Court Reverses LIBs Ruling; Remands for Trial
The Houston Court of Appeals [1st Dist] has issued an important decision regarding Lifetime Income Benefits. On February 9, 2016 the court reversed the judgment of a trial court that a claimant had failed to meet the statutory standard for entitlement to LIBs, and remanded the case to the trial court for further proceedings.
In Chamul v. Amerisure Mut. Ins. Co., No. 1-14-00508-CV, the court considered the case of Francisco Chamul, an employee of Camarat Masonry, who fell while at work, injuring his head and other parts of his body. Chamul was examined by a designated doctor, Stanley Hite, M.D. According to Dr. Hite, Chamul functions at the level of an 11 or 12 year-old, is unable to care for himself, and will need a caretaker for the rest of his life. Dr. Hite opined that Chamul’s condition will not improve. Dr. Cindy B. Ivanhoe, at doctor at The Institute for Rehabilitation and Research in Houston, testified that Chamul suffers from seizures and cognitive problems that affect his memory, thought organization, and understanding interpersonal dynamics. Chamul is not capable of living independently, needs to be supervised, is unable to operate a motor vehicle, and is permanently unable to return to competitive employment as a result of his brain injury. She further stated: “It is my opinion that Francisco Chamul is permanently mentally incapacitated because of his work related injuries.”
Amerisure retained neuropsychiatrist Dr. Andrew Brylowski to examine Chamul. Dr. Brylowski concluded that, although Chamul had a significant, traumatic brain injury with diffuse brain swelling, he “did not sustain any type of irreversible brain injury which would rise to the level of rendering him permanently unemployable because of eliminating his ability to engage in a range of usual cognitive processes.” Dr. Brylowski diagnosed Chamul with “malingering,” concluding that he inaccurately reported information during the examination. Dr. Brylowski opined that “any cognitive, conative, neuroendocrine, sensory and motor function, or brainstem/cranial nerve function can be treated and managed to help [Chamul] reintegrate into the workforce.”
Chamul sought LIBs from the carrier, which denied his claim on the basis that she failed to meet the statutory criteria for entitlement. Section 408.161 of the Act, provides that LIBs are recoverable when, among other things, an injured worker suffers “a physically traumatic injury to the brain resulting in incurable insanity or imbecility.”
The Division determined that Chamul was not entitled to LIBs, following which he filed suit for judicial review in a district court in Harris County. There, following cross motions for summary judgment, the trial court found that Chamul suffered an injury to his brain, but that he did not meet the definition of “imbecility.” The claimant appealed the case to the Court of Appeals, where a three-judge panel considered the case.
The court of appeals rejected the trial court’s reliance upon a 1991 dictionary definition of imbecility. This definition “contemplates that the affected individual will not only require supervision in the performance of routine tasks, but will have a mental age1 of three to seven years.” WEBSTER’S NINTH NEW COLLEGIATE DICTIONARY (1991).
In resolving the case, the court wrote:
Amerisure argues that “imbecility,” in the context of a lifetime-income-benefits claim, means “a mentally deficient person, especially a feebleminded person having a mental age of three to seven years and requiring supervision in the performance of routine daily tasks or caring for himself.” Amerisure reads this definition narrowly to require that the claimant establish a mental age between three and seven years.
Amerisure obtained summary judgment that Chamul did not meet the definition of “imbecility” in the trial court. The trial court’s holding was explicitly based on the narrow definition urged by Amerisure and adopted by the hearing officer. We conclude that the trial court erred by granting summary judgment to Amerisure. In doing so, we reject the narrow definition that would place a burden on claimants to establish a mental age of between three and seven years for three reasons. First, the 1991 dictionary from which the narrow definition was obtained was not an appropriate source to discern the meaning of a term incorporated into a statute more than 70 years earlier. Second, the mandate that the workers’ compensation statute be liberally construed to confer benefits upon injured workers suggests that Section 408.161 of the Labor Code should not be read to require proof of a mid-range mental age—a result achieved only through the most narrow reading of the statute and the definition possible. See Lujan, 756 S.W.2d at 297. Third, applying the 1991 dictionary definition would lead to absurd results and, therefore, must be rejected.
The court of appeals remanded the case for a new trial. In doing so, the court did not specifically identify a new definition that the trial court should apply.
The carrier can file a motion for rehearing with the court of appeals, file a petition for writ of error with the Texas Supreme Court, or allow the case to be remanded in accordance with the court of appeals’ opinion and judgment.
FOLIO
