Rodriguez v. American General Fire & Casualty Co.

788 S.W.2d 583, 1990 WL 37477
CourtCourt of Appeals of Texas
DecidedMay 2, 1990
Docket08-89-00153-CV
StatusPublished
Cited by22 cases

This text of 788 S.W.2d 583 (Rodriguez v. American General Fire & Casualty Co.) 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
Rodriguez v. American General Fire & Casualty Co., 788 S.W.2d 583, 1990 WL 37477 (Tex. Ct. App. 1990).

Opinion

OPINION

KOEHLER, Justice.

Hilario Rodriguez, Appellant, filed suit against American General Fire & Casualty Company, Appellee, to recover unpaid past medical bills and damages for breach of contract, breach of the duty of good faith and fair dealing, violations of the Deceptive Trade Practices Act and the Texas Insurance Code, all arising out of a worker’s compensation case. Appellee filed a plea to the jurisdiction which was granted by the trial court. We reverse and remand.

Appellant was injured on the job on April 23, 1985. He thereafter filed a claim with the Industrial Accident Board (“IAB” or “Board”) for compensation and for payment of certain disputed medical bills, which Appellee had refused to pay. Following an award by the Board on May 2, 1986, which ordered payment of $29,279.15 compensation and the medical bills, Appel-lee gave timely notice of intent to appeal. Before that appeal was perfected, the parties entered into a Compromise and Settlement Agreement (“CSA”), which called for a lump sum payment of $30,500.00 and no future medical but as to past medical, provided that Appellee:

[Wjill pay or has paid for all accrued hospital and medical expenses resulting from said injury per Article 8306, Sections 7, 7A, 7B.

It also provided that:

It is the express agreement of the parties to this Compromise Settlement Agreement that the Board shall have continuing jurisdiction of all medical benefits provided by this Compromise Settlement Agreement and The Texas Workers’ Compensation Act until all obligations described herein are fully discharged.

The CSA was approved by the Board on May 30, 1986 and the lump sum payment was thereafter made to Appellant. The disputed medical bills were not paid, however. In August 1986, a doctor, on behalf of all of the health care providers whose bills were unpaid, filed a claim with the IAB for the same medical bills included in Appellant’s original claim and covered by the CSA. While the doctor’s claim was pending before the IAB, Appellant, apparently unaware that the doctor was proceeding on his own, filed this suit on March 25, 1987 seeking to recover the same medical bills on the theory that since the IAB by its order of May 2, 1986 had ordered Appellee to pay the medical bills, Appellee was obligated under the terms of the CSA to pay those bills. On November 20, 1987, Appel *585 lant amended his petition to its present posture, alleging breach of the compromise settlement agreement, unfair insurance practices, violations of the Deceptive Trade Practices Act, breach of the common law duty of good faith and gross negligence.

Following a scheduled hearing on the doctor’s claim, the IAB denied payment of the medical bills on November 23, 1987. That order was subsequently rescinded and the claim reinstated on the IAB docket following a false allegation by the doctor’s representative that suit had been filed by the doctor. Thereafter, Appellee filed in this suit a motion for reconsideration of its plea to the jurisdiction which had been denied prior to the filing of Appellant’s latest amended petition. On February 24, 1989, the trial court granted the plea to the jurisdiction and dismissed Appellant’s lawsuit.

In his first point of error, Appellant complains that there was no evidence to support the granting of Appellee’s plea to the jurisdiction. He argues that Appel-lee had the burden of proving no jurisdiction by competent evidence, which it failed to do. Appellant also contends that the court erred by not finding jurisdiction based solely upon his pleadings, citing Hachar v. County of Webb, 563 S.W.2d 693, 694 (Tex.Civ.App.—San Antonio 1978, writ ref’d n.r.e.). An examination of the petition and the attached exhibits show on their face that Appellant had not complied, prior to the filing of this suit, with Tex. Rev.Civ.Stat.Ann. art. 8307, secs. 5 and 12b (Vernon Pamphlet 1990), which requires that all disputes over the payment of medical bills arising in connection with a Board-approved compromise settlement agreement must first be presented to the Board for determination before suit can be filed. When state law requires a plaintiff to take preliminary administrative action prior to the filing of suit, he has the burden of showing that such administrative prerequisite has been met. Southwestern Apparel, Inc. v. Bullock, 598 S.W.2d 702, 703 (Tex.Civ.App.—Austin 1980, no writ); Castillo v. Allied Insurance Company, 537 S.W.2d 486, 487 (Tex.Civ.App.—Amarillo 1976, writ ref’d n.r.e.).

Following the May 2, 1986 award of the IAB, ordering the payment of the disputed medical bills, Appellee gave its notice of intent to appeal. The CSA was entered into by the parties, approved by the IAB, and contained the quoted provisions relating to past medical expenses. The statutory reference in the quotation is to Tex. Rev.Civ.Stat.Ann. art. 8306 (Vernon 1967). Section 7 of that article requires the IAB, in the event that the carrier contends to the Board that a medical bill is not fair and reasonable, to make a finding as to the amount that is fair and reasonable. If the health care provider is not satisfied, it may appeal the Board’s determination. Section 7b requires that the charges for all medical services are to be fair and reasonable and are subject to regulation of the Board.

It is Appellant’s contention that the May 2, 1986 Board order on the medical expenses became final when Appellee failed to file suit to set aside the award. The problem with Appellant’s argument is that the CSA was entered into by the parties and approved by the Board prior to the expiration of time within which to file suit, with the result that Appellant’s claim and the Board award never became final. A provision of the CSA specifically covered past medical expenses. When the CSA was approved by the Board, it became an accord and satisfaction, superseding Appellant’s pending claim in all respects, including his claim for past medical expenses. Barnes v. Bituminous Casualty Corporation, 495 S.W.2d 5, 8 (Tex.Civ.App.—Amarillo 1973, writ ref’d n.r.e.); Angelina Casualty Company v. Bennett, 415 S.W.2d 271, 275 (Tex.Civ.App.—Houston 1967, no writ).

As to the no evidence contention, we must consider only the evidence tending to support the finding of the trial court, viewing it in the light most favorable to the finding, giving effect to all reasonable inferences therefrom, and disregarding all contrary or conflicting evidence. Glover v. Texas General Indemnity Company, 619 S.W.2d 400 (Tex.1981). The finding or conclusion of which Appellant complains is “[tjhat the subject of the reasonableness and necessity of the medical bills made the *586

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Bluebook (online)
788 S.W.2d 583, 1990 WL 37477, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rodriguez-v-american-general-fire-casualty-co-texapp-1990.