Court Opinion

ID: 9779346
Source: CourtListenerOpinion
Date Created: 2023-08-29 21:47:45.524857+00
Date Added: 2024-06-11T07:33:25.606311
License: Public Domain

ON MOTIONS FOR REHEARING
The Employees Retirement System and Metropolitan, by motions for rehearing, challenge in various ways our refusal to hold that § 4(e) of the Act impliedly vests in the trustee a power to adjudicate claims based upon a denial of coverage. Some of their contentions suggest the need for a reply.
The Employees Retirement System and Metropolitan apparently agree that a power of adjudication exists in the trustee only if that be the meaning assigned to § 4(e), wherein the Legislature confers upon the trustee full power and authority as to the
establishment of grievance procedures by which the trustee shall act as an appeals body for complaints by employ*574ees regarding the allowance and payment of claims, eligibility, and other matters ....
Apparently, they do not challenge the proposition that nothing in the Act purports expressly to confer upon the trustee a general power of adjudication with respect to ordinary policy claims. Does § 4(e) imply a general power of adjudication in that regard?
It is said that we overlook or deem-phasize certain key phrases in § 4(e), specifically the term “appeals body” and the phrase “the allowance and payment of claims_” It is argued that these phrases clearly imply a power of adjudication, which is the meaning that has been assigned to them by the trustee — an administrative construction entitled to our consideration. Ex parte Roloff, 510 S.W.2d 913, 915 (Tex.1974). We have not overlooked or deemphasized the quoted phrases.
The grammatical answer to appellees’ contentions is that § 4(e), and the phrases in question, are facially limited in their scope and meaning by the threshold phrase “establishment of grievance procedures.” Nothing in this phrase suggests a judicial proceeding and the following words — “appeals body for complaints by employees regarding the allowance and payment of claims” — must be interpreted in light of that antecedent, modifying, and limiting phrase. Aside from this, however, appel-lees’ theory contradicts certain fundamental rules of statutory construction relative to the legislative delegation of powers to administrative agencies.
It is a general principle of administrative law that an administrative agency has no inherent power. An agency’s jurisdiction and the nature and extent of its powers must be found within the constitutional and statutory provisions applicable to the agency. It has been said that an agency may exercise only such authority as is conferred upon it by statute in “unmistakable terms.” Board of Insurance Com’rs v. Guardian Life Ins. Co., 142 Tex. 630, 180 S.W.2d 906 (1944). While every administrative body must determine for itself whether it has jurisdiction of a matter, its decision does not amount to a judicial adjudication of the existence and extent of its authority; and if an agency indeed has no jurisdiction over the subject matter, any order made in that matter is void. Security State Bank v. State, 169 S.W.2d 554 (Tex.Civ.App.1943, writ ref’d w.o.m.). See also Key Western Life Ins. Co. v. State Board of Ins., 163 Tex. 11, 350 S.W.2d 839 (1961).
The issue before us is whether one may reasonably interpret § 4(e) of the Act to be a grant of power to the trustee to find facts and apply common-law rules in making an “adjudication” of a beneficiary’s claim under the policy, that is, a determination that is binding on the beneficiary and the insurer as the judgment of a court would be. We do not believe that is the sense of the words used in § 4(e); they are not in our view reasonably susceptible of that interpretation. This is the primary basis for our decision. We have absolutely no doubt that a court, motivated by honest convictions of policy (judicial economy, for example), could exercise its raw judicial power and simply declare that the words of § 4(e) do “unmistakably” and “clearly” imply a grant of general or special adjudicatory power to the trustee, whether that be the ordinary sense of § 4(e) or not. We do not believe that to be the proper function of a court, however, and we will not do it.
We prefer the more rational and traditional interpretative process illustrated in Stauffer v. City of San Antonio, 162 Tex. 13, 344 S.W.2d 158 (1961) wherein the Court assigned meaning to Tex.Rev.Civ. Stat.Ann. art. 1269m, § 22a (1963) (amended by 1979 Tex.Gen.Laws, ch. 753, § 9 at 1864). That statute provided that a city fireman may be given military leave of absence without pay; and upon his return from military service he *575Stauffer, a fireman granted military leave, applied on his return for a position in the fire department of the City of San Antonio. He was denied re-employment on the basis that he was not physically qualified, as indicated in his medical discharge from military service and as found by the City’s examining physician, upon which evidence the City’s Civil Service Commission acted in denying Stauffer re-employment.
*574shall be entitled to be returned to the position in the department held by him at the time the leave of absence is granted ... provided he ... remains physically and mentally fit to discharge the duties of that position. ...
*575The City, on writ of error, argued three points of error attacking the trial court’s judgment that Stauffer be reinstated:
(1) Section 9 of Article 1269m makes the Chief of the Fire Department the sole judge of whether petitioner is physically qualified to discharge the duties of his position; (2) the courts have no power to review the action of the Commission in refusing reinstatement; and (3) the decision of the Commission on the question of petitioner’s physical fitness is supported by substantial evidence.
344 S.W.2d at 159. The Supreme Court answered these contentions with an analysis of the applicable statute along the same lines we have set forth above. The Court stated:
Section 22a states in no uncertain terms that a returning fireman shall be reinstated if he remains physically and mentally fit to discharge the duties of his position.... It does not provide for reinstatement upon a finding by the Commission that the applicant is qualified, and there is no language suggesting that the Commission is to hear and decide that question. The statute does not even disclose where the application for reinstatement is to be filed. An intention that the same should be presented to the Commission can fairly be implied from the provision authorizing that body to grant military leave of absence, but this affords no basis for a further implication that the Commission is authorized to conduct a hearing and make an administrative determination of the fact questions that may arise. Article 1269m contains no general grant of power to hear and decide disputed issues.
Id. 344 S.W.2d at 160 (emphasis added). After analyzing other sections of art. 1269m, the Court quoted at length from the decision in French v. Cook, 173 Cal. 126, 160 P. 411, 413 (1916), indicating the Court’s obvious approval of the California court’s analysis of a provision, in a city charter, requiring the grant of a pension to a policeman killed or injured in the performance of his duty:
There is absolutely nothing in the charter purporting to confide to the [pension] board the power to finally determine any question of fact in connection with such a pension. The board is apparently in the same position with relation to such a matter as is any officer required by law to do a prescribed act in a certain contingency, where no special method is provided by law for the ascertainment of the facts. Under such circumstances it may often be true that there is uncertainty or dispute as to the facts, but in such a case the only resort of the officer is such investigations as he may be able to himself make for the purpose of determining his own course of action. His determination as to the facts, however, is not effectual for any other purpose. If not satisfied as to the evidence of the essential facts, he may refuse to act until required to do so by the judgment of some tribunal invested with the power to finally determine such controversy, but before such tribunal any conclusion to which he may have come on the facts has no legal force whatever. The sole question there is whether the facts are in reality such as to require the performance of the act, and this altogether regardless of the officer’s conclusion as to the facts. The party having a vested right in the performance of the act, if the facts are as claimed by him, has also the right to have his claim as to the facts judicially determined. The functions of the board in such a matter as this are really ministerial only, and come under the same principle as would apply in the *576ease of a county or city auditor, in so far as any finality to its conclusions are [sic] concerned.
344 S.W.2d at 160 (emphasis added). The Supreme Court of Texas then concluded its opinion in Stauffer by stating:
Section 22a gives petitioner a legal right to reinstatement if he is physically and mentally fit to discharge the duties of his position. Since the power to hear and determine that question in a judicial sense is not conferred by law upon some other tribunal, the district court has jurisdiction to decide the same from a preponderance of the evidence. Texas Constitution, Article V, Section 8.
Id. 344 S.W.2d at 161 (emphasis added). The parallels with the present case are obvious and require no elaboration.
In the meaning we have assigned to § 4(e), we have suggested the limits of the power conferred by that section upon the trustee. The words of that section, standing alone and considered in light of the entirety of the Act, do not suggest that the trustee has in any sense the power finally to determine the question of coverage, depending upon his fact finding as to the issue of suicide, so that his decision will be binding on the parties as a judgment would be or as an administrative decision would be, subject to “substantial evidence” review under APTRA. Hence, Mrs. Blount was entitled to have the issue determined by a judicial tribunal, which does have that power, based upon a preponderance of the evidence, and not upon the basis of “substantial evidence” shown in an administrative record.
Some other suggestions made in the motions for rehearing deserve comment. We point out that the “scope of review” and the “manner of review” under APTRA § 19 are not the same thing, although they may be intertwined, a point upon which one of the motions for rehearing is mistaken. For example, the “scope of review” may be the “substantial evidence” review based upon an agency record in a case where the “manner of review” prescribed by statute is “other than trial de novo.”
Our reference to the absence of statutory standards applicable to the trustee’s presumed decision-making power under § 4(e) should not be misunderstood. Our reference to the absence of such standards is intended to demonstrate the improbability that the legislature intended to grant to the trustee an adjudication power. We have conceded that the standards may be quite general. See, e.g., Southwestern Sav. & L. Ass’n. of Houston v. Falkner, 160 Tex. 417, 331 S.W.2d 917 (1960)., In the statute under review, however, there are no standards at all.
Next, we have no doubt of the trustee’s rule-making power; however, he may not, through an exercise of that power, enlarge his jurisdiction beyond that granted by the Legislature.
Finally, with respect to the difficulties envisioned from a circumstance where the trustee does not have the power of adjudication, we emphasize that we must declare and enforce the statutes as they are made by the Legislature and it is for that body, and not the courts, to give relief if the legislation proves unwise. Board of Insurance Com’rs v. Guardian Life Ins. Co., supra. We will not, however, prejudge the constitutionality of any such future statute.
The motions for rehearing are overruled.