American Zurich Insurance Co. v. Samudio
370 S.W.3d 363
| Tex. | 2012Background
- Samudio sustained a compensable back injury; underwent four surgeries including spinal fusion/laminectomy; no preoperative flexion/extension x-rays taken; Advisories 2003-10/10B used to base impairment when x-rays were absent; Machado issued 20% impairment rating based on Advisories; Obermiller opined 10% but did not examine patient and did not issue a rating; Lumbermens decision invalidated Advisories; American Zurich petitioned for review seeking relief beyond the Division’s rating; trial court dismissed and court of appeals affirmed that dismissal.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether absence of a valid rating defeats jurisdiction | Samudio contends no valid rating presented to agency so court lacks power | American Zurich argues no valid rating means no relief | Remand allowed, jurisdiction preserved for remand to determine valid rating |
| Whether trial court can remand to agency when rating is invalid | Remand available to obtain a valid rating | Remand unnecessary because rating could be pursued at agency | Court may remand to agency to determine a conforming rating |
| Whether the court can set aside an invalid rating and remand | Court should set aside invalid rating to proceed | Remand is proper, but not to set aside without an alternative rating | Court may set aside invalid rating and remand for new determination |
| Whether fees were appropriate given later reversal | Fees prevailed due to successful review | No prevailing issue after reversal | Fees reversed in light of reversal |
Key Cases Cited
- Texas Workers’ Comp. Comm’n v. Garcia, 893 S.W.2d 504 (Tex.1995) (establishes modified trial de novo review; impairment; 410.306(c) scope)
- Lumbermens Mut. Cas. Co. v. Texas Dept. of Ins., 212 S.W.3d 870 (Tex.App.-Austin 2006) (advisories inconsistent with Guides; invalid; no relief under advisory scheme)
- State Bar of Tex. v. Gomez, 891 S.W.2d 243 (Tex.1994) (illustrates limits of court’s authority in regulatory matters)
- Dubai Petroleum Co. v. Kazi, 12 S.W.3d 71 (Tex.2000) (distinguishes subject-matter jurisdiction from evidentiary scope)
- Am. Home Assur. Co. v. Poehler, 323 S.W.3d 626 (Tex.App.Tyler 2010) ( Guides-based impairment method; preoperative imaging relevance)