LIBERTY MUTUAL INSURANCE COMPANY, Pеtitioner, v. Ricky ADCOCK, Respondent. Texas Department of Insurance, Division of Workers’ Compensation, Respondent.
No. 11-0934.
Supreme Court of Texas.
Argued Dec. 6, 2012. Delivered Aug. 30, 2013.
Rehearing Denied Nov. 22, 2013.
412 S.W.3d 492
Joan M. Durkin, Durkin & Graham, P.C., Bedford, TX, for Respondent Rick Adcock.
Bryan Dwayne Snoddy, Assistant Attorney General, Daniel T. Hodge, David A. Talbot Jr., Consumer Protection Office of the Attorney General, David C. Mattax, Director of Defense Litigation Office of the Attorney General, Greg W. Abbott, Attorney General of Texas, Ted Anthony Ross, Assistant Attorney General Administrative Law Division, Austin, TX, for Amicus Curiae Texas Department of Insurance, Division of Workers’ Compensation.
Justice GUZMAN delivered the opinion of the Court, in which Justice JOHNSON, Justice WILLETT, Justice LEHRMANN, Justice BOYD, and Justice DEVINE joined.
I. Background
In 1991, Ricky Adcock suffered a compensable injury to his right ankle. Though he underwent reconstructive surgery, he developed reflex sympathetic dystrophy in the injured ankle. In 1997, the appeals panel determined that Adcock was entitled tо Lifetime Income Benefits (LIBs) because “the great weight and preponderance of the evidence is that the claimant has the total and permanent loss of use of his right hand at his wrist” in addition to the stipulated loss of use of Adcock‘s right foot. Liberty Mutual Insurance Company (Liberty), the workers’ compensation carrier for Adcock‘s employer, did not seek judicial review of that decision.
Over a decade later, Liberty sought a new contested case hearing on Adcock‘s
Both parties sought judicial review. Adcock moved for summary judgment, contending the hearing officer lacked jurisdiction to re-open the previous LIB determination. The Texas Department of Insurance, Division of Workers’ Compensation (the Division) subsequently intervened, asserting that it has jurisdiction to re-open LIB determinations.2 The trial court granted Adcock‘s motion for summary judgment. The court of appeals affirmed, noting the Legislature had specifically removed the procedure to re-open LIB determinations in 1989 and the current
II. Discussion
“Enforcing the law as written is a court‘s safest refuge in matters of statutory construction, and we should always refrain from rewriting text that lawmakers chose....” Entergy Gulf States, Inc. v. Summers, 282 S.W.3d 433, 443 (Tex.2009). We review issues of statutory construction de novo, and our primary objective in construing a statute is to ascertain and give effect to the Legislature‘s intent. Molinet v. Kimbrell, 356 S.W.3d 407, 411 (Tex. 2011). The plain meaning of the text, given the context of the statute as a whole, provides the best expression of legislative intent. Id.; Ruttiger, 381 S.W.3d at 454.
Although we have held that “when the Legislature expressly confers a power on an agency, it also impliedly intends that the agency have whatever powers are reasonably necessary to fulfill its express functions or duties,” an agency has no authority to “exercise what is effectively a new power, or a power contradictory to the statute, on the theory such a the power is expedient for administrative purposes.” Pub. Util. Comm‘n of Tex. v. City Pub. Serv. Bd. of San Antonio, 53 S.W.3d 310, 316 (Tex.2001).
The narrow question before us is whether the current version of the
A. Plain Language
Section 408.161(a) of the
Liberty argues that the term “lifetime” in LIBs “pertains to the duration of a worker‘s eligibility for benefits; it does not determine entitlement.” But the statute does not state that LIBs “may be paid” until the employee‘s death; rather, it mandates LIBs “are paid” until the employee‘s death.
B. The Legislature‘s Comprehensive Benefits Scheme
We recently determined that “[t]he Act effectively eliminates the need for a judicially imposed cause of action outside the administrative processes and other remedies in the Act.” Ruttiger, 381 S.W.3d at 451. “It is apparent that the Act prescribes detailed, [Division]-supervised, time-compressed processes for carriers to handle claims and for dispute resolution.” Id. at 443. We observed: “[k]ey parts of the [workers’ compensation] system are the amount and types of benefits, the delivery system for benefits, the dispute resolution processes for inevitable disputes that arise among participants, the penalties imposed for failing to comply with legislatively mandated rules, and the procedures for imposing such penalties.” Id. at 450 (emphasis added). Further, we questioned “to what extent the judiciary will respect the Legislature‘s function of addressing the concerns and adjusting the rights of the parties in the workers’ compensation system as part of its policy-making function.” Id. In answering that question, we ultimately held that “[t]he Act effectively eliminates the need for a judicially imposed cause of action outside the administrative processes and other remedies in the Act.” Id. at 451. In sum, the Legislature devised a comprehensive workers’ compensation system, with specific benefits and procedures based on the public policy of the State of Texas. We concluded in Ruttiger that the Court should not alter the Act‘s comprehensive scheme, and we reaffirm that principle today.
The Act‘s comprehensive framework requires that we respect the Legislature‘s choice to not include a procedure to re-open the LIB determination. Before its comprehensive reform of the workers’ compensation system in 1989, the Legislature specifically incorporated such a procedure, providing that:
[u]pon its own motion or upon the application of any person interested showing a change of condition, mistake, or fraud, the Board at any time within the compensation period, may review any award or order, ending, diminishing or increasing compensation previously awarded, within the maximum and minimum provided, in this Law, or change or revoke its previous order denying compensation, sending immediately to the parties a copy of its subsequent order or award.
As part of its revised comprehensive scheme of the workers’ compensation system, the Legislature established a dichotomy containing two distinct classes of income benefits: temporary benefits and permanent benefits. Temporary benefits are only paid as long as certain conditions (e.g., medical conditions) continue to exist, whereas permanent benefits continue until the occurrence of a stаtutory, terminating event (e.g., death).
With respect to temporary benefits, the
Similarly, temporary income benefits (TIBs)—another form of temporary benefits—are contingent on the employee‘s recovery. “An employee is entitled to temporary income benefits if the employee has a disability and has not attained maximum medical improvement.”
While temporary benefits require cоntinuous monitoring to determine whether the employee has achieved the statutory level of improvement, permanent benefits require no such monitoring. This is because such benefits are permanent determinations, only terminating on the occurrence of a specific statutorily mandated life event. For example, death income benefits (DIBs) are paid to eligible beneficiaries when an injury to an employee results in death.
Similarly, LIBs—like DIBs—are permanent income benefits. LIBs are paid upon the establishment of eligibility—here by the loss of use of two limbs—until the occurrence of a particular event: the death of the employee.
When the Legislature expresses its intent regarding a subject in one setting, but, as here, remains silent on that subject in another, we generally abide by the rule that such silence is intentional.4 Thus, the Legislature‘s express provision of procedures for re-evaluating temporary benefit eligibility and the absence of such a procedure for permanent benefits indicates a deliberate choice, and we must respect the Legislature‘s prerogative to establish the rights and procedures in the workers’ compensation system. Therefore, we decline Liberty‘s invitation to judicially engraft a procedure inconsistent with the dichotomy the Legislature constructed. Ruttiger, 381 S.W.3d at 450; Entergy, 282 S.W.3d at 443.5
Liberty responds that if—as we hold today—the LIB determination is permanent, this will harm injured employees becausе they will not be able to obtain LIBs if their initial request is denied but their medical condition subsequently deteriorates. But the Legislature‘s scheme for payment of LIBs belies this argument. Specifically, section 408.081 states that
C. Response to the Dissent
The dissent argues that: (1) despite the statute‘s failure to include a procedure to re-open the LIB determination, the Act‘s general definition of “impairment” implies such a procedure; (2) the Act also necessarily implies the authority of the Division to re-open the LIB determination; (3) our remand in American Zurich Insurance Co. v. Samudio, 370 S.W.3d 363 (Tex. 2012), requires us to allow the Division to re-open LIB determinations; and (4) the Legislature‘s framework credits the Division as “being able to predict the future and knowing absolutely which claimants will always be entitled to” LIBs. These assertions, however, are unavailing.
To support its first argument, the dissent relies on the
Additionally, the dissent contends that principles of agency deference necessarily imply the authority for the Division to re-open the LIB determination. See R.R. Comm‘n of Tex. v. Tex. Citizens for a Safe Future & Clean Water, 336 S.W.3d 619, 624 (Tex.2011) (“We have long held that an agency‘s interpretation of a statute it is charged with enforcing is entitled to ‘serious cоnsideration,’ so long as the construction is reasonable and does not conflict with the statute‘s language.“). But such deference is in direct conflict with the “well-established principle that” administrative agencies “may exercise only those powers that the Legislature confers upon [them] in clear and express language, and cannot erect and exercise what really amounts to a new or additional power for the purpose of administrative expediency.” See Tex. Natural Res. Conservation Comm‘n v. Lakeshore Util. Co., 164 S.W.3d 368, 377 (Tex.2005) (emphasis added). Here, the Legislature deliberately
Further, the dissent‘s reliance on Samudio is misplaced. Samudio involved workers’ compensation impairment income benefits. 370 S.W.3d at 365. The
Lastly, the dissent asserts that our construction of the comprehensive scheme requires the Division to predict with certainty which claimants will always be entitled to LIB s, a requirement that is unworkable because the future is unknowable. Yet common law and statutory claims, and their procedures for recovering future damages, have long been a cornerstone of our court system. The question is not whether future damages are absolutely knowable but whether the plaintiff proved such damages within a reasonable degree of certainty. See Columbia Med. Ctr. of Las Colinas, Inc. v. Hogue, 271 S.W.3d 238, 247 (Tex.2008). It is not grounds to re-open a judgment simply because a plaintiff incurred fewer future medical expenses than the judgment awarded. Here, the question is whether the Division could determine that an employee lost the use of two limbs.
III. Conclusion
We defer to the Legislature to craft statutes and we interpret them as written. The Legislature previously included a procedure to re-open LIB determinations—which it removed in 1989. Currently, the Legislature only allows temporary benefit determinations (not permanent benefit determinations like LIBs) to be re-opened. We will not judicially engraft into this comprehensive statute a procedure the Legislature deliberately removed. Accordingly, the Division had no jurisdiction to re-open Adcock‘s LIB determination, and we therefore affirm the judgment of the court of appeals.
Justice GREEN filed a dissenting opinion, in which Chief Justice JEFFERSON and Justice HECHT joined.
Justice GREEN, joined by Chief Justice JEFFERSON, Justice HECHT, and Justice DEVINE, dissenting.
The Court today holds that, once award-ed, lifetime income benefits (LIBs) are
I. Background
In March 1991, Ricky Adcock sustained on-the-job injuries to his right foot and his right hand. Six years later, he was awarded LIBs. Liberty Mutual, the worker‘s compensation insurance carrier for Adcock‘s employer, did not appeal that decision to the trial court and began issuing payments pursuant to the order.1 More than ten years later, Liberty Mutual sought a new hearing, asserting that it had received video evidence of Adcock walking and handling objects, indicating that his condition had improved enough that he no longer had total and permanent functional loss of his ankle and hand, and he was therefore not entitled to LIBs. At a contested case hearing, the parties agreed on the following questions to be certified to the hearing officer:
- Is [Adcock] entitled to lifetime income benefits (LIBs) as of this date based оn total and permanent loss of use of his hands and legs?
- As a result of the decision and order of Appeals Panel in Appeal No. 970981, does the Division have jurisdiction to determine continuing entitlement to lifetime income benefits (LIBs)?
The video evidence presented at the hearing clearly demonstrated that, at one time, Adcock could walk and handle objects. The hearing officer issued its decision and order, finding that it had jurisdiction to hear the case but that, despite the video evidence, Adcock remained entitled to LIBs. The appeals panel affirmed. Adcock appealed to the district court, arguing that the Division lacked jurisdiction to hear the case under section 408.161 of the Labor Code, and asserting res judicata and collateral estoppel.
II. The Division‘s Jurisdiction
The Court holds that jurisdiction to determine continuing eligibility for LIBs cannot be found in the plain language of the Act, and therefore our inquiry can go no further. I disagree. When construing a statute, “[w]e rely on the plain meaning of the text as expressing legislative intent unless a different meaning is . . . apparent from the context.” Tex. Lottery Comm‘n v. First State Bank of DeQueen, 325 S.W.3d 628, 635 (Tex.2010). Additionally, we are not constrained to the text of the statute if “the plain meaning leads to absurd or nonsensical results.” Molinet v. Kimbrell, 356 S.W.3d 407, 411 (Tex.2011).
A. The Statute Indicates Jurisdiction to Consider Continuing Eligibility to Receive LIBS
Section 408.161 of the Texas Labor Code provides that “[l]ifetime income benefits are paid until the death of the employee” when an impairment qualifies under the statute.
We determine legislative intent by reading the statute as a whole and interpreting the legislation to give effect to the entire act and not just its isolated portions. City of San Antonio v. City of Boerne, 111 S.W.3d 22, 25 (Tex.2003). We may be “aided by the interpretive context provided by the surrounding statutory landscape.” LTTS Charter Sch., Inc. v. C2 Constr., Inc., 342 S.W.3d 73, 75 (Tex.2011) (internal quotation marks omitted). The Division is charged with the duty to “administer and operate the workers’ compensation system.”
Although we held in Texas Mutual Insurance Co. v. Ruttiger, 381 S.W.3d 430 (Tex.2012), that a common law cause of action for breach of the duty of good faith and fair dealing against a workers’ compensation insurance carrier “operate[d] outside the administrative processes and other remedies in the Act and [was] in tension with . . . the Act‘s goals or processes,” id. at 450, here an action to determine continuing eligibility for LIBs is not in tension with the Act; rather, it is consistent with the Legislature‘s intent to give the Division the responsibility of properly administering benefits. I agree with the Court that the Legislature has enacted a comprehensive scheme for workers’ compensation. 412 S.W.3d at 493. As discussed below, however, the Legislature cannot and need not envision every circumstance that may arise in the workers’ compensation context. And the Court should not be required to order absurd results if the Legislature happened to leave a particular circumstance unaddressed. See R.R. Comm‘n v. Lone Star Gas Co., 844 S.W.2d 679, 689 (Tex.1992) (noting that requiring the Legislature to anticipate all circumstances would defeat the purpose of delegation).
As Adcoсk and the Court point out, other income benefits in the Act, such as supplemental income benefits and temporary income benefits, have a cap on the length of time an employee may receive benefits, while an award of LIBs does not. See 412 S.W.3d at 496 (citing
The Court argues that because the provisions governing death income benefits (DIBs)—a form of permanent benefit that is paid to a deceased employee‘s beneficiaries until the occurrence of a specified event—contain no procedure for ensuring continuing eligibility, LIBs must likewise be paid in perpetuity with no mechanism fоr ensuring continuing eligibility. See 412 S.W.3d at 496 (citing
The Court holds, and I agree, that the Division has jurisdiction to later consider a claimant‘s eligibility for LIBs when LIBs have previously been denied. See 412 S.W.3d at 496. Just as the Act must be construed to impliedly allow an injured employee to subsequently establish eligibility for LIBs based upon a change of cоndition after LIBs were denied, the Act should also be construed to impliedly allow an insurance carrier to establish, based upon a change of condition, that eligibility no longer exists for a claimant receiving LIBs. The Legislature must have intended an effective and efficient exercise of the Division‘s power to award LIBs, including the power to assess LIB entitlement, whether previously awarded or previously denied, to determine if the statutory criteria for receipt of benefits are satisfied. See Samudio, 370 S.W.3d at 368-69 (explaining that the overall regulatory scheme suggested that the trial court had the authority to remand to the Division despite the lack of an express provision in the statute).
I recognize that we are to construe the Act liberally in favor of employees and not supply “by implication restrictions on an employee‘s rights.” In re Poly-Am., L.P., 262 S.W.3d 337, 350 (Tex.2008) (orig. proceeding) (quoting Kroger Co. v. Keng, 23 S.W.3d 347, 349 (Tex.2000)). However,
The Court holds that the words “total and permanent” and “death” foreclose the Division from evaluating a claimant‘s continuing eligibility to receive LIBs. 412 S.W.3d at 493, 496. But the determination that an injury is permanent can be “nothing more than a prediction” that the condition will continue indefinitely. Hartford Accident & Indem. Co. v. McCardell, 369 S.W.2d 331, 338 (Tex.1963), superseded by rule on other grounds as recognized in Bay Area Healthcare Grp., Ltd. v. McShane, 239 S.W.3d 231, 235 (Tex.2007); cf. Schneider Nat‘l Carriers, Inc. v. Bates, 147 S.W.3d 264, 272 (Tex.2004) (defining a permanent nuisance as an activity which is presumed to continue indefinitely). We have explained that the “injuries enumerated in section 408.161 all result in impairments,” Ins. Co. of State of Pa. v. Muro, 347 S.W.3d 268, 275 (Tex.2011), and “impairment” is defined in the Act to include an injury that “is reasonably presumed to bе permanent,” and therefore may change at a later time.
B. The Division‘s Interpretation of the Statute Is Entitled to Serious Consideration
If a statute is ambiguous, “[c]onstruction of [that] statute by the administrative agency charged with its enforcement is entitled to serious consideration, so long as the construction is reasonable and does not contradict the plain language of the statute.” Mid-Century Ins. Co. of Tex. v. Ademaj, 243 S.W.3d 618, 623 (Tex.2007) (internal quotation marks and citation omitted); see R.R. Comm‘n. v. Tex. Citizens for a Safe Future & Clean Water, 336 S.W.3d 619, 624 (Tex.2011) (“We have stated this principle in differing ways, but our opinions consistently state that we should grant an administrative agency‘s interpretation of a statute it is charged with enforcing some deference.“). In this case, both the hearing officer and the appeals panel held that the Division had jurisdiction to consider continuing eligibility to receive LIBs under section 408.161, and the Division has taken that position throughout these proceedings. The appeals panel reached a similar result in a decision the parties refer to as Deep East Texas Self Insurance Fund, Appeals Panеl No. 020432-s, 2002 WL 971079 (Tex. Workers’ Comp. Comm‘n Apr. 10, 2002), in which an insurance carrier challenged the claimant‘s continuing entitlement to LIBs and sought to show that the claimant fraudulently obtained the award. Id. at *1-2. The appeals panel held that the Division had jurisdiction to consider a claimant‘s continuing entitlement to LIBs, but the court of appeals in this case disagreed with the appeals panel‘s reasoning in Deep East Texas, concluding that because the insurance company was claiming fraud, it should have sought a remedy under section 415.031. 353 S.W.3d 246, 252 (Tex. App.-Fort Worth 2011, pet. granted); see
The Court asserts that the Legislature knows how to provide for review of income benefit determinations, as it has done with temporary income benefits, and the lack of an express review provision in section 408.161 indicates the Legislature‘s intent to prohibit the Division from considering continuing eligibility to receive LIBs. 412 S.W.3d at 498. However, “[t]he Legislature is not required to set forth in detail all the provisions necessary to govern the agency
As the Court points out, article 8306, section 12d of the former
The Court characterizes the issue in this case as one of re-opening a previous LIB adjudicatiоn. 412 S.W.3d 492, 499. I view Liberty Mutual‘s claims as seeking a new determination of Adcock‘s continuing eligibility to LIBs. As a new claim, as opposed to an appeal of the original LIB award, the
III. Conclusion
Section 408.161 awards LIBs for functional impairments that equate to a total and permanent loss of body parts and other serious life-altering injuries. It is impossible for the Division or anyone else to know whether loss of use will actually be total and permаnent. When, by good fortune or advances in medical science, a claimant‘s impairments improve so that he no longer meets the statutory eligibility criteria for LIBs, he should not receive a windfall, as the Court would hold, merely because the Legislature failed to provide for this unique circumstance. Surely the Legislature did not intent such a nonsensical result. I would hold that the Division, which is charged with the effective administration of income benefits, has jurisdiction to consider a claimant‘s continuing eligibility to receive LIBs. I respectfully dissent.