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Cruz v Houston General

December 22, 2008 – Case Report

 

Cruz v. Houston General Insurance Co. No. 01-07-00225 CV (Tex. App. Houston [1st Dis.] December 18, 2008)

 

This case falls under the heading of “do not go to court without a lawyer.”  Victoria Cruz injured her lower back on June 16, 1996, while working for Gulf Coast Regional Blood Center (Gulf Coast). Houston General Insurance Company (Houston General) was the workers' compensation carrier for Gulf Coast. As a result of her injury, Ms. Cruz had an impairment rating of 17%.  Ms. Cruz's doctor released her to return to work full time on June 23, 1998. Ms. Cruz returned to work at the same job title she had before she got injured and she earned more money when she returned to work.  Ms. Cruz agreed with Houston General that March 14, 1999 was her last day with Gulf Coast and that she moved out of state because her husband found a job in Kentucky.

 

Ms. Cruz filed an application for Supplemental Income Benefits (SIBs) for the first (1st) quarter of 1999 on July 16, 1999.  On July 19, 1999, the Texas Worker's Compensation Commission (TWCC) provided notice that Ms. Cruz was not entitled to SIBs for the first (1st) quarter because there was no good faith effort to look for work commensurate with her ability to work and her inability to work was not a direct result of her impairment.  Although the notice from TWCC provided that Ms. Cruz had to request a benefit review conference to dispute the denial decision that she was not entitled to SIBs for the first (1st) quarter, the record before the Court did not show that Ms. Cruz attempted to appeal TWCC's denial of SIBs.

 

About five (5) years later, Ms. Cruz applied for SIBs for quarters two (2) through twenty (20). On December 13, 2004, Ms. Cruz and Houston General participated in a benefit review conference but were unable to reach an agreement. On February 9, 2005, the parties participated in a contested case hearing in which they stipulated that (1) Ms. Cruz's applications for SIBs for quarters 2 through 20 were first received by Houston General on November 2, 2004; (2) that November 2, 2004, was 401 weeks from June 16, 1996 (the date of Ms. Cruz's injury); and (3) Ms. Cruz's earnings during the sixth quarter qualifying period were less than 80 percent of her average weekly wage. The Contested Case Hearing Officer concluded that Houston General was relieved from liability for SIBs for quarters two (2) through twenty (20) because Ms. Cruz did not timely file the SIB applications. Ms. Cruz appealed, and the TWCC appeals panel affirmed the Contested Case Hearing Officer's decision.

 

Ms. Cruz sought judicial review of the Appeals Panel's decision by filing suit in county court on June 15, 2005.  She apparently was not represented by a lawyer.  In her original petition, Ms. Cruz argued that she wished to "set aside the final decision of the Workers' Compensation Commission." She specifically challenged finding number two, that the "Carrier is relieved of liability for SIBs for the 2nd through 20th quarters since the Claimant failed to timely file her SIBs applications with the Carrier."

 

Houston General filed a motion for summary judgment arguing that Ms. Cruz did not timely file her application for SIBs for quarters two (2) through twenty (20) because the  applications were received after 401 weeks from the date of her injury.  Texas Labor Code Section 408.083(a) provides that “an employee's eligibility for temporary income benefits, impairment income benefits, and supplemental income benefits terminates on the expiration of 401 weeks after the date of injury.”

In response to Houston General’s motion for summary judgment, Ms. Cruz did not raise a genuine issue of material fact on whether her SIB applications were timely filed.  She also did not challenge the legal basis for the motion for summary judgment.  A lawyer in this writer’s opinion could have raised arguments under Texas Labor Code Section 409.004 and Rule 130.105 and possibly defeat a summary judgment.

 

The trial court granted the summary judgment and Ms. Cruz lost her case.

 

Ms. Cruz also argued that the trial court should not have rendered judgment without the  proposed judgment first being filed with the Division of Workers’ Compensation pursuant to Section 410.258 of the Labor Code.  The court of appeals holds that since Houston General did not initiate the proceedings (presumably the appeal in the trial court), it was not necessary for Houston General to comply with Section 410.258.  If Ms. Cruz had been represented by a lawyer, she could have tried to argue that Houston General’s denial of her applications was the initiation of the “proceedings.”

 

 

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