in Re Old Republic Insurance Company, 02-17-00269-CV

Background

In 2006, Trena Jones suffered severe work-related injuries (including cervical, bilateral shoulders, and right little finger degloving) from a motor vehicle accident.
By 2015 Jones had received all supplemental income benefits available under the "no ability to work" theory and sought lifetime-income benefits (LIBs) from the Division of Workers’ Compensation (DWC) based on alleged total loss of use of both hands at or above the wrist.
A DWC hearing officer found Jones had not proven total or permanent loss of use of both hands for the period June 10, 2014–July 1, 2015; the hearing officer also stated several hand/arm conditions were not part of the compensable injury and based Jones’s impairment rating on cervical, lumbar, bilateral shoulder, and right little-finger injuries.
Jones appealed, and the DWC appeals panel allowed the hearing officer’s decision to become final without issuing a separate decision.
Old Republic filed a plea to the jurisdiction in county court arguing Jones had not exhausted administrative remedies because the DWC had not made findings defining the exact nature/extent of her hand/shoulder injuries for LIB purposes; the trial judge denied the plea and Old Republic sought mandamus relief.
The appellate court held the DWC had not fully resolved the extent/compensability of Jones’s injury for LIBs, that the trial court therefore lacked jurisdiction, and conditionally granted mandamus directing the trial court to vacate its order and abate proceedings pending DWC resolution.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether trial court has jurisdiction to adjudicate LIB claim when DWC has not made findings defining extent/compensability of injury	Jones: DWC decision denying LIBs is final and judicial review may proceed	Old Republic: Jones has not exhausted administrative remedies because DWC did not resolve extent/compensability for LIB purposes	Court: Trial court lacked jurisdiction; administrative exhaustion required and mandamus granted to abate proceedings pending DWC resolution
Whether loss of use of hands for LIBs requires a DWC finding that the hands themselves were injured	Jones: LIB denial stands; argued compensability as decided	Old Republic: Compensability/extent (including whether hands were directly injured) remains unresolved and must be determined by DWC	Court: Determination of LIB entitlement depends on extent/compensability (including whether hands were injured); DWC exclusive forum for these fact-bound issues

Key Cases Cited

Tex. Mut. Ins. Co. v. Baker, 292 S.W.3d 798 (Tex. App.—Fort Worth 2009) (discussing "no ability to work" supplemental income benefits theory)
Liberty Mut. Ins. Co. v. Adcock, 412 S.W.3d 492 (Tex. 2013) (LIBs are permanent benefits paid upon establishment of eligibility and are subject to judicial review but not reopening)
Dallas Nat’l Ins. Co. v. De La Cruz, 470 S.W.3d 56 (Tex. 2015) (total loss of use of hands compensable only if hands’ physical structures were damaged)
Am. Motorists Ins. Co. v. Fodge, 63 S.W.3d 801 (Tex. 2001) (DWC has exclusive jurisdiction to determine entitlement to workers’ compensation benefits)
In re H.E.B. Grocery Co., L.P., 492 S.W.3d 300 (Tex. 2016) (mandamus proper to correct clear abuse of discretion when no adequate remedy by appeal)
In re Sw. Bell Tel. Co., 235 S.W.3d 619 (Tex. 2007) (analysis balancing adequacy of appellate review for interlocutory decisions)
Tex. Ass’n of Bus. v. Tex. Air Control Bd., 852 S.W.2d 440 (Tex. 1993) (subject matter jurisdiction cannot be waived)
In re Crawford & Co., 458 S.W.3d 920 (Tex. 2015) (estoppel cannot create subject-matter jurisdiction)