Court Holds: Claimant Failed to Name a Proper Party
The Fort Worth Court of Appeals has affirmed a decision that granted a claims administrator’s motion for summary judgment dismissing a claimant’s attempted appeal from a Division decision. The decision in Taylor v. Tristar Risk Management No.02-19-00398-CV was published on May 7, 2020.
Flahive attorney Chuck Finch handled the appeal. The firm’s team of Kevin Poteete and Victoria McDaniel-Sonnier secured the underlying judgment in favor of Tristar.
Sabrina Taylor was injured on the job in two separate accidents. After disputes arose between herself and her employer—the Dallas Independent School District—an Administrative Law Judge with the Division of Workers’ Compensation issued a ruling mostly in DISD’s favor. Taylor eventually filed suit in the trial court against DISD’s third-party insurance administrator—appellee Tristar Risk Management—seeking a judicial review of the administrative determination.
The trial court granted Tristar’s summary-judgment motion, and Taylor appealed to the court of appeals, where she argued that the summary judgment deprived her of the statutory and due-process right to judicial review and was based on inapplicable “rules.”
The court of appeals concluded that the summary-judgment rule applies to the judicial-review petition and that Tristar conclusively established an affirmative defense to Taylor’s claim. Therefore, the court affirmed the trial court’s summary-judgment order.
Tristar’s assertion that it was an improper party is an affirmative defense; thus, we must determine whether Tristar conclusively established it. See Edlund v. Bounds, 842 S.W.2d 719, 725 (Tex. App.—Dallas 1992, writ denied). The Texas Labor Code provides that an “insurance carrier” is liable for compensation for an employee’s injury. Tex. Lab. Code Ann. § 406.031(a). The statutory definition of an insurance carrier does not include a third-party insurance administrator but it does include “a certified self-insurer for workers’ compensation insurance.” Id. § 401.011(27)(B); see also 28 Tex. Admin. Code § 41.30 (Tex. Dep’t of Ins., Self-insureds). Here, the undisputed summary-judgment evidence established that DISD was self-insured for purposes of the Texas Workers’ Compensation Act and that Taylor had been notified that DISD was the insurance carrier. Accordingly, Tristar was “not the proper defendant” to Taylor’s suit for judicial review of the administrative determination of her claim for workers’-compensation benefits. Flour Bluff ISD v. Bass, 133 S.W.3d 272, 273 (Tex. 2004) (per curiam). This legal theory, therefore, supports the trial court’s summary judgment.
The case is subject to review on rehearing at the court of appeals or may be appealed to the Texas Supreme Court.
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