National Mut. Casualty Co. v. Lowery

135 S.W.2d 1044, 1939 Tex. App. LEXIS 1254
CourtCourt of Appeals of Texas
DecidedDecember 22, 1939
DocketNo. 1964.
StatusPublished
Cited by9 cases

This text of 135 S.W.2d 1044 (National Mut. Casualty Co. v. Lowery) 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
National Mut. Casualty Co. v. Lowery, 135 S.W.2d 1044, 1939 Tex. App. LEXIS 1254 (Tex. Ct. App. 1939).

Opinions

Thomas Jefferson Lowery, by way of appeal from an adverse decision of the Industrial Accident Board, brought this suit seeking to recover compensation for allegedly total and permanent disability resulting from hernia sustained by him as an employee of National Tank Company. The National Mutual Casualty Company, compensation insurance carrier for said employer, was the defendant. Plaintiff's petition (trial pleading), among other things, alleged that "he has been willing at all, times and is willing now [file date of pleading, October 10, 1938] to undergo a surgical operation, but the defendant has at all times refused to have him operated on as it is their legal duty to do, and have refused to pay him any compensation * * * The plaintiff demands of the defendant an operation for said hernia at the expense of said defendant, and said defendant has refused to furnish same unto plaintiff and he is now totally and permanently disabled and is therefore entitled to compensation under the general provisions of the Workmen's Compensation Act."

In a jury trial the case being submitted on special issues, all issues were found in favor of plaintiff. Included in the issues so submitted and found, was one inquiring whether "Lowery has at all times since the date of the development of the hernia, *Page 1047 if any, been willing to submit to a surgical operation." Another made inquiry whether "The National Mutual Casualty Company has at all times refused to provide a surgical operation for plaintiff's said hernia, if any, resulting from the injury, if any, inquired about in special issue No. 1." Judgment having been rendered for plaintiff on the verdict awarding recovery of $4,961.59, the defendant has appealed.

The merit of most of appellant's assignments of error and propositions thereunder is either wholly dependent upon or materially affected by the proper construction of R.S. 1925, Art. 8306, sec. 12b. The general question presented may, we think, adequately be stated thus: Where an employee of an employer subject to the Workmen's Compensation Statutes sustains an injury consisting of, or resulting in, hernia under the specified circumstances rendering such an injury compensable, and the insurance carrier fails or refuses to "provide * * * surgical treatment by * * * operation", not being excused from doing so by refusal of the employee to submit to such operation, may the employee in a timely suit to set aside an adverse decision of the Industrial Accident Board, upon his claim for compensation, recover for total and permanent disability, if any, resulting from such injury? This question, we think, must be answered in the affirmative.

Hernia differs from other general injuries in two general respects; one being absolute and the other conditional. It differs absolutely in certain required special elements to render the injury compensable. Superadded to the ordinary elements of an injury as defined in R.S. 1925, Art. 8309, sec. 1, are (to use the numbering in the statute) these three: (2) appearance of the hernia "suddenly and immediately following the injury" (accident). (3) Nonexistence of hernia "in any degree prior to the injury for which compensation is claimed." (4) Pain accompanying the injury. (We have designedly omitted mention of (1) only because the existence of a hernia as an injury is manifestly not special and would have to be shown even if hernia was in no respect different from any other general injury.)

These elements may properly be regarded as a matter of required special proof of hernia as an injury. The language of the statute is "it must be definitely proven" etc.

The conditional difference between hernia and other general injuries is in the compensation to be awarded. The statute in terms purports to impose upon the insurance carrier the duty to provide an operation. The language of the statute is that "where liability for compensation exists, the association shall provide competent surgical treatment by radical operation."1 Unless such operation is provided and the employee submits to the operation and it is a success there is no qualification or abridgment of the rights of the employee to compensation for disability resulting from hernia, the same as any other general injury.

The Industrial Accident Board has potential jurisdiction to determine whether an employee should have an operation for hernia. A prerequisite fact *Page 1048 essential, in a particular case, to the exercise of such jurisdiction is the refusal of the employee to submit to such operation. Only when the potential jurisdiction of the Board becomes active by refusal of the employee to submit to an operation is the Board empowered to make any order which can have the effect, in any event, to qualify or restrict the right of the employee to compensation for disability resulting from hernia the same as any other general injury. If the active jurisdiction of the Board be invoked by refusal of the employee to submit to a proffered operation there still is no absolute qualification upon, or restriction of, his right to compensation as for a general injury. If the Board, following the prescribed procedure, decides that the employee should not undergo an operation then the employee (in the language of the statute) "shall, if unwilling to submit to the operation, be entitled to compensation for incapacity under the general provisions of this law." If the decision of the Board be in favor of an operation and the employee submits thereto but the operation is not a success there results no abridgment of the employee's right to compensation as for a general injury. If the operation results in death the rights of the beneficiary to claim as for general injury remains unaffected.

The only conditions upon which the employee may be restricted to compensation different from a general injury are (1) that the jurisdiction of the Board to determine the advisability of an operation be invoked by the fact of the refusal of the employee to submit to an operation; (2) that the Board, exercising such jurisdiction, decide against an operation, but the employee submits anyway and the operation is not a success. (In such case compensation shall consist only of the expenses of the operation and weekly compensation for one year). (3) That the Board, exercising its jurisdiction, decide in favor of an operation and the employee refuses to submit. (In that case compensation is limited to payment of average weekly wages for 26 weeks).

The statute does not purport to condition any right of the employee upon his making request, or demand, for an operation. No duty to request or demand an operation we think rests upon the employee and for one very good reason, among possibly others, that the employee would not be expected to know whether he was in need of an operation or not. That would be a matter naturally and primarily for the decision of the insurer's medical advisers. The statute, we think, clearly implies the intention to give the insurer the right, in the nature of an option, if the facts to be determined as prescribed so warrant, to substitute a different compensation from that provided for a general injury. In the instant case that optional right has not been exercised by appellant, nor was such right rendered nonavailable to the appellant by any action of the employee. Such a construction of the statute has been forecast in previous decisions of the courts of this state, particularly in Texas Employers' Insurance Ass'n v. Neatherlin, Tex.Com.App., 48 S.W.2d 967; Texas Employers' Insurance Ass'n v. Henson, Tex.Civ.App.

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

Related

Clem v. Dallas Independent School District
593 S.W.2d 347 (Court of Appeals of Texas, 1979)
Texas Employers' Insurance Ass'n v. Brantley
394 S.W.2d 824 (Court of Appeals of Texas, 1965)
American General Insurance Company v. Quinn
277 S.W.2d 223 (Court of Appeals of Texas, 1955)
Hartford Accident & Indemnity Co. v. Black
193 F.2d 971 (Fifth Circuit, 1952)
Traders & General Ins. Co. v. Bass
193 S.W.2d 848 (Court of Appeals of Texas, 1946)
Panhandle Stages, Inc. v. Aston
171 S.W.2d 911 (Court of Appeals of Texas, 1943)
Zurich General Accident & Liability Ins. Co. v. Chancey
166 S.W.2d 966 (Court of Appeals of Texas, 1942)
National Mutual Casualty Co. v. Lowery
148 S.W.2d 1089 (Texas Supreme Court, 1941)

Cite This Page — Counsel Stack

Bluebook (online)
135 S.W.2d 1044, 1939 Tex. App. LEXIS 1254, Counsel Stack Legal Research, https://law.counselstack.com/opinion/national-mut-casualty-co-v-lowery-texapp-1939.