Case Title: Smith v. Stephenson

Citation: 641 S.W.2d 900

Docket Number: 

State: texas

Court: Texas Supreme Court

Date: 1982-11-03T00:00:00Z

Document:
641 S.W.2d 900 (1982) Thomas D. SMITH, Petitioner, v. E.R. STEPHENSON, Respondent. No. C-970. Supreme Court of Texas. November 3, 1982. Rehearing Denied December 15, 1982. Stubbeman, McRae, Sealy, Laughlin & Browder, Robert A. MacInnes and J. Stockton Williams, Jr., Austin, for petitioner. W. Tyler Moore, Jr., Bryan, for respondent. CAMPBELL, Justice. This is a suit on sworn account by a chiropractor, E.R. Stephenson, against his patient, Thomas D. Smith, for chiropractic services rendered in connection with a work-related injury. The trial court rendered judgment for Stephenson's chiropractic fees plus attorneys' fees. The court of appeals affirmed the judgment of the trial court. 624 S.W.2d 324. We reverse the judgment of the court of appeals and dismiss the cause. Trial was to the court upon stipulations that Smith came to Dr. Stephenson for the treatment of an on-the-job injury; that Dr. Stephenson was aware his patient had a claim under the Workers' Compensation Act (the "Act"); that the injury was compensable; and that Dr. Stephenson sent his fee statements to the Industrial Accident Board (the "Board") and the self-insurer. A dispute arose before the Board as to the amount charged for the chiropractic services. Dr. Stephenson withdrew his claim from the Board proceedings and filed this suit upon sworn account against Smith in county court. The Board never made an award upon Dr. Stephenson's claim. Smith filed a plea to the jurisdiction on the ground the trial court had no subject matter jurisdiction until final disposition by the Board of his compensation claim. Smith also filed a motion to dismiss claiming that, under the Act, the obligation to *901 pay for chiropractic services is placed solely upon the compensation carrier. The trial court overruled Smith's plea to the jurisdiction and motion to dismiss. Smith contends the Act places the obligation for payment of medical services provided an injured worker solely upon the compensation carrier; and that the Act relieves the worker of personal liability for payment for medical services provided for a compensable injury, at least, until the health care provider pursues its administrative remedy through the Board and through the courts if appealed. We agree. Article 8306, § 6[1] provides: Article 8306, § 7 provides: Article 8306, § 7a states: Article 8306, § 7b provides: Article 8307, § 5 provides: The preceding sections of the Act prescribe a comprehensive arrangement by which an injured worker may be relieved, in great part, of the burdens arising from a work-related injury. The Act gives the employee the right to needed medical services, allows him to choose his own health care provider, obligates the carrier to pay for the services within limitations, requires the provider to supply medical reports and prescribes payment by the carrier resulting in an increased security of payment for the provider. The reasonableness and necessity of the medical fees is regulated by the Board. The provider has the right to appeal the Board award, and has the right to penalties and attorney's fees if the provider prevails upon appeal. The rights and obligations of the parties to a claim under the Act are entirely controlled by statute except for some matters of form and procedure. Where the statute directs that action be taken in a certain way it may be performed in no other manner. Truck Ins. Exchange v. Seelbach, 161 Tex. 250, 339 S.W.2d 521, 523 (1960). The Act places the obligation upon the carrier to furnish or pay for reasonable medical services required to "cure and relieve" the injured worker; and it does so in mandatory language. Art. 8306, § 7. The authority to regulate the resulting medical fees is placed upon the Board, also in mandatory language. Arts. 8306, § 7b and 8307, § 5. The court of appeals relies upon a construction of the art. 8306, § 7 requirement that a provider furnish reports to the carrier and the employee, and that the provider's failure to do so relieves the association and the employee from the duty to pay. The court reasoned "that such language contemplates the employee's obligation to pay, otherwise the employee would have no duty of which to be relieved." The court concluded that the Act allowed the employee to look to the carrier for payment or reimbursement for medical expenses incurred by the employee but does not relieve the employee from his contractual liability to pay his debt. We do agree the employee maintains a contractual obligation to the provider, but his obligation is secondary to the primary (and mandatory) obligation of the carrier created by the Act. The employee is liable for the medical bills, but his liability is contingent upon a finding by the Board or the courts that the carrier is not obligated. The carrier's obligation is limited to those medical services reasonably required to "cure and relieve" the employee from the effects of his work-related injury and does not include hospital services not ordinarily provided by hospitals as part of their services. Art. 8306, § 7. The employee may very well remain liable for such charges as a private room, where a semi-private would be reasonable; or charges for a TV in the *903 room; or charges for services not related to the work-related injury; or charges for un-prescribed medicines. These are the obligations of the employee referred to in Art. 8306, § 7. The extent of the employee's obligation for these charges depends upon the disposition of the claims before the Board as to what charges the carrier must pay. The employee may even become liable for all the medical expenses if the injury is found to be non-compensable. Until the claim is processed by the Board and a determination of reimbursement for or payment of medical expenses incurred by the employee is made, the provider may not pursue a private claim against the employee. Allowing the provider the right to file suit prior to final determination by the Board, or by the courts if the Board award is appealed, would circumvent the principal purpose of the Act, to protect the employee. Maryland Cas. Co. v. Hendricks Memorial Hosp., 141 Tex. 23, 169 S.W.2d 969, 974 (1943). This construction affords protection to the provider and the employee within the framework of the Act. The result is the smooth administration of medical benefits as intended by the Legislature. The Legislature has substituted a just, certain and adequate legal remedy for the remedy given the provider at common law. Lebohm v. City of Galveston, 154 Tex. 192, 275 S.W.2d 951, 954 (1955). We believe the general rule well stated by Larson: A. Larson, The Law of Workmen's Compensation § 61.12(K) at 10-720 (1981). Dr. Stephenson may not recover directly from Smith without first exhausting his remedy under the Act. The judgment of the court of appeals is reversed, and the cause is dismissed. [1] All statutory references are to Vernon's Tex. Rev.Civ.Stat.Ann., unless otherwise indicated.