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Tuesday, April 7, 2020

Insurer wins Texas case over back injury

By Stephanie Ostrowski | Nov 5, 2012


AUSTIN, Texas (Legal Newsline) - A case between Texas Mutual Insurance Company and Lance Morris regarding a work-place injury was reversed and judgment rendered for TMIC Oct. 26 in the Texas Supreme Court.

Three years after Lance Morris, from the Justin Community Volunteer Fire Department, injured his back and was granted workers compensation by the insurer, TMIC, he developed herniated lumbar intervertebral discs.

In 2003 Morris was approved by TMIC for surgery as medically necessary but later disputed its compensability on the basis that the herniated discs were not casually related to the original injury in March 2000.

It was determined by the Texas Department of Insurance Division of Workers' Compensation that the disc herniations were related, and the division ordered TMIC to pay medical benefits, which they did.

Subsequently Morris sued TMIC for damages caused by its delay in paying benefits, violating the Insurance Code, breaching its common law duty of good faith and fair dealing, and violating the Deceptive Trade Practices Act.

A trial court jury awarded Morris damages for past mental anguish, damage to his credit reputation, and attorneys fees.

The judgment was reversed by the court of appeals, concluding that there was no evidence to support the damages awarded for loss of credit reputation.

In the Supreme Court, TMIC sought reversal of the court of appeals' judgment favorable to Morris.

According to TMIC, the evidence is undisputed that Morris took six months to request the first benefit review after TMIC contested compensability and agreed to two non-expedited benefit review, and Morris did not request the division to enter an interlocutory order directing TMIC to pay benefits.

In part, Morris responded that the timeliness of his benefit review cannot be jurisdictional because they are permissive, not mandatory, and also back surgery and medical treatment were compensable. The court agreed and did not further address.

TMIC argued that their dispute for Morris's injury in 2000 and the direct relation to the disc herniation's in 2003 was simply not a misrepresentation of its policy.

The court agreed with TMIC in that there is no evidence it misrepresented its policy.

The Supreme Court granted TMIC's petition for review. Without hearing an oral argument, the court of appeals' judgment was reversed and rendered judgment that Morris takes nothing.

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