AUSTIN COURT OF APPEALS PERMITS WORKER TO PURSUE CLAIMS FOR DENIAL OF WORKER’S COMPENSATION BENEFITS SINCE HE EXHAUSTED ALL ADMINISTRATIVE REMEDIES
Recently, the Austin Court of Appeals concluded that an employee had exhausted his administrative remedies, such that the district court possessed subject-matter jurisdiction over Jones's suit, despite delays that may have occurred. In re Texas Mutual Insurance Company and Natalie L. Garcia, 2011 WL 3435738 (Tex. App.–Austin, 2011). An injured worker sued Texas Mutual for Texas Mutual's alleged delays in handling his workers' compensation claim. Texas Mutual asserted that Jones's delays in exhausting his administrative remedies before the DWC had deprived the district court of subject-matter jurisdiction. The district court denied the plea. Texas Mutual filed a petition for writ of mandamus requesting the Austin Court of Appeals to compel the district court to grant its plea to the jurisdiction and to dismiss Jones's suit in its entirety for failure to exhaust his administrative remedies.
Texas Mutual argued that Jones failed to exhaust his administrative remedies because he failed to seek pre-authorization for shoulder surgery from the carrier until 15 months after his accident and failure to have the surgery immediately after obtaining pre-authorization from Texas Mutual. Texas Mutual further argued that Jones failed to seek an interlocutory order requiring Texas Mutual to pay the disputed benefits during the extent-of-injury dispute. The Court stated that Texas Mutual’s complaints that Jones delayed having surgery and failed to seek an interlocutory order were in nature of a mitigating defense or an assertion that the plaintiff’s recovery should be reduced by a percentage of the plaintiff’s damages attributable to the plaintiff’s actions or inactions and that such defenses should be addressed by a trier of fact.