Wendell H. Taylor v. Lubbock Regional MHMR & JI Texas Risk Management and Texas Department of Insurance Division of Workers' Compensation, 07-12-00232-CV

Taylor, an employee of MHMR, sustained a compensable injury on February 10, 2009; MHMR is a self-insured governmental entity under the Texas Workers' Compensation Act.
The Division held a contested case hearing in 2011 to determine if the injury extended to chronic conditions; the hearing officer and appeals panel found no extension arising from the 2009 injury.
Taylor filed suit in district court seeking judicial review of the appeals panel decision and additional relief including lifetime medical benefits and other damages.
Defendants moved for pleas to the jurisdiction; the trial court dismissed certain claims against JI Specialty Services, the Risk Management Fund, and MHMR, and dismissed the Division from suit.
The court concluded Taylor had not exhausted administrative remedies for benefits not presented to the appeals panel and thus lacked subject-matter jurisdiction for those claims; it also addressed immunity defenses for tort claims.
The court ultimately held that the trial court erred in dismissing Taylor’s claims against JI Specialty Services but was correct in dismissing claims against MHMR, the Risk Management Fund, and the Division.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Taylor exhausted administrative remedies for benefits not tested by the appeals panel.	Taylor seeks benefits beyond the panel’s decision and argues for judicial review of those broader relief rights.	Division/OTs argue judicial review is limited to issues decided by the appeals panel and non-exhausted claims are outside jurisdiction.	Taylor’s non-tested benefit claims are dismissed for lack of jurisdiction due to failure to exhaust.
Whether MHMR, the Risk Management Fund, and the Division possess immunity to Taylor’s tort claims.	Taylor asserts torts arising from administrators’ actions; waivers of immunity may apply via the Workers’ Compensation Act.	Immunity vests unless a clear waiver exists; the Tort Claims Act and Workers’ Comp Act do not expressly waive immunity for these torts.	Tort claims against MHMR, the Risk Management Fund, and the Division are barred by governmental or sovereign immunity.
Whether Specialty Services is shielded by MHMR’s governmental immunity.	Specialty Services, as third-party administrator, should bear the same immunity as MHMR.	Immunity analyses depend on contract and control relationships; record is insufficient to conclude immunity for Specialty Services.	The trial court erred in dismissing Taylor’s claims against Specialty Services; jurisdiction was not shown to be precluded by exhaustion or immunity.

Holland v. State, 221 S.W.3d 639 (Tex. 2007) (determines de novo review standard for jurisdictional pleas)
Saenz v. Fidelity & Guar. Ins. Underwriters, 925 S.W.2d 607 (Tex. 1996) (exhaustion of administrative remedies required for judicial review)
Texas Dept. of Parks & Wildlife v. Miranda, 133 S.W.3d 217 (Tex. 2004) (liberal construction of pleadings; nature of jurisdictional review)
Frank v. Liberty Ins. Corp., 255 S.W.3d 314 (Tex. App.––Austin 2008) (limits on judicial review of administrative decisions in workers’ comp)
Milner v. City of Leander, 64 S.W.3d 33 (Tex. App. Austin 2000) (immunity considerations for officials and duty analysis)
Foster v. Teacher Ret. Sys., 273 S.W.3d 883 (Tex. App.––Austin 2008) (agency relationship and immunity in insurer/administration context)
GAB Business Services, Inc. v. Moore, 829 S.W.2d 345 (Tex. App.–Texarkana 1992) (whether private adjuster was entitled to immunity; agency considerations)
Campbell v. Tex. Employers’ Ins. Ass’n, 920 S.W.2d 323 (Tex. App.––Houston 1995) (official immunity and discretionary acts analysis)
Krueger v. Atascosa County, 155 S.W.3d 614 (Tex. App.––San Antonio 2004) (limits on judicial review; statutory interpretation of §410.302)
Hill v. Texas Council Risk Mgmt. Fund, 20 S.W.3d 209 (Tex. App.––Texarkana 2000) (self-insurance pool immunity and governmental functions)