In re Accident Fund Gen. Ins. Co.
543 S.W.3d 750
| Tex. | 2017Background
- Ricky Sayaz, injured at work while employed by Coil Tubing Solutions, received workers’ compensation benefits from Accident Fund General Insurance Company and adjuster Kriste Henderson.
- Coil Tubing sent two “Bona Fide Offer of Employment” modified-duty letters while Sayaz was recuperating; Sayaz did not accept or reject them and was later terminated.
- Sayaz sued Coil Tubing (wrongful discharge/retaliation and defamation); his wife sued for bystander/spousal injuries.
- Sayaz sued Accident Fund and Henderson alleging they aided-and-abetted Coil Tubing, tortiously interfered with employment, and conspired to manufacture sham job offers as a pretext for termination.
- Accident Fund filed a plea to the jurisdiction arguing the Division of Workers’ Compensation has exclusive jurisdiction; the trial court denied the plea and the carriers sought mandamus relief from the Texas Supreme Court.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Division has exclusive jurisdiction over claims against the carrier arising from the bona-fide-offer process | Sayaz: carrier had no decisive role; Coil Tubing made the offers and fired him before carrier acted, so claims lie in court | Accident Fund: claims arise from the carrier’s handling of claims and the bona-fide-offer process, so the Division has exclusive jurisdiction | Held: Division has exclusive jurisdiction; claims against Accident Fund must be administratively exhausted |
| Whether alleged “sham” offers and related tort claims are outside the Act because labeled as common-law torts/statutory retaliation | Sayaz: labels (conspiracy, tortious interference, aiding-and-abetting) place them outside the Act | Accident Fund: substance—not label—controls; claims depend on whether offers were bona fide, a Division determination | Held: substance controls; claims arise from statutory claims-handling process and are within Division’s exclusive remedies |
| Whether exhaustion of administrative remedies was required before suing Accident Fund | Sayaz: did not pursue administrative remedies | Accident Fund: plaintiffs must exhaust Division remedies before court suit | Held: exhaustion required; failure to exhaust deprives trial court of subject-matter jurisdiction |
| Whether mandamus relief should be granted to carrier (and employer) | N/A (plaintiffs) | Accident Fund sought mandamus to compel dismissal; Coil Tubing also filed petition | Held: Mandamus conditionally granted for Accident Fund and Henderson; court directed dismissal of claims against them; Coil Tubing’s petition denied as not properly before the Court |
Key Cases Cited
- In re Crawford & Co., 458 S.W.3d 920 (Tex. 2015) (Act provides exclusive procedures/remedies for carrier claims handling)
- Tex. Mut. Ins. Co. v. Ruttiger, 381 S.W.3d 430 (Tex. 2012) (common-law and Insurance Code claims barred when they conflict with Division’s exclusive process)
- In re Entergy Corp., 142 S.W.3d 316 (Tex. 2004) (trial court lacks jurisdiction where agency has exclusive jurisdiction and administrative remedies are unexhausted)
- In re Liberty Mut. Fire Ins. Co., 295 S.W.3d 327 (Tex. 2009) (claims dependent on administrative benefits determinations must be addressed administratively first)
- Am. Motorists Ins. Co. v. Fodge, 63 S.W.3d 801 (Tex. 2001) (courts cannot award compensation or damages that would circumvent Commission’s authority)