Texas Political Subdivisions Joint Self-Insurance Fund v. Texas Department of Insurance - Division of Workers' Compensation and Commissioner Cassie Brown in Her Official Capacity

CourtCourt of Appeals of Texas
DecidedOctober 31, 2023
Docket03-22-00241-CV
StatusPublished

This text of Texas Political Subdivisions Joint Self-Insurance Fund v. Texas Department of Insurance - Division of Workers' Compensation and Commissioner Cassie Brown in Her Official Capacity (Texas Political Subdivisions Joint Self-Insurance Fund v. Texas Department of Insurance - Division of Workers' Compensation and Commissioner Cassie Brown in Her Official Capacity) 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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Texas Political Subdivisions Joint Self-Insurance Fund v. Texas Department of Insurance - Division of Workers' Compensation and Commissioner Cassie Brown in Her Official Capacity, (Tex. Ct. App. 2023).

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-22-00241-CV

Texas Political Subdivisions Joint Self-Insurance Fund, Appellant

v.

Texas Department of Insurance–Division of Workers’ Compensation and Commissioner Cassie Brown in her Official Capacity, Appellees

FROM THE 455TH DISTRICT COURT OF TRAVIS COUNTY NO. D-1-GN-21-004227, THE HONORABLE MADELEINE CONNOR, JUDGE PRESIDING

OPINION

Appellant Texas Political Subdivisions Joint Self-Insurance Fund (TPS Fund)

challenges the trial court’s order denying its combined plea to the jurisdiction and

summary-judgment motion. In the underlying suit, the TPS Fund seeks judicial review of two

Commissioner’s Orders issued by appellees Texas Department of Insurance–Division of Workers’

Compensation and Commissioner Cassie Brown in her official capacity (collectively, the

Division). In the orders, the Division assessed administrative penalties totaling $132,500 against

the TPS Fund for violations of the Texas Labor Code involving the nonpayment or late payment

of workers’ compensation benefits. In the TPS Fund’s plea and motion, it asserted that it retains

governmental immunity from liability for administrative penalties assessed against it. For the

reasons explained below, we affirm the trial court’s order. BACKGROUND

Statutory Framework

The Texas Workers’ Compensation Act is a comprehensive legislative framework

that creates a statewide no-fault insurance system for workers injured or killed in the course and

scope of their employment. See generally Tex. Lab. Code §§ 401.001-419.007; see also Texas W.

Oaks Hosp., LP v. Williams, 371 S.W.3d 171, 186 (Tex. 2012) (explaining that when employer

elects to subscribe to workers’ compensation insurance, employer’s insurance carrier is liable for

compensation of employee’s injury if employee is subject to Workers’ Compensation Act and

employee’s injury arises out of course and scope of employment). The Texas Department of

Insurance is the state agency designated to oversee the workers’ compensation system, and within

the Department, the Division was established to administer and operate the workers’ compensation

system. See Tex. Lab. Code § 402.001.

The TPS Fund is a joint fund formed under the Interlocal Cooperation Act by

certain self-insured governmental entities for the purpose of providing workers’ compensation

benefits for its participants’ employees. See generally Tex. Gov’t Code Ch. 791 (governing

Interlocal Cooperation Contracts); see also Tex. Lab. Code § 406.003 (establishing that employers

may obtain workers’ compensation insurance coverage through licensed insurance company or

through self-insurance as provided by Act). The TPS Fund describes itself as a political

subdivision of the State that operates as a risk-management pool and workers’ compensation claim

administrator for its members, which are public-school districts, counties, cities, and other units of

local government.

2 The Commissioner’s Orders

In November 2019, the Division’s staff initiated two separate cases before an

administrative-law judge (ALJ) at the State Office of Administrative Hearings (SOAH), seeking

to sanction the TPS Fund. In one case, the Division sought sanctions in the amount of $160,000

based on allegations that a 2018 audit identified multiple instances in which the TPS Fund failed

to accurately pay death benefits and failed to timely or accurately report claim data. The ALJ

ultimately found that the TPS Fund underpaid the death-benefit amounts for three claims by a total

of $384,132. 1 In the other case, the Division sought sanctions in the amount of $7,500 based on

allegations that the TPS Fund failed to timely pay benefits to an injured employee that should have

begun by October 30, 2017. The ALJ ultimately found that the TPS Fund paid the injured

employee the principal amount 112 days late and paid accrued interest 526 days late.

In each of the proceedings, the TPS Fund filed a plea to the jurisdiction, asserting

that, at the time of the TPS Fund’s alleged violations, the TPS Fund enjoyed governmental

immunity from suit and liability for administrative penalties and sanctions, based on a recent

amendment to Texas Labor Code Section 504.053(e). See Act of May 26, 2019, 86th Leg., R.S.

ch. 701, § 6, sec. 504.053, 2019 Tex. Gen. Laws 2005, 2006 (SB 2551 or Act) (codified at Tex.

Labor Code § 504.053(e)). In the proposals for decision (PFDs) in each case, the ALJ explained

that she had denied the TPS Fund’s pleas to the jurisdiction and her reasoning for those denials.

The ALJ determined that the enforcement actions had been brought by Division staff under

Chapters 408, 409, and 415 of the Labor Code, not Chapter 504, and that “[t]he Texas Workers’

1 By the time the ALJ issued the proposal for decision in the SOAH proceeding, the TPS Fund had paid all outstanding amounts, including interest, to the beneficiaries for the underpaid death-benefit amounts. 3 Compensation Act contains a clear and unambiguous waiver of sovereign immunity for

governmental entities that self-insure, either individually or collectively.” Based on the evidence

of violations and the applicable law, the ALJ recommended that the TPS Fund be ordered to pay

$125,000 as an administrative penalty in the death-benefits case and $7,500 as an administrative

penalty in the injured-employee case.

The Commissioner subsequently issued two Orders incorporating the ALJ’s PFDs

by reference. The Orders also incorporated and adopted by reference the findings of fact and

conclusions of law listed in the PFDs. Accordingly, the Division assessed administrative penalties

of $7,500 and $125,000 against the TPS Fund.

The TPS Fund subsequently sought judicial review of the Commissioner’s Orders

in Travis County District Court. The TPS Fund filed a combined plea to the jurisdiction and

summary-judgment motion, again asserting that its governmental immunity has not been waived

for the assessment of administrative penalties by the Division and seeking attorneys’ fees and costs

under Texas Civil Practice and Remedies Code Sections 105.005 and 37.009.2 See Tex. Civ. Prac.

& Rem. Code § 37.009 (allowing court to “award costs and reasonable and necessary attorney’s

fees as are equitable and just” in proceeding brought under Uniform Declaratory Judgments Act);

id. § 105.005 (allowing court to award prevailing party “reasonable attorney’s fees and costs

incurred in defending against a frivolous regulatory action during the contested case and judicial

review of the decision in the contested case if . . . there is a final determination that the regulatory

action is frivolous”).

2 The TPS Fund also sought a declaratory judgment that its governmental immunity has not been waived for the assessment of administrative penalties by the Division and that the TPS Fund’s substantial rights had been prejudiced by the Orders. 4 After a hearing, the trial court denied the plea and motion. This interlocutory appeal

followed. See id. § 51.014(a)(5), (8).

ANALYSIS

In two issues, the TPS Fund asserts that the trial court erred by denying its plea to

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Texas Political Subdivisions Joint Self-Insurance Fund v. Texas Department of Insurance - Division of Workers' Compensation and Commissioner Cassie Brown in Her Official Capacity, Counsel Stack Legal Research, https://law.counselstack.com/opinion/texas-political-subdivisions-joint-self-insurance-fund-v-texas-department-texapp-2023.