). The act should not be hedged about with strict construction, but should be given a liberal construction to carry out its evident purpose. Id.(citingYeldell v. Holiday Hills Retirement & Nursing Center, 701 S.W.2d 243, 245 (Tex.1985)).

THE COMPROMISE SETTLEMENT AGREEMENT

Because the incident in question occurred before Jan. 1, 1991, this cause of action is governed by Texas’ prior workers’ compensation law. Tex.Rev.Civ. Stat. Ann. arts. 8306-8309 (Vernon 1967), repealed by Texas Workers’ Compensation Act, 71st Leg., 2nd C.S., ch. 1, § 16.01, 1989 Tex. Gen. Laws 1, 114 (eff.Jan. 1, 1991). Under this law, any compromise settlement agreement between an injured worker and the insuror binds the parties only as to those matters covered by its express terms. Garcia v. City of Lubbock, 634 S.W.2d 776, 778-779 (Tex. App.—Amarillo 1982, writ ref'd n.r.e.).

Garcia is very nearly on point.. In Garcia, as here, a worker suffered an on-the-job injury and reported it to the Industrial Accident Board; after the injury was reported, but before the first injury was settled, the worker claimed that another on-the-job injury occurred. The employer moved for, and was granted, summary judgment on basis that the second injury was encompassed in the CSA that settled the first claim and that the worker was therefore estopped from asserting the second claim. Id. at 778. The court of appeals held that the city had not proved, as a matter of law, that the parties meant to compromise the second injury claim [383]*383and that the worker was therefore estopped from asserting it. Id. As in our case, the settlement agreement referred specifically to an injury by IAB case number; in both eases the claim for the second injury had not yet been filed at the time of the CSA. Id. at 779. The Garcia court held that this was inadequate to establish as a matter of law that the parties had intended to compromise the second injury in the CSA and reversed the summary judgment. Id.

Garcia shows us that a worker was not precluded from filing a second claim for an injury because a claim for a previous injury was pending at the time of the second injury. Now we must consider whether the parties here intended to settle both claims with the CSA, and whether this injury was a result of medical treatment for the original injury and so part of the first injury as a matter of law.

1. Intent of the Parties to Settle Both Claims

Employers urges that the parties intended to settle both claims at the time of the agreement. In support of this contention Employers provides a copy of the CSA, the case file and an affidavit from Tracy Streiber, who represented Employers in the original settlement negotiations. Streiber stated that Employers intended to settle both claims at the time of the CSA. But before we consider Streiber’s affidavit, we must first consider whether the CSA is ambiguous.

The first line of the CSA references an Industrial Accident Board claim number and file number. We know that no claim number had been assigned the October injury because it had not yet been reported to the IAB. Furthermore, the CSA makes no reference to any “subsequent injury” or “aggravation” of a preexisting injury as being covered by the agreement. If Employers had wanted to encompass both injuries in the compromise settlement agreement, it should have said so in the agreement.

We find this agreement unambiguously covers only the March 3 injury, and therefore Macias was not estopped from bringing a separate claim for the October 3 injury. Therefore summary judgment on this basis would have been improper. Moreover, we need not consider Macias’ third point of error challenging the adequacy of Streiber’s affidavit.

We now turn to whether summary judgment would have been proper because the October injury was sustained in the course of medical treatment for a previous injury.

2. Injury in the Course of Medical Treatment

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Related

Wornick Co. v. Casas
856 S.W.2d 732 (Texas Supreme Court, 1993)
Sipes v. Petry and Stewart
812 S.W.2d 428 (Court of Appeals of Texas, 1991)
Garcia v. City of Lubbock
634 S.W.2d 776 (Court of Appeals of Texas, 1982)
Biggs v. United States Fire Insurance Co.
611 S.W.2d 624 (Texas Supreme Court, 1981)
Malooly Brothers, Inc. v. Napier
461 S.W.2d 119 (Texas Supreme Court, 1970)
Lujan v. Houston General Insurance Co.
756 S.W.2d 295 (Texas Supreme Court, 1988)
Haug v. Franklin
690 S.W.2d 646 (Court of Appeals of Texas, 1985)
Montgomery v. Kennedy
669 S.W.2d 309 (Texas Supreme Court, 1984)
Swilley v. Hughes
488 S.W.2d 64 (Texas Supreme Court, 1972)
Cigna Insurance Co. of Texas v. Rubalcada
960 S.W.2d 408 (Court of Appeals of Texas, 1998)
Yeldell v. Holiday Hills Retirement and Nursing Center, Inc.
701 S.W.2d 243 (Texas Supreme Court, 1985)
United Employers Casualty Co. v. Marr
144 S.W.2d 973 (Court of Appeals of Texas, 1940)

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974 S.W.2d 381, 1998 Tex. App. LEXIS 3642, 1998 WL 315573, Counsel Stack Legal Research, https://law.counselstack.com/opinion/macias-v-texas-property-casualty-insurance-guaranty-assn-texapp-1998.