383 S.W.3d 146
Tex.2012Background
- Morris injured his back at work in 2000; TMIC accepted the injury as compensable and paid benefits.
- In 2003 Morris developed herniated lumbar discs; TMIC disputed causality to the original injury.
- The division ordered TMIC to pay medical benefits after a contested process, which TMIC did.
- Morris sued TMIC for delay damages, bad faith, and DTPA violations based on the delay and the dispute over compensability.
- Trial court ruled for Morris on several claims; court of appeals affirmed in part and remanded.
- Texas Supreme Court reversed and rendered for TMIC, addressing jurisdiction and other statutory/insurance-code theories.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Jurisdiction over delay claims | Morris exhausted administrative remedies under the Act. | Delay damages require exhaustion; delays were jurisdictional prerequisites. | Delays were not jurisdictional; they were damages-mitigation issues. |
| Applicability of unfair claims practices and good faith in WC | DTPA and common-law good faith claims apply to WC insurers. | Ruttiger controls; no recovery for these theories in WC context. | Reaffirmed no recovery under Insurance Code 541.060 and no common-law duty in WC. |
| Insurance Code misrepresentation claim | Misrepresentation actionable under Insurance Code 541.061 despite WC context. | Dispute was about extent/causation, not policy misrepresentation. | No misrepresentation found; claim fails. |
| DTPA claim dependence on IC claim | If IC claim stands, DTPA may survive. | IC claim fails; DTPA cannot stand with it. | DTPA claim fails because IC claim fails. |
Key Cases Cited
- Am. Motorists Ins. Co. v. Fodge, 63 S.W.3d 801 (Tex. 2001) (jurisdictional limits for delay claims under the Act)
- Aranda v. Ins. Co. of N. Am., 748 S.W.2d 210 (Tex. 1988) (breach-of-good-faith immunity in WC context based on Act changes)