INSURANCE OF STATE OF PENNSYLAVANIA v. Muro
347 S.W.3d 268
| Tex. | 2011Background
- Muro injured at work in 1996, including hips, lower back, right shoulder, and neck, with multiple surgeries and temporary return to work before disability resumed in 1999.
- She sought lifetime income benefits under Tex. Lab. Code § 408.161, contending loss of use of right hand and both feet due to hip/shoulder injuries.
- TWCC-appointed physician testified hips/shoulder injuries limited use of legs and right arm, but feet and hands were functionally near normal.
- Jury found total and permanent loss of use of both feet at or above the ankle and loss of use of one foot and one hand, awarding lifetime benefits and fees.
- Court of Appeals affirmed; insurer petitioned for review to determine scope of § 408.161 and eligibility based on enumerated injuries.
- Court reverses, holding lifetime benefits are limited to the enumerated injuries in § 408.161 and that non-enumerated injuries do not trigger benefits absent injury to the enumerated body parts.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 408.161 requires an enumerated injury to trigger lifetime benefits. | Muro argues any injury causing total loss of use of a statutory part suffices. | Muro’s injuries need not target enumerated parts if total loss of use results from non-enumerated injuries. | Limited to enumerated injuries; non-enumerated injuries cannot support lifetime benefits. |
| Whether the old-law 'other loss' clause governs the current act to extend benefits. | Old-law cases support broader recovery via 'other loss' reasoning. | New law repealed the 'other loss' clause; only enumerated injuries confer lifetime benefits. | Old-law reasoning is not applicable; § 408.161 controls. |
| Whether evidence shows loss of use of enumerated body parts through non-enumerated injuries. | Injuries to hips/shoulder could cause loss of use of feet/hand qualifying under § 408.161. | There must be direct or indirect injury to the enumerated parts themselves. | No evidence of injury to feet or right hand; cannot award lifetime benefits. |
Key Cases Cited
- Seabolt, Travelers Ins. Co. v., 361 S.W.2d 204 (Tex.1962) (defines total loss of use; companion define injury relation to statutory parts)
- Galindo v. Old Republic Ins. Co., 146 S.W.3d 755 (Tex.App.-El Paso 2004) (non-enumerated injuries raised fact questions about total incapacity under old-law approach)
- Burdine, Hartford Underwriters Ins. Co., 34 S.W.3d 700 (Tex.App.-Fort Worth 2000) (foot/ankle injury extending to feet; distinguishes case from non-enumerated injuries)
- Avon, Second Injury Fund of Tex., 985 S.W.2d 93 (Tex.App.-Eastland 1998) (old-law approach applying 'other loss' clause)
- Martin, Tex. Employers' Ins. Ass'n v., 836 S.W.2d 636 (Tex.App.-Tyler 1992) (old-law cases applying 'other loss' reasoning to non-enumerated injuries)
- Gutierrez, Tex. Gen. Indem. Co., 795 S.W.2d 5 (Tex.App.-El Paso 1990) (old-law approach cited by courts for broader interpretation)