Edna A. Martinez v. State Office of Risk Management
04-14-00558-CV
| Tex. App. | Apr 9, 2015Background
- Claimant Edna Martinez, a CPS Specialist II, reported she slipped and fell at her home on June 9, 2001 while allegedly working on reports; she sought workers’ compensation benefits for multiple injuries.
- Employer/SORM denied the claim arguing Martinez was not in the course and scope of employment, was not furthering employer affairs, and no causal connection existed; employer policy required prior written authorization to work off‑site or overtime.
- A contested case hearing (CCH) hearing officer found Martinez did not sustain a compensable injury and had no disability; the appeals panel reversed that decision. SORM sought judicial review in district court.
- The district court granted SORM’s summary judgment, reversed the appeals panel, and held Martinez did not sustain a compensable injury; Martinez appealed to the Fourth Court of Appeals.
- SORM’s main legal contentions on appeal: (1) the hearing officer’s factual findings do not establish compensability because the injury neither arose out of nor occurred in the course and scope of employment; (2) Martinez violated Gov’t Code §§ 658.010 and 659.018 (no prior authorization to work at home), which takes her activity outside the scope of employment; and (3) sovereign immunity bars recovery of attorney’s fees under Tex. Labor Code § 408.221(c).
Issues
| Issue | Plaintiff's Argument (Martinez) | Defendant's Argument (SORM) | Held |
|---|---|---|---|
| Whether SORM may challenge compensability on judicial review when appeals‑panel findings favored Martinez | Hearing officer findings establish compensability and SORM cannot contest compensability on judicial review because it did not appeal adverse contested‑case findings to the appeals panel | SORM preserved the issue: it timely responded to Martinez’s request for review, exhausted administrative remedies, and properly sought judicial review of the appeals‑panel decision | Court upheld that SORM properly challenged compensability on judicial review (trial court granted SORM summary judgment) |
| Whether the hearing‑officer findings establish the "arose out of" element | Martinez: testimony that she was working on reports at home links the injury causally to employment | SORM: injury resulted from a household condition (wet kitchen floor) not created by employment; no employer instrumentality or hazard placed her in harm’s way | Court accepted SORM’s view that the record does not support the “arise out of” element |
| Whether the injury was within the course and scope of employment | Martinez: doing work (reports) at home furthered employer affairs, so injury occurred in course and scope | SORM: the act producing injury was walking in her kitchen (not required by employer); she lacked prior authorization to work off‑site, so activity did not originate in or further employer business | Court accepted SORM’s argument that activity did not originate in or further employer’s affairs; course and scope not established |
| Whether statutory/procedural defenses (Gov’t Code §§ 658.010, 659.018) could be raised on judicial review and defeat compensability | Martinez: SORM failed to raise statutory violation at administrative stage so cannot raise it for first time on judicial review | SORM: statutory violation is part of its compensability argument and was raised during administrative proceedings (employer policy and refusal to pay were argued) and demonstrates she acted outside authorized scope of employment | Court found SORM could rely on the employer‑rule/statute argument to show Martinez acted outside scope; statutory violation defeats compensability |
| Whether attorney’s fees are recoverable against SORM under Tex. Lab. Code § 408.221(c) | Martinez: prevailing claimant entitled to attorney’s fees under § 408.221(c) after carrier’s appeal | SORM: sovereign immunity not waived; § 408.221(c) does not contain a clear, unambiguous waiver of sovereign immunity and Chapter 501 preserves Tort Claims Act limits | Court accepted SORM’s sovereign‑immunity argument; attorney’s fees not recoverable from the state agency |
Key Cases Cited
- American Motorists Ins. Co. v. Steel, 229 S.W.2d 386 (Tex. Civ. App. 1950) (both “arise out of” and “course and scope” elements required for compensability)
- Transcontinental Ins. Co. v. Crump, 330 S.W.3d 211 (Tex. 2010) (causation for “arise out of” requires the activity be a substantial factor in producing the injury)
- Leordeanu v. Am. Prot. Ins. Co., 330 S.W.3d 239 (Tex. 2010) (course and scope requires both origination in and furtherance of employer’s affairs)
- Maryland Casualty Co. v. Brown, 115 S.W.2d 394 (Tex. 1938) (violation of employer instructions intended to limit scope of employment can bar compensation)
- Lumberman’s Reciprocal Ass’n v. Behnken, 246 S.W. 72 (Tex. 1922) (an activity ‘originates in’ employment when it results from risks inherent in the job)
- Texas Workers’ Comp. Ins. Fund v. Simon, 980 S.W.2d 730 (Tex. App.—San Antonio 1998) (to determine “arise out of,” ask whether employment placed the claimant in harm’s way)