Norman Engel v. Texas Department of Insurance-Division of Workers' Compensation and Commissioner Cassie Brown, in Her Official Capacity The State of Texas and the Attorney General of the State of Texas by and Through Ken Paxton in His Official Capacity as Attorney General of the State of Texas And Illinois National Insurance Company

Court of Appeals of Texas·Decided July 17, 2024·No. 03-23-00077-CV·Published

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-23-00077-CV

Norman Engel, Appellant

v.

Texas Department of Insurance–Division of Workers’ Compensation; Commissioner Cassie Brown, in Her Official Capacity; The State of Texas and the Attorney General of the State of Texas by and through Ken Paxton in His Official Capacity as Attorney General of the State of Texas; and Illinois National Insurance Company, Appellees

FROM THE 53RD DISTRICT COURT OF TRAVIS COUNTY NO. D-1-GN-19-001342, THE HONORABLE KARIN CRUMP, JUDGE PRESIDING

ME MO RAN DU M O PI N I O N

Norman Engel, after sustaining a workplace injury, sued his workers’ compensation carrier, Illinois National Insurance Company, as well as various State of Texas parties, including the Texas Department of Insurance–Division of Workers’ Compensation (TDI or the Division); Division Commissioner Cassie Brown in her Official Capacity; The State of Texas; and the Attorney General of the State of Texas by and through Ken Paxton in his Official Capacity. The trial court granted the pleas to the jurisdiction of the State parties and the motion for summary judgment of the insurance carrier. On appeal, Engel raises constitutional, statutory-conflict, and delegation issues. We will affirm.

ISSUES

Engel sought to allege four complaints against the State parties: (1) a rule challenge regarding delegation of the “Official Disability Guidelines” (ODG), see 28 Tex. Admin. Code § 137.100 (2024) (Texas Division of Workers’ Compensation, Treatment Guidelines); (2) a statutory conflict between the 90-day deadline for challenging a previously assessed Maximum Medical Improvement (MMI) date and either the one-year deadline for filing a workers’ compensation claim or the 104-week maximum for certification of any claimant’s MMI; (3) arguably seeking a declaration of his rights under the Texas Workers’ Compensation Act (WCA), Tex. Lab. Code §§ 401.001–419.007; and (4) a challenge to the constitutionality of all or part of the WCA. His complaint against the insurance carrier relied on the foregoing issues.

STATUTORY FRAMEWORK

The history and general statutory framework of the WCA has been set forth in detail in other court opinions and will not be repeated here except as necessary to put the current issues in context. See, e.g., Texas Workers’ Comp. Comm’n v. Garcia, 893 S.W.2d 504, 510–16 (Tex. 1995); Holt v. Texas Dep’t of Ins.-Div. of Workers’ Comp., No. 03-17-00758-CV, 2018 WL 6695725, at *2–4 (Tex. App.—Austin Dec. 20, 2018, pet. denied) (mem. op.); see also Kroger Co. v. Keng, 23 S.W.3d 347, 349–50 (Tex. 2000). Because Section 408.123 of the Labor Code plays a central role in this case, however, we set forth the history of that provision below.

A claimant’s MMI date is important because “[u]ntil an employee reaches maximum medical improvement, he or she may receive temporary income benefits [but] [o]nce an employee reaches maximum medical improvement, temporary income benefits end.” Rodriguez v. Service Lloyds Ins. Co., 997 S.W.2d 248, 253 (Tex. 1999). From the enactment of the Labor

Code in 1993—and even before—the WCA had set 104 weeks as the maximum time for any claimant’s MMI to be reached:

“Maximum medical improvement” means the earlier of: (A) the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated; or (B) the expiration of 104 weeks from the date on which income benefits begin to accrue.

Tex. Lab. Code, Act of May 12, 1993, 73rd Leg., R.S., ch. 269, § 1, Sec. 401.011 (30), 1993 Tex. Gen. Laws 987, 1132, codified at Tex. Lab. Code § 401.011(30). Subject to the foregoing, the provision relating to the medical certification of a claimant’s MMI did not at that time contain any deadline for disputing an MMI assessment:

Sec. 408.123. CERTIFICATION OF MAXIMUM MEDICAL IMPROVEMENT;

EVALUATION OF IMPAIRMENT RATING.

(a) After an employee has been certified by a doctor as having reached maximum medical improvement, the certifying doctor shall evaluate the condition of the employee and assign an impairment rating using the impairment rating guidelines described by Section 408.124. If the certification and evaluation are performed by a doctor other than the employee’s treating doctor, the certification and evaluation shall be submitted to the treating doctor, and the treating doctor shall indicate agreement or disagreement with the certification and evaluation.

(b) A certifying doctor shall issue a written report certifying that maximum medical improvement has been reached, stating the employee’s impairment rating, and providing any other information required by the commission to:

(1) the commission;

(2) the employee; and

(3) the insurance carrier.

(c) If an employee is not certified as having reached maximum medical improvement before the expiration of 102 weeks after the date income benefits

begin to accrue, the commission shall notify the treating doctor of the requirements of this subchapter.

Id. Sec. 408.123, 1993 Tex. Gen. Laws 987, 1185.

TDI subsequently adopted former administrative rule 130.5(e) that effectively prohibited a claimant from challenging his MMI certification more than 90 days after receiving notice of the assessment. See 28 Tex. Admin. Code § 130.5(e) (2000) (Texas Workers’ Compensation Comm’n, Impairment and Supplemental Income Benefits). In 2001, in Fulton v. Associated Indemnity Corp., 46 S.W.3d 364 (Tex. App.—Austin 2001, pet. denied), this Court struck down the agency’s 90-day rule, holding that TDI had exceeded its authority because the rule “effectively shortened the time period in which an injured worker may revisit the issue of maximum medical improvement.” Id. at 371–73.

In 2003, presumably in response to this Court’s ruling in Fulton, the Legislature amended Section 408.123 of the Labor Code to add its own statutory 90-day deadline for challenging an MMI assessment:

Except as otherwise provided by this section, an employee’s first valid certification of maximum medical improvement and first valid assignment of an impairment rating is final if the certification or assignment is not disputed before the 91st day after the date written notification of the certification or assignment is provided to the employee and the carrier by verifiable means.

Act of May 30, 2003, 78th Leg., R.S. ch. 1323, § 2, Sec. 408.123(d), 2003 Tex. Gen. Laws 4882, 4882. Though since renumbered, the current version of the statute reads the same. See Tex. Lab. Code § 408.123(e). For ease of understanding, we will refer to Section 408.123(e) as the “90-day law.”

FACTUAL AND PROCEDURAL BACKGROUND On March 6, 2017, Engel, a carpenter, sustained a ruptured bicep while in the course of his employment. His employer’s workers’ compensation carrier was Illinois National. On March 24, Engel underwent surgery to repair the injury. The surgery was not disputed and was paid for by Illinois National. After returning to work a week later wearing a sling, Engel gradually returned to regular duty.

On July 18, 2017, a “designated doctor” selected by the Division examined Engel and certified that he had reached MMI on that date, with a 6% permanent impairment rating (IR). The evidence indicated that the doctor’s certification was delivered to Engel on July 31, 2017.

On February 18, 2018, Engel suffered a re-rupture of his bicep and had a second surgery on March 19, 2018. He was unable to work for a substantial period of time after that surgery. On April 20 of that year, Engel filed a dispute of his earlier July 18, 2017 MMI certification, based in part on alleged inadequate initial treatment.

On July 5, 2018, an MRI revealed yet another re-rupture of Engel’s bicep. A third surgery was recommended, but the record does not reflect whether that surgery has ever taken place.

On October 29, 2018, an administrative hearing was held on Engel’s MMI dispute.

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Norman Engel v. Texas Department of Insurance-Division of Workers' Compensation and Commissioner Cassie Brown, in Her Official Capacity The State of Texas and the Attorney General of the State of Texas by and Through Ken Paxton in His Official Capacity as Attorney General of the State of Texas And Illinois National Insurance Company, (Tex. Ct. App. 2024).

Norman Engel v. Texas Department of Insurance-Division of Workers' Compensation and Commissioner Cassie Brown, in Her Official Capacity The State of Texas and the Attorney General of the State of Texas by and Through Ken Paxton in His Official Capacity as Attorney General of the State of Texas And Illinois National Insurance Company (Norman Engel v. Texas Department of Insurance-Division of Workers' Compensation and Commissioner Cassie Brown, in Her Official Capacity The State of Texas and the Attorney General of the State of Texas by and Through Ken Paxton in His Official Capacity as Attorney General of the State of Texas And Illinois National Insurance Company) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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