Texas Mutual Insurance Company v. Anita DeJaynes, Individually and as Next Friend of Alyssa DeJaynes, Noah Matthew DeJaynes, and Emma Michelle DeJaynes, Minor Children

Court of Appeals of Texas·Decided November 25, 2019·No. 08-18-00147-CV·Published

Opinion

COURT OF APPEALS

EIGHTH DISTRICT OF TEXAS

EL PASO, TEXAS

TEXAS MUTUAL INSURANCE § COMPANY, §

No. 08-18-00147-CV

Appellant, §

Appeal from

v. § 143rd District Court

§

ANITA DEJAYNES, of Ward County, Texas INDIVIDUALLY AND AS NEXT § FRIEND OF ALYSSA DEJAYNES, (TC# 15-12-23771-CVW)

NOAH MATTHEW DEJAYNES, § AND EMMA MICHELLE DEJAYNES, MINOR CHILDREN, §

Appellee. §

OPINION

In a worker’s compensation case, a worker’s attorney who successfully appeals an adverse determination of the Division of Worker’s Compensation (DWC)--subject to approval by the court--is entitled to attorney’s fees.1 The fees, however, cannot exceed 25 percent of the claimant’s recovery. 2 They are also paid out of that recovery. 3 In this case, the DeJayneses’ attorney

1 TEX.LAB CODE ANN. § 408.221(a),(b).

2 TEX.LAB CODE ANN. § 408.221(i).

3 TEX.LAB CODE ANN. § 408.221(b).

successfully overturned a DWC decision, and as a result, obtained for a widow and the children of a deceased worker past benefits, and a stream of future weekly benefits. The attorney asked for a fee equal to 25 percent of unpaid past benefits, and 25 percent of future benefits calculated on the basis of the widow’s anticipated life expectancy. The attorney also presented some evidence of his fee based on the time actually spent and an hourly rate, which somewhat approximates the 25 percent contingency fee. The trial court ordered payment of a commuted lump sum fee equal to a 25 percent contingency adjusted for interest and discounting (that is, taking 25 percent of past benefits with added interest, and 25 percent of projected future benefits discounted to present value).

Texas Mutual Insurance Company (Texas Mutual) appeals only the attorney’s fee award, claiming: (1) the commutation of the fee award is at odds with the worker’s compensation statute and a DWC rule; (2) the fees must be based on an hourly rate multiplied by the time spent, and not a contingency; (3) measured by the time and rate standard, some of the work claimed was not reasonable or necessary, and the hourly rate was excessive; and (4) a jury must decide the amount of the fees. Appellees, (collectively the DeJayneses), challenge our subject matter jurisdiction to hear this matter.

We conclude that we have subject matter jurisdiction. While we reject most of Texas Mutual’s contentions, we agree that the hourly rate used to justify the fee included a risk modifier that the legislature has rejected in worker’s compensation cases. Accordingly, we reverse the order on attorney’s fees and remand for a new hearing solely on that issue.

BACKGROUND

This case arises out of a workplace accident that took the life of Jaime DeJaynes.4 He died in a single vehicle accident while driving a company work truck. The worker’s compensation insurance carrier, Texas Mutual, initially paid Jaime’s widow and children weekly death benefits under the Texas Worker’s Compensation Act (the Act). Under the Act, a deceased worker’s spouse is entitled to death benefits for life, unless the spouse remarries (and if remarried, then for only an additional 104 weeks). TEX.LAB CODE ANN. § 408.183(b). Qualifying children are entitled to benefits until they reach age 18, or up to age 25 if they are enrolled as a full-time student in an accredited education institution. Id. at § 408.183(c)(d). Benefits are based on a percentage of the deceased worker’s average weekly wage. Id. at § 408.181.

Texas Mutual, however, stopped those payments after it obtained a toxicology report from Jaime’s post-accident medical records. Under the Act, a blood test or urinalysis showing the voluntary introduction into the body of certain controlled substances creates a rebuttable presumption that the worker is intoxicated and does not have the normal use of mental or physical faculties. Id. at § 401.013(c). An insurance carrier is not liable for worker’s compensation benefits if the injury “occurred while the employee was in a state of intoxication” as defined in the Act. Id. at § 406.032. In this case, the toxicology report showed the presence of Delta 9 Carboxy THC, which is a metabolite found in the blood after the ingestion of marijuana.

Disputed issues in worker’s compensation claims must first be resolved through an administrative review process. Id. at § 410.024 (benefit review conferences); § 410.151 (contested case hearings); § 410.202 (administrative appeals); § 410.251 (requirement to exhaust administrative process prior to filing suit). Ms. DeJaynes challenged the carrier’s suspension of benefits through that process. The DWC identified and resolved two issues: (1) was Jaime

4 Mr. DeJaynes first name is spelled differently in the record. We use the “Jaime” spelling for clarity.

intoxicated so as to impair his normal functions (the applicable statutory test for an intoxication defense); and (2) did Texas Mutual waive that defense by not asserting it timely. As to this second issue, an insurance carrier is required to raise a defense within 60 days of receiving a claim unless the defense could not reasonably have been discovered earlier. Id. at § 409.021(c),(d). Texas Mutual contended that through no fault of its own, it did not obtain the toxicology report until 83 days after learning of the claim. Texas Mutual prevailed on both of these issues before the DWC.

Jaime’s widow and children then appealed that adverse determination to a district court.

The trial court then acquired jurisdiction over the two issues that had been administratively resolved. Id. at § 410.302 (“A trial under this subchapter is limited to issues decided by the appeals panel and on which judicial review is sought.”). Texas Mutual filed a motion for partial summary judgment on the first issue--whether Jaime was intoxicated at the time of the accident. Texas Mutual prevailed on that motion when the DeJayneses effectively conceded the issue by not filing a response. The court tried the second issue--whether the carrier waived the defense--to a jury. This time, the DeJayneses prevailed and Texas Mutual does not contest that portion of the case on appeal. It has in fact paid past due benefits and restarted death benefits to the DeJayneses. Rather, we are asked to review only a separate order incorporated into the final judgment that awards the DeJayneses’ attorney his fees.

Regarding attorney’s fees, the DeJayneses’ counsel filed a motion with the trial court that asked two things: (1) approve 25 percent of the benefits as the amount of the attorney’s fees; and (2) to “commute” the fee such that Texas Mutual would advance the total amount due, rather than pay incremental portions of the fee as it made on-going benefit payments to the DeJayneses. As to the fee amount, the DeJayneses’ counsel included his own affidavit that set out the terms of his fee contract. He also set out his qualifications, described the work done in the case, and described

what a comparative fee would be under a time and rate analysis. We add a bit more detail to each of those topics.

First, the Dejayneses and their counsel had previously entered into a written fee contract entitling the attorney to a 25 percent contingency fee from any benefits awarded to the DeJayneses. Because of their success at trial, the DeJayneses will potentially recover a total of $1,936,778.54. Broken down, that sum includes past-due benefits, that with interest, totals $144,978.54. Twenty- five percent of those past benefits amounts to $36,244.64 in fees. Based on life expectancy tables, Ms. DeJaynes will be paid future benefits for 40.4 years that when reduced to present value, totals $803,305.97. Twenty-five percent of that discounted sum amounts to $200,826.49, and when combined with the past due attorney’s fees, they both total $237,071.13 in attorney’s fees.

Counsel’s affidavit further attests that he was well qualified to handle this matter, being:

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Texas Mutual Insurance Company v. Anita DeJaynes, Individually and as Next Friend of Alyssa DeJaynes, Noah Matthew DeJaynes, and Emma Michelle DeJaynes, Minor Children, (Tex. Ct. App. 2019).

Texas Mutual Insurance Company v. Anita DeJaynes, Individually and as Next Friend of Alyssa DeJaynes, Noah Matthew DeJaynes, and Emma Michelle DeJaynes, Minor Children (Texas Mutual Insurance Company v. Anita DeJaynes, Individually and as Next Friend of Alyssa DeJaynes, Noah Matthew DeJaynes, and Emma Michelle DeJaynes, Minor Children) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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