AP Rules that ALJ Did Not Have Jurisdiction to Relitigate Disability Finding

The appeals panel has reversed a contested case hearing decision and order issued by an Administrative Law Judge who had determined that a claimant had sustained disability during a period when disability had previously been found not to exist. The ALJ had concluded that the first disability finding had been reversed on judicial review. That judgment on judicial review has been appealed to the appellate courts. The appeals panel concludes that the first ALJ decision is effective and binding until the appeal has been concluded.

The appeal is posted in Texas Division of Workers’ Compensation Appeals Panel Decision No. 200483, decided May 18, 2020.

In 2018, an ALJ issued a decision in which she determined, in pertinent part, that the claimant did not have disability from the date of injury through the date of the CCH. The claimant timely exhausted his administrative remedies. Therefore, the ALJ’s decision that the claimant did not have disability from the date of injury through the date of the CCH became final.

The claimant then appealed the appeals panel to district court. In December 2019 the district court signed a judgment in which it reversed the Division’s decision on disability, finding instead that the claimant had disability from February 8, 2016, through July 20, 2017. The carrier then appealed the district court judgment to the appellate courts.

The claimant then requested dispute resolution at the Division on the issue whether the claimant had sustained disability from the date of injury through the date of the first decision and order. the ALJ determined that the claimant suffered disability from the date of injury through July 20, 2017 but that the claimant did not have disability from July 21, 2017 through the date of the first CCH.

The carrier appealed to the appeals panel. The appeals panel first pointed out that the statute and appellate decisions provide that a Division decision is binding during the pendency of an entire appeal, not just the trial court portion of an appeal.

Section 410.205(b) provides that the decision of the Appeals Panel regarding benefits is binding during the pendency of an appeal under Subchapter F or G (relating to Judicial Review). In Lopez v. Texas Workers’ Comp. Ins. Fund, 11 S.W.3d 490 (Tex. App.–Austin 2000, pet. denied), the court held that Section 410.205(b) clearly provides that the ultimate administrative ruling, whether granting or denying benefits, remains in effect until overturned by a final and enforceable judicial decision. The claimant in Lopez argued that the decision of the Appeals Panel denying benefits remains in effect only until the district court renders a decision, but that the trial court’s decision awarding benefits then becomes effective without regard to further appellate review. The court disagreed, noting that the text of the Labor Code did not support the claimant’s interpretation. The court noted that the claimant would have the district court’s decision enforced even though it is not yet final and still on appeal, and that “[n]owhere does the statute expressly provide for such an outcome.” The court in Lopez stated “[w]e believe the statute as written reflects the State’s policy that benefits should be payable or not in accordance with the [A]ppeals [P]anel’s decision until a final judicial decision rules otherwise.”

The Appeals Panel’s prior decision that the claimant did not have disability from (date of injury), through the date of the CCH is binding until there is a final, nonappealable judgment in this case. See Appeals Panel Decision 142336, decided December 5, 2014.

In the case on appeal the carrier contended at the CCH that the Appeals Panel’s decision that the claimant did not have disability from (date of injury), through the date of the prior CCH is binding on the ALJ. The carrier is correct. Pursuant to Section 410.205(b), the decision that the claimant did not have disability from (date of injury), through the date of the CCH is binding, and the Division does not have jurisdiction to reconsider the issue of disability from (date of injury), through February 13, 2018, the date the record closed in the prior CCH. Given that the Division does not have jurisdiction to make a new determination on disability from (date of injury), through February 13, 2018, the ALJ erred in making some of his disability determinations.

The appeals panel concluded that the Division did not have jurisdiction to reconsider the earlier periods of alleged disability that had been litigated in the first CCH. The appeals panel struck those portions of the ALJ’s decision and order which reconsidered the periods that had previously been considered by the Division.