Court Finds that 401 Week Date is a Limitation on Recovery, not a Filing Deadline
The Fourth Court of Appeals, sitting in San Antonio, has affirmed the judgment of a trial court, which awarded impairment income benefits to an injured worker who first applied for those benefits after the expiration of 401 weeks from the date of injury. In Texas Mutual Insurance Co. v. McGahey, (No. 04-14-00175-CV, May 11, 2016), the court held that section 408.083(a) is intended to limit the maximum number of weeks for which an employee can be paid temporary income benefits, impairment income benefits, and supplemental income benefits to 401 weeks; it does not represent a type of statute of limitations, barring any action or proceeding related to the award of income benefits after 401 weeks from the date of injury.
On August 5, 2002, McGahey sustained a work-related injury entitling him to compensation under the Act and began receiving TIBs. On October 25, 2010, the Division sent McGahey notice that the Division had received a request for the assignment of a designated doctor to evaluate the date of McGahey’s maximum medical improvement and his impairment rating. Dr. John Debender was the assigned designated doctor.
On November 15, 2010, Dr. Debender examined McGahey and completed a report of medical evaluation, certifying that McGahey reached maximum medical improvement on August 13, 2004, and assigning a 20% impairment rating. The carrier requested an additional examination by a required medical examination doctor who reached the same conclusions as Dr. Debender.
The carrier disputed its obligation to pay McGahey IIBs based on these medical evaluations. In a contested case hearing the hearing officer found McGahey was entitled to receive sixty weeks of IIBs which began on August 14, 2004 and ended on October 7, 2005.1 The hearing officer ordered The carrier to pay the benefits. The carrier appealed to the appeals panel which affirmed the hearing officer’s decision without a written opinion.
The carrier filed a suit for judicial review of the appeals panel’s decision. In its petition, The carrier filed a motion for summary judgment asserting, “The 401-week period of eligibility for benefits terminated by law on April 10, 2010. … Under the plain meaning of Section 408.083, Mr. McGahey was not eligible for impairment income benefits after April 10, 2010.” The Division, which was a party to the case, filed a response to the motion and a cross-motion for summary judgment. In its response, the Division noted that the carrier was contending section 408.083 contained a “type of statute of limitations, barring any action or proceeding related to the award of income benefits after 401 weeks from the date of injury.” The Division asserted, however, that the carrier’s “reading of the statute is not supported by Texas law” and “is contrary to the Texas Supreme Court’s stated policy applicable to interpretation of worker’s compensation law.” McGahey also filed an opposition to Texas Mutual’s motion and a cross-motion for summary judgment incorporating the Division’s arguments.
Before the trial court’s hearing on the motions for summary judgment, the carrier nonsuited its claims against the Division. After a hearing on the motions, the trial court entered an order granting McGahey’s motion for summary judgment and denying the carrier’s motion. This appeal followed. The court wrote that the carrier’s appeal
focuses on the word “eligibility” in section 408.083(a) and contends an employee cannot receive impairment income benefits after the expiration of 401 weeks from the date of his injury because the statute provides the employee is not “eligible” to receive benefits after that date. We disagree with this construction. Instead, we construe section 408.083(a) as limiting the maximum number of weeks of temporary income benefits, impairment income benefits, and supplemental income benefits an employee can receive to 401 weeks. See Ins. Co. of State of Pa., 347 S.W.3d at 271 (“A claimant’s combined eligibility for temporary income benefits, impairment income benefits, and supplemental income benefits generally terminates 401 weeks after the date of injury.”). This construction is consistent with the need to liberally construe the Act in favor of injured employees, the statutory requirement that the Division notify the treating doctor if the employee is not certified as having reached maximum medical improvement before the expiration of 102 weeks after the date income benefits begin to accrue, and the administrative rules adopted by the Division. See SeaBright Ins. Co., 465 S.W.3d at 642; TEX. LAB. CODE ANN. § 408.123(d); 28 TEX. ADMIN CODE §§ 130.2(e), 130.4(b).
Reading section 408.083(a) in the context of the entire statutory scheme and the rules adopted by the Division, the court held that the term “eligibility” was intended to limit the maximum number of weeks for which an employee can be paid TIBs, IIBs and SIBs to 401 weeks. Therefore, the court concluded that McGahey was “entitled to sixty weeks of impairment income benefits based on a 20% impairment rating which began on 8/14/04 and ended on 10/7/05.” The trial court’s judgment was affirmed.
FOLIO
