Liberty Mutual Insurance Company v. Ricky Adcock
412 S.W.3d 492
| Tex. | 2013Background
- In 1991 Ricky Adcock suffered work-related injuries to his right ankle (and later issues with his hand/foot) and in 1997 the appeals panel awarded him lifetime income benefits (LIBs); Liberty Mutual did not appeal that award then.
- More than a decade later Liberty Mutual sought a contested-case hearing asserting Adcock’s condition had improved and the Division could re-open the prior LIB determination.
- A hearing officer and the appeals panel concluded the Division had jurisdiction to re-open but ultimately affirmed that Adcock remained entitled to LIBs.
- Adcock sued, moving for summary judgment that the Division lacked jurisdiction to re-open an LIB award; the trial court and the court of appeals granted summary judgment for Adcock.
- The Supreme Court considered whether the current Texas Workers’ Compensation Act contains any procedure authorizing the Division to re-open LIB determinations, given that a broad re-opening provision present before the 1989 reform was repealed.
Issues
| Issue | Plaintiff's Argument (Adcock) | Defendant's Argument (Liberty/Division) | Held |
|---|---|---|---|
| Whether the Act permits the Division to re-open LIB awards | LIBs are statutorily permanent: §408.161 mandates LIBs “are paid until the death of the employee” and contains no re-opening procedure | If a claimant medically improves and no longer meets LIB criteria, the Division has implicit authority to re-open eligibility determinations | Held: No. The Act does not provide a procedure to re-open LIBs; the Division lacked jurisdiction. |
| Role of plain statutory text and permanence language | “Total and permanent” and “are paid until death” create a permanent eligibility once awarded | “Lifetime” relates to duration of payments, not entitlement, so re-opening should be implicit | Held: Court reads the plain language to make LIB determinations permanent; mandatory payment continues until death. |
| Effect of the Act’s comprehensive scheme and legislative history | Deletion of pre-1989 re-opening language shows Legislature removed re-opening authority | Division’s administrative role implies ancillary powers to administer benefits, including ensuring ongoing eligibility | Held: Because the Act is a comprehensive scheme and the Legislature expressly provided re-opening procedures for temporary benefits but removed re-opening for LIBs in 1989, courts will not judicially engraft a re-opening procedure. |
| Weight to give agency interpretation and related precedents (e.g., Samudio) | Agency deference and the regulatory scheme support permitting the Division to determine continuing eligibility | Agency cannot create effectively new powers contrary to statutory text; Samudio does not require allowing re-opening of LIBs | Held: Agency deference does not permit creation of a re-opening power that the Legislature removed or failed to provide. |
Key Cases Cited
- Texas Mutual Ins. Co. v. Ruttiger, 381 S.W.3d 430 (Tex. 2012) (Act is a comprehensive administrative scheme precluding courts from creating remedies outside it)
- Entergy Gulf States, Inc. v. Summers, 282 S.W.3d 433 (Tex. 2009) (courts should enforce statutes as written and not rewrite legislative text)
- Molinet v. Kimbrell, 356 S.W.3d 407 (Tex. 2011) (statutory construction is driven by the plain text and context)
- Public Util. Comm’n v. City Pub. Serv. Bd. of San Antonio, 53 S.W.3d 310 (Tex. 2001) (agencies lack authority to exercise new powers contrary to statute)
- Tex. Natural Res. Conservation Comm’n v. Lakeshore Util. Co., 164 S.W.3d 368 (Tex. 2005) (agencies may only exercise powers clearly conferred by the Legislature)
- American Zurich Ins. Co. v. Samudio, 370 S.W.3d 363 (Tex. 2012) (remand to Division appropriate where statute requires a division-determined impairment rating)
- Ins. Co. of State of Pa. v. Muro, 347 S.W.3d 268 (Tex. 2011) (analysis of statutory deletion/retention informs legislative intent regarding lifetime benefits)