WACO COURT OF APPEALS HOLDS DIVISION OF WORKERS’ COMPENSATION LACKS RIGHT TO REVIEW LIFETIME INCOME BENEFITS AFTER ADMINISTRATIVE AND APPELLATE REMEDIES HAVE BEEN EXHAUSTED

Also last week, in Liberty Mut. Ins. Co. v. Adcock, --- S.W.3d ----, 2011 WL 5009821 (Tex.App. – Waco Oct. 20, 2011), the court of appeals in Waco affirmed a summary judgment in favor of Ricky Adcock following a review in 2009 of an earlier award of Lifetime Income Benefits (LIBs) to Adcock.  In 1991, Adcock received a compensable on-the-job injury and, in 1997, the Texas Department of Insurance Division of Workers’ Compensation Appeals Panel held Adcock was entitled to LIBs.  Several years later, Liberty Mutual, the workers’ compensation carrier, sought to reopen Adcock’s case, asserting that Adcock was no longer entitled to LIBs because he no longer had the total and permanent functional loss of use that was the basis of his award.  After a hearing officer determined that Adcock was entitled to continued LIBs, the Division’s Appeals Panel found that the Division had jurisdiction to reopen the case but that Adcock continued to be entitled to LIBs.  On appeal to the district court, Adcock argued the case could not be reopened. The Division intervened, asserting that it had jurisdiction.  The trial court agreed with Adcock’s premise that the Division could not reopen the 1997 case and granted Adcock’s summary judgment finding the Division, and by extension the trial court, lacked jurisdiction to revisit the issue of LIBs awarded in 1997.

Liberty Mutual and the Division argued to the court of appeals that the Division can revisit whether the loss of use of a body part is permanent because the legislature vested the Division with exclusive jurisdiction to resolve workers’ compensation disputes.  They also argued that to hold otherwise would be nonsensical because an injured worker who improved would continue to receive LIBs, even though the worker no longer met the statutory criteria.  Adcock responded by asserting that that once he became eligible for LIBs, no further review was permitted.

The court of appeals reviewed the statutory scheme, which states that LIBs are “paid until the death of the employee,” and which clearly allowed for review under several other circumstances but not once entitlement to LIBs has been established.  Specifically, there is no express language in the statutes that give the Division the right to revisit the issue of LIBs entitlement whenever it chooses, and the statutory scheme clearly shows that the legislature knew how to include this authority if it so desired.  Therefore, the court of appeals concluded that the Division has no right to review LIBs after the initial administrative and appellate remedies have been exhausted.