Court Opinion

ID: 4053357
Source: CourtListenerOpinion
Date Created: 2016-09-29 03:36:31.275075+00
Date Added: 2024-06-11T14:27:24.741826
License: Public Domain

ACCEPTED
                                                                                              01-15-00235-CV
                                                                                    FIRST COURT OF APPEALS
                                                                                            HOUSTON, TEXAS
                                                                                         3/13/2015 8:34:01 PM
                                  01-15-00235-CV                                          CHRISTOPHER PRINE
                                                                                                       CLERK

                     Local Rule Notice of and Assignment
                    of Related Case in Original Proceedings
                                                                         FILED IN
      As required by the Local Rules Relating to Assignment of     1stRelated
                                                                      COURT OF    APPEALS
                                                                                Cases   to
                                                                       HOUSTON, TEXAS
and Transfers of Related Cases between the First and Fourteenth Courts of
                                                                   3/13/2015 8:34:01 PM
Appeals, I certify that the following related appeal or original proceeding    has been
                                                                   CHRISTOPHER A. PRINE
previously filed in either the First Court of Appeals:                     Clerk

      Guillory v. Seaton, LLC d/b/a Staff Management

      Appellate Case No. 01-14-00379-CV

      Trial Case No. 2012-61407A, 113th District Court, Harris County, Texas

                                        Respectfully submitted,

                                         /s/ David N. Anderson
                                        DAVID N. ANDERSON
                                        TBN: 00797951
                                        THE ANDERSON LAW FIRM
                                        4309 Yoakum
                                        Houston, TX 77006
                                        (713) 521-6563 - Telephone
                                        (888) 824-5624 – Fax
                                        danderson@lodna.net
      FILED IN
 st
1 COURT OF APPEALS
    HOUSTON, TX
    MAR 13, 2015                  01-15-00235-CV
CHRISTOPHER A. PRINE,
       CLERK
                            No. __________________

                           IN THE COURT OF APPEALS
                        FOR THE FIRST DISTRICT OF TEXAS

                       In re IWORKS PERSONNEL, INC.,
                   LUIS TREVINO, AND HAYDEE GUTIERREZ,

                                    Relators

             Original Proceeding on Petition for Writ of Mandamus
              From the 113th District Court, Harris County, Texas
           Honorable Michael Landrum, Judge Presiding, Respondent
                            Cause No. 2012-61407

                        PETITION FOR WRIT OF MANDAMUS

                                     DAVID N. ANDERSON
                                     TBN: 00797951
                                     THE ANDERSON LAW FIRM
                                     4309 Yoakum
                                     Houston, TX 77006
                                     (713) 521-6563 - Telephone
                                     (888) 824-5624 – Fax
                                     danderson@lodna.net

                                     ATTORNEY FOR DEFENDANTS
                                     IWORKS PERSONNEL, INC.,
                                     LUIS TREVINO, and
                                     HAYDEE GUTIERREZ

                          ORAL ARGUMENT REQUESTED
                       Identity of Parties and Counsel
Relators                            iWORKS Personnel, Inc., Luis Trevino, and
                                    Haydee Gutierrez

Counsel for Relators                David N. Anderson
                                    Texas Bar No. 00797951
                                    THE ANDERSON LAW FIRM
                                    4309 Yoakum
                                    Houston, TX 77006
                                    (713) 521-6563 - Telephone
                                    (888) 824-5624 – Fax
                                    danderson@lodna.net

Respondent                          The Honorable Michael Landrum
                                    113th Judicial District Court
                                    Harris County Civil Courthouse
                                    201 Caroline, 10th Floor
                                    Houston, TX 77002
                                    (713) 368-6113 – Telephone

Real Parties in Interest            Mose Guillory and Mary Guillory

Counsel forReal Party in Interest   Bradford J. Gilde
                                    Texas Bar No. 24045941
                                    bjg@gildelawfirm.com
                                    GILDE LAW FIRM
                                    55 Waugh, Suite 850
                                    Houston, TX 77007
                                    (281) 973-2772 – Telephone
                                    (281) 973-2771 – Fax

Co-Defendant / Cross-Defendant      Waste Management, Inc.

Counsel for Co-Defendant /          B. Lee Wertz, Jr.
Cross-Defendant                     Texas Bar No. 00797796
                                    lwertz@munsch.com
                                    MUNSCH, HARDT, KOPF, AND HARR, P.C
                                    700 Milam Street, Suite 2700
                                    Houston, Texas 77002-2806
                                    (713) 222-1470– Telephone
                                    (713) 222-1475– Fax

                                      ii
                                         Table of Contents
Identity of Parties and Counsel ......................................................................... ii
Table of Contents ............................................................................................. iii
Table of Authorities ...........................................................................................v
         Cases ......................................................................................................v
         Statutes .................................................................................................. vi
         Other Authorities ................................................................................... vii
         Rules ..................................................................................................... vii
         Regulations ........................................................................................... vii
I. Statement of the Case................................................................................... 2
III. Issue Presented .......................................................................................... 4
    Did the trial court abuse its discretion when it refused to dismiss claims
    over which it has no subject matter jurisdiction because the Division
    of Worker’s Compensation has exclusive jurisdiction and Plaintiff has
    not exhausted his administrative remedies? ............................................... 4
IV. Statement of Facts ...................................................................................... 4
V. Summary of Argument ................................................................................. 6
VI. Standard of Review..................................................................................... 7
VII. Argument ................................................................................................... 8
   A. The trial court does not have subject matter jurisdiction and any judgment
       it renders is void as a matter of law. ........................................................ 8
   B. The Act demonstrates the legislature’s intent that the Act provide the
      exclusive remedy for on-the-job injuries. ............................................... 10
   C. Through its broad rule making and enforcement provisions, the Act
       empowers the DWC to resolve disputes, enforce compliance, and
       punish offenders. ................................................................................... 13
   D.     Real Party’s failure to exhaust his administrative remedies under the
        Act precludes the trial court’s exercise of jurisdiction over this matter. . 16
         1. Real Party consciously chose to circumvent the Act in pursuit of
         common-law remedies for his work-place injury. ................................. 16
         2. The laws embodied in the Act and the rules promulgated by the DWC
         mandate that iWORKS policy was in effect on the date that Real Party
         was injured at work. ............................................................................. 19
   E. The DWC has exclusive jurisdiction to determine coverage. .................. 28

                                                        iii
   F. The newly released Crawford opinion confirms the Court’s prior findings
       that it is the intent of the legislature that the DWC have exclusive
       jurisdiction out of work-place injury claims and that even artful pleadings
       will not let Plaintiff’s recast their claims outside of the purview of the Act.
       ............................................................................................................... 34
VIII. Conclusion ............................................................................................. 37
IX. Prayer ....................................................................................................... 39
Certificate of Service ...................................................................................... 40
Verification and Certificate of Compliance ..................................................... 41
Appendix ........................................................................................................ 42

                                                        iv
                                              Table of Authorities

         Cases

Aranda v. Insurance Co. of N. Am., 748 S.W.2d 210, 212 (Tex. 1988) ........ 10, 14
Arranda v. Ins. Co. of North Amer., 748 S.W.2d 210 (Tex. 1988)................. 11, 16
Bland Indep. Sch. Dist. v. Blue, 34 S.W.3d 547, 553–54 (Tex.2000) ............... 7, 9
Cain v. Bain, 709 S.W.2d 175 (Tex. 1986 ........................................................... 33
Carr v. Carroll Company, 646 S.W.2d 561 (Tex. App.-Dallas 1982, writ ref'd
  n.r.e.) ................................................................................................................ 32
Carroll v. Carroll, 304 S.W.3d 366, 367 (Tex. 2010) ............................................. 9
Cash Am. Int’l., Inc. v. Bennett, 35 S.W.3d 12, 15 (Tex. 2000)........................... 17
City of Houston v. Rhule, 417 S.W.3d 440, 442 (Tex. 2014, per curium) . 9, 17, 18
County of Cameron v. Brown, 80 S.W.3d 549, 555 (Tex. 2002) ....................... 7, 8
Cunningham Lindsey Claims Mgmt. v. Snyder, 291 S.W.3d 472, 477 (Tex.App.—
  Houston [14th Dist.] 2009, pet. denied) ............................................................ 18
Dubai Petrol. Co. v. Kazi, 12 S.W.3d 71, 76 (Tex.2000) ....................................... 9
Entergy Gulf States, Inc. v. Summers, 282 S.W.3d 433, 453 (Tex., 2009) ......... 20
Gonzales v. Cigna Ins. Co. of Tex, 924 S.W.2d 183, 184-87 (Tex.App.—San
  Antonio 1996, write denied) ............................................................................. 36
Houston Gen. Ins. Co. v. Ass’n Cas. ins. Co., 977 S.W.3d 634, 636 (Tex.App.—
  Tyler 1998, no pet.) .......................................................................................... 31
Houston Gen. Ins. Co. v. Association Cas. Ins. Co., 972 S.W.2d 634, 636
  (Tex.App.—Tyler 1998, no pet.) ....................................................................... 36
Huffman v. S. Underwriters, 133 Tex. 354, 128 S.W.2d 4, 6 (1939) ................... 20
Hulshouser v. Texas Workers’ Compensation Ins. Fund, 139 S.W.3d 789, 792
  (Tex. App.—Dallas 2004, no pet.). ................................................................... 11
In Re Crawford, No. 14-0256 (Tex. February 27, 2015) (per curiam) ...... 11, 37-39
In re Entergy Corp., 142 S.W.3d 316, 321 (Tex. 2004). ........................................ 4
In Re Liberty Ins. Corp., 321 S.W.3d 630 (Tex.App.—Houston [14th Dist.] 2010)
  (orig. proceeding) ............................................................................................. 10
In Re Liberty Mut. Fire Ins. Co., 295 S.W.3d 327 329 (Tex. 2009) ................. 4, 40
In Re Liberty Mut. Fire Ins. Co., 295 S.W.3d 327, 328 (Tex. 2009) (orig.
  proceeding) (per curiam) .............................................................................. 4, 10
In re Liberty Mutual Fire Ins. Co., 295 S.W.3d 327, 328 (Tex. 2009).................... 3
In Re Mid-Century Ins. Co. of Tex., 426 S.W.3d 169, 172 (Tex.App.—Houston
  [1st Dist] 2012) (orig. proceeding) ..................................................................... 15
In re Poly-Am., L.P., 262 S.W.3d 337, 349 (Tex. 2008) .......................... 11, 15, 22
In Re Sw. Bell Tel. Co., 235 S.W.3d 619, 624 (Tex. 2007) ................................... 4
In Re Tex. Mut. Ins. Co. ...................................................................................... 32
In Re United Servs. Auto Ass’n, 307 S.W.3d 299, 209 (Tex. 2010)...................... 9
In re United Servs. Auto. Ass'n, 307 S.W.3d 299, 306 (Tex.2010) ..................... 10

                                                             v
Ins. Co. of Pa. v. Hartford Underwriters Ins. Co., 164 S.W.3d 747 (Tex.App.—
  Houston [14th Dist.] 2005, no pet.) ................................................................... 31
Liberty Mut. Ins. Co. v. Adcock, 412, S.W.3d 492, 495 (Tex. 2013) ................... 14
Millers' Mut. Cas. Co. v. Hoover, 235 S.W. 863, 864 (Tex. Comm'n App.1921,
  judgm't adopted) .............................................................................................. 22
Morales v. Liberty Mut. Sinc. Co., 241 S.W.3d 514 (Tex. 2007)....................... 31, 33
Peek v. Equip. Serv. Co. of San Antonio, 779 S.W.2d 802, 805 (Tex. 1989). ...... 8
Port Elevator-Brownsville, L.L.C. v. Casados, 358 S.W.3d 238 (Tex. 2012) ...... 20
Richmond v. L. D. Brinkman & Co. (Texas) Inc., 36 S.W.3d 903 (Tex. App.-Dallas
  2001, pet. denied) ............................................................................................ 33
Saenz v. Fidelity & Guaranty Insurance Underwriters ........................................ 15
Scwartz v. Ins. Co. of Pa. ...................................................................................... 7
Southern Sur. Co. v. Inabnit, 1 S.W.2d 412, 413-414 (Tex.Civ.App.-Eastland
  1927, no writ) ................................................................................................... 22
Subaru of Am. v. David McDavid Nissan, Inc., 84 S.W.3d 212, 221 (Tex. 2002) 15
Tex. Ass'n of Bus. v. Tex. Air Control Bd., 852 S.W.2d 440, 446 (Tex.1993). ...... 7
Tex. Dep't of Parks & Wildlife v. Miranda, 133 S.W.3d 217, 226 (Tex.2004) ........ 7
Tex. Dep't of Transp. v. Jones, 8 S.W.3d 636, 638 (Tex.1999) ............................ 7
Tex. educ. Agency v. Cypress-Fairbanks I.S.D., 830 S.w.2d 88, 90 (Tex. 1992) 18
Tex. Mut. Ins. Co. v. Ruttiger, 381 S.W.3d 430, 344 (Tex. 2012) ........... 16, 38, 39
Tex. Worker’s Comp. Comm’n v. Garcia, 893 S.W.2d 504, 517 n.15 (Tex. 1995) 9
Texas Workers’ Compensation Insurance Fund v. DEL Industrial, Inc., 35 S.W.3d
591 (Tex. 2000) ................................................................................................ 32
U.S. Fid. & Guar. Co. v. Goudeau, 272 S.W.3d 603, 610 (Tex. 2008) ............... 26
Waco ISD v. Gibson, 22 S.W.3d 849, 851 (Tex. 2000) ....................................... 10

         Statutes1

§ 91.001, et seq. .................................................................................................. 29
§ 93.004 .............................................................................................................. 29
§§ 401.001 – 451.003 ........................................................................................... 1
§ 401.011 ............................................................................................................ 32
§ 401.012 ............................................................................................................ 32
§ 401.013 ............................................................................................................ 36
§ 402.001 ................................................................................................ 10, 21, 34
§ 402.00111 ........................................................................................................ 21
§ 402.00114 ........................................................................................................ 35
§ 402.00117 ........................................................................................................ 21
§ 402.061 ............................................................................................................ 21
§ 406.002 ............................................................................................................ 21
§ 406.008 ............................................................................................................ 26

1   All cites are to the Texas Labor Code.
                                                           vi
§ 406.031 ............................................................................................................ 32
§ 406.032 ............................................................................................................ 36
§ 406.033 ............................................................................................................ 36
§ 408.001 ...................................................................................................... 10, 13
§ 409.004 ...................................................................................................... 18, 20
§ 409.005 ............................................................................................................ 10
§ 409.021 ............................................................................................................ 11
§ 410.165 ............................................................................................................ 30
§ 410.205 ............................................................................................................ 11
§ 410.301 ...................................................................................................... 31, 32
§ 414.002 ............................................................................................................ 35
§ 415.001 ............................................................................................................ 11
§ 415.002 ............................................................................................................ 11
§ 415.008 ............................................................................................................ 11
§ 415.021 ...................................................................................................... 11, 35
§ 415.031 ............................................................................................................ 11
§ 415.034 ............................................................................................................ 11

         Other Authorities

Appeals Panel No. 021771 (Division of Worker’s Compensation, September 3,
 2002) ................................................................................................................ 29
Appeals Panel No. 030660 (Division of Worker’s Compensation, April 28, 2003)
  ......................................................................................................................... 29
Appeals Panel No. 101718 (Division of Worker’s Compensation, March 21, 2011)
  ......................................................................................................................... 30

         Rules

Tex. Rule of Civ. P. 198.3 ................................................................................... 24

         Regulations

28 TEX. ADMIN. CODE § 43.10 ........................................................................ 26, 27
28 TEX. ADMIN. CODE § 110.1 .............................................................................. 27

                                                             vii
                             No. __________________

                         IN THE COURT OF APPEALS
                      FOR THE FIRST DISTRICT OF TEXAS

                       In re IWORKS PERSONNEL, INC.,
                   LUIS TREVINO, AND HAYDEE GUTIERREZ,

                                       Relators

              Original Proceeding on Petition for Writ of Mandamus
               From the 113th District Court, Harris County, Texas
            Honorable Michael Landrum, Judge Presiding, Respondent
                             Cause No. 2012-61407

                      PETITION FOR WRIT OF MANDAMUS

TO THE HONORABLE FIRST COURT OF APPEALS:

      This is a worker’s compensation case. Through artful pleading Plaintiff has

sought to recast this case as a non-subscriber case, a breach of contract case, a

fraud case, a third-party beneficiary case, and so on. However, the Division of

Worker’s Compensation has exclusive jurisdiction over Plaintiff’s claims, no matter

how artfully plead, and the trial court lacks subject matter jurisdiction until Plaintiff

has exhausted the administrative remedies provided by the Worker’s

Compensation Act2 (the “Act”).

2TEXAS LABOR CODE, Title V, Subtitle A (“Texas Workers’ Compensation Act), §§ 401.001
– 451.003. Unless otherwise indicated, all code references in this petition refer to the
Texas Labor Code.

                                           1
       This issue is of vital importance because the carefully balanced dispute

resolution and enforcement procedures that the legislature built into the system

are lost if a claimant can circumvent the Act by refusing to pursue his administrative

remedies and simply recasting his claims as common-law or extra-statutory

causes of action. This Court should exercise its mandamus jurisdiction in this case

and order the trial court to dismiss Plaintiff’s causes of action.

                              I. Statement of the Case
       Nature of the case. Relator, iWORKS Personnel, Inc. (“iWORKS”) is a

temporary staffing company who contracted with Defendant, Waste Management,

Inc. (“WM”) to provide temporary labor at its waste processing facility. Real Party,

Mose Guillory (“Real Party”),3 was a temporary worker assigned by iWORKS to

work at WM’s facility. Real Party was injured on August 5, 2012 while working at

the WM facility. He subsequently sued iWORKS,4 WM, Inc. (“WM”), and Seaton,

LLC d/b/a Staff Management (“SM”),5 a third party administrator of WM’s

temporary labor program.

3 Real Party’s wife, Mary Guillory, is a Plaintiff in this case. Plaintiffs’ Fifth Amended
Petition makes no express claims on her behalf, but it does seek damages for loss of
consortium and loss of household services. Her claims are all derivative of Real Party’s
claims. As used in this petition, “Real Party” refers to both Mose Guillory and Mary
Guillory.
4 Plaintiff also sued iWORKS’ CEO, Luis Trevino, and President, Haydee Gutierrez, in
their individual capacities. They joined iWORKS in this petition. As used in this petition,
“iWORKS” refers to both the company and the two individuals.
5The trial court granted SM’s Rule 91a motion to dismiss. Plaintiff’s appeal is currently
pending before this Court (No. 01-14-00379-CV).

                                            2
          Trial court. The Honorable Michael Landrum, 113th Judicial District Court of

Harris County, Texas (“Respondent” or “trial court” herein).

          Proceedings in the trial court. Relators challenged the trial court’s subject

matter jurisdiction based upon the exclusive jurisdiction of the Texas Department

of Insurance, Division of Worker’s Compensation (“DWC”) and Real Party’s failure

to exhaust the administrative remedies available under the Act before the DWC.

Relators also challenged Real Party’s causes of action based on traditional and no

evidence motions for summary judgment, aside from the jurisdictional challenges.

The trial court granted Relators’ challenges to numerous of Real Party’s causes of

action, but denied Relators’ jurisdictional challenges on the remaining claims and

causes of action by Order dated February 20, 2015.6 It is from the trial court’s

assertion of jurisdiction over those remaining claims that Relators seek mandamus

relief.

                                 II. Statement of Jurisdiction

            This Court has jurisdiction pursuant to Tex. Gov’t Code § 22.002(a).

    Mandamus relief is appropriate to correct a trial court’s assertion of subject

    matter jurisdiction over a case that lies squarely within the exclusive jurisdiction

    of an administrative agency, here the DWC over the Texas workers’

6   Tab 1

                                            3
    compensation system.7 This erroneous assertion of jurisdiction is an abuse of

    discretion. Permitting the trial court to improperly assert jurisdiction results not

    only in hardship to Relators, but also interferes with the “legislatively mandated

    function and purpose” of the DWC, undermines the Legislature’s intent to create

    a comprehensive scheme to govern workers’ compensation claims in Texas,8

    and effectively abrogates the Act, leaving Relators with no adequate remedy by

    appeal.9 This court can correct the trial court’s assertion of subject matter

    jurisdiction here through a writ of mandamus because the underlying claims lie

    within the exclusive jurisdiction of the DWC.

                                  III. Issue Presented
Did the trial court abuse its discretion when it refused to dismiss claims over
which it has no subject matter jurisdiction because the Division of Worker’s
Compensation has exclusive jurisdiction and Plaintiff has not exhausted his
administrative remedies?

                                IV. Statement of Facts
         Real Party was severely injured on August 5, 2012 while in the course of

his employment at Waste Management’s waste reclamation facility in Houston,

Texas. Real Party was a temporary worker recruited by IWORKS and assigned

to operate a front-end loader at WM’s facility. At some point WM reassigned Real

7In re Liberty Mutual Fire Ins. Co., 295 S.W.3d 327, 328 (Tex. 2009), citing In Re Sw.
Bell Tel. Co., 235 S.W.3d 619, 624 (Tex. 2007); In re Entergy Corp., 142 S.W.3d 316,
321 (Tex. 2004).
8   Tex. Mut. Ins. Co. v. Ruttiger, 381 S.W.3d 430, 344 (Tex. 2012)
9See In re Entergy, 142 SW.3d at 321; In Re Liberty Mut. Fire Ins. Co., 295 S.W.3d at
328.

                                             4
Party to operate a Harris Baler.10 Real Party was injured when he entered the

baler to clear a jam without depowering the machine. The baler activated and

severed his right leg below the knee and half of his left foot.

        This lawsuit arises from Real Party’s attempt to recover damages for the

injuries he sustained while employed at the WM facility. Throughout this suit Real

Party has asserted various causes of action, some sounding in tort (negligence,

gross negligence, negligence per se, negligent hiring, training, and supervision,

common law fraud, fraud by non-disclosure, and negligent undertaking); some

sounding in contract (breach of contract as third-party beneficiary to the iWORKS

/ WM service agreement and breach of contract as a third-party beneficiary of the

WM / SMX agreement).            Real Party has also alleged numerous theories of

vicarious liability (respondeat superior, joint enterprise, and partnership liability).

Real Party’s claims against iWORKS have been narrowed down to negligence,

negligence per se, gross negligence, negligent hiring, training, and supervision,

breach of contract, respondeat superior, partnership liability, and joint enterprise

liability.11   Regardless of how artfully or inventively labeled or recast, all of

10 A Harris Baler is essentially a gigantic trash compactor which compacts sorted refuse
into dense bales. The material is fed into the baler via a conveyor belt which dumps the
material into the compacting chamber.
11 The trial court denied iWORKS’ motion for summary judgment on all causes except for
breach of contract, which it granted. However, the trial court declined to dismiss the same
contract claims against Trevino and Gutierrez, even though they were neither parties nor
signatories to the contract in their individual capacities. The trial court also dismissed
Plaintiff’s negligence claims against Trevino and Gutierrez, but left the gross negligence
claims against them intact. Thus, while as a matter of law Trevino and Gutierrez are not
negligent, they are still subject to liability on Plaintiff’s gross negligence claims. Likewise,
                                               5
Plaintiff’s claims flows directly from his on-the-job injury.

                             V. Summary of Argument

      Real Party’s claims fall within the exclusive jurisdiction of the DWC, and

therefore, the trial court is without subject matter jurisdiction to consider these

claims until they have exhausted all administrative remedies provided for under

the Act. Allowing a participant in the worker’s compensation system to pursue such

claims in a civil action is incompatible with the comprehensive administrative

processes and other remedies in the Act.

      Despite Real Party’s attempts to avoid the Act by creatively pleading their

complaints, the essence of their suit falls squarely under the purview of the DWC.

To hold otherwise would allow claimants to easily avoid the exclusive jurisdiction

of the Act by simply relabeling their claims as other common law or statutory

theories, even though such claims are equally incompatible with the administrative

processes and other remedies in the Act. This is precisely why the Texas Supreme

Court has repeatedly emphasized the legislative intent that there be no alternative

remedies available outside the Act.

they are also subject to same breach of contract liability that the trial court found their
company, a party to the contract, not liable for as a matter of law. The trial court denied
Relators’ motion to reconsider these paradoxical results.

                                            6
                               VI. Standard of Review
         This Court set forth the proper standard of review in in this matter in Scwartz

v. Ins. Co. of Pa.12

         A plea to the jurisdiction contests a trial court's subject matter
         jurisdiction. Tex. Dep't of Transp. v. Jones, 8 S.W.3d 636, 638
         (Tex.1999). Whether a court has subject matter jurisdiction is a matter
         of law. Tex. Dep't of Parks & Wildlife v. Miranda, 133 S.W.3d 217, 226
         (Tex.2004). Accordingly, we review a challenge to the trial court's
         subject matter jurisdiction de novo. Id. at 228.

         When reviewing a plea to the jurisdiction, we must look to the
         allegations in the pleadings, construe them in the plaintiff's favor, and
         consider the pleader's intent. See County of Cameron v. Brown, 80
S.W.3d 549, 555 (Tex. 2002). In doing so, we consider the facts
         alleged in the petition, and to the extent relevant to the jurisdictional
         issue, any evidence submitted by the parties to the trial court. See
         Bland Indep. Sch. Dist. v. Blue, 34 S.W.3d 547, 555 (Tex. 2000). The
         plaintiff bears the burden to allege facts affirmatively demonstrating
         the trial court's jurisdiction to hear a case. See Tex. Ass'n of Bus. v.
         Tex. Air Control Bd., 852 S.W.2d 440, 446 (Tex.1993). If a plaintiff
         pleads facts that affirmatively demonstrate an absence of jurisdiction
         and the jurisdictional defect is incurable, then the cause is properly
         dismissed. Peek v. Equip. Serv. Co. of San Antonio, 779 S.W.2d 802,
         805 (Tex. 1989). However, when the plaintiff fails to plead facts that
         establish jurisdiction, but the petition does not affirmatively
         demonstrate incurable defects in jurisdiction, the issue is one of
         pleading sufficiency, and the plaintiff should be afforded the
         opportunity to amend. Brown, 80 S.W.3d at 555.
Plaintiff’s Fifth Amended Petition pleads facts and cites exhibits that place this

matter squarely within the exclusive jurisdiction of the DWC. The evidence

considered by the trial court in relation iWORKS’ plea to the jurisdiction also

supports the DWC’s exclusive jurisdiction.

12   274 S.W.3d 270, 273-74 (Tex. App.—Houston [1st Dist.] 2008, pet. denied).

                                            7
         In support of this petition iWORKS has provided this Court with the following

pleadings:

               1) Plaintiff’s Fifth Amended Petition;13
               2) iWORKS’ Plea to the Jurisdiction;14
               3) iWORKS’ Supplemental Plea to the Jurisdiction15; and
               4) Plaintiff’s Response to iWORKS’ Plea to the Jurisdiction.16

All exhibits submitted with these pleadings and considered by the trial court are

found in the Appendix.17 No party offered sworn testimony at the oral hearing on

this matter. Relators have ordered a transcript of the oral argument and will

supplement the mandamus record as soon as the transcript is received from the

court reporter.

                                     VII. Argument
A.       The trial court does not have subject matter jurisdiction and any
         judgment it renders is void as a matter of law.

         The trial court erred when it exercised jurisdiction in this case because it

does not have subject-matter jurisdiction over Plaintiff’s claims related to his injury

at work. Without subject-matter jurisdiction the trial court cannot render a valid

judgment in this matter.18 “Subject matter jurisdiction is ‘essential to a court’s

13 Tab 2 (hereinafter “Petition”).
14 Tab 5
15 Tab 12
16 Tab 15 (hereinafter “Response”)
17 Real Party attached three exhibits totaling 561 pages to his Response. Real Party’s

exhibits are submitted to this Court in the same form as submitted to the trial court.
18   City of Houston v. Rhule, 417 S.W.3d 440, 442 (Tex. 2014, per curium)

                                             8
power to decide a case.’”19 Subject-matter jurisdiction cannot be waived, nor can

it be given or taken away by consent.20 “A judgment rendered without subject

matter jurisdiction cannot be considered final.”21

         Lack of subject-matter jurisdiction makes a judgment void, not just

voidable.22 Lack of subject-matter jurisdiction is fundamental error and can be

raised at any time.23 Lack of subject-matter jurisdiction can even be raised for the

first time on appeal. “Not only may a reviewing court assess jurisdiction for the

first time on appeal, but all courts bear the affirmative obligation ‘to ascertain that

subject matter jurisdiction exists regardless of whether the parties have questioned

it.’”24 Furthermore, the failure to grant a plea to the jurisdiction for failure to exhaust

administrative remedies with the DWC is subject to this Court’s mandamus

review.25

19   Id. (quoting Bland Indep. Sch. Dist. v. Blue, 34 S.W.3d 547, 553–54 (Tex.2000)).
20   Carroll v. Carroll, 304 S.W.3d 366, 367 (Tex. 2010).
21 Rhule, 417 S.W.3d at 442 (citing Dubai Petrol. Co. v. Kazi, 12 S.W.3d 71, 76
(Tex.2000)).
22   In Re United Servs. Auto Ass’n, 307 S.W.3d 299, 209 (Tex. 2010).
23Tex. Worker’s Comp. Comm’n v. Garcia, 893 S.W.2d 504, 517 n.15 (Tex. 1995) (noting
that a trial court can question its subject-matter jurisdiction even without a motion by either
party).
24Waco ISD v. Gibson, 22 S.W.3d 849, 851 (Tex. 2000); see Rhule, 417 S.W.3d at 442
(quoting In re United Servs. Auto. Ass'n, 307 S.W.3d 299, 306 (Tex.2010)).
25 See In Re Liberty Mut. Fire Ins. Co., 295 S.W.3d 327, 328 (Tex. 2009) (orig.
proceeding) (per curiam); In Re Liberty Ins. Corp., 321 S.W.3d 630 (Tex.App.—Houston
[14th Dist.] 2010) (orig. proceeding).

                                              9
B.       The Act demonstrates the legislature’s intent that the Act provide the
         exclusive remedy for on-the-job injuries.

           The Act provides a compensation system for “personal injuries sustained

     by an employee in the course and scope of his employment.”26 In exchange for

     prompt remuneration of benefits to the employee with no burden of proof as to

     negligence, the Act prevents employees from seeking common law remedies

     against the employer, agent or employee of the employer for on-the-job

     injuries.27 The Act also limits employers’ exposure to the uncertainties of

     litigation costs and awards.28 Recovery under the Act is intended to be an

     injured employee’s sole remedy for work-related injuries.29

           The legislature empowered the DWC to administer and operate the

     workers’ compensation system of Texas.30 The system’s processes are initiated

     by the worker reporting an occupational injury or disease to the employer, after

     which the employer must report the injury claim to the carrier. 31 Disputes

     regarding general compensability and extent of injury are addressed under

26   Aranda v. Insurance Co. of N. Am., 748 S.W.2d 210, 212 (Tex. 1988).
27Id.; see § 408.001(a); Hulshouser v. Texas Workers’ Compensation Ins. Fund, 139
S.W.3d 789, 792 (Tex. App.—Dallas 2004, no pet.).
28See Ruttiger, 381 S.W.3d at 441, citing In re Poly-Am., L.P., 262 S.W.3d 337, 349
(Tex. 2008). 29 Hulshouser, 139 S.W.3d at 792.
29 In Re Crawford at p. 9, No. 14-0256 (Tex. February 27, 2015) (per curiam) (a copy is
attached to the Appendix at Tab 22).
30   § 402.001(b).
31   § 409.005(a).

                                           10
     Chapter 410 of the Texas Labor Code, while Chapter 413 controls disputes

     concerning specific medical benefits, including medical fees disputes and

     medical necessity disputes. This matter falls under Chapter 410

           Additional safeguards are built into the workers’ compensation system to

     monitor compliance with the rules and regulations in Chapter 415, entitled

     “Administrative Violations,” as well as provisions in Chapters 409 and 410.32 For

     example, these provisions allow fines of up to $25,000 per day, per violation for

     an insurer’s conduct, including, for example:

          a) making a false or misleading statement; 33
          b) failing to process claims reasonably;34
          c) unreasonably disputing the reasonableness and necessity of health
             care;35
          d) conspiring to commit an act that is a violation;36 and
          e) other conduct violating Commission rules.37

     Any system participant can initiate an investigation by the DWC of possible

     administrative violations.38 Procedurally, administrative violations follow a path

     similar to Chapter 413 disputes.39

32   See generally §415.001, et seq.; §409.021; §410.205.
33   §415.008.
34   §415.002(a)(11).
35   §415.002(a)(19).
36   §415.008.
37   §415.008; §415.021.
38   §415.031.
39   §415.034-5.

                                            11
           In 1989 the Texas Legislature overhauled the worker’s compensation

     system to address the system’s deficiencies, to balance the interests and

     concerns of the worker and the employer (or insurance carrier), and to provide

     more efficient results for all parties. Prior to that time and up to this Court’s

     opinion in Ruttiger, the shortcomings of the system necessitated this Court’s

     acknowledgement of a common law cause of action for extra-contractual

     damages. In Ruttiger, this Court set out its analysis of the respective roles of

     the Legislature and this Court in relation to the Act and the worker’s

     compensation system as a whole. Improvements to the pre-1989 system were

     cited to include the following:

         1)    reduction of the disparity of bargaining power between
               employees and insurance carriers;
         2)    removal of insurers’ exclusive control over the processing of
               claims;
         3)    curtailment of insurers’ ability to refuse or unreasonably deny
               payment of valid claims in an arbitrary manner;
         4)    provision of information to employees and free assistance before
               the DWC process through the ombudsman program; and
         5)    provision of multiple remedies and penalties to enforce the
               parties’ rights and to regulate the parties’ conduct, up to and
               including revocation of a carrier’s right to do business in Texas “if
               on multiple occasions it fails to pay benefits promptly and as they
               accrue.”40 The Legislature provided injured workers with tools
               to which they did not previously have access. Carefully
               considering these improvements to the system, this Court held
               that common law causes of action outside the framework of the
               Act are no longer necessary when the Act covers the
               complained-of conduct or the remedy sought.41

40   Ruttiger, 381 S.W.3d at 449-450.
41   Id. at 444, 445, 451.

                                             12
Recognizing the broad scope and encompassing remedies brought about by the

1998 revisions to the Act, the Texas Supreme Court held that “the Court should

not alter the Act’s comprehensive scheme.” 42

C.       Through its broad rule making and enforcement provisions, the Act
         empowers the DWC to resolve disputes, enforce compliance, and
         punish offenders.

           The Act provides a compensation system for “personal injuries sustained

     by an employee in the course and scope of his employment.” 43 In exchange for

     prompt remuneration of benefits to the employee with no burden of proof as to

     negligence, the Act prevents employees from seeking common law remedies

     against the employer, agent or employee of the employer for on-the-job

     injuries.44 The Act also limits employers’ exposure to the uncertainties of

     litigation costs and awards.45 Recovery under the Act is intended to be an

     injured employee’s sole remedy for work-related injuries.29

         An agency has exclusive jurisdiction “when a pervasive regulatory scheme

indicates that Congress intended for the regulatory process to be the exclusive

42Liberty Mut. Ins. Co. v. Adcock, 412, S.W.3d 492, 495 (Tex. 2013) (explaining that “the
Legislature devised a comprehensive workers’ compensation system, with specific
benefits and procedures based on the public policy of the State of Texas. We concluded
in Ruttiger that the Court should not alter the Act’s comprehensive scheme, and we
reaffirm that principle today.”)
43   Aranda v. Insurance Co. of N. Am., 748 S.W.2d 210, 212 (Tex. 1988).
44Id.; § 408.001(a); Hulshouser v. Texas Workers’ Compensation Ins. Fund, 139 S.W.3d
789, 792 (Tex. App.—Dallas 2004, no pet.).
45See Ruttiger, 381 S.W.3d at 441, citing In re Poly-Am., L.P., 262 S.W.3d 337, 349 (Tex.
2008).

                                           13
means of remedying the problem to which the regulation is address.”46 “An agency

has exclusive jurisdiction . . . when a pervasive regulatory scheme reflects

legislative intent that an agency have the sole power to make the initial

determination in the dispute.”47 Exclusive jurisdiction is a question of law that turns

on statutory interpretation.48 The Texas Supreme Court held in Saenz v. Fidelity

& Guaranty Insurance Underwriters that “the Workers’ Compensation Act vests the

power to award compensation benefits solely in the [DWC]..., subject to judicial

review.”49

         In Tex. Mut. Ins. Co. v. Ruttiger50 the Texas Supreme Court discussed the

significant changes the Legislature made to the Act in 1989.51 It noted that the

“amendments included significant reforms, among which were changes in how to

calculating benefits for injured workers, the amount of income benefits workers

could recover, the dispute resolution process, the addition of an ombudsman

program to provide assistance for injured workers who had disputes with insurers,

46   Subaru of Am. v. David McDavid Nissan, Inc., 84 S.W.3d 212, 221 (Tex. 2002)
47In Re Mid-Century Ins. Co. of Tex., 426 S.W.3d 169, 172 (Tex.App.—Houston [1st Dist.]
2012) (orig. proceeding)
48   See Rhule, 417 S.W.3d at 442 (citing Subaru, 84 S.W.3d at 221).
49   925 S.W.2d 607, 612 (Tex. 1996)
50   381 S.W.3d 430 (Tex. 2012).
51 The Ruttiger opinion addressed the viability of a common-law cause of action for breach
of the duty of good faith and fair dealing against a worker’s compensation carrier, a cause
of action previously approved of by the Texas Supreme Court in Arranda v. Ins. Co. of
North Amer., 748 S.W.2d 210 (Tex. 1988). The Ruttiger court held that the 1989
amendments to the Act manifested the Legislatures’ intent to vitiate the need for such a
cause of action and expressly overruled Arranda. Id., 381 S.W.3d at 438-56.

                                            14
and increasing sanctions for violations of the Act.”52 The Ruttiger court stated that

“[t]he purpose of the Act is to provide employees with certainty that their medical

bills and lost wages will be covered if they are injured.” Id. at 441.

         To accomplish these purposes, the Act provides detailed notice and
         administrative dispute resolution proceedings that include specific
         deadlines and incorporate a “conveyor-belt” approach. That is, once
         the administrative dispute resolution process is initiated, a dispute
         continues through the process until the dispute is resolved either by
         the parties or by a binding decision through the resolution procedures.

Id. at 441.

         The Ruttiger opinion provides a lengthy description of “the detailed notice

and administrative dispute resolution proceedings” encompassed by the Act. 53 In

describing the pervasiveness of the Act the Ruttiger court noted that the Act affords

the DWC significant power to enforce the Act against the various parties in the

worker’s compensation system. Id. The Ruttiger court concluded:

         It is apparent that the Act prescribes detailed, WCD-supervised, time-
         compressed processes for carriers to handle claims and for dispute
         resolution. It has multiple, sometimes redundant but sometimes
         additive, penalty and sanction provisions for enforcing compliance
         with its requirements.54

The court recognized that allowing an employee to circumvent the act by asserting

common law causes of action would be “inconsistent with the Act’s goals and

legislative intent exhibited in the act” and could also “result in rewarding an

52   Id., 381 S.W.2d at 433.
53   Id. at 441-43.
54   Id. at 443.

                                           15
employee who is dilatory in utilizing the Act’s detailed dispute resolution

procedures, regardless of whether the delay was intentional or inadvertent,

because whether and when the dispute resolution begins is by and large

dependent on the employee.” Id.

D.       Real Party’s failure to exhaust his administrative remedies under the
         Act precludes the trial court’s exercise of jurisdiction over this matter.

         When an agency has exclusive jurisdiction a party must exhaust its

administrative remedies before seeking recourse through judicial review. 55 “If an

agency has exclusive jurisdiction... a party must first exhaust all administrative

remedies before a trial court has subject matter jurisdiction.”56 “Absent exhaustion

of administrative remedies, a trial court must dismiss the case.”57

         1. Real Party consciously chose to circumvent the Act in pursuit of
            common-law remedies for his work-place injury.

         There is no question that Real Party not exhausted his administrative

remedies through the DWC. He readily admits this.58 Real Party claims that it is

55Rhule, 417 S.W.2d at 442 (citing Cash Am. Int’l., Inc. v. Bennett, 35 S.W.3d 12, 15
(Tex. 2000)).
56Cunningham Lindsey Claims Mgmt. v. Snyder, 291 S.W.3d 472, 477 (Tex.App.—
Houston [14th Dist.] 2009, pet. denied).
57Rhule, 417 S.W.2d at 442 (citing Tex. educ. Agency v. Cypress-Fairbanks I.S.D., 830
S.w.2d 88, 90 (Tex. 1992).
58   Tab 15, p. 18, ¶ 80. Real Party states:
         In accordance with the Texas Labor Code Ch. 409, Plaintiffs did previously
         file their DWC 41 form on the 1-year anniversary of the injury in question.
         However, Plaintiffs did so solely to preserve their right to seek benefits in
         the event that this Court or the Court of Appeals later determined that
         iWorks Defendants and/or WM Defendants were workers’ compensation
         subscribers. Plaintiffs are not seeking workers’ compensation benefits from
                                               16
justified in foregoing the Texas Workers’ Compensation System because both

iWORKS and WM are nonsubscribers.59 However, an examination of the Plaintiff’s

allegations and the evidence submitted in connection with Relator’s Plea to the

Jurisdiction demonstrate that Relator was a subscriber the Act.

           Real Party was injured on August 5, 2012.60            On August 30, 2012 he

executed a DWC-041 form61 requesting compensation for a work-related injury.62

On that form he stated that he was represented by Bradford J. Gilde (“Gilde”).63

Thus, fifteen days after his work-related injury (over 2 ½ years ago) Real Party was

at a minimum aware of the potential availability of benefits under the Act. It is also

fair to assume that his attorney knew (or had the ability to find out) how to obtain

those benefits.

           Nearly a year later on August 12, 2013, Gilde sent a letter to the DWC.64 It

was styled as a “Notice, Stay, and Preservation Letter.” Although litigation was

ongoing and both iWORKS and Waste Management were represented by

           any provider, and are surely not attempting to get blood from the turnip that
           is iWorks Defendants’ cancelled policy.
59   Tab 2, Petition, p. 6, ¶¶ 19-20.
60   Id. at p. 13, ¶ 36.
61“Employee’s Claim for Compensation for a Work Related Injury or Occupational
Disease.”
62   Tab 10.
63   Id.
64   Tab 14.

                                                17
counsel,65 neither Defendant was copied on this correspondence. Gilde attached

two separate DWC-041 forms to the letter. One names iWORKS as Real Party’s

employer and the other names WM as his employer. Thus, as of the date of his

letter to the DWC, Real Party’s counsel had actual knowledge of two separate

worker’s compensation policies which would potentially provide benefits to his

client. He consciously chose to forego pursuing his client’s benefits under either

one of the policies in lieu of proceeding with his claims in the trial court. 66

           Gilde’s letter to the DWC states that it:

           “is submitted: (1) as a notice of claim for compensation...as a
           preservation of right to file and seek a claim for compensation...and
           pursuant to Tex. Labor Code §409.004.”67

           The letter further states that “this letter...is not an election or denial of a claim

for coverage.”68 Real Party cannot hedge his bets with the DWC while seeking a

judicial remedy in the trial court without first exhausting his administrative

65   At that time attorney Aric Garza was counsel for iWORKS.
66On information and belief, as of the filing of this petition Real Party has still not sought
benefits under WM’s worker’s compensation policy even though the trial court dismissed
his claims against WM pursuant to the “comp bar” defense.
Port Elevator-Brownsville, L.L.C. v. Casados, 358 S.W.3d 238 (Tex. 2012) held that for
purposes of the Act a temporary staffing company and its client are both co-employers
and that the client company cannot exclude or segregate temporary workers from its
worker’s compensation coverage. Simply put, the state of Texas wants all workers
covered. Thus, a temporary staffing employee typically has two different worker’s
compensation policies which can cover him for on-the-job injuries. Which policy actually
covers the worker is usually a matter of contract between the staffing company and its
client.
67   Tab 14 (emphasis in original).
68   Id.

                                                18
remedies. His failure to do so in this matter, despite knowing the administrative

requirements set forth in the Act, deprives the trial court of subject-matter

jurisdiction over his claims.

         Gilde’s letter to the DWC purports to reserve Real Party’s right to seek relief

from the DWC in the event he was unsuccessful in in the trial court. This approach

turns the purpose of the entire worker’s compensation system on its head. This

letter demonstrates that Real Party was well aware of the requirements under the

Texas Labor Code yet consciously chose to attempt to circumvent that process in

hopes of a common law verdict. This is not the public policy of Texas. As the

Ruttiger court observed, “the extra-statutory cause of action provides incentive for

an injured worker to delay using the avenues for immediate relief that the

Legislature painstakingly built into the law” and “distorts the balances struck in the

Act and frustrates the Legislature’s intent to have disputes resolved quickly and

objectively.”69

         2. The laws embodied in the Act and the rules promulgated by the
            DWC mandate that iWORKS policy was in effect on the date that
            Real Party was injured at work.

         iWORKS is a subscriber under the Act. iWORKS purchased a worker’s

compensation policy from Texas Mutual with the effective dates of 09/04/2011

through 09/04/2012.70 That iWORKS actually purchased this policy is not disputed

69   Ruttiger, 381 S.W.3d at 451.
70   Tab 6.

                                            19
by Real Party. Rather, Real Party argues that the policy was terminated prior to

his August 5, 2012 injury.71 To support this claim he cites to a Notice of Dismissal

purportedly issued by Texas Mutual72 and discovery responses from Texas Mutual

and Lette Insurance Company, iWORKS’ insurance agent who procured the

policy.73

           But it has long been ‘the settled policy of this State to construe liberally
           the provisions of the [Act] in order to effectuate the purposes for which
           it was enacted.’ Coverage is a fundamental purpose of the Act.74

Real Party’s contentions and the evidence offered to support them do not comport

with the statutory provisions provided for in the Act and only serve to thwart the

fundamental purpose of the Act, coverage.

71   Tab 15, p. 5-9, ¶¶ 28-39.
72   Id.
73   Id.
74Entergy Gulf States, Inc. v. Summers, 282 S.W.3d 433, 453 (Tex., 2009) (J. Hecht
concurring) (emphasis added) (quoting Huffman v. S. Underwriters, 133 Tex. 354, 128
S.W.2d 4, 6 (1939) (quoted in In re Poly-America, L.P., 262 S.W.3d 337, 350 (Tex. 2008)).
In support of his proposition that the Act has historically been interpreted by the courts as
broadly as possible so as to find coverage, Justice Hecht cites Citing Millers' Mut. Cas.
Co. v. Hoover, 235 S.W. 863, 864 (Tex. Comm'n App.1921, judgm't adopted) (“It has
been thought, inasmuch as the [Act] is in derogation of the common law, that it should be
given a strict construction, but the courts have very generally held that a spirit of liberality
should characterize its interpretations, for the reason that it is to be classed as remedial
legislation.” (quotation omitted)); Southern Sur. Co. v. Inabnit, 1 S.W.2d 412, 413-414
(Tex.Civ.App.-Eastland 1927, no writ) (“The leading authorities ... agree that Workmen's
Compensation Laws came into existence in response to a general acceptation of the
broad economic theory that industrial accidents should properly be chargeable as a part
of the overhead expenses of the industries. These laws are remedial in their nature, and
should be liberally construed with the view of promoting their objects. The early tendency
of our courts to construe them strictly because they were thought to be in derogation of
common law has long since given place to a liberal rule of construction. The rule now
prevailing prevents the restriction of the scope of the laws by exceptions and exact
definitions not in harmony with their spirit.”).

                                               20
         In 2005 the DWC was established as a division of the Texas Department

Insurance, replacing the abolished Texas Workers’ Compensation Commission.75

The DWC is administered by the commissioner of workers’ compensation who is

appointed by the governor for a two-year term.76 The Act gives the commissioner

authority to “adopt rules as necessary for the implementation and enforcement of

this sub-title [the Act].”77 These rules are codified in the Texas Administrative

Code.78 The Labor Code and the Texas Administrative Code (“TAC”) establish the

statutory and regulatory provisions by which an employer can elect to submit to

the Act by purchasing workers’ compensation insurance and, more importantly in

this case, the manner, effectiveness, and effect of the termination of workers’

compensation insurance by a carrier.

         Under the Act an employer “may elect to obtain worker’s compensation

insurance coverage” and is thereby “subject to this subtitle [the Act].” 79 It is

undisputed that iWORKS elected to obtain workers’ compensation insurance

coverage and thereby subject itself to the Act. 80 iWORKS purchased a workers’

75   §402.001(b).
76   §402.00111; §402.00117.
77   §402.061; §402.00111
78See generally Title 28 Tex. Admin. Code, Part II. (“Texas Department of Insurance,
Division of Workers’ Compensation”).
79   §406.002.
80Even Plaintiff’s Petition states that “[a]s is clear, in addition to supplying client
companies with leased employees or temporary workers, IWORKS DEFENDANTS also
have the duty and responsibility to provide worker’s compensation.” Tab 2, p. 10, ¶ 24;
                                          21
compensation        policy   from   Texas     Mutual   effective   09/04/2011   through

09/04/2012.81 Luis Trevino, owner of iWORKS, testified that iWORKS subscribed

to worker’s compensation insurance from its inception and that this is the normal

course of business for a temporary staffing company. 82 Furthermore, the Service

Agreement between iWORKS and WM required that iWORKS carry workers’

compensation insurance.83 It is not Real Party’s contention that iWORKS was a

non-subscriber, rather, he contends that the Texas Mutual policy was cancelled

several weeks before his injury.84          As is discussed below, this contention is

unsupported by the Pleadings and the evidence.

         In opposition to iWORKS’ Plea to the Jurisdiction, Real Party relied upon

four single-page documents85 as well as discovery responses from Texas Mutual

and Lette Insurance Company.86 The primary document he relies upon is a “Notice

of Termination.”87 However, this document has no probative value. There is no

but see Id., p. 6, ¶¶ 19-21 where Real Party makes the global allegation (without factual
support) that both iWORKS and WM are non-subscribers.
81   Tab 6.
82 Tab 11; Trevino testified: “Since it has been in business iWORKS has continuously
subscribed to Worker’s Compensation insurance and has covered all of its temporary
employees that it sends out on assignment. This is the standard course of business for
a temporary staffing company.”
83   Tab 3.
84   Tab 15, pp. 5-8, ¶¶ 25-32.
85   Real Party attached 560 pages of documents to his response (Tabs 16-18).
86Tabs 16 and 17. For the sake of simplicity, Relator has separated the evidence
specifically cited in Real Party’s response and has combined it under Tab 19 in the
Appendix.
87   Tab 19 The same document was produced by both Texas Mutual and Lette Ins.

                                             22
evidence that this Notice was ever sent to iWORKS. Luis Trevino testified that

iWORKS never received notice of termination.88 He stated:

         The first knowledge that iWORKS had of an alleged gap in its worker’s
         compensation coverage was when Mose Guillory’s attorney made
         that allegation during my deposition in this case. Although Guillory’s
         attorney presented what appeared to be a notice of termination, I had
         no knowledge of such notice. During that alleged period of time we
         had never missed a premium payment, we had received no
         communication from our broker regarding any termination, we had
         received no denial of any claims, and we never had problems
         obtaining Certificates of Insurance.

The testimony is uncontroverted. The notice relied upon by Real Party purports to

have been sent by certified mail which begs the question – where is the green card

or the unclaimed envelope?

         The only other evidence offered by Real Party is the self-serving discovery

responses from Texas Mutual. Texas Mutual’s canned response to almost all of

the questions posed by Real Party (subject to objection) was:

         Texas Mutual insurance policy no. STA_0001244473 301 10904
         (“The Policy”) was issued to Preferred Staffing Company, LLC d/b/a
         iWorks Personnel (“Preferred Staffing”) for the coverage period of
         09/04/2011 to 09/04/2012. The Policy was cancelled, effective
         07/16/2012 (See Notice of Cancellation, document Bates No.
         TXM00318). Texas Mutual Insurance’s Company’s actions regarding
         issuance of The Policy and subsequent cancellation were conducted
         pursuant to and in accordance with the Rules set by the Texas
         Department of Insurance Division of Workers’ Compensation and the
         Texas Worker’s Compensation Act.89

88   Tab 11.
89   Tab 19.

                                          23
Real Party also relies upon admissions submitted by Texas Mutual “admitting” that

1) the policy “was cancelled prior to August 5, 2012”, and 2) that “iWORKS was a

‘nonsubscriber,’ under Texas law to your [Texas Mutual’s] knowledge and

definition of “nonsubscriber.”90 Notwithstanding the fact that these admissions are

conclusory and lack any evidentiary foundation, these admissions have no

evidentiary value as they cannot be used against iWORKS.91

         What Texas Mutual’s evidence does show is that iWORKS did indeed have

a policy covering the date of Real Party’s injury. What it does not show is any

evidence that the policy was properly terminated pursuant to the Labor Code and

the rules established by the DWC. Again, where is the green card? Where is the

unclaimed envelope? It is not in any of the documents submitted by Real Party.

Texas Mutual’s testimony also supports the exclusive jurisdiction of the DWC when

it claims that it has adhered to all of the requirements of the Act and the DWC rules

appurtenant thereto. It is solely within the DWC’s province to determine Texas

Mutual’s actual compliance and solely within the DWC’s administrative power to

punish and sanction Texas Mutual for violations of the Act and/or the DWC rules.

         Real Party also referenced an August 24, 2012 letter written by Texas

Mutual to show cancellation of the policy.92 Again there is no evidence to show

90   Tab 19.
91Tex. Rule of Civ. P. 198.3; see U.S. Fid. & Guar. Co. v. Goudeau, 272 S.W.3d 603,
610 (Tex. 2008).
92   Tab 19.

                                         24
that this was actually sent to iWORKS or that iWORKS ever received it. Nor is

there any mention of termination in this letter. However, the very next document

in Real Party’s exhibit does show that iWORKS paid Texas Mutual just under

$44,000.00 in premiums for that policy period.93

           The only other document offered by Real Party in opposition to iWORKS

Plea to the Jurisdiction is an “Appointment Confirmation” dated October 18, 2012 94

that Real Party offered as proof that iWORKS “was in direct contact with Texas

Mutual during this cancellation period.”95 Notwithstanding the same issues of

delivery and receipt, this letter makes no mention of termination even though it is

dated over three months since the policy was supposed to have been cancelled.

The very next two documents in Real Party’s exhibit shows that on November 12,

2012 a copy of an “Incomplete Final Audit Notification” allegedly sent to iWORKS96

was also faxed to Lette Insurance. What is interesting about this document is that

it states

           To prevent cancellation of your current coverage, please contact the
           Premium Audit department promptly.97

93   Tab 20.
94   Tab 19.
95   Tab 15, p. 9, ¶ 38.
96Tab 21; Again, Real Party provides no evidence that this letter was actually sent to or
received by iWORKS.
97   Id.

                                           25
This begs the question, if iWORKS’ coverage was terminated in July, 2012, how

could its current coverage in November, 2012 be subject to cancellation? This

court, looking at this evidence de novo, should find that the evidence submitted by

Real Party to show the trial court’s jurisdiction in this matter is of no probative effect

at all. However, even had the trial court (or this Court) given any weight to the

evidence submitted by Real Party, the laws of the Act and the Rules of the DWC

still confer exclusive jurisdiction to the DWC.

           The Act and the rules enacted by the DWC have very specific requirements

governing the termination of a workers’ compensation policy. The Act provides that

an insurance company that terminates a policy “shall deliver notice of the

cancellation... by certified mail or in person to the employer and the division” at

least thirty days prior to the effective date of the cancellation. 98 If the insurance

company does not give notice as required, then the policy is extended until proper

notice is provided.99

           Pursuant to the rule making authority given to it in the Act, the DWC has

promulgated additional rules for the termination of a worker’s compensation policy

which are codified in the TAC.100 Chapter 43 provides that “[r]ejection of the

workers’ compensation system [o]ccurs when a subscriber terminates coverage or

98   §406.008.
99   Id.
100   See 28 TEX. ADMIN. CODE, Chapter 43.

                                             26
fails or refuses to purchase a policy of workers’ compensation insurance.”101 Thus,

there is no allegation that iWORKS “rejected” the workers’ compensation system.

            Under the DWC’s rules a carrier must give the employer written notice of

termination at least thirty days before the effective date of termination. 102 Notice

must be by certified mail; there is no provision for personal delivery.103 The

effective date of the termination under Chapter 43 is “the latest of the following

dates: (A) on the 31st day after the carrier notifies the subscriber as provided in

subsection (c) . . . ; (B) the day the carrier files notice of termination with the board

. . .; or (C) the actual termination date recited on the notice.”104

            Chapter 110 provides substantially more protection for both the employer

and the employee. It provides that:

               f) Cancellation or non-renewal of a workers' compensation insurance
               policy by an insurance company takes effect on the later of:

                  (1) the end of the workers' compensation insurance policy period; or

                  (2) the date the division and the employer receive the notification
                      from the insurance company of coverage cancellation or non-
                      renewal and the later of:

                           (A)   the date 30 days after receipt of the notice required by
                                 Labor Code, §406.008(a)(1);

                           (B)   the date 10 days after receipt of the notice required by
                                 Labor Code, §406.008(a)(2); or

101   Id., § 43.10(a)(2).
102   Id., § 43.10(c)(1-3)
103   Id.
104   Id., § 43.10(d)(1)

                                               27
                       (C)    the effective date of the cancellation if later than the date
                              in paragraph (1) or (2) of this subsection.105

The rules promulgated by the DWC and codified in the TAC reflect the driving

intent of the State of Texas that its workers be covered.

         How do these laws and regulations apply in this case? Under Rule 110.1,

regardless of when or how or if iWORKS was provided with notice of cancellation

by Texas Mutual, the effective date of termination would be at the end of the policy

period on September 4, 2012. Under Rule 43.10 the effective date of termination

would be on the 31st day after iWORKS received notice of cancellation from Texas

Mutual through certified mail.        Under Section 408.10, the termination date is

extended until Texas Mutual provides notice of cancellation to iWORKS through

either certified mail or personal delivery. Since iWORKS never received notice of

cancellation through certified mail, under both Rule 43.10 and Section 408.10 the

policy terminated under its own terms on September 4, 2012. Real Party was

injured on August 5, 2012. Thus he falls under the coverage of iWORKS’ workers’

compensation policy.

105   Id., § 110.1(f) (emphasis added).

                                             28
E.       The DWC has exclusive jurisdiction to determine coverage.

         The DWC routinely addresses the issues raised in this case through its

administrative proceedings.106 For example, in Appeals Panel No. 030660 107

(Division of Worker’s Compensation, April 28, 2003) the DWC appeals panel

addressed a temporary staffing situation and determined which employer was

liable, the proper application of the Staff Leasing Services Act108 (“SLSA”), and

approved the use of the borrowed servant doctrine in determining liability.

         In Appeals Panel No. 021771 (Division of Worker’s Compensation,

September 3, 2002) the appeals panel addressed a matter factually similar to this

case analyzing the interplay between the contractual obligations between a staffing

106
  See e.g. Ins. Co. of Pa. v. Hartford Underwriters Ins. Co., 164 S.W.3d 747 (Tex.App.—
Houston [14th Dist.] 2005, no pet.) (“Though we are not bound by the decisions [of the
DWC], we find them instructive . . . . “); Houston Gen. Ins. Co. v. Ass’n Cas. ins. Co., 977
S.W.3d 634, 636 (Tex.App.—Tyler 1998, no pet.) (noting that administrative decisions,
while not binding, are entitled to substantial weight).
DWC Appeals Panel decisions are available on the Texas Department of Insurance
website at http://www.tdi.texas.gov/appeals. Copies of the Appeals Panel decisions cited
herein are found in the Appendix at Tab 22.
107   Tab 22.
108  TEX. LABOR CODE, Chapter 91 (“STAFF LEASING SERVICES”). The Texas Legislature
amended Chapter 91 in 2013 renaming it “PROFESSIONAL EMPLOYMENT ORGANIZATIONS”.
This amendment supports iWORKS’ opposition to Real Party’s continuing assertion that
iWORKS is a staff leasing company. Rather, iWORKS temporary employment service as
set forth in Chapter 93 of the TEXAS LABOR CODE. Furthermore, effective September 1,
2013, TEX. LABOR CODE § 93.004(a) holds that a Certificate of Insurance “constitutes proof
of workers’ compensation insurance coverage for the temporary employment service and
the client of the temporary employment service with respect to all employees of the
temporary employment services assigned to the client.” Subsection (a) further holds that
“[t]he state or political subdivision of the state shall accept a certificate of insurance
coverage described by this section as proof of worker’s compensation coverage under
Chapter 406.”

                                            29
company and its client company, the applicability of the SLSA, and the application

of the borrowed servant doctrine to determine coverage. The appeals panel upheld

the hearing officer’s determination that the client company was responsible for the

worker’s injury rather than the staffing company. The panel held that:

      Texas courts have recognized that a general employee of one
      employer may become the borrowed servant of another employer.
      The determinative question then becomes which employer had the
      right of control of the details and manner in which the employee
      performed the necessary services. Carr v. Carroll Company, 646
S.W.2d 561 (Tex. App.-Dallas 1982, writ ref'd n.r.e.). We note that in
      Texas Workers’ Compensation Insurance Fund v. DEL Industrial, Inc.,
      35 S.W.3d 591 (Tex. 2000), the court held that the Staff Services
      Leasing Act (SSLA), Texas Labor Code Chapter 91, supersedes the
      common law right-of-control test in determining employer status of
      leased employees for workers’ compensation purposes. However,
      (Employer 2) was not licensed under the SSLA. The hearing officer
      determined that on the date of injury, (Employer 2) was a licensed
      provider of temporary common workers under Chapter 92 of the
      Texas Labor Code, entitled Temporary Common Worker Employers
      (TCWE). In Richmond v. L. D. Brinkman & Co. (Texas) Inc., 36 S.W.3d
903 (Tex. App.-Dallas 2001, pet. denied), the court determined that
      the common law right-of-control test is not superseded by Chapter 92
      (TCWE) of the Texas Labor Code. The hearing officer is the sole
      judge of the weight and credibility of the evidence. Section 410.165(a).
      We conclude that the hearing officer did not err in applying the right-
      of-control test and in determining that at the time of the injury, the
      claimant was the borrowed servant of (Employer 1). The hearing
      officer’s decision is supported by sufficient evidence and is not so
      against the great weight and preponderance of the evidence as to be
      clearly wrong and unjust. Cain v. Bain, 709 S.W.2d 175 (Tex. 1986).

Id. at p. 1-2. The client company also argued that the staffing company should be

responsible because the client company paid fees to the staffing company which

went towards worker’s compensation coverage for the temporary employees. The

panel rejected these arguments. Id.
                                        30
         In Appeals Panel No. 101718 (Division of Worker’s Compensation, March

21, 2011) the appeals panel examined a complex claim involving a contractor, a

subcontractor, a PEO, and a temporary staffing company. In finding that the

employee did not suffer a compensable injury the panel had to address issues

related to coverage (including whether or not the temporary staffing company’s

carrier properly terminated coverage), contractual duties between the parties,

liability issues between three different worker’s compensation insurance providers,

employment status of the claimant, and other related issues.

         The legal issues discussed above are all issues that are in play in this case.

These are issues that the DWC routinely addresses through its administration of

the Act. These are issues that fall squarely within the exclusive jurisdiction of the

DWC. The trial court does not have subject-matter jurisdiction over these matters

until all of the administrative remedies available through the Act have been

exhausted in the same manner as demonstrated in the DWC opinions cited above.

         In Morales v. Liberty Mut. Sinc. Co.,109 the Texas Supreme Court addressed

the issue of the relationship between compensability under the Texas Worker’s

Compensation Act (“the Act”), employee status, and subscriber status.110 The

109   241 S.W.3d 514 (Tex. 2007).
110 The Morales Court addressed these issues in the context of determining which
standard of review set forth in the Act should apply to judicial review of a final decision
from a DWC appeals panel. If the issues being appealed involve “compensability” then
the standard of review is the “modified de novo” standard established by §410.301. Issues
that do not address compensability are reviewed under a “substantial-evidence” standard.
                                            31
Court held that issues of coverage such as the one in this case fall within the rubric

of the existence of a compensable injury which is properly resolved through the

Act. Morales was killed while repairing a roof on a motel.111 His wife sought death-

benefits under the act claiming he was injured while in the course and scope of his

employment with three different employers.112 Two of the employers were insured

under separate worker’s compensation policies, and the third was a

nonsubscriber.113 The court explained that:

            The existence of a compensable injury is the threshold requirement
            for payment of benefits under the Act. See TEX. LAB.CODE §§
            401.011(5), 406.031(a). And there are various elements that affect
            whether an injury is compensable, including the worker's employment
            status as an employee or independent contractor at the time of injury,
            whether the worker was injured in the course and scope of
            employment, who controlled the employee's work when the injury
            occurred, and whether a particular employer has an insurance policy
            in effect. See id. §§ 401.011(12), (18), 401.012(a).
                   ....

            A dispute about any of these elements regards “compensability or
            eligibility for . . . benefits” and is subject to judicial review under section
            410.301.114

            In In Re Tex. Mut. Ins. Co.115 the court addressed the DWC’s exclusive

jurisdiction in the context of common law breach of contract claims and disputed

Morales, 241 at 516-17. The outcome of this question of compensability also effects
venue and the appropriate scope of judicial review. Id.
111   Id. at 515.
112   Id.
113   Id.
114   Id. at 519.
115   157 S.W.3d 75 (Tex.App.—Austin 2004, orig. proceeding).

                                                  32
coverage. The Court held that the Fodge decision mandated that the claimant’s

breach-of-contract claim “is within the Commission’s exclusive jurisdiction.”116 The

Court also held that:

            We likewise reject [Claimant’s] assertions that the Commission’s
            exclusive jurisdiction over worker’s compensation benefits claims
            does not extend to determining whether coverage existed at the time
            of [Claimant’s] injury. The legislature has granted the Commission
            exclusive jurisdiction over claims for policy benefits. Fodge, 63
S.W.3d at 805. In adjudicating such claims, the Commission will
            necessarily have to interpret compensation policies and determine the
            period in which coverage existed. Indeed, it appears to routinely do
            so. See, e.g., Gonzales v. Cigna Ins. Co. of Tex, 924 S.W.2d 183,
            184-87 (Tex.App.—San Antonio 1996, write denied); Houston Gen.
            Ins. Co. v. Association Cas. Ins. Co., 972 S.W.2d 634, 636
            (Tex.App.—Tyler 1998, no pet.).
            Moreover, [Claimant’s] argument would imply that whenever the
            Commission, in the exercise of its exclusive jurisdiction, encounters a
            coverage issue that can be characterized as going to "policy
            formation," the agency must abate its proceedings pending judicial
            resolution of the "formation" issue. We doubt that the legislature, in
            conferring exclusive jurisdiction upon the Commission to determine
            compensation benefits claims, intended such an absurd result that
            seemingly turns traditional concepts of exclusive jurisdiction on their
            head.117

116   Id. at 80.
117   Id.

                                              33
F.     The newly released Crawford opinion confirms the Court’s prior
       findings that it is the intent of the legislature that the DWC have
       exclusive jurisdiction out of work-place injury claims and that even
       artful pleadings will not let Plaintiff’s recast their claims outside of the
       purview of the Act.

       One week after the trial court denied iWORKS’ plea, the Texas Supreme

Court issued its opinion in In Re Crawford & Co.118 The Supreme Court held that

the DWC has exclusive jurisdiction over the Plaintiff’s claims and that the Act

provided the exclusive remedies, even over plaintiff’s common law claims. The

Crawford Court reversed the Amarillo Court of Appeals and dismissed the

Plaintiff’s district court claims.

       The Crawford opinion both clarifies and expands the Supreme Court’s

holding in Ruttiger.119     In Crawford the Plaintiff sued his employer’s worker’s

compensation carrier alleging that it improperly denied him benefits from a 1998

injury. He argued that the carrier engaged in conduct that gave rise to liability

independent from and unrelated to worker’s compensation and, thus, did not fall

under the exclusive jurisdiction of the DWC. The Supreme Court rejected this

argument. The critical distinction between this case and Crawford is that the

Crawford plaintiff had already invoked the DWC’s jurisdiction, while the Real Party

has refused to invoke the DWC’s jurisdiction claiming that Relator is a non-

118No. 14-0256 (Tex. February 27, 2015) (per curiam) (a copy is attached to the Appendix
at Tab 23).
119“We agree with Crawford that the court of appeals read Ruttiger too narrowly.”
Crawford at p. 7.

                                          34
subscriber under the Texas Labor Code. However, the seminal messages from

the Texas Supreme Court in Crawford are equally commanding in this case.

         The first seminal message from Crawford is that it is the clearly established

intent of the legislature “that the current Act with its definitions, detailed

procedures, and dispute resolution processes” be the exclusive remedy for work-

place injuries, and, moreover, that this “demonstrates legislative intent for there to

be no alternative remedies.”120 The Court observed that:

         The Act designates the Department of Insurance as the administrative
         agency responsible “[for overseeing] the workers’ compensation
         system of this state” and establishes the Division of Workers’
         Compensation within the Department to “administer and operate” that
         system. TEX. LAB. CODE § 402.001. It is the Division’s duty to “(1)
         regulate and administer the business of workers’ compensation in this
         state; and (2) ensure that [the Act] and other laws regarding workers’
         compensation are executed.” Id. § 402.00114. The Division must
         monitor insurance carriers, employers, and others “for compliance
         with commissioner rules, this subtitle, and other laws relating to
         workers’ compensation.” Id. § 414.002(a). The Division or its
         commissioner may impose an array of sanctions against those who
         fail to comply, including a cease-and-desist order and administrative
         penalties up to $25,000 per day per occurrence. Id. § 415.021(a). As
         we explained in Ruttiger, the Act, as substantially revised in 1989,
         “prescribes     detailed,    [Division]supervised,   time-compressed
         processes for carriers to handle claims and for dispute resolution” and
         “has multiple, sometimes redundant but sometimes additive, penalty
         and sanction provisions for enforcing compliance with its
         requirements.” 381 S.W.3d at 443121.

120   Crawford at p. 9 (quotes and citations omitted).
121   Crawford at p. 4.
                                              35
Thus, the broad scope and powerful enforcement provisions provided to the DWC

by the 1989 revisions to the Act evince the legislature’s unequivocal intent that the

DWC be the forum for which work-place injuries are resolved.

         The second seminal message from Crawford is that it is the substance of

the claims and not the label of the cause of action asserted which determines the

exclusively jurisdiction of the DWC.

         Whether the Act provides the exclusive process and remedies,
         therefore, does not depend on the label of the cause of action
         asserted. As we have often explained, claimants may not recast
         claims to avoid statutory requirements or to qualify for statutory
         protections. [citations omitted] Instead, in assessing whether a claim
         falls within the Division’s exclusive jurisdiction, courts must look at the
         substance of the claim.122

Thus, Real Party’s creative and questionable assertion of causes of action

putatively beyond the scope of the Act are of no consequence. The substance of

this claim is that Real Party was injured at work and is seeking damages for those

injuries. The Crawford opinion and its predecessors hold that resolution of these

claims falls under the exclusive jurisdiction of the DWC. Therefore, the trial court

cannot exercise its jurisdiction in this matter until Real Party has exhausted his

administrative remedies. If is fundamental error for it to do so.

         The crux of Real Party’s adamant disavowal of the DWC’s exclusive

jurisdiction is twofold. First is its contention that iWORKS is a non-subscriber. By

making this assertion Real Party not only seeks access to the potentially much

122   Crawford at p. 8.

                                             36
greater recovery provided by common law remedies, but he also seeks the tactical

advantage conferred by the Act which would strip away most if Relator’s common-

law affirmative defenses, particularly contributory negligence.123 Second is the fact

that Real Party tested positive for marijuana immediately following his work-place

injury. The Act provides that an employee that tests positive for marijuana is

presumed intoxicated and that the burden is on that employee to rebut that

presumption.124 The Act further provides that an employee is not entitled to benefits

under the Act if the injury occurred while he was intoxicated. 125 Thus, Real Party

has an incredibly strong incentive to avoid the DWC at all costs, both on the upside

(potentially greater remedies) and on the downside (denial of benefits due to

intoxication). “[P]arties cannot avoid exhaustion of administrative remedies

because they fear they might not prevail.” In Re Liberty Mut. Fire Ins. Co., 295
S.W.3d 327 329 (Tex. 2009).

                                 VIII. Conclusion
         This Court should grant Relator’s request for mandamus relief and dismiss

Real Party’s claims. The trial court does not have subject matter jurisdiction. The

Legislature has made clear through the Act that the DWC has exclusive jurisdiction

over Real Party’s claims and that Real Party must exhaust all of his administrative

123   § 406.033 (a).
124   § 401.013(c).
125   § 406.032(1)(A).

                                         37
remedies as set forth in the Act. Real Party has intentionally tried to circumvent

the act by recasting his work-place injury claims under various common law tort

and contract claims. He has done this in the hope of obtaining more generous

common law remedies and out of fear that he will not prevail in the administrative

proceedings due to his presumed intoxication. Creative pleadings notwithstanding,

Real Party’s failure to exhaust his administrative remedies through the DWC

precludes the trial court from exercising subject matter jurisdiction. The trial court

erred by doing so.

      Real Party’s contention that Relator is a nonsubscriber also has no merit. It

is not supported by the pleadings and the evidence offered to the trial court. Even

if the trial court had taken Real Party’s unsupported claims as true, the Labor Code

and the Administrative Act both mandate as a matter of law that Relator’s policy

was in effect at the time of Real Party’s on-the-job injury. The Texas Supreme

Court has made abundantly clear from Ruttiger through Crawford that it is the

public policy of the State of Texas that the Act be interpreted so as to provide

coverage. Furthermore, in this matter the question of whether or not Texas Mutual

properly terminated Relator’s policy goes to compensability and is something that

the DWC resolves on a regular basis. Thus, it has no impact on the DWC’s

exclusive jurisdiction and, rather, further compels such jurisdiction.

                                         38
                                     IX. Prayer
      Relator asks this Court to grant this petition for mandamus relief and dismiss

Real Party’s claims for lack of jurisdiction.

                                        Respectfully submitted,

                                          /s/ David N. Anderson

                                        DAVID N. ANDERSON
                                        TBN: 00797951
                                        THE ANDERSON LAW FIRM
                                        4309 Yoakum
                                        Houston, TX 77006
                                        (713) 521-6563 - Telephone
                                        (888) 824-5624 – Fax
                                        danderson@lodna.net

                                        ATTORNEY FOR DEFENDANTS
                                        IWORKS PERSONNEL, INC.,
                                        LUIS TREVINO, and
                                        HAYDEE GUTIERREZ

                                          39
                             Certificate of Service

      As required by Texas Rule of Appellate Procedure 6.3 and 9.5(b), (d), (e),
and 52.7(c), I certify that on March 13, 2015 I have served this Petition for Writ of
Mandamus on all other parties listed below through the Texas eFile system as
follows:

      The Honorable Michael Landrum
      113th Judicial District Court
      Harris County Civil Courthouse
      201 Caroline, 10th Floor
      Houston, TX 77002
      Respondent

      Bradford J. Gilde
      Texas Bar No. 24045941
      bjg@gildelawfirm.com
      GILDE LAW FIRM
      55 Waugh, Suite 850
      Houston, TX 77007
      Counsel for Real Parties in Interest
      Mose Guillory and Mary Guillory

      B. Lee Wertz, Jr.
      Texas Bar No. 00797796
      lwertz@munsch.com
      MUNSCH, HARDT, KOPF, AND HARR, P.C
      700 Milam Street, Suite 2700
      Houston, Texas 77002-2806
      Counsel for Defendant, Waste Management, Inc.

                                       __/s/ David N. Anderson______________
                                       David N. Anderson

                                         40
                                       Appendix

Tab 1 – Order denying iWORKS’ Plea to the Jurisdiction

Tab 2 – Plaintiff’s Fifth Amended Petition

Tab 3 – Master Service Agreement

Tab 4 – Hold Harmless Agreement

Tab 5 – iWORKS’ Plea to the Jurisdiction

Tab 6 – iWORKS’ WC Policy

Tab 7 – Waste Management’s WC Policy

Tab 8 – Employer’s First Report of Injury or Illness (DWC-001)

Tab 9 – Hold Harmless Agreement

Tab 10 – Employee’s Claim for Compensation (DWC-041)

Tab 11 – Affidavit of Luis Trevino

Tab 12 – iWORKS’ Supplemental Plea to the Jurisdiction

Tab 13 – Texas Mutual’s Receipt of Claim

Tab 14 – Gilde’s Correspondence to DWC and Employee’s Notice of Claim

Tab 15 – Plaintiffs’ Response to iWORKS’ Plea to the Jurisdiction

Tab 16 – Texas Mutual Insurance Discovery Responses

Tab 17 – Lette Insurance Company Discovery Responses

Tab 18 – Master Service Agreement (incomplete copy of Tab 2)

Tab 19 – Documents cited in Plaintiff’s Response

Tab 20 – Final Audit Statement

Tab 21 – Incomplete Final Audit Notification

Tab 22 – DWC Review Board Decisions

                                             42
Tab 23 – In Re Crawford, No. 14-0256 (Tex. February 27, 2015) (per curiam)

Tab 24 – Texas Administrative Code Rule 43.10 and 110.1

Tab 25 – TEXAS LABOR CODE, Chapter 401

Tab 26 – TEXAS LABOR CODE, Chapter 402

Tab 27 – TEXAS LABOR CODE, Chapter 406

Tab 28 – TEXAS LABOR CODE, Chapter 408

Tab 29 – TEXAS LABOR CODE, Chapter 409

Tab 30 – TEXAS LABOR CODE, Chapter 410

Tab 31 – TEXAS LABOR CODE, Chapter 414

Tab 32 – TEXAS LABOR CODE, Chapter 415

                                       43
                                                    CAUSE	
  NO.	
  2012-­‐61407	
  
                                                                     	
  
       MOSE	
  A.	
  GUILLORY	
  and	
  	
                                §	
                  IN	
  THE	
  DISTRICT	
  COURT	
  
       MARY	
  GUILLORY,	
                                                §	
  
                                                  Plaintiffs	
            §	
                                                	
  
       	
                                                                 §	
                                                	
  
                                   v.	
                                   §	
             OF	
  HARRIS	
  COUNTY,	
  TEXAS	
  
       	
                                                                 §	
                                                	
  
       IWORKS	
  PERSONNEL,	
  INC.;	
                                    §	
                                                	
  
       WASTE	
  MANAGEMENT,	
  INC.;	
                                    §	
                                                	
  
       WASTE	
  MANAGEMENT	
  OF	
  TEXAS,	
  INC.;	
  	
                 §	
                                                	
  
       WM	
  RECYCLE	
  AMERICA,	
  LLC;	
                                §	
                                                	
  
       LUIS	
  TREVINO;	
  and	
                                          §	
                                                	
  
       HAYDEE	
  GUTIERREZ.	
                                             §	
                                                	
  
                                                Defendants.	
             §	
                  113 	
  JUDICIAL	
  DISTRICT	
  
                                                                                                      th

                                                                     	
  
                                                                     	
  
                        PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
  
                                                                     	
  
	
  
                                                               I.        INTRODUCTION	
  

                  “Few	
  problems	
  in	
  the	
  law	
  have	
  given	
  greater	
  variety	
  of	
  application	
  and	
  conflict	
  in	
  
                  results	
   than	
   the	
   cases	
   arising	
   in	
   the	
   borderland	
   between	
   what	
   is	
   clearly	
   an	
  
                  employer-­‐employee	
   relationship	
   and	
   what	
   is	
   clearly	
   one	
   of	
   independent,	
  
                  entrepreneurial	
   dealing.”	
   	
   See	
   NLRB	
   v.	
   Hearst	
   Publ’ns,	
   Inc.,	
   322	
   U.S.	
   111,	
   121	
   (1944)	
  
                  (quoting	
  U.S.	
  Supreme	
  Court	
  Justice	
  Wiley	
  Blount	
  Rutledge).	
  
                  	
  
1.            Plaintiffs	
   MOSE	
   A.	
   GUILLORY	
   and	
   MARY	
   GUILLORY	
   (hereinafter	
   collectively	
   referred	
   to	
   as	
  

“PLAINTIFFS”),	
   complain	
   of	
   the	
   above-­‐named	
   Defendants’,	
   IWORKS	
   PERSONNEL,	
   INC.;	
   LUIS	
   TREVINO;	
  

and	
  HAYDEE	
  GUTIERREZ;	
  (hereinafter	
  collectively	
  referred	
  to	
  as	
  “IWORKS”	
  or	
  “IWORKS	
  DEFENDANTS”);	
  

and	
  WASTE	
  MANAGEMENT,	
  INC.;	
  WASTE	
  MANAGEMENT	
  OF	
  TEXAS,	
  INC.;	
  WM	
  RECYCLE	
  AMERICA,	
  LLC	
  

(hereinafter	
   collectively	
   referred	
   to	
   as	
   “WM”	
   or	
   “WM	
   DEFENDANTS”)	
   incompetence,	
   inter	
   alia,	
   which	
  

incompetence	
   proximately	
   caused	
   Plaintiff	
   Mose	
   Guillory’s	
   injuries	
   and	
   PLAINTIFFS’	
   damages	
   –	
   to	
   wit:	
  

IWORKS	
   was	
   an	
   incompetent	
   employer/entity	
   when	
   it	
   failed	
   to	
   subscribe	
   to	
   Texas	
   Workers	
  

Compensation	
  Insurance	
  Coverage	
  for	
  Plaintiff	
  Mose	
  Guillory	
  and	
  was	
  incompetent	
  when	
  it	
  failed	
  to	
  train	
  

Plaintiff	
  Mose	
  Guillory.	
  	
  WM,	
   as	
  confirmed	
  by	
  OSHA,	
  was	
  an	
  equally	
  incompetent	
  employer/entity	
  who	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                         1	
  
likewise	
  failed	
  to	
  train	
  Plaintiff	
  Mose	
  Guillory	
  and	
  was	
  an	
  incompetent	
  employer/entity	
  when	
  it	
  failed	
  to	
  

ensure	
   Texas	
   Workers	
   Compensation	
   Insurance	
   Coverage	
   for	
   Plaintiff	
   Mose	
   Guillory,	
   by	
   virtue	
   of	
   its	
   Staff	
  

Leasing	
  Agreement	
  with	
  IWORKS.	
  

2.          U.S.	
   Supreme	
   Court	
   Justice	
   Wiley	
   Blount	
   Rutledge’s	
   “borderland”	
   of	
   liability	
   is	
   evidenced	
   in	
   the	
  

legal	
   issues	
   involved	
   in	
   this	
   case	
   that	
   include	
   Contract	
   Law,	
   Employment	
   Law,	
   and	
   Tort	
   Law.	
  	
  

Defendants	
   architected	
   this	
   “borderland”	
   of	
   liability	
   through	
   their	
   contractual	
   agreements	
   in	
   an	
  

effort	
   to	
   skirt	
   around	
   employment	
   obligations	
   that	
   ultimately	
   resulted	
   in	
   the	
   conduct	
   that	
  

proximately	
   caused	
   PLAINTIFFS’	
   injuries	
   and	
   damages.	
   	
   That	
   is,	
   Defendants’	
   contractual	
   agreements	
  

were	
  designed	
  to	
  obscure	
  employment	
  responsibility	
  thereby	
  setting	
  the	
  stage	
  for	
  work-­‐related	
  accidents	
  

without	
   civil	
   redress	
   to	
   the	
   victims	
   (Plaintiffs	
   herein)	
   and	
   resulting	
   in	
   an	
   economic	
   windfall	
   to	
   the	
  

victimizer	
  (Defendants	
  herein).	
  	
  	
  

3.          This	
  is	
  not	
  a	
  simple	
  case	
  of	
  who	
  has	
  coverage	
  –	
  the	
  holder	
  of	
  which	
  entitles	
  that	
  party	
  or	
  all	
  parties	
  

to	
  a	
  comp-­‐bar	
  defense.	
  	
  Rather	
  and	
  unfortunately,	
  it	
  is	
  a	
  complicated	
  case.	
  	
  IWORKS	
  Defendants	
  would	
  

have	
   this	
   Court	
   and	
   our	
   jury	
   believe	
   that	
   it	
   is	
   not	
   responsible	
   for	
   obtaining	
   workers	
   compensation	
  

coverage	
   and	
   not	
   responsible	
   for	
   training	
   its	
   leased	
   employees	
   by	
   virtue	
   of	
   a	
   contract	
   with	
   WM	
  

Defendants	
   –	
   absolving	
   IWORKS	
   Defendants	
   of	
   any	
   and	
   all	
   liability.	
   	
   WM	
   Defendants	
   would	
   have	
   this	
  

Court	
   and	
   our	
   jury	
   believe	
   that	
   its	
   workers	
   compensation	
   coverage	
   policy	
   entitles	
   it	
   to	
   a	
   comp-­‐bar	
  

defense	
   –	
   absolving	
   WM	
   Defendants	
   of	
   civil	
   liability	
   in	
   the	
   present	
   action,	
   so	
   that	
   WM	
   Defendants	
   can	
  

later	
  deny	
  workers	
  compensation	
  coverage	
  by	
  pointing	
  to	
  IWORKS	
  Defendants’	
  obligation	
  to	
  secure	
  same	
  

by	
   virtue	
   of	
   a	
   contract	
   with	
   IWORKS	
   Defendants	
   in	
  a	
  subsequent	
  action	
   –	
   absolving	
   WM	
   Defendants	
   of	
  

any	
  and	
  all	
  liability.	
  

4.          Based	
   on	
   Defendants’	
   incompetence,	
   inter	
   alia,	
   PLAINTIFFS	
   hereby	
   bring	
   this	
   their	
   latest	
   live	
  

pleading	
  and	
  would	
  respectfully	
  show	
  unto	
  this	
  honorable	
  Court	
  the	
  following:	
  	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                            2	
  
                                                       II.        DISCOVERY	
  CONTROL	
  PLAN	
  

5.         PLAINTIFFS	
   intend	
   to	
   conduct	
   discovery	
   under	
   Level	
   3	
   of	
   Texas	
   Rule	
   of	
   Civil	
   Procedure	
   190.4.	
  	
  

Given	
  the	
  introduction	
  of	
  SEATON,	
  L.L.C.’S	
  (d/b/a	
  STAFF	
  MANAGEMENT),	
  Defendants’	
  dispositive	
  motion	
  

practice,	
  and	
  other	
  issues	
  concerning	
  discovery,	
  PLAINTIFFS	
  have	
  requested	
  discovery	
  under	
  Level	
  3	
  and	
  

have	
  submitted	
  to	
  the	
  Court	
  Plaintiffs’	
  Proposed	
  Docket	
  Control	
  Order.	
  	
  	
  	
  	
  

                                                                       III.        PARTIES	
  

6.         Plaintiff	
  MOSE	
  A.	
  GUILLORY,	
  an	
  individual,	
  is	
  a	
  resident	
  and	
  citizen	
  of	
  Fort	
  Bend	
  County,	
  Texas.	
  

7.         Plaintiff	
  MARY	
  GUILLORY,	
  an	
  individual,	
  is	
  the	
  wife	
  of	
  MOSE	
  A.	
  GUILLORY	
  and	
  is	
  a	
  resident	
  and	
  

citizen	
  of	
  Fort	
  Bend	
  County,	
  Texas.	
  	
  

8.         Defendant	
  IWORKS	
  PERSONNEL,	
  INC.	
  purports	
  to	
  be	
  a	
  Texas	
  corporation	
  organized	
  and	
  existing	
  

under	
   the	
   laws	
   of	
   the	
   state	
   of	
   Texas,	
   whose	
   principal	
   office	
   is	
   P.O.	
   Box	
   100111,	
   San	
   Antonio,	
   Bexar	
  

County,	
   Texas	
   78201-­‐1411.	
   	
   Defendant	
   IWORKS	
   PERSONNEL,	
   INC.	
   has	
   filed	
   its	
   Answer	
   and	
   appeared	
  

herein.	
  

9.         Defendant	
  WASTE	
  MANAGEMENT,	
  INC.	
  is	
  a	
  Texas	
  corporation	
  organized	
  and	
  existing	
  under	
  the	
  

laws	
   of	
   the	
   state	
   of	
   Texas,	
   whose	
   principal	
   office	
   is	
   1001	
   Fannin,	
   Suite	
   4000,	
   Houston,	
   Harris	
   County,	
  

Texas	
  77002.	
  	
  Defendant	
  WASTE	
  MANAGEMENT,	
  INC.	
  has	
  filed	
  its	
  Answer	
  and	
  appeared	
  herein.	
  	
  	
  

10.        Defendant	
   WASTE	
   MANAGEMENT	
   OF	
   TEXAS,	
   INC.	
  is	
  a	
  Texas	
  corporation	
  organized	
  and	
  existing	
  

under	
  the	
  laws	
  of	
  the	
  state	
  of	
  Texas,	
  whose	
  principal	
  office	
  is	
  1001	
  Fannin,	
  Suite	
  4000,	
  Houston,	
  Harris	
  

County,	
   Texas	
   77002.	
   	
   Defendant	
   WASTE	
   MANAGEMENT	
   OF	
   TEXAS,	
   INC.	
   has	
   filed	
   its	
   Answer	
   and	
  

appeared	
  herein.	
  

11.        Defendant	
  WM	
  RECYCLE	
  AMERICA,	
  LLC	
  is	
  a	
  Texas	
  corporation	
  organized	
  and	
  existing	
  under	
  the	
  

laws	
   of	
   the	
   state	
   of	
   Texas,	
   whose	
   principal	
   office	
   is	
   1001	
   Fannin,	
   Suite	
   4000,	
   Houston,	
   Harris	
   County,	
  

Texas	
  77002.	
  	
  Defendant	
  WM	
  RECYCLE	
  AMERICA,	
  LLC	
  has	
  filed	
  its	
  Answer	
  and	
  appeared	
  herein.	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                     3	
  
12.         Defendant	
  LUIS	
  TREVINO,	
  an	
  individual,	
  may	
  be	
  served	
  with	
  process	
  at	
  Defendant’s	
  usual	
  place	
  

of	
  abode,	
   217	
   Country	
   Meadow	
   Dr.,	
   Boerne,	
   Kendall	
   County,	
   Texas	
   78006.	
   	
   Defendant	
   LUIS	
   TREVINO	
   has	
  

filed	
  his	
  Answer	
  and	
  appeared	
  herein.	
  

13.         Defendant	
  HAYDEE	
  GUTIERREZ,	
  and	
  individual,	
  may	
  be	
  serve	
  with	
  process	
  at	
  Defendants’	
  usual	
  

place	
   of	
   business,	
   IWORKS	
   PERSONNEL,	
   INC.,	
   6653	
   San	
   Pedro	
   Ave,	
   San	
   Antonio,	
   Bexar	
   County,	
   Texas	
  

78216.	
  	
  Defendant	
  HAYDEE	
  GUTIERREZ	
  has	
  filed	
  her	
  Answer	
  and	
  appeared	
  herein.	
  	
  	
  

                                                                           IV.          JURISDICTION	
  

14.         This	
  Court	
  has	
  jurisdiction	
  over	
  the	
  lawsuit	
  because	
  the	
  District	
  Court’s	
  jurisdiction	
  begins	
  at	
  $500	
  

and	
  has	
  no	
  upper	
  limits.	
  	
  The	
  amount	
  in	
  controversy	
  in	
  this	
  case	
  is	
  within	
  the	
  jurisdictional	
  limits	
  of	
  this	
  

court.	
  	
  In	
  addition,	
  this	
  Court	
  has	
  jurisdiction	
  over	
  Defendants	
  because	
  Defendants	
  purposefully	
  availed	
  

themselves	
  of	
  the	
  privileges	
  and	
  benefits	
  of	
  conducting	
  business	
  in	
  Texas	
  by	
  engaging	
  in	
  business	
  in	
  the	
  

State	
  of	
  Texas.	
  	
  Finally,	
  this	
  Court	
  has	
  jurisdiction	
  over	
  Defendants	
  because	
  Defendants	
  committed	
  torts	
  

in	
   whole	
   or	
   in	
   part	
   in	
   Texas,	
   which	
   torts	
   are	
   the	
   subject	
   of	
   this	
   suit	
   and	
   which	
   are	
   set	
   forth	
   more	
   fully	
  

below.	
  	
  

                                                                                  V.           VENUE	
  

15.         Venue	
   is	
   proper	
   in	
   Harris	
   County,	
   Texas	
   under	
   Texas	
   Civil	
   Practice	
   &	
   Remedies	
   Code	
   section	
  

15.002	
   because	
   all	
   or	
   a	
   substantial	
   part	
   of	
   the	
   events	
   or	
   omissions	
   giving	
   rise	
   to	
   this	
   suit	
   occurred	
   in	
  

Harris	
   County,	
   Texas.	
   	
   See	
  TEX.	
   CIV.	
   PRAC.	
   &	
   REM.	
   CODE	
   §15.002(a)(1).	
   	
   That	
   is,	
   PLAINTIFFS’	
   injuries	
   and	
  

damages	
  were	
  caused	
  by	
  Defendants’	
  actions	
  and/or	
  inactions	
  that	
  arose	
  out	
  of	
  an	
  incident	
  that	
  occurred	
  

at	
  4939	
  Gasmer	
  Dr.,	
  Houston,	
  Harris	
  County,	
  Texas	
  77035.	
  	
  Venue	
  is	
  proper	
  in	
  Harris	
  County,	
  Texas	
  under	
  

Texas	
   Civil	
   Practice	
   &	
   Remedies	
   Code	
   section	
   15.002	
   because	
   one	
   or	
   more	
   defendant	
  corporations	
  

maintain	
   its	
   principal	
   office	
   in	
   Harris	
   County,	
   Texas.	
   See	
   Tex.	
   Civ.	
   Prac.	
   &	
   Rem.	
   Code	
   §15.002(a)(3).	
  	
  

Finally,	
  venue	
  in	
  Harris	
  County,	
  Texas	
  is	
  proper	
  pursuant	
  to	
  §15.002	
  because	
  the	
  venue	
  facts	
  show	
  the	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                                           4	
  
convenience	
  of	
  the	
  parties,	
  witnesses,	
  and	
  in	
  the	
  interest	
  of	
  justice,	
  Harris	
  County,	
  Texas	
  is	
  proper	
  venue.	
  	
  

Maintenance	
   of	
   this	
   action	
   in	
   Harris	
   County,	
   Texas	
   would	
   not	
   work	
   an	
   injustice	
   to	
   any	
   party	
   and	
   the	
  

balanced	
  interests	
  of	
  all	
  parties	
  predominate	
  in	
  favor	
  of	
  the	
  action	
  being	
  brought	
  within	
  Harris	
  County,	
  

Texas.	
  	
  

                                                               VI.         NO	
  BASIS	
  FOR	
  REMOVAL	
  

16.          There	
  is	
  no	
  basis	
  for	
  removal	
  of	
  this	
  case	
  to	
  federal	
  court.	
  	
  There	
  is	
  no	
  federal	
  question	
  at	
  issue	
  

pursuant	
   to	
   28	
   U.S.C.	
   §1441(b).	
   	
   There	
   is	
   no	
   total	
   diversity	
   of	
   citizenship	
   pursuant	
   to	
   28	
   U.S.C.	
   §1441	
   and	
  

28	
  U.S.C.	
  §1332,	
  because	
  one	
  or	
  more	
  of	
  the	
  Defendants	
  is	
  a	
  citizen	
  of	
  the	
  state	
  of	
  Texas.	
  	
   See	
  28	
  U.S.C.	
  

§1441(b),	
  §1332(c).	
  	
  PLAINTIFFS	
  are	
  not	
  asserting	
  any	
  claims	
  against	
  any	
  Defendant	
  whom	
  was	
  acting	
  

as/under	
  any	
  officer	
  of	
  the	
  United	
  States	
  or	
  any	
  such	
  agency	
  thereof,	
  or	
  person	
  acting	
  under	
  him,	
  or	
  for	
  

any	
   act	
   under	
   color	
   of	
   such	
   office,	
   or	
   against	
   any	
   Defendant	
   during	
   a	
   time	
   period	
   when	
   this	
   facility	
   was	
   a	
  

federal	
  enclave.	
  	
  Accordingly,	
  there	
  is	
  no	
  basis	
  for	
  removal	
  of	
  this	
  case	
  to	
  federal	
  court,	
  and	
  any	
  attempt	
  

to	
  do	
  so	
  by	
  any	
  Defendant	
  will	
  be	
  met	
  with	
  an	
  immediate	
  motion	
  to	
  remand	
  and	
  a	
  motion	
  for	
  sanctions.	
  	
  

                                                                             VII.        EXHIBITS	
  

17.          PLAINTIFFS	
   hereby	
   incorporate	
   by	
   reference,	
   as	
   though	
   set	
   forth	
   fully	
   herein,	
   the	
   following	
  

attached	
  exhibits	
  –	
  to	
  wit:	
  

                  •     EXHIBIT	
  A:	
   WM	
  DEFENDANTS’	
  Master	
  Agreement	
  

                  •     EXHIBIT	
  B:	
   Heavy	
  Equipment	
  Operator	
  Agreement	
  

18.          PLAINTIFFS’	
  exhibits	
  are	
  “written	
  instruments”	
  constituting,	
  “in	
  whole	
  or	
  in	
  part,”	
  the	
  claim	
  sued	
  

upon,	
  pursuant	
  to	
  TRCP	
  59.	
  	
  	
  

	
                                               	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                                    5	
  
                    VIII.      IWORKS	
  DEFENDANTS	
  &	
  WM	
  DEFENDANTS	
  ARE	
  NON-­‐SUBSCRIBER’S	
  	
  
                                          TO	
  THE	
  WORKERS’	
  COMPENSATION	
  ACT	
  
	
  
19.        IWORKS	
   DEFENDANTS	
   did	
   not	
   maintain	
   a	
   workers’	
   compensation	
   insurance	
   policy	
   in	
   accordance	
  

with	
   the	
   Workers’	
   Compensation	
   Act	
   and/or	
   did	
   not	
   maintain	
   a	
   workers’	
   compensation	
   insurance	
   policy	
  

that	
  covered	
  MOSE	
  GUILLORY	
  at	
  the	
  time	
  of	
  the	
  incident,	
  which	
  failure	
  makes	
  IWORKS	
  DEFENDANTS	
  a	
  

nonsubscriber.	
  	
  TEXAS	
  LABOR	
  CODE	
  §408.001(a).	
  	
  Because	
  IWORKS	
  DEFENDANTS	
  are	
  nonsubscribers	
  and	
  

their	
  employee,	
  PLAINTIFF	
  MOSE	
  GUILLORY,	
  was	
  injured	
  on	
  the	
  job	
  and	
  by	
  their	
  negligence	
  and/or	
  gross	
  

negligence,	
   the	
   Workers’	
   Compensation	
   Act	
   does	
   not	
   shield	
   IWORKS	
   DEFENDANTS	
   from	
   suit.	
   	
   See	
  TEX.	
  

LAB.	
  CODE	
  §§406.033,	
  408.001	
  

20.        Upon	
   information	
   and	
   belief,	
   WM	
   DEFENDANTS	
   did	
   not	
   maintain	
   a	
   workers’	
   compensation	
  

insurance	
   policy	
   in	
   accordance	
   with	
   the	
   Workers’	
   Compensation	
   Act,	
   did	
   not	
   maintain	
   a	
   workers’	
  

compensation	
   insurance	
   policy	
   that	
   covered	
   MOSE	
   GUILLORY,	
   and/or	
   cannot	
   claim	
   “subscriber”	
   status	
  

under	
   Texas	
   law	
   at	
   the	
   time	
   of	
   the	
   incident,	
   which	
   failure	
   makes	
   WM	
   DEFENDANTS	
   a	
   nonsubscriber.	
  	
  

TEXAS	
   LABOR	
   CODE	
   §408.001(a).	
   	
   Because	
   WM	
   DEFENDANTS	
   are	
   nonsubscribers	
   and	
   their	
   employee,	
  

PLAINTIFF	
  MOSE	
  GUILLORY,	
  was	
  injured	
  on	
  the	
  job	
  and	
  by	
  their	
  negligence	
  and/or	
  gross	
  negligence,	
  the	
  

Workers’	
  Compensation	
  Act	
  does	
  not	
  shield	
  WM	
  DEFENDANTS	
  from	
  suit.	
  	
  See	
   TEX.	
  LAB.	
  CODE	
  §§406.033,	
  

408.001.	
  

21.        Additionally,	
   by	
   virtue	
   of	
   being	
   nonsubscribers,	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
  

are	
   precluded	
   from	
   asserting	
   the	
   following	
   defenses	
   in	
   answering,	
   responding,	
   or	
   defending	
   this	
  

lawsuit:	
  (1)	
  contributory	
  negligence;	
  (2)	
  assumption	
  of	
  the	
  risk;	
  (3)	
  negligence	
  of	
  a	
  fellow	
  employee;	
  

and	
  (4)	
  pre-­‐injury	
  waiver	
  of	
  liability.	
  See	
  TEX.	
  LAB.	
  CODE	
  §406.033(a),	
  (e).	
  	
  

                                                                        IX.         FACTS	
  

22.        LEGAL	
   ISSUES	
   INVOLVED	
   –	
   BACKGROUND.	
   	
   The	
   legal	
   issues	
   involved	
   in	
   this	
   case	
   include	
  

Contract	
  Law,	
  Employment	
  Law,	
  and	
  Tort	
  Law.	
   	
   A	
  brief	
  historical	
  analysis	
  of	
  the	
  interplay	
  of	
  these	
  legal	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                            6	
  
issues	
   is	
   important	
   in	
   understanding	
   Defendants’	
   motivation	
   and	
   Defendants’	
   “borderland”	
   of	
   liability.	
  

Employment	
   law	
   looks	
   at	
   “Who	
   is	
   the	
   Employee?”	
   and	
   “Who	
   is	
   the	
   Employer?”	
   –	
   the	
   latter	
   of	
   which	
   is	
  

critical	
   in	
   assessing	
   who	
   is	
   responsible	
   for	
   employment	
   benefits	
   under	
   various	
   federal	
   and	
   state	
  

employment	
  laws	
  (e.g.	
  worker	
  misclassification	
  –	
  where	
  the	
  misclassification	
  or	
  wrongful	
  classification	
  of	
  

an	
   employee	
   as	
   a	
   “contractor”	
   would	
   essentially	
   deny	
   an	
   employee	
   of	
   most	
   federal	
   employment	
   law	
  

benefits	
   –	
   collective	
   bargaining	
   for	
   example 1 ) 2 .	
   	
   Although	
   seemingly	
   simple,	
   determining	
   this	
  

“employment	
   relationship”	
   is	
   often	
   times	
   difficult,	
   under	
   the	
   law3.	
   	
   In	
   determining	
   this	
   “employment	
  

relationship,”	
  employers	
  have	
  taken	
  great	
  strides	
  in	
  blurring	
  the	
  lines	
  of	
  the	
  employment	
  relationship	
  in	
  

an	
   effort	
   to	
   operate	
   outside	
   federal	
   and	
   state	
   employment	
   laws	
   –	
   to	
   operate	
   in	
   the	
   “borderland”4	
  of	
  

liability.	
  	
  The	
  objective	
  is	
  obvious	
   –	
  when	
  the	
  employment	
  relationship	
  is	
  unclear,	
  employment	
  rights	
  are	
  

unclear5;	
   and,	
   as	
   a	
   result,	
   a	
   financial	
   windfall	
   is	
   reaped	
   by	
   the	
   employer	
   who	
   blurred	
   the	
   lines6.	
   	
   This	
  

	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
1	
  http://mynlrb.nlrb.gov/link/document.aspx/09031d4580022ea1	
  
2	
  See	
   WHD	
  News	
  Release	
  11-­‐1373-­‐NAT,	
  Labor	
  Secretary,	
  IRS	
  Commissioner	
  Sign	
  Memorandum	
  of	
  Understanding	
  to	
  Improve	
  

Agencies’	
  Coordination	
  on	
  Employee	
  Misclassification	
  Compliance	
  and	
  Education	
  (Sept.	
  19,	
  2011).	
  Deputy	
  Secretary	
  of	
  Labor	
  
Seth	
  Harris	
  explained	
  the	
  significance	
  of	
  the	
  problem	
  of	
  worker	
  misclassification	
  in	
  his	
  testimony	
  before	
  Congress:	
  
	
  	
  
               “Misclassification”	
   seems	
   to	
   suggest	
   a	
   technical	
   violation	
   or	
   a	
   paperwork	
   error.	
   But	
   “worker	
  
               misclassification”	
   actually	
   describes	
   workers	
   being	
   illegally	
   deprived	
   of	
   labor	
   and	
   employment	
   law	
  
               protections,	
   as	
   well	
   as	
   public	
   benefits	
   programs	
   like	
   unemployment	
   insurance	
   and	
   workers’	
  
               compensation	
   because	
   such	
   programs	
   generally	
   apply	
   only	
   to	
   “employees”	
   rather	
   than	
   workers	
   in	
  
               general.	
   .	
   .	
   .	
   Misclassification	
   is	
   no	
   mere	
   technical	
   violation.	
   It	
   is	
   a	
   serious	
   threat	
   to	
   workers	
   and	
   the	
   fair	
  
               application	
  of	
  the	
  laws	
  Congress	
  has	
  enacted	
  to	
  assure	
  workers	
  have	
  good,	
  safe	
  jobs.	
  	
  
	
  
Leveling	
   the	
   Playing	
   Field:	
   Protecting	
   Workers	
   and	
   Businesses	
   Affected	
   by	
   Misclassification	
   Before	
   the	
   S.	
   Comm.	
   On	
   Health,	
  
Education,	
  Labor	
  and	
  Pensions,	
  111th	
  Cong.	
  (2010)	
  (statement	
  of	
  Seth	
  Harris,	
  Deputy	
  Sec’y	
  of	
  Labor).	
  
3	
  The	
   Supreme	
   Court,	
   for	
   example,	
   has	
   referred	
   to	
   the	
   definition	
   of	
   an	
   employee	
   under	
   the	
   Americans	
   with	
   Disabilities	
   Act	
   as	
   a	
  

“mere	
   ‘nominal	
   definition,’”	
   Clackamas	
   Gastroenterology	
   Assocs.	
   v.	
   Wells,	
   538	
   U.S.	
   440,	
   444	
   (2003),	
   and	
   has	
   stated	
   that	
   the	
  
definition	
  of	
  an	
  employee	
  under	
  the	
  Employee	
  Retirement	
  Income	
  Security	
  Act	
  is	
  “completely	
  circular	
  and	
  explains	
  nothing,”	
  
Nationwide	
  Mut.	
  Ins.	
  Co.	
  v.	
  Darden,	
  503	
  U.S.	
  318,	
  323	
  (1992).	
  
4	
  See	
  NLRB	
  v.	
  Hearst	
  Publ’ns,	
  Inc.,	
  322	
  U.S.	
  111,	
  121	
  (1944)	
  (quoting	
  U.S.	
  Supreme	
  Court	
  Justice	
  Wiley	
  Blount	
  Rutledge).	
  
5	
  See	
  Mitchell	
   H.	
   Rubinstein,	
   Our	
  Nation’s	
  Forgotten	
  Workers:	
  The	
  Unprotected	
  Volunteers,	
   9	
   U.	
   OF	
   PA.	
   J.	
   LAB.	
   &	
   EMP.	
   L.	
   147,	
   151	
  

(2006)	
  (citing	
  Seattle	
  Opera	
  v.	
  NLRB,	
  292	
  F.3d	
  757,	
  759	
  (D.C.	
  Cir.	
  2002))	
  (holding	
  that	
  an	
  individual	
  was	
  an	
  employee	
  under	
  
NLRA	
  even	
  though	
  he	
  was	
  not	
  paid	
  the	
  minimum	
  wage	
  and	
  did	
  not	
  receive	
  tax	
  form	
  W-­‐2);	
  see	
  also	
  Hopkins	
  v.	
  Cornerstone	
  Am,	
  
545	
   F.3d	
   338,	
   347	
   (5th	
   Cir.	
   2008)	
   (stating	
   that	
   it	
   is	
   not	
   inconsistent	
   to	
   be	
   considered	
   an	
   employee	
   under	
   the	
   FLSA,	
   but	
   an	
  
independent	
   contractor	
   under	
   other	
   statutes);	
   City	
  Cab	
  Co.	
  of	
  Orlando,	
   285	
   N.L.R.B.	
   1191,	
   1193	
   (1987)	
   (holding	
   that	
   employee	
  
status	
  determinations	
  of	
  other	
  governmental	
  agencies	
  are	
  not	
  controlling,	
  but	
  should	
  be	
  given	
  consideration	
  by	
  the	
  NLRB);	
  see	
  
BWI	
  Taxi	
  Mgmt,	
  No.	
  5-­‐RC-­‐4836874,	
  2010	
  WL	
  4836874,	
  at	
  *9	
  n.15	
  (NLRB	
  Reg.	
  Dir.	
  Sept.	
  16,	
  2010)	
  (stating	
  that	
  the	
  petitioner	
  
received	
  a	
  letter	
  saying	
  he	
  was	
  an	
  independent	
  contractor	
  under	
  the	
  EEOC,	
  but	
  was	
  considered	
  an	
  employee	
  under	
  the	
  NLRA);	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                                                                                7	
  
financial	
   windfall	
   and	
   danger	
   to	
   the	
   American	
   worker	
   has	
   seen	
   its	
   greatest	
   rise	
   in	
   the	
   “contingent	
  

workforce”	
  and	
  in	
  recent	
  years	
  –	
  to	
  wit:	
  

                                                      •                                                      U.S.	
  Labor	
  Department	
  reports	
  that	
  in	
  2013,	
  the	
  nation	
  had	
  more	
  temp	
  workers	
  than	
  ever	
  
                                                                                                             before:	
  2.7	
  million	
  	
  temp	
  workers	
  in	
  U.S.7.	
  
                                                                                                             	
  
                                                      •                                                      Since	
  the	
  recession	
  ended	
  in	
  mid-­‐2009,	
  20%	
  of	
  job	
  growth	
  has	
  been	
  the	
  temp	
  sector8.	
  
                                                                                                             	
  
                                                      •                                                      Temp	
  work	
  is	
  roaring	
  back	
  10x	
  faster	
  than	
  private-­‐sector	
  employment9.	
  
                                                                                                             	
  
                                                      •                                                      On	
  average,	
  temps	
  earn	
  25%	
  less	
  than	
  permanent	
  workers.	
  
	
  
                                                      •                                                      African	
   Americans	
   make	
   up	
   11%	
   of	
   the	
   overall	
   workforce	
   but	
   20%	
   of	
   the	
   temp	
  
                                                                                                             workforce.	
  	
  	
  
                                                                                                             	
  
                                                      •                                                      U.S.	
  Government	
  does	
  not	
  keep	
  statistics	
  on	
  injuries	
  among	
  temp	
  workers.	
  	
  
                                                                                                             	
  
                                                      •                                                      Study	
   shows	
   that	
   temp	
   workers	
   in	
   construction	
   and	
   manufacturing	
   were	
   2x	
   as	
   likely	
   to	
   be	
  
                                                                                                             injured	
  as	
  regular	
  staff	
  doing	
  the	
  same	
  work10.	
  
                                                                                                             	
  
                                                      •                                                      OSHA	
   announced	
   an	
   initiative	
   to	
   get	
   better	
   information	
   on	
   temp-­‐worker	
   safety	
   –	
   stating:	
  
                                                                                                             “Employers,	
  we	
  think,	
  do	
  not	
  have	
  the	
  same	
  commitment	
  to	
  providing	
  a	
  safe	
  workplace,	
  
                                                                                                             to	
   providing	
   the	
   proper	
   training,	
   to	
   a	
   worker	
   who	
   they	
   may	
   only	
   be	
   paying	
   for	
   a	
   few	
  
                                                                                                             weeks…	
  	
  I	
  mean,	
  we’ve	
  seen	
  just	
  ghastly	
  situations.11”	
  
	
  
                                                      •                                                      Adding	
  to	
  the	
  “Who	
  is	
  the	
  Employer”	
  confusion	
  -­‐	
  33	
  states	
  have	
  statutes	
  or	
  regulations	
  
                                                                                                             that	
   address	
   employee	
   leasing	
   and	
   its	
   effect	
   on	
   which	
   entity	
   is	
   the	
   actual	
   employer,	
  
                                                                                                             while	
  17	
  states	
  and	
  the	
  District	
  of	
  Columbia	
  make	
  such	
  decisions	
  by	
  Court	
  opinions.	
  
	
  

	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
Seattle	
   Opera,	
   292	
   F.3d	
   at	
   761–62	
   (holding	
   individual	
   was	
   an	
   employee	
   even	
   though	
   he	
   was	
   treated	
   as	
   an	
   independent	
  
contractor	
   for	
   tax	
   purposes	
   in	
   that	
   he	
   did	
   not	
   receive	
   a	
   W-­‐2	
   tax	
   form).	
   	
   See	
  also	
  Richard	
   R.	
   Carlson,	
   Why	
  the	
  Law	
  Still	
  Can’t	
  Tell	
  
an	
  Employee	
  When	
  It	
  Sees	
  One	
  and	
  How	
  It	
  Ought	
  to	
  Stop	
  Trying,	
  22	
  BERKELEY	
  J.	
  EMP.	
  &	
  LAB.	
  L.	
  295,	
  296	
  (2001)	
  (describing	
  
statutory	
  definitions	
  of	
  employee	
  status	
  as	
  “baffling”).	
  
6	
  It	
   has	
   been	
   estimated	
   that	
   classifying	
   individuals	
   as	
   independent	
   contractors	
   instead	
   of	
   as	
   employees	
   might	
   result	
   in	
   a	
  

savings	
  of	
  twenty	
  to	
  forty	
  percent	
  of	
  labor	
  costs	
  to	
  the	
  quasi-­‐employer.	
  	
  See	
  Jenna	
  Amato	
  Moran,	
  Note,	
   Independent	
  Contractor	
  
or	
  Employee?	
  Misclassification	
  of	
  Workers	
  and	
  Its	
  Effect	
  on	
  the	
  State,	
  28	
  BUFF.	
  PUB.	
  INT.	
  L.J.	
  105,	
  121	
  (2010).	
  	
  	
  
7	
  See	
  http://www.bls.gov/news.release/empsit.t17.htm	
  
8	
  Id.	
  	
  	
  
9	
  American	
  Staffing	
  Association	
  
10	
  http://www.ncbi.nlm.nih.gov/pubmed/19618410	
  
11 	
  http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=23994	
   (quoting	
   David	
  

Michaels,	
  OSHA	
  Director).	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        8	
  
                      •                      Recently,	
   temp	
   firms	
   have	
   successfully	
   lobbied	
   to	
   change	
   laws	
   or	
   regulatory	
  
                                             interpretations	
  in	
  31	
  states,	
  so	
  that	
  workers	
  who	
  lose	
  their	
  temp	
  assignments	
  and	
  are	
  
                                             out	
  of	
  work	
  cannot	
  get	
  unemployment	
  benefits12.	
  
	
  
As	
  is	
   clear,	
  the	
   “contingent	
   workforce”	
   is	
   larger	
   than	
   ever	
   at	
   2.7	
   million	
   temp	
   workers,	
   growing	
   ten	
   times	
  

faster	
   than	
   private	
   sector	
   employment,	
   and	
   is	
   made	
   up	
   of	
   minorities	
   whom	
   earn	
   a	
   quarter	
   less,	
   get	
  

injured	
  twice	
  as	
  much,	
  and	
  are	
  less	
  likely	
  to	
  understand	
  or	
  be	
  able	
  to	
  exercise	
  their	
  employment	
  rights	
  

under	
  the	
  law.	
  	
  That	
  is,	
  cases	
  like	
  Plaintiffs’	
  case	
  are	
  expected	
  to	
  rise	
  with	
  this	
  horrific	
  trend.	
  	
  Applying	
  the	
  

above	
   to	
   the	
   case	
   at	
   bar,	
   it	
   is	
   no	
   wonder	
   the	
   incident	
   involving	
   Plaintiff	
   Mose	
   Guillory	
   happened	
  

necessitating	
  this	
  lawsuit.	
  

23.                   PLAINTIFFS.	
   	
   Plaintiffs	
   complain	
   of	
   Defendants	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS,	
  

for	
   their	
   actions	
   and	
   inactions,	
   both	
   singularly,	
   in	
   combination,	
   and/or	
   collectively,	
   for	
   breaching	
   their	
  

duties	
  of	
  safety,	
  safety	
  training,	
  and	
  workers’	
  compensation	
  coverage/compliance	
  to	
  and	
  for	
  the	
  benefit	
  

of	
  Plaintiff	
  Mose	
  Guillory,	
  inter	
  alia,	
  which	
  breaches	
  proximately	
  caused	
  Plaintiffs’	
  damages,	
  as	
  set	
  forth	
  

more	
  fully	
  below.	
  	
  	
  	
  	
  

24.                   IWORKS	
   DEFENDANTS.	
   	
   Defendant	
   IWORKS	
   PERSONNEL,	
   INC.	
   is	
   owned	
   and	
   operated	
   by	
   LUIS	
  

TREVINO	
  and	
  HAYDEE	
  GUTIERREZ.	
  	
  IWORKS	
  PERSONNEL,	
  INC.	
  is	
  in	
  the	
  business	
  of	
  leasing	
  employees	
  

for	
   skilled	
   jobs	
   in	
   many	
   different	
   industries,	
   including	
   but	
   not	
   limited	
   to:	
   “construction,	
   manufacturing,	
  

warehousing,	
   retail,	
   events	
   and	
   hospitality,	
   waste,	
   recycling,	
   transportation,	
   and	
   disaster	
   relief.”	
   	
   See	
  

http://www.iworkspersonnel.com.	
  	
  Regarding	
  the	
  type	
  of	
  services	
  provided	
  to	
  its	
  leased	
  employees	
  and	
  

to	
  client	
  companies,	
  Defendant	
  IWORKS	
  PERSONNEL,	
  INC.	
  also	
  states	
  the	
  following	
  –	
  to	
  wit:	
  

                                                      How	
  does	
  iWORKS	
  PERSONNEL	
  help	
  solve	
  your	
  people	
  issues?	
  
                                                                                                                                                                                                                                   	
  
                                                                                                                                                                                                                                 ***	
  
                                                      	
  
                                                      *	
  	
                                                We	
  offer	
  free	
  Basic	
  PPE	
  (Personal	
  Protective	
  Equipment)	
  
                                                      *	
  	
                                                Basic	
  Safety	
  Training	
  (not	
  site	
  specific)	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
12	
  http://www.workforcesecurity.doleta.gov/unemploy/pdf/uilawcompar/2013/nonmonetary.pdf	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                                                                                        9	
  
           *	
  	
     WE	
  PAY	
  ALL	
  PAYROLL	
  TAXES	
  and	
  file	
  them	
  
           *	
  	
     WE	
  PAY	
  ALL	
  UNEMPLOYMENT	
  TAXES	
  and	
  file	
  them	
  
           *	
  	
     WE	
  PROVIDE	
  WORKERS	
  COMPENSATION	
  
           *	
  	
     WE	
  PROVIDE	
  1	
  worker	
  or	
  hundreds,	
  for	
  the	
  day	
  or	
  as	
  long	
  as	
  you	
  need	
  them	
  
                       (minimum	
  4	
  hours)	
  
	
  
See	
  http://iworkspersonnel.com/clientsolution.aspx	
  (emphasis	
  added).	
  	
  As	
  is	
  clear,	
  in	
  addition	
  to	
  

supplying	
  client	
  companies	
  with	
  leased	
  employees	
  or	
  temporary	
  workers,	
  IWORKS	
  DEFENDANTS	
  also	
  

have	
  the	
  duty	
  and	
  responsibility	
  to	
  provide	
  worker’s	
  compensation.	
  	
  	
  	
  

25.        WM	
  DEFENDANTS.	
  	
  Defendants	
  WASTE	
  MANAGEMENT,	
  INC.,	
  WASTE	
  MANAGEMENT	
  OF	
  TEXAS,	
  

INC.,	
  and	
  WM	
  RECYCLE	
  AMERICA,	
  LLC	
  are	
  hereinafter	
  sometimes	
  referred	
  to	
  as	
  “WASTE	
  MANAGEMENT”	
  

or	
   “WM	
   DEFENDANTS.”	
   	
   Upon	
   information	
   and	
   belief,	
   WASTE	
   MANAGEMENT,	
   INC.	
   is	
   a	
   holding	
   company	
  

and	
  WASTE	
  MANAGEMENT	
  OF	
  TEXAS,	
  INC.	
  and	
  WM	
  RECYCLE	
  AMERICA,	
  LLC	
  are	
  its	
  subsidiaries,	
  which	
  

operate	
   Defendants	
   WASTE	
  MANAGEMENT’s	
   Facility	
   at	
   4939	
   Gasmer	
   Dr.,	
   Houston,	
  Harris	
   County,	
   Texas	
  

77035	
   (“Facility”)	
   and	
   which	
   provide	
   collection,	
   transfer,	
   recycling,	
   and	
   disposal	
   services,	
   under	
   the	
  

direction	
  and	
  control	
  of	
  Defendant	
  WASTE	
  MANAGEMENT,	
  INC.	
  	
  WM	
  DEFENDANTS	
  claim	
  the	
  following	
  

about	
  itself	
  as	
  a	
  corporation(s)	
  and	
  about	
  its	
  safety	
  policies	
  –	
  to	
  wit:	
  

           Waste	
  Management	
  is	
  the	
  largest	
  environmental	
  solutions	
  provider	
  in	
  North	
  America,	
  
           serving	
   more	
   than	
   20	
   million	
   customers	
   in	
   the	
   U.S.,	
   Canada	
   and	
   Puerto	
   Rico….	
   	
   As	
   North	
  
           America’s	
  largest	
  residential	
  recycler,	
  we	
  expect	
  to	
  manage	
  more	
  than	
  20	
  million	
  tons	
  
           every	
  year	
  by	
  2020,	
  up	
  from	
  the	
  more	
  than	
  12	
  million	
  tons	
  we	
  handled	
  in	
  2012.	
  	
  
	
  
See	
  http://www.wm.com/about/index.jsp	
  (emphasis	
  added).	
  

           At	
   Waste	
   Management,	
   safety	
   is	
   a	
   core	
   value	
   and	
   a	
   cornerstone	
   of	
   operational	
  
           excellence.	
  This	
  philosophy	
  is	
  embedded	
  in	
  the	
  way	
  we	
  work,	
  the	
  decisions	
  we	
  make	
  and	
  
           the	
  actions	
  we	
  take….	
  	
  Our	
  plan	
  of	
  action	
  is	
  called	
  Mission	
  to	
  Zero	
  (M2Z),	
  which	
  means	
  zero	
  
           tolerance	
   for	
   unsafe	
   actions,	
   unsafe	
   decisions,	
   unsafe	
   conditions,	
   unsafe	
   equipment	
  
           and	
   unsafe	
   attitudes.	
   	
   The	
   cornerstone	
   of	
   M2Z	
   is	
   training,	
   which	
   provides	
   classroom	
  
           and	
   on-­‐the-­‐job	
   site	
   instruction	
   in	
   safety	
   fundamentals	
   for	
   supervisors,	
   drivers	
   and	
  
           helpers.	
   Operations	
   Rule	
   Book,	
   Driving	
   Science	
   Series	
   videos	
   and	
   Electronic	
   Observation	
  
           Behavior	
  Assessments	
  are	
  just	
  a	
  few	
  of	
  the	
  tools	
  available	
  to	
  our	
  frontline	
  managers	
  to	
  help	
  
           them	
   to	
   develop	
   our	
   employees….	
   	
   Waste	
   Management	
   sites	
   continuously	
   monitor	
   and	
  
           measure	
   safety	
   performance….	
   	
   Through	
   established	
   safety	
   processes	
   and	
   procedures,	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                 10	
  
           our	
  goal	
  of	
  zero	
  accidents	
  and	
  injuries	
  is	
  transformed	
  into	
  measurable	
  results	
  that	
  have	
  a	
  
           positive	
  impact	
  on	
  thousands	
  of	
  people.	
  
	
  
See	
  http://investors.wm.com/phoenix.zhtml?c=119743&p=irol-­‐govhighlights	
  (“Safety	
  Policy”	
  download)	
  

(emphasis	
  added).	
  	
  As	
  is	
  clear,	
  WM	
  DEFENDANTS,	
  combined,	
  are	
  a	
  large	
  corporation	
  who,	
  given	
  its	
  size	
  

and	
  breadth,	
  recognize	
  their	
  duty	
  and	
  responsibility	
  to	
  provide	
  safety,	
  training,	
  and	
  monitoring	
  of	
  safety	
  

and	
  training.	
  

26.        DEFENDANTS’	
   Relationships.	
   	
   At	
   all	
   times	
   material	
   hereto,	
   DEFENDANTS	
   entered	
   into	
  

contractual	
   agreements	
   and	
   relationships	
   with	
   one	
   another	
   for	
   the	
   performance	
   of	
   their	
   duties,	
   as	
   it	
  

pertains	
   to	
   Plaintiff	
  Mose	
  Guillory,	
  which	
  contractual	
  agreements	
  were	
  entered	
  into	
  prior	
  to	
  July	
  9,	
  2012.	
  	
  

See	
  Exhibit	
   A	
  (WM	
  DEFENDANTS’	
  Master	
  Agreement	
  with	
  IWORKS	
  DEFENDANTS)	
  and	
  Exhibit	
   B	
  (Heavy	
  

Equipment	
  Operator	
  Agreement	
  between	
  WM	
  DEFENDANTS	
  and	
  IWORKS	
  DEFENDANTS).	
  

27.        Plaintiff	
   Mose	
   Guillory	
   –	
   Employed	
   by	
   IWORKS	
   DEFENDANTS	
   and	
   Leased	
   to	
   WM	
  

DEFENDANTS.	
  	
  On	
  or	
  about	
  the	
  morning	
  of	
  July	
  9,	
  2012,	
  Plaintiff	
  MOSE	
  GUILLORY	
  applied	
  for	
  a	
  job	
  at	
  

IWORKS’s	
   Houston,	
   Texas	
   office.	
   	
   Shortly	
   after	
   filling	
   out	
   an	
   application	
   at	
   IWORKS’s	
   Houston,	
   Texas	
  

office,	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  received	
  a	
  call	
  from	
  IWORKS,	
  wherein	
  IWORKS	
  informed	
  PLAINTIFF	
  

MOSE	
   GUILLORY	
   that	
   he	
   was	
   hired	
   and	
   that	
   he	
   was	
   being	
   assigned	
   to	
   WASTE	
   MANAGEMENT	
   at	
   its	
  

facility	
  located	
  at	
  4939	
  Gasmer	
  Dr.,	
  Houston,	
  Harris	
  County,	
  Texas	
  77035	
  (“Facility”	
  or	
  “Gasmer	
  MRF”).	
  

28.        MOSE	
   GUILLORY	
   was	
   leased	
   to	
   Gasmer	
   MRF	
   to	
   perform	
   tasks	
   involving	
   “a	
   particular	
   skill;	
   .	
   .	
   .	
  

training	
   in	
   a	
   particular	
   occupation,	
   craft,	
   or	
   trade;	
   .	
   .	
   .	
   or	
   practical	
   knowledge	
   of	
   the	
   principles	
   or	
  

processes	
  of	
  an	
  art,	
  science,	
  craft,	
  or	
  trade.”	
  See	
  Tex.	
  Lab.	
  Code	
  §92.002(3)(a)-­‐(c).	
  	
  	
  

29.        Plaintiff	
   Mose	
   Guillory	
   –	
   Employed	
   by	
   WM	
   DEFENDANTS.	
  	
  At	
  or	
  around	
  12:00	
  pm	
  on	
  July	
  9,	
  

2012,	
   Plaintiff	
   MOSE	
   GUILLORY	
   reported	
   to	
   the	
   WASTE	
   MANAGEMENT	
   Facility	
   where	
   he	
   was	
   instructed	
  

to	
   drive	
   a	
   front-­‐end	
   loader	
   while	
   a	
   maintenance	
   employee,	
   Abraham	
   Hernandez,	
   observed.	
   	
   After	
   a	
   short	
  

demonstration,	
   Abraham	
   Hernandez	
   was	
   satisfied	
   that	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   had	
   the	
   requisite	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                       11	
  
skill	
  to	
  drive	
  and	
  operate	
  the	
  front-­‐end	
  loader	
  at	
  WASTE	
  MANAGEMENT	
  and	
  instructed	
  PLAINTIFF	
  MOSE	
  

GUILLORY	
  to	
  report	
  for	
  work	
  the	
  next	
  morning	
  –	
  July	
  10,	
  2012.	
  	
  

30.         For	
   the	
   first	
   week	
   of	
   his	
   employment,	
   from	
   roughly	
   July	
   10,	
   2012—July	
   16,	
   2012,	
   PLAINTIFF	
  

MOSE	
   GUILLORY	
   worked	
   on	
   the	
   day	
   shift	
   at	
   WASTE	
   MANAGEMENT’s	
   Facility.	
   	
   This	
   shift	
   was	
   from	
  

approximately	
   5:00	
   a.m.	
   until	
   4:30	
   p.m.,	
   approximately	
   seven	
   days	
   per	
   week.	
   	
   During	
   that	
   time,	
  

PLAINTIFF	
   MOSE	
   GUILLORY’S	
   primary	
   job	
   duty	
   was	
   to	
   drive	
   and	
   operate	
   a	
   front-­‐end	
  loader.	
  	
  Thereafter,	
  

approximately	
   one	
   or	
   two	
   weeks	
   after	
   starting	
   work	
   at	
   WASTE	
   MANAGEMENT’s	
   Facility,	
   PLAINTIFF	
  

MOSE	
  GUILLORY	
  was	
  re-­‐scheduled	
  to	
  work	
  the	
  night	
  shift	
  from	
  4:30	
  p.m.	
  until	
  5:00	
  a.m.	
  	
  

31.         Upon	
   joining	
   the	
   night	
   shift	
   and	
   sometime	
   thereafter,	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   was	
   instructed	
  

to	
  operate	
  a	
  Harris	
  Centurion	
  Baler.	
  	
  	
  	
  

32.         Harris	
  Baler.	
  	
  The	
  product	
  in	
  question,	
  a	
  Harris	
   Centurion	
  Baler,	
  is	
  a	
  piece	
  of	
   “heavy	
  equipment”	
  

or	
  industrial	
  machinery	
  used	
  in	
  recycling	
  facilities	
  primarily	
  for	
  baling	
  metal,	
  plastic,	
  cardboard,	
  or	
  paper	
  

for	
   transport.	
   	
   The	
   product	
   is	
   designed	
   to	
   operate	
   in	
   the	
   following	
   manner:	
   the	
   user	
   stands	
   on	
   a	
   platform	
  

in	
  front	
  of	
  a	
  control	
  port	
  and	
  activates	
  a	
  conveyor	
  belt	
  that	
  carries	
  loose	
  product	
  (paper,	
  plastic,	
  metal,	
  

etc.)	
   into	
   the	
   baler;	
   then,	
   the	
   user	
   engages	
   the	
   baler’s	
   hydraulic	
   rams,	
   which	
   compresses	
   the	
   material	
  

loaded	
  into	
  compact,	
  transportable	
  bales.	
  	
  	
  

33.         The	
   Harris	
   Baler	
   is	
   sold	
   with	
   a	
   25-­‐minute	
   training	
   video	
   that	
   addresses	
   safety	
   and	
   a	
   200-­‐page	
  

“Operator/Service	
   Manual”	
   that	
   must	
   be	
   read	
   and	
   understood	
   before	
   operation.	
   	
   Before	
   operating	
   the	
  

Harris	
   Centurion	
   Baler,	
   one	
   must	
   have	
   received	
   OSHA-­‐mandated	
   “Lockout-­‐Tagout”	
   (“LOTO”)	
   training.	
  	
  

See	
   29	
   C.F.R.	
   1910.147.	
   LOTO	
   requires	
   that	
   hazardous	
   power	
   sources	
   be	
   “isolated	
   and	
   rendered	
  

inoperative”	
  before	
  any	
  maintenance	
  or	
  servicing	
  work	
  is	
  performed	
  to	
  prevent	
  serious	
  injury	
  or	
  death.	
  

34.         No	
   Training	
   on	
   the	
   Harris	
   Baler.	
   	
   At	
   no	
   point	
   was	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   shown	
   any	
  

training	
   video	
   detailing	
   how	
   to	
   safely	
   operate	
   the	
   Harris	
   Baler.	
   	
   At	
   no	
   point	
   was	
   PLAINTIFF	
   MOSE	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                             12	
  
GUILLORY	
  told	
  about	
  or	
  given	
  any	
  operator’s	
  manual	
  detailing	
  how	
  to	
  safely	
  operate	
  the	
  Harris	
  Baler.	
  	
  At	
  

no	
   point	
   was	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   given	
   any	
   training	
   or	
   exposed	
   to	
   any	
   material	
   whatsoever,	
  

whether	
   in	
   audio,	
   video,	
   written,	
   electronic,	
   or	
   other	
   format,	
   detailing	
   how	
   to	
   safely	
   operate	
   the	
   Harris	
  

Baler.	
   	
   At	
   no	
   point	
   was	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   provided	
   any	
   OSHA-­‐mandated	
   “Lockout-­‐Tagout”	
  

(“LOTO”)	
  training.	
  	
  See	
  29	
  C.F.R.	
  1910.147.	
  	
  	
  

35.         No	
   Training	
   on	
   the	
   Harris	
   Baler	
   -­‐	
   Carlos.	
   	
   Instead,	
   the	
   full	
   extent	
   of	
   PLAINTIFF	
   MOSE	
  

GUILLORY’S	
   “training”	
   (which	
   Plaintiffs	
   dispute)	
   was	
   observations	
   from	
   a	
   coworker	
   named	
   Carlos.	
  	
  

Carlos	
   is	
   a	
   Hispanic	
   man	
   whose	
   first	
   language	
   is	
   Spanish.	
   	
   Carlos	
   cannot	
   fluently	
   speak	
   or	
   understand	
  

English	
   well.	
   	
   PLAINTIFF	
   MOSE	
   GUILLORY’S	
   first	
   language	
   is	
   English.	
   	
   PLAINTIFF	
   MOSE	
   GUILLORY	
  

cannot	
   speak	
   or	
   understand	
   Spanish.	
   Regardless,	
   Carlos	
   demonstrated	
   that,	
   at	
   certain	
   times,	
   the	
   baler	
  

operator	
  must	
  disengage	
  the	
  baler,	
  climb	
  onto	
  the	
  conveyor,	
  walk	
  up	
  to	
  the	
  top	
  of	
  the	
  conveyor	
  near	
  the	
  

baler	
  mouth,	
  and	
  use	
  a	
  pole	
  to	
  sweep	
  product	
  down	
  onto	
  the	
  conveyor	
  belt	
  from	
  various	
  bins	
  adjacent	
  to	
  

the	
  baler.	
  	
  Little	
  more	
  was	
  provided	
  to	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  on	
  how	
  to	
  safely	
  operate	
  the	
  Harris	
  

Baler.	
   	
   And,	
   at	
   no	
   time	
   did	
   Carlos	
   ever	
   instruct	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   on	
   proper	
   OSHA	
  

Lockout/Tagout	
  procedures.	
  	
  	
  	
  	
  	
  

36.         August	
  5,	
  2012	
   –	
  Incident	
  at	
  Issue.	
  	
  On	
  August	
  5,	
  2012,	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  reported	
  for	
  

work	
   on	
   the	
   night	
   shift	
   and	
   began	
   to	
   operate	
   the	
   Harris	
   Baler,	
   as	
   instructed.	
   	
   At	
   that	
   time,	
   PLAINTIFF	
  

MOSE	
  GUILLORY	
  had	
  only	
  operated	
  the	
  Harris	
  Baler	
  approximately	
  three	
  to	
  four	
  times	
  total.	
   	
   Sometime	
  

after	
  beginning	
  to	
  operate	
  the	
  Harris	
  Baler,	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  disengaged	
  the	
  baler/conveyor	
  

and	
  climbed	
  onto	
  the	
  conveyor	
  and	
  then	
  into	
  the	
  baler,	
  as	
  he	
  had	
  seen	
  Carlos	
  do	
  before.	
  	
  Suddenly,	
  and	
  

without	
   warning,	
   the	
   Harris	
   Baler	
   turned	
   on	
   and	
   the	
   baler	
   rams	
   engaged.	
   	
   The	
   baler	
   rams	
   severed	
  

PLAINTIFF	
  MOSE	
  GUILLORY’S	
  right	
  leg	
  just	
  below	
  the	
  knee	
  and	
  severed	
  all	
  toes	
  and	
  a	
  portion	
  of	
  his	
  left	
  

foot.	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                          13	
  
37.        Plaintiff	
  Mose	
  Guillory	
  –	
  Hospitalized.	
  	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  was	
  taken	
  by	
  ambulance	
  to	
  

Memorial	
   Hermann	
   Hospital	
   in	
   the	
   Houston	
   Medical	
   Center.	
   	
   There,	
   PLAINTIFF	
   MOSE	
   GUILLORY	
  

underwent	
  multiple	
  surgeries	
  lasting	
  several	
  hours.	
  	
  These	
  surgeries	
  were	
  required	
  to	
  complete	
  the	
  full	
  

amputation	
   of	
   PLAINTIFF	
   MOSE	
   GUILLORY’S	
   right	
   leg	
   below	
   the	
   knee	
   as	
   well	
   as	
   all	
   toes	
   and	
   a	
   portion	
   of	
  

his	
  left	
  foot.	
  	
  As	
  a	
  result	
  of	
  the	
  aforementioned	
  events,	
  Plaintiff	
  MOSE	
  GUILLORY	
  was	
  hospitalized	
  for	
  

roughly	
  seventeen	
  (17)	
  days.	
  

38.        While	
   in	
   the	
   hospital	
   and	
   while	
   in	
   ICU,	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   was	
   heavily	
   medicated.	
  	
  

During	
   this	
   time,	
   he	
   was	
   approached	
   by	
   agents	
   of	
   IWORKS	
   whom	
   presented	
   him	
   with	
   various	
   papers,	
  

authorizations,	
  and/or	
  releases	
  to	
  obtain	
  information	
  without	
  his	
  informed	
  consent.	
  	
  In	
  an	
  incapacitated	
  

state,	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   signed	
   documents	
   for	
   IWORKS	
   DEFENDANTS	
   and/or	
   WM	
  

DEFENDANTS.	
  

39.        IWORKS	
  and	
  WM	
  DEFENDANTS’	
  Cover-­‐Up.	
  	
  Upon	
  information	
  and	
  belief	
  following	
  the	
  incident,	
  

IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   took	
   steps	
   to	
   cover	
   up	
   the	
   incident	
   including,	
   among	
  

others,	
  firing	
  employees,	
  which	
  former	
  employees	
  have	
  advised	
  counsel	
  for	
  PLAINTIFFS	
  that	
  Defendant	
  

WASTE	
  MANAGEMENT	
  is	
  and	
  was	
  taking	
  steps	
  to	
  cover	
  up	
  the	
  incident.	
  	
  	
  	
  	
  

40.        iWorks	
   did	
   not	
   think	
   it	
   was	
   iWorks’	
   obligation	
   to	
   train	
   employees	
   before	
   sending	
   them	
   to	
   Gasmer	
  

MRF.	
   	
   iWorks	
   claims	
   it	
   did	
   not	
   know	
   WM	
   DEFENDANTS	
   were	
   expecting	
   it	
   (IWORKS)	
   to	
   train.	
   	
   WM	
  

DEFENDANTS	
   did	
   not	
   know	
   that	
   iWorks	
   was	
   not	
   training	
   or	
   qualifying	
   employees	
   it	
   (IWORKS)	
   was	
  

sending	
   over.	
   	
   Accordingly,	
   WM	
   DEFENDANTS	
   did	
   not	
   train.	
   	
   Instead,	
   due	
   to	
   the	
   break	
   down	
   in	
  

communications,	
   Mose	
   Guillory	
   received	
   zero	
   training	
   from	
   either	
   iWorks	
   or	
   WM	
   DEFENDANTS.	
   	
   In	
   fact,	
  

the	
  failure	
  to	
  train	
  Mose	
  Guillory	
  on	
  lock-­‐out/tag-­‐out	
  (“LO/TO”)	
  and	
  to	
  ensure	
  that	
  he	
  did	
  not	
  operate	
  the	
  

Harris	
   Baler	
   without	
   proper	
   LO/TO	
   training	
   resulted	
   in	
   violations	
   of	
   OSHA	
   regulations	
   and	
   hefty	
   fines	
  

imposed	
  on	
  the	
  site	
  owner,	
  WM	
  DEFENDANTS.	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                         14	
  
41.       As	
   further	
   evidence	
   of	
   the	
   communication	
   (“conduit”)	
   breakdown,	
   Plaintiffs	
   offer	
   the	
   deposition	
  

testimony	
  Defendant	
  LUIS	
  TREVINO,	
  CEO	
  and	
  part	
  owner	
  of	
  iWorks.	
  	
  Mr.	
  Trevino	
  testified,	
  inter	
  alia,	
  that	
  

Defendant	
  iWorks	
  “[does	
  not]	
  provide	
  site-­‐specific	
  training.”	
  	
  Mr.	
  Trevino	
  then	
  unequivocally	
  stated	
  the	
  

following:	
  

                       p.	
  69	
  
        18.	
  Q.	
  You	
  don't.	
  So	
  if	
  -­‐-­‐	
  if	
  Waste	
  Management	
  or	
  
        19	
  somebody	
  at	
  Gasmer	
  had	
  given	
  y'all	
  a	
  DVD	
  of	
  
        20	
  site-­‐specific	
  training	
  to	
  provide	
  to	
  iWorks	
  employees	
  
        21	
  who	
  are	
  temporary	
  laborers	
  and	
  going	
  out	
  there,	
  then	
  you	
  
        22	
  wouldn't	
  have	
  done	
  it?	
  
        23	
  MR.	
  GARZA:	
  Objection,	
  form.	
  
        24	
  A.	
  We	
  never	
  received	
  one,	
  nor	
  would	
  I	
  have	
  played	
  
        25	
  it.	
  

Next,	
   LUIS	
   TREVINO	
   was	
   asked	
   about	
   iWorks’s	
   obligation	
   under	
   the	
   “Master	
   Services	
   Agreement”	
  

executed	
  between	
  iWorks	
  and	
  WM	
  Defendants	
  –	
  to	
  wit:	
  

         	
   	
           p.	
  70	
  
         16	
  Q.	
  "Contractor	
  is	
  obligated	
  to	
  ensure	
  that	
  
         17	
  Personnel	
  supplied	
  to	
  Waste	
  Management	
  are	
  fully	
  
         18	
  qualified	
  and	
  trained	
  for	
  the	
  jobs	
  they	
  are	
  being	
  
         19	
  supplied	
  to	
  perform	
  and	
  they	
  have	
  been	
  given	
  safety	
  
         20	
  training	
  that	
  meets	
  or	
  exceeds	
  the	
  training	
  Waste	
  
         21	
  Management	
  provides	
  to	
  its	
  employees	
  for	
  the	
  same	
  or	
  
         22	
  similar	
  jobs."	
  
         23	
  Okay.	
  So	
  you're	
  telling	
  me	
  that	
  that	
  is	
  
         24	
  not	
  something	
  that	
  you	
  did	
  with	
  any	
  of	
  the	
  workers	
  that	
  
         25	
  were	
  sent	
  to	
  Waste	
  Management.	
  
         	
  
         	
   	
           p.	
  71	
  
         1	
  A.	
  I	
  don't	
  know	
  Waste	
  Management	
  policy	
  and	
  
         2	
  procedure.	
  How	
  could	
  I	
  train	
  them	
  on	
  Waste	
  Management	
  
         3	
  policy	
  or	
  procedure,	
  safety	
  rules,	
  machinery[?]	
  
         4	
  Q.	
  Okay.	
  But	
  if	
  -­‐-­‐	
  but	
  if	
  that	
  information	
  had	
  
         5	
  been	
  provided	
  to	
  you	
  or	
  provided	
  to	
  the	
  folks	
  in	
  the	
  
         6	
  field	
  in	
  Houston,	
  then	
  they	
  should	
  have	
  done	
  that,	
  
         7	
  right?	
  
         8	
  A.	
  It	
  wasn't	
  provided,	
  and	
  I	
  would	
  not	
  have	
  done	
  
         9	
  it.	
  
	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                     15	
  
42.       As	
  further	
  evidence	
  of	
  the	
  communication	
  (“Conduit”)	
  breakdown,	
  Plaintiffs	
  offer	
  the	
  deposition	
  

testimony	
   Steve	
   Hasley,	
   former	
   Recycling	
   Director	
   of	
   WM	
   DEFENDANTS.	
   On	
   the	
   issue	
   of	
   training	
   and	
  

safety,	
  Steve	
  Hasley	
  directly	
  contradicts	
  the	
  testimony	
  of	
  Luis	
  Trevino	
  –	
  to	
  wit:	
  

                                                             p.	
  86	
  
         1	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  Yes.	
  
         2	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  Okay.	
  	
  Is	
  there	
  any	
  document	
  that	
  identifies	
  that	
  
         3	
  	
  	
  this	
  training	
  topic,	
  everything	
  that's	
  above	
  Environmental	
  
         4	
  	
  	
  Protection	
  Orientation	
  Training,	
  was	
  to	
  be	
  conducted	
  by	
  the	
  
         5	
  	
  	
  temp	
  agency?	
  
         6	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  I	
  have	
  not	
  seen	
  one.	
  
         7	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  Okay.	
  
         8	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  That	
  was	
  supposedly	
  in	
  the	
  contract.	
  	
  But	
  I've	
  
         9	
  	
  	
  never	
  seen	
  the	
  contract.	
  	
  So	
  I	
  don't	
  -­‐-­‐	
  I	
  can't	
  say	
  for	
  
         10	
  	
  	
  sure.	
  
         11	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  And	
  what	
  contract	
  are	
  you	
  speaking	
  of?	
  
         12	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  The	
  contract	
  that	
  Staff	
  Management	
  had	
  with	
  the	
  
         13	
  	
  	
  temp	
  labor	
  provider.	
  
         14	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  Why	
  would	
  Waste	
  Management	
  allow	
  someone	
  else	
  to	
  
         15	
  	
  	
  perform	
  this	
  orientation	
  training?	
  
         16	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MS.	
  SCHADLE:	
  	
  Objection;	
  form.	
  
         17	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  Well,	
  it	
  all	
  -­‐-­‐	
  it	
  all	
  depends	
  on	
  the	
  site	
  and	
  
         18	
  	
  	
  what	
  you	
  got	
  going.	
  	
  If	
  you	
  got	
  a	
  lot	
  of	
  employees	
  and	
  
         19	
  	
  	
  you're	
  bringing	
  in	
  a	
  lot	
  of	
  employees,	
  then	
  it	
  does	
  relieve	
  
         20	
  	
  	
  the	
  burden	
  off	
  the	
  -­‐-­‐	
  the	
  management	
  at	
  the	
  site,	
  the	
  
         21	
  	
  	
  supervision	
  to	
  have	
  to	
  sit	
  down	
  for,	
  you	
  know,	
  two	
  hours	
  to	
  
         22	
  	
  	
  go	
  through	
  this	
  DVD	
  and	
  discussion	
  and	
  all	
  that	
  kind	
  of	
  
         23	
  	
  	
  thing.	
  	
  And	
  that's	
  why	
  it's	
  done	
  at	
  some	
  sites	
  like	
  that,	
  
         24	
  	
  	
  why	
  the	
  temp	
  labor	
  provider	
  does	
  it.	
  
         25	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  (BY	
  MR.	
  GILDE)	
  Can	
  you	
  identify	
  all	
  the	
  sites	
  in	
  
         	
  
                                                             p.	
  87	
  
         1	
  	
  	
  Texas	
  where	
  the	
  temp	
  laborer	
  provider	
  performs	
  this	
  
         2	
  	
  	
  training?	
  
         3	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MS.	
  SCHADLE:	
  	
  Objection;	
  form.	
  
         4	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  I	
  don't	
  know	
  all	
  of	
  them.	
  	
  I	
  know	
  that	
  they	
  do	
  it	
  
         5	
  	
  	
  at	
  Arlington	
  and	
  I	
  know	
  that	
  they	
  do	
  it	
  at	
  -­‐-­‐	
  at	
  Brittmoore.	
  
         6	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  (BY	
  MR.	
  GILDE)	
  At	
  Brittmoore?	
  
         7	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  Yes.	
  
         8	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  And	
  also	
  at	
  Gasmer?	
  
         9	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  I	
  think	
  -­‐-­‐	
  yes,	
  I	
  think	
  they	
  do	
  it	
  at	
  Gasmer,	
  too.	
  
         10	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  Okay.	
  	
  Anywhere	
  else?	
  
         11	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MS.	
  SCHADLE:	
  	
  Objection;	
  form.	
  
         12	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  Not	
  that	
  I	
  can	
  think	
  of.	
  	
  I	
  don't	
  know.	
  	
  They	
  may	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                     16	
  
         13	
  	
  	
  be	
  doing	
  it.	
  	
  Where	
  JG	
  is	
  at,	
  any	
  place	
  JG	
  is	
  at,	
  I	
  think	
  
         14	
  	
  	
  they're	
  doing	
  -­‐-­‐	
  they	
  do	
  it	
  for	
  their	
  temp	
  employees.	
  
         15	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  (BY	
  MR.	
  GILDE)	
  Okay.	
  	
  And	
  what	
  is	
  the	
  basis	
  for	
  
         16	
  	
  	
  that	
  opinion?	
  
         17	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  Because	
  that's	
  part	
  of	
  their	
  service	
  that	
  they	
  
         18	
  	
  	
  offer	
  within	
  their	
  rate.	
  
         9	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  (BY	
  MR.	
  GILDE)	
  Is	
  there	
  -­‐-­‐	
  it's	
  not	
  going	
  to	
  be	
  
         10	
  	
  	
  your	
  testimony	
  that	
  it	
  would	
  be	
  impossible	
  to	
  perform	
  safety	
  
         11	
  	
  	
  orientation	
  training	
  at	
  the	
  4939	
  Gasmer	
  Drive	
  facility?	
  
         12	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MS.	
  SCHADLE:	
  	
  Objection;	
  form.	
  
         13	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MR.	
  GARZA:	
  	
  Same	
  objection.	
  
         14	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  It	
  would	
  not	
  be	
  impossible.	
  
         15	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  (BY	
  MR.	
  GILDE)	
  Okay.	
  	
  That's	
  something	
  Waste	
  
         16	
  	
  	
  Management	
  could	
  do?	
  
         17	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MR.	
  GARZA:	
  	
  Objection;	
  form.	
  
         18	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MS.	
  SCHADLE:	
  	
  Objection;	
  form.	
  
         19	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  That's	
  something	
  that	
  the	
  plant	
  site	
  personnel	
  
         20	
  	
  	
  could	
  -­‐-­‐	
  could	
  do.	
  
         21	
  	
  	
  	
  	
  	
  	
  	
  Q.	
  	
  	
  (BY	
  MR.	
  GILDE)	
  Okay.	
  	
  And	
  in	
  this	
  case	
  Waste	
  
         22	
  	
  	
  Management	
  chose	
  not	
  to	
  do	
  that,	
  true?	
  
         23	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MR.	
  GARZA:	
  	
  Objection;	
  form.	
  
         24	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  MS.	
  SCHADLE:	
  	
  Objection;	
  form.	
  
         25	
  	
  	
  	
  	
  	
  	
  	
  A.	
  	
  	
  Yeah.	
  	
  In	
  this	
  case	
  the	
  plant	
  site	
  was	
  contracted	
  
         	
  
                                                    p.	
  105	
  
         1	
  	
  	
  through	
  Staff	
  Management	
  for	
  the	
  temporary	
  service	
  provider	
  
         2	
  	
  	
  to	
  conduct	
  this	
  training.	
  
	
  
	
  
As	
  is	
  clear,	
  WM	
  DEFENDANTS	
  didn’t	
  know	
  what	
  IWORKS	
  DEFENDANTS	
  were	
  doing	
  and	
  vice	
  versa	
  with	
  

respect	
  to	
  training	
  and	
  safety.	
  	
  WM	
  DEFENDANTS	
  point	
  the	
  finger	
  at	
  IWORKS	
  DEFENDANTS	
  and	
  IWORKS	
  

DEFENDANTS	
  point	
  the	
  finger	
  at	
  WM	
  DEFENDANTS.	
  	
  	
  	
  	
  

43.       Defendants’	
   Liability	
   and	
   Vicarious	
   Liability.	
   	
   Defendants’	
   actions	
   and/or	
   inactions	
   and	
  

breaches	
   of	
   duties	
   to	
   Plaintiffs	
   were	
   effectuated	
   by	
   Defendants’	
   employees,	
   agents,	
   service	
   providers,	
  

officers,	
   directors,	
   assigns,	
   and/or	
   individuals	
   under	
   the	
   control	
   or	
   direction	
   of	
   Defendants.	
   	
   As	
   such,	
  

Defendants,	
   each	
   of	
   them,	
   are	
   responsible/liable	
   for	
   the	
   following	
   claims	
   and	
   causes	
   of	
   action	
   detailed	
  

below	
   and	
   herein,	
   which	
   responsibility/liability	
   includes	
   but	
   is	
   not	
   limited	
   to:	
   Aiding	
   &	
   Abetting;	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                            17	
  
Assisting	
   &	
   Participating;	
   Concert	
   of	
   Action;	
   Respondeat	
  Superior;	
   Nondelegable	
   Duty;	
   Partnership;	
   and	
  

Joint	
  Enterprise	
  theories	
  of	
  liability.	
  

44.         Due	
   to	
   Defendants’	
   actions	
   and/or	
   inactions	
   and	
   breaches	
   of	
   duties	
   to	
   Plaintiffs,	
   Plaintiffs	
   bring	
  

the	
  following	
  claims	
  and	
  causes	
  of	
  action	
  against	
  Defendants	
  –	
  to	
  wit	
  	
  

                                           X.   RESPONDEAT	
  SUPERIOR	
  (ALL	
  DEFENDANTS	
  )	
  
                                                                                    	
  
45.         PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

46.         Plaintiff	
  MOSE	
  GUILLORY	
  was	
  injured	
  and	
  PLAINTIFFS	
  have	
  suffered	
  damages,	
  as	
  a	
  result	
  of	
  the	
  

torts	
  detailed	
  below.	
  

47.         IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   are	
   employer-­‐tortfeasors	
   whom	
   employed	
  

tortfeasor-­‐employees	
  that	
  breached	
  duties	
  to	
  PLAINTIFFS,	
  which	
  resulted	
  in	
  Plaintiff	
  MOSE	
  GUILLORY’s	
  

injuries	
  and	
  PLAINTIFFS’	
  damages,	
  as	
  detailed	
  more	
  fully	
  below.	
  

48.         DEFENDANTS’	
   tortfeasor-­‐employees	
   committed	
   torts	
   while	
   said	
   tortfeasor-­‐employees	
   were	
  

acting	
  within	
  the	
  scope	
  of	
  their	
  employment.	
  	
  That	
  is,	
  their	
  acts	
  were:	
  (i)	
  within	
  the	
  tortfeasor-­‐employees’	
  

general	
  authority;	
  (ii)	
  in	
  furtherance	
  of	
  DEFENDANTS’	
  business;	
  and	
  (iii)	
  for	
  the	
  accomplishment	
  of	
  the	
  

object	
  for	
  which	
  tortfeasor-­‐employees	
  were	
  hired.	
  	
  	
  

                 XI.PARTNERSHIP	
  LIABILITY	
  (IWORKS	
  PERSONNEL,	
  INC.,	
  LUIS	
  TREVINO,	
  and	
  	
  
                                                                    HAYDEE	
  GUTIERREZ)	
  
                                                                                    	
  
49.         PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

50.         IWORKS	
  PERSONNEL,	
  INC.	
  appears	
  to	
  have	
  been	
  duly	
  incorporated	
  under	
  the	
  laws	
  of	
  the	
  State	
  of	
  

Texas	
   on	
   February	
   26,	
   2007.	
   	
   However,	
   IWORKS	
   PERSONNEL,	
   INC.	
   has	
   forfeited	
   its	
   corporate	
   status	
  

numerous	
  times	
  pursuant	
  to	
  TEXAS	
   TAX	
   CODE	
  §	
  171.309,	
  the	
  last	
  of	
  which	
  occurred	
  on	
  or	
  about	
  May	
  16,	
  

2012	
   and	
   certainly	
   no	
   later	
   than	
   February	
   8,	
   2013.	
   	
   At	
   present,	
   the	
   Texas	
   Secretary	
   of	
   State	
   lists	
   IWORKS	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                             18	
  
PERSONNEL,	
   INC.’s	
   corporate	
   status	
   as	
   “forfeited	
   existence,”	
   meaning	
   it	
   no	
   longer	
   exist	
   as	
   a	
   “de	
   jure	
  

corporation.”	
  	
  Regardless,	
  IWORKS	
  PERSONNEL,	
  INC.	
  was	
  not	
  operating	
  as	
  a	
  corporation	
  under	
  the	
  laws	
  

of	
  the	
  State	
  of	
  Texas	
  at	
  the	
  time	
  of	
  the	
  incident	
  at	
  issue.	
  

51.         Defendants	
  LUIS	
  TREVINO	
  and	
  HAYDEE	
  GUTIERREZ	
  are	
  personally	
  liable	
  for	
  the	
  debts	
  and	
  acts	
  of	
  

each	
  other	
  and	
  of	
  IWORKS	
  PERSONNEL,	
  INC.	
  because	
  LUIS	
  TREVINO	
  and	
  HAYDEE	
  GUTIERREZ	
  operated	
  

and	
  continue	
  to	
  operate	
  IWORKS	
  PERSONNEL,	
  INC.	
  (d/b/a	
  “Preferred	
  Staffing,	
  L.L.C.”)	
  as	
  a	
  partnership.	
  

Specifically,	
  LUIS	
  TREVINO	
  and	
  HAYDEE	
  GUTIERREZ:	
  

            a. Incorporated	
  Preferred	
  Staffing,	
  L.L.C.	
  under	
   the	
   laws	
   of	
   the	
   State	
   of	
   Texas	
   on	
  or	
  about	
  July	
  18,	
  
               2005.	
  	
  However,	
  upon	
  information	
  and	
  belief,	
  Preferred	
  Staffing,	
  L.L.C.	
  forfeited	
  its	
  corporate	
  
               status	
  pursuant	
  to	
  TEXAS	
  TAX	
  CODE	
  §	
  171.309	
  on	
  or	
  about	
  July	
  24,	
  2009.	
  	
  At	
  present,	
  the	
  Texas	
  
               Secretary	
  of	
  State	
  lists	
  Preferred	
  Staffing,	
  L.L.C.’s	
  corporate	
  status	
  as	
  “forfeited	
  existence”;	
  	
  
               	
  
            b. Incorporated	
   IWORKS	
   PERSONNEL,	
   INC.	
   under	
   the	
   laws	
   of	
   the	
   State	
   of	
   Texas	
   on	
   or	
   about	
  
               February	
   26,	
   2007.	
   	
   However,	
   upon	
   information	
   and	
   belief,	
   IWORKS	
   PERSONNEL,	
   INC.	
  
               thereafter	
   forfeited	
   its	
   corporate	
   status	
   on	
   multiple	
   occasions	
   pursuant	
   to	
   TEXAS	
   TAX	
   CODE	
   §	
  
               171.309.	
  	
  At	
  present,	
  the	
  Texas	
  Secretary	
  of	
  State	
  lists	
  IWORKS	
  PERSONNEL,	
  INC.’s	
  corporate	
  
               status	
  as	
  “forfeited	
  existence”;	
  	
  
	
  
            c. Shared	
  or	
  have	
  the	
  right	
  to	
  share	
  profits	
  of	
  IWORKS	
  PERSONNEL,	
  INC.	
  	
  Upon	
  information	
  and	
  
               belief,	
  both	
  LUIS	
  TREVINO	
  and	
  HAYDEE	
  GUTIERREZ	
  intended	
  that	
  IWORKS	
  PERSONNEL,	
  INC.	
  
               be	
  operated	
  as	
  a	
  corporation	
  and	
  believed	
  this	
  to	
  be	
  the	
  case.	
  	
  LUIS	
  TREVINO	
  maintains	
  60%	
  
               ownership	
  of	
  IWORKS	
  PERSONNEL,	
  INC.	
  and	
  HAYDEE	
  GUTIERREZ	
  maintains	
  40	
  %	
  ownership;	
  	
  
	
  
            d. Expressed	
   an	
   intent	
   to	
   be	
   partners	
   in	
   the	
   business,	
   as	
   evidenced	
   by	
   their	
   deposition	
   testimony	
  
               and	
  exhibits	
  attached	
  thereto	
  (i.e.	
  Articles	
  of	
  Incorporation)	
  to	
  that	
  effect;	
  	
  
	
  
            e. Participate	
   and/or	
   have	
   the	
   right	
   to	
   participate	
   in	
   control	
   of	
   the	
   business.	
   	
   Specifically,	
   LUIS	
  
               TREVINO	
   is	
   Chief	
   Executive	
   Officer	
   who	
   allegedly	
   oversees	
   operations	
   while	
   HAYDEE	
  
               GUTIERREZ	
  is	
  President	
  and	
  allegedly	
  oversees	
  marketing,	
  sales,	
  and	
  client	
  relations;	
  	
  
	
  
            f. Shared	
  and/or	
  agreed	
  to	
  share	
  in	
  the	
  losses	
  and	
  liabilities	
  of	
  the	
  business;	
  	
  
	
  
            g. Contributed	
  and/or	
  agreed	
  to	
  contribute	
  money	
  or	
  property	
  to	
  the	
  business;	
  	
  
	
  
            h. Co-­‐owned	
  property;	
  and	
  	
  
	
  
            i.    Shared	
  or	
  had	
  a	
  right	
  to	
  share	
  gross	
  returns	
  and/or	
  revenues	
  of	
  the	
  business.	
  
                     	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                    19	
  
52.       At	
  the	
  time	
  of	
  the	
  events	
  and	
  incidents	
  at	
  issue	
  herein,	
  LUIS	
  TREVINO	
  and	
  HAYDEE	
  GUTIERREZ	
  

were	
   committing	
   various	
   acts	
   and	
   omissions	
   while	
   in	
   the	
   ordinary	
   course	
   of	
   business	
   and	
   with	
   the	
  

authority	
  of	
  the	
  partnership.	
  	
  

53.       Specifically,	
  the	
  decisions	
  made,	
  policies	
  enacted,	
  contracts	
  signed,	
  and	
  all	
  other	
  negligent	
  acts	
  or	
  

omissions	
  committed	
  by	
  LUIS	
  TREVINO	
  and	
  HAYDEE	
  GUTIERREZ,	
  were	
  done	
  so	
  while	
  LUIS	
  TREVINO	
  and	
  

HAYDEE	
   GUTIERREZ	
   were	
   acting	
   in	
   the	
   ordinary	
   course	
   of	
   business	
   and	
   with	
   the	
   authority	
   of	
   the	
  

partnership,	
  IWORKS	
  PERSONNEL,	
  INC.	
  (d/b/a	
  Preferred	
  Staffing).	
  	
  	
  

              XII.
                JOINT-­‐ENTERPRISE	
  LIABILITY	
  (IWORKS	
  PERSONNEL,	
  INC.,	
  LUIS	
  TREVINO,	
  and	
  	
  
                                                                  HAYDEE	
  GUTIERREZ)	
  
                                                                                  	
  
54.       PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

55.       At	
  the	
  time	
  of	
  the	
  events	
  and	
  incidents	
  at	
  issue	
  herein,	
  LUIS	
  TREVINO	
  and	
  HAYDEE	
  GUTIERREZ	
  

were	
   engaged	
   in	
   a	
   joint	
   enterprise.	
   	
   Defendants	
   LUIS	
   TREVINO	
   and	
   HAYDEE	
   GUTIERREZ	
   had	
   an	
  

agreement,	
  a	
  common	
  purpose,	
  a	
  community	
  of	
  pecuniary	
  interest	
  in	
  that	
  common	
  purpose,	
  and	
  an	
  equal	
  

right	
  to	
  direct	
  and	
  control	
  various	
  aspects	
  of	
  the	
  enterprise	
  (i.e.	
  IWORKS	
  PERSONNEL,	
  INC.).	
  

56.       Thus,	
   Defendants	
   LUIS	
   TREVINO	
   and	
   HAYDEE	
   GUTIERREZ	
   are	
   personally	
   liable	
   for	
   each	
   other’s	
  

acts	
  and	
  for	
  the	
  acts	
  of	
  employees	
  of	
  IWORKS	
  PERSONNEL,	
  INC.	
  (d/b/a	
  Preferred	
  Staffing).	
  

57.       At	
  the	
  time	
  of	
  the	
  decisions	
  made,	
  policies	
  enacted,	
  contracts	
  signed,	
  and	
  all	
  other	
  negligent	
  acts	
  or	
  

omissions	
   committed	
   regarding	
   the	
   incident	
   in	
   question,	
   LUIS	
   TREVINO,	
   HAYDEE	
   GUTIERREZ,	
   and	
   other	
  

IWORKS	
  PERSONNEL,	
  INC.	
  employees	
  were	
  acting	
  within	
  the	
  scope	
  of	
  the	
  enterprise.	
  	
  

                 XIII.      COUNT	
  1:	
  NEGLIGENCE	
  (IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  )	
  
             	
  
58.       PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

59.       IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  are	
  liable	
  to	
  PLAINTIFFS	
  for	
  negligence.	
  	
  	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                 20	
  
60.       IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   owed	
   a	
   legal	
   duty	
   to	
   PLAINTIFFS	
   in	
   hiring,	
  

employing,	
   training,	
   and	
   supervising	
   PLAINTIFF	
   MOSE	
   GUILLORY,	
   which	
   duties	
   include	
   but	
   are	
   not	
  

limited	
  the	
  following	
  duties	
  and	
  nondelegable	
  duties	
  –	
  to	
  wit:	
  

          a. An	
  employer	
  has	
  a	
  nondelegable	
  duty	
  to	
  provide	
  a	
  safe	
  workplace	
  for	
  its	
  employees;	
  
             	
  
          b. An	
   employer	
   has	
   a	
   nondelegable	
   duty	
   to	
   provide	
   rules	
   and	
   regulations	
   for	
   the	
   safety	
   of	
   its	
  
             employees;	
  
             	
  
          c. An	
   employer	
   has	
   a	
   nondelegable	
   duty	
   to	
   furnish	
   reasonably	
   safe	
   machinery	
   or	
   tools	
   for	
   its	
  
             employees;	
  and	
  
             	
  
          d. An	
  employer	
  has	
  a	
  nondelegable	
  duty	
  to	
  select	
  careful	
  and	
  competent	
  employees.	
  
	
  
          e. An	
  employer	
  has	
  a	
  duty	
  to	
  train	
  its	
  employees	
  regarding	
  hazards	
  and	
  safety.	
  
	
  
          f. An	
  employer	
  has	
  a	
  duty	
  to	
  supervise	
  its	
  employees.	
  
	
  
          g. An	
  employer	
  has	
  the	
  duty	
  to	
  act	
  as	
  a	
  reasonably	
  prudent	
  employer	
  in	
  the	
  same	
  field	
  and	
  under	
  
             the	
  same	
  circumstances.	
  	
  	
  	
  
             	
  
61.       Defendants	
   breached	
   their	
   duty	
   through	
   their	
   negligent	
   employment,	
   actions,	
   and/or	
   inactions,	
   in	
  

the	
  following	
  non-­‐exclusive	
  ways:	
  

          a.     Failing	
  to	
  provide	
  a	
  reasonably	
  safe	
  workplace;	
  
          	
  
          b.     Failing	
  to	
  establish	
  rules	
  and	
  regulations	
  for	
  PLAINTIFF	
  MOSE	
  GUILLORY’S	
  safety;	
  
          	
  
          c.     Failing	
  to	
  warn	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  of	
  the	
  hazards	
  of	
  his	
  employment;	
  
          	
  
          d.     Failing	
  to	
  train	
  PLAINTIFF	
  MOSE	
  GUILLORY;	
  
          	
  
          e.     Failing	
   to	
   train	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   in	
   the	
   purpose	
   and	
   use	
   of	
   energy	
   control	
  
                 procedures	
  (i.e.	
  “Lockout/Tagout”	
  Procedures);	
  	
  
          	
  
          f.     Failing	
  to	
  certify	
  and/or	
  conduct	
  periodic	
  inspections	
  of	
  energy	
  control	
  procedures;	
  	
  
          	
  
          g.     Exposing	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  to	
  unknown	
  hazards	
  in	
  the	
  workplace;	
  	
  
          	
  
          h.     Failing	
  to	
  furnish	
  reasonably	
  safe	
  machinery	
  or	
  instrumentalities;	
  	
  
          	
  
          i.     Failing	
  to	
  provide	
  equipment	
  with	
  proper	
  safety	
  mechanisms;	
  
          	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                               21	
  
         j.   Failing	
   to	
   provide	
   equipment	
   with	
   proper	
   guards	
   to	
   prevent	
   employees	
   from	
   entering	
   the	
  
              machinery;	
  
         	
  
         k. Failing	
   to	
   inspect	
   equipment	
   for	
   defects,	
   disabled	
   safety	
   mechanisms,	
   lack	
   of	
   safety	
  
              mechanisms,	
  removed	
  guards,	
  or	
  lack	
  of	
  guards;	
  
         	
  
         l. Failing	
  to	
  repair	
  unsafe	
  equipment;	
  
         	
  
         m. Failing	
  to	
  provide	
  equipment	
  with	
  proper	
  safety	
  mechanisms	
  in	
  working	
  order	
  or	
  which	
  were	
  
              adequate	
  for	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  to	
  do	
  his	
  job;	
  
         	
  
         n. Failing	
  to	
  supervise	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  while	
  he	
  was	
  operating	
  the	
  baler;	
  
         	
  
         o. Failing	
  to	
  provide	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  adequate	
  help	
  in	
  the	
  performance	
  of	
  work;	
  
         	
  
         p. Failing	
  to	
  prevent	
  an	
  employee	
  from	
  causing	
  an	
  unreasonable	
  risk	
  of	
  harm	
  to	
  PLAINTIFF	
  MOSE	
  
              GUILLORY;	
  
         	
  
         q. Failing	
   to	
   keep	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   in	
   a	
   position	
   for	
   which	
   he	
   was	
   qualified	
   and	
  
              instead	
  ordering	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  to	
  operate	
  a	
  machine	
  he	
  had	
  not	
  been	
  trained	
  to	
  
              operate;	
  
         	
  
         r. Failing	
   to	
   adequately	
   train	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   on	
   how	
   to	
   safely	
   operate	
   the	
   Harris	
  
              Baler;	
  
         	
  
         s. Failing	
  to	
  adopt	
  proper	
  policies	
  and	
  procedures	
  regarding	
  maintenance	
  of	
  the	
  equipment	
  that	
  
              would	
  require	
  employees	
  to	
  fix	
  disabled	
  safety	
  mechanisms	
  and	
  guards;	
  
         	
  
         t. Failing	
   to	
   adopt	
   proper	
   policies	
   and	
   procedures	
   for	
   safely	
   un-­‐jamming	
   or	
   dislodging	
   lodged	
  
              product	
  from	
  the	
  bins;	
  
         	
  
         u. Failing	
  to	
  adopt	
  proper	
  policies	
  and	
  procedures	
  for	
  safely	
  extracting	
  additional	
  product	
  from	
  
              the	
  bins	
  and/or	
  the	
  baler;	
  
         	
  
         v. Failing	
  to	
  provide	
  PLAINTIFF	
  with	
  safe	
  equipment	
  and/or	
  safety	
  equipment;	
  
         	
  
         w. Failing	
  to	
  provide	
  English-­‐speaking	
  employees	
  to	
  train	
  and	
  advise	
  PLAINTIFF	
  on	
  how	
  to	
  safely	
  
              operate	
  the	
  Harris	
  Baler;	
  and	
  
         	
  
         x. Failure	
   to	
   identify,	
   employee,	
   contract-­‐with,	
   delegate,	
   supervise,	
   and	
   manage	
   competent	
  
              vendor	
   management	
   and/or	
   employee-­‐leasing/employee-­‐staffing	
   companies	
   in	
   the	
  
              performance	
  of	
  their	
  duties.	
  
                   	
  
62.      IWORKS	
   DEFENDANTS’	
   and	
   WM	
   DEFENDANTS’	
   negligent	
   acts	
   directly	
   and	
   proximately	
   caused	
  

injury	
  to	
  Plaintiff	
  MOSE	
  GUILLORY,	
  which	
  resulted	
  in	
  PLAINTIFFS’	
  damages	
  detailed	
  below.	
  	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                     22	
  
63.       PLAINTIFFS	
  seek	
  unliquidated	
  damages	
  within	
  the	
  jurisdictional	
  limits	
  of	
  this	
  Court.	
  

              XIV.     COUNT	
  2:	
  NEGLIGENT	
  HIRING,	
  TRAINING,	
  SUPERVISION,	
  and/or	
  RETENTION	
  
                                       (IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  )	
  
	
  
64.       PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

65.       IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   are	
   liable	
   to	
   PLAINTIFFS	
   for	
   negligent	
   hiring,	
  

training,	
  supervision,	
  and/or	
  retention.	
  

66.       Additionally,	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   had	
   a	
   legal	
   duty	
   to	
   hire,	
   train,	
  

supervise,	
  and/or	
  retain	
  competent	
  employees.	
  	
  IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  also	
  had	
  

a	
  legal	
  duty	
  to	
  terminate	
  incompetent	
  employees.	
  

67.       IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   breached	
   their	
   duties	
   when	
   IWORKS	
  

DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  negligently	
  hired,	
  trained,	
  and	
  supervised	
  IWORKS	
  DEFENDANTS’	
  

and	
   WM	
   DEFENDANTS’	
   tortfeasor-­‐employees	
   whom	
   breached	
   duties	
   to	
   PLAINTIFFS,	
   which	
   resulted	
   in	
  

Plaintiff	
  MOSE	
  GUILLORY	
  injuries	
  and	
  PLAINTIFFS’	
  damages,	
  as	
  detailed	
  more	
  fully	
  below.	
  	
  	
  

68.       IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   also	
   breached	
   their	
   duties	
   when	
   Defendants	
  

terminated	
  competent	
  employees	
  whom	
  could	
  have	
  prevented	
  the	
  incident	
  and/or	
  negligently	
  retained	
  

incompetent	
  employees	
  whom	
  failed	
  to	
  prevent	
  the	
  incident,	
   which	
   resulted	
   in	
  Plaintiff	
  MOSE	
   GUILLORY	
  

injuries	
  and	
  PLAINTIFFS’	
  damages,	
  as	
  detailed	
  more	
  fully	
  below.	
  

69.       IWORKS	
   DEFENDANTS’	
   and	
   WM	
   DEFENDANTS’	
   negligent	
   acts	
   directly	
   and	
   proximately	
   caused	
  

injury	
  to	
  Plaintiff	
  MOSE	
  GUILLORY,	
  which	
  resulted	
  in	
  PLAINTIFFS’	
  damages	
  detailed	
  below.	
  	
  

PLAINTIFFS	
  seek	
  unliquidated	
  damages	
  within	
  the	
  jurisdictional	
  limits	
  of	
  this	
  Court.	
  	
  	
  	
  

           XV.        COUNT	
  3:	
  NEGLIGENCE	
  PER	
  SE	
  (IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS)	
  

70.       PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                 23	
  
71.      IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  are	
  liable	
  to	
  PLAINTIFFS	
  for	
  negligence	
  per	
  se.	
  

72.      Additionally,	
  IWORKS	
  DEFENDANTS’	
  and	
  WM	
  DEFENDANTS’	
  negligence	
  violated	
  various	
  statutes,	
  

ordinances,	
   and/or	
   administrative	
   regulations.	
   Specifically,	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
  

DEFENDANTS	
   violated	
   various	
   statutes	
   and	
   provisions	
   pertaining	
   to	
   the	
   Occupational	
   Safety	
   &	
   Health	
  

Administration	
  (“OSHA”)	
  Act	
  of	
  1970—to	
  wit:	
              	
  

         a. OSHA	
   Regulation	
   1926.20(b)(3),	
   which	
   provides	
   that	
   “[t]he	
   use	
   of	
   any	
   machinery,	
   tool,	
  
            material,	
  or	
  equipment	
  that	
  is	
  not	
  in	
  compliance	
  with	
  any	
  applicable	
  requirement	
  of	
  29	
  C.F.R.	
  
            1926	
  is	
  prohibited.	
  	
   Such	
  machinery,	
  tool,	
  material,	
  or	
  equipment	
  shall	
  either	
  be	
  identified	
  as	
  
            unsafe	
   by	
   tagging	
   or	
   locking	
   the	
   controls	
   to	
   render	
   them	
   inoperable	
   or	
   shall	
   be	
   physically	
  
            removed	
  from	
  its	
  place	
  of	
  operation.”	
  29	
  C.F.R.	
  1926.20(b)(3).	
  	
  
            	
  
         b. OSHA	
   Regulation	
   1926.20(b)(4),	
   which	
  provides	
  that	
  the	
  “employer	
  shall	
  permit	
  only	
  those	
  
            employees	
   qualified	
   by	
   training	
   or	
   experience	
   to	
   operate	
   equipment	
   and	
   machinery”.	
   29	
  
            C.F.R.	
  1926.20(c)	
  (emphasis	
  added).	
  
            	
  
         c. OSHA	
   Regulation	
   1926.21(b)(2),	
   which	
   provides	
   that	
   the	
   employer	
   “shall	
   instruct	
   each	
  
            employee	
   in	
   the	
   recognition	
   and	
   avoidance	
   of	
   unsafe	
   conditions	
   and	
   the	
   regulations	
  
            applicable	
  to	
  his	
  work	
  environment”.	
  29	
  C.F.R.	
  1926.21(b)(2)	
  (emphasis	
  added).	
  
            	
  
         d. OSHA	
   Regulation	
   1910.145(f)(3),	
   which	
  provides	
  that	
  “[t]ags	
  shall	
  be	
  used	
  as	
  a	
  means	
  to	
  
            prevent	
   accidental	
   injury	
   or	
   illness	
   to	
   employees	
   who	
   are	
   exposed	
   to	
   hazardous	
   or	
  
            potentially	
   hazardous	
   conditions,	
   equipment,	
   or	
   operations	
   which	
   are	
   out	
   of	
   the	
   ordinary,	
  
            unexpected,	
  or	
  not	
  readily	
  apparent.”	
  29	
  C.F.R.	
  1910.145(f)(3)	
  (emphasis	
  added).	
  
            	
  
         e. OSHA	
   Regulation	
   1910.147,	
   et	
   seq.,	
   which	
   mandates	
   the	
   use	
   of	
   lockout	
   and	
   tagout	
  
            procedures	
  and	
  provide	
  that	
  the	
  employer	
  “shall	
  establish	
  a	
  program	
  consisting	
  of	
  energy	
  
            control	
  procedures,	
  employee	
  training	
  and	
  periodic	
  inspections	
  to	
  ensure	
  that	
  before	
  any	
  
            employee	
  performs	
  any	
  servicing	
  or	
  maintenance	
  on	
  a	
  machine	
  or	
  equipment	
  where	
  the	
  
            unexpected	
  energizing,	
  startup	
  or	
  release	
  of	
  stored	
  energy	
  could	
  occur	
  and	
  cause	
  injury,	
  
            the	
   machine	
   or	
   equipment	
   shall	
   be	
   isolated	
   from	
   the	
   energy	
   source	
   and	
   rendered	
  
            inoperative.”	
  29	
  C.F.R.	
  1910.147(c)(1)	
  (emphasis	
  added).	
  	
  
            	
  
         f. OSHA	
   Regulation	
   1910.147(c)(7)(i)(B),	
   which	
   mandates	
   that	
   “[e]ach	
   affected	
   employee	
  
            shall	
  be	
  instructed	
  in	
  the	
  purpose	
  and	
  use	
  of	
  the	
  energy	
  control	
  procedure”	
  so	
  as	
  to	
  avoid	
  
            exposing	
  employees	
  to	
  unknown	
  hazards.”	
  	
  See	
  29	
  C.F.R.	
  1910.147(c)(7)(i)(B).	
  
            	
  
         g. OSHA	
  Regulations	
  1910.147(c)(6),	
  et	
  seq.,	
  which	
  mandate	
  the	
  following:	
  
            	
  
                 i. The	
  employer	
  shall	
  conduct	
  a	
  periodic	
  inspection	
  of	
  the	
  energy	
  control	
  procedure	
  at	
  least	
  
                    annually	
   to	
   ensure	
   that	
   the	
   procedure	
   and	
   the	
   requirements	
   of	
   this	
   standard	
   are	
   being	
  
                    followed.	
  	
  1910.147(c)(6)(i).	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                          24	
  
                       	
  
                 ii.   The	
   periodic	
   inspection	
   shall	
   be	
   performed	
   by	
   an	
   authorized	
   employee	
   other	
   than	
   the	
  
                       ones(s)	
  utilizing	
  the	
  energy	
  control	
  procedure	
  being	
  inspected.	
  	
  1910.147(c)(6)(i)(A).	
  	
  
                       	
  
                iii.   The	
   periodic	
   inspection	
   shall	
   be	
   conducted	
   to	
   correct	
   any	
   deviations	
   or	
   inadequacies	
  
                       identified.	
  	
  1910.147(c)(6)(i)(B).	
  	
  
                       	
  
                iv.    Where	
   lockout	
   is	
   used	
   for	
   energy	
   control,	
   the	
   periodic	
   inspection	
   shall	
   include	
   a	
   review,	
  
                       between	
   the	
   inspector	
   and	
   each	
   authorized	
   employee,	
   of	
   that	
   employee's	
   responsibilities	
  
                       under	
  the	
  energy	
  control	
  procedure	
  being	
  inspected.	
  	
  1910.147(c)(6)(i)(C).	
  	
  
                       	
  
                 v.    Where	
   tagout	
   is	
   used	
   for	
   energy	
   control,	
   the	
   periodic	
   inspection	
   shall	
   include	
   a	
   review,	
  
                       between	
   the	
   inspector	
   and	
   each	
   authorized	
   and	
   affected	
   employee,	
   of	
   that	
   employee's	
  
                       responsibilities	
  under	
  the	
  energy	
  control	
  procedure	
  being	
  inspected,	
  and	
  the	
  elements	
  set	
  
                       forth	
  in	
  paragraph	
  (c)(7)(ii)	
  of	
  this	
  section.	
  	
  1910.147(c)(6)(i)(D).	
  	
  
                       	
  
                vi.    The	
   employer	
   shall	
   certify	
   that	
   the	
   periodic	
   inspections	
   have	
   been	
   performed.	
   The	
  
                       certification	
   shall	
   identify	
   the	
   machine	
   or	
   equipment	
   on	
   which	
   the	
   energy	
   control	
  
                       procedure	
   was	
   being	
   utilized,	
   the	
   date	
   of	
   the	
   inspection,	
   the	
   employees	
   included	
   in	
   the	
  
                       inspection,	
  and	
  the	
  person	
  performing	
  the	
  inspection.	
  	
  1910.147(c)(6)(ii).	
  
	
  
73.        The	
   aforementioned	
   OSHA	
   regulations	
   are	
   designed	
   to	
   protect	
   a	
   class	
   of	
   persons	
   to	
   which	
  

PLAINTIFF	
   MOSE	
   GUILLORY	
   belongs	
   (i.e.	
   employees	
   or	
   persons	
   working	
   at	
   a	
   job	
   site)	
   against	
   the	
   type	
   of	
  

on-­‐the-­‐job	
  injury	
  suffered	
  by	
  PLAINTIFF	
  MOSE	
  GUILLORY.	
  	
  	
  

74.        Each	
  regulation	
  is	
  of	
  the	
  type	
  that	
  imposes	
  tort	
  liability.	
  

75.        IWORKS	
   DEFENDANTS’	
   and	
   WM	
   DEFENDANTS’	
   violations	
   of	
   the	
   above-­‐mentioned	
   regulations	
  

were	
  without	
  legal	
  excuse.	
  

76.        IWORKS	
   DEFENDANTS’	
   and	
   WM	
   DEFENDANTS’	
   breach	
   of	
   the	
   duty	
   imposed	
   by	
   the	
   above-­‐

mentioned	
   regulations	
   proximately	
   caused	
   injury	
   to	
   Plaintiff	
   MOSE	
   GUILLORY,	
   which	
   resulted	
   in	
  

PLAINTIFFS’	
  damages	
  detailed	
  below.	
  

77.        PLAINTIFFS	
  seek	
  unliquidated	
  damages	
  within	
  the	
  jurisdictional	
  limits	
  of	
  this	
  Court.	
  

              XVI.     COUNT	
  4:	
  GROSS	
  NEGLIGENCE	
  (IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS)	
  

78.        PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                  25	
  
79.         ALL	
  DEFENDANTS	
  are	
  liable	
  to	
  PLAINTIFFS	
  for	
  gross	
  negligence.	
  

80.         Defendants	
  owed	
  legal	
  duties	
  to	
  PLAINTIFFS,	
  as	
  detailed	
  in	
  the	
  Negligent-­‐based	
  counts	
  supra,	
  inter	
  

alia.	
  

81.         Defendants	
   breached	
   their	
   duties	
   owed	
   to	
   PLAINTIFFS	
   through	
   Defendants’	
   negligent	
   activities,	
  

actions,	
  and/or	
  inactions,	
  as	
  detailed	
  in	
  the	
  Negligence-­‐based	
  counts	
  supra,	
  inter	
  alia.	
  

82.         Defendants	
   consciously	
   and/or	
   deliberately	
   engaged	
   in	
   recklessness,	
   oppression,	
   willfulness,	
  

wantonness	
  and/or	
  malice	
  through	
  Defendants’	
  actions	
  and/or	
  inactions,	
  which	
  entitles	
  PLAINTIFFS	
  to	
  

punitive	
  and	
  exemplary	
  damages	
  under	
  Texas	
  Civil	
  Practice	
  &	
  Remedies	
  Code	
  section	
  41.003(a).	
  	
  	
  

83.         DEFENDANTS’	
  grossly	
  negligent	
  acts	
  and/or	
  omissions	
  directly	
  and	
  proximately	
  caused	
  injury	
  to	
  

Plaintiff	
  MOSE	
  GUILLORY,	
  which	
  resulted	
  in	
  PLAINTIFFS’	
  damages	
  detailed	
  below.	
  	
  

84.         Accordingly,	
  Defendants	
  should	
  be	
  held	
  liable	
  for	
  punitive	
  and	
  exemplary	
  damages	
  to	
  PLAINTIFFS.	
  

85.         PLAINTIFFS	
  also	
  seek	
  unliquidated	
  damages	
  within	
  the	
  jurisdictional	
  limits	
  of	
  this	
  court.	
  

            XVII. COUNT	
  5:	
  BREACH	
  OF	
  CONTRACT	
  (IWORKS	
  DEFENDANTS	
  AND	
  WM	
  DEFENDANTS)	
  

86.         PLAINTIFFS	
   re-­‐allege	
   all	
   of	
   the	
   allegations	
   in	
   the	
   previous	
   paragraphs,	
   as	
   though	
   set	
   forth	
   fully	
  

herein.	
  

87.         IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  are	
  liable	
  to	
  PLAINTIFFS	
  for	
  breach	
  of	
  contract.	
  

88.         On	
   September	
   22,	
   2010	
   and	
   July	
   24,	
   2012,	
   respectively,	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
  

DEFENDANTS	
  executed	
  valid	
  and	
  enforceable	
  written	
  contracts.	
  See	
  Exhibits	
  A	
  and	
  B.	
  	
  

89.         The	
  contracts	
  provided	
  that	
  IWORKS	
  DEFENDANTS	
  would	
  lease	
  employees	
  to	
  perform	
  work	
  for	
  

WM	
  DEFENDANTS.	
  	
  The	
  contracts	
  at	
  issue	
  also	
  expressly	
  or	
  impliedly	
  provided	
  that	
  WM	
  DEFENDANTS	
  

and	
  IWORKS	
  DEFENDANTS	
  would:	
  

            a. Provide	
  a	
  reasonably	
  safe	
  workplace;	
  
            	
  
            b. Establish	
  rules	
  and	
  regulations	
  for	
  worker	
  safety;	
  
            	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                   26	
  
          c.     Warn	
  workers	
  of	
  the	
  hazards	
  of	
  his	
  employment;	
  
          	
  
          d.     Properly	
  train	
  workers;	
  
          	
  
          e.     Ensure	
  that	
  workers	
  had	
  been	
  properly	
  trained	
  before	
  assigning	
  them	
  to	
  a	
  task;	
  	
  
          	
  
          f.     Certify	
  and/or	
  conduct	
  periodic	
  inspections	
  of	
  energy	
  control	
  procedures;	
  	
  
          	
  
          g.     Provide	
   equipment	
   with	
   proper	
   guards	
   and	
   safety	
   mechanisms	
   that	
   were	
   adequate	
   and	
   in	
  
                 working	
  order;	
  
          	
  
          h.     Supervise	
  workers	
  while	
  they	
  were	
  performing	
  tasks,	
  including	
  the	
  operation	
  of	
  machinery;	
  
          	
  
          i.     Ensure	
  that	
  workers	
  had	
  adequate	
  help	
  in	
  the	
  performance	
  of	
  work;	
  
          	
  
          j.     Ensure	
  that	
  workers	
  are	
  assigned	
  a	
  task	
  they	
  are	
  qualified	
  and	
  trained	
  to	
  perform;	
  
          	
  
          k.     Ensure	
   that	
   workers	
   are	
   trained	
   in	
   the	
   safe	
   and	
   proper	
   operation	
   of	
   all	
   heavy	
   equipment	
  
                 operated	
  in	
  the	
  worker’s	
  assigned	
  task;	
  and	
  
          	
  
          l.Identify,	
   employ,	
   contract-­‐with,	
   delegate,	
   supervise,	
   and	
   manage	
   competent	
   vendor	
  
            management	
   and/or	
   employee-­‐leasing/employee-­‐staffing	
   companies	
   in	
   the	
   performance	
   of	
  
            their	
  duties.	
  
            	
  
90.       When	
   entering	
   into	
   the	
   contracts	
   at	
   issue,	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
  

intended	
   to	
   secure	
   a	
   benefit	
   for	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   and	
   entered	
   into	
   the	
   contracts	
   for	
   the	
  

benefit	
   of	
   MOSE	
   GUILLORY	
   and	
   his	
   coworkers.	
   	
   Thus,	
   PLAINTIFF	
   MOSE	
   GUILLORY	
   has	
   standing	
   to	
  

enforce	
   the	
   aforementioned	
   contracts	
   executed	
   by	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
  

because	
  PLAINTIFF	
  MOSE	
  GUILLORY	
  is	
  a	
  third-­‐party	
  beneficiary	
  of	
  those	
  contracts.	
  

91.       IWORKS	
   DEFENDANTS	
   and	
   WM	
   DEFENDANTS	
   each	
   breached	
   the	
   contracts	
   at	
   issue	
   in	
   the	
  

following	
  non-­‐exclusive	
  ways:	
  

          a.     Failing	
  to	
  provide	
  MOSE	
  GUILLORY	
  a	
  reasonably	
  safe	
  workplace;	
  
          	
  
          b.     Failing	
  to	
  establish	
  rules	
  and	
  regulations	
  for	
  MOSE	
  GUILLORY’s	
  safety;	
  
          	
  
          c.     Failing	
  to	
  warn	
  MOSE	
  GUILLORY	
  of	
  the	
  hazards	
  of	
  his	
  employment;	
  
          	
  
          d.     Failing	
  to	
  properly	
  train	
  MOSE	
  GUILLORY;	
  
          	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                            27	
  
          e. Failing	
   to	
   ensure	
   that	
   MOSE	
   GUILLORY	
   had	
   been	
   properly	
   trained	
   before	
   assigning	
   him	
   to	
   a	
  
               task;	
  	
  
          	
  
          f. Failing	
  to	
  certify	
  and/or	
  conduct	
  periodic	
  inspections	
  of	
  energy	
  control	
  procedures	
  for	
  MOSE	
  
               GUILLORY’s	
  safety;	
  	
  
          	
  
          g. Failing	
  to	
  provide	
  MOSE	
  GUILLORY	
  equipment	
  with	
  proper	
  guards	
  and	
  safety	
  mechanisms	
  that	
  
               were	
  adequate	
  and	
  in	
  working	
  order;	
  
          	
  
          h. Failing	
  to	
  supervise	
  MOSE	
  GUILLORY	
  while	
  he	
  was	
  performing	
  tasks,	
  including	
  operating	
  the	
  
               Harris	
  Centurion	
  Baler;	
  
          	
  
          i. Failing	
  to	
  ensure	
  that	
  MOSE	
  GUILLORY	
  had	
  adequate	
  help	
  in	
  the	
  performance	
  of	
  his	
  work;	
  
          	
  
          j. Failing	
   to	
   ensure	
   that	
   MOSE	
   GUILLORY	
   was	
   assigned	
   to	
   a	
   task	
   he	
   qualified	
   and	
   trained	
   to	
  
               perform;	
  
          	
  
          k. Failing	
   to	
   ensure	
   that	
   MOSE	
   GUILLORY	
   was	
   trained	
   in	
   the	
   safe	
   and	
   proper	
   operation	
   of	
   all	
  
               heavy	
   equipment	
   operated	
   in	
   MOSE	
   GUILLORY’s	
   assigned	
   task,	
   including	
   the	
   Harris	
   Centurion	
  
               Baler;	
  and	
  
	
  
          l.    Failing	
  to	
  identify,	
  employ,	
  contract-­‐with,	
  delegate,	
  supervise,	
  and	
  manage	
  competent	
  vendor	
  
                management	
   and/or	
   employee-­‐leasing/employee-­‐staffing	
   companies	
   in	
   the	
   performance	
   of	
  
                their	
  duties.	
  
          	
  
92.       IWORKS	
  DEFENDANTS	
  and	
  WM	
  DEFENDANTS	
  were	
  unjustly	
  enriched	
  by	
  IWORKS	
  DEFENDANTS’	
  

and	
  WM	
  DEFENDANTS’	
  breaches.	
  

93.       IWORKS	
   DEFENDANTS’	
   and	
   WM	
   DEFENDANTS’	
   breaches	
   proximately	
   caused	
   injury	
   to	
   Plaintiff	
  

MOSE	
  GUILLORY,	
  which	
  resulted	
  in	
  PLAINTIFFS’	
  damages	
  detailed	
  below.	
  

94.       PLAINTIFFS	
  seek	
  unliquidated	
  damages	
  within	
  the	
  jurisdictional	
  limits	
  of	
  this	
  Court.	
  

95.       PLAINTIFF	
   MOSE	
   GUILLORY	
   is	
   entitled	
   to	
   recover	
   reasonable	
   attorney	
   fees	
   under	
   Texas	
   Civil	
  

Practice	
   &	
   Remedies	
   Code	
   Chapter	
   38	
   because	
   this	
   suit	
   is	
   for	
   breach	
   of	
   written	
   contracts.	
   PLAINTIFF	
  

MOSE	
   GUILLORY	
   retained	
   counsel,	
   who	
   presented	
   PLAINTIFF’s	
   claim	
   to	
   IWORKS	
   DEFENDANTS	
   and	
   WM	
  

DEFENDANTS.	
   DEFENDANTS	
   did	
   not	
   tender	
   the	
   amount	
   owed	
   within	
   30	
   days	
   of	
   when	
   the	
   claim	
   was	
  

presented.	
  	
  

	
                                         	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                             28	
  
                                                                      XVIII. DAMAGES	
  

96.      DEFENDANTS’	
   activities,	
   actions,	
   and/or	
   inactions,	
   as	
   detailed	
   above,	
   directly	
   and/or	
   proximately	
  

caused	
  injury	
  to	
  PLAINTIFFS,	
  which	
  include	
  the	
  following:	
  

         a.     Pain	
  and	
  suffering	
  in	
  the	
  past	
  and	
  future	
  
         	
  
         b.     Mental	
  anguish	
  in	
  the	
  past	
  and	
  future.	
  
         	
  
         c.     Physical	
  disfigurement	
  in	
  the	
  past	
  and	
  future.	
  
         	
  
         d.     Physical	
  impairment	
  in	
  the	
  past	
  and	
  future.	
  	
  
         	
  
         e.     Medical	
  expenses	
  in	
  the	
  past	
  and	
  future.	
  
         	
  
         f.     Loss	
  of	
  past	
  earning	
  capacity.	
  
         	
  
         g.     Loss	
  of	
  future	
  earning	
  capacity.	
  
         	
  
         h.     Loss	
  of	
  consortium	
  in	
  the	
  past	
  and	
  future.	
  
         	
  
         i.     Loss	
  of	
  household	
  services	
  in	
  the	
  past	
  and	
  future.	
  	
  
         	
  
         j.     Consequential	
  and/or	
  incidental	
  damages.	
  
         	
  
         k.     Other	
  unliquidated	
  damages	
  within	
  the	
  jurisdictional	
  limits	
  of	
  this	
  Court.	
  
         	
  
         l.     Exemplary	
  damages	
  under	
  Texas	
  Civil	
  Practice	
  &	
  Remedies	
  Code	
  section	
  41.003(a).	
  	
  
         	
  
         m.     Contract	
  damages	
  including	
  but	
  not	
  limited	
  to	
  restitution	
  and	
  profit	
  disgorgement.	
  
	
  
         n. Nominal	
  damages.	
  
	
  
         o. Attorneys’	
  fees,	
  as	
  permitted	
  by	
  law.	
  
         	
  
         p. Pre-­‐judgment	
   interest	
   and	
   post-­‐judgment	
   interest.	
   TEXAS	
   FINANCE	
   CODE	
   §304.001,	
   et	
   seq.,	
   and	
  
              any	
  other	
  applicable	
  law.	
  	
  	
  
	
  

                                                                  XIX.        JURY	
  DEMAND	
  

97.      PLAINTIFFS	
  demand	
  a	
  jury	
  trial	
  and	
  tender	
  the	
  appropriate	
  fee	
  with	
  this	
  petition.	
  	
  

	
                                          	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                    29	
  
                                                         XX.         CONDITIONS	
  PRECEDENT	
  

98.        All	
  conditions	
  precedent	
  to	
  PLAINTIFFS’	
  claims	
  for	
  relief	
  have	
  been	
  performed	
  or	
  have	
  occurred.	
  	
  

                                                        XXI.       REQUEST	
  FOR	
  DISCLOSURE	
  

99.        Under	
   Texas	
   Rule	
   of	
   Civil	
   Procedure	
   194,	
   PLAINTIFFS	
   request	
   that	
   DEFENDANTS	
   disclose	
   the	
  

information	
  or	
  material	
  described	
  in	
  Rule	
  194.2.	
  

                            	
  	
  
                                                                        XXII. PRAYER	
  

100.       WHEREFORE,	
   PREMISES	
   CONSIDERED,	
   PLAINTIFFS	
   ask	
   that	
   Defendants	
   be	
   cited	
   to	
   appear	
   and	
  

answer	
  and,	
  on	
  final	
  trial,	
  that	
  PLAINTIFFS	
  be	
  awarded	
  a	
  judgment	
  against	
  IWORKS	
  PERSONNEL,	
  INC.,	
  

LUIS	
  TREVINO,	
  HAYDEE	
  GUTIERREZ,	
  and	
  WM	
  DEFENDANTS	
  for	
  PLAINTIFFS’	
  damages	
  and	
  for	
  all	
  other	
  

relief	
  to	
  which	
  PLAINTIFFS	
  are	
  entitled	
  at	
  law	
  and	
  in	
  equity.	
  	
  

                                                                                            Respectfully	
  submitted,	
  
                                                                                            GILDE	
  LAW	
  FIRM	
  

                                                                                            ________________________________________________	
  
                                                                                            BRADFORD	
  J.	
  GILDE	
  
                                                                                            TSB#:	
  24045941	
  
                                                                                            NICHOLAS	
  A.	
  HOMAN	
  
                                                                                            TSB#:	
  24083194	
  
                                                                                            55	
  Waugh	
  Dr.,	
  Suite	
  850	
  
                                                                                            Houston,	
  TX	
  77007	
  
                                                                                            281-­‐973-­‐2771	
  –	
  facsimile	
  
                                                                                            281-­‐973-­‐2772	
  –	
  phone	
  
                                                                                            bjg@gildelawfirm.com	
  
                                                                                     	
  
	
                                           	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                    30	
  
                                                                    CERTIFICATE	
  OF	
  SERVICE	
  
                                                                                         	
  
            I	
   hereby	
   certify	
   that	
   a	
   true	
   and	
   correct	
   copy	
   of	
   the	
   foregoing	
   has	
   been	
   served	
   to	
   all	
   counsel	
   of	
  

record	
  via	
  TexFile	
  on	
  this	
  13th	
  day	
  of	
  June,	
  2014.	
  	
                	
        	
          	
  

	
          	
          	
  

	
          	
          	
          	
          	
          	
           	
          	
                                                      	
  
	
          	
          	
          	
          	
          	
           	
          	
            ______________________________________________	
  
	
          	
          	
          	
          	
          	
           	
          	
            BRADFORD	
  J.	
  GILDE	
  
                                                                                            	
  
	
                                              	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
                                                                                                31	
  
                                            	
  
                                            	
  
                                      EXHIBIT	
  
                                            	
  
                                           A	
  
                                            	
  
	
                                    	
  
PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
     32	
  
WMRA 000022
WMRA 000023
WMRA 000024
WMRA 000025
WMRA 000026
WMRA 000027
WMRA 000028
WMRA 000029
WMRA 000030
WMRA 000031
WMRA 000032
WMRA 000033
WMRA 000034
                                          	
  
                                          	
  
                                      EXHIBIT	
  
                                          	
  
                                         B	
  

PLAINTIFFS’	
  FIFTH	
  AMENDED	
  PETITION	
  &	
  REQUESTS	
  FOR	
  DISCLOSURE	
     33	
  
iWorks Personnel Inc. Resp to P RFP00002
                                   Case No. 201261407

 MOSE A. GUILLORY AND MARY                    §             IN THE DISTRICT COURT OF
 GUILLORY                                     §
                                              §                 HARRIS COUNTY, TEXAS
 V.                                           §
                                              §
 IWORKS PERSONNEL, INC, ET AL.                §                113TH JUDICIAL DISTRICT

                              IWORKS PERSONNEL, INC.’S
                              PLEA TO THE JURISDICTION

       DEFENDANTS, iWORKS PERSONNEL, INC., LUIS TREVINO, and HAYDEE

GUTIERREZ (hereinafter “IWORKS”) file this Plea to the Jurisdiction. In support thereof

it would show this honorable Court the following:

                                              I.
                                        Introduction

       This is a worker’s compensation case.         IWORKS has prefaced almost every

pleading it has filed with this assertion. This is because, to date, the great bulk of legal

efforts expended in this case are the direct result of Plaintiffs’ numerous and continued

attempts to circumvent the Texas Labor Code in the face of well settled law and clear

public policy dictating otherwise. For well over a year Plaintiff’s counsel has had two

separate worker’s compensation policies which would provide him with worker’s

compensation coverage. See Exhibit A (iWORKS’) and Exhibit B (Waste Management’s).

Nevertheless, Plaintiff has refused to file a claim on either policy even though he would

begin receiving benefits within fifteen days and despite the fact that this is what is required

by the Texas Labor Code.

       iWORKS has consistently asserted that 1) it is a subscriber to worker’s

compensation insurance, and 2) that Waste Management is responsible for the worker’s

compensation coverage for Guillory because a) it executed a hold harmless agreement
related to Guillory’s employment, and b) it is solely responsible for moving Guillory from

the duties he was assigned to perform by iWORKS (operation of a front-end loader) and

placing him in operation of a machine (the Harris Baler) without any notice to iWORKS,

for failing to provide Guillory with the training and supervision necessary to operate the

Harris Baler safely, and for controlling the scope, manner and details of Guillory’s work in

a negligent fashion. For these reasons, iWORKS did not initiate a worker’s compensation

claim related to Guillory’s work-place injury. Moreover, to the best knowledge of iWORKS,

Waste Management has not filed an Employer’s First Report of Injury or Illness (Form

DWC-001) with its worker’s compensation carrier, Indemnity Insurance Company of North

America (“IICNA”).

        In order to put this matter on the administrative path it should have been on from

its inception, iWORKS has filed an Employers First Report of Injury or Illness (Claim #

1420000952677) with its worker’s compensation carrier, Texas Mutual Insurance

Company (“TMIC”).1 See Exhibit C. The compensability of Guillory’s injury is now being

determined by TMIC claims adjuster Patricia Westin. It is very likely that Texas Mutual

will seek some form of contribution from IICNA. In the event of an adverse compensability

finding iWORKS will instigate a Benefit Review Conference with the Texas Department

of Insurance – Division of Worker’s Compensation (“DWC”)2, the first step in exhausting

the administrative remedies necessary to pursue judicial review.

1 By filing a claim on its worker’s compensation insurance, iWORKS does NOT waive or otherwise retreat
from its position that Guillory’s injury is the sole responsibility of Waste Management and/or Guillory and
expressly reserves its rights to raise these issues in the administrative proceedings (if any) and any judicial
review of any administrative determinations.

2 In 2005, the Legislature abolished the Texas Workers’ Compensation Commission and transferred its
functions to the Texas Department of Insurance-Division of Worker’s Compensation. See Act of May 29,
2005, 70th Leg., R.A., ch. 265, § 8.001, 2005 Tex. Gen. Laws 469, 607-08. For ease of reference Movant

                                                      2
        The DWC has exclusive jurisdiction over this matter. Plaintiffs’ have not exhausted

their administrative remedies. Thus, this Court lacks subject-matter jurisdiction and

should dismiss Plaintiffs’ causes of action.

                                          II.
                Evidence in Support of iWORKS’ Plea to the Jurisdiction

        Exhibit A –     iWORKS’ Workers’ Compensation Policy

        Exhibit B –     Waste Management’s Workers’ Compensation Policy.

        Exhibit C –     Employer’s First Report of Injury or Illness (DWC-001) filed by

        Exhibit D –     Hold Harmless Agreement

        Exhibit E –     Employee’s Claim for Compensation for a Work-Related Injury or
                        Occupational Disease (DWC-041) executed Guillory

        Exhibit F –     Affidavit of Luis Trevino

                                                III.
                                       Factual Background

        IWORKS is a temporary staffing company based out of San Antonio, Texas. It

provides temporary employees to companies throughout Texas for assignments as short

as one day or as long as six months. IWORKS’ duty is to recruit, screen, interview, and

assign its employees to perform the type of work requested by its clients. The work is to

be performed at its client’s facilities and under its client’s direct supervision. IWORKS

also pays the employee’s wages, pays, withholds and transmits payroll taxes, provides

unemployment insurance and worker’s compensation benefits, and handles any

unemployment and worker’s compensation claims for employees we assign to its clients.

IWORKS is not licensed as a staff leasing agency and has never offered staff leasing

will refer to any reference to the Division of Worker’s Compensation or any of its predecessor agencies as
“DWC.”

                                                    3
services. Nor has it ever provided any PEO services. Its sole business is recruiting and

assigning temporary workers as required by its clients. IWORKS provides no site specific

training to the temporary workers that it provides to its clients. IWORKS does not

supervise any of the work performed at its client’s sites. IWORKS has no control over its

client’s facilities or equipment.

       One of IWORKS’ clients was Waste Management, Inc. (“Waste Management”).

In July 2012, Waste Management contacted IWORKS’ Houston branch requesting a

temporary employee who was qualified to operate a front-end loader at Waste

Management’s Gasmer facility. The provision of heavy equipment operators is not an

area in which IWORKS does a lot of business. Therefore, as a condition of procuring

such employees for Waste Management, IWORKS and Waste Management agreed that

IWORKS would locate temporary employees who had experience operating front-end

loaders, but that it would be Waste Management’s responsibility to ensure that

employees supplied by IWORKS were trained in the safe and proper operation of all

heavy equipment to be operated in their assigned task. IWORKS and Waste

Management also agreed that Waste Management would be solely responsible for any

damages related to the operation of the heavy machinery at the Waste Management

facility by an IWORKS temporary employee, and that Waste Management would hold

IWORKS harmless in the event there was a claim made against them related to the

operation of heavy machinery by an IWORKS temporary employee. See Exhibit D.

       Mose Guillory applied for temporary work with IWORKS and indicated that he had

experience operating a front-end loader. IWORKS instructed him to report to Waste

Management’s Gasmer facility to be evaluated. Waste Management reported to

                                            4
IWORKS that Guillory had sufficient skill and experience operating a front-end loader

and Guillory began working at the Waste Management Gasmer facility. From that point

forward IWORKS sole responsibility was to pay Guillory based upon the time sheets

submitted by Guillory’s Waste Management supervisors.

           IWORKS did not control any aspect whatsoever of Guillory’s work at the Waste

Management facility; Waste Management had sole control over the manner and details

of Guillory’s work. IWORKS did not control or even participate in evaluating whether or

not Guillory possessed sufficient skill to operate a front-end loader; Waste Management

had sole control in determining whether or not Guillory possessed sufficient skill.

IWORKS did not control any site-specific training for Guillory; Waste Management had

sole control over any site-specific training that Guillory may have needed to perform his

duties at Waste Management’s Gasmer facility.

      The following undisputed facts are alleged in Plaintiff’s Fifth Amended Original

Petition:

     Waste Management hired IWORKS to locate temporary employees to work at Waste
      Management’s Gasmer facility. Petition3, p. 11, ¶26; Petition, Exhibit A

     As a condition of procuring such employees IWORKS and Waste Management
      executed an agreement which specified that Waste Management was solely
      responsible for ensuring that the candidates were sufficiently trained in the operation
      of the heavy machinery. Id., p. 11, ¶26; Petition, Exhibit B

     On July 9, 2012 Guillory applied for a job at IWORKS. Id., p. 11, ¶ 27.

     Guillory was assigned to operate a front-end loader at the Waste Management facility
      located at 4939 Gasmer Dr., Houston, Texas. Id., p. 11, ¶ 29.

     iWORKS does not provide site specific training as that is the duty of the client
      company. Id., p. 15, ¶ 41.
3   Unless otherwise indicated, “Petition” refers to Plaintiff’s Fifth Amended Petition.

                                                         5
    When Guillory reported to the Gasmer facility on July 9th he was required to
     demonstrate his proficiency in driving a front-end loader to a Waste Management
     employee. Id.

    Waste Management was responsible for determining whether or not Guillory had
     sufficient experience, training, and skill to operate a front-end loader at Waste
     Management’s Gasmer facility. Id., p. 11, ¶ 29, p. 14, ¶¶ 40-41.

    Waste Management employee Abraham Hernandez determined that Guillory was
     sufficiently skilled in operating a front-end loader and instructed him to report for work
     on July 10, 2012. Id.

    Guillory operated the front-end loader at the Gasmer facility on the day shift from
     roughly July 10, 2012 to July16, 2012. Id., p. 12, ¶ 30.

    Soon thereafter Guillory moved to the night shift at the Gasmer facility. Id.

    While working on the night shift Waste Management instructed Guillory to operate a
     Harris Baler. Id., ¶ 31.

    On August 5, 2012 Guillory reported for work on the night shift and began to operate
     the Harris Baler. Petition, p. 13, ¶ 36.

    During this shift Guillory climbed into the baler which engaged while he was in there,
     severing his right leg below the knee and severing a portion of his left foot. Id.

                                           IV.
                                  Arguments & Authorities

A.      This Court does not have subject-matter jurisdiction.

        This Court does not have subject-matter jurisdiction over Plaintiffs’ claims related

to his injury at work. Without subject-matter jurisdiction this Court cannot render a valid

judgment in this matter. City of Houston v. Rhule, 417 S.W.3d 440, 442 (Tex. 2014, per

curium) (“Subject matter jurisdiction is ‘essential to a court’s power to decide a case’”

quoting Bland Indep. Sch. Dist. v. Blue, 34 S.W.3d 547, 553–54 (Tex.2000)). Subject-

matter jurisdiction cannot be waived, nor can it be given or taken away by consent. Carroll

v. Carroll, 304 S.W.3d 366, 367 (Tex. 2010); see Rhule, 417 S.W.3d at 442 (“A judgment

                                                6
rendered without subject matter jurisdiction cannot be considered final” citing Dubai

Petrol. Co. v. Kazi, 12 S.W.3d 71, 76 (Tex.2000)).

       Lack of subject-matter jurisdiction makes a judgment void, not just voidable. In Re

United Servs. Auto Ass’n, 307 S.W.3d 299, 209 (Tex. 2010). Lack of subject-matter

jurisdiction is fundamental error and can be raised at any time. Tex. Worker’s Comp.

Comm’n v. Garcia, 893 S.W.2d 504, 517 n.15 (Tex. 1995) (noting that a trial court can

question its subject-matter jurisdiction even without a motion by either party). Lack of

subject-matter jurisdiction can even be raised for the first time on appeal. Waco ISD v.

Gibson, 22 S.W.3d 849, 851 (Tex. 2000); see Rhule, 417 S.W.3d at 442 (“Not only may

a reviewing court assess jurisdiction for the first time on appeal, but all courts bear the

affirmative obligation ‘to ascertain that subject matter jurisdiction exists regardless of

whether the parties have questioned it.’” quoting In re United Servs. Auto. Ass'n, 307
S.W.3d 299, 306 (Tex.2010)). Furthermore, the failure to grant a plea to the jurisdiction

for failure to exhaust administrative remedies with the DWC is subject to mandamus

review.   In Re Liberty Mut. Fire Ins. Co., 295 S.W.3d 327, 328 (Tex. 2009) (orig.

proceeding) (per curiam); In Re Liberty Ins. Corp., 321 S.W.3d 630 (Tex.App.—Houston

[14th Dist.] 2010) (orig. proceeding).

B.     The Division of Workers’ Compensation has exclusive jurisdiction.

       This is a worker’s compensation case and falls under the exclusive jurisdiction of

the Texas Department of Insurance – Division of Worker’s Compensation. As such, this

court lacks subject-matter jurisdiction to adjudicate Plaintiffs’ claims until Plaintiffs have

exhausted their administrative remedies through the DWC.

                                              7
        An agency has exclusive jurisdiction “when a pervasive regulatory scheme

indicates that Congress intended for the regulatory process to be the exclusive means of

remedying the problem to which the regulation is address.” Subaru of Am. v. David

McDavid Nissan, Inc., 84 S.W.3d 212, 221 (Tex. 2002); In Re Mid-Century Ins. Co. of

Tex., 426 S.W.3d 169, 172 (Tex.App.—Houston [1st Dist] 2012) (orig. proceeding) (“An

agency has exclusive jurisdiction . . . when a pervasive regulatory scheme reflects

legislative intent that an agency have the sole power to make the initial determination in

the dispute.”) Exclusive jurisdiction is a question of law that turns on statutory

interpretation. See Rhule, 417 S.W.3d at 442 (citing Subaru, 84 S.W.3d at 221. The

Texas Supreme Court held in Saenz v. Fidelity & Guaranty Insurance Underwriters4 that

“the Workers’ Compensation Act vests the power to award compensation benefits solely

in the [DWC]. . ., subject to judicial review.” Saenz, 925 S.W.2d at 612.

        In Tex. Mut. Ins. Co. v. Ruttiger5 the Texas Supreme Court discussed the

significant changes the Legislature made to the Worker’s Compensation Act6 (“Act”) in

19897. It noted that the “amendments included significant reforms, among which were

changes in how to calculating benefits for injured workers, the amount of income benefits

workers could recover, the dispute resolution process, the addition of an ombudsman

program to provide assistance for injured workers who had disputes with insurers, and

increasing sanctions for violations of the Act.” Id., 381 S.W.2d at 433. The Ruttiger court

4 925 S.W.2d 607 (Tex. 1996)
5 381 S.W.3d 430 (Tex. 2012).
6 Tex. Lab. Code §§ 401.001 – 506.002.
7 The Ruttiger opinion addressed the viability of a common-law cause of action for breach of the duty of

good faith and fair dealing against a worker’s compensation carrier, a cause of action previously approved
of by the Texas Supreme Court in Arranda v. Ins. Co. of North Amer., 748 S.W.2d 210 (Tex. 1988). The
Ruttiger court held that the 1989 amendments to the Act manifested the Legislatures’ intent to vitiate the
need for such a cause of action and expressly overruled Arranda. Id., 381 S.W.3d at 438-56.

                                                    8
stated that “[t]he purpose of the Act is to provide employees with certainty that their

medical bills and lost wages will be covered if they are injured.” Id. at 441.

       To accomplish these purposes, the Act provides detailed notice and
       administrative dispute resolution proceedings that include specific
       deadlines and incorporate a “conveyor-belt” approach. That is, once the
       administrative dispute resolution process is initiated, a dispute continues
       through the process until the dispute is resolved either by the parties or by
       a binding decision through the resolution procedures.

Id. at 441.

       The Ruttiger opinion provides a lengthy description of “the detailed notice and

administrative dispute resolution proceedings” encompassed by the Act. Id. at 441-43.

In describing the pervasiveness of the Act the Ruttiger court noted that the Act affords the

DWC significant power to enforce the Act against the various parties in the worker’s

compensation system. Id. The Ruttiger court concluded:

       It is apparent that the Act prescribes detailed, WCD-supervised, time-
       compressed processes for carriers to handle claims and for dispute
       resolution. It has multiple, sometimes redundant but sometimes additive,
       penalty and sanction provisions for enforcing compliance with its
       requirements.

Id. at 443. The court recognized that allowing an employee to circumvent the act by

asserting common law causes of action would be “inconsistent with the Act’s goals and

legislative intent exhibited in the act” and could also “result in rewarding an employee who

is dilatory in utilizing the Act’s detailed dispute resolution procedures, regardless of

whether the delay was intentional or inadvertent, because whether and when the dispute

resolution begins is by and large dependent on the employee.” Id.

       The number of appellate decisions recognizing the DWC’s exclusive jurisdiction

over work-place injuries is voluminous. Both Houston Courts of Appeal have recognized

the DWC’s exclusive jurisdiction. The Fourteenth held that “[t]he Workers’ Compensation

                                             9
Act vests the Workers’ Compensation Division with exclusive jurisdiction to determine a

claimant’s entitlement to medical benefits.” In Re Liberty Insurance Corporation, 321
S.W.3d 630, 636 (Tex.App.—Houston [14th Dist.] 2010, orig. proceeding) (granting

Relator’s petition for mandamus relief and dismissing Plaintiff’s case for lack of

jurisdiction). Likewise, the First District held that “[t]he Worker’s Compensation Act gives

the DWC exclusive jurisdiction over certain workers’ compensation disputes relating to

entitlement to medical benefits, preauthorization of medical care and reimbursement of

medical expenses.” In Re Mid-Century Ins. Co. of Tex., 426 S.W.3d 169, 172 (Tex.App.—

Houston [1st Dist.] 2012, orig. proceeding) (granting Relator’s petition for mandamus).

C. Plaintiff has not exhausted his administrative remedies.

       When an agency has exclusive jurisdiction a party must exhaust its administrative

remedies before seeking recourse through judicial review. Rhule, 417 S.W.2d at 442

(citing Cash Am. Int’l., Inc. v. Bennett, 35 S.W.3d 12, 15 (Tex. 2000); Cunningham

Lindsey Claims Mgmt. v. Snyder, 291 S.W.3d 472, 477 (Tex.App.—Houston [14th Dist.]

2009, pet. denied) (“If an agency has exclusive jurisdiction. . . a party must first exhaust

all administrative remedies before a trial court has subject matter jurisdiction.”). “Absent

exhaustion of administrative remedies, a trial court must dismiss the case.” Rhule, 417
S.W.2d at 442 (citing Tex. educ. Agency v. Cypress-Fairbanks I.S.D., 830 S.w.2d 88, 90

(Tex. 1992). There is no question that Guillory has not exhausted his administrative

remedies through the DWC. The question before this court is, “Why?”

       Guillory was injured on August 5, 2012.       Approximately two weeks later, he

executed a claim form requesting compensation for a work-related injury. See Exhibit E.

On that form he stated that he was represented by Bradford J. Gilde. Id. Thus, fifteen

                                            10
days after his work-related injury (over 2 ½ years ago) Guillory was at a minimum aware

of the potential availability of worker’s compensation benefits. It is also fair to assume

that his legal representative knew (or had the ability to find out) how to obtain those

benefits. As was stated above, for almost two years Guillory has had two separate

worker’s compensation policies by which he could have sought benefits. Yet he has made

no effort to invoke his rights under either policy.

       This court has found as a matter of law that Guillory’s claims against Waste

Management are barred by the “comp bar” defense, yet Guillory still refuses to file a claim

on Waste Management’s worker’s compensation policy. The Texas Supreme Court held

in Port Elevator-Brownsville, L.L.C. v. Casados, 358 S.W.3d 238 (Tex., 2012) that a

company cannot segregate its temporary employees and permanent employees for

purposes of coverage under its worker’s compensation policy. The Casados court further

noted that:

       [P]remiums are an issue between the employer and the insurer; they do not
       affect the employee's coverage. Tex. Emp'rs' Ins. Ass'n v. Stanton, 140
S.W.2d 337, 339–40 (Tex.Civ.App.-Amarillo 1940, writ. ref'd) (“[T]he failure
       to pay the premiums which may be due upon a policy is a matter of no
       importance as between the insurer and the employee but only concerns the
       insurer and the employer.”). If Port Elevator's policy had set out certain
       premiums solely for temporary workers and Port Elevator had not paid those
       premiums, Casados would still have been covered under the policy and the
       failure to pay premiums would be an issue between Port Elevator and Texas
       Mutual. See Coal Operators Cas. Co. v. Richardson, 414 S.W.2d 735, 738
       (Tex.Civ.App.—Beaumont 1967, writ ref'd n.r.e.) (“This [workers'
       compensation] protection to plaintiff was not lost because his employer
       failed to pay the proper premium to the insurance company.”).

Id.   at 243-44.    Thus, Guillory is covered under Waste Management’s worker’s

compensation policy as a matter of law. This may be another reason why Waste

                                              11
Management has failed to invoke its rights under the Act. See discussion, infra, n. 8

(below).

        The only plausible explanation for Guillory’s failure to even try to claim his benefits

under the Texas Workers’ Compensation Act is that he and his counsel decided early in

the course of this litigation to try and circumvent the worker’s compensation system in an

attempt to recover common law damages. Given the extreme nature of Guillory’s injury

it is understandable why he would prefer common law remedies. However, this approach

flies in the face of long standing legal precedence and well-established public policy. As

the Ruttiger court stated, “the extra-statutory cause of action provides incentive for an

injured worker to delay using the avenues for immediate relief that the Legislature

painstakingly built into the law” and “distorts the balances struck in the Act and frustrates

the Legislature’s intent to have disputes resolved quickly and objectively.” Ruttiger, 381
S.W.3d at 451. That is what happened in this case.8

        This is not a factually complicated matter; the basic underlying facts are, for the

most part, undisputed. However, in his attempt to circumvent the worker’s compensation

system, Guillory has had to assert highly questionable causes of action and include

parties that simply have no business being in this litigation. As a result this litigation has

burgeoned into an unnecessarily complicated and contentious morass. It has even

resulted in an award of substantial attorney fees being assessed against Guillory, himself.

Nevertheless, Guillory continues down this untenable path fearing that any recognition by

8 Fairness demands that the same inquiry be directed at both iWORKS and Waste Management: why didn’t
either one of them file a claim with their worker’s compensation carrier? iWORKS’ position is stated, supra,
at p. 1-2. iWORKS’ understanding of Waste Management’s position is that the Hold Harmless Agreement
is unenforceable and that iWORKS has a contractual duty to provide the worker’s compensation coverage
for Guillory. This question is now moot given that iWORKS has filed a claim with TMIC and has begun the
administrative process required by the Act.

                                                    12
him of a viable worker’s compensation claim will preclude him from his questionable

attempt at recovering common law damages for his work-place injury. This is not how

the State of Texas wants work-place injuries to be resolved. “[P]arties cannot avoid

exhaustion of administrative remedies because they fear they might not prevail.” In Re

Liberty Mut. Fire Ins. Co., 295 S.W.3d 327 329 (Tex. 2009).

      The Corpus Christi Court of Appeals provides a concise description of the

administrative process required to exhaust the DWC administrative remedies.

      The Texas Workers' Compensation Act provides a four-tiered system for
      the disposition of claims by the DWC. See TEX. LAB. CODE ANN. §§ 410.021–
      .308 (West 2006 & Supp. 2010). In the first tier, the parties participate in a
      “benefit review conference” conducted by a “benefit review officer.” TEX.
      LAB. CODE ANN. §§ 410.021–.034 (West 2006 & Supp.2010). The
      conference, which is a “nonadversarial, informal dispute resolution
      proceeding,” is designed to inform the parties regarding the procedures
      regarding a claim, discuss the facts and issues pertaining to the claim, and
      “mediate and resolve disputed issues by agreement of the parties.” Id. §
      410.021(3) (West 2006). “A dispute may be resolved either in whole or in
      part at a benefit review conference.” Id. § 410.029(a) (West 2006). If the
      conference results in the resolution of disputed issues or in a settlement,
      the benefit review officer reduces the agreement to writing and the parties
      and the officer sign the agreement. Id. § 410.029(b) (West 2006). If the
      parties fail to resolve all parts of a dispute at the benefit review conference,
      the benefit review officer similarly prepares a written report that delineates
      the status of the case. Id. § 410.031 (West 2006).

      In the second tier, “[i]f issues remain unresolved after a benefit review
      conference,” the parties may agree to arbitrate, and absent such an
      agreement, the parties may seek relief at a “contested case” hearing. Id. §§
      410.104, 410.151–.169 (West 2006). In the third tier, a party may seek
      review by an administrative appeals panel. Id. §§ 410.201–.208 (West
      2006). Finally, in the fourth tier, a party that has exhausted its administrative
      remedies may seek judicial review. Id. §§ 410.251–.308 (West 2006).

In Re New Hampshire Ins. Co., 360 S.W.3d 597 (Tex. App.—Corpus Christi 2011, pet.

denied). This is the process that Guillory must exhaust. Only after Guillory has availed

himself of these administrative remedies may he seek redress in this Court.

                                             13
D.      The DWC has exclusive jurisdiction to determine coverage in this matter.
        Guillory claims that both iWORKS and Waste Management are non-subscribers.

See Petition, p. 6, ¶¶ 19-20. iWORKS contends that it had a worker’s compensation policy

in effect at the time of Guillory’s injury. See Exhibit F.9 By raising this coverage issue

Plaintiff hopes to thwart the “worker’s comp bar”10 and avoid resolution of this matter

through the DWC. However, this approach does not comport with Texas law. The DWC

has both the exclusive authority and the administrative ability to resolve these issues.

        The DWC routinely addresses these types of issues through its administrative

proceedings. See e.g. Ins. Co. of Pa. v. Hartford Underwriters Ins. Co., 164 S.W.3d 747

(Tex.App.—Houston [14th Dist.] 2005, no pet.) (“Though we are not bound by the

decisions [of the DWC], we find them instructive . . . . “); Houston Gen. Ins. Co. v. Ass’n

Cas. ins. Co., 977 S.W.3d 634, 636 (Tex.App.—Tyler 1998, no pet.) (noting that

administrative decisions, while not binding, are entitled to substantial weight).

        In Appeals Panel No. 03066011 (Division of Worker’s Compensation, April 28,

2003) the DWC appeals panel addressed a temporary staffing situation and determined

which employer was liable, the proper application of the Staff Leasing Services Act12

(“SLSA”), and approved the use of the borrowed servant doctrine in determining liability.

9 Exhibit F is the Affidavit of Luis Trevino which is incorporated by reference as if set forth in full herein.
10 The Texas Workers' Compensation Act provides that the "exclusive remedy of an employee covered by
workers' compensation insurance coverage" for a work-related injury is "recovery of workers' compensation
benefits" as provided under the Act. TEX. LAB. CODE ANN. § 408.001(a).
11 DWC Appeals Panel decisions are available on the Texas Department of Insurance website at

http://www.tdi.texas.gov/appeals. Copies of the Appeals Panel decisions cited in this brief are attached
hereto in an Appendix.
12 TEX. LABOR CODE, Chapter 91 (“STAFF LEASING SERVICES”). The Texas Legislature amended Chapter 91

in 2013 renaming it “PROFESSIONAL EMPLOYMENT ORGANIZATIONS”. This amendment supports iWORKS’
opposition to Plaintiff’s proposition that it is a staff leasing company. Rather, iWORKS temporary

                                                     14
        In Appeals Panel No. 021771 (Division of Worker’s Compensation, September 3,

2002) the appeals panel addressed a matter factually similar to this case analyzing the

interplay between the contractual obligations between a staffing company and its client

company, the applicability of the SLSA, and the application of the borrowed servant

doctrine to determine coverage.              The appeals panel upheld the hearing officer’s

determination that the client company was responsible for the worker’s injury rather than

the staffing company. The panel held that:

        Texas courts have recognized that a general employee of one employer
        may become the borrowed servant of another employer. The determinative
        question then becomes which employer had the right of control of the details
        and manner in which the employee performed the necessary services. Carr
        v. Carroll Company, 646 S.W.2d 561 (Tex. App.-Dallas 1982, writ ref'd
        n.r.e.). We note that in Texas Workers’ Compensation Insurance Fund v.
        DEL Industrial, Inc., 35 S.W.3d 591 (Tex. 2000), the court held that the Staff
        Services Leasing Act (SSLA), Texas Labor Code Chapter 91, supersedes
        the common law right-of-control test in determining employer status of
        leased employees for workers’ compensation purposes. However,
        (Employer 2) was not licensed under the SSLA. The hearing officer
        determined that on the date of injury, (Employer 2) was a licensed provider
        of temporary common workers under Chapter 92 of the Texas Labor Code,
        entitled Temporary Common Worker Employers (TCWE). In Richmond v. L.
        D. Brinkman & Co. (Texas) Inc., 36 S.W.3d 903 (Tex. App.-Dallas 2001,
        pet. denied), the court determined that the common law right-of-control test
        is not superseded by Chapter 92 (TCWE) of the Texas Labor Code. The
        hearing officer is the sole judge of the weight and credibility of the evidence.
        Section 410.165(a). We conclude that the hearing officer did not err in
        applying the right-of-control test and in determining that at the time of the
        injury, the claimant was the borrowed servant of (Employer 1). The hearing
        officer’s decision is supported by sufficient evidence and is not so against
        the great weight and preponderance of the evidence as to be clearly wrong
        and unjust. Cain v. Bain, 709 S.W.2d 175 (Tex. 1986).

employment service as set forth in Chapter 93 of the TEXAS LABOR CODE. Furthermore, effective September
1, 2013, TEX. LABOR CODE § 93.004(a) holds that a Certificate of Insurance “constitutes proof of workers’
compensation insurance coverage for the temporary employment service and the client of the temporary
employment service with respect to all employees of the temporary employment services assigned to the
client.” Subsection (a) further holds that “[t]he state or political subdivision of the state shall accept a
certificate of insurance coverage described by this section as proof of worker’s compensation coverage
under Chapter 406.”

                                                    15
Id. at p. 1-2. The client company also argued that the staffing company should be

responsible because the client company paid fees to the staffing company which went

towards worker’s compensation coverage for the temporary employees.                The panel

rejected these arguments. Id.

          In Appeals Panel No. 101718 (Division of Worker’s Compensation, March 21,

2011) the appeals panel examined a complex claim involving a contractor, a

subcontractor, a PEO, and a temporary staffing company. In finding that the employee

did not suffer a compensable injury the panel had to address issues related to coverage

(including whether or not the temporary staffing company’s carrier properly terminated

coverage), contractual duties between the parties, liability issues between three different

worker’s compensation insurance providers, employment status of the claimant, and

other related issues.

          The legal issues discussed above are all issues that are in play in this case. These

are issues that the DWC routinely addresses through its administration of the Act. These

are issues that fall squarely within the exclusive jurisdiction of the DWC. This court does

not have subject-matter jurisdiction over these matters until all of the administrative

remedies available through the Act have been exhausted.

          In Morales v. Liberty Mut. Sinc. Co.13, the Texas Supreme Court addressed the

issue of the relationship between compensability under the Texas Worker’s

13   241 S.W.3d 514 (Tex. 2007).

                                               16
Compensation Act (“the Act”), employee status, and subscriber status.14 The Court held

that issues of coverage such as the one in this case fall within the rubric of the existence

of a compensable injury which is properly resolved through the Act. Morales was killed

while repairing a roof on a motel. Id. at 515. His wife sought death-benefits under the

act claiming he was injured while in the course and scope of his employment with three

different employers. Id. Two of the employers were insured under separate worker’s

compensation policies, and the third was a nonsubscriber. Id.

        The existence of a compensable injury is the threshold requirement for
        payment of benefits under the Act. See TEX. LAB.CODE §§ 401.011(5),
        406.031(a). And there are various elements that affect whether an injury is
        compensable, including the worker's employment status as an employee or
        independent contractor at the time of injury, whether the worker was injured
        in the course and scope of employment, who controlled the employee's
        work when the injury occurred, and whether a particular employer has an
        insurance policy in effect. See id. §§ 401.011(12), (18), 401.012(a).

                ....

        A dispute about any of these elements regards “compensability or eligibility
        for . . . benefits” and is subject to judicial review under section 410.301.

Morales v. Liberty Mut. Ins. Co., 241 S.W.3d at 519. iWORKS has consistently claimed

that it has a worker’s compensation policy and that Waste Management controlled the

Guillory’s work when his injury occurred. These are issues within the purview of the Act

and over which the DWC has exclusive jurisdiction.

14 The Morales Court addressed these issues in the context of determining which standard of review set
forth in the Act should apply to judicial review of a final decision from a DWC appeals panel. If the issues
being appealed involve “compensability” then the standard of review is the “modified de novo” standard
established by §410.301. Issues that do not address compensability are reviewed under a “substantial-
evidence” standard. Morales, 241 at 516-17. The outcome of this question of compensability also effects
venue and the appropriate scope of judicial review. Id.

                                                    17
          In In Re Tex. Mut. Ins. Co.15 the court addressed the DWC’s exclusive jurisdiction

in the context of common law breach of contract claims and disputed coverage. The Court

held that the Fodge decision mandated that the claimant’s breach-of-contract claim “is

within the Commission’s exclusive jurisdiction.” Id., 157 S.W.3d at 80. The Court also

held that:

          We likewise reject [Claimant’s] assertions that the Commission’s exclusive
          jurisdiction over worker’s compensation benefits claims does not extend to
          determining whether coverage existed at the time of [Claimant’s] injury. The
          legislature has granted the Commission exclusive jurisdiction over claims
          for policy benefits. Fodge, 63 S.W.3d at 805. In adjudicating such claims,
          the Commission will necessarily have to interpret compensation policies
          and determine the period in which coverage existed. Indeed, it appears to
          routinely do so. See, e.g., Gonzales v. Cigna Ins. Co. of Tex, 924 S.W.2d
183, 184-87 (Tex.App.—San Antonio 1996, write denied); Houston Gen.
          Ins. Co. v. Association Cas. Ins. Co., 972 S.W.2d 634, 636 (Tex.App.—Tyler
          1998, no pet.).
          Moreover, [Claimant’s] argument would imply that whenever the
          Commission, in the exercise of its exclusive jurisdiction, encounters a
          coverage issue that can be characterized as going to "policy formation," the
          agency must abate its proceedings pending judicial resolution of the
          "formation" issue. We doubt that the legislature, in conferring exclusive
          jurisdiction upon the Commission to determine compensation benefits
          claims, intended such an absurd result that seemingly turns traditional
          concepts of exclusive jurisdiction on their head.
Id. at p.

          Nor does iWORKS’ delay in reporting Guillory’s injury to its insurance carrier

preclude it from invoking the administrative procedures of the Act. See Hand v. SGS

Control Servs., Inc., 409 S.W.3d 743, 749 (Tex.App.—Houston [1st Dist.] 2013). The court

held that “[the employer] ‘invoked” its workers’ compensation insurance coverage when

it initially obtained the coverage; it was not required to take an specific action to ‘invoke’

15   157 S.W.3d 75 (Tex.App.—Austin 2004, orig. proceeding).

                                                   18
that coverage after [Plaintiff] was injured, and it did not forfeit its protections under the

Workers’ Compensation Act when it failed to notify its insurance carrier of Reagan’s injury

in a timely manner.” Id.

                                            V.
                                        Conclusion

       This is a workers’ compensation case which should have been filed with the DWC

over two years ago. For the various reasons discussed above, none of the parties were

eager to do so. iWORKS’ has relented and filed a claim with its worker’s compensation

carrier. This will start the administrative process necessary to exhaust the remedies

provided by the DWC. However, until those remedies are fully exhausted this Court lacks

subject-matter jurisdiction. Therefore, this Court must dismiss Plaintiffs’ claims as a

matter of law.

                                             VI.
                                           Prayer

       Defendants iWORKS, Trevino, and Gutierrez pray that the Court grant the relief

requested herein and for any and all other relief to which they are entitled in law or equity.

                                           Respectfully submitted,

                                           ___/s/_David N. Anderson___________
                                           David N. Anderson
                                           TBN: 00797951
                                           4309 Yoakum
                                           Houston, TX 77006
                                           (713) 521-6563 - Telephone
                                           (866) 524-4294 – Fax
                                           danderson@lodna.net

                                           ATTORNEY FOR DEFENDANTS
                                           IWORKS PERSONNEL, INC.,
                                           LUIS TREVINO, and
                                           HAYDEE GUTIERREZ

                                             19
                                 NOTICE OF HEARING

      The foregoing motion will be heard by the Court on Friday, February 20, 2015 at

9:00 a.m.

                                         _/s/_David N. Anderson___________
                                         David N. Anderson

                              CERTIFICATE OF SERVICE

       I certify that on February 13, 2015 all parties were served a copy of the foregoing
via eFILE in accordance with the Texas Rules of Civil Procedure, to whit:

              Bradford J. Gilde                  Nicholas A. Homan
              Texas Bar No. 24045941             Texas Bar No. 24083194
              bjg@gildelawfirm.com               nah@gildelawfirm.com

             GILDE LAW FIRM
             55 Waugh, Suite 850
             Houston, TX 77007
             (281) 973-2772 – phone
             (281) 973-2771 –facsimile
             Attorneys for Plaintiffs

               B. Lee Wertz, Jr.                 Carrie Schadle
               Texas Bar No. 00797796            Texas Bar No. 24051618
               lee.wertz@harrisonbettis.com      carrie.schadle@harrisonbettis.com

             HARRISON, BETTIS, STAFF, MCFARLAND & W EEMS, L.L.P.
             1415 Louisiana, 37th Floor
             Houston, Texas 77002
             (713) 843-7900 – phone
             (713) 843-7901 – facsimile
             Attorneys for Defendant Waste Management, Inc., et al.

                                                /s/ David N. Anderson__________
                                                David N. Anderson

                                           20
                                   Case No. 201261407

 MOSE A. GUILLORY AND MARY                    §            IN THE DISTRICT COURT OF
 GUILLORY                                     §
                                              §               HARRIS COUNTY, TEXAS
 V.                                           §
                                              §
 IWORKS PERSONNEL, INC, ET AL.                §               113TH JUDICIAL DISTRICT

                    IWORKS PERSONNEL, INC.’S SUPPLEMENT TO
                       iWORKS’ PLEA TO THE JURISDICTION

         DEFENDANTS, iWORKS PERSONNEL, INC., LUIS TREVINO, and HAYDEE

GUTIERREZ (hereinafter “IWORKS”) file this Supplement to iWORKS’ Plea to the

Jurisdiction. In support thereof it would show this honorable Court the following:

                                             I.

         iWORKS files this Supplement to iWORKS’ Plea to the Jurisdiction in order to

present to the Court additional evidence, recently obtained, which supports its Plea to the

Jurisdiction.

      A. Exhibit G – Texas Mutual Claim

         Exhibit G is Texas Mutual Insurance Company’s acknowledgement of a claim for

Mose Guillory.     This shows that there is a pending matter subject to the exclusive

jurisdiction of the Texas Department of Insurance – Division of Workers’ Compensation

(“DWC”). Until this administrative process has run its course and Plaintiff has exhausted

all of his administrative remedies, this Court lacks subject-matter-jurisdiction.

      B. Exhibit H – Correspondence from Gilde to the DWC

         Exhibit H is correspondence that was produced this week by Plaintiff’s counsel.

This is a letter from Brad Gilde to the DWC dated August 12, 2013. It is styled as a

“Notice, Stay, and Preservation Letter.”      Although litigation was ongoing and both
iWORKS and Waste Management were represented by counsel,1 neither Defendant was

copied on this correspondence. Plaintiff attached two separate DWC-041 (“Employee’s

Claim for Compensation for a Work-Related Injury of Occupational Disease”) forms to the

letter.    One names iWORKS as Plaintiff’s employer and the other names Waste

Management as his employer. Thus, Plaintiff’s counsel recognized that Plaintiff had a

claim for compensation under two separate worker’s compensation policies and elected

to forego pursuing those claims.

          Gilde’s letter to the DWC purports to reserve Plaintiff’s right to seek relief from the

DWC in the event he is unsuccessful in this Court. This approach turns the purpose of

the entire worker’s compensation system on its head. This letter demonstrates that

Plaintiff was well aware of the requirements under the Texas Labor Code yet consciously

chose to attempt to circumvent that process in hopes of a common law verdict. This is

not the public policy of Texas.

          This letter to the DWC admits that it “is submitted: (1) as a notice of claim for

compensation . . . (3) as a preservation of right to file and seek a claim for compensation

. . . and (5) pursuant to Tex. Labor Code §409.004.” Ex. G (emphasis in original). The

letter further states that “. . . this letter . . . is not an election or denial of a claim for

coverage.” Id. Plaintiff cannot hedge his bets with the administrative agency while

improperly seeking a judicial remedy in this Court without first exhausting his

administrative remedies.         His failure to do so in this matter, despite knowing the

administrative requirements set forth in the Texas Labor Code, deprives this Court of

subject-matter jurisdiction over Plaintiff’s claims.

                                                  II.

1   At that time Aric Garza was counsel for iWORKS.
                                           Prayer

       Defendants iWORKS, Trevino, and Gutierrez pray that the Court grant the relief

requested in their Plea to the Jurisdiction and for any and all other relief to which they are

entitled in law or equity.

                                           Respectfully submitted,

                                           ___/s/_David N. Anderson___________
                                           David N. Anderson
                                           TBN: 00797951
                                           4309 Yoakum
                                           Houston, TX 77006
                                           (713) 521-6563 - Telephone
                                           (866) 524-4294 – Fax
                                           danderson@lodna.net

                                           ATTORNEY FOR DEFENDANTS
                                           IWORKS PERSONNEL, INC.,
                                           LUIS TREVINO, and
                                           HAYDEE GUTIERREZ
                              CERTIFICATE OF SERVICE

       I certify that on February 19, 2015 all parties were served a copy of the foregoing
via eFILE in accordance with the Texas Rules of Civil Procedure as follows:

              Bradford J. Gilde                  Nicholas A. Homan
              Texas Bar No. 24045941             Texas Bar No. 24083194
              bjg@gildelawfirm.com               nah@gildelawfirm.com

             GILDE LAW FIRM
             55 Waugh, Suite 850
             Houston, TX 77007
             (281) 973-2772 – phone
             (281) 973-2771 –facsimile
             Attorneys for Plaintiffs

               B. Lee Wertz, Jr.                 Carrie Schadle
               Texas Bar No. 00797796            Texas Bar No. 24051618
               lee.wertz@harrisonbettis.com      carrie.schadle@harrisonbettis.com

             HARRISON, BETTIS, STAFF, MCFARLAND & W EEMS, L.L.P.
             1415 Louisiana, 37th Floor
             Houston, Texas 77002
             (713) 843-7900 – phone
             (713) 843-7901 – facsimile
             Attorneys for Defendant Waste Management, Inc., et al.

                                                /s/ David N. Anderson__________
                                                David N. Anderson
                                                                                                              CAUSE	
  NO.	
  2012-­‐61407	
  
                                                                                                                               	
  
MOSE	
  A.	
  GUILLORY	
  and	
  MARY	
  GUILLORY,	
                                                                             §	
                  IN	
  THE	
  DISTRICT	
  COURT	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  Plaintiffs	
                                         §	
                                                	
  
                                                                                                                                 §	
                                                	
  
                                                                                           	
                                    §	
                                                	
  
	
                                                                                                                               §	
                                                	
  
v.	
                                                                                                                             §	
                OF	
  HARRIS	
  COUNTY,	
  TEXAS	
  
                                                                                                                                 §	
                                                	
  
                                                                                           	
                                    §	
    	
  
IWORKS	
  PERSONNEL,	
  INC.;	
  et	
  al.	
                                                                                     §	
                                                	
  
                                                                           Defendants	
                                          §	
                 113th	
  JUDICIAL	
  DISTRICT	
  
	
  
                                                                                                                               	
  
                                                                            PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
  
                                                                                                                               	
  
	
  
                                                      COME	
  NOW,	
  MOSE	
  A.	
  GUILLORY	
  and	
  MARY	
  GUILLORY	
  and	
  file	
  this	
  PLAINTIFFS’	
   RESPONSE	
   TO	
  

IWORKS	
   DEFENDANTS’	
   PLEA	
   TO	
   THE	
   JURISDICTION	
   (hereinafter	
   “Response”)	
   asking	
   the	
   Court	
   to	
  

DENY	
   iWorks	
   Defendants’	
   Plea	
   to	
   the	
   Jurisdiction,	
   and	
   in	
   support	
   of	
   same,	
   Plaintiffs	
   respectfully	
   show	
  

this	
  Court	
  as	
  follows:	
  

            “[A]	
   negligence	
   claim	
   is	
   outside	
   the	
   [Workers’	
   Compensation]	
  
            Commission’s	
   exclusive	
   jurisdiction.	
   The	
   Commission’s	
   exclusive	
  
            jurisdiction	
   extends	
   to	
   claims	
   for	
   benefits	
   under	
   workers’	
   compensation	
  
            insurance	
  policies.”	
  

In	
   re	
   Texas	
   Mut.	
   Ins.	
   Co.,	
   157	
   S.W.3d	
   75,	
   81	
   (Tex.	
   App.—Austin	
   2004,	
   pet.	
   denied)	
   (orig.	
  

proceeding)	
  (citing	
  Tex.	
  Lab.	
  Code	
  Ann.	
  §	
  408.001(a)).	
  

            The	
   Commission’s	
   exclusive	
   jurisdiction,	
   however,	
   does	
   not	
   extend	
   to	
   all	
  
            cases	
   that	
   touch	
   on	
   workers’	
   compensation	
   issues.	
   The	
   district	
   courts	
  
            decide	
   disputes	
   about	
   whether	
   the	
   Act’s	
   exclusive	
   remedy	
   provision	
  
            applies	
  as	
  a	
  defense	
  to	
  an	
  injured	
  worker's	
  personal	
  injury	
  suit.	
  	
  
            	
  
AMS	
   Constr.	
   Co.	
   v.	
   K.H.K.	
   Scaffolding	
   Hous.,	
   Inc.,	
   357	
   S.W.3d	
   30,	
   38-­‐39	
   (Tex.	
   App.—Houston	
   [1st	
   Dist.]	
  

2011,	
  pet.	
  denied)	
  (emphasis	
  added)	
  (citing	
  Garza	
  v.	
  Excel	
  Logistics,	
  Inc.,	
  161	
  S.W.3d	
  473,	
  481	
  (Tex.	
  2005)	
  

(holding	
   that	
   company	
   did	
   not	
   establish	
   that	
   it	
   was	
   covered	
   by	
   workers’	
   compensation	
   insurance	
   for	
  

temporary	
   employee’s	
   injury	
   because,	
   even	
   if	
   temporary	
   worker	
   agency	
   was	
   contractually	
   obligated	
   to	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                       1	
  
provide	
   workers’	
   compensation	
   insurance	
   that	
   named	
   company	
   as	
   insured,	
   company	
   produced	
   no	
  

evidence	
  of	
  such	
  policy);	
  Wingfoot	
  Enters.	
  v.	
  Alvarado,	
  111	
  S.W.3d	
  134,	
  149	
  (Tex.	
  2003)).	
  

                                                           I.          INTRODUCTORY	
  FACTS	
  

1.         iWorks	
   Defendants’	
   PTJ	
   begins	
   by	
   claiming	
   that	
   “the	
   great	
   bulk	
   of	
   legal	
   efforts	
   expended	
   in	
   this	
  

case	
  are	
  the	
  direct	
  result	
  of	
  Plaintiffs’	
  numerous	
  and	
  continued	
  attempts	
  to	
  circumvent	
  the	
  Texas	
  Labor	
  

Code	
  in	
  the	
  face	
  of	
  well	
  settled	
  law	
  and	
  clear	
  public	
  policy	
  dictating	
  otherwise.”	
  	
  This	
  is	
  but	
  one	
  of	
  many	
  

brazenly	
  false	
  statements	
  advanced	
  by	
  iWorks	
  Defendants	
  in	
  their	
  meritless	
  Plea	
  to	
  the	
  Jurisdiction.	
  

2.         Never	
   mind	
   the	
   fact	
   that	
   iWorks	
   Defendants	
   have	
   claimed	
   to	
   be	
   workers’	
   compensation	
  

subscribers	
   for	
   2	
   ½	
   years	
   but	
   they	
   have	
   NEVER	
   produced	
   a	
   valid	
   workers’	
   compensation	
   policy	
   or	
  

produced	
   proof	
   of	
   a	
   valid	
   workers’	
   compensation	
   policy.	
   	
   In	
   fact,	
   iWorks	
   Defendants	
   claimed	
   to	
   be	
  

workers’	
   compensation	
   subscribers	
   for	
   2	
   ½	
   years	
   before	
   taking	
   any	
   action	
   to	
   initiate	
   a	
   workers’	
  

compensation	
  claim	
  for	
  Mose	
  Guillory	
  on	
  an	
  invalid,	
  terminated	
  policy.	
  	
  

3.         Nonetheless,	
  Plaintiffs	
  can	
  only	
  hope	
  that	
  this	
  Plea	
  to	
  the	
  Jurisdiction	
  is	
  truly	
  iWorks	
  Defendants’	
  

last	
  ditch	
  effort	
  in	
  a	
  desperate	
  pattern	
  of	
  dilatory	
  tactics	
  designed	
  to	
  forestall	
  the	
  inevitable	
  trial	
  in	
  this	
  

case—to	
  wit:	
  

4.         On	
   August	
   21,	
   2014,	
   the	
   Court	
   signed	
   a	
   “Second	
   Partial	
   Summary	
   Judgment”	
   Order	
   largely	
  

denying	
  iWorks	
  Defendants’	
  summary	
  judgment	
  motions.	
  	
  The	
  result	
  of	
  the	
  summary	
  judgment	
  motion	
  

practice	
  revealed	
  that	
  iWorks	
  Defendants	
  are	
  Non-­‐Subscribers.	
  

5.         Immediately	
   following	
   the	
   Court’s	
   denial	
   of	
   iWorks	
   Defendants’	
   summary	
   judgment	
  

motions,	
   iWorks	
   Defendants	
   took	
   a	
   number	
   of	
   actions	
   –	
   the	
   effect	
   of	
   which	
   delayed	
   or	
   were	
  

designed	
  to	
  delay	
  the	
  impending	
  trial.	
  	
  

6.         DILATORY	
   ACTION	
   #1:	
   On	
   September	
   2,	
   2014,	
   iWorks	
   Defendants	
   filed	
   a	
   Motion	
   for	
  

Continuance	
   seeking	
   a	
   90-­‐day	
   trial	
   continuance	
   based	
   on	
   the	
   health	
   of	
   counsel.	
   	
   On,	
   September	
   29,	
   2014,	
  

the	
   Court	
   signed	
   an	
   order	
   granting	
   iWorks’	
   Motion	
   for	
   Continuance	
   and	
   gave	
   Counsel	
   for	
   iWorks	
  

Defendants	
  a	
  168-­‐day	
  trial	
  continuance.	
  

7.         DILATORY	
   ACTION	
   #2:	
   On	
   November	
   3,	
   2014,	
   forty-­‐two	
   (42)	
   days	
   after	
   Counsel	
   for	
   iWorks	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                             2	
  
Defendants’	
   scheduled	
   back	
   surgery,	
   iWorks	
   Defendants’	
   filed	
   a	
   Motion	
   to	
   Reconsider	
   the	
   NEMSJs	
   and	
  

TMSJs	
  ruled	
  on	
  in	
  this	
  Court’s	
  2nd	
  Partial	
  Summary	
  Judgment	
  Order.	
  

8.            On	
   December	
   4,	
   2014,	
   this	
   Court	
   signed	
   an	
   Order	
   denying	
   iWorks	
   Defendants’	
   Motion	
   to	
  

Reconsider.	
  	
  	
  

9.            DILATORY	
   ACTION	
   #3:	
   On	
   December	
   8,	
   2014,	
   iWorks	
   Defendants	
   filed	
   their	
   Third	
   Amended	
  

Answer	
  and	
  Cross-­‐Claims	
  against	
  WM	
  Defendants.	
  	
  iWorks	
  Defendants’	
  cross-­‐claims	
  contain	
  Declaratory	
  

Judgment	
  and	
  Breach	
  of	
  Contract	
  claims	
  against	
  WM	
  Defendants.	
  

10.           This	
   lawsuit	
   was	
   filed	
   on	
   October	
   17,	
   2012,	
   nearly	
   2	
   ½	
   years	
   ago.	
   	
   Yet,	
  iWorks	
  Defendants	
  

participated	
   fully	
   in	
   pre-­‐trial	
   activities	
   for	
   over	
   2	
   years	
   before	
   they	
   decided	
   to	
   assert	
   non-­‐compulsory	
  

cross-­‐claims	
  only	
  3	
  months	
  before	
  trial.	
  	
  	
  

11.           DILATORY	
   ACTION	
   #4:	
   On	
   December	
   12,	
   2014,	
   the	
   Court	
   held	
   an	
   oral	
   hearing	
   on	
   WM	
  

Defendants’	
  Motion	
  to	
  Sever.	
  	
  At	
  that	
  hearing,	
  Counsel	
  for	
  iWorks	
  orally	
  represented	
  that	
  he	
  intended	
  to	
  

file	
  a	
  Motion	
  to	
  Abate	
  trial	
  until	
  any	
  alleged	
  workers’	
  compensation	
  claim	
  is	
  resolved.	
  

12.           On	
   January	
   28,	
   2015,	
   Waste	
   Management,	
   Inc.	
   (“WM”)	
   filed	
   a	
   Traditional	
   Motion	
   for	
   Summary	
  

Judgment	
   against	
   iWorks	
   Personnel,	
   Inc.	
   and	
   its	
   newly	
   asserted	
   cross-­‐claims.	
   	
   WM	
   Defendants’	
   TMSJ	
   is	
  

set	
  for	
  hearing	
  on	
  March	
  27,	
  2015.	
  	
  	
  	
  	
  	
  

13.           Plaintiffs	
  and	
  WM	
  Defendants	
  seem	
  to	
  be	
  in	
  some	
  agreement	
  that	
  Plaintiffs’	
  claims	
  against	
  iWorks	
  

Defendants	
  ought	
  to	
  be	
  tried	
  separately	
  from	
  iWorks	
  Defendants’	
  cross-­‐claims	
  against	
  WM	
  Defendants.	
  

14.           As	
  such,	
  on	
  February	
  9,	
  2015,	
  Plaintiffs	
  filed	
  their	
  Partially	
  Unopposed	
  Motion	
  for	
  Separate	
  Trials	
  

asking	
  the	
  Court	
  to	
  separate	
  the	
   trial	
  of	
  Plaintiffs’	
  claims	
  and	
  iWorks	
  Defendants’	
  cross-­‐claims,	
  thereby	
  

avoiding	
   any	
   further	
   delay	
   of	
   Plaintiffs’	
   day	
   in	
   court.	
   	
   Plaintiffs	
   set	
   their	
   Motion	
   for	
   Separate	
   Trials	
   for	
  

hearing	
  on	
  February	
  20,	
  2015.	
  	
  

15.           DILATORY	
   ACTION	
   #5:	
   Plaintiffs	
   attempted	
   to	
   confer	
   with	
   Counsel	
   Defendants	
   regarding	
  

Plaintiffs’	
   Motion	
   for	
   Separate	
   Trials.	
   	
   WM	
   Defendants	
   indicated	
   they	
   were	
   “unopposed.”	
   Plaintiffs	
  

received	
  no	
  response	
  from	
  iWorks	
  Defendants.	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                   3	
  
16.         DILATORY	
   ACTION	
   #6:	
   On	
   February	
   7,	
   2015,	
   iWorks	
   Defendants	
   served	
   a	
   letter	
   and	
   an	
  

unsigned,	
  undated,	
  DWC	
  Form-­‐001	
  (Notice	
  of	
  Injury).	
  	
  This	
  was	
  done	
  in	
  an	
  attempt	
  to	
  create	
  a	
  doomed	
  

workers’	
   compensation	
   claim	
   on	
   an	
   insurance	
   policy	
   that	
   had	
   been	
   cancelled	
   at	
   time	
   of	
   the	
   incident	
   in	
  

question.	
  

17.         DILATORY	
   ACTION	
   #7:	
   On	
  February	
   13,	
   2015,	
   iWorks	
  Defendants	
  filed	
  their	
  improper	
  Plea	
  to	
  

the	
   Jurisdiction	
   asking	
   this	
   Court	
   to	
   hold	
   that	
   a	
   non-­‐subscribing	
   employer	
   may	
   invoke	
   Division	
   of	
  

Workers’	
   Compensation	
   (hereinafter	
   “DWC”)	
   jurisdiction	
   and	
   gain	
   dismissal	
   simply	
   by	
   filing	
   a	
   claim	
   on	
   a	
  

workers’	
  compensation	
  policy	
  that	
  was	
  ineffective	
  and	
  invalid	
  on	
  the	
  injury	
  date.	
  	
  

18.         As	
   is	
   clear	
   from	
   the	
   pattern	
   of	
   actions	
   summarized	
   above,	
   iWorks	
   Defendants’	
   PTJ	
   is	
   but	
   their	
  

latest	
   attempt	
   to	
   have	
   this	
   Court	
   delay	
   Plaintiffs’	
   day	
   in	
   Court	
   and	
   reward	
   iWorks	
   for	
   being	
   a	
   non-­‐

subscribing	
   company	
   that,	
   quoting	
   CEO	
   Luis	
   Trevino,	
   “JUST	
   BLEW	
   IT”	
   and	
   “DIDN’T	
   DO	
   ITS	
   JOB.”	
   See	
  

Deposition	
  of	
  Luis	
  Trevino.	
  	
  	
  

                                           II.      FACTS	
  RELEVANT	
  TO	
  PLAINTIFFS’	
  RESPONSE	
  

19.         On	
  or	
  about	
  July	
  9,	
  2012,	
  Plaintiff	
  was	
  hired	
  by	
  Defendant	
  IWORKS	
  PERSONNEL,	
  INC.	
  (“iWorks”	
  or	
  

“IWORKS”)	
   and	
   was	
   assigned	
   to	
   work	
   for	
   the	
   WM	
   Defendants	
   at	
   a	
   “Material	
   Recovery	
   Facility”	
   located	
   at	
  

4939	
  Gasmer	
  Drive,	
  Houston	
  Texas	
  77035	
  (hereinafter	
  “Facility”	
  or	
  “Gasmer	
  MRF”).	
  	
  

20.         On	
   August	
   5,	
   2012,	
   after	
   working	
   at	
   the	
   Gasmer	
   MRF	
   for	
   approximately	
   one	
   month,	
   Plaintiff	
   Mose	
  

Guillory	
  was	
  catastrophically	
  injured	
  while	
  operating	
  a	
  Harris	
  Centurion	
  Baler	
  in	
  the	
  performance	
  of	
  his	
  

job	
  for	
  Defendants.	
  	
  

21.         Prior	
   to	
   August	
   5,	
   2012,	
   Plaintiff	
   had	
   not	
   received	
   any	
   training,	
   instruction,	
   manuals	
   or	
   guidelines	
  

on	
  how	
  to	
  properly	
  and	
  safely	
  operate	
  the	
  baler.	
  	
  Moreover,	
  as	
  evidenced	
  by	
  the	
  OSHA	
  Citations	
  issued	
  to	
  

WM	
   Defendants,	
   Plaintiff	
   Mose	
   Guillory	
   was	
   never	
   provided	
   any	
   training	
   on	
   proper	
   Lock	
   Out/Tag	
   Out	
  

procedures.	
  

22.         On	
   page	
   4	
   of	
   their	
   PTJ,	
   iWorks	
   Defendants	
   readily	
   admit:	
   “IWORKS	
   provides	
   no	
   site	
   specific	
  

training	
  to	
  the	
  temporary	
  workers’	
  that	
  it	
  provides	
  to	
  its	
  clients.”	
  See	
  iWorks	
  PTJ	
  at	
  p.	
  4.	
  	
  However,	
  the	
  

“Master	
   Agreement”	
   between	
   iWorks	
   Defendants	
   and	
   WM	
   Defendants	
   provided	
   that	
   iWorks	
   was	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                            4	
  
“obligated	
  to	
  ensure	
  that	
  Personnel	
  supplied	
  to	
  Waste	
  Management	
  are	
  fully	
  qualified	
  and	
  trained	
  

for	
  the	
  jobs	
  they	
  are	
  being	
  supplied	
  to	
  perform	
  and	
  that	
  they	
  have	
  been	
  given	
  safety	
  training	
  that	
  

meets	
   or	
   exceeds	
   the	
   training	
   Waste	
   Management	
   provides	
   its	
   employees	
   for	
   the	
   same	
   or	
   similar	
  

jobs.”	
  	
  See	
  EXHIBIT	
  C	
  at	
  p.	
  2.	
  

23.          Therefore,	
   on	
   October	
   17,	
   2012,	
   Plaintiffs	
   filed	
   their	
   Original	
   Petition	
   against	
   Defendant	
   iWorks	
  

and	
  WM	
  Defendants.	
  

24.          In	
   its	
   PTJ,	
   iWorks	
   Defendants	
   claim	
   that	
   “Plaintiff’s	
   counsel	
   has	
   had	
   two	
   separate	
   worker’s	
  

compensation	
  policies	
  which	
  would	
  provide	
  [Mose	
  Guillory]	
  with	
  worker’s	
  compensation	
  coverage.”	
  See	
  

iWorks	
  PTJ	
  at	
  p.	
  1.	
  	
  THIS	
  IS	
  FALSE.	
  

25.          First,	
  the	
  “policy”	
  iWorks	
  Defendants	
  are	
  referring	
  to,	
  and	
  which	
  they	
  attach	
  as	
  Exhibit	
  A	
  to	
  their	
  

PTJ,	
  is	
  not	
  a	
  policy	
  at	
  all.	
  Exhibit	
  A	
  to	
  iWorks	
  Defendants’	
  PTJ	
  is	
  an	
  “Information	
  Page”	
  and	
  it	
  references	
  

an	
  insurance	
  policy	
  with	
  Texas	
  Mutual	
  belonging	
  to	
  “Preferred	
  Staffing	
  Company,	
  LLC.”	
  See	
  iWorks	
  PTJ,	
  

Exhibit	
   A.	
   	
   In	
   2	
   ½	
   years	
   of	
   litigation,	
   iWorks	
   Defendants	
   have	
   NEVER	
   produced	
   a	
   workers’	
  

compensation	
  policy	
  allegedly	
  covering	
  iWorks	
  Personnel,	
  Inc.	
  

26.          The	
   Texas	
   Mutual	
   information	
   page	
   references	
   policy	
   number	
   “STA-­‐0001204473	
   20110904.”	
  	
  

See	
  iWorks	
  PTJ,	
  Exhibit	
  A.	
  	
  Counsel	
  for	
  iWorks	
  Defendants	
  attempted	
  to	
  initiate	
  a	
  claim	
  on	
  this	
  policy	
  on	
  

our	
  about	
  February	
  5,	
  2015,	
  as	
  seen	
  in	
  Exhibit	
  C	
  to	
  iWorks	
  PTJ.	
  

27.          However,	
   on	
   October	
   31,	
   2013,	
   Plaintiffs	
   executed	
   a	
   Deposition	
   by	
   Written	
   Questions	
   on	
   2	
  

entities:	
  Texas	
  Mutual	
  Insurance	
  Co.	
  and	
  Lette	
  Insurance	
  Agency.	
  	
  Texas	
  Mutual	
  is	
  the	
  carrier	
  on	
  iWorks	
  

Defendants’	
   purported	
   insurance	
   policy	
   and	
   Lette	
   Insurance	
   is	
   the	
   agency	
   through	
   which	
   iWorks	
  

Defendants	
  attempted	
  to	
  procure	
  same.	
  

28.          Regarding	
   iWorks	
   Defendants’	
   policy	
   number	
   STA-­‐0001204473	
   20110904,	
   Texas	
   Mutual	
  

testified	
  as	
  follows:	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                        5	
  
                                                                                                                                           	
  

                                                                                                                                                  	
  
See	
  EXHIBIT	
  A	
  at	
  p.	
  6.	
  

29.         Regarding	
  iWorks	
  Defendants	
  ineffective	
  policy,	
  Texas	
  Mutual	
  further	
  testified	
  as	
  follows:	
  

                                                                                                                                                  	
  

See	
  EXHIBIT	
  A	
  at	
  p.	
  10.	
  

30.         Finally,	
  Texas	
  Mutual	
  confirmed	
  that	
  iWorks	
  Defendants	
  were	
  non-­‐subscribers	
  on	
  the	
  date	
  

of	
  the	
  incident	
  in	
  question—to	
  wit:	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                              6	
  
                                                                                                                                                         	
  

                                                                                                                                                         	
  
See	
  EXHIBIT	
  A	
  at	
  pp.	
  10-­‐11.	
  

31.        The	
  foregoing	
  testimony	
  was	
  sworn	
  and	
  is	
  admissible	
  under	
  the	
  Texas	
  Rules	
  of	
  Evidence—to	
  wit:	
  

                                                                                                                                             	
  
See	
  EXHIBIT	
  A	
  at	
  p.	
  16.	
  
	
  
32.      In	
  relevant	
  part,	
  Texas	
  Mutual’s	
  “NOTICE	
   OF	
   CANCELLATION”	
   of	
  iWorks	
  Defendants’	
  purported	
  

workers’	
  compensation	
  insurance	
  policy	
  reads	
  as	
  follows:	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                        7	
  
                                                                                                                                                                            	
  
EXHIBIT	
  A,	
  Bates	
  No.	
  TXM00318	
  (p.	
  340	
  of	
  418).	
  

33.        When	
  presented	
  with	
  this	
  information	
  at	
  a	
  summary	
  judgment	
  hearing,	
  Your	
  Honor	
  inquired	
  as	
  to	
  

whether	
  there	
  was	
  any	
  evidence	
  proving	
  that	
  iWorks	
  Defendants	
  had	
  cured	
  their	
  violations	
  and	
  renewed	
  

their	
   cancelled	
   policy	
   prior	
   to	
   Mose	
   Guillory’s	
   incident	
   on	
   August	
   5,	
   2012.	
   	
   The	
   answer	
   is	
   “NO.”	
   	
   A	
  

deficiency	
  letter	
  dated	
  August	
   24,	
   2012	
   proves	
  that	
  iWorks	
  Defendant	
  had	
  not	
  revived	
  their	
  cancelled	
  

policy	
  and	
  were	
  still	
  non-­‐subscribers	
  on	
  August	
  5,	
  2012.	
  	
  See	
  EXHIBIT	
  A,	
  Bates	
  No.	
  TXM00355–360	
  (p.	
  

377-­‐418).	
  

34.        In	
   their	
   PTJ,	
   iWorks	
   Defendants	
   claim	
   “[t]he	
   only	
   plausible	
   explanation	
   for	
   Guillory’s	
   failure	
   to	
  

even	
   try	
   to	
   claim	
   his	
   benefits	
   under	
   the	
   Texas	
   Workers’	
   Compensation	
   Act	
   is	
   that	
   he	
   and	
   his	
   counsel	
  

decided	
  early	
  in	
  the	
  course	
  of	
  this	
  litigation	
  to	
  try	
  and	
  circumvent	
  the	
  worker’s	
  compensation	
  system	
  in	
  

an	
  attempt	
  to	
  recover	
  common	
  law	
  damages.”	
  iWorks	
  PTJ	
  at	
  p.	
  12.	
  	
  	
  

35.        What	
   truly	
   happened	
   is	
   the	
   following:	
   Counsel	
   for	
   Plaintiffs	
   attempted	
   to	
   confirm	
   workers’	
  

compensation	
   coverage	
   for	
   iWorks	
   or	
   Preferred	
   Staffing	
   through	
   the	
   Texas	
   Department	
   of	
   Insurance	
  

website—there	
  was	
  no	
  coverage.	
  	
  Counsel	
  for	
  Plaintiffs	
  then	
  called	
  the	
  Texas	
  Department	
  of	
  Insurance	
  to	
  

confirm	
  coverage	
  for	
  iWorks	
  or	
  Preferred	
  Staffing—there	
  was	
  no	
  coverage.	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                              8	
  
36.         Plaintiffs	
  then	
  filed	
  this	
  lawsuit	
  and	
  served	
  Requests	
  for	
  Disclosures	
  in	
  October	
  of	
  2012.	
  	
  However,	
  

Counsel	
  for	
  iWorks	
  did	
  not	
  produce	
  the	
  cancelled	
  policy	
  information	
  page	
  until	
  Luis	
  Trevino’s	
  deposition	
  

in	
   August	
   of	
   2013.	
   	
   Thereafter,	
   one	
   brief	
   phone	
   call	
   to	
   the	
   DWC	
   casted	
   serious	
   doubt	
   as	
   to	
   the	
  

effectiveness	
   of	
   the	
   policy	
   underlying	
   iWorks’s	
   policy	
   information	
   page.	
   	
   At	
   last,	
   the	
   foregoing	
   deposition	
  

testimony	
   from	
   Texas	
   Mutual	
   and	
   Lette	
   Insurance	
   put	
   the	
   final	
   nail	
   in	
   the	
   coffin	
   regarding	
   iWorks	
  

Defendants’	
  status	
  as	
  non-­‐subscribers.	
  	
  	
  

37.         iWorks	
   Defendants	
   have	
   been	
   in	
   possession	
   of	
   the	
   foregoing	
   testimony	
   and	
   documents	
   since	
  

October	
   of	
   2013.	
   	
   The	
   Texas	
   Mutual	
   and	
   Lette	
   Insurance’s	
   responses	
   to	
   DWQ	
   clearly	
   disprove	
   iWorks	
  

Defendants’	
  untenable	
  position	
  that	
  they	
  are	
  workers’	
  compensation	
  “subscribers.”	
  	
  iWorks	
  Defendants	
  

only	
  attempt	
  to	
  disprove	
  the	
  foregoing	
  comes	
  in	
  the	
  form	
  of	
  Luis	
  Trevino’s	
  Affidavit,	
  attached	
  as	
  Exhibit	
  F	
  

to	
  iWorks	
  PTJ.	
  

38.         In	
   his	
   affidavit,	
   Luis	
   Trevino	
   claims	
   that	
   Texas	
   Mutual’s	
   cancellation	
   of	
   coverage	
   was	
   incorrect	
  

because	
  he	
  never	
  received	
  notice.	
  	
  The	
  Notice	
  of	
  Cancellation	
  above	
  shows	
  that	
  it	
  was	
  sent	
  via	
  certified	
  

mail	
   to	
   iWorks	
   Personnel,	
   Inc.’s	
   registered	
   address.	
   	
   See	
   EXHIBIT	
   A,	
   Bates	
   No.	
   TXM00318	
   (p.	
   340	
   of	
  

418).	
   	
   Lette	
   Insurance’s	
   responses	
   to	
   DWQ	
   prove	
   that	
   they	
   were	
   in	
   receipt	
   of	
   the	
   required	
   Notices	
   of	
  

Cancellation	
  as	
  iWorks	
  Defendants’	
  insurance	
  agent.	
  	
  See	
  EXHIBIT	
  B,	
  Bates	
  No.	
  000008	
  (p.	
  48	
  of	
  138).	
  

Moreover,	
   documents	
   produced	
   by	
   Lette	
   Insurance	
   in	
   response	
   to	
   DWQ	
   prove	
   that	
   iWorks	
   President	
  

Haydee	
  Gutierrez	
  was	
  in	
  direct	
  contact	
  with	
  Texas	
  Mutual	
  during	
  this	
  cancellation	
  period.	
  	
  See	
  EXHIBIT	
  

B,	
  Bates	
  No.	
  000015	
  (p.	
  55	
  of	
  138).	
  	
  	
  

39.         This	
  all	
  leads	
  to	
  one,	
  indisputable	
  conclusion:	
  

                           IWORKS	
  DEFENDANTS	
  ARE	
  NON-­‐SUBSCRIBERS	
  AS	
  TO	
  MOSE	
  GUILLORY.	
  

40.         Plaintiffs	
  Mose	
  and	
  Mary	
  Guillory	
  have	
  endured	
  indescribable	
  suffering	
  and	
  despair	
  to	
  reach	
  this	
  

point	
   in	
   their	
   case.	
   	
   The	
   road	
   has	
   been	
   hard	
   fought,	
   and	
   their	
   day	
   in	
   court	
   is	
   well	
   earned.	
   	
   iWorks	
  

Defendants	
   now	
   seek	
   to	
   rob	
   the	
   Guillory’s	
   of	
   their	
   Constitutional	
   Right	
   to	
   try	
   their	
   case	
   to	
   a	
   jury	
   by	
  

disingenuously	
  filing	
  a	
  claim	
  on	
  a	
  dead	
  workers’	
  compensation	
  policy.	
  	
  	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                      9	
  
41.         Texas	
   Mutual	
   confirms	
   that	
   iWorks	
   Defendants	
   were	
   non-­‐subscribers	
   as	
   to	
   Mose	
   Guillory,	
   and	
  

there	
   will	
   never	
   be	
   workers’	
   compensation	
   benefits	
   paid	
   under	
   policy	
   number	
   STA-­‐0001204473	
  

20110904.	
   	
   What’s	
   worse	
   is	
   that	
   iWorks	
   Defendants	
   and	
   their	
   Counsel	
   know	
   the	
   policy	
   at	
   issue	
   was	
  

ineffective	
   on	
   the	
   date	
   of	
   the	
   incident	
   in	
   question	
   and	
   they	
   know	
   that	
   the	
  claim	
   would	
   be	
   denied	
   even	
  

before	
  it	
  was	
  filed.	
  

42.         Because	
  iWorks	
  Defendants’	
  PTJ	
  is	
  untimely,	
  improper,	
  and	
  meritless,	
  Plaintiffs	
  ask	
  this	
  Court	
  to	
  

DENY	
  iWorks	
  Defendants’	
  PTJ.	
  

                                                 III.        PLEA	
  TO	
  THE	
  JURISDICTION	
  STANDARD	
  

43.         Plaintiffs	
  incorporate	
  all	
  preceding	
  paragraphs	
  by	
  reference	
  as	
  though	
  fully	
  set	
  forth	
  herein.	
  

44.         When	
  a	
  defendant	
  asks	
  the	
  court	
  to	
  dismiss	
  for	
  lack	
  of	
  subject-­‐matter	
  jurisdiction,	
  the	
  court	
  must	
  

overrule	
   the	
   motion	
   unless	
   the	
   pleadings	
   and	
   the	
   parties’	
   evidence	
   clearly	
   demonstrate	
   that	
   the	
   court	
  

lacks	
   jurisdiction.	
   See	
   Bland	
   Indep.	
   Sch.	
   Dist.	
   v.	
   Blue,	
   34	
   S.W.3d	
   547,	
   555	
   (Tex.	
   2000);	
   see,	
   e.g.,	
   State	
   v.	
  

Sledge,	
   36	
   S.W.3d	
   152,	
   155	
   (Tex.	
   App.—Houston	
   [1st	
   Dist.]	
   2000,	
   pet.	
   denied)	
   (trial	
   court	
   conducted	
  

hearing	
  and	
  received	
  oral	
  testimony,	
  affidavits,	
  exhibits,	
  and	
  stipulations).	
  	
  	
  

45.         In	
  ruling	
  on	
  the	
  motion,	
  the	
  court	
  is	
  required	
  to	
  construe	
  the	
  pleadings	
  in	
  the	
  plaintiff’s	
  favor.	
  See	
  

Texas	
  Ass’n	
  of	
  Bus.	
  v.	
  Texas	
  Air	
  Control	
  Bd.,	
   852	
   S.W.2d	
   440,	
   446	
   (Tex.	
   1993).	
   	
   The	
   plea	
   to	
   the	
   jurisdiction	
  

standard	
   mirrors	
   the	
   summary-­‐judgment	
   procedure	
   under	
   TRCP	
   166a(c).	
   	
   Mission	
   Consol.	
   ISD	
   v.	
  

Garcia,	
  372	
  S.W.3d	
  629,	
  635	
  (Tex.	
  2012).	
  

46.         DEFENDANTS’	
  BURDEN.	
  	
  A	
  defendant	
  is	
  entitled	
  to	
  summary	
  judgment	
  ONLY	
  when	
  he/she/it,	
  as	
  

a	
   matter	
   of	
   law,	
   disproves	
   one	
   or	
   more	
   of	
   the	
   essential	
   elements	
   of	
   each	
   of	
   the	
   plaintiff's	
   causes	
   of	
   action	
  

or	
  pleads	
  and	
  conclusively	
  establishes	
  each	
  essential	
  element	
  of	
  an	
  affirmative	
  defense,	
  thereby	
  rebutting	
  

the	
   plaintiff’s	
   cause	
   of	
   action.	
   Lear	
   Siegler,	
   Inc.	
   v.	
   Perez,	
   819	
   S.W.2d	
   470,	
   471	
   (Tex.	
   1991)	
   (emphasis	
  

added);	
   Peeler	
   v.	
   Hughes	
   &	
   Luce,	
   868	
   S.W.2d	
   823,	
   827	
   (Tex.	
   App.—Dallas	
   1993),	
   aff'd,	
   909	
   S.W.2d	
   494	
  

(Tex.	
   1995);	
   International	
   Union	
   UAW	
   Local	
   119	
   v.	
   Johnson	
   Controls,	
   Inc.,	
   813	
   S.W.2d	
   558,	
   563	
   (Tex.	
  

App.—Dallas	
   1991,	
   writ	
   denied);	
   Traylor	
   v.	
   Unitedbank	
   Orange,	
   675	
   S.W.2d	
   802,	
   804	
   (Tex.	
   App.—

Beaumont	
  1984,	
  writ	
  ref'd	
  n.r.e.).	
  	
  	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                         10	
  
47.         DEFENDANTS’	
   BURDEN	
   –	
   CONT.	
   	
   A	
  matter	
  is	
  conclusively	
  established	
  if	
  ordinary	
  minds	
  cannot	
  

differ	
   as	
   to	
   the	
   conclusion	
   to	
   be	
   drawn	
   from	
   the	
   summary	
   judgment	
   proof.	
   	
   Triton	
   Oil	
   &	
   Gas	
   Corp.	
   v.	
  

Marine	
  Contractors	
  &	
  Supply,	
  Inc.,	
  644	
  S.W.2d	
  443,	
  446	
  (Tex.	
  1982)	
  (emphasis	
  added).	
  

48.         DEFENDANTS’	
  BURDEN	
  –	
  CONT.	
  	
  When	
  evaluating	
  a	
  Traditional	
  Motion	
  for	
  Summary	
  Judgment	
  

based	
  on	
  summary	
  judgment	
  evidence,	
  the	
  trial	
  court	
  MUST	
  do	
  the	
  following:	
  

            a.          Assume	
   ALL	
   of	
   the	
   nonmovant’s	
   proof	
   is	
   true.	
   Limestone	
   Prods.	
   Distrib.,	
   Inc.	
   v.	
  
                        McNamara,	
   71	
   S.W.3d	
   308,	
   311	
   (Tex.	
   2002);	
   Shah	
   v.	
   Moss,	
   67	
   S.W.3d	
   836,	
   842	
   (Tex.	
  
                        2001);	
  M.D.	
  Anderson	
  Hosp.	
  &	
  Tumor	
  Inst.	
  v.	
  Willrich,	
  28	
  S.W.3d	
  22,	
  23	
  (Tex.	
  2000);	
  Nixon	
  
                        v.	
  Mr.	
  Prop.	
  Mgmt.,	
  690	
  S.W.2d	
  546,	
  548-­‐49	
  (Tex.	
  1985)	
  (emphasis	
  added).	
  
                        	
  
            b.          Make	
   EVERY	
   reasonable	
   inference	
   in	
   favor	
   of	
   the	
   nonmovant.	
   	
   Provident	
  Life	
  &	
  Acc.	
  Ins.	
  
                        Co.	
   v.	
   Knott,	
   128	
   S.W.3d	
   211,	
   215	
   (Tex.	
   2003);	
   M.D.	
   Anderson	
   Hosp.	
   &	
   Tumor	
   Inst.	
   v.	
  
                        Willrich,	
   28	
   S.W.3d	
   22,	
   23	
   (Tex.	
   2000);	
   Science	
  Spectrum,	
  Inc.	
  v.	
  Martinez,	
   941	
   S.W.2d	
   910,	
  
                        911	
   (Tex.	
   1997);	
   Nixon	
  v.	
  Mr.	
  Prop.	
  Mgmt.,	
   690	
   S.W.2d	
   546,	
   549	
   (Tex.	
   1985)	
   (emphasis	
  
                        added).	
  
                        	
  
            c.          Resolve	
  ALL	
  doubts	
  about	
  the	
  existence	
  of	
  a	
  genuine	
  issue	
  of	
  material	
  fact	
  against	
  the	
  
                        movant.	
   	
   M.D.	
   Anderson	
   Hosp.	
   &	
   Tumor	
   Inst.	
   v.	
   Willrich,	
   28	
   S.W.3d	
   22,	
   23	
   (Tex.	
   2000);	
  
                        Johnson	
  Cty.	
  Sheriff’s	
  Posse,	
  Inc.	
  v.	
  Endsley,	
  926	
  S.W.2d	
  284,	
  285	
  (Tex.	
  1996);	
  Nixon	
  v.	
  Mr.	
  
                        Prop.	
  Mgmt.,	
  690	
  S.W.2d	
  546,	
  548-­‐49	
  (Tex.	
  1985).	
  
	
  
See	
   also	
   Rhône-­‐Poulenc,	
   Inc.	
   v.	
   Steel,	
   997	
   S.W.2d	
   217,	
   223	
   (Tex.	
   1999);	
   Collins	
   v.	
   County	
   of	
   El	
   Paso,	
   954	
  

S.W.2d	
  137,	
  145	
  (Tex.	
  App.—El	
  Paso	
  1997,	
  pet.	
  denied).	
  	
  

49.         DEFENDANTS’	
   BURDEN	
   –	
   CONT.	
   	
   Regarding	
   the	
   “Exclusive	
   Remedy”	
   defense,	
   the	
   defendant	
  

must	
   (1)	
   conclusively	
   prove	
   that	
   it	
   was	
   the	
   plaintiff’s	
   employer	
   within	
   the	
   meaning	
   of	
   the	
   TWCA,	
   (2)	
  

conclusively	
  prove	
  that	
  it	
  subscribed	
  to	
  workers’	
  compensation	
  insurance	
  as	
  to	
  the	
  injured	
  employee.	
  

Western	
   Steel	
   Co.	
   v.	
   Altenburg,	
   206	
   S.W.3d	
   121,	
   123	
   (Tex.	
   2006);	
   see	
   also	
   Port	
   Elevator-­‐Brownsville	
   v.	
  

Casados,	
  358	
  S.W.3d	
  238	
  (Tex.	
  2012).	
  	
  	
  

50.         PLAINTIFFS’	
   BURDEN.	
   	
   When	
  the	
  movant	
  does	
  not	
  meet	
  its	
  burden	
  of	
  proof,	
  the	
  burden	
  does	
  

not	
   shift	
   to	
   the	
   nonmovant.	
   	
   M.D.	
  Anderson	
  Hosp.	
  &	
  Tumor	
  Inst.	
  v.	
  Willrich,	
   28	
   S.W.3d	
   22,	
   23	
   (Tex.	
   2000);	
  

City	
   of	
   Houston	
   v.	
   Clear	
   Creek	
   Basin	
   Auth.,	
   589	
   S.W.2d	
   671,	
   678	
   n.5	
   (Tex.	
   1979).	
   	
   A	
   nonmovant	
   in	
   a	
  

traditional	
   summary-­‐judgment	
   proceeding	
   is	
   not	
   required	
   to	
   produce	
   summary-­‐judgment	
   evidence	
  

until	
  after	
  the	
  movant	
  establishes	
  it	
  is	
  entitled	
  to	
  summary	
  judgment	
  as	
  a	
  matter	
  of	
  law.	
  	
  Casso	
  v.	
  Brand,	
  

776	
  S.W.2d	
  551,	
  556	
  (Tex.	
  1989)	
  (emphasis	
  added).	
  	
  After	
  the	
  movant	
  has	
  established	
  conclusively	
  as	
  a	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                    11	
  
matter	
  of	
  law	
  that	
  movant	
  is	
  entitled	
  to	
  summary	
  judgment,	
  only	
  then	
  shall	
  a	
  nonmovant	
  be	
  responsible	
  

for	
  producing	
  summary	
  judgment	
  evidence	
  to	
  raise	
  a	
  fact	
  issue	
  in	
  a	
  response.	
  	
  	
  	
  

51.          PLAINTIFFS’	
   RESPONSE.	
   	
   Once	
  the	
  movant	
  establishes	
  that	
  he	
  is	
  entitled	
  to	
  summary	
  judgment,	
  

the	
   burden	
   shifts	
   to	
   the	
   non-­‐movant	
   to	
   show	
   why	
   summary	
   judgment	
   should	
   be	
   avoided	
   in	
   the	
   non-­‐

movant’s	
   response.	
   	
   Casso	
   v.	
   Brand,	
   776	
   S.W.2d	
   551,	
   556	
   (Tex.	
   1989).	
   	
   The	
   response	
   may	
   be	
   filed	
   by	
  

mailing	
   it	
   on	
   the	
   day	
   it	
   is	
   due,	
   and	
   it	
   is	
   timely	
   filed	
   even	
   if	
   it	
   is	
   reaches	
   the	
   court	
   less	
   than	
   seven	
   days	
  

before	
  the	
  hearing,	
  as	
  long	
  as	
  it	
  is	
  received	
  by	
  the	
  clerk	
  no	
  more	
  than	
  ten	
  days	
  after	
  the	
  due	
  date.	
  	
  TRCP	
  5,	
  

21a;	
  Geiselman	
  v.	
  Cramer	
  Fin.	
  Grp.,	
  965	
  S.W.2d	
  532,	
  535	
  (Tex.	
  App.—Houston	
  [14th	
  Dist.]	
  1997,	
  no	
  writ);	
  

Clendennen	
  v.	
  Williams,	
  898	
  S.W.2d	
  257,	
  259	
  (Tex.	
  App.—Texarkana	
  1995,	
  no	
  writ).	
  	
  	
  

52.          In	
   TRCP	
   21a,	
   the	
   three-­‐day	
  rule	
  does	
  not	
  require	
  the	
  non-­‐movant	
   to	
   mail	
   the	
   response	
   ten	
   days	
  

before	
   the	
   hearing.	
   	
   Holmes	
   v.	
   Ottawa	
   Truck,	
   Inc.,	
   960	
   S.W.2d	
   866,	
   869	
   (Tex.	
   App.—El	
   Paso	
   1997,	
   pet.	
  

denied).	
  	
  What’s	
  more,	
  the	
  trial	
  court	
  must	
  render	
  a	
  summary	
  judgment	
  on	
  the	
  pleadings	
  on	
  file	
  at	
  the	
  

time	
   of	
   the	
   hearing.	
   	
   TRCP	
   166a(c);	
   Cluett	
  v.	
  Medical	
  Prot.	
  Co.,	
   829	
   S.W.2d	
   822,	
   826-­‐26	
   (Tex.	
   App.—Dallas	
  

1992,	
   writ	
   denied)	
   (holding	
   that	
   a	
   party	
   may	
   file	
   an	
   amended	
   pleading	
   after	
   it	
   files	
   its	
   motion	
   or	
  

response).	
  

53.          If	
  the	
  facts	
  are	
  disputed,	
  the	
  court	
  cannot	
  grant	
  the	
  plea	
  to	
  jurisdiction,	
  and	
  the	
  issue	
  must	
  be	
  

resolved	
  by	
  the	
  fact-­‐finder	
  at	
  trial.	
  	
  Mission	
  Consol.,	
  372	
  S.W.3d	
  at	
  635;	
  University	
  of	
  Tex.	
  v.	
  Hayes,	
  327	
  

S.W.3d	
  113,	
  116	
  (Tex.	
  2010).	
  

54.          EVIDENCE.	
  	
  The	
   trial	
   court	
   may	
   consider	
   evidence	
   in	
   ruling	
   on	
   a	
   plea	
   to	
   the	
   jurisdiction	
   and	
   must	
  

consider	
  evidence	
  when	
  necessary	
  to	
  resolve	
  the	
  jurisdictional	
  issue	
  raised.	
  	
   Bland	
  ISD	
  v.	
  Blue,	
  34	
  S.W.3d	
  

547,	
  555	
  (Tex.	
  2000).	
  	
  When	
  jurisdiction	
  involves	
  the	
  merits	
  of	
  the	
  case,	
  the	
  trial	
  court	
  must	
  review	
  the	
  

evidence	
  to	
  determine	
  whether	
  there	
  is	
  a	
  fact	
  issue.	
  	
  Texas	
  Dept.	
  of	
  Parks	
  &	
  Wildlife	
  v.	
  Miranda,	
  133	
  S.W.3d	
  

217,	
  227	
  (Tex.	
  2004).	
  

                                        IV.           PLEA	
  TO	
  THE	
  JURISDICTION	
  –	
  EVIDENCE	
  ATTACHED	
  

      •      EXHIBIT	
  A:	
   DWQ	
  Responses	
  from	
  Texas	
  Mutual	
  Insurance	
  Company	
  

      •      EXHIBIT	
  B:	
   DWQ	
  Responses	
  from	
  Lette	
  Insurance	
  Agency	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                                         12	
  
      •    EXHIBIT	
  C:	
   Pages	
  from	
  WM	
  and	
  iWorks	
  “Master	
  Agreement”	
  (WMRA	
  000022–23)	
  

                                                     V.         ARGUMENT	
  &	
  AUTHORITIES	
  

55.        Plaintiffs	
  incorporate	
  all	
  preceding	
  paragraphs	
  by	
  reference	
  as	
  though	
  fully	
  set	
  forth	
  herein.	
  

56.        iWorks	
  Defendants’	
  PTJ	
  is	
  meritless	
  and	
  should	
  be	
  denied	
  for	
  a	
  at	
  least	
  three	
  reasons.	
  	
  The	
  bolded,	
  

centered	
   case	
   quotations	
   above	
   are	
   enough	
   for	
   this	
   Court	
   to	
   summarily	
   deny	
   iWork	
   Defendants’	
   baseless	
  

Plea	
  to	
  the	
  Jurisdiction.	
  	
  However,	
  Plaintiffs	
  provide	
  additional	
  reasons	
  and	
  support	
  for	
  this	
  Court’s	
  denial	
  

of	
  iWorks	
  Defendants’	
  PTJ,	
  as	
  specified	
  below.	
  

57.        First,	
   the	
   Court	
   should	
   deny	
   iWorks	
   Defendants’	
   PTJ	
   because	
   the	
   DWC	
   does	
   not	
   have	
   exclusive	
  

jurisdiction	
  over	
  an	
  injured	
  employee’s	
  suit	
  for	
  common-­‐law	
  damages.	
  	
  iWorks	
  Defendants’	
  entire	
  PTJ	
  is	
  

based	
   on	
   one	
   premise—that	
   the	
   Division	
   of	
   Workers’	
   Compensation	
   has	
   exclusive	
   jurisdiction	
   over	
  

Plaintiffs’	
   claims	
   simply	
   because	
   iWorks	
   Defendants	
   filed	
   a	
   notice	
   of	
   injury	
   against	
   a	
   workers’	
  

compensation	
  policy	
  that	
  was	
  invalid,	
  ineffective,	
  and	
  terminated	
  on	
  the	
  date	
  of	
  the	
  injury.	
  	
  However,	
  as	
  

explained	
  below,	
  this	
  argument	
  is	
  unavailing	
  and	
  this	
  Court	
  should	
  deny	
  iWorks	
  Defendants’	
  PTJ.	
  

58.        Second,	
  the	
  Court	
  should	
  deny	
  iWorks	
  Defendants’	
  PTJ	
  because	
  iWorks	
  Defendants	
  have	
  failed	
  to	
  

conclusively	
   prove	
   that	
   they	
   were	
   workers’	
   compensation	
   subscribers	
   at	
   the	
   time	
   of	
   the	
   incident	
   in	
  

question.	
  	
  iWorks	
  Defendants	
  cannot	
  invoke	
  the	
  jurisdiction	
  of	
  the	
  DWC	
  without	
  proving	
  that	
  they	
  have	
  

some,	
  effective	
  workers’	
  compensation	
  insurance	
  coverage.	
  	
  This	
  Court	
  should	
  deny	
  iWorks	
  Defendants’	
  

PTJ	
  because	
  it	
  seeks	
  dismissal	
  so	
  that	
  the	
  DWC	
  can	
  determine	
  whether	
  there	
  are	
  benefits	
  under	
  a	
  policy	
  

that	
  was	
  invalid,	
  ineffective,	
  and	
  terminated	
  long	
  before	
  the	
  incident	
  in	
  question.	
  

59.        Third,	
  in	
  the	
  alternative,	
  this	
  Court	
  should	
  deny	
  iWorks	
  Defendants’	
  PTJ	
  because	
  Plaintiffs’	
  claims	
  

fall	
  under	
  the	
  exceptions	
  to	
  exhaustion	
  of	
  administrative	
  remedies.	
  

           a. THE	
  COURT	
  SHOULD	
  DENY	
  IWORKS	
  DEFENDANTS’	
  PTJ	
  BECAUSE	
  THE	
  DWC	
  DOES	
  NOT	
  HAVE	
  
              EXCLUSIVE	
   JURISDICTION	
   OVER	
   AN	
   INJURED	
   EMPLOYEE’S	
   SUIT	
   FOR	
   COMMON-­‐LAW	
  
              DAMAGES	
  AGAINST	
  HIS	
  NON-­‐SUBSCRIBING	
  EMPLOYER.	
  
              	
  
60.        DISTRICT	
   COURTS	
   HAVE	
   GENERAL	
   JURISDICTION.	
   Trial	
   courts	
   are	
   courts	
   of	
   general	
  

jurisdiction.	
  Dubai	
  Petroleum	
  Co.	
  v.	
  Kazi,	
  12	
  S.W.3d	
  71,	
  75	
  (Tex.	
  2000).	
  	
  Article	
  V,	
  Section	
  8	
  of	
  the	
  Texas	
  

Constitution	
   provides	
   that	
   a	
   district	
   court	
   has	
   jurisdiction	
   over	
   “all	
   actions,	
   proceedings,	
   and	
   remedies,	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                      13	
  
except	
  in	
  cases	
  where	
  exclusive,	
  appellate,	
  or	
  original	
  jurisdiction	
  may	
  be	
  conferred	
  by	
  this	
  Constitution	
  

or	
  other	
  law	
  on	
  some	
  other	
  court,	
  tribunal,	
  or	
  administrative	
  body.”	
  Tex.	
  Const.	
  art	
  V,	
  §	
  8.	
  	
  	
  

61.         Absent	
  a	
  contrary	
  showing,	
  courts	
  of	
  general	
  jurisdiction	
  (i.e.	
  Trial	
  Courts)	
  are	
  presumed	
  to	
  have	
  

subject	
   matter	
   jurisdiction.	
   AMS	
  Constr.	
  Co.	
  v.	
  K.H.K.	
  Scaffolding	
  Hous.,	
  Inc.,	
   357	
   S.W.3d	
   30,	
   37	
   (Tex.	
   App.—

Houston	
  [1st	
  Dist.]	
  2011,	
  pet.	
  denied)	
  (citing	
  Dubai	
  Petroleum	
  Co.,	
  12	
  S.W.3d	
  at	
  75).	
  There	
  is	
  no	
  similar	
  

presumption	
   that	
   administrative	
   agencies	
   are	
   authorized	
   to	
   resolve	
   disputes.	
   Subaru	
  of	
  Am.,	
   84	
   S.W.3d	
   at	
  

220.	
  

62.         DWC	
   EXCLUSIVE	
   JURISDICTION.	
   	
   Whether	
   an	
   agency	
   has	
   exclusive	
   jurisdiction	
   depends	
   upon	
  

statutory	
   interpretation,	
   and	
   is	
   a	
   question	
   of	
   law	
   to	
   be	
   reviewed	
   de	
   novo.	
   Subaru	
   of	
   Am.,	
   Inc.	
   v.	
   David	
  

McDavid	
  Nissan,	
  Inc.,	
  84	
  S.W.3d	
  212,	
  222	
  (Tex.	
  2002).	
  

63.         Multiple	
  Texas	
  courts	
  have	
  examined	
  the	
  DWC’s	
  exclusive	
  jurisdiction	
  and	
  have	
  universally	
  held	
  

that	
   it	
   extends	
   only	
   to	
   claims	
   for	
   benefits	
   under	
   workers’	
   compensation	
   insurance	
   policies.	
   	
   See	
   In	
   re	
  

Texas	
   Mut.	
   Ins.	
   Co.,	
   157	
   S.W.3d	
   75,	
   78	
   (Tex.	
   App.—Austin	
   2004,	
   pet.	
   denied);	
   (DWC	
   does	
   not	
   have	
  

exclusive	
   jurisdiction	
   over	
   employee’s	
   negligence	
   claim);	
   Nat’l	
  Am.	
  Ins.	
  Co.	
  v.	
  Tex.	
  Prop.	
  &	
  Cas.	
  Ins.	
  Guar.	
  

Ass’n	
   for	
   Paula	
   Ins.	
   Co.,	
   2013	
   Tex.	
   App.	
   LEXIS	
   10865,	
   15	
   (Tex.	
   App.—Austin	
   2013,	
   no	
   pet.)	
   (DWC’s	
  

exclusive	
  jurisdiction	
  does	
  not	
  extend	
  to	
  the	
  right	
  to	
  reimbursement	
  for	
  a	
  claim	
  paid	
  by	
  a	
  carrier.);	
  see	
  

also	
  AMS	
  Constr.	
  Co.,	
  357	
  S.W.3d	
  at	
  39.	
  	
  

            The	
   Commission’s	
   exclusive	
   jurisdiction	
   .	
   .	
   .	
   does	
   not	
   extend	
   to	
   all	
   cases	
   that	
   touch	
   on	
  
            workers’	
  compensation	
  issues.	
   The	
   district	
   courts	
   decide	
   disputes	
   about	
   whether	
   the	
  
            Act’s	
   exclusive	
   remedy	
   provision	
   applies	
   as	
   a	
   defense	
   to	
   an	
   injured	
   worker's	
  
            personal	
  injury	
  suit.”	
  	
  	
  

AMS	
  Constr.	
  Co.	
  v.	
  K.H.K.	
  Scaffolding	
  Hous.,	
  Inc.,	
  357	
  S.W.3d	
  at	
  38-­‐39.	
  

64.         As	
  such,	
  the	
  only	
  civil	
  claims	
  the	
  DWC	
  has	
  jurisdiction	
  over	
  are	
  those	
  involving	
  claims	
  for	
  wrongful	
  

deprivation	
   of	
   workers’	
   compensation	
   benefits.	
   	
   AMS	
   Constr.	
   Co.	
   v.	
   K.H.K.	
   Scaffolding	
   Hous.,	
   Inc.,	
   357	
  

S.W.3d	
  at	
  38;	
  (citing	
  Am.	
  Motorists	
  Ins.	
  Co.	
  v.	
  Fodge,	
  63	
  S.W.3d	
  at	
  804	
  (holding	
  that	
  a	
  claim	
  for	
  wrongful	
  

deprivation	
  of	
  workers’	
  compensation	
  benefits	
  brought	
  by	
  an	
  injured	
  worker	
  against	
  an	
  insurance	
  carrier	
  

fall	
  within	
  the	
  Commission’s	
  exclusive	
  jurisdiction.);	
  In	
  re	
  Liberty	
  Mut.	
  Fire	
  Ins.	
  Co.,	
  295	
  S.W.3d	
  327,	
  328	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                14	
  
(Tex.	
  2009)	
  (holding	
  that	
  trial	
  court	
  did	
  not	
  have	
  jurisdiction	
  to	
  adjudicate	
  injured	
  worker’s	
  bad-­‐faith	
  suit	
  

against	
   his	
   workers’	
   compensation	
   carrier	
   for	
   denying	
   medical	
   benefits	
   because	
   Commission	
   had	
  

exclusive	
   jurisdiction	
   to	
   determine	
   claimant's	
   entitlement	
   to	
   medical	
   benefits);	
   Henry	
   v.	
   Dillard	
   Dept.	
  

Stores,	
   Inc.,	
   70	
   S.W.3d	
   808,	
   809	
   (Tex.	
   2002)	
   (holding	
   that	
   trial	
   court	
   did	
   not	
   have	
   jurisdiction	
   to	
  

adjudicate	
   injured	
   worker’s	
   suit	
   against	
   self-­‐insured	
   employer	
   for	
   bad	
   faith	
   denial	
   of	
   reasonable	
   and	
  

timely	
   benefits);	
   Macias	
   v.	
   Schwedler,	
   135	
   S.W.3d	
   826,	
   830	
   (Tex.	
   App.—Houston	
   [1st	
   Dist.]	
   2004,	
   pet.	
  

denied)	
   (holding	
   that	
   trial	
   court	
   did	
   not	
   have	
   jurisdiction	
   to	
   adjudicate	
   wrongful	
   death	
   action	
   against	
  

workers’	
   compensation	
   carrier	
   because	
   the	
   claims	
   depended	
   on	
   determination	
   that	
   worker	
   sustained	
  

compensable	
  injury)).	
  

65.            Moreover,	
  iWorks	
  Defendants	
  cannot	
  cite	
  this	
  Court	
  to	
  one	
  Texas	
  court	
  opinion	
  holding	
  that	
  the	
  

DWC	
   has	
   exclusive	
   jurisdiction	
   over	
   common-­‐law	
   negligence	
   claims	
   like	
   Plaintiffs	
   or	
   contractual	
  

indemnity	
  claims	
  like	
  iWorks	
  Defendants’.	
  	
  See,	
  e.g.	
  In	
  re	
  Texas	
  Mut.	
  Ins.	
  Co.,	
  157	
  S.W.3d	
  at	
  81.	
  

66.            That	
   is	
   because	
   Texas	
   law	
   is	
   clear	
   that	
   the	
   DWC	
   does	
   not	
   have	
   exclusive	
   jurisdiction	
   over	
  

common-­‐law	
  claims	
  that	
  are	
  not	
  seeking	
  workers’	
  compensation	
  benefits:	
  

               “[A]	
   negligence	
   claim	
   is	
   outside	
   the	
   [Workers’	
   Compensation]	
   Commission’s	
  
               exclusive	
  jurisdiction.	
  The	
  Commission’s	
  exclusive	
  jurisdiction	
  extends	
  to	
  claims	
  for	
  
               benefits	
  under	
  workers’	
  compensation	
  insurance	
  policies.”	
  	
  
               	
  
In	
   re	
   Texas	
   Mut.	
   Ins.	
   Co.,	
   157	
   S.W.3d	
   75,	
   81	
   (Tex.	
   App.—Austin	
   2004,	
   pet.	
   denied)	
   (orig.	
   proceeding)	
  

(citing	
  Tex.	
  Lab.	
  Code	
  Ann.	
  §	
  408.001(a)).1	
  

67.            In	
   addition	
   to	
   common-­‐law	
   tort	
   claims,	
   “[c]ourts	
   regularly	
   preside	
   over	
   the	
   hashing	
   out	
   of	
   the	
  

contractual	
  relationships	
  between	
  staff	
  leasing	
  companies,	
  their	
  client	
  companies,	
  and	
  even	
  on	
  occasion	
  

their	
   carriers.”	
   AMS	
   Constr.	
   Co.	
   v.	
   K.H.K.	
   Scaffolding	
   Hous.,	
   Inc.,	
   357	
   S.W.3d	
   at	
   39.	
   	
   For	
   example,	
   in	
   Tex.	
  

Workers'	
  Compensation	
  Fund	
  v.	
  Del	
  Indus.	
  Inc.,	
  the	
  supreme	
  court	
  held	
  that	
  the	
  workers	
  leased	
  from	
  a	
  staff	
  

leasing	
   company	
   to	
   a	
   client	
   company	
   were	
   not	
   the	
   client	
   company’s	
   employees	
   for	
   the	
   purposes	
   of	
  

	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
1	
  The	
   quote	
   above	
   was	
   taken	
   directly	
   from	
   a	
   case	
   that	
   iWorks	
   Defendants	
   cited	
   in	
   their	
   PTJ.	
   	
   In	
   fact,	
   the	
   quoted	
   text	
   is	
   located	
  
only	
  4	
  paragraphs	
  after	
  an	
  excerpt	
  cited	
  by	
  iWorks	
  Defendants	
  in	
  their	
  PTJ.	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                                                               15	
  
computing	
  the	
  premiums	
  for	
  the	
  client	
  company’s	
  own	
  workers’	
  compensation	
  insurance.	
  	
  35	
  S.W.3d	
  591,	
  

596	
  (Tex.	
  2000).	
  

68.         In	
   re	
   Texas	
   Mut.	
   Ins.	
   Co.,	
  157	
  S.W.3d	
  75	
  (Tex.	
  App.—Austin	
  2004,	
  pet.	
  denied).	
   	
   In	
   In	
  re	
  Texas	
  

Mut.,	
   an	
   employer	
   brought	
   two	
   claims	
   against	
   Texas	
   Mutual	
   Insurance	
   Company:	
   (1)	
   breach	
   of	
   the	
  

insurance	
   contract	
   by	
   refusing	
   to	
   provide	
   coverage	
   during	
   the	
   disputed	
   period;	
   and	
   in	
   the	
   alternative	
   (2)	
  

negligence	
  in	
  causing	
  the	
  insured	
  to	
  have	
  a	
  coverage	
  gap.	
  	
  157	
  S.W.3d	
  at	
  77.	
  	
  	
  

69.         Not	
  long	
  into	
  its	
  discussion	
  of	
  exclusive	
  jurisdiction,	
  the	
  court	
  in	
  In	
   re	
   Tex.	
   Mut.	
   Ins.	
   Co.	
   explained	
  

that	
   the	
   Workers’	
   Compensation	
   Commission	
   has	
   exclusive	
   jurisdiction	
   over	
   one	
   thing—the	
   award	
   of	
  

workers’	
   compensation	
   benefits.	
   	
   157	
   S.W.3d	
   at	
   78.	
   	
   Specifically,	
   the	
   court	
   said	
   “[t]he	
   [Texas	
   Workers’	
  

Compensation]	
  Act	
  ‘vests	
  the	
  power	
  to	
  award	
  compensation	
  benefits	
  solely	
  in	
  the	
  Workers’	
  Compensation	
  

Commission	
   (formerly	
   the	
   Industrial	
   Accident	
   Board),	
   subject	
   to	
   judicial	
   review.”	
   Id.	
   (citing	
   American	
  

Motorists	
  Ins.	
  Co.	
  v.	
  Fodge,	
  63	
  S.W.3d	
  801,	
  803	
  (Tex.	
  2001)	
  (emphasis	
  added).	
  	
  	
  

70.         On	
  the	
  other	
  hand,	
  the	
  DWC	
  does	
  not	
   have	
  exclusive	
  jurisdiction	
  over	
  claims	
  that	
  do	
  not	
  seek	
  an	
  

award	
  of	
  workers’	
  compensation	
  benefits.	
  	
  Id.	
  at	
  81.	
  

71.         The	
   Court	
   in	
   In	
   re	
   Tex.	
   Mut.	
   ultimately	
   held	
   that	
   the	
   DWC	
   had	
   exclusive	
   jurisdiction	
   over	
   the	
  

plaintiff’s	
   breach	
   of	
   contract	
   claims	
   because	
   they	
   (1)	
   presupposed	
   “the	
   existence	
   of	
   a	
   workers’	
  

compensation	
   insurance	
   policy,”	
   and	
   (2)	
   “quite	
   plainly	
   [sought]	
   benefits	
   due	
   under	
   that	
   policy.”	
   Id.	
   at	
   80-­‐

81	
  (citing	
  Fodge,	
  63,	
  S.W.3d	
  at	
  803).	
  

72.         By	
  contrast,	
  the	
  plaintiff’s	
  negligence	
  claim	
  presupposed	
  that	
  no	
  workers’	
  compensation	
  insurance	
  

policy	
   was	
   in	
   effect	
   at	
   the	
   time	
   of	
   the	
   plaintiff’s	
   injuries.	
   	
   Id.	
   at	
   81-­‐82.	
   	
   Thus,	
   the	
   DWC	
   did	
   not	
   have	
  

exclusive	
  jurisdiction	
  over	
  the	
  plaintiff’s	
  negligence	
  claim.	
  	
  Id.	
  	
  Moreover,	
  the	
  Court	
  swiftly	
  rejected	
  any	
  

attempts	
  to	
  characterize	
  the	
  plaintiff’s	
  “negligence	
  damages	
  claim”	
  as	
  one	
  “seeking	
  the	
  specific	
  workers’	
  

compensation	
  benefits	
  of	
  which	
  [plaintiffs]	
  were	
  negligently	
  deprived.”	
  Id.	
  at	
  81-­‐82.	
  

73.         AMS	
   Constr.	
   Co.	
   v.	
   K.H.K.	
   Scaffolding	
   Hous.,	
   Inc.,	
   357	
   S.W.3d	
   30	
   (Tex.	
   App.—Houston	
   [1st	
  

Dist.]	
   2011,	
   pet.	
   denied).	
   	
   AMS	
  Constr.	
  Co.	
  v.	
  K.H.K.	
  Scaffolding	
  Hous.,	
  Inc.	
   is	
   factually	
   analogous	
   to	
   the	
  

case	
  at	
  bar.	
  	
  There,	
  a	
  leased	
  employee	
  sued	
  the	
  client	
  company	
  for	
  negligence	
  and	
  gross	
  negligence	
  after	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                               16	
  
sustaining	
   work-­‐related	
   injuries.	
   	
   Id.	
  at	
   35.	
   	
   The	
   client	
   company	
   then	
   asserted	
   cross-­‐claims	
   against	
   the	
  

staff	
   leasing	
   company	
   regarding	
   its	
   failure	
   to	
   maintain	
   workers’	
   compensation	
   insurance.	
   	
   The	
   staff	
  

leasing	
   company	
   contended	
   that	
   the	
   trial	
   court	
   lacked	
   subject	
   matter	
   jurisdiction	
   to	
   enter	
   a	
   judgment	
  

against	
   it	
   on	
   the	
   client	
   company’s	
   breach	
   of	
   contract	
   claim	
   because	
   it	
   loosely	
   involved	
   the	
   issue	
   of	
  

workers’	
  compensation	
  coverage.	
  	
  Id.	
  at	
  37.	
  

74.            In	
  denying	
  the	
  leasing	
  company’s	
  plea	
  to	
  the	
  jurisdiction,	
  the	
  Court	
  held	
  that	
  “[t]his	
  case	
  does	
  not	
  

involve	
  a	
  dispute	
  about	
  workers’	
  compensation	
  benefits	
  from	
  a	
  carrier	
  under	
  an	
  insurance	
  policy.”	
  357	
  

S.W.3d	
   at	
   39.	
   Instead,	
   the	
   dispute	
   was	
   whether	
   AMS	
   was	
   contractually	
   obligated	
   to	
   obtain	
   workers’	
  

compensation	
   benefits	
   for	
   a	
   leased	
   employee	
   from	
   an	
   insurance	
   carrier,	
   and	
   the	
   consequence	
   of	
   its	
  

failure	
  to	
  do	
  so.	
  	
  Id.	
  	
  

75.            The	
   Court	
   in	
   AMS	
   Constr.	
   Co.	
   denied	
   the	
   plea	
   to	
   the	
   jurisdiction	
   for	
   the	
   same	
   reasons	
   that	
   this	
  

Court	
  should	
  deny	
  iWorks	
  Defendants’	
  PTJ—to	
  wit:	
  	
  

               (1) “Neither	
   AMS	
   nor	
   KHK	
   was	
   seeking	
   workers’	
   compensation	
   benefits	
   as	
   a	
   claimant	
   or	
   a	
  
                   subclaimant	
   under	
   an	
   insurance	
   policy.”	
   =	
   Neither	
   iWorks	
   nor	
   WM	
   are	
   seeking	
   workers’	
  
                   compensation	
  benefits	
  as	
  a	
  claimant	
  or	
  subclaimant	
  under	
  any	
  policy;	
  
                   	
  
               (2) “[The	
   employee]	
   sued	
   KHK	
   as	
   a	
   non-­‐subscriber.”	
   =	
   Plaintiffs	
   are	
   suing	
   iWorks	
   as	
   a	
   non-­‐
                   subscriber;	
  
	
  
               (3) “The	
   insurance	
   company	
   that	
   issued	
   AMS’s	
   workers’	
   compensation	
   insurance	
   policy	
   denied	
  
                   him	
   coverage.”	
   =	
   Texas	
   Mutual	
   has	
   given	
   sworn	
   deposition	
   testimony	
   indicating	
   that	
   it	
  
                   will	
  deny	
  coverage	
  on	
  iWorks’s	
  terminated	
  policy	
  (see	
  EXHIBIT	
  A);	
  and	
  
	
  
               (4) “AMS	
  never	
  produced	
  a	
  policy	
  that	
  covers	
  [plaintiff]	
  or	
  KHK.”	
  =	
  iWorks	
  has	
  never	
  produced	
  a	
  
                   workers’	
  compensation	
  policy	
  that	
  covers	
  Mose	
  Guillory	
  or	
  WM.	
  
	
  
AMS	
  Constr.	
  Co.,	
  357	
  S.W.3d	
  at	
  39.	
  

76.            APPLICATION.	
   	
   Like	
   in	
   In	
   re	
   Texas	
   Mut.	
   Ins.	
   Co.,	
   this	
   Court	
   should	
   deny	
   iWorks	
   PTJ	
   because	
  

Plaintiff’s	
   personal	
   injury	
   claims	
   do	
   not	
   seek	
   an	
   award	
   of	
   workers’	
   compensation	
   benefits.	
   	
   157	
   S.W.3d	
  at	
  

81.	
   	
   To	
   the	
   contrary,	
   much	
   like	
   the	
   negligence	
   claims	
   asserted	
   in	
   In	
  re	
  Tex.	
  Mut.,	
   Plaintiffs’	
   claims	
   here	
  

presuppose	
   that	
   no	
   workers’	
   compensation	
   insurance	
   was	
   in	
   effect	
   at	
   the	
   time	
   of	
   the	
   Mose	
   Guillory’s	
  

injuries.	
  	
  See	
  id.	
  at	
  81-­‐82.	
  	
  	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                   17	
  
77.         Further,	
  as	
  in	
  AMS	
  Constr.	
  Co.,	
  “[t]his	
  case	
  does	
  not	
  involve	
  a	
  dispute	
  about	
  workers’	
  compensation	
  

benefits	
  from	
  a	
  carrier	
  under	
  an	
  insurance	
  policy.”	
  357	
  S.W.3d	
  at	
  39.	
  	
  Plaintiffs	
  are	
  not	
  seeking	
  workers’	
  

compensation	
   insurance	
   benefits	
   from	
   WM	
   Defendants	
   or	
   iWorks	
   Defendants.	
   	
   Instead,	
   Plaintiffs	
   are	
  

seeking	
  compensatory	
  damages	
  under	
  common-­‐law	
  tort	
  principles.	
  

78.         On	
   February	
   19,	
   2015,	
   iWorks	
   Defendants	
   filed	
   a	
   supplement	
   to	
   their	
   PTJ	
   pointing	
   out	
   2	
  

immaterial	
   facts:	
   (1)	
   that	
   Texas	
   Mutual	
   created	
   a	
   claim	
   number	
   for	
   iWorks	
   Defendants’	
   phantom	
  

workers’	
  compensation	
  claim	
  on	
  their	
  non-­‐existent	
  policy;	
  and	
  (2)	
  that	
  Plaintiffs	
  served	
  a	
  DWC	
  41	
  Notice	
  

of	
  Injury	
  Form	
  on	
  the	
  one-­‐year	
  anniversary	
  of	
  Mose	
  Guillory’s	
  injury.	
  	
  	
  

79.         As	
  to	
  the	
  first	
  point,	
  iWorks	
  Defendants	
  provide	
  no	
  argument	
  or	
  authority	
  explaining	
  how	
  Texas	
  

Mutual’s	
   creation	
   of	
   a	
   claim	
   prejudices	
   Plaintiff’s	
   right	
   to	
   sue	
   his	
   non-­‐subscribing	
   employer.	
   	
   As	
   to	
   the	
  

second	
   point,	
   iWorks	
   Defendants	
   claim	
   that	
   “Plaintiff	
   cannot	
   hedge	
   his	
   bets	
   with	
   the	
   administrative	
  

agency	
  while	
  improperly	
  seeking	
  a	
  judicial	
  remedy	
  in	
  this	
  Court[.]”	
  iWorks	
  Supp.	
  to	
  PTJ	
  at	
  p.	
  2.	
  	
  	
  

80.         First,	
   iWorks	
   Defendants	
   provide	
   no	
   authority	
   for	
   this	
   proposition—it	
   is	
   merely	
   Counsel	
   for	
  

iWorks’s	
  unfounded	
  opinion.	
  	
  In	
  accordance	
  with	
  the	
  Texas	
  Labor	
  Code	
  Ch.	
  409,	
  Plaintiffs	
  did	
  previously	
  

file	
   their	
   DWC	
   41	
   form	
   on	
   the	
   1-­‐year	
   anniversary	
   of	
   the	
   injury	
   in	
   question.	
   	
   However,	
   Plaintiffs	
   did	
   so	
  

solely	
   to	
   preserve	
   their	
   right	
   to	
   seek	
   benefits	
   in	
   the	
   event	
   that	
   this	
   Court	
   or	
   the	
   Court	
   of	
   Appeals	
   later	
  

determined	
   that	
   iWorks	
   Defendants	
   and/or	
   WM	
   Defendants	
   were	
   workers’	
   compensation	
   subscribers.	
  	
  

Plaintiffs	
   are	
   not	
   seeking	
   workers’	
   compensation	
   benefits	
   from	
   any	
   provider,	
   and	
   are	
   surely	
   not	
  

attempting	
  to	
  get	
  blood	
  from	
  the	
  turnip	
  that	
  is	
  iWorks	
  Defendants’	
  cancelled	
  policy.	
  

81.         Moreover,	
   Plaintiffs’	
   direct	
   this	
   Court	
   to	
   Footnote	
   1	
   on	
   page	
   2	
   of	
   iWorks	
   Defendants’	
   PTJ,	
   which	
  

reads	
  as	
  follows:	
  

            “By	
   filing	
   a	
   claim	
   on	
   its	
   worker’s	
   compensation	
   insurance,	
   iWORKS	
   does	
   NOT	
   waive	
   or	
  
            otherwise	
  retreat	
  from	
  its	
  position	
  that	
  Guillory’s	
  injury	
  is	
  the	
  sole	
  responsibility	
  of	
  Waste	
  
            Management	
  and/or	
  Guillory	
  and	
  expressly	
  reserves	
  its	
  rights	
  to	
  raise	
  these	
  issues	
  in	
  the	
  
            administrative	
   proceedings	
   (if	
   any)	
   and	
   any	
   judicial	
   review	
   of	
   any	
   administrative	
  
            determinations.”	
  

iWorks	
  PTJ,	
  p.	
  1,	
  n.	
  1.	
  	
  That	
  sounds	
  an	
  awful	
  lot	
  like	
  hedging	
  one’s	
  bets	
  with	
  the	
  administrative	
  agency	
  

while	
  waiting	
  for	
  the	
  judicial	
  review	
  to	
  play	
  out.	
  	
  What’s	
  good	
  for	
  the	
  goose	
  is	
  good	
  for	
  the	
  gander.	
  	
  	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                       18	
  
82.         AMS	
  Constr.	
  Co.,	
  In	
  re	
  Tex.	
  Mut.,	
  and	
  Fodge	
  illustrate	
  that	
  the	
  DWC’s	
  exclusive	
  jurisdiction	
  does	
  not	
  

apply	
  to	
  Plaintiffs’	
  claims	
  here	
  because	
  Plaintiffs’	
  claims	
  have	
  nothing	
  to	
  do	
  with	
  the	
  payment	
  of	
  or	
  claims	
  

for	
   workers’	
   compensation	
   benefits.	
   	
   Plaintiffs	
   have	
   never	
   made	
   a	
   claim	
   for	
   workers’	
   compensation	
  

benefits	
  from	
  any	
  provider	
  in	
  this	
  case.	
  	
  	
  

83.         Tex.	
  Mut.	
  Ins.	
  Co.	
  v.	
  Ruttiger,	
  381	
  S.W.3d	
  430	
  (Tex.	
  2012)	
  and	
  Morales	
  v.	
  Liberty	
  Mut.	
  Sinc.	
  Co.,	
  

241	
   S.W.3d	
   514	
   (Tex.	
   2007)	
   are	
   inapposite	
   and	
   neither	
   case	
   aids	
   iWorks	
   Defendants	
   with	
   regard	
   to	
  

their	
   unsustainable	
   argument.	
   	
   Ruttiger	
  and	
   Morales	
   are	
   inapplicable	
   here	
   because	
   the	
   Texas	
   Supreme	
  

Court	
   merely	
   confirmed	
   that	
   the	
   DWC’s	
   exclusive	
   jurisdiction	
   and	
   the	
   requirement	
   for	
   exhausting	
  

administrative	
  remedies	
  only	
  apply	
  to	
  claims	
  for	
  the	
  payment	
  or	
  non-­‐payment	
  of	
  workers’	
  compensation	
  

benefits.	
  	
  Ruttiger,	
  381	
  S.W.3d	
  at	
  436-­‐37;	
  Morales,	
  241	
  S.W.3d	
  at	
  519.	
  	
  	
  

84.         Additionally,	
  in	
  its	
  citation	
  to	
  Ruttiger,	
  Counsel	
  for	
  iWorks	
  is	
  blatantly	
  attempting	
  to	
  mislead	
  the	
  

Court.	
   	
   Counsel	
   for	
   iWorks	
   cherry	
   picks	
   and	
   manipulates	
   the	
   Court’s	
   holding	
   as	
   follows:	
   “The	
   court	
  

recognized	
   that	
   allowing	
   an	
   employee	
   to	
   circumvent	
   the	
   act	
   by	
   asserting	
   common	
   law	
   causes	
   of	
   action	
  

would	
  be	
  ‘inconsistent	
  with	
  the	
  Act’s	
  goals	
  and	
  legislative	
  intent’.”	
  	
  iWorks	
  PTJ	
  at	
  p.	
  9.	
  

85.         In	
   the	
   preceding	
   sentence,	
   the	
   Ruttiger	
   Court	
   expressly	
   stated	
   that	
   its	
   holding	
   did	
   not	
   apply	
   to	
  

common-­‐law	
  claims—to	
  wit:	
  

          Permitting	
   a	
   workers’	
   compensation	
   claimant	
   to	
   additionally	
   recover	
   by	
   simply	
   suing	
  
          under	
   general	
   provisions	
   of	
   Insurance	
   Code	
   section	
   541.060	
   would	
   be	
   inconsistent	
   with	
  
          the	
  structure	
  and	
  detailed	
  processes	
  of	
  the	
  Act.	
  	
  
          	
  
Tex.	
  Mut.	
  Ins.	
  Co.	
  v.	
  Ruttiger,	
  381	
  S.W.3d	
  430,	
  443	
  (Tex.	
  2012).	
  	
  Thus,	
  the	
  analysis	
  in	
  Ruttiger	
  does	
  not	
  avail	
  

iWorks	
   because	
   it	
   pertained	
   to	
   bad-­‐faith	
   insurance	
   lawsuits	
   over	
   the	
   denial	
   of	
   insurance	
   benefits—not	
  

common-­‐law	
  personal	
  injury	
  claims.	
  

86.         Many	
  of	
  the	
  other	
  cases	
  cited	
  by	
  iWorks	
  Defendants	
  similarly	
  disprove	
  iWorks’	
  PTJ	
  on	
  their	
  face.	
  

iWorks	
  Defendants	
  cite	
  In	
  re	
  Liberty	
  Ins.	
  Corp.	
  for	
  the	
  proposition	
  that	
  “[t]he	
  Workers’	
  Compensation	
  Act	
  

vests	
   the	
   Workers’	
   Compensation	
   Division	
   with	
   exclusive	
   jurisdiction	
   to	
   determine	
   a	
   claimant's	
  

entitlement	
   to	
   medical	
   benefits.”	
   321	
   S.W.3d	
   630,	
   636	
   (Tex.	
   App.—Houston	
   14th	
   [Dist.]	
   2010,	
   orig.	
  

proceeding).	
  	
  iWorks	
  Defendants	
  also	
  cite	
  In	
  Re	
  Mid-­‐Century	
  Ins.	
  Co.	
  of	
  Tex.	
  for	
  the	
  proposition	
  that	
  “[t]he	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                            19	
  
Worker’s	
   Compensation	
   Act	
   gives	
   the	
   DWC	
   exclusive	
   jurisdiction	
   over	
   certain	
   workers’	
   compensation	
  

disputes	
  relating	
  to	
  entitlement	
  to	
  medical	
  benefits,	
  preauthorization	
  of	
  medical	
  care	
  and	
  reimbursement	
  

of	
   medical	
   expenses.”	
   In	
  Re	
  Mid-­‐Century	
  Ins.	
  Co.	
  of	
  Tex.,	
   426	
   S.W.3d	
   169,	
   172	
   (Tex.	
   App.—Houston	
   [1st	
  

Dist.]	
  2012,	
  orig.	
  proceeding).	
  

87.        These	
   holdings	
   are	
   irrelevant	
   because	
   Plaintiffs	
   are	
   not	
   suing	
   iWorks	
   Defendants	
   for	
   medical	
  

benefits	
  under	
  workers’	
  compensation—Plaintiffs	
  are	
  suing	
  for	
  compensatory	
  damages	
  under	
  tort	
  law.	
  

88.        iWorks	
   Defendants	
   also	
   improperly	
   cite	
   and	
   rely	
   on	
   Port	
   Elevator-­‐Brownsville,	
   L.L.C.	
   v.	
   Casados,	
  

358	
   S.W.3d	
   238	
   (Tex.	
   2012).	
   There,	
   it	
   was	
   undisputed	
   that	
   the	
   employer	
   had	
   a	
   valid	
   workers’	
  

compensation	
  policy,	
  but	
  the	
  question	
  was	
  whether	
  or	
  not	
  it	
  covered	
  temporary	
  workers.	
  	
  Id.	
  at	
  243.	
  	
  	
  

89.        The	
  Court	
  held	
  that	
  “a	
  client	
  company	
  is	
  entitled	
  to	
  the	
  exclusive	
  remedy	
  defense	
  upon	
  showing	
  

that	
  it	
  was	
  the	
  plaintiff’s	
  employer	
  and	
  that	
  it	
  was	
  covered	
  by	
  a	
  workers’	
  compensation	
  policy.”	
  	
  Id.	
  	
  In	
  

Casados,	
  the	
  employer	
  could	
  assert	
  the	
  exclusive	
  remedy	
  defense	
  against	
  a	
  temporary	
  common	
  worker	
  

even	
   though	
   its	
   workers’	
   compensation	
   policy	
   purported	
   to	
   exclude	
   such	
   workers	
   and	
   even	
   though	
   it	
  

never	
  paid	
  premiums	
  to	
  cover	
  such	
  workers.	
  	
  Id.	
  at	
  243-­‐244.	
  	
  	
  

90.        iWorks	
   Defendants	
   are	
   using	
   that	
   holding	
   to	
   argue	
   that	
   a	
   company	
   can	
   cease	
   paying	
   premiums	
  

altogether,	
   allow	
   its	
   workers’	
   compensation	
   policy	
   to	
   be	
   cancelled,	
   yet	
   continue	
   to	
   reap	
   the	
   benefits	
   of	
  

being	
  a	
  subscriber.	
  	
  Such	
  an	
  absurd	
  result	
  cannot	
  be	
  extrapolated	
  from	
  the	
  opinion	
  in	
  Casados.	
  

91.        Finally,	
  the	
  DWC	
  Appeals	
  Panel	
  Decisions	
  cited	
  in	
  iWorks’	
  motion	
  are	
  inapposite.	
  	
  Those	
  decisions	
  

resulted	
  from	
  contested	
   case	
   hearings	
   regarding	
  the	
  payment	
  or	
  non-­‐payment	
  of	
  workers’	
  compensation	
  

insurance	
   benefits.	
   	
   It	
   bears	
   repeating	
   that	
   Plaintiffs’	
   claims	
   are	
   common-­‐law	
   tort	
   claims—Negligence;	
  

Negligent	
   Hiring,	
   Training,	
   Supervision,	
   Retention;	
   Negligence	
   Per	
   Se;	
   and	
   Gross	
   Negligence.	
   	
   Thus,	
  

Plaintiffs’	
   claims	
   have	
   NOTHING	
   to	
   do	
   with	
   entitlement,	
   request,	
   award,	
   payment,	
   or	
   non-­‐payment	
   of	
  

workers’	
  compensation	
  benefits.	
  	
  	
  

92.        Like	
   the	
   common-­‐law	
   claims	
   in	
   AMS	
   Constr.	
   Co.,	
   the	
   DWC	
   lacks	
   exclusive	
   jurisdiction	
   over	
  

Plaintiffs’	
  claims	
  and	
  this	
  Court	
  should	
  deny	
  iWorks	
  PTJ	
  accordingly.	
  

	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                      20	
  
	
  

           b. THE	
   COURT	
   SHOULD	
   DENY	
   IWORKS	
   DEFENDANTS’	
   PTJ	
   BECAUSE	
   IWORKS	
   DEFENDANTS	
  
                   HAVE	
   FAILED	
   TO	
   CONCLUSIVELY	
   PROVE	
   THEY	
   WERE	
   WORKERS’	
   COMPENSATION	
  
                   “SUBSCRIBERS”.	
  
                   	
  
93.        In	
   their	
   PTJ,	
   iWorks	
   Defendants	
   spend	
   much	
   time	
   and	
   effort	
   apparently	
   attempting	
   to	
   educate	
   the	
  

Court	
  on	
  the	
  administrative	
  procedures	
  followed	
  within	
  the	
  workers’	
  compensation	
  claims	
  process.	
  	
  See	
  

iWorks	
  PTJ	
  at	
  pp.	
  8-­‐11,	
  13.	
  	
   However,	
  before	
  launching	
  into	
  their	
  gratuitous	
  diatribe	
  on	
  administrative	
  

protocol,	
   iWorks	
   Defendants	
   conveniently	
   neglect	
   to	
   address	
   the	
   threshold	
   issue—i.e.	
   the	
   existence	
   of	
   an	
  

active,	
  applicable	
  workers’	
  compensation	
  policy.	
  	
  

94.        If	
  the	
  case	
  law	
  makes	
  anything	
  clear,	
  it	
  is	
  that	
  the	
  Court	
  does	
  not	
  even	
  reach	
  the	
  issue	
  of	
  the	
  DWC’s	
  

exclusive	
   jurisdiction	
   and	
   the	
   exhaustion	
   administrative	
   remedies	
   if	
   it	
   determines	
   that	
   iWorks	
  

Defendants	
  are	
  “non-­‐subscribers”	
  as	
  to	
  Mose	
  Guillory.	
  	
  	
  

95.        The	
   Court	
   in	
   Port	
   Elevator-­‐Brownsville,	
   L.L.C.	
   v.	
   Casados	
   begins	
   and	
   ends	
   its	
   analysis	
   with	
   this	
  

essential	
   element—the	
   existence	
   of	
   worker’s	
   compensation	
   coverage.	
   	
   358	
   S.W.3d	
   238	
   (Tex.	
   2012).	
   	
   In	
  

fact,	
   the	
   Texas	
   Supreme	
   Court’s	
   holding	
   in	
   Casados	
   begins	
   as	
   follows:	
   “Because	
   Port	
   Elevator	
   had	
   a	
  

workers’	
  compensation	
  policy[.]”	
  	
  Id.	
  at	
  239.	
  

96.        Moreover,	
   the	
   Texas	
   Supreme	
   Court	
   has	
   made	
   it	
   abundantly	
   clear	
   that	
   the	
   fundamental	
  

prerequisite	
  for	
  the	
  exclusive-­‐remedy	
  defense	
  is	
  the	
  existence	
  of	
  a	
  valid,	
  effective	
  workers’	
  compensation	
  

policy	
   existing	
   at	
   the	
   time	
   of	
   the	
   incident	
   in	
   question.	
   	
   For	
   example,	
   the	
   Court	
   in	
   Casados	
   noted	
   that	
  

“employer”	
  under	
  the	
  Texas	
  Workers’	
  Compensation	
  Act	
  means	
  “a	
  person	
  who	
  makes	
  a	
  contract	
  of	
  hire,	
  

employs	
   one	
   or	
   more	
   employees,	
   and	
   has	
   workers’	
   compensation	
   insurance	
   coverage.”	
   Casados,	
   358	
  

S.W.3d	
  at	
  241	
  (emphasis	
  added).	
  

97.        One	
   page	
   later,	
   the	
   Court	
   held	
   that	
   “each	
   employer	
   who	
   subscribes	
   to	
   workers’	
   compensation	
  

insurance	
   may	
   raise	
   the	
   exclusive-­‐remedy	
   provision	
   as	
   a	
   bar	
   to	
   claims	
   about	
   the	
   injury.”	
   	
   Casados,	
   358	
  

S.W.3d	
  at	
  242	
  (emphasis	
  added)	
  (citing	
  Garza	
  v.	
  Excel	
  Logistics,	
  Inc.,	
  161	
  S.W.3d	
  473,	
  475-­‐76	
  (Tex.	
  2005)	
  

(stating	
  that	
  client	
  company	
  could	
  assert	
  exclusive-­‐remedy	
  defense	
  to	
  claims	
  by	
  temporary	
  employee	
  if	
  it	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                               21	
  
was	
  covered	
  by	
  workers’	
  compensation	
  insurance);	
   Wingfoot	
  Enters.	
  v.	
  Alvarado,	
   111	
   S.W.3d	
   134,	
   143	
   (Tex.	
  

2003).	
  	
  	
  

98.            It	
   is	
   important	
   to	
   note	
   that	
   the	
   Court	
   in	
   Casados	
  used	
   the	
   present	
   tense	
   form	
   of	
   the	
   verbs	
   “has”	
  

and	
   “subscribes”	
   instead	
   of	
   the	
   past	
   tense	
   (“had,”	
   “subscribed”)	
   or	
   the	
   future	
   tense	
   (“will	
   have,”	
   “will	
  

subscribe.”).	
   	
   Thus,	
   an	
   employer’s	
   status	
   as	
   a	
   workers’	
   compensation	
   “subscriber”	
   has	
   nothing	
   to	
   do	
   with	
  

whether	
  it	
  maintained	
  some	
  workers’	
  compensation	
  policy	
  in	
  the	
  past	
  (as	
  iWorks	
  did	
  here)	
  or	
  whether	
  it	
  

plans	
  to	
  obtain	
  workers’	
  compensation	
  in	
  the	
  future.	
  	
  	
  

99.            If	
  that	
  were	
  the	
  case,	
  every	
  Texas	
  business	
  could	
  obtain	
  a	
  workers’	
  compensation	
  policy,	
  cancel	
  it	
  

after	
   one	
   month,	
   and	
   still	
   be	
   considered	
   a	
   “subscriber”	
   in	
   perpetuity	
   merely	
   because	
   it	
   had	
   workers’	
  

compensation	
  coverage	
  at	
  some	
  irrelevant	
  point	
  in	
  the	
  past.	
  	
  Such	
  an	
  illogical	
  result	
  was	
  clearly	
  not	
  the	
  

intent	
  of	
  the	
  Texas	
  Legislature	
  when	
  fashioning	
  the	
  Workers’	
  Compensation	
  Act.	
  	
  

100.           Additionally,	
  an	
  employer’s	
  status	
  as	
  a	
  “subscriber”	
  has	
  nothing	
  to	
  do	
  with	
  whether	
  the	
  employer	
  

intended	
  to	
  have	
  coverage	
  or	
  whether	
  it	
  plans	
  to	
  obtain	
  coverage	
  in	
  the	
  future.	
  	
  Only	
  the	
  employer	
  who	
  

“has”	
   or	
   “subscribes”	
   to	
   workers’	
   compensation	
   insurance	
   may	
   raise	
   the	
   exclusive-­‐remedy	
   provision	
   as	
   a	
  

bar	
  to	
  claims	
  about	
  the	
  injury.	
  	
  Casados,	
  358	
  S.W.3d	
  at	
  242.	
  	
  For	
  iWorks	
  Defendants	
  to	
  have	
  had	
  workers’	
  

compensation	
   coverage	
   in	
   this	
   case,	
   they	
   needed	
   a	
   valid	
   workers’	
   compensation	
   policy	
   that	
   was	
   effective	
  

on	
  the	
  date	
  of	
  the	
  incident	
  in	
  question.	
  	
  As	
  confirmed	
  by	
  the	
  DWQ	
  responses	
  attached	
  hereto	
  as	
  EXHIBIT	
  

A	
  and	
  EXHIBIT	
  B,	
  iWorks	
  Defendants	
  failed	
  to	
  meet	
  this	
  requirement.	
  

101.           The	
   Court	
   in	
   Casados	
   also	
   explained	
   why	
   the	
   “Exclusive	
   Remedy”	
   provision	
   is	
   obviously	
  

inequitable	
   if	
   there	
   is	
   no	
   valid	
   workers’	
   compensation	
   policy	
   covering	
   the	
   incident	
   in	
   question.	
   	
   The	
   first,	
  

basic	
   premise	
   behind	
   the	
   Workers’	
   Compensation	
   Act	
   is	
   that	
   Texas	
   employers	
   are	
   permitted	
   to	
   choose	
  

whether	
   or	
   not	
   to	
   maintain	
   workers’	
   compensation	
   insurance.	
   	
   Casados,	
  358	
  S.W.3d	
  at	
  241.	
  	
  In	
  response,	
  

employees	
  of	
  subscribing	
  employers	
  can	
  choose	
  whether	
  to	
  accept	
  such	
  coverage	
  or	
  opt	
  out	
  and	
  retain	
  

their	
   common-­‐law	
   rights.	
   Id.	
  (citing	
   Tex.	
   Lab.	
   Code	
   §	
   406.034;	
   Lawrence	
  v.	
  CDB	
  Servs.,	
  Inc.,	
   44	
   S.W.3d	
   544,	
  

552	
  (Tex.	
  2001)).	
  

PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                       22	
  
102.         The	
   Court	
   in	
   Casados	
  goes	
   on	
   to	
   explain	
   the	
   intention	
   of	
   the	
   Texas	
   Legislature	
   and	
   the	
   rationale	
  

that	
  justifies	
  this	
  law:	
  	
  	
  

              “The	
  Legislature	
  intended	
  the	
  TWCA	
  to	
  benefit	
  both	
  employees	
  and	
  employers.	
  For	
  
              employees,	
   the	
   TWCA	
   allows	
   them	
   to	
   recover	
   workers’	
   compensation	
   benefits	
   for	
  
              injuries	
   in	
   the	
   course	
   and	
   scope	
   of	
   employment	
   without	
   proving	
   fault	
   by	
   the	
  
              employer	
  and	
  without	
  regard	
  to	
  their	
  negligence	
  .	
  .	
  .	
  For	
  employers,	
  their	
  liability	
  to	
  
              employees	
  is	
  limited.”	
  
              	
  
Id.	
  at	
  241	
  (citing	
  Tex.	
  Lab.	
  Code	
  §	
  406.031).	
  	
  

103.         It	
   is	
   clear	
   that	
   the	
   rationale	
   of	
   the	
   Texas	
   Legislature	
   and	
   Texas	
   Supreme	
   Court	
   assumes	
   the	
  

existence	
   of	
   workers’	
  compensation	
   insurance	
   coverage,	
   and	
   it	
   must.	
   	
   Otherwise,	
   what	
   is	
   the	
   employee	
  

being	
  forced	
  to	
  give	
  up	
  his	
  common	
  law	
  rights	
  for?	
  	
  	
  

104.         It	
  cannot	
  be	
  argued	
  that	
  the	
  Texas	
  Legislature	
  intended	
  for	
  this	
  Court	
  to	
  dismiss	
  Mose	
  Guillory’s	
  

claims	
   against	
   iWorks,	
   only	
   to	
   have	
   iWorks	
   then	
   hand	
   him	
   the	
   same,	
   expired,	
   terminated	
   policy	
  

information	
   page	
   and	
   say:	
   “Sorry,	
   you	
   don’t	
   get	
   workers’	
   compensation	
   coverage	
   because	
   I	
   DIDN’T	
   DO	
  

MY	
  JOB	
  .	
  .	
  .	
  I	
  BLEW	
  IT.”	
  	
  That	
  was	
  not,	
  and	
  is	
  not,	
  the	
  intent	
  behind	
  the	
  workers’	
  compensation	
  act	
  and	
  this	
  

Court	
  should	
  not	
  follow	
  iWorks	
  Defendants	
  down	
  this	
  non-­‐sensical	
  path.	
  	
  See	
  Casados	
  at	
  241	
  (citing	
  Tex.	
  

Lab.	
  Code	
  §	
  406.031).	
  

             c. ALTERNATIVELY,	
   THIS	
   COURT	
   SHOULD	
   DENY	
   IWORKS	
   DEFENDANTS’	
   PTJ	
   BECAUSE	
  
                  PLAINTIFFS’	
  CLAIMS	
  FALL	
  UNDER	
  AN	
  EXCEPTION	
  TO	
  THE	
  RULE	
  REGARDING	
  EXHAUSTION	
  
                  OF	
  REMEDIES.	
  
             	
  
105.         Plaintiffs	
  incorporate	
  all	
  preceding	
  paragraphs	
  by	
  reference	
  as	
  though	
  fully	
  set	
  forth	
  herein.	
  

106.         In	
  the	
  unlikely	
  event	
  that	
  this	
  Court	
  agrees	
  with	
  iWorks	
  Defendants’	
  argument,	
  the	
  Court	
  should	
  

still	
   deny	
   iWorks	
   Defendants’	
   PTJ	
   because	
   Plaintiffs’	
   claims	
   fall	
   within	
   the	
   recognized	
   exceptions	
   to	
  

exhaustion	
  of	
  remedies.	
  

107.         Texas	
   courts	
   have	
   recognized	
   four	
   exceptions	
   to	
   the	
   exhaustion	
   requirement:	
   (1)	
   exhausting	
  

agency	
  procedures	
  would	
   cause	
   irreparable	
   harm;	
   (2)	
   the	
   agency	
   cannot	
   grant	
   the	
   requested	
   relief,	
   such	
  

as	
   with	
   constitutional	
   claims;	
   (3)	
   the	
   cause	
   of	
   action	
   involves	
   a	
   pure	
   question	
   of	
   law	
   and	
   the	
   facts	
   are	
  

undisputed;	
  and	
  (4)	
  the	
  agency	
  has	
  acted	
  beyond	
  its	
  jurisdiction.	
  Tex.	
  Educ.	
  Agency	
  v.	
  Cypress-­‐Fairbanks	
  

Indep.	
  Sch.	
  Dist.,	
   830	
   S.W.2d	
   88,	
   90-­‐91	
   (Tex.	
   1992);	
   Houston	
  Fed.	
  of	
  Teachers	
  v.	
  Houston	
  Indep.	
  Sch.	
  Dist.,	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                  23	
  
730	
   S.W.2d	
   644,	
   646	
   (Tex.	
   1987);	
   Janik	
   v.	
   Lamar	
   Consol.	
   Indep.	
   Sch.	
   Dist.,	
   961	
   S.W.2d	
   322,	
   324	
   (Tex.	
  

App.—Houston	
  [1st	
  Dist.]	
  1997,	
  pet.	
  denied).	
  

108.        Plaintiffs	
   have	
   already	
   incurred	
   the	
   time	
   and	
   expense	
   of	
   litigating	
   this	
   lawsuit	
   for	
   nearly	
   2	
   ½	
  

years.	
  	
  During	
  that	
  time,	
  Mose	
  and	
  Mary	
  Guillory	
  have	
  endured	
  the	
  tremendous	
  hardship	
  of	
  Mr.	
  Guillory’s	
  

disabilities	
   and	
   his	
   inability	
   to	
   work.	
   	
   Moreover,	
   the	
   2-­‐year	
   statute	
   of	
   limitations	
   on	
   Plaintiffs’	
   tort	
   claims	
  

has	
   run.	
   	
   As	
   such,	
   it	
   would	
   cause	
   irreparable	
   harm	
   were	
   this	
   Court	
   to	
   force	
   Plaintiffs	
   to	
   incur	
   the	
  

additional	
   time	
   and	
   expense	
   of	
   the	
   administrative	
   gauntlet	
   only	
   to	
   have	
   the	
   DWC	
   tell	
   Plaintiffs	
   what	
   they	
  

already	
  know—iWorks	
  Defendants	
  are	
  non-­‐subscribers.	
  

109.        The	
   DWC	
   cannot	
   grant	
   all	
   of	
   Plaintiffs’	
   requested	
   relief.	
   	
   The	
   Texas	
   Workers’	
   Compensation	
   Act	
  

places	
   caps	
   on	
   the	
   pecuniary	
   benefits	
   that	
   may	
   be	
   awarded	
   and	
   does	
   not	
   provide	
   for	
   non-­‐pecuniary	
  

damages	
  such	
  as	
  pain	
  and	
  suffering,	
  mental	
  anguish,	
  etc.	
  	
  These	
  are	
  damages	
  that	
  Plaintiffs	
  are	
  seeking	
  

and	
  which	
  the	
  DWC	
  cannot	
  provide.	
  

110.        Based	
   on	
   the	
   foregoing,	
   this	
   Court	
   should	
   deny	
   iWorks	
   PTJ	
   because	
   Plaintiffs’	
   claims	
   fall	
   within	
  

recognized	
  exceptions	
  to	
  the	
  requirement	
  for	
  exhaustion	
  of	
  remedies.	
  

                                                                        VI.         CONCLUSION	
  

111.        Plaintiffs	
  incorporate	
  all	
  preceding	
  paragraphs	
  by	
  reference	
  as	
  though	
  fully	
  set	
  forth	
  herein.	
  

112.        iWorks	
   Defendants	
   are	
   asking	
   this	
   Court	
   to	
   take	
   unprecedented	
   action	
   that	
   directly	
   contradicts	
  

binding	
   precedent	
   handed	
   down	
   from	
   the	
   1st	
   District	
   Court	
   of	
   Appeals	
   only	
   4	
   years	
   ago.	
   	
   See	
  AMS	
  Constr.	
  

Co.,	
  357	
  S.W.3d	
  at	
  39.	
  	
  In	
  effect,	
  iWorks	
  Defendants	
  are	
  asking	
  this	
  Court	
  to	
  re-­‐write	
  the	
  Texas	
  Labor	
  Code	
  

so	
  as	
  to	
  extend	
  the	
  DWC’s	
  exclusive	
  jurisdiction	
  to	
  common-­‐law	
  claims	
  over	
  which	
  it	
  has	
  no	
  jurisdiction.	
  

113.        More	
  than	
  that,	
  iWorks	
  Defendants	
  are	
  asking	
  this	
  Court	
  to	
  strip	
  away	
  its	
  general	
  jurisdiction	
  to	
  

hear	
   common-­‐law	
   tort	
   claims.	
   	
   The	
   only	
   way	
   such	
   action	
   is	
   permitted	
   is	
   if	
   iWorks	
   Defendants	
  

conclusively	
   prove	
   their	
   entitlement	
   to	
   the	
   “Exclusive	
   Remedy”	
   defense.	
   	
   However,	
   iWorks	
   Defendants	
  

are	
  not	
  entitled	
  to	
  the	
  “Exclusive	
  Remedy”	
  defense	
  because	
  iWorks	
  Defendants	
  are	
  non-­‐subscribers.	
  

114.        Because	
  plaintiff’s	
  pleadings	
  establish	
  the	
  court’s	
  jurisdiction,	
  and	
  defendant’s	
  factual	
  allegations	
  

disputing	
  jurisdiction	
  are	
  untrue,	
  the	
  court	
  should	
  retain	
  plaintiff’s	
  suit	
  on	
  the	
  court’s	
  docket.	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                                  24	
  
                                                                         VII.      PRAYER	
  

115.       For	
  these	
  reasons,	
  Plaintiffs	
  pray	
  that	
  this	
  Court	
  DENY	
  iWorks	
  Defendants	
  Plea	
  to	
  the	
  Jurisdiction	
  

and	
  grant	
  Plaintiffs	
  such	
  other	
  and	
  further	
  relief	
  to	
  which	
  they	
  have	
  shown	
  themselves	
  justly	
  entitled.	
  

                                                                                Respectfully	
  submitted,	
  
                                                                                	
  
                                                                                GILDE	
  LAW	
  FIRM	
  

	
         	
         	
                     	
     	
     	
     	
                                             	
    	
   	
                 	
         	
  
	
         	
         	
  	
  	
  	
  	
     	
     	
     	
     	
            ___________________________________	
  
	
         	
         	
                     	
     	
     	
     	
            BRADFORD	
  J.	
  GILDE	
  
	
         	
         	
                     	
     	
     	
     	
            TSB#:	
  24045941	
  
	
         	
         	
                     	
     	
     	
     	
            NICHOLAS	
  A.	
  HOMAN	
  
	
         	
         	
                     	
     	
     	
     	
            TSB#:	
  24083194	
  
                                                                                55	
  Waugh	
  Dr.,	
  Ste.	
  800	
  
                                                                                Houston,	
  TX	
  77007	
  
                                                                                281-­‐973-­‐2771	
  –	
  facsimile	
  
                                                                                281-­‐973-­‐2772	
  –	
  phone	
  
                                                                                bjg@gildelawfirm.com	
  
                                                                                nah@gildelawfirm.com	
  
                                                                                	
  
                                                                                MATTHEWS	
  &	
  ASSOCIATES	
  
                                                                                DAVID	
  P.	
  MATTHEWS	
  
                                                                                2905	
  Sackett	
  Street	
  
                                                                                Houston,	
  TX	
  77098	
  
                                                                                713-­‐522-­‐5250	
  –	
  phone	
  
                                                                                713-­‐535-­‐7136	
  –	
  facsimile	
  
                                                                                	
  
                                                                                THE	
  GALLAGHER	
  LAW	
  FIRM,	
  LLP	
  
                                                                                MIKE	
  GALLAGHER	
  
                                                                                2905	
  Sackett	
  Street	
  
                                                                                Houston,	
  TX	
  77098	
  
                                                                                713-­‐238-­‐7705	
  –	
  phone	
  
                                                                                713-­‐222-­‐0066	
  –	
  facsimile	
  
                                                                                ATTORNEYS	
  FOR	
  PLAINTIFFS	
  
	
  
                                                             CERTIFICATE	
  OF	
  SERVICE	
  
                                                                                	
  
            I	
  hereby	
  certify	
  that	
  a	
  true	
  and	
  correct	
  copy	
  of	
  the	
  foregoing	
  has	
  been	
  served	
  to	
  all	
  counsel	
  of	
  
record	
  via	
  facsimile	
  and/or	
  eTexFile	
  on	
  February	
  19,	
  2015.	
  	
  
	
  
                                                                             Respectfully	
  
                                                                                            1. submitted,	
  
                                                                                                    	
  

                                                                                                              	
  
                                                                                Nicholas	
  A.	
  Homan	
  
PLAINTIFFS’	
  RESPONSE	
  TO	
  IWORKS	
  DEFENDANTS’	
  PLEA	
  TO	
  THE	
  JURISDICTION	
                                                                    25	
  
    	
  
    	
  
    	
  
EXHIBIT	
  
   A	
  
    	
  
    	
  
    	
  
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WMRA 000022
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                IN THE SUPREME COURT OF TEXAS
                                       ════════════
                                         NO. 14-0256
                                       ════════════

          IN RE CRAWFORD & COMPANY, CRAWFORD & COMPANY HEALTHCARE
           MANAGEMENT, INC., PATSY HOGAN AND OLD REPUBLIC INSURANCE
                              COMPANY, RELATORS

            ══════════════════════════════════════════
                      ON PETITION FOR WRIT OF MANDAMUS
            ══════════════════════════════════════════

                                          PER CURIAM

       Relators in this mandamus proceeding contend that the trial court abused its discretion

when it refused to dismiss claims over which the Division of Workers’ Compensation has

exclusive jurisdiction. Because all of the claims arise out of relators’ investigation, handling, and

settling of claims for workers’ compensation benefits, we agree.

       In 1998, Glenn Johnson suffered traumatic and debilitating injuries while working for

ASARCO. The parties do not dispute that Johnson was severely injured or that he is entitled to

receive lifetime workers’ compensation benefits. Disputes over the details and amounts of those

benefits, however, led Johnson to request a benefit review conference in 2008, which led to a

contested case hearing the following year. It appears from the parties’ briefs that the suit for

judicial review of that decision remains pending in the district court.

       Meanwhile, separate from the administrative proceedings, Johnson and his wife, Natalie,

filed the underlying suit against ASARCO’s workers’ compensation insurance provider Old

Republic Insurance Company; its claims services contractors Crawford & Company and Crawford

& Company Healthcare Management, Inc.; and their employee Patsy Hogan (collectively,
Crawford). The Johnsons allege that, over a period of nearly ten years, Crawford engaged in “a

battle plan to delay, discourage and deny” benefits that the Johnsons were entitled to receive.

Specifically, the Johnsons contend that Crawford (a) wrongfully disputed, denied, and delayed

medical benefits, (b) misrepresented which benefits were and were not covered, (c) failed to

provide required notices and other information, (d) repeatedly agreed to pay for benefits and

services but then refused to do so, (e) performed inadequate and misleading investigations into the

Johnsons’ claim for benefits, and (f) falsely accused the Johnsons of insurance fraud, leading to

their wrongful arrests and a two-year prosecution that ultimately terminated in the Johnsons’ favor.

In short, the Johnsons allege that, “[r]ather than manage the claim” and adjust it “in a fair and

reasonable manner,” Crawford “resorted to combat tactics to wreak havoc on Glenn’s and

Natalie’s lives.”

       Based on these allegations, the Johnsons pled numerous causes of action, some sounding

in tort (negligence; gross negligence; negligent, fraudulent, and intentional misrepresentation;

fraud; fraud by non-disclosure; fraudulent inducement; intentional infliction of emotional distress;

malicious prosecution; and conspiracy); some sounding in contract (breach of contract; quantum

meruit; and breach of the common law duty of good faith and fair dealing); and some alleging

violations of statutory duties (under the Texas Insurance Code and the Texas Deceptive Trade

Practices Act). The Johnsons sought relief in the form of actual damages for physical injuries,

mental injuries, loss of income, and loss of reputation; exemplary damages; statutory damages;

and injunctive relief prohibiting Crawford from continuing to engage in such “extreme and

outrageous” conduct.

       The Johnsons specifically pled that the Texas Workers’ Compensation Act does not require

them to pursue their claims through its administrative procedures or otherwise exhaust

                                                 2
administrative remedies because (1) the Act’s administrative procedures do not apply to some of

their claims; (2) Crawford’s “subterfuge” of the workers’ compensation system relieves the

Johnsons from any duties under that system; and (3) the Johnsons are seeking to recover for

“independent injuries . . . that are unrelated to [Glenn’s] workers[’] compensation injuries and the

benefits that he is entitled to under that system.” While the Johnsons agree that they must pursue

their claims for workers’ compensation benefits through the administrative process, they contend

that they can pursue these claims for additional, independent, and “unrelated” damages in the

courts.

          Crawford disagreed and filed a plea to the jurisdiction and motion for summary judgment.

Relying primarily on our decision in Texas Mutual Insurance Co. v. Ruttiger, 381 S.W.3d 430

(Tex. 2012), Crawford argued that the Texas Department of Insurance Division of Workers’

Compensation has exclusive jurisdiction over all of the Johnsons’ claims because they arise out of

the workers’ compensation claims-handling process. Conceding that the claims for malicious

prosecution and for intentional infliction of emotional distress could “arguably survive the

landmark decision in Ruttiger,” Crawford alternatively asserted that no evidence supported those

claims. The trial court dismissed the Johnsons’ claims for breach of the common law duty of good

faith and fair dealing and for violations of the Texas Insurance Code but refused to dismiss any of

the other claims. The court of appeals denied Crawford’s petition for mandamus relief.1

          1
           ___ S.W.3d ___. The court of appeals concluded that Crawford is not entitled to mandamus relief because
(1) “one could interpret” Crawford’s five-month delay in filing its petition for writ of mandamus, shortly before trial,
as an “effort to further hinder the timely adjudication of the Johnsons’ claims”; (2) even if the court could review the
denial of Crawford’s plea to the jurisdiction by mandamus, Crawford has not shown that “unrelated topics appearing
in the motion for summary judgment may also be reviewed via the same proceeding”; (3) the Johnsons created a fact
issue by certifying through their counsel that they had exhausted all administrative remedies; and (4) “claims of
malicious prosecution inherently involve activity or misconduct outside the administrative avenues created by the
workers’ compensation laws,” nothing in the Act “purports to regulate such conduct or remedy . . . damages unrelated
to the amount of workers’ compensation benefits to which an employee may be entitled,” and “because at least one

                                                           3
         We conclude that the Division of Workers’ Compensation has exclusive jurisdiction over

the Johnsons’ claims and the Workers’ Compensation Act provides their exclusive remedies. The

Act designates the Department of Insurance as the administrative agency responsible “[for

overseeing] the workers’ compensation system of this state” and establishes the Division of

Workers’ Compensation within the Department to “administer and operate” that system. TEX. LAB.

CODE § 402.001. It is the Division’s duty to “(1) regulate and administer the business of workers’

compensation in this state; and (2) ensure that [the Act] and other laws regarding workers’

compensation are executed.” Id. § 402.00114. The Division must monitor insurance carriers,

employers, and others “for compliance with commissioner rules, this subtitle, and other laws

relating to workers’ compensation.” Id. § 414.002(a). The Division or its commissioner may

impose an array of sanctions against those who fail to comply, including a cease-and-desist order

and administrative penalties up to $25,000 per day per occurrence. Id. § 415.021(a). As we

explained in Ruttiger, the Act, as substantially revised in 1989, “prescribes detailed, [Division]-

supervised, time-compressed processes for carriers to handle claims and for dispute resolution”

and “has multiple, sometimes redundant but sometimes additive, penalty and sanction provisions

for enforcing compliance with its requirements.” 381 S.W.3d at 443.

         In light of the Act’s comprehensive system for resolving workers’ compensation claims 2

and the Division’s role in that process, we concluded in Ruttiger that the Act provides the exclusive

procedures and remedies for claims alleging that a workers’ compensation carrier has improperly

cause of action continues to exist, despite Ruttiger, we cannot say that the trial court abused its discretion in refusing
to dismiss all the causes of action.” Id. at ___.

         2
           See Liberty Mut. Ins. Co. v. Adcock, 412 S.W.3d 492, 495 (Tex. 2013) (explaining that “the Legislature
devised a comprehensive workers’ compensation system, with specific benefits and procedures based on the public
policy of the State of Texas. We concluded in Ruttiger that the Court should not alter the Act’s comprehensive scheme,
and we reaffirm that principle today.”).

                                                            4
investigated, handled, or settled a workers’ claim for benefits. Specifically, we held that the worker

in that case could not recover against the carrier for violations of section 541.060 of the Texas

Insurance Code, which prohibits all insurance carriers generally (not just workers’ compensation

carriers) from engaging in “unfair settlement practices with respect to a claim by an insured.” TEX.

INS. CODE § 541.060(a). “Permitting a workers’ compensation claimant to additionally recover by

simply suing under general provisions of Insurance Code section 541.060,” we explained, “would

be inconsistent with the structure and detailed processes of the Act.” Ruttiger, 381 S.W.3d at 443.

We concluded that the Act’s “provisions for dispute resolution and remedies for failing to comply

with those provisions in the workers’ compensation context are exclusive of those in section

541.060.” Id. at 444.3

        We also held that the claimant in Ruttiger could not recover on his claims under section

542.003(a)(3) of the Insurance Code, which requires insurers to “adopt and implement reasonable

standards for the prompt investigation of claims arising under the insurer’s policies.” TEX. INS.

CODE § 542.003(a)(3). “[I]n light of the specific substantive and procedural requirements built into

the Act,” we concluded, “and the detrimental effects on carriers flowing from penalties that can be

imposed for failing to comply with those requirements, the Legislature did not intend for workers’

compensation claimants to have a cause of action against the carrier under the general provision

of section 542.003.” Ruttiger, 381 S.W.3d at 445.

        For the same reasons, we also overruled our precedent that pre-dated the current version of

the Act and held that “an injured employee may not assert a common-law claim for breach of the

duty of good faith and fair dealing against a workers’ compensation carrier.” Id. at 433 (overruling

Aranda v. Ins. Co. of N. Am., 748 S.W.2d 210 (Tex. 1988)). We reasoned that allowing the carrier

        3
          We likewise held that the claimant could not recover on his DTPA claim because that claim, “as pled and
submitted to the jury[,] depended on the validity of his Insurance Code claim[s].” Ruttiger, 381 S.W.3d at 446.

                                                       5
to risk common law liability in addition to liability under the Act “distorts the balances struck in

the Act and frustrates the Legislature’s intent to have disputes resolved quickly and objectively.”

Id. at 451. “Recognizing and respecting the Legislature’s prime position in enacting, studying,

analyzing, and reforming the system, and its efforts in having done that,” we concluded that “[t]he

Act effectively eliminates the need for a judicially imposed cause of action outside the

administrative processes and other remedies in the Act.” Id.

       We did not hold in Ruttiger, however, that the Act bars every statutory and common law

claim that can be asserted against a workers’ compensation carrier. To the contrary, we concluded

that the Act did not bar a claim under section 541.061 of the Insurance Code, which makes it

unlawful for an insurer to “misrepresent an insurance policy.” Id. at 445–46; see also TEX. INS.

CODE § 541.061. We explained that, “[u]nlike section 541.060,” which prohibits unfair settlement

practices, “section 541.061 does not specify that it applies in the context of settling claims.”

Ruttiger, 381 S.W.3d at 446. We held that because section 541.061’s prohibition against

misrepresentation of an insurance policy “does not evidence intent that it be applied in regard to

settling claims, it is not at odds with the dispute resolution process of the workers’ compensation

system.” Id. We ultimately concluded, however, that there was no evidence to support the section

541.061 claim in that case because there was no evidence of an “untrue statement made by [the

insurer] regarding the policy or any statement about the policy that misled [the plaintiff-insured].”

Id.

       In summary, we held in Ruttiger that workers’ compensation carriers cannot be liable under

the Insurance Code for unfair claims settlement practices or for failing to adopt reasonable

standards for investigating claims, or under the common law for breach of a duty of good faith and

fair dealing, because these claims “simply are not compatible with amended detailed procedural

                                                 6
and substantive provisions of the new Act.” Id. at 456. Although we agreed that “the new Act’s

language does not purport to preclude all types of claims against workers’ compensation insurers,”

we concluded that, for claims arising out of the claims-settlement process, “the current Act with

its definitions, detailed procedures, and dispute resolution process demonstrate[s] legislative intent

for there to be no alternative remedies.” Id. at 444, 456.

         In this case, the parties dispute whether and how Ruttiger applies to causes of action that

we did not specifically address in that case. The court of appeals concluded that it “is not as clear”

that we “vitiated the existence of” any other claims in Ruttiger because we “said nothing of” them.

___ S.W.3d ___. The court read our Ruttiger decision to focus on whether the claims are

“inconsistent with the current legislative/administrative workers’ compensation scheme,” and

concluded that neither Ruttiger nor Crawford explains how a malicious prosecution claim asserting

“baseless criminal proceedings by an insurer against an employee and the amelioration of damages

caused by such misconduct fits in the legislative/administrative workers’ compensation scheme.”

Id. at ___. The court concluded that a malicious prosecution claim “does not serve to protect,

secure or timely resolve disputes involving the availability of workers’ compensation benefits due

a claimant,” and “because at least one cause of action continues to exist, despite Ruttiger, [the

court could not] say that the trial court abused its discretion in refusing to dismiss all the causes of

action.” Id.

         We agree with Crawford that the court of appeals read Ruttiger too narrowly. As other

courts of appeals have recognized,4 the rule we applied in Ruttiger is that the Act provides the

         4
            See, e.g., Davis v. Am. Cas. Co. of Reading, Pa., No. 07-13-00190-CV, 2014 WL 2553379, at *2 (Tex.
App.—Amarillo June 4, 2014, pet. denied) (holding that Ruttiger precludes claims for breach of contract, breach of
the duty of good faith and fair dealing, Insurance Code and DTPA violations, and negligence because all claims “arise
out of [the carrier’s] handling of [the] workers’ compensation claim”); Hopper v. Argonaut Ins. Co., No. 03-12-00734-
CV, 2013 WL 5853747, at *4 (Tex. App.—Austin Oct. 18, 2013, no pet.) (mem. op.) (holding that Ruttiger
“eliminates” claims because there is no evidence of any “conduct that does not implicate the claim-settlement process”
and all claims “are limited to complaints about delays, claim handling, and disputes regarding entitlement to benefits”);

                                                           7
exclusive process and remedies for claims arising out of a carrier’s investigation, handling, or

settling of a claim for workers’ compensation benefits. We held that the Act bars claims for breach

of the duty of good faith and fair dealing and claims under sections 541.060 and 542.003, not

because those are the only claims the Act bars, but because those claims are necessarily based on

the investigation and settlement of benefit claims. Ruttiger, 381 S.W.3d at 443–45. Similarly, we

held that the Act did not bar the claim under section 541.061, not because that is the only claim

the Act does not bar, but because that section does not address misrepresentations made “in regard

to settling claims” for benefits. Id. at 446.

        Whether the Act provides the exclusive process and remedies, therefore, does not depend

on the label of the cause of action asserted. As we have often explained, claimants may not recast

claims to avoid statutory requirements or to qualify for statutory protections. See Diversicare Gen.

Partner, Inc. v. Rubio, 185 S.W.3d 842, 851 (Tex. 2005) (focusing on the essence of plaintiff’s

claim and finding it had to meet MLIIA requirements) (citing MacGregor Med. Ass’n v. Campbell,

985 S.W.2d 38, 38 (Tex. 1998); Gormley v. Stover, 907 S.W.2d 448, 450 (Tex. 1995) (per curiam)

(finding that plaintiff’s pleading was an attempt to recast malpractice claim as a DTPA action);

Sorokolit v. Rhodes, 889 S.W.2d 239, 242 (Tex. 1994) (emphasizing that health care liability claim

could not be re-cast as a different claim)). Instead, in assessing whether a claim falls within the

Division’s exclusive jurisdiction, courts must look at the substance of the claim. Id.

Bean v. Tex. Mut. Ins. Co., No. 09-11-00123-CV, 2012 WL 5450826, at *1 (Tex. App.—Beaumont Nov. 8, 2012, no
pet.) (mem. op.) (holding that claims “are within the exclusive jurisdiction of the Texas Department of Insurance”
because they “concern[] the claims handling process”); Carpenter v. Sw. Med. Examination Servs., Inc., 381 S.W.3d
583, 585–87 (Tex. App.—Eastland 2012, no pet.) (applying Ruttiger to hold that the Act precludes claims for
common-law bad faith, statutory bad faith, fraud, and conspiracy to commit fraud based on allegations that carrier
delayed paying benefits and concealed the nature of its relationship with reviewing doctor because the claims related
to “the manner in which the carrier had handled the processing of [the] workers’ compensation claim”).

                                                         8
       Nor does the Ruttiger rule depend on the nature of the relief the claimant seeks. The

Johnsons contend that the Act does not bar their claims because they are seeking damages that are

“unrelated” to workers’ compensation benefits and based on injuries that are “independent” of

harm the Act is intended to prevent. As we noted in Ruttiger, however, “the current Act with its

definitions, detailed procedures, and dispute resolution process demonstrat[es] legislative intent

for there to be no alternative remedies.” 381 S.W.3d at 444.

       Applying the Ruttiger rule to this case, we first conclude that the Act bars the Johnsons’

claims for negligence, gross negligence, breach of contract, quantum meruit, breach of the duty of

good faith and fair dealing, and statutory violations. In support of these causes of action, the

Johnsons allege that Crawford failed to act reasonably in responding to the Johnsons’ claims for

benefits and made and then breached promises and representations that it would pay certain

benefits. Because all of these claims arise out of Crawford’s investigation, handling, and settling

of the Johnsons’ claim for workers’ compensation benefits, the Act provides the exclusive

procedures and remedies for these claims.

       We reach the same conclusion regarding all of the Johnsons’ common law and statutory

causes of action based on allegations of deception, fraud, and misrepresentation. Because we held

in Ruttiger that the Act does not necessarily bar a claim for misrepresenting an insurance policy

under section 541.061 of the Insurance Code, our analysis on these claims is a bit more complex.

The Johnsons contend that our holding in Ruttiger confirms that they can pursue all of their claims

for misrepresentation and fraud. But we based our holding in Ruttiger on the fact that “section

541.061 does not specify that it applies in the context of settling claims.” Ruttiger, 381 S.W.3d at

446. We held that, because section 541.061 “does not evidence intent that it be applied in regard

                                                 9
to settling claims, it is not at odds with the dispute resolution process of the workers’ compensation

system.” Id.

         This case presents a question we did not expressly address in Ruttiger: whether the Division

has exclusive jurisdiction over a claim for “misrepresentation of an insurance policy” when the

alleged misrepresentation occurs within the claims-settlement context. We hold that it does.5 The

Act specifically addresses and prohibits a carrier from making misrepresentations, including

misrepresentations “to an employee” regarding the Act’s provisions and “the reason for not paying

benefits or terminating or reducing the payment of benefits.” TEX. LAB. CODE

§ 415.002(a)(1), (13). The Act’s comprehensive system for resolving workers’ compensation

claims encompasses prohibitions against fraud and misrepresentations made within the claims-

settlement context, and grants the Division authority to regulate and sanction any such conduct.

Because all of the Johnsons’ misrepresentation-based claims complain of misrepresentations that

Crawford allegedly made in connection with its investigation, handling, and settling of the

Johnsons’ claims for workers’ compensation benefits,6 we hold that the Division had exclusive

jurisdiction to address those claims.

         5
           At least two courts of appeals have reached this same conclusion. See Hopper, 2013 WL 5853747, at *1, 4
(holding that carrier was entitled to summary judgment on claim regarding “false statements” that claimants “were
not entitled to coverage” because the claim was “limited to complaints about delays, claim handling, and disputes
regarding entitlement to benefits”); Bean, 2012 WL 5450826, at *1 (holding that misrepresentation claims were within
the Division’s exclusive jurisdiction because those claims “concern[] the claims handling process,” and worker “did
not claim that the terms of the insurance policy covering his employer had been misrepresented to his employer”). As
the Hopper court explained, we stated in Ruttiger “that section 541.061 applies to misrepresentations of a policy’s
terms, not misrepresentations about whether a specific claim is factually within a policy’s terms.” Hopper, 2013 WL
5853747, at *3. The alleged misrepresentations in that case “concerned statements about whether [the worker’s] death
resulted from a compensable injury and whether the Hoppers were his true beneficiaries,” and “[a]lthough Ruttiger
did not specifically involve common-law claims of fraudulent and negligent misrepresentation or unconscionability,
these claims fail in the present case because there is no evidence here of any fraudulent, negligent, or unconscionable
conduct that does not implicate the claim-settlement process.” Id. at *3–*4.
         6
           The Johnsons allege, for example, that Crawford “made blatantly false statements to avoid coverage and to
avoid paying both income and medical benefits”; made “clearly untrue statements of material facts, including
withholding proper home healthcare and paying the injured worker and his spouse directly to arrange and provide
necessary care”; and “failed to state and to disclose known material facts that the lifetime income benefits were
payable.”

                                                         10
         We now turn to the Johnsons’ claims for malicious prosecution and intentional infliction

of emotional distress, which are both based on allegations that Crawford falsely reported to a

district attorney that the Johnsons committed insurance fraud by requesting mileage

reimbursements for travel that had not occurred. We hold that the Division has exclusive

jurisdiction over these claims because they also arise out of Crawford’s investigation, handling,

and settling of the Johnsons’ claims for workers’ compensation benefits. The mileage

reimbursements at issue were part of the Johnsons’ medical benefits under the Act, and carriers

are required to report suspected fraud to the Department or to an authorized governmental entity

as part of their claims-handling responsibilities. TEX. INS. CODE § 701.051(a). If a carrier

knowingly and intentionally makes a false or misleading statement with the intent to deny the

payment of a benefit, as the Johnsons allege Crawford did in this case, the Act provides the

claimant with remedies, including criminal penalties. TEX. LAB. CODE §§ 415.008, 418.001.

Because the Johnsons’ causes of action for malicious prosecution and intentional infliction of

emotional distress arise out of Crawford’s investigation, handling, and settling of a workers’

compensation claim, we hold that the Division had exclusive jurisdiction over those complaints.7

         Finally, we turn to the Johnsons’ argument that Natalie Johnson is not seeking relief as an

ASARCO employee and thus her claims are independent of the Act and therefore not barred by it.

         7
           Because the Act’s grant of exclusive jurisdiction bars the courts from exercising jurisdiction over the claims,
we reject the Johnsons’ complaints that Crawford waived its argument that the Act bars the claims for malicious
prosecution and is judicially estopped from raising them on mandamus. The Johnsons contend that Crawford’s counsel
“judicially admitted” in the trial court that the malicious prosecution claim “is outside of comp,” and “[c]omp has
nothing to do with malicious prosecution and we’re not arguing that it does.” We need not decide whether these
statements could constitute a waiver, judicial admission, or the basis for judicial estoppel, because even if they could,
such doctrines cannot create subject-matter jurisdiction where it does not otherwise exist. Wilmer-Hutchins Indep.
Sch. Dist. v. Sullivan, 51 S.W.3d 293, 294 (Tex. 2001) (“As a general rule, a court cannot acquire subject-matter
jurisdiction by estoppel.”); Dubai Petroleum Co. v. Kazi, 12 S.W.3d 71, 76 (Tex. 2000) (“[S]ubject-matter jurisdiction
is a power that ‘exists by operation of law only, and cannot be conferred upon any court by consent or waiver’ . . . .”)
(quoting Federal Underwriters Exch. v. Pugh, 141 Tex. 539, 174 S.W.2d 598, 600 (1943)).

                                                           11
Specifically, the Johnsons argue that Natalie “has causes of action for malicious prosecution,

intentional infliction of emotional distress, quantum meruit, and breach of contract all of

which . . . do not arise under the Act because she was not an employee of ASARCO.” But Natalie’s

claims, like Glenn’s, arise out of Crawford’s conduct in investigating, handling, and settling

Glenn’s claim for workers’ compensation benefits. Specifically, she complains that Crawford

breached promises to pay her to provide services to Glenn and that Crawford maliciously caused

her to be prosecuted for insurance fraud. We have held that an employee’s spouse cannot bring a

separate action alleging claims under the Act. See Rodriguez v. Naylor Indus., Inc., 763 S.W.2d
411, 412 (Tex. 1989) (recognizing that any claims compensable under the Act could not be brought

by non-employee spouse except for intentional tort claims). The only noted exception to this rule

is if a spouse is pursuing a loss of consortium claim where there is evidence that the employer’s

intentional tort caused the employee’s injury. Id. (“Therefore, Mrs. Rodriguez’ suit for loss of

consortium is barred by the Workers’ Compensation Act unless she can establish that the injury

caused her husband was intentional.”); see also Reed Tool Co. v. Copelin, 610 S.W.2d 736, 738–

39 (Tex. 1980). We conclude that, even if Natalie Johnson has standing to assert her claims, they

fall within the Division’s exclusive jurisdiction.

       Having concluded that the Division has exclusive jurisdiction over the Johnsons’ claims

against Crawford, we further conclude that Crawford is entitled to mandamus relief. In re Sw. Bell

Tel. Co., L.P., 235 S.W.3d 619, 624 (Tex. 2007) (granting mandamus to require dismissal of claims

over which Public Utility Commission had exclusive jurisdiction because “[a]llowing the trial

court to proceed if the PUC has exclusive jurisdiction would disrupt the orderly processes of

government”); In re Entergy Corp., 142 S.W.3d 316, 321 (Tex. 2004) (same). Because the

Johnsons’ claims arise out of Crawford’s investigation, handling, and settling of workers’

                                                 12
compensation claims, they fall within the Division’s exclusive jurisdiction and the Act provides

the sole process and remedies for those claims. Because the Johnsons failed to exhaust their

administrative remedies under the Act prior to filing this action, the trial court lacked jurisdiction

and should have dismissed it. See City of Houston v. Rhule, 417 S.W.3d 440, 442 (Tex. 2013)

(“Absent exhaustion of administrative remedies, a trial court must dismiss the case.”).

        Pursuant to Texas Rule of Appellate Procedure 52.8(c), without hearing oral arguments,

we conditionally grant mandamus relief and direct the 108th District Court to withdraw its order

denying Crawford’s plea to the jurisdiction and dismiss the Johnsons’ claims for lack of subject-

matter jurisdiction. Our writ will issue only if the court fails to act in accordance with this opinion.

Opinion Delivered: February 27, 2015

                                                  13
<>

TITLE 28                  INSURANCE
PART 2                    TEXAS DEPARTMENT OF INSURANCE, DIVISION OF
                          WORKERS' COMPENSATION
CHAPTER 43                INSURANCE COVERAGE
RULE §43.10               Termination of Coverage

(a) Definitions. The following words and terms, when used in this section, shall have the
following meanings, unless the context clearly indicates otherwise.
  (1) Termination of coverage--Occurs when either party withdraws from a policy of workers'
compensation insurance, either by canceling the policy in the middle of its term, or by declining
to renew the policy on its anniversary date.
  (2) Rejection of the workers' compensation system--Occurs when a subscriber terminates
coverage and fails or refuses to purchase a policy of workers' compensation insurance.
(b) Carrier's notice to the Industrial Accident Board. The carrier shall notify the board when
coverage is terminated by filing Board Form IAB-9, "Cancellation or Non-Renewal Notice."
The notice shall be:
  (1) filed in person or by certified mail; and
  (2) filed on or before the effective date of termination.
(c) Carrier's notice to subscriber. The carrier shall notify the subscriber when the carrier
terminates coverage. No notice is required when the subscriber terminates coverage. Notice to
the subscriber shall be:
  (1) in writing;
  (2) sent by certified mail; and
  (3) mailed no later than the 30th day before the effective date of termination; or
  (4) mailed no later than the 10th day before the effective date of termination if termination is
due to:
   (A) fraud in obtaining coverage;
   (B) failure to pay a premium when payment is due;
   (C) an increase in the hazard for which the subscriber seeks coverage that results from an
action or omission of the subscriber and that would produce an increase in the rate; or
   (D) a determination by the commissioner of insurance that coverage would be illegal or
hazardous to the interests of subscribers, creditors, or the general public.
(d) Effective date of termination of coverage.
  (1) Termination by the carrier shall be effective on the latest of the following dates:
   (A) on the 31st day after the carrier notifies the subscriber as provided in subsection (c) of
this section, or, if the termination is due to one of the conditions set out in subsection (c)(4) of
this section, on the 11th day after the carrier notifies the subscriber as provided in subsection (c)
of this section;
   (B) the day the carrier files notice of termination with the board, as provided in subsection (b)
of this section; or
   (C) the actual termination date recited on the notice.
 (2) Termination by the subscriber shall be effective on the actual termination date recited on
the notice.
 (3) Termination shall be deemed effective on the date a subsequent carrier files notice of
inception of coverage for the subscriber.
(e) Duties of a subscriber who terminates coverage and rejects the workers' compensation
system.
 (1) A subscriber who terminates coverage and rejects the workers' compensation system shall,
on or before the effective date of termination:
   (A) post copies of notice of noncoverage, on a board-prescribed form, in three places around
each work site affected; and
   (B) file a copy of the notice of noncoverage with the board.
 (2) Failure to comply renders the subscriber liable for statutory benefits to injured employees.
Source Note: The provisions of this §43.10 adopted to be effective December 21, 1989, 14
TexReg 6419.

<>

TITLE 28                 INSURANCE
PART 2                   TEXAS DEPARTMENT OF INSURANCE, DIVISION OF
                         WORKERS' COMPENSATION
CHAPTER 110              REQUIRED NOTICES OF COVERAGE
SUBCHAPTER A             CARRIER NOTICES
RULE §110.1              Requirements for Notifying the Commission of Insurance Coverage
Historical                                                                             Texas
                                                                                      Register

(a) An approved insurance policy, as referenced in Texas Labor Code §401.011(44)(A),
includes a binder, which serves as evidence of a temporary agreement that legally provides
workers' compensation insurance coverage until the approved insurance policy is issued or the
binder is canceled.
(b) As used in this section, "insurance coverage information" includes information regarding
whether or not an employer has workers' compensation insurance coverage and, if so,
information about the means of insurance coverage used.
(c) This rule applies to employers whose employees are not exempt from coverage under the
Workers' Compensation Act (the Act), and to insurance carriers. It does not apply to employers
whose only employees are exempt from coverage under the Act. Certified Self Insurers are also
subject to requirements specified in Chapter 114 of this title (relating to Self-Insurance).
(d) Employers and insurance carriers shall submit to the commission, or its designee, insurance
coverage information in the form and manner prescribed by the commission. The commission
may designate and contract with a data collection agency to collect and maintain insurance
coverage information.
(e) Employers who do not have workers' compensation insurance coverage are required to
provide insurance coverage information in the form of a notice of non-coverage, in accordance
with subsection (d) of this section as follows:
 (1) if the employer elects not to be covered by workers' compensation insurance, the earlier of
the following:
   (A) 30 days after receiving a commission request for the filing of a notice of non-coverage
and annually thereafter on the anniversary date of the original filing;
   (B) 30 days after hiring an employee who is subject to coverage under the Act, and annually
thereafter on the anniversary date of the original filing;
 (2) if the employer cancels coverage without purchasing a new policy or becoming a certified
self-insurer, within ten days after notifying the insurance carrier and annually thereafter on the
anniversary of the cancellation date of the workers' compensation policy; or
  (3) if the employer is principally located outside of Texas, within ten days after receiving a
written request from the commission for information about the coverage status of its Texas
operations.
(f) When an employer elects to cancel coverage, the effective date of that cancellation shall be
the later of:
  (1) 30 days after filing the notice of non-coverage with the commission; or
  (2) the cancellation date of the policy.
(g) The workers' compensation insurance coverage shall be extended until the effective date of
withdrawal as established in subsection (f) of this section, and the employer is obligated to pay
premiums which accrue during this period.
(h) Insurance carriers are required to provide insurance coverage information for insured Texas
employers in accordance with subsection (d) of this rule as follows:
  (1) within ten days after the effective date of coverage or endorsement and annually thereafter
no later than ten days after the anniversary date of coverage;
  (2) 30 days prior to the date on which cancellation or non-renewal becomes effective if the
insurance carrier cancels the workers' compensation insurance coverage, does not renew the
workers' compensation insurance coverage on the anniversary date, or cancels a binder before
it issues a policy;
  (3) ten days prior to the date on which the cancellation becomes effective if the insurance
carrier cancels an employer's workers' compensation coverage in accordance with Texas Labor
Code, §406.008(a)(2); or
  (4) within ten days after receiving notice of the effective date of cancellation from the covered
employer because the employer switched workers' compensation insurance carriers.
(i) Workers' compensation insurance coverage remains in effect until the later of:
  (1) the end of the policy period, or
  (2) the date the commission and the employer receive the notification from the insurance
carrier of coverage cancellation or non-renewal and the later of:
    (A) the date 30 days after receipt of the notice required by Texas Labor Code,
§406.008(a)(1);
    (B) the date ten days after receipt of the notice required by Texas Labor Code,
§406.008(a)(2); or
    (C) the effective date of the cancellation if later than the date in paragraphs (1) or (2) of this
subsection.
(j) "Claim administration contact" as it applies to this chapter is the person responsible for
identifying or confirming an employer's coverage information with the commission. Each
insurance carrier shall file a notice with the commission of their designated claim
administration contact not later than the 10th day after the date on which the coverage or claim
administration agreement takes effect. A single administration address for the purpose of
identifying or confirming an employer's coverage status shall be provided. If the single claims
administration contact address changes, the insurance carrier shall provide the new address to
the commission at least 30 days in advance of the change taking effect. This information shall
be filed in the form and manner prescribed by the commission.
(k) An insurance carrier may elect to have a servicing agent process and file all coverage
information, but the insurance carrier remains responsible for meeting all filing requirements of
this rule.
(l) Notwithstanding the other provisions of this section, if an employer switches workers'
compensation insurance carriers, the original policy is considered canceled as of the date the
new coverage takes effect. Employers shall notify the prior insurance carrier of the cancellation
date of the original policy, in writing, within ten days of the effective date.

Source Note: The provisions of this §110.1 adopted to be effective September 15, 1993, 18
TexReg 5884; amended to be effective March 13, 2000, 25 TexReg 2080; amended to be
effective June 5, 2003, 28 TexReg 4284
                                 LABOR CODE

                       TITLE 5. WORKERS ’ COMPENSATION

                 SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

                      CHAPTER 401. GENERAL PROVISIONS

        SUBCHAPTER A. SHORT TITLE;           APPLICATION OF SUNSET ACT

        Sec.A401.001.AASHORT TITLE.           This subtitle may be cited as

the Texas Workers ’ Compensation Act.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A401.003.AAACTIVITIES OF THE STATE AUDITOR.                (a)   The

division is subject to audit by the state auditor in accordance with

Chapter 321, Government Code.AAThe state auditor may audit:

              (1)AAthe     structure     and     internal   controls    of   the

division;

              (2)AAthe level and quality of service provided by the

division    to    employers,   injured       employees,   insurance    carriers,

self-insured governmental entities, and other participants;

              (3)AAthe implementation of statutory mandates by the

division;

              (4)AAemployee turnover;

              (5)AAinformation management systems, including public

access to nonconfidential information;

              (6)AAthe adoption and implementation of administrative

rules by the commissioner; and

              (7)AAassessment of administrative violations and the

penalties for those violations.

        (b)AANothing in this section limits the authority of the

state auditor under Chapter 321, Government Code.

Added by Acts 2001, 77th Leg., ch. 1456, Sec. 7.02, eff. June 17,

2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.002, eff.

September 1, 2005.

                         SUBCHAPTER B. DEFINITIONS

                                         1
       Sec.A401.011.AAGENERAL DEFINITIONS.                      In this subtitle:

                 (1)AA"Adjuster" means a person licensed under Chapter

4101, Insurance Code.

                 (2)AA"Administrative violation" means a violation of

this subtitle, a rule adopted under this subtitle, or an order or

decision    of    the   commissioner     that        is   subject     to   penalties     and

sanctions as provided by this subtitle.

                 (3)AA"Agreement" means the resolution by the parties to

a dispute under this subtitle of one or more issues regarding an

injury, death, coverage, compensability, or compensation.                            The term

does not include a settlement.

                 (4)AA"Alien" means a person who is not a citizen of the

United States.

                 (5)AA"Benefit"    means         a   medical       benefit,     an    income

benefit, a death benefit, or a burial benefit based on a compensable

injury.

                 (5-a)AA"Case management" means a collaborative process

of assessment, planning, facilitation, and advocacy for options and

services to meet an individual ’s health needs through communication

and   application        of   available      resources           to   promote    quality,

cost-effective outcomes.

                 (6)AA"Certified self-insurer" means a private employer

granted a certificate of authority to self-insure, as authorized by

this subtitle, for the payment of compensation.

                 (7)AA"Child" means a son or daughter.                The term includes

an adopted child or a stepchild who is a dependent of the employee.

                 (8)AA"Commissioner" means the commissioner of workers ’

compensation.

                 (9)AA"Commute" means to pay in a lump sum.

                 (10)AA"Compensable injury" means an injury that arises

out   of   and    in    the   course   and       scope     of    employment     for    which

compensation is payable under this subtitle.

                 (11)AA"Compensation" means payment of a benefit.

                 (12)AA"Course     and    scope           of    employment"     means     an

activity of any kind or character that has to do with and originates

in the work, business, trade, or profession of the employer and that

                                             2
is   performed   by    an   employee     while       engaged       in    or    about     the

furtherance of the affairs or business of the employer.                          The term

includes an activity conducted on the premises of the employer or at

other locations.      The term does not include:

                   (A)AAtransportation           to       and    from    the    place       of

employment unless:

                            (i)AAthe    transportation            is    furnished      as    a

part of the contract of employment or is paid for by the employer;

                            (ii)AAthe    means       of   the    transportation          are

under the control of the employer; or

                            (iii)AAthe       employee       is     directed       in     the

employee ’s employment to proceed from one place to another place;

or

                   (B)AAtravel by the employee in the furtherance of

the affairs or business of the employer if the travel is also in

furtherance of personal or private affairs of the employee unless:

                            (i)AAthe travel to the place of occurrence of

the injury would have been made even had there been no personal or

private affairs of the employee to be furthered by the travel; and

                            (ii)AAthe travel would not have been made had

there been no affairs or business of the employer to be furthered by

the travel.

              (12-a)AA"Credentialing"          has    the       meaning       assigned      by

Chapter 1305, Insurance Code.

              (13)AA"Death benefit" means a payment made under this

subtitle to a legal beneficiary because of the death of an employee.

              (13-a)AA"Department"           means    the       Texas    Department         of

Insurance.

              (14)AA"Dependent" means an individual who receives a

regular     or   recurring      economic         benefit          that        contributes

substantially to the individual ’s welfare and livelihood if the

individual is eligible for distribution of benefits under Chapter

408.

              (15)AA"Designated doctor" means a doctor appointed by

mutual agreement of the parties or by the division to recommend a

resolution of a dispute as to the medical condition of an injured

employee.

                                         3
                 (16)AA"Disability"            means    the    inability    because            of   a

compensable           injury    to    obtain    and     retain    employment         at    wages

equivalent to the preinjury wage.

                 (16-a)AA"Division"             means    the     division       of    workers ’

compensation of the department.

                 (17)AA"Doctor" means a doctor of medicine, osteopathic

medicine, optometry, dentistry, podiatry, or chiropractic who is

licensed and authorized to practice.

                 (18)AA"Employer" means, unless otherwise specified, a

person who makes a contract of hire, employs one or more employees,

and    has   workers ’         compensation      insurance       coverage.           The       term

includes         a     governmental       entity        that     self-insures,            either

individually or collectively.

                 (18-a)AA"Evidence-based               medicine"    means       the       use       of

current best quality scientific and medical evidence formulated

from credible scientific studies, including peer-reviewed medical

literature           and   other     current    scientifically          based    texts,         and

treatment and practice guidelines in making decisions about the

care of individual patients.

                 (19)AA"Health          care"       includes      all     reasonable            and

necessary medical aid, medical examinations, medical treatments,

medical diagnoses, medical evaluations, and medical services.AAThe

term      does       not    include     vocational        rehabilitation.AAThe                 term

includes:

                           (A)AAmedical, surgical, chiropractic, podiatric,

optometric,           dental,      nursing,      and     physical       therapy       services

provided by or at the direction of a doctor;

                           (B)AAphysical       rehabilitation services               performed

by    a   licensed         occupational    therapist          provided     by    or       at    the

direction of a doctor;

                           (C)AApsychological           services     prescribed            by        a

doctor;

                           (D)AAthe services of a hospital or other health

care facility;

                           (E)AAa     prescription       drug,     medicine,         or    other

remedy; and

                           (F)AAa     medical    or     surgical    supply,       appliance,

                                                4
brace,    artificial    member,      or    prosthetic         or   orthotic            device,

including the fitting of, change or repair to, or training in the

use of the appliance, brace, member, or device.

             (20)AA"Health        care         facility"       means       a      hospital,

emergency clinic, outpatient clinic, or other facility providing

health care.

             (21)AA"Health care practitioner" means:

                    (A)AAan individual who is licensed to provide or

render and provides or renders health care; or

                    (B)AAa     nonlicensed        individual        who     provides         or

renders health care under the direction or supervision of a doctor.

             (22)AA"Health       care      provider"       means       a    health        care

facility or health care practitioner.

             (22-a)AA"Health care reasonably required" means health

care that is clinically appropriate and considered effective for

the injured employee ’s injury and provided in accordance with best

practices consistent with:

                    (A)AAevidence-based medicine; or

                    (B)AAif that evidence is not available, generally

accepted standards of medical practice recognized in the medical

community.

             (23)AA"Impairment"           means   any    anatomic          or    functional

abnormality or loss existing after maximum medical improvement that

results from a compensable injury and is reasonably presumed to be

permanent.

             (24)AA"Impairment        rating"          means    the    percentage            of

permanent impairment of the whole body resulting from a compensable

injury.

             (25)AA"Income      benefit"         means    a    payment          made    to   an

employee for a compensable injury.                The term does not include a

medical benefit, death benefit, or burial benefit.

             (25-a)AA"Independent review organization" has the same

meaning as in Section 1305.004(a)(11), Insurance Code.

             (26)AA"Injury" means damage or harm to the physical

structure    of   the   body   and    a    disease       or    infection          naturally

resulting    from   the   damage      or       harm.     The       term     includes         an

occupational disease.

                                           5
             (27)AA"Insurance carrier" means:

                        (A)AAan insurance company;

                        (B)AAa      certified            self-insurer                for     workers ’

compensation insurance;

                        (C)AAa      certified            self-insurance               group     under

Chapter 407A; or

                        (D)AAa     governmental               entity     that        self-insures,

either individually or collectively.

             (28)AA"Insurance company" means a person authorized and

admitted    by    the    Texas     Department        of       Insurance         to    do   insurance

business    in    this    state     under      a    certificate            of    authority       that

includes authorization to write workers ’ compensation insurance.

             (29)AA"Legal beneficiary" means a person entitled to

receive a death benefit under this subtitle.

             (30)AA"Maximum medical improvement" means the earlier

of:

                        (A)AAthe     earliest            date      after      which,        based    on

reasonable medical probability, further material recovery from or

lasting    improvement        to   an    injury      can        no   longer          reasonably     be

anticipated;

                        (B)AAthe expiration of 104 weeks from the date on

which income benefits begin to accrue;                    or

                        (C)AAthe date determined as provided by Section

408.104.

             (31)AA"Medical benefit" means payment for health care

reasonably       required     by   the   nature          of    a    compensable         injury      and

intended to:

                        (A)AAcure        or    relieve             the   effects           naturally

resulting    from       the   compensable            injury,         including             reasonable

expenses incurred by the employee for necessary treatment to cure

and   relieve     the    employee       from       the    effects        of     an    occupational

disease before and after the employee knew or should have known the

nature of the disability and its relationship to the employment;

                        (B)AApromote recovery;                 or

                        (C)AAenhance the ability of the employee to return

to or retain employment.

             (31-a)AA"Network" or "workers ’ compensation health care

                                               6
network" means an organization that is:

                   (A)AAformed as a health care provider network to

provide health care services to injured employees;

                   (B)AAcertified in accordance with Chapter 1305,

Insurance Code, and rules of the commissioner of insurance; and

                   (C)AAestablished by, or operates under contract

with, an insurance carrier.

              (32)AA"Objective"      means         independently       verifiable        or

confirmable results that are based on recognized laboratory or

diagnostic tests, or signs confirmable by physical examination.

              (33)AA"Objective clinical or laboratory finding" means

a   medical   finding   of   impairment       resulting       from     a       compensable

injury, based on competent objective medical evidence, that is

independently    confirmable    by   a       doctor,    including          a   designated

doctor, without reliance on the subjective symptoms perceived by

the employee.

              (34)AA"Occupational disease" means a disease arising

out of and in the course of employment that causes damage or harm to

the physical structure of the body, including a repetitive trauma

injury.     The term includes a disease or infection that naturally

results from the work-related disease.              The term does not include an

ordinary disease of life to which the general public is exposed

outside of employment, unless that disease is an incident to a

compensable injury or occupational disease.

              (34-a)AA"Orthotic      device"         means    a   custom-fitted          or

custom-fabricated medical device that is applied to a part of the

human body to correct a deformity, improve function, or relieve

symptoms related to a compensable injury or occupational disease.

              (35)AA"Penalty"    means         a    fine     established          by   this

subtitle.

              (35-a)AA"Prosthetic device" means an artificial device

designed to replace, wholly or partly, an arm or leg.

              (36)AA"Repetitive trauma injury" means damage or harm

to the physical structure of the body occurring as the result of

repetitious, physically traumatic activities that occur over time

and arise out of and in the course and scope of employment.

              (37)AA"Representative"          means    a     person,       including     an

                                         7
attorney, authorized by the commissioner to assist or represent an

employee,     a     person      claiming    a   death        benefit,         or   an   insurance

carrier in a matter arising under this subtitle that relates to the

payment of compensation.

               (38)AA"Research center" means the research functions of

the Texas Department of Insurance required under Chapter 405.

               (38-a)AA"Retrospective review" means the utilization

review     process         of     reviewing          the        medical        necessity        and

reasonableness of health care that has been provided to an injured

employee.

               (39)AA"Sanction"            means      a    penalty       or    other      punitive

action   or    remedy      imposed    by    the       commissioner            on   an   insurance

carrier,      representative,         employee,            employer,          or   health       care

provider for an act or omission in violation of this subtitle or a

rule, order, or decision of the commissioner.

               (40)AA"Settlement" means a final resolution of all the

issues in a workers ’ compensation claim that are permitted to be

resolved under the terms of this subtitle.

               (41)AA"Subjective"               means       perceivable            only    by    an

employee      and    not     independently           verifiable      or        confirmable       by

recognized laboratory or diagnostic tests or signs observable by

physical examination.

               (42)AA"Treating         doctor"            means     the       doctor      who    is

primarily responsible for the employee ’s health care for an injury.

               (42-a)AA"Utilization review" has the meaning assigned

by Chapter 4201, Insurance Code.

               (42-b)AA"Utilization                 review      agent"    has      the     meaning

assigned by Chapter 4201, Insurance Code.

               (42-c)AA"Violation" means an administrative violation

subject to penalties and sanctions as provided by this subtitle.

               (43)AA"Wages"         includes             all    forms        of   remuneration

payable for a given period to an employee for personal services.

The term includes the market value of board, lodging, laundry,

fuel, and any other advantage that can be estimated in money that

the employee receives from the employer as part of the employee ’s

remuneration.

               (44)AA"Workers ’            compensation            insurance            coverage"

                                                8
means:

                       (A)AAan approved insurance policy to secure the

payment of compensation;

                       (B)AAcoverage       to        secure      the     payment       of

compensation through self-insurance as provided by this subtitle;

or

                       (C)AAcoverage provided by a governmental entity to

secure the payment of compensation.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 1997, 75th Leg., ch. 1443, Sec. 1, eff. Sept. 1, 1997;                      Acts

2003, 78th Leg., ch. 275, Sec. 2, eff. Sept. 1, 2003.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.003, eff.

September 1, 2005.

         Acts 2007, 80th Leg., R.S., Ch. 133 (H.B. 1003), Sec. 1, eff.

September 1, 2007.

         Acts 2007, 80th Leg., R.S., Ch. 134 (H.B. 1006), Sec. 1, eff.

September 1, 2007.

         Acts 2007, 80th Leg., R.S., Ch. 147 (S.B. 458), Sec. 1, eff.

September 1, 2007.

         Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 13,

eff. September 1, 2009.

         Sec.A401.012.AADEFINITION            OF     EMPLOYEE.         (a)     In   this

subtitle, "employee" means each person in the service of another

under a contract of hire, whether express or implied, or oral or

written.

         (b)AAThe term "employee" includes:

               (1)AAan employee employed in the usual course and scope

of    the   employer ’s      business   who     is    directed    by    the    employer

temporarily to perform services outside the usual course and scope

of the employer ’s business;

               (2)AAa person, other than an independent contractor or

the   employee    of    an   independent      contractor,        who   is    engaged   in

construction, remodeling, or repair work for the employer at the

premises of the employer;         and

               (3)AAa person who is a trainee under the Texans Work

                                         9
program established under Chapter 308.

      (c)AAThe term "employee" does not include:

             (1)AAa master of or a seaman on a vessel engaged in

interstate or foreign commerce;           or

             (2)AAa   person      whose    employment        is   not    in    the      usual

course and scope of the employer ’s business.

      (d)AAA person who is an employee for the purposes of this

subtitle    and   engaged    in    work    that    otherwise           may    be   legally

performed is an employee despite:

             (1)AAa   license,        permit,      or   certificate             violation

arising under state law or municipal ordinance;                   or

             (2)AAa violation of a law regulating wages, hours, or

work on Sunday.

      (e)AAThis section may not be construed to relieve from fine

or imprisonment any individual, firm, or corporation employing or

performing work or a service prohibited by a statute of this state

or a municipal ordinance.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                         Amended

by Acts 1997, 75th Leg., ch. 456, Sec. 6, eff. Sept. 1, 1997.

      Sec.A401.013.AADEFINITION            OF   INTOXICATION.            (a)       In    this

subtitle, "intoxication" means the state of:

             (1)AAhaving     an     alcohol      concentration          to    qualify      as

intoxicated under Section 49.01(2), Penal Code; or

             (2)AAnot having the normal use of mental or physical

faculties resulting from the voluntary introduction into the body

of:

                   (A)AAan alcoholic beverage, as defined by Section

1.04, Alcoholic Beverage Code;

                   (B)AAa         controlled       substance           or      controlled

substance   analogue,   as    defined      by    Section     481.002,         Health      and

Safety Code;

                   (C)AAa    dangerous          drug,   as    defined         by   Section

483.001, Health and Safety Code;

                   (D)AAan abusable glue or aerosol paint, as defined

by Section 485.001, Health and Safety Code; or

                   (E)AAany similar substance, the use of which is

                                          10
regulated under state law.

         (b)AAThe term "intoxication" does not include the loss of

normal     use   of   mental   or   physical     faculties     resulting     from     the

introduction into the body of a substance:

                 (1)AAtaken under and in accordance with a prescription

written for the employee by the employee ’s doctor;                  or

                 (2)AAlisted     under    Subsection     (a)    by     inhalation      or

absorption incidental to the employee ’s work.

         (c)AAOn      the   voluntary    introduction    into    the      body   of   any

substance listed under Subsection (a)(2)(B), based on a blood test

or urinalysis, it is a rebuttable presumption that a person is

intoxicated and does not have the normal use of mental or physical

faculties.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                       Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 14.48, eff. Sept. 1, 1995;

Acts 1999, 76th Leg., ch. 1426, Sec. 1, eff. Sept. 1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.004, eff.

September 1, 2005.

                   SUBCHAPTER C. MISCELLANEOUS PROVISIONS

         Sec.    401.021.AAAPPLICATION         OF    OTHER     ACTS.       Except      as

otherwise provided by this subtitle:

                 (1)AAa     proceeding,     hearing,     judicial         review,      or

enforcement of a commissioner order, decision, or rule is governed

by   the    following       subchapters    and      sections    of    Chapter      2001,

Government Code:

                       (A)AASubchapters A, B, D, E, G, and H, excluding

Sections 2001.004(3) and 2001.005;

                       (B)AASections 2001.051, 2001.052, and 2001.053;

                       (C)AASections 2001.056 through 2001.062; and

                       (D)AASection 2001.141(c);

                 (2)AAa     proceeding,     hearing,     judicial         review,      or

enforcement of a commissioner order, decision, or rule is governed

by Subchapters A and B, Chapter 2002, Government Code, excluding

Sections 2002.001(3) and 2002.023;

                                          11
              (3)AAChapter   551,   Government       Code,    applies    to   a

proceeding under this subtitle, other than:

                   (A)AAa benefit review conference;

                   (B)AAa contested case hearing;

                   (C)AAa proceeding of the appeals panel;

                   (D)AAarbitration; or

                   (E)AAanother proceeding involving a determination

on a workers ’ compensation claim; and

              (4)AAChapter   552,   Government       Code,    applies    to   a

workers ’ compensation record of the division, the department, or

the office of injured employee counsel.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.              Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 5.92, 5.95(82), (88), eff.

Sept. 1, 1995.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.005, eff.

September 1, 2005.

      Sec.A401.022.AADISCRIMINATION         PROHIBITED.          (a)       This

subtitle may not be applied to discriminate because of race, sex,

national origin, or religion.

      (b)AAThis    section   does   not   prohibit    consideration      of   an

anatomical difference in application of the impairment guidelines

under Chapter 408 in rating an injury or a disease such as, but not

limited to, breast cancer or an inguinal hernia.             If an impairment

rating assigns different values to the same injury for males and

females, the higher value shall be applied.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A401.023.AAINTEREST OR DISCOUNT RATE.          (a)    Interest or a

discount under this subtitle shall be computed at the rate provided

by this section.

      (b)AAThe division shall compute and publish the interest and

discount rate quarterly, using the treasury constant maturity rate

for one-year treasury bills issued by the United States government,

as published by the Federal Reserve Board on the 15th day preceding

the first day of the calendar quarter for which the rate is to be

                                    12
effective, plus 3.5 percent.AAFor this purpose, calendar quarters

begin January 1, April 1, July 1, and October 1.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                           Amended

by Acts 1999, 76th Leg., ch. 1426, Sec. 2, eff. Oct. 1, 1999;                             Acts

2001, 77th Leg., ch. 1456, Sec. 15.01, eff. June 17, 2001.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.006, eff.

September 1, 2005.

       Sec.A401.024.AATRANSMISSION OF INFORMATION.                           (a)     In this

section,    "electronic        transmission"              means    the    transmission       of

information       by    facsimile,         electronic         mail,      electronic       data

interchange, or any other similar method.

       (b)AANotwithstanding another provision of this subtitle that

specifies the form, manner, or procedure for the transmission of

specified     information,         the    commissioner        by    rule    may    permit   or

require    the    use   of    an    electronic       transmission          instead   of     the

specified     form,       manner,         or    procedure.AAIf            the     electronic

transmission of information is not authorized or permitted by rule,

the transmission of that information is governed by any applicable

statute or rule that prescribes the form, manner, or procedure for

the transmission, including standards adopted by the Department of

Information Resources.

       (c)AAThe commissioner may designate and contract with one or

more   data      collection        agents      to    fulfill       the    data    collection

requirements of this subtitle.AATo qualify as a data collection

agent, an organization must demonstrate at least five years of

experience     in   data     collection,           data    maintenance,      data    quality

control, accounting, and related areas.

       (d)AAThe commissioner may prescribe the form, manner, and

procedure for transmitting any authorized or required electronic

transmission,          including         requirements         related       to     security,

confidentiality, accuracy, and accountability.

       (e)AAA data collection agent may collect from a reporting

insurance     carrier,       other   than      a    governmental         entity,    any   fees

necessary for the agent to recover the necessary and reasonable

costs of collecting data from that reporting insurance carrier.

                                               13
         (f)AAA       reporting   insurance     carrier,     other    than   a

governmental entity, shall pay the fee to the data collection agent

for the data collection services provided by the data collection

agent.

         (g)AAThe commissioner may adopt rules necessary to implement

this section.

Added by Acts 1999, 76th Leg., ch. 954, Sec. 1, eff. Sept. 1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.007, eff.

September 1, 2005.

         Acts 2011, 82nd Leg., R.S., Ch. 410 (S.B. 800), Sec. 1, eff.

June 17, 2011.

         Sec.     401.025.AAREFERENCES     TO   COMMISSION    AND    EXECUTIVE

DIRECTOR.       (a)   A reference in this code or other law to the Texas

Workers ’ Compensation Commission or the executive director of that

commission means the division or the commissioner as consistent

with the respective duties of the commissioner and the division

under this code and other workers ’ compensation laws of this state.

         (b)AAA reference in this code or other law to the executive

director of the Texas Workers ’ Compensation Commission means the

commissioner.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.008, eff.

September 1, 2005.

                                      14
                                          LABOR CODE

                         TITLE 5. WORKERS ’ COMPENSATION

                 SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

CHAPTER 402.      OPERATION AND ADMINISTRATION OF WORKERS ’ COMPENSATION

                                           SYSTEM

       SUBCHAPTER A.      GENERAL ADMINISTRATION OF SYSTEM; WORKERS ’

                               COMPENSATION DIVISION

        Sec. 402.001.AAADMINISTRATION OF SYSTEM:AATEXAS DEPARTMENT

OF    INSURANCE;     WORKERS ’ COMPENSATION             DIVISION.              (a)     Except    as

provided by Section 402.002, the Texas Department of Insurance is

the state agency designated to oversee the workers ’ compensation

system of this state.AA

        (b)AAThe division of workers ’ compensation is established as

a division within the Texas Department of Insurance to administer

and    operate    the    workers ’ compensation             system        of    this   state     as

provided by this title.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                               Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.02, eff. Sept. 1, 1995.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.003, eff.

September 1, 2005.

        Sec.     402.00111.AARELATIONSHIP                BETWEEN          COMMISSIONER           OF

INSURANCE AND COMMISSIONER OF WORKERS ’ COMPENSATION; SEPARATION OF

AUTHORITY; RULEMAKING.              (a)    The division is administered by the

commissioner        of    workers ’       compensation          as    provided          by    this

subchapter.AAExcept           as    otherwise        provided        by   this       title,     the

commissioner of workers ’ compensation shall exercise all executive

authority, including rulemaking authority, under this title.

        (b)AAThe      commissioner         of       insurance    may      delegate       to     the

commissioner of workers ’ compensation or to that person ’s designee

and may redact any delegation, and the commissioner of workers ’

compensation may delegate to the commissioner of insurance or to

that    person ’s    designee,       any    power      or   duty      regarding         workers ’

compensation        imposed    on    the    commissioner         of       insurance      or     the

                                                1
commissioner of workers ’ compensation under this title, including

the authority to make final orders or decisions.AAA delegation made

under this subsection must be made in writing.

      (c)AAThe       commissioner     of        insurance      shall        develop    and

implement     policies        that   clearly         separate      the        respective

responsibilities of the department and the division.

      (d)AAThe       commissioner     of       insurance    may    provide       advice,

research,    and    comment    regarding       the   adoption     of    rules    by    the

commissioner of workers ’ compensation under this subtitle.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

      Sec. 402.00112.AAINVESTIGATION OF DIVISION.                      The department

shall investigate the conduct of the work of the division.AAFor

that purpose, the department shall have access at any time to all

division books and records and may require an officer or employee of

the division to furnish written or oral information.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

      Sec.    402.00113.AAADMINISTRATIVE             ATTACHMENT        TO    DEPARTMENT.

(a)   The division of workers ’ compensation is administratively

attached to the department.

      (b)AAThe department shall provide the staff and facilities

necessary    to    enable   the   division      to   perform    the    duties    of    the

division under this title, including:

             (1)AAadministrative           assistance       and   services       to    the

division, including budget planning and purchasing;

             (2)AApersonnel and financial services; and

             (3)AAcomputer equipment and support.

      (c)AAThe       commissioner     of       workers ’   compensation         and    the

commissioner of insurance may enter into agreements as necessary to

implement this title.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

      Sec.    402.00114.AADUTIES           OF     DIVISION;       SINGLE       POINT    OF

                                           2
CONTACT.      (a)     In addition to other duties required under this

title, the division shall:

               (1)AAregulate and administer the business of workers ’

compensation in this state; and

               (2)AAensure that this title and other laws regarding

workers ’ compensation are executed.

         (b)AATo the extent determined feasible by the commissioner,

the division shall establish a single point of contact for injured

employees receiving services from the division.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.00115.AACOMPOSITION OF DIVISION.                  The division is

composed of the commissioner of workers ’ compensation and other

officers and employees as required to efficiently implement:

               (1)AAthis title;

               (2)AAother workers ’ compensation laws of this state;

and

               (3)AAother laws granting jurisdiction or applicable to

the division or the commissioner.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.00116.AACHIEF EXECUTIVE.            (a)      The commissioner of

workers ’     compensation    is     the   division ’s      chief    executive    and

administrative        officer.AAThe      commissioner      shall    administer    and

enforce this title, other workers ’ compensation laws of this state,

and   other    laws   granting      jurisdiction     to   or   applicable    to   the

division or the commissioner.AAExcept as otherwise specifically

provided      by    this   title,    a   reference    in     this    title   to   the

"commissioner" means the commissioner of workers ’ compensation.

         (b)AAThe commissioner has the powers and duties vested in the

division by this title and other workers ’ compensation laws of this

state.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

                                           3
         Sec. 402.00117.AAAPPOINTMENT; TERM.                  (a)       The governor, with

the   advice      and    consent      of    the    senate,          shall    appoint        the

commissioner.AAThe        commissioner           serves       a    two-year     term     that

expires on February 1 of each odd-numbered year.

         (b)AAThe     governor      shall   appoint      the      commissioner        without

regard    to    the   race,   color,    disability,        sex,         religion,   age,     or

national origin of the appointee.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.00118.AAQUALIFICATIONS.               The commissioner must:

                (1)AAbe a competent and experienced administrator;

                (2)AAbe well-informed and qualified in the field of

workers ’ compensation; and

                (3)AAhave     at    least   five    years         of     experience    as    an

executive in the administration of business or government or as a

practicing attorney, physician, or certified public accountant.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec.    402.00119.AAINELIGIBILITY              FOR       PUBLIC    OFFICE.         The

commissioner is ineligible to be a candidate for a public elective

office in this state unless the commissioner has resigned and the

governor has accepted the resignation.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.00120.AACOMPENSATION.             The commissioner is entitled

to compensation as provided by the General Appropriations Act.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.00121.AAGROUNDS FOR REMOVAL.                    (a)    It is a ground for

removal from office that the commissioner:

                (1)AAdoes     not    have   at    the     time      of    appointment       the

qualifications required by Section 402.00118;

                (2)AAdoes not maintain during service as commissioner

                                            4
the qualifications required by Section 402.00118;

                (3)AAviolates        a       prohibition        established           by   Section

402.00122, 402.00124, 402.00125, or 402.00126; or

                (4)AAcannot because of illness or incapacity discharge

the   commissioner ’s        duties          for     a       substantial         part      of    the

commissioner ’s term.

         (b)AAThe validity of an action of the commissioner or the

division is not affected by the fact that it is taken when a ground

for removal of the commissioner exists.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec.         402.00122.AAPROHIBITED                   GIFTS;            ADMINISTRATIVE

VIOLATION.       (a)    The commissioner or an employee of the division may

not accept a gift, a gratuity, or entertainment from a person having

an interest in a matter or proceeding pending before the division.

         (b)AAA       violation    of    Subsection           (a)    is   an     administrative

violation       and    constitutes       a    ground     for    removal        from     office   or

termination of employment.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec.    402.00123.AACIVIL            LIABILITY         OF    COMMISSIONER.              The

commissioner is not liable in a civil action for an act performed in

good faith in the execution of duties as commissioner.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.00124.AACONFLICT OF INTEREST.                       (a)      In this section,

"Texas    trade       association"       means       a   cooperative         and    voluntarily

joined     statewide        association             of       business       or     professional

competitors in this state designed to assist its members and its

industry    or        profession     in       dealing         with    mutual       business      or

professional problems and in promoting their common interest.

         (b)AAA person may not be the commissioner and may not be a

division        employee     employed           in       a     "bona        fide      executive,

administrative, or professional capacity" as that phrase is used

                                                5
for    purposes   of     establishing       an        exemption          to    the     overtime

provisions of the federal Fair Labor Standards Act of 1938 (29

U.S.C. Section 201 et seq.) if:

               (1)AAthe      person    is   an       officer,       employee,          or    paid

consultant of a Texas trade association in the field of workers ’

compensation; or

               (2)AAthe person ’s spouse is an officer, manager, or paid

consultant of a Texas trade association in the field of workers ’

compensation.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

        Sec.   402.00125.AAPROHIBITION                ON     CERTAIN          EMPLOYMENT       OR

REPRESENTATION.        (a)    A former commissioner or former employee of

the division involved in hearing cases under this title may not:

               (1)AAbe    employed     by       an    insurance       carrier         that   was

subject to the scope of the commissioner ’s or employee ’s official

responsibility while the commissioner or employee was associated

with the division; or

               (2)AArepresent a person before the division or a court

in a matter:

                    (A)AAin        which the         commissioner         or    employee     was

personally involved while associated with the division; or

                    (B)AAthat         was       within       the     commissioner ’s           or

employee ’s    official      responsibilities             while    the    commissioner        or

employee was associated with the division.

        (b)AAThe prohibition under Subsection (a)(1) applies until

the:

               (1)AAsecond anniversary of the date the commissioner

ceases to serve as the commissioner; and

               (2)AAfirst      anniversary           of    the     date       the    employee ’s

employment with the division ceases.

        (c)AAThe prohibition under Subsection (a)(2) applies to a

current   commissioner        or    employee         of    the     division          while   the

commissioner or employee is involved in hearing cases under this

title and at any time thereafter.

        (d)AAA person commits an offense if the person violates this

                                            6
section.AAAn offense under this section is a Class A misdemeanor.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

      Sec. 402.00126.AALOBBYING ACTIVITIES.                     A person may not serve

as commissioner or act as general counsel to the commissioner if the

person is required to register as a lobbyist under Chapter 305,

Government     Code,     because       of       the     person ’s       activities        for

compensation related to the operation of the department or the

division.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

      Sec.   402.00127.AATRAINING               PROGRAM    FOR       COMMISSIONER.        (a)

NotAAlater   than      the    90th    day       after     the    date       on   which   the

commissioner    takes    office,      the       commissioner          shall      complete   a

training program that complies with this section.

      (b)AAThe training program must provide the commissioner with

information regarding:

             (1)AAthe legislation that created the division;

             (2)AAthe programs operated by the division;

             (3)AAthe role and functions of the division;

             (4)AAthe        rules    of    the       commissioner          of    insurance

relating to the division, with an emphasis on the rules that relate

to disciplinary and investigatory authority;

             (5)AAthe current budget for the division;

             (6)AAthe results of the most recent formal audit of the

division;

             (7)AAthe requirements of:

                    (A)AAthe         open       meetings        law,        Chapter      551,

Government Code;

                    (B)AAthe     public         information          law,    Chapter     552,

Government Code;

                    (C)AAthe     administrative            procedure         law,   Chapter

2001, Government Code; and

                    (D)AAother       laws       relating        to    public     officials,

including conflict-of-interest laws; and

                                            7
              (8)AAany    applicable      ethics        policies      adopted   by     the

division or the Texas Ethics Commission.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.00128.AAGENERAL POWERS AND DUTIES OF COMMISSIONER.

(a)   The commissioner shall conduct the daily operations of the

division and otherwise implement division policy.

         (b)AAThe commissioner or the commissioner ’s designee may:

              (1)AAinvestigate misconduct;

              (2)AAhold hearings;

              (3)AAissue    subpoenas        to    compel       the    attendance       of

witnesses and the production of documents;

              (4)AAadminister oaths;

              (5)AAtake    testimony         directly      or    by    deposition       or

interrogatory;

              (6)AAassess    and      enforce     penalties      established         under

this title;

              (7)AAenter    appropriate        orders     as    authorized      by    this

title;

              (8)AAinstitute       an   action     in    the    division ’s     name    to

enjoin the violation of this title;

              (9)AAinitiate      an     action     under       Section    410.254      to

intervene in a judicial proceeding;

              (10)AAprescribe the form, manner, and procedure for the

transmission of information to the division;

              (11)AAcorrect clerical errors in the entry of orders;

and

              (12)AAexercise other powers and perform other duties as

necessary to implement and enforce this title.

         (c)AAThe commissioner is the agent for service of process on

out-of-state employers.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.004, eff.

September 1, 2005.

         Sec. 402.002.AAADMINISTRATION OF SYSTEM:AAOFFICE OF INJURED

EMPLOYEE     COUNSEL.      The     office     of    injured       employee      counsel

                                         8
established under Chapter 404 shall perform the functions regarding

the    provision   of    workers ’ compensation          benefits   in   this     state

designated by this subtitle as under the authority of that office.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                   Amended

by Acts 2003, 78th Leg., ch. 1170, Sec. 47.01, eff. Sept. 1, 2003.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.005, eff.

September 1, 2005.

      SUBCHAPTER B.     SYSTEM GOALS; GENERAL ADMINISTRATION OF SYSTEM

         Sec. 402.021.AAGOALS; LEGISLATIVE INTENT; GENERAL WORKERS ’

COMPENSATION MISSION OF DEPARTMENT.                (a)    The basic goals of the

workers ’ compensation system of this state are as follows:

              (1)AAeach employee shall be treated with dignity and

respect when injured on the job;

              (2)AAeach injured employee shall have access to a fair

and accessible dispute resolution process;

              (3)AAeach injured employee shall have access to prompt,

high-quality medical care within the framework established by this

subtitle; and

              (4)AAeach injured employee shall receive services to

facilitate the employee ’s return to employment as soon as it is

considered    safe    and   appropriate       by   the   employee ’s     health    care

provider.

         (b)AAIt    is    the   intent       of    the    legislature      that,    in

implementing the goals described by Subsection (a), the workers ’

compensation system of this state must:

              (1)AApromote      safe     and       healthy     workplaces    through

appropriate incentives, education, and other actions;

              (2)AAencourage the safe and timely return of injured

employees to productive roles in the workplace;

              (3)AAprovide appropriate income benefits and medical

benefits in a manner that is timely and cost-effective;

              (4)AAprovide      timely,       appropriate,       and   high-quality

medical    care    supporting    restoration        of   the   injured    employee ’s

physical condition and earning capacity;

                                         9
                 (5)AAminimize the likelihood of disputes and resolve

them promptly and fairly when identified;

                 (6)AApromote compliance with this subtitle and rules

adopted under this subtitle through performance-based incentives;

                 (7)AApromptly detect and appropriately address acts or

practices of noncompliance with this subtitle and rules adopted

under this subtitle;

                 (8)AAeffectively educate and clearly inform each person

who participates in the system as a claimant, employer, insurance

carrier, health care provider, or other participant of the person ’s

rights     and     responsibilities            under       the    system    and       how    to

appropriately interact within the system; and

                 (9)AAtake maximum advantage of technological advances

to   provide      the    highest      levels    of      service       possible   to     system

participants           and     to     promote       communication          among        system

participants.

         (c)AAThis section may not be construed as:

                 (1)AAcreating a cause of action; or

                 (2)AAestablishing an entitlement to benefits to which a

claimant is not otherwise entitled by this subtitle.

         (d)AAAs provided by this subtitle, the division shall work to

promote    and    help       ensure   the   safe     and   timely      return    of   injured

employees to productive roles in the workforce.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                            Amended

by Acts 1997, 75th Leg., ch. 1098, Sec. 7, eff. Sept. 1, 1997.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.0065, eff.

September 1, 2005.

         Sec.    402.0215.AAREFERENCE              TO    COMMISSION       DIVISIONS.          A

reference in this title or any other law to the division of workers ’

health and safety, the division of medical review, the division of

compliance       and    practices,      the     division         of   hearings,       and   the

division of self-insurance regulation of the former Texas Workers ’

Compensation           Commission       means        the     division       of        workers ’

compensation of the Texas Department of Insurance.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.001, eff.

                                              10
September 1, 2005.

      Sec.    402.022.AAPUBLIC     INTEREST       INFORMATION.        (a)    The

commissioner     shall   prepare    information         of   public    interest

describing the functions of the division and the procedures by

which complaints are filed with and resolved by the division.

      (b)AAThe commissioner shall make the information available

to the public and appropriate state agencies.

      (c)AAThe commissioner by rule shall ensure that each division

form, standard letter, and brochure under this subtitle:

              (1)AAis written in plain language;

              (2)AAis in a readable and understandable format; and

              (3)AAcomplies    with        all    applicable     requirements

relating to minimum readability requirements.

      (d)AAThe     division   shall        make   informational        materials

described by this section available in English and Spanish.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.002, eff.

September 1, 2005.

      Sec.AA402.023.AACOMPLAINT            INFORMATION.          (a)         The

commissioner shall:

              (1)AAadopt rules regarding the filing of a complaint

under this subtitle against an individual or entity subject to

regulation under this subtitle; and

              (2)AAensure that information regarding the complaint

process is available on the division ’sAAInternet website.

      (b)AAThe rules adopted under this section must, at a minimum:

              (1)AAensure that the division clearly defines in rule

the method for filing a complaint; and

              (2)AAdefine   what   constitutes      a   frivolous      complaint

under this subtitle.

      (c)AAThe division shall develop and post on the division ’s

Internet website:

              (1)AAa simple standardized form for filing complaints

under this subtitle; and

                                      11
                (2)AAinformation         regarding          the       complaint           filing

process.

      (c-1)AAThe         division      shall      adopt    a    policy       outlining        the

division ’s complaint process from receipt of the initial complaint

to the complaint ’s disposition.

      (d)AAThe division shall keep an information file about each

written complaint filed with the division under this subtitle that

is unrelated to a specific workers ’ compensation claim, including a

complaint       regarding       the      administration               of     the     workers ’

compensation system.AAThe information must include:

                (1)AAthe date the complaint is received;

                (2)AAthe name of the complainant;

                (3)AAthe subject matter of the complaint;

                (4)AAa record of all persons contacted in relation to

the complaint;

                (5)AAa    summary      of    the     results      of        the    review       or

investigation of the complaint; and

                (6)AAfor    complaints       for    which       the    division       took      no

action,    an   explanation       of   the   reason       the   complaint          was    closed

without action.

      (e)AAFor      each    written      complaint        that    is        unrelated      to   a

specific    workers ’      compensation           claim    that       the     division        has

authority to resolve, the division shall provide to the person

filing the complaint and the person about whom the complaint is made

information about the division ’s policies and procedures under this

subtitle relating to complaint investigation and resolution.AAThe

division, at least quarterly and until final disposition of the

complaint,      shall    notify   those      persons      about       the    status      of   the

complaint       unless    the   notice       would     jeopardize            an    undercover

investigation.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                               Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.08, eff. Sept. 1, 1995.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.003, eff.

September 1, 2005.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 6, eff.

September 1, 2011.

                                             12
      Sec. 402.0231.AADOCUMENTATION AND ANALYSIS OF COMPLAINTS.

(a)AAThe division shall develop procedures to formally document and

analyze complaints received by the division.

      (b)AAThe division shall compile detailed statistics on all

complaints   received    and   analyze       complaint       information    trends,

including:

             (1)AAthe number of complaints;

             (2)AAthe source of each complaint;

             (3)AAthe types of complaints;

             (4)AAthe    length    of    time      from     the   receipt    of   the

complaint to its disposition; and

             (5)AAthe disposition of complaints.

      (c)AAThe     division    shall    further       analyze     the    information

compiled under Subsection (b) by field office and by program.

      (d)AAThe division shall report the information compiled and

analyzed   under   Subsections    (b)    and    (c)    to   the   commissioner    at

regular intervals.

Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 7,

eff. September 1, 2011.

      Sec.   402.0235.AAPRIORITIES           FOR   COMPLAINT      INVESTIGATIONS.

(a)    The    division     shall       assign      priorities       to    complaint

investigations under this subtitle based on risk.AAIn developing

priorities under this section, the division shall develop a formal,

risk-based complaint investigation system that considers:

             (1)AAthe severity of the alleged violation;

             (2)AAwhether the alleged violator showed continued or

wilful noncompliance; and

             (3)AAwhether a commissioner order has been violated.

      (b)AAThe     commissioner    may       develop      additional     risk-based

criteria as determined necessary.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.003, eff.

September 1, 2005.

      Sec. 402.024.AAPUBLIC PARTICIPATION.                  (a)   The commissioner

shall develop and implement policies that provide the public with a

                                        13
reasonable opportunity to appear before the division and to speak

on issues under the general jurisdiction of the division.

      (b)AAThe division shall comply with federal and state laws

related to program and facility accessibility.

      (c)AAIn    addition   to    compliance        with       Subsection    (a),    the

commissioner    shall   prepare    and       maintain      a    written     plan    that

describes how a person who does not speak English may be provided

reasonable access to the division ’s programs and services.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                    Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.09, eff. Sept. 1, 1995.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.004, eff.

September 1, 2005.

                         SUBCHAPTER C.        PERSONNEL

      Sec. 402.041.AAAPPOINTMENTS.                (a)   Subject to the General

Appropriations Act or other law, the commissioner shall appoint

deputies, assistants, and other personnel as necessary to carry out

the powers and duties of the commissioner and the division under

this title, other workers ’ compensation laws of this state, and

other laws granting jurisdiction or applicable to the division or

the commissioner.

      (b)AAA person appointed under this section must have the

professional, administrative, and workers ’ compensation experience

necessary to qualify the person for the position to which the person

is appointed.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                    Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.10, eff. Sept. 1, 1995.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.007, eff.

September 1, 2005.

      Sec.      402.042.AADIVISION           OF     RESPONSIBILITIES.                The

commissioner    shall   develop   and    implement      policies      that    clearly

define the respective responsibilities of the commissioner and the

staff of the division.

                                        14
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.007, eff.

September 1, 2005.

       Sec.      402.043.AACAREER              LADDER;      ANNUAL       PERFORMANCE

EVALUATIONS.     (a)      The commissioner or the commissioner ’s designee

shall develop an intra-agency career ladder program that addresses

opportunities for mobility and advancement for employees within the

division.AAThe program shall require intra-agency postings of all

positions concurrently with any public posting.

       (b)AAThe commissioner or the commissioner ’s designee shall

develop a system of annual performance evaluations that are based

on documented employee performance.AAAll merit pay for division

employees     must   be    based    on   the   system     established        under   this

subsection.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.007, eff.

September 1, 2005.

       Sec.      402.044.AAEQUAL          EMPLOYMENT        OPPORTUNITY          POLICY

STATEMENT.     (a)     The commissioner or the commissioner ’s designee

shall prepare and maintain a written policy statement to ensure

implementation of a program of equal employment opportunity under

which all personnel transactions are made without regard to race,

color, disability, sex, religion, age, or national origin.AAThe

policy statement must include:

              (1)AApersonnel policies, including policies related to

recruitment,     evaluation,        selection,     appointment,        training,     and

promotion of personnel that are in compliance with the requirements

of Chapter 21;

              (2)AAa      comprehensive        analysis    of   the    division      work

force that meets federal and state guidelines;

              (3)AAprocedures by which a determination can be made of

significant underuse in the division work force of all persons for

whom   federal    or      state    guidelines     encourage     a     more    equitable

                                          15
balance; and

              (4)AAreasonable methods to appropriately address those

areas of underuse.

       (b)AAA policy statement prepared under this section must:

              (1)AAcover an annual period;

              (2)AAbe updated annually;

              (3)AAbe reviewed by the civil rights division of the

Texas Workforce Commission for compliance with Subsection (a)(1);

and

              (4)AAbe filed with the Texas Workforce Commission.

       (c)AAThe Texas Workforce Commission shall deliver a biennial

report to the legislature based on the information received under

Subsection (b).AAThe report may be made separately or as part of

other biennial reports made to the legislature.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.         Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.11, eff. Sept. 1, 1995.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 1.007, eff.

September 1, 2005.

       SUBCHAPTER D.   GENERAL POWERS AND DUTIES OF DIVISION AND

                              COMMISSIONER

       Sec. 402.061.AAADOPTION OF RULES.           The commissioner shall

adopt rules as necessary for the implementation and enforcement of

this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.006, eff.

September 1, 2005.

       Sec.A402.062.AAACCEPTANCE OF GIFTS, GRANTS, AND DONATIONS.

(a)   The division may accept gifts, grants, or donations as provided

by rules adopted by the commissioner.

       (b)AARepealed    by   Acts   2005,   79th   Leg.,   Ch.   265,   Sec.

7.01(15), eff. September 1, 2005.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.         Amended

                                    16
by Acts 1999, 76th Leg., ch. 1426, Sec. 4, eff. Sept. 1, 1999;              Acts

2001, 77th Leg., ch. 1195, Sec. 2.08, eff. Sept. 1, 2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.007, eff.

September 1, 2005.

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 7.01(15), eff.

September 1, 2005.

        Sec. 402.064.AAFEES.   In addition to fees established by this

subtitle, the commissioner shall set reasonable fees for services

provided   to    persons   requesting     services     from    the   division,

including services provided under Subchapter E.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.008, eff.

September 1, 2005.

        Sec.    402.065.AAEMPLOYMENT      OF   COUNSEL.       Notwithstanding

Article 1.09-1, Insurance Code, or any other law, the commissioner

may employ counsel to represent the division in any legal action the

division is authorized to initiate.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.009, eff.

September 1, 2005.

        Sec.   402.066.AARECOMMENDATIONS       TO   LEGISLATURE.      (a)    The

commissioner     shall   consider   and   recommend     to    the   legislature

changes to this subtitle, including any statutory changes required

by an evaluation conducted under Section 402.074.

        (b)AAThe commissioner shall forward the recommended changes

to the legislature not later than December 1 of each even-numbered

year.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.010, eff.

September 1, 2005.

                                     17
        Sec. 402.0665.AALEGISLATIVE OVERSIGHT.          The legislature may

adopt   requirements    relating    to    legislative    oversight     of   the

division and the workers ’ compensation system of this state.AAThe

division   shall    comply   with   any   requirements     adopted     by   the

legislature under this section.

Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.13, eff. Sept. 1,

1995.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.011, eff.

September 1, 2005.

        Sec. 402.067.AAADVISORY COMMITTEES.          The commissioner may

appoint    advisory    committees    as    the     commissioner    considers

necessary.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.012, eff.

September 1, 2005.

        Sec. 402.068.AADELEGATION OF RIGHTS AND DUTIES.            Except as

expressly provided by this subtitle, the division may not delegate

rights and duties imposed on it by this subchapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.             Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.14, eff. Sept. 1, 1995.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.013, eff.

September 1, 2005.

        Sec.   402.069.AAQUALIFICATIONS      AND    STANDARDS     OF   CONDUCT

INFORMATION.     The commissioner or the commissioner ’s designee shall

provide to division employees, as often as necessary, information

regarding their:

               (1)AAqualifications for office or employment under this

subtitle; and

               (2)AAresponsibilities under applicable law relating to

standards of conduct for state officers or employees.

                                     18
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                  Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.15, eff. Sept. 1, 1995.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.014, eff.

September 1, 2005.

      Sec.A402.071.AAREPRESENTATIVES.           (a)    The commissioner shall

establish qualifications for a representative and shall adopt rules

establishing procedures for authorization of representatives.

      (b)AAA    representative      may     receive    a    fee    for    providing

representation under this subtitle only if the representative is:

              (1)AAan adjuster representing an insurance carrier; or

              (2)AAlicensed to practice law.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.015, eff.

September 1, 2005.

      Sec.      402.073.AACOOPERATION          WITH        STATE     OFFICE       OF

ADMINISTRATIVE      HEARINGS.    (a)AAThe     commissioner         and    the   chief

administrative law judge of the State Office of Administrative

Hearings    shall   adopt   a   memorandum    of     understanding        governing

administrative      procedure    law      hearings     under       this    subtitle

conducted by the State Office of Administrative Hearings in the

manner provided for a contested case hearing under Chapter 2001,

Government Code.AAThe memorandum of understanding must address the

payment of costs by parties to a medical fee dispute under Section

413.0312.

      (b)AAIn a case in which a hearing is conducted by the State

Office of Administrative Hearings under Section 413.031 or 413.055,

the administrative law judge who conducts the hearing for the State

Office of Administrative Hearings shall enter the final decision in

the case after completion of the hearing.

      (c)AAIn a case in which a hearing is conducted in conjunction

with Section 402.072, 407.046, 408.023, or 415.034, and in other

cases under this subtitle that are not subject to Subsection (b),

the administrative law judge who conducts the hearing for the State

                                       19
Office of Administrative Hearings shall propose a decision to the

commissioner       for   final   consideration       and   decision     by   the

commissioner.

         (d)AAThe notice of the commissioner ’s order must include a

statement of the right of the person to judicial review of the

order.

         (e)AAIn issuing an order under this section, the commissioner

shall comply with the requirements applicable to a state agency

under Section 2001.058, Government Code.

Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.17, eff. Sept. 1,

1995.    Amended by Acts 1999, 76th Leg., ch. 955, Sec. 1, eff. Sept.

1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.017, eff.

September 1, 2005.

         Acts 2007, 80th Leg., R.S., Ch. 1007 (H.B. 724), Sec. 3, eff.

September 1, 2007.

         Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 8, eff.

September 1, 2011.

         Sec.   402.074.AASTRATEGIC      MANAGEMENT;       EVALUATION.       The

commissioner shall implement a strategic management plan that:

                (1)AArequires the division to evaluate and analyze the

effectiveness of the division in implementing:

                     (A)AAthe    statutory   goals   adopted    under    Section

402.021, particularly goals established to encourage the safe and

timely return of injured employees to productive work roles; and

                     (B)AAthe other standards and requirements adopted

under this code, the Insurance Code, and other applicable laws of

this state; and

                (2)AAmodifies     the    organizational        structure     and

programs of the division as necessary to address shortfalls in the

performance of the workers ’ compensation system of this state.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.018, eff.

September 1, 2005.

         Sec. 402.075.AAINCENTIVES; PERFORMANCE-BASED OVERSIGHT.             (a)

                                        20
The commissioner by rule shall adopt requirements that:

             (1)AAprovide incentives for overall compliance in the

workers ’ compensation system of this state; and

             (2)AAemphasize performance-based oversight linked to

regulatory outcomes.

       (b)AAThe commissioner shall develop key regulatory goals to

be used in assessing the performance of insurance carriers and

health care providers.AAThe goals adopted under this subsection

must align with the general regulatory goals of the division under

this   subtitle,        such     as   improving          workplace     safety    and

return-to-work outcomes, in addition to goals that support timely

payment of benefits and increased communication.

       (c)AAAt     least    biennially,      the    division   shall    assess   the

performance of insurance carriers and health care providers in

meeting    the    key   regulatory    goals.AAThe        division    shall   examine

overall compliance records and dispute resolution and complaint

resolution practices to identify insurance carriers and health care

providers who adversely impact the workers ’ compensation system and

who may require enhanced regulatory oversight.AAThe division shall

conduct the assessment through analysis of data maintained by the

division    and   through      self-reporting       by   insurance   carriers    and

health care providers.

       (d)AABased on the performance assessment, the division shall

develop regulatory tiers that distinguish among insurance carriers

and health care providers who are poor performers, who generally

are average performers, and who are consistently high performers.

The division shall focus its regulatory oversight on insurance

carriers and health care providers identified as poor performers.

       (e)AAThe     commissioner      by     rule   shall    develop    incentives

within each tier under Subsection (d) that promote greater overall

compliance and performance. The regulatory incentives may include

modified    penalties,         self-audits,        or    flexibility     based    on

performance.

       (f)AAThe division shall:

             (1)AAensure that high-performing entities are publicly

recognized; and

             (2)AAallow those entities to use that designation as a

                                        21
marketing tool.

        (g)AAIn conjunction with the division ’s accident prevention

services    under   Subchapter    E,   Chapter    411,    the   division      shall

conduct audits of accident prevention services offered by insurance

carriers based on the comprehensive risk assessment. The division

shall    periodically    review    those    services,       but   may    provide

incentives for less regulation of carriers based on performance.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.018, eff.

September 1, 2005.

        Sec. 402.076.AAGENERAL DUTIES; FUNDING.             (a)   The division

shall perform the workforce education and safety functions of the

workers ’ compensation system of this state.AA

        (b)AAThe operations of the division under this section are

funded through the maintenance tax assessed under Section 403.002.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.018, eff.

September 1, 2005.

        Sec. 402.077.AAEDUCATIONAL PROGRAMS.        (a)    The division shall

provide education on best practices for return-to-work programs and

workplace safety.

        (b)AAThe    division   shall    evaluate    and    develop      the   most

efficient,     cost-effective     procedures       for     implementing        this

section.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.018, eff.

September 1, 2005.

        Sec.   402.078.AAREGIONAL      OFFICES.      The    department        shall

operate regional offices throughout this state as necessary to

implement the duties of the division and the department under this

subtitle.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.018, eff.

September 1, 2005.

             SUBCHAPTER E. RECORDS AND EMPLOYEE INFORMATION

        Sec. 402.081.AADIVISION RECORDS.          (a)     The commissioner is

                                       22
the   custodian       of   the   division ’s      records     and   shall      perform    the

duties of a custodian required by law, including providing copies

and the certification of records.

        (b)AAThe       division     shall       comply    with      records         retention

schedules as provided by Chapter 441.185, Government Code.

        (c)AAA record maintained by the division may be preserved in

any format permitted by Chapter 441, Government Code, and rules

adopted by the Texas State Library and Archives Commission under

that chapter.

        (d)AAThe division may charge a reasonable fee for making

available      for    inspection     any   of     its   information          that   contains

confidential         information      that      must     be     redacted       before     the

information      is    made      available.AAHowever,           when     a    request     for

information is for the inspection of 10 or fewer pages, and a copy

of the information is not requested, the division may charge only

the cost of making a copy of the page from which confidential

information must be redacted.AAThe fee for access to information

under Chapter 552, Government Code, shall be in accord with the

rules   of     the    attorney     general      that    prescribe      the     method     for

computing the charge for copies under that chapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                           Amended

by Acts 1997, 75th Leg., ch. 1270, Sec. 1 eff. June 20, 1997.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.019, eff.

September 1, 2005.

        Acts    2005, 79th       Leg., Ch.        329   (S.B.    727),   Sec.       13,   eff.

September 1, 2005.

        Acts    2005, 79th       Leg., Ch.        716   (S.B.    452),   Sec.       11,   eff.

September 1, 2005.

        Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 10.003,

eff. September 1, 2007.

        Sec. 402.082.AAINJURY INFORMATION MAINTAINED BY DIVISION.

(a)   The division shall maintain information on every compensable

injury as to the:

                (1)AArace, ethnicity, and sex of the claimant;

                (2)AAclassification of the injury;

                                             23
              (3)AAidentification        of     whether      the    claimant      is

receiving medical care through a workers ’ compensation health care

network certified under Chapter 1305, Insurance Code;

              (4)AAamount of wages earned by the claimant before the

injury; and

              (5)AAamount of compensation received by the claimant.

        (b)AAOn request from the office of injured employee counsel,

the   division   shall   provide   to    the    office     the   identity,    claim

number, and contact information of claimants receiving assistance

from the office.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.020, eff.

September 1, 2005.

        Acts 2011, 82nd Leg., R.S., Ch. 289 (H.B. 1774), Sec. 5, eff.

September 1, 2011.

        Sec.A402.083.AACONFIDENTIALITY OF INJURY INFORMATION.                     (a)

Information in or derived from a claim file regarding an employee is

confidential and may not be disclosed by the division except as

provided by this subtitle or other law.

        (b)AAInformation concerning an employee who has been finally

adjudicated of wrongfully obtaining payment under Section 415.008

is not confidential.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                  Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.42, 14.49, eff. Sept. 1,

1995.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.021, eff.

September 1, 2005.

        Sec.A402.084.AARECORD CHECK;           RELEASE OF INFORMATION.            (a)

The   division   shall   perform   and       release   a   record   check    on   an

employee, including current or prior injury information, to the

parties listed in Subsection (b) if:

              (1)AAthe claim is:

                   (A)AAopen or pending before the division;

                                        24
                   (B)AAon   appeal       to    a     court    of   competent

jurisdiction; or

                   (C)AAthe subject of a subsequent suit in which the

insurance carrier or the subsequent injury fund is subrogated to

the rights of the named claimant; and

             (2)AAthe requesting party requests the release on a

form prescribed by the division for this purpose and provides all

required information.

      (b)AAInformation on a claim may be released as provided by

Subsection (a) to:

             (1)AAthe employee or the employee ’s legal beneficiary;

             (2)AAthe   employee ’s       or   the     legal   beneficiary ’s

representative;

             (3)AAthe employer at the time of injury;

             (4)AAthe insurance carrier;

             (5)AAthe   Texas    Certified           Self-Insurer    Guaranty

Association established under Subchapter G, Chapter 407, if that

association has assumed the obligations of an impaired employer;

             (6)AAthe Texas Property and Casualty Insurance Guaranty

Association, if that association has assumed the obligations of an

impaired insurance company;

             (7)AAa third-party litigant in a lawsuit in which the

cause of action arises from the incident that gave rise to the

injury; or

             (8)AAwith regard to information described by Subsection

(c-3), an insurance carrier that has adopted an antifraud plan

under Subchapter B, Chapter 704, Insurance Code, or the authorized

representative of such an insurance carrier.

      (c)AAThe requirements of Subsection (a)(1) do not apply to a

request from a third-party litigant described by Subsection (b)(7).

      (c-1)AAFor     purposes   of    this     section    only,     "insurance

carrier" means:

             (1)AAa certified self-insurer; or

             (2)AAan entity authorized under the Insurance Code or

another insurance law of this state that provides health insurance

coverage or health benefits in this state, including:

                   (A)AAan insurance company, including an insurance

                                     25
company    that   holds   a    certificate     of   authority    issued     by     the

commissioner of insurance to engage in the business of workers ’

compensation insurance in this state;

                      (B)AAa group hospital service corporation under

Chapter 842, Insurance Code;

                      (C)AAa    health     maintenance       organization     under

Chapter 843, Insurance Code;

                      (D)AAa stipulated premium company under Chapter

884, Insurance Code;

                      (E)AAa fully self-insured plan, as described by

the Employee Retirement Income Security Act of 1974 (29 U.S.C.

Section 1001 et seq.);

                      (F)AAa governmental plan, as defined by Section

3(32), Employee Retirement Income Security Act of 1974 (29 U.S.C.

Section 1002(32));

                      (G)AAan employee welfare benefit plan, as defined

by Section 3(1), Employee Retirement Income Security Act of 1974

(29 U.S.C. Section 1002(1)); and

                      (H)AAan insurer authorized by the Texas Department

of Insurance to offer disability insurance in this state.

       (c-2)AAAn insurance carrier is not required to demonstrate

that   a   subclaim    exists     in   order   to   obtain    information     under

Subsection (b)(8).

       (c-3)AAAn insurance carrier described by Subsection (b)(8)

or an authorized representative of the insurance carrier may submit

to the commission on a monthly basis a written request for claims

information.AAThe       request    must   contain    a   list   of   the   names    of

persons about whom claims information is requested.AAThe insurance

carrier must certify in the carrier ’s request that each person

listed is, or has been, an insured under the carrier ’s insurance

program.AAThe commission shall examine the commission ’s records to

identify all claims related to the listed persons.AAIf a claims

record exists for a listed person, the commission promptly shall

provide information on each workers ’ compensation claim filed by

that person to the carrier or the carrier ’s representative in an

electronic format.AAThe information provided under this subsection

must include, if available:

                                          26
             (1)AAthe     full     name       of    the        workers ’         compensation

claimant;

             (2)AAthe     social       security          number        of    the     workers ’

compensation claimant;

             (3)AAthe    date    of    birth       of    the    workers ’ compensation

claimant;

             (4)AAthe     name     of     the       employer        of       the     workers ’

compensation claimant;

             (5)AAthe date of the injury;

             (6)AAa description of the type of injury or the body

part   affected,   including      the     workers ’           compensation         claimant ’s

description of how the injury occurred;

             (7)AAthe name of the treating doctor;

             (8)AAthe     name,       address,          and    claim        number    of    the

insurance carrier handling the claim;

             (9)AAthe name of the insurance adjustor handling the

claim; and

             (10)AAthe identifying number assigned to the claim by

the commission and the commission field office handling the claim.

       (c-4)AAA    potential      subclaim         identified          by     an   insurance

carrier     described    by     Subsection          (b)(8)        or        an     authorized

representative of the insurance carrier may form the basis for the

identification     and   filing    of    a    subclaim          against       an   insurance

carrier under this subtitle.

       (c-5)AAInformation        received          under        this     section       by    an

insurance carrier described by Subsection (b)(8) or an authorized

representative     of    the    insurance          carrier       remains          subject   to

confidentiality     requirements        of     this       subtitle          while     in    the

possession of the insurance carrier or representative.AAHowever,

the following laws do not prohibit the commission from disclosing

full information regarding a claim as necessary to determine if a

valid subclaim exists:

             (1)AAChapter 552, Government Code;

             (2)AAChapter 159, Occupations Code; or

             (3)AAany other analogous law restricting disclosure of

health care information.

       (c-6)AAThe commission may not redact claims records produced

                                         27
in   an   electronic       data   format       under       a   request          made    under       this

section.

          (c-7)AAAn        insurance           carrier           and            its     authorized

representative        may    request         full    claims          data       under   Subsection

(b)(8), and the records shall be produced once each month.AAFor

purposes of this subsection, "full claims data" means an electronic

download or tape in an electronic data format of the information

listed in Subsection (c-3) on all cases relating to the workers ’

compensation      claimants        listed       as    insureds             of    the    requesting

insurance carrier.

          (d)AA The commissioner by rule may establish a reasonable

fee,   not   to   exceed     five      cents    for    each          claimant         listed    in    an

information request, for all information requested by an insurance

carrier      described       by        Subsection          (b)(8)          or     an    authorized

representative        of    the   insurance         carrier          in   an     electronic         data

format.       The     commissioner           shall     adopt          rules       under    Section

401.024(d) to establish:

               (1)AAreasonable security parameters for all transfers

of information requested under this section in electronic data

format; and

               (2)AArequirements               regarding             the        maintenance           of

electronic data in the possession of an insurance carrier described

by   Subsection       (b)(8)      or    an    authorized         representative                of    the

insurance carrier.

          (e)AAThe    insurance         carrier       or       the    carrier ’s        authorized

representative must execute a written agreement with the commission

before     submitting       the   carrier ’s        first      request          under   Subsection

(c-3).AAThe agreement must contain a provision by which the carrier

and the representative agree to comply with the commission ’s rules

governing     security       parameters         applicable            to        the    transfer      of

information       under      Subsection        (d)(1)          and        the    maintenance         of

electronic data under Subsection (d)(2).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                                 Amended

by Acts 2001, 77th Leg., ch. 1033, Sec. 5, eff. Sept. 1, 2001.

Amended by:

          Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.022, eff.

September 1, 2005.

                                               28
      Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.132, eff.

September 1, 2005.

      Acts 2005, 79th Leg., Ch. 1190 (H.B. 251), Sec. 1, eff. June

18, 2005.

      Sec.     402.085.AAEXCEPTIONS       TO   CONFIDENTIALITY.         (a)AAThe

division shall release information on a claim to:

              (1)AAthe   Texas   Department        of    Insurance      for   any

statutory or regulatory purpose, including a research purpose under

Chapter 405;

              (2)AAa legislative committee for legislative purposes;

              (3)AAa state or federal elected official requested in

writing to provide assistance by a constituent who qualifies to

obtain injury information under Section 402.084(b), if the request

for assistance is provided to the division;

              (4)AAthe   attorney   general       or    another   entity      that

provides child support services under Part D, Title IV, Social

Security Act (42 U.S.C. Section 651 et seq.), relating to:

                   (A)AAestablishing,          modifying,   or    enforcing     a

child support or medical support obligation; or

                   (B)AAlocating an absent parent; or

              (5)AAthe office of injured employee counsel for any

statutory or regulatory purpose that relates to a duty of that

office as provided by Section 404.111(a).

      (b)AAThe division may release information on a claim to a

governmental agency, political subdivision, or regulatory body to

use to:

              (1)AAinvestigate an allegation of a criminal offense or

licensing or regulatory violation;

              (2)AAprovide:

                   (A)AAunemployment compensation benefits;

                   (B)AAcrime victims compensation benefits;

                   (C)AAvocational rehabilitation services; or

                   (D)AAhealth care benefits;

              (3)AAinvestigate      occupational         safety    or     health

violations;

              (4)AAverify income on an application for benefits under

                                     29
an income-based state or federal assistance program; or

              (5)AAassess financial resources in an action, including

an administrative action, to:

                    (A)AAestablish, modify, or enforce a child support

or medical support obligation;

                    (B)AAestablish paternity;

                    (C)AAlocate an absent parent; or

                    (D)AAcooperate       with    another     state in      an    action

authorized under Part D, Title IV, Social Security Act (42 U.S.C.

Section 651 et seq.), or Chapter 231, Family Code.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.43(a), eff. Sept. 1, 1995;

Acts 1999, 76th Leg., ch. 1426, Sec. 5, eff. Sept. 1, 1999.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.023, eff.

September 1, 2005.

       Acts 2011, 82nd Leg., R.S., Ch. 289 (H.B. 1774), Sec. 6, eff.

September 1, 2011.

       Sec.A402.086.AATRANSFER            OF         CONFIDENTIALITY.               (a)

Information relating to a claim that is confidential under this

subtitle remains confidential when released to any person, except

when used in court for the purposes of an appeal.

       (b)AAThis      section    does    not    prohibit      an    employer       from

releasing information about a former employee to another employer

with   whom   the   employee     has    applied       for   employment,     if     that

information was lawfully acquired by the employer releasing the

information.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A402.087.AAINFORMATION              AVAILABLE       TO      PROSPECTIVE

EMPLOYERS.      (a)      A   prospective        employer      who    has    workers ’

compensation    insurance       coverage       and    who   complies    with       this

subchapter is entitled to obtain information on the prior injuries

of an applicant for employment if the employer obtains written

authorization from the applicant before making the request.

       (b)AAThe employer must make the request by telephone or file

                                        30
the request in writing not later than the 14th day after the date on

which the application for employment is made.

        (c)AAThe request must include the applicant ’s name, address,

and social security number.

        (d)AAIf the request is made in writing, the authorization

must be filed simultaneously.          If the request is made by telephone,

the employer must file the authorization not later than the 10th day

after the date on which the request is made.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A402.088.AAREPORT OF PRIOR INJURY.                  (a)   On receipt of a

valid request made under and complying with Section 402.087, the

division shall review its records.

        (b)AAIf the division finds that the applicant has made two or

more    general    injury   claims     in   the   preceding       five    years,      the

division shall release the date and description of each injury to

the employer.

        (c)AAThe    information       may   be    released       in   writing    or    by

telephone.

        (d)AAIf the employer requests information on three or more

applicants at the same time, the division may refuse to release

information until it receives the written authorization from each

applicant.

        (e)AAIn this section, "general injury" means an injury other

than an injury limited to one or more of the following:

              (1)AAan injury to a digit, limb, or member;

              (2)AAan inguinal hernia;           or

              (3)AAvision or hearing loss.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.024, eff.

September 1, 2005.

        Sec. 402.089.AAFAILURE TO FILE AUTHORIZATION.                    An employer

who    receives    information   by    telephone       from     the   division   under

Section 402.088 and who fails to file the necessary authorization

in    accordance    with    Section    402.087        commits    an   administrative

                                        31
violation.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.025, eff.

September 1, 2005.

         Sec. 402.090.AASTATISTICAL INFORMATION.           The division, the

Texas Department of Insurance, or any other governmental agency may

prepare and release statistical information if the identity of an

employee is not explicitly or implicitly disclosed.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.026, eff.

September 1, 2005.

         Sec.A402.091.AAFAILURE        TO    MAINTAIN       CONFIDENTIALITY;

OFFENSE;    PENALTY.     (a)    A person commits an offense if the person

knowingly, intentionally, or recklessly publishes, discloses, or

distributes information that is confidential under this subchapter

to a person not authorized to receive the information directly from

the division.

         (b)AAA person commits an offense if the person knowingly,

intentionally,     or     recklessly    receives     information     that      is

confidential    under    this   subchapter   and   that   the   person   is   not

authorized to receive.

         (c)AAAn offense under this section is a Class A misdemeanor.

         (d)AAAn offense under this section may be prosecuted in a

court in the county where the information was unlawfully received,

published, disclosed, or distributed.

         (e)AAA district court in Travis County has jurisdiction to

enjoin    the   use,    publication,   disclosure,    or    distribution      of

confidential information under this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.               Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.18, eff. Sept. 1, 1995.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.027, eff.

September 1, 2005.

                                       32
         Sec. 402.092.AAINVESTIGATION FILES CONFIDENTIAL; DISCLOSURE

OF CERTAIN INFORMATION.       (a)   In this section, "investigation file"

means any information compiled or maintained by the division with

respect to a division investigation authorized under this subtitle

or other workers ’ compensation          law.AAThe term       does not include

information or material acquired by the division that is relevant

to an investigation by the insurance fraud unit and subject to

Section 701.151, Insurance Code.

         (b)AAInformation maintained in the investigation files of

the division is confidential and may not be disclosed except:

               (1)AAin a criminal proceeding;

               (2)AAin a hearing conducted by the division;

               (3)AAon a judicial determination of good cause;

               (4)AAto a governmental agency, political subdivision,

or regulatory body if the disclosure is necessary or proper for the

enforcement of the laws of this or another state or of the United

States; or

               (5)AAto an insurance carrier if the investigation file

relates directly to a felony regarding workers ’ compensation or to

a claim in which restitution is required to be paid to the insurance

carrier.

         (c)AADivision investigation files are not open records for

purposes of Chapter 552, Government Code.

         (d)AAInformation     in    an        investigation     file     that    is

information in or derived from a claim file, or an employer injury

report    or   occupational    disease         report,   is   governed    by    the

confidentiality provisions relating to that information.

         (e)AAThe division, upon request, shall disclose the identity

of a complainant under this section if the division finds:

               (1)AAthe complaint was groundless or made in bad faith;

               (2)AAthe complaint lacks any basis in fact or evidence;

               (3)AAthe complaint is frivolous; or

               (4)AAthe complaint is done specifically for competitive

or economic advantage.

         (f)AAUpon   completion     of    an    investigation    in    which    the

division determines a complaint is described by Subsection (e), the

                                         33
division    shall    notify   the    person     who    was    the    subject   of   the

complaint of its finding and the identity of the complainant.

Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.19, eff. Sept. 1,

1995.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.028, eff.

September 1, 2005.

SUBCHAPTER F.       COOPERATION WITH OFFICE OF INJURED EMPLOYEE COUNSEL

        Sec. 402.251.AACOOPERATION; FACILITIES.                (a)    The department

and   the   division    shall    cooperate      with    the    office    of    injured

employee counsel in providing services to claimants under this

subtitle.

        (b)AAThe department shall provide facilities to the office of

injured     employee   counsel      in   each   regional      office    operated     to

administer the duties of the division under this subtitle.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 2.029, eff.

September 1, 2005.

                                          34
                                   LABOR CODE

                     TITLE 5. WORKERS ’ COMPENSATION

               SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

        CHAPTER 406. WORKERS ’ COMPENSATION INSURANCE COVERAGE

        SUBCHAPTER A. COVERAGE ELECTION;           SECURITY PROCEDURES

       Sec.A406.001.AADEFINITION.             In this subchapter, "employer"

means a person who employs one or more employees.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.002.AACOVERAGE GENERALLY ELECTIVE.                 (a)    Except for

public employers and as otherwise provided by law, an employer may

elect to obtain workers ’ compensation insurance coverage.

       (b)AAAn employer who elects to obtain coverage is subject to

this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.003.AAMETHODS OF OBTAINING COVERAGE.                     An employer

may   obtain   workers ’ compensation          insurance    coverage      through   a

licensed insurance company or through self-insurance as provided by

this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec. 406.004.AAEMPLOYER NOTICE TO DIVISION.                (a)    An employer

who does not obtain workers ’ compensation insurance coverage shall

notify the division in writing, in the time and as prescribed by

commissioner rule, that the employer elects not to obtain coverage.

       (b)AAThe commissioner shall prescribe forms to be used for

the employer notification and shall require the employer to provide

reasonable     information    to    the       division    about   the     employer ’s

business.

       (c)AAThe    division   may    contract      with    the    Texas    Workforce

Commission or the comptroller for assistance in collecting the

notification required under this section.AAThose agencies shall

cooperate with the division in enforcing this section.

       (d)AAThe employer notification filing required under this

                                          1
section shall be filed with the division in accordance with Section

406.009.

       (e)AAAn employer commits an administrative violation if the

employer fails to comply with this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                          Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.47(a), eff. Sept. 1, 1995.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.023, eff.

September 1, 2005.

       Sec.A406.005.AAEMPLOYER NOTICE TO EMPLOYEES;                       ADMINISTRATIVE

VIOLATION.    (a)    An employer shall notify each employee as provided

by   this   section     whether      or    not    the         employer        has   workers ’

compensation insurance coverage.

       (b)AAThe      employer      shall    notify        a    new     employee      of   the

existence or absence of workers ’ compensation insurance coverage at

the time the employee is hired.

       (c)AAEach      employer     shall       post   a       notice     of    whether    the

employer     has     workers ’     compensation           insurance           coverage     at

conspicuous       locations   at    the    employer ’s         place     of    business    as

necessary    to    provide    reasonable       notice         to   the   employees.AAThe

commissioner may adopt rules relating to the form and content of the

notice.AAThe employer shall revise the notice when the information

contained in the notice is changed.

       (d)AAAn employer who obtains workers ’ compensation insurance

coverage or whose coverage is terminated or canceled shall notify

each employee that the coverage has been obtained, terminated, or

canceled not later than the 15th day after the date on which the

coverage, or the termination or cancellation of the coverage, takes

effect.

       (e)AAAn employer commits an administrative violation if the

employer fails to comply with this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.024, eff.

September 1, 2005.

                                           2
        Sec.A406.006.AAINSURANCE COVERAGE AND CLAIM ADMINISTRATION

REPORTING     REQUIREMENTS;          ADMINISTRATIVE        VIOLATION.       (a)      An

insurance company from which an employer has obtained workers ’

compensation        insurance      coverage,     a   certified    self-insurer,       a

workers ’ compensation self-insurance group under Chapter 407A, and

a political subdivision shall file notice of the coverage and claim

administration contact information with the division not later than

the    10th   day    after   the    date    on   which    the   coverage   or     claim

administration       agreement      takes   effect,      unless   the   commissioner

adopts a rule establishing a later date for filing.AACoverage takes

effect on the date on which a binder is issued, a later date and time

agreed to by the parties, on the date provided by the certificate of

self-insurance, or on the date provided in an interlocal agreement

that   provides      for    self-insurance.AAThe         commissioner      may    adopt

rules that establish the coverage and claim administration contact

information required under this subsection.

        (b)AAThe notice required under this section shall be filed

with the division in accordance with Section 406.009.

        (c)AAAn      insurance      company,     a   certified    self-insurer,       a

workers ’ compensation self-insurance group under Chapter 407A, or a

political subdivision commits an administrative violation if the

person fails to file notice with the division as provided by this

section.

        (d)AAIn      this    section,      "political      subdivision"     has     the

meaning assigned by Section 504.001.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                   Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.48(a), eff. Sept. 1, 1995;

Acts 1999, 76th Leg., ch. 954, Sec. 2.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.025, eff.

September 1, 2005.

        Sec.A406.007.AATERMINATION OF COVERAGE BY EMPLOYER;                  NOTICE.

(a)    An employer who terminates workers ’ compensation insurance

coverage obtained under this subtitle shall file a written notice

with the division by certified mail not later than the 10th day

after the date on which the employer notified the insurance carrier

                                            3
to terminate the coverage.AAThe notice must include a statement

certifying the date that notice was provided or will be provided to

affected employees under Section 406.005.

       (b)AAThe notice required under this section shall be filed

with the division in accordance with Section 406.009.

       (c)AATermination of coverage takes effect on the later of:

              (1)AAthe 30th day after the date of filing of notice

with the division under Subsection (a); or

              (2)AAthe cancellation date of the policy.

       (d)AAThe coverage shall be extended until the date on which

the   termination   of   coverage   takes    effect,    and   the    employer   is

obligated for premiums due for that period.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.               Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.49(a), eff. Sept. 1, 1995.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.026, eff.

September 1, 2005.

       Sec.   406.008.AACANCELLATION        OR   NONRENEWAL     OF   COVERAGE    BY

INSURANCE COMPANY; NOTICE.      (a)   An insurance company that cancels a

policy of workers ’ compensation insurance or that does not renew

the policy by the anniversary date of the policy shall deliver

notice of the cancellation or nonrenewal by certified mail or in

person to the employer and the division not later than:

              (1)AAthe   30th   day   before      the    date   on    which     the

cancellation or nonrenewal takes effect; or

              (2)AAthe   10th   day   before      the    date   on    which     the

cancellation or nonrenewal takes effect if the insurance company

cancels or does not renew because of:

                    (A)AAfraud in obtaining coverage;

                    (B)AAmisrepresentation of the amount of payroll

for purposes of premium calculation;

                    (C)AAfailure to pay a premium when due;

                    (D)AAan   increase      in   the   hazard   for   which     the

employer seeks coverage that results from an act or omission of the

employer and that would produce an increase in the rate, including

an increase because of a failure to comply with:

                                      4
                                 (i)AAreasonable          recommendations           for     loss

control; or

                                 (ii)AArecommendations designed to reduce a

hazard under the employer ’s control within a reasonable period; or

                      (E)AAa determination made by the commissioner of

insurance     that    the   continuation            of   the    policy     would    place    the

insurer    in   violation        of   the     law   or    would      be   hazardous    to    the

interest of subscribers, creditors, or the general public.

       (b)AAThe notice required under this section shall be filed

with the division.

       (c)AAFailure         of    the    insurance        company     to    give    notice    as

required by this section extends the policy until the date on which

the required notice is provided to the employer and the division.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                            Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.50(a), eff. Sept. 1, 1995.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.027, eff.

September 1, 2005.

       Sec.     406.009.AACOLLECTING                AND       MAINTAINING        INFORMATION;

MONITORING      AND   ENFORCING         COMPLIANCE.            (a)    The   division       shall

collect and maintain the information required under this subchapter

and   shall     monitor     compliance          with      the     requirements        of    this

subchapter.

       (b)AAThe commissioner may adopt rules as necessary to enforce

this subchapter.

       (c)AAThe commissioner may designate a data collection agent,

implement an electronic reporting and public information access

program,    and   adopt      rules       as    necessary        to   implement       the    data

collection requirements of this subchapter.AAThe commissioner may

establish the form, manner, and procedure for the transmission of

information to the division.AAA data collection agent designated

under this subsection must be qualified and may collect fees in the

manner described by Section 401.024.

       (d)AAThe       division        may     require     an     employer     or    insurance

carrier    subject     to    this       subtitle         to    identify     or     confirm    an

employer ’s     coverage         status       and    claim      administration        contact

                                                5
information as necessary to achieve the purposes of this subtitle.

       (e)AAAn       employer        or        insurance    carrier      commits    an

administrative       violation       if    that    person   fails   to   comply    with

Subsection (d).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                    Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.51(a), eff. Sept. 1, 1995;

Acts 1999, 76th Leg., ch. 954, Sec. 3, eff. Sept. 1, 1999.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.028, eff.

September 1, 2005.

       Acts 2011, 82nd Leg., R.S., Ch. 410 (S.B. 800), Sec. 2, eff.

June 17, 2011.

       Sec.A406.010.AACLAIMS              SERVICE;      ADMINISTRATIVE    VIOLATION.

(a)   An insurance carrier shall provide claims service:

              (1)AAthrough offices of the insurance carrier located

in this state;      or

              (2)AAby other resident representatives with full power

to act for the insurance carrier.

       (b)AAEach         insurance    carrier       shall   designate     persons   to

provide claims service in sufficient numbers and at appropriate

locations     to     reasonably       service          policies   written     by    the

carrier.AAIf an insurance carrier uses the services of a person

required to hold a certificate of authority under Chapter 4151,

Insurance Code, the carrier must comply with the requirements of

that chapter.

       (c)AAThe      commissioner         by    rule   shall   further   specify    the

requirements of this section.

       (d)AAA      person   commits       an    administrative    violation   if    the

person violates a rule adopted under this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.029, eff.

September 1, 2005.

       Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 3.01,

eff. September 1, 2007.

                                               6
        Sec.     406.011.AAAUSTIN           REPRESENTATIVE;           ADMINISTRATIVE

VIOLATION.     (a)    The commissioner by rule may require an insurance

carrier   to   designate      a   representative       in   Austin    to   act    as   the

insurance carrier ’s agent before the division in Austin.AANotice to

the designated agent constitutes notice to the insurance carrier.

        (b)AAA   person      commits   an   administrative        violation       if   the

person violates a rule adopted under this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.030, eff.

September 1, 2005.

        Sec.A406.012.AAENFORCEMENT OF SUBCHAPTER.                    The commission

shall enforce the administrative penalties established under this

subchapter in accordance with Chapter 415.

Acts 1993, 73rd Leg., ch. 269, Sec.             1, eff. Sept. 1, 1993.

                     SUBCHAPTER B. COVERAGE REQUIREMENTS

        Sec.A406.031.AALIABILITY            FOR      COMPENSATION.          (a)         An

insurance carrier is liable for compensation                   for an employee ’s

injury without regard to fault or negligence if:

               (1)AAat the time of injury, the employee is subject to

this subtitle;       and

               (2)AAthe injury arises out of and in the course and

scope of employment.

        (b)AAIf an injury is an occupational disease, the employer in

whose   employ   the       employee   was   last     injuriously     exposed      to   the

hazards of the disease is considered to be the employer of the

employee under this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A406.032.AAEXCEPTIONS.              An    insurance      carrier     is    not

liable for compensation if:

               (1)AAthe injury:

                      (A)AAoccurred while the employee was in a state of

intoxication;

                                            7
                   (B)AAwas caused by the employee ’s wilful attempt

to injure himself or to unlawfully injure another person;

                   (C)AAarose out of an act of a third person intended

to injure the employee because of a personal reason and not directed

at the employee as an employee or because of the employment;

                   (D)AAarose out of voluntary participation in an

off-duty recreational, social, or athletic activity that did not

constitute part of the employee ’s work-related duties, unless the

activity is a reasonable expectancy of or is expressly or impliedly

required by the employment;     or

                   (E)AAarose   out   of        an    act   of   God,    unless   the

employment exposes the employee to a greater risk of injury from an

act of God than ordinarily applies to the general public; or

              (2)AAthe employee ’s horseplay was a producing cause of

the injury.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A406.033.AACOMMON-LAW           DEFENSES;           BURDEN     OF   PROOF.

(a)AAIn an action against an employer by or on behalf of an employee

who is not covered by workers ’ compensation insurance obtained in

the manner authorized by Section 406.003 to recover damages for

personal injuries or death sustained by an employee in the course

and scope of the employment, it is not a defense that:

              (1)AAthe   employee         was        guilty      of     contributory

negligence;

              (2)AAthe employee assumed the risk of injury or death;

or

              (3)AAthe injury or death was caused by the negligence of

a fellow employee.

      (b)AAThis section does not reinstate or otherwise affect the

availability of defenses at common law, including the defenses

described by Subsection (a).

      (c)AAThe employer may defend the action on the ground that

the injury was caused:

              (1)AAby an act of the employee intended to bring about

the injury;   or

              (2)AAwhile the employee was in a state of intoxication.

                                      8
       (d)AAIn an action described by Subsection (a), the plaintiff

must prove negligence of the employer or of an agent or servant of

the employer acting within the general scope of the agent ’s or

servant ’s employment.

       (e)AAA cause of action described in Subsection (a) may not be

waived by an employee before the employee ’s injury or death.                  Any

agreement by an employee to waive a cause of action or any right

described in Subsection (a) before the employee ’s injury or death

is void and unenforceable.

       (f)AAA cause of action described by Subsection (a) may not be

waived by an employee after the employee ’s injury unless:

              (1)AAthe employee voluntarily enters into the waiver

with knowledge of the waiver ’s effect;

              (2)AAthe waiver is entered into not earlier than the

10th business day after the date of the initial report of injury;

              (3)AAthe   employee,    before      signing    the   waiver,     has

received a medical evaluation from a nonemergency care doctor; and

              (4)AAthe waiver is in a writing under which the true

intent of the parties is specifically stated in the document.

       (g)AAThe     waiver   provisions    required    under   Subsection      (f)

must be conspicuous and appear on the face of the agreement.AATo be

conspicuous, the waiver provisions must appear in a type larger

than   the   type   contained   in   the   body   of   the   agreement    or   in

contrasting colors.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.               Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 16.01, eff. June 17, 2001.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.031, eff.

September 1, 2005.

       Acts 2011, 82nd Leg., R.S., Ch. 1108 (S.B. 1714), Sec. 1, eff.

September 1, 2011.

       Sec.A406.034.AAEMPLOYEE ELECTION.           (a)   Except as otherwise

provided by law, unless the employee gives notice as provided by

Subsection (b), an employee of an employer waives the employee ’s

right of action at common law or under a statute of this state to

recover damages for personal injuries or death sustained in the

                                      9
course and scope of the employment.

        (b)AAAn employee who desires to retain the common-law right

of action to recover damages for personal injuries or death shall

notify the employer in writing that the employee waives coverage

under this subtitle and retains all rights of action under common

law.   The employee must notify the employer not later than the fifth

day after the date on which the employee:

              (1)AAbegins the employment;                or

              (2)AAreceives written notice from the employer that the

employer has obtained workers ’ compensation insurance coverage if

the employer is not a covered employer at the time of the employment

but later obtains the coverage.

        (c)AAAn   employer      may    not       require      an       employee   to       retain

common-law rights under this section as a condition of employment.

        (d)AAAn employee who elects to retain the right of action or a

legal beneficiary of that employee may bring a cause of action for

damages   for   injuries   sustained         in    the    course         and   scope of      the

employment      under   common        law    or     under          a    statute       of     this

state.AANotwithstanding Section 406.033, the cause of action is

subject to all defenses available under common law and the statutes

of this state unless the employee has waived coverage in connection

with an agreement with the employer.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2011, 82nd Leg., R.S., Ch. 1108 (S.B. 1714), Sec. 2, eff.

September 1, 2011.

        Sec.A406.035.AAWAIVER OF COMPENSATION PROHIBITED.                             Except as

provided by this subtitle, an agreement by an employee to waive the

employee ’s right to compensation is void.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

          SUBCHAPTER C. COVERAGE THROUGH COMMERCIAL INSURANCE

        Sec.A406.051.AASECURITY BY COMMERCIAL INSURANCE.                               (a)     An

insurance company may contract to secure an employer ’s liability

and    obligations   and   to   pay    compensation           by       issuing    a   workers ’

                                            10
compensation insurance policy under this subchapter.

         (b)AAThe contract for coverage must be written on a policy

and endorsements approved by the Texas Department of Insurance.

         (c)AAThe employer may not transfer:

              (1)AAthe obligation to accept a report of injury under

Section 409.001;

              (2)AAthe      obligation       to   maintain    records     of    injuries

under Section 409.006;

              (3)AAthe obligation to report injuries to the insurance

carrier under Section 409.005;

              (4)AAliability for a violation of Section 415.006 or

415.008 or of Chapter 451; or

              (5)AAthe       obligation      to   comply      with   a   commissioner

order.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                       Amended

by Acts 1999, 76th Leg., ch. 954, Sec. 4, eff. Sept. 1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.032, eff.

September 1, 2005.

         Sec.A406.052.AAEFFECT OF OTHER INSURANCE COVERAGE.                       (a)    A

contract entered into to indemnify an employer from loss or damage

resulting     from    an    injury    sustained        by    an   employee      that    is

compensable under this subtitle is void unless the contract also

covers liability for payment of compensation under this subtitle.

         (b)AAThis section does not prohibit an employer who is not

required to have workers ’ compensation insurance coverage and who

has elected not to obtain workers ’ compensation insurance coverage

from obtaining insurance coverage on the employer ’s employees if

the   insurance      is    not   represented      to   any    person     as    providing

workers ’ compensation           insurance    coverage      authorized        under   this

subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec.A406.053.AAALL STATES COVERAGE.                The Texas Department of

Insurance shall coordinate with the appropriate agencies of other

states to:

                                          11
              (1)AAshare       information        regarding         an   employer      who

obtains all states coverage; and

              (2)AAensure that the department has knowledge of an

employer who obtains all states coverage in another state but fails

to file notice with the department.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                SUBCHAPTER D. EXTRATERRITORIAL COVERAGE

       Sec.A406.071.AAEXTRATERRITORIAL COVERAGE.                     (a)    An employee

who   is   injured     while   working      in   another       jurisdiction       or   the

employee ’s legal beneficiary is entitled to all rights and remedies

under this subtitle if:

              (1)AAthe injury would be compensable if it had occurred

in this state;   and

              (2)AAthe employee has significant contacts with this

state or the employment is principally located in this state.

       (b)AAAn employee has significant contacts with this state if

the employee was hired or recruited in this state and the employee:

              (1)AAwas injured not later than one year after the date

of hire; or

              (2)AAhas worked in this state for at least 10 working

days during the 12 months preceding the date of injury.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.072.AAPRINCIPAL LOCATION.                    The principal location

of a person ’s employment is where:

              (1)AAthe employer has a place of business at or from

which the employee regularly works; or

              (2)AAthe employee resides and spends a substantial part

of the employee ’s working time.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.073.AAAGREEMENT                  ON          PRINCIPAL       LOCATION;

ADMINISTRATIVE VIOLATION.             (a)    An employee whose work requires

regular    travel      between   this       state      and    at    least   one     other

jurisdiction     may    agree    in    writing        with    the   employer      on   the

                                            12
principal location of the employment.

      (b)AAThe employer shall file the agreement with the division

on request.

      (c)AAA    person   commits   an    administrative        violation       if   the

person violates Subsection (b).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.033, eff.

September 1, 2005.

      Sec.A406.074.AAINTERJURISDICTIONAL              AGREEMENTS.            (a)     The

commissioner may enter into an agreement with an appropriate agency

of another jurisdiction with respect to:

              (1)AAconflicts of jurisdiction;

              (2)AAassumption of jurisdiction in a case in which the

contract   of   employment   arises      in    one   state   and   the   injury      is

incurred in another;

              (3)AAprocedures      for       proceeding      against     a    foreign

employer who fails to comply with this subtitle; and

              (4)AAprocedures for the appropriate agency to use to

proceed against an employer of this state who fails to comply with

the workers ’ compensation laws of the other jurisdiction.

      (b)AAAn executed agreement that has been adopted as a rule by

the commissioner binds all subject employers and employees.

      (c)AAIn this section, "appropriate agency" means an agency of

another jurisdiction that administers the workers ’ compensation

laws of that jurisdiction.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.034, eff.

September 1, 2005.

      Sec.A406.075.AAEFFECT         OF        COMPENSATION      PAID     IN        OTHER

JURISDICTION.     (a)    An injured employee who elects to pursue the

employee ’s remedy under the workers ’ compensation laws of another

jurisdiction and who recovers benefits under those laws may not

recover under this subtitle.

                                        13
        (b)AAThe amount of benefits accepted under the laws of the

other jurisdiction without an election under Subsection (a) shall

be    credited   against   the   benefits      that     the   employee   would   have

received had the claim been made under this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      SUBCHAPTER E. APPLICATION OF COVERAGE TO CERTAIN EMPLOYEES

        Sec.A406.091.AAEXEMPT EMPLOYEES;                VOLUNTARY COVERAGE.         (a)

The following employees are not subject to this subtitle:

             (1)AAa person employed as a domestic worker or a casual

worker engaged in employment incidental to a personal residence;

             (2)AAa     person   covered       by   a   method     of   compensation

established under federal law;       or

             (3)AAexcept as provided by Subchapter H, a farm or ranch

employee.

        (b)AAAn employer may elect to obtain workers ’ compensation

insurance coverage for an employee or classification of employees

exempted    from    coverage     under        Subsection       (a)(1)    or   (a)(3).

Obtaining that coverage constitutes acceptance by the employer of

the rights and responsibilities imposed under this subtitle as of

the effective date of the coverage for as long as the coverage

remains in effect.

        (c)AAAn employer who does not obtain coverage for exempt

employees is not deprived of the common-law defenses described by

Section 406.033, but this section does not reinstate or otherwise

affect the availability of those or other defenses at common law.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A406.092.AAALIEN EMPLOYEES AND BENEFICIARIES.                     (a)    A

resident or nonresident alien employee or legal beneficiary is

entitled to compensation under this subtitle.

        (b)AAA nonresident alien employee or legal beneficiary, at

the    election    of   the   employee    or     legal        beneficiary,    may   be

represented officially by a consular officer of the country of

which the employee or legal beneficiary is a citizen.                   That officer

may receive benefit payments for distribution to the employee or

                                         14
legal beneficiary.       The receipt of the payments constitutes full

discharge of the insurance carrier ’s liability for those payments.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec.A406.093.AALEGALLY        INCOMPETENT             EMPLOYEES.        (a)      The

guardian of an injured employee who is a minor or is otherwise

legally    incompetent     may   exercise       on    the      employee ’s    behalf      the

rights and privileges granted to the employee under this subtitle.

         (b)AAThe   commissioner         by    rule       shall       adopt   procedures

relating    to    the   method    of     payment          of    benefits      to   legally

incompetent employees.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.035, eff.

September 1, 2005.

         Sec.A406.094.AACERTAIN PERSONS LICENSED BY TEXAS REAL ESTATE

COMMISSION.       (a)    An    employer       who    elects      to    provide     workers ’

compensation insurance coverage may include in the coverage a real

estate salesperson or broker who is:

              (1)AAlicensed      under    Chapter         1101,       Occupations      Code;

and

              (2)AAcompensated solely by commissions.

         (b)AAIf coverage is elected by the employer, the insurance

policy    must   specifically     name    the       salesperson        or   broker.       The

coverage continues while the policy is in effect and the named

salesperson or broker is endorsed on the policy.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                         Amended

by Acts 2003, 78th Leg., ch. 1276, Sec. 14A.788, eff. Sept. 1, 2003.

         Sec.A406.095.AACERTAIN        PROFESSIONAL             ATHLETES.          (a)        A

professional     athlete      employed    under       a   contract      for   hire       or   a

collective bargaining agreement who is entitled to benefits for

medical care and weekly benefits that are equal to or greater than

the benefits provided under this subtitle may not receive benefits

under this subtitle and the equivalent benefits under the contract

or collective bargaining agreement.                 An athlete covered by such a

                                          15
contract or agreement who sustains an injury in the course and scope

of   the   athlete ’s      employment      shall    elect      to    receive    either    the

benefits available under this subtitle or the benefits under the

contract or agreement.

         (b)AAThe commissioner by rule shall establish the procedures

and requirements for an election under this section.

         (c)AAIn this section, "professional athlete" means a person

employed as a professional athlete by a franchise of:

                (1)AAthe National Football League;

                (2)AAthe National Basketball Association;

                (3)AAthe        American      League     of    Professional          Baseball

Clubs;

                (4)AAthe        National      League     of    Professional          Baseball

Clubs;

                (5)AAthe International Hockey League;

                (6)AAthe National Hockey League; or

                (7)AAthe Central Hockey League.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                           Amended

by Acts 1995, 74th Leg., ch. 668, Sec. 1, eff. Sept. 1, 1995.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.036, eff.

September 1, 2005.

         Acts   2005,      79th    Leg.,   Ch.     815   (S.B.      742),     Sec.   1,   eff.

September 1, 2005.

         Sec.A406.096.AAREQUIRED              COVERAGE    FOR       CERTAIN    BUILDING    OR

CONSTRUCTION CONTRACTORS.               (a)    A governmental entity that enters

into   a   building        or     construction      contract         shall     require    the

contractor      to   certify       in   writing    that   the       contractor       provides

workers ’ compensation insurance coverage for each employee of the

contractor employed on the public project.

         (b)AAEach subcontractor on the public project shall provide

such a certificate relating to coverage of the subcontractor ’s

employees       to   the    general      contractor,          who    shall     provide    the

subcontractor ’s certificate to the governmental entity.

         (c)AAA contractor who has a contract that requires workers ’

compensation insurance coverage may provide the coverage through a

                                              16
group plan or other method satisfactory to the governing body of the

governmental entity.

       (d)AAThe employment of a maintenance employee by an employer

who is not engaging in building or construction as the employer ’s

primary     business         does   not   constitute        engaging         in   building     or

construction.

       (e)AAIn this section:

                 (1)AA"Building or construction" includes:

                        (A)AAerecting or preparing to erect a structure,

including a building, bridge, roadway, public utility facility, or

related appurtenance;

                        (B)AAremodeling,                extending,           repairing,        or

demolishing a structure;             or

                        (C)AAotherwise           improving     real         property      or   an

appurtenance to real property through similar activities.

                 (2)AA"Governmental          entity"        means          this   state   or   a

political        subdivision        of    this    state.       The         term   includes     a

municipality.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.097.AAEXECUTIVE                  EMPLOYEES        OF       CERTAIN    BUSINESS

ENTITIES.        (a)   A sole proprietor, partner, or corporate executive

officer     of    a    business     entity       that    elects    to       provide   workers ’

compensation insurance coverage is entitled to benefits under that

coverage as an employee unless the sole proprietor, partner, or

corporate executive officer is specifically excluded from coverage

through an endorsement to the insurance policy or certificate of

authority to self-insure.

       (b)AAThe dual capacity doctrine does not apply to a corporate

executive officer with an equity ownership in the covered business

entity of at least 25 percent and will not invalidate the exclusion

of   such    a     corporate        executive       officer       from       coverage     under

Subsection (a).

       (c)AAA         sole   proprietor      or    partner    of       a    covered   business

entity or a corporate officer with an equity ownership in a covered

business entity of at least 25 percent may be excluded from coverage

under this section notwithstanding Section 406.096.

                                             17
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.20, eff. Sept. 1,

1995.

         Sec.A406.098.AAVOLUNTEER              EMERGENCY        SERVICE     MEMBERS          AND

PERSONNEL.      (a)     An emergency service organization which is not a

political    subdivision         or    which   is     separate     from    any    political

subdivision may elect to obtain workers ’ compensation insurance

coverage for its named volunteer members who participate in the

normal functions of the organization.                   A person covered under this

subsection is entitled to full medical benefits and the minimum

compensation payments under the law.

         (b)AAIn this section, unless a different meaning is plainly

required by law:

                (1)AA"Emergency          service        organization"         means          any

organization established to provide for the general public:

                       (A)AAfire prevention and suppression;

                       (B)AAhazardous materials response operations;                         or

                       (C)AAemergency medical services.

                (2)AA"Volunteer         members"       means      individuals      who       are

carried    on   the    membership       list     of    the   organization         as    active

participants and who receive no remuneration for their services.

                (3)AA"Normal          functions"        means      any     response          to,

participation in, or departure from an incident scene;                            training;

meetings;    performance of equipment maintenance;                   or organizational

functions.

                (4)AA"Political           subdivision"            means      a         county,

municipality, special district, school district, junior college

district, housing authority, community center for mental health and

mental    retardation          services    established          under      Subchapter         A,

Chapter    534,       Health    and     Safety      Code,    or    any     other       legally

constituted political subdivision of the state.

         (c)AAThe      commissioner       of     insurance         shall    adopt        rules

governing       the    method     of     calculating         premiums       for    workers ’

compensation      insurance       coverage       for    volunteer     members          who   are

covered pursuant to this section.

Added by Acts 1995, 74th Leg., ch. 849, Sec. 1, eff. Aug. 28, 1995.

Renumbered from Labor Code Sec. 406.097 by Acts 1997, 75th Leg., ch.

                                           18
165, Sec. 31.01(63), eff. Sept. 1, 1997.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.037, eff.

September 1, 2005.

      SUBCHAPTER F. COVERAGE OF CERTAIN INDEPENDENT CONTRACTORS

        Sec.A406.121.AADEFINITIONS.           In this subchapter:

               (1)AA"General contractor" means a person who undertakes

to procure the performance of work or a service, either separately

or   through    the   use   of    subcontractors.             The   term     includes   a

"principal contractor," "original contractor," "prime contractor,"

or other analogous term.          The term does not include a motor carrier

that provides a transportation service through the use of an owner

operator.

               (2)AA"Independent       contractor"            means    a    person     who

contracts to perform work or provide a service for the benefit of

another and who ordinarily:

                      (A)AAacts as the employer of any employee of the

contractor by paying wages, directing activities, and performing

other   similar   functions       characteristic         of   an    employer-employee

relationship;

                      (B)AAis free to determine the manner in which the

work or service is performed, including the hours of labor of or

method of payment to any employee;

                      (C)AAis required to furnish or to have employees,

if any, furnish necessary tools, supplies, or materials to perform

the work or service; and

                      (D)AApossesses        the   skills        required         for   the

specific work or service.

               (3)AA"Motor       carrier"    means   a    person      who    operates   a

motor vehicle over a public highway in this state to provide a

transportation service or who contracts to provide that service.

               (4)AA"Owner       operator"    means      a    person       who   provides

transportation services under contract for a motor carrier.                             An

owner operator is an independent contractor.

               (5)AA"Subcontractor" means a person who contracts with

                                        19
a general contractor to perform all or part of the work or services

that the general contractor has undertaken to perform.

              (6)AA"Transportation service" means providing a motor

vehicle, with a driver under contract, to transport passengers or

property.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A406.122.AASTATUS AS EMPLOYEE.                      (a)     For purposes of

workers ’ compensation insurance coverage, a person who performs

work or provides a service for a general contractor or motor carrier

who is an employer under this subtitle is an employee of that

general contractor or motor carrier, unless the person is:

              (1)AAoperating as an independent contractor;                       or

              (2)AAhired to perform the work or provide the service as

an employee of a person operating as an independent contractor.

        (b)AAA subcontractor and the subcontractor ’s employees are

not    employees     of    the   general   contractor           for   purposes     of    this

subtitle if the subcontractor:

              (1)AAis operating as an independent contractor;                         and

              (2)AAhas       entered    into    a       written   agreement       with      the

general     contractor      that    evidences       a    relationship       in   which      the

subcontractor assumes the responsibilities of an employer for the

performance of work.

        (c)AAAn owner operator and the owner operator ’s employees are

not employees of a motor carrier for the purposes of this subtitle

if the owner operator has entered into a written agreement with the

motor carrier that evidences a relationship in which the owner

operator     assumes       the   responsibilities          of    an   employer     for      the

performance of work.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A406.123.AAELECTION TO PROVIDE COVERAGE;                     ADMINISTRATIVE

VIOLATION.     (a)       A general contractor and a subcontractor may enter

into    a   written       agreement    under    which       the    general       contractor

provides      workers ’      compensation       insurance             coverage     to       the

subcontractor and the employees of the subcontractor.

        (b)AAIf      a    general     contractor         has    workers ’   compensation

                                           20
insurance to protect the general contractor ’s employees and if, in

the course and scope of the general contractor ’s business, the

general contractor enters into a contract with a subcontractor who

does not have employees, the general contractor shall be treated as

the employer of the subcontractor for the purposes of this subtitle

and may enter into an agreement for the deduction of premiums paid

in accordance with Subsection (d).

       (c)AAA motor carrier and an owner operator may enter into a

written agreement under which the motor carrier provides workers ’

compensation       insurance    coverage          to    the    owner    operator        and   the

employees of the owner operator.

       (d)AAIf a general contractor or a motor carrier elects to

provide coverage under Subsection (a) or (c), then, notwithstanding

Section 415.006, the actual premiums, based on payroll, that are

paid or incurred by the general contractor or motor carrier for the

coverage may be deducted from the contract price or other amount

owed   to   the     subcontractor       or    owner       operator          by   the    general

contractor or motor carrier.

       (e)AAAn      agreement       under    this       section        makes     the    general

contractor         the    employer      of        the         subcontractor            and    the

subcontractor ’s         employees    only        for    purposes       of       the   workers ’

compensation laws of this state.

       (f)AAA general contractor shall file a copy of an agreement

entered     into    under    this    section      with        the   general      contractor ’s

workers ’ compensation insurance carrier not later than the 10th day

after the date on which the contract is executed.AAIf the general

contractor is a certified self-insurer, the copy must be filed with

the division.

       (g)AAA general contractor who enters into an agreement with a

subcontractor        under    this     section          commits        an    administrative

violation if the contractor fails to file a copy of the agreement as

required by Subsection (f).

       (h)AANotwithstanding Subsection (b), a person who performs

work or provides a service for an oil or gas well operator and who is

an independent contractor that has no employees shall be treated in

the same manner as an independent contractor with employees and is

not entitled to coverage under the general contractor ’s workers ’

                                             21
compensation insurance policy unless the independent contractor

and   the   general   contractor   enter     into   an   agreement   under   this

section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.              Amended

by Acts 1997, 75th Leg., ch. 88, Sec. 1, eff. Sept. 1, 1997.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.038, eff.

September 1, 2005.

       Sec.A406.124.AACAUSE OF ACTION.            If a person who has workers ’

compensation insurance coverage subcontracts all or part of the

work to be performed by the person to a subcontractor with the

intent to avoid liability as an employer under this subtitle, an

employee of the subcontractor who sustains a compensable injury in

the course and scope of the employment shall be treated as an

employee of the person for purposes of workers ’ compensation and

shall have a separate right of action against the subcontractor.

The right of action against the subcontractor does not affect the

employee ’s right to compensation under this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.125.AARESTRICTION            OF     UNSAFE    WORK    PRACTICES

UNAFFECTED.    This subchapter does not prevent a general contractor

from directing a subcontractor or the employees of a subcontractor

to stop or change an unsafe work practice.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.126.AAEXEMPTION.         This subchapter does not apply to

farm or ranch employees.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A406.127.AAEFFECT       OF   CERTAIN     CONTRACTS   OF   HIRE.     An

insurance    company   may   not   demand    an   insurance   premium   from   an

employer for coverage of an independent contractor or an employee

of an independent contractor if the independent contractor is under

a contract of hire with the employer.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                        22
SUBCHAPTER G. COVERAGE OF CERTAIN BUILDING AND CONSTRUCTION WORKERS

      Sec.A406.141.AADEFINITIONS.             In this subchapter:

              (1)AA"Hiring contractor" means a general contractor or

subcontractor who, in the course of regular business, subcontracts

all or part of the work to be performed to other persons.

              (2)AA"Independent       contractor"           means     a    person      who

contracts to perform work or provide a service for the benefit of

another and who:

                     (A)AAis paid by the job and not by the hour or some

other time-measured basis;

                     (B)AAis free to hire as many helpers as desired and

may determine the pay of each helper; and

                     (C)AAis   free     to,    while      under   contract        to   the

hiring contractor, work for other contractors or is free to send

helpers to work for other contractors.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A406.142.AAAPPLICATION.             This subchapter applies only to

contractors    and   workers   preparing           to    construct,       constructing,

altering, repairing, extending, or demolishing:

              (1)AAa residential structure;

              (2)AAa commercial structure that does not exceed three

stories in height or 20,000 square feet in area; or

              (3)AAan   appurtenance          to    a    structure        described     by

Subdivision (1) or (2).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A406.143.AAPROVISION                OF         WORKERS ’         COMPENSATION

INSURANCE;    INDEPENDENT CONTRACTOR WITHOUT EMPLOYEES.                     (a)   Unless

the independent contractor and hiring contractor enter into an

agreement    under   Section   406.144,       the       independent   contractor        is

responsible    for    any   workers ’    compensation         insurance       coverage

provided to an employee of the independent contractor, and the

independent contractor ’s employees are not entitled to workers ’

compensation insurance coverage from the hiring contractor.

                                        23
        (b)AAAn independent contractor without employees shall be

treated     in    the    same    manner     as    an    independent      contractor          with

employees        and    is   not    entitled      to     coverage      under     the    hiring

contractor ’s      workers ’ compensation               insurance     policy     unless       the

independent        contractor        and    hiring          contractor    enter       into    an

agreement under Section 406.144.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A406.144.AAELECTION              TO    PROVIDE      COVERAGE;        AGREEMENT.

(a)   Except as provided by this section, a hiring contractor is not

responsible for providing workers ’ compensation insurance coverage

for   an    independent         contractor       or    the    independent       contractor ’s

employee, helper, or subcontractor.                     An independent contractor and

a hiring contractor may enter into a written agreement under which

the independent contractor agrees that the hiring contractor may

withhold the cost of workers ’ compensation insurance coverage from

the contract price and that, for the purpose of providing workers ’

compensation        insurance       coverage,         the    hiring   contractor       is    the

employer     of        the   independent         contractor      and     the    independent

contractor ’s employees.

        (b)AAA      hiring      contractor        and    independent         contractor       may

enter      into    an     agreement       under       Subsection       (a)     even    if    the

independent contractor does not have an employee.

        (c)AAAn agreement under this section shall be filed with the

division either by personal delivery or by registered or certified

mail and is considered filed on receipt by the division.

        (d)AAThe hiring contractor shall send a copy of an agreement

under this section to the hiring contractor ’s workers ’ compensation

insurance carrier on filing of the agreement with the division.

        (e)AAAn         agreement    under       this       section    makes     the    hiring

contractor        the    employer    of    the    independent         contractor       and   the

independent contractor ’s employees only for the purposes of the

workers ’ compensation laws of this state.

        (f)AAThe deduction of the cost of the workers ’ compensation

insurance        coverage     from    the   independent          contractor ’s        contract

price is permitted notwithstanding Section 415.006.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                             24
Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.039, eff.

September 1, 2005.

         Sec.A406.145.AAJOINT AGREEMENT.                   (a)   A hiring contractor and

an independent subcontractor may make a joint agreement declaring

that the subcontractor is an independent contractor as defined in

Section 406.141(2) and that the subcontractor is not the employee

of the hiring contractor.AAIf the joint agreement is signed by both

the hiring contractor and the subcontractor and filed with the

division, the subcontractor, as a matter of law, is an independent

contractor and not an employee, and is not entitled to workers ’

compensation         insurance       coverage       through      the    hiring     contractor

unless    an    agreement       is    entered       into    under      Section    406.144    to

provide         workers ’       compensation               insurance         coverage.AAThe

commissioner shall prescribe forms for the joint agreement.

         (b)AAA joint agreement shall be delivered to the division by

personal delivery or registered or certified mail and is considered

filed on receipt by the division.

         (c)AAThe      hiring    contractor         shall    send      a   copy   of   a   joint

agreement signed under this section to the hiring contractor ’s

workers ’ compensation           insurance carrier on filing of the joint

agreement with the division.

         (d)AAThe division shall maintain a system for accepting and

maintaining the joint agreements.

         (e)AAA joint agreement signed under this section applies to

each    hiring       agreement       between    the    hiring       contractor         and   the

independent contractor until the first anniversary of its filing

date, unless a subsequent hiring agreement expressly states that

the joint agreement does not apply.

         (f)AAIf a subsequent hiring agreement is made to which the

joint    agreement       does        not   apply,      the       hiring     contractor       and

independent contractor shall notify the division and the hiring

contractor ’s workers ’ compensation insurance carrier in writing.

         (g)AAIf a hiring contractor and an independent contractor

have    filed    a   joint   agreement       under     this       section,    an   insurance

company may not require the payment of an insurance premium by a

                                               25
hiring contractor for coverage of an independent contractor or an

independent contractor ’s employee, helper, or subcontractor other

than under an agreement entered into in compliance with Section

406.144.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.040, eff.

September 1, 2005.

       Sec.A406.146.AAWRONGFUL           INDUCEMENT           PROHIBITED.           (a)      A

hiring contractor may not:

              (1)AAwrongfully        induce      an    employee      to     enter     into   a

joint agreement under Section 406.145 stating that the employee is

an independent contractor;          or

              (2)AAexert controls over an independent contractor or

an employee of an independent contractor sufficient to make that

person an employee under common-law tests.

       (b)AAA      hiring     contractor        does    not     exert       employer-like

controls    over        an   independent        contractor      or     an     independent

contractor ’s employee solely because of:

              (1)AAcontrolling the hours of labor, if that control is

exercised only to:

                        (A)AAestablish the deadline for the completion of

the work called for by the contract;

                        (B)AAschedule work to occur in a logical sequence

and   to   avoid    delays     or   interference        with     the      work   of    other

contractors;       or

                        (C)AAschedule work to avoid disturbing neighbors

during night or early morning hours or at other times when the

independent     contractor ’s       activities        would    unreasonably         disturb

activities in the neighborhood;            or

              (2)AAstopping or directing work solely to prevent or

correct an unsafe work practice or condition or to control work to

ensure that the end product is in compliance with the contracted for

result.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                           26
        SUBCHAPTER H. COVERAGE OF FARM AND RANCH EMPLOYEES

      Sec.A406.161.AADEFINITIONS.          In this subchapter:

             (1)AA"Agricultural        labor"       means      the   planting,

cultivating,   or   harvesting   of   an   agricultural     or   horticultural

commodity in its unmanufactured state.

             (2)AA"Family" means persons related within the third

degree by consanguinity or affinity.

             (3)AA"Labor agent" means a person who:

                    (A)AAis a farm labor contractor for purposes of

the Migrant and Seasonal Agricultural Worker Protection Act (29

U.S.C. Section 1801 et seq.); or

                    (B)AAotherwise         recruits,     solicits,         hires,

employs, furnishes, or transports migrant or seasonal agricultural

workers who work for the benefit of a third party.

             (4)AA"Migrant worker" means an individual who is:

                    (A)AAemployed in agricultural labor of a seasonal

or temporary nature;    and

                    (B)AArequired     to   be   absent   overnight    from      the

worker ’s permanent place of residence.

             (5)AA"Seasonal worker" means an individual who is:

                    (A)AAemployed in agricultural or ranch labor of a

seasonal or temporary nature; and

                    (B)AAnot required to be absent overnight from the

worker ’s permanent place of residence.

             (6)AA"Truck farm" means a farm on which fruits, garden

vegetables   for    human   consumption,        potatoes,   sugar    beets,     or

vegetable seeds are produced for market.           The term includes a farm

primarily devoted to one of those crops that also has incidental

acreage of other crops.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A406.162.AASCOPE.         (a)     This    subtitle     applies   to    an

action to recover damages for personal injuries or death sustained

by a farm or ranch employee who is:

             (1)AAa migrant worker;

             (2)AAa seasonal worker:

                                      27
                  (A)AAemployed             on       a    truck      farm,          orchard,        or

vineyard;

                  (B)AAemployed         by       a       person     with       a    gross      annual

payroll for the preceding year in an amount not less than the

greater of the required payroll for the year preceding that year,

adjusted for inflation, or $25,000;              or

                  (C)AAworking         for       a       farmer,     ranch          operator,       or

labor agent who employs a migrant worker and doing the same work at

the same time and location as the migrant worker; or

             (3)AAan     employee,     other             than   a   migrant             or   seasonal

worker:

                  (A)AAfor years before 1991, employed by a person

with a gross annual payroll for the preceding year of at least

$50,000;    and

                  (B)AAfor 1991 and subsequent years, employed by a

person:

                            (i)AAwith a gross annual payroll in an amount

required for coverage of seasonal workers under Subdivision (2)(B);

or

                            (ii)AAwho employs three or more farm or ranch

employees other than migrant or seasonal workers.

      (b)AAThe comptroller shall prepare a consumer price index for

this state and shall certify the applicable index factor to the

division before October 1 of each year.AAThe division shall adjust

the gross annual payroll requirement under Subsection (a)(2)(B)

accordingly.

      (c)AAFor    the      purposes    of    this         section,       the        gross     annual

payroll of a person includes any amount paid by the person to a

labor agent for the agent ’s services and for the services of migrant

or seasonal workers but does not include wages paid to:

             (1)AAthe person or a member of the person ’s family, if

the person is a sole proprietor;

             (2)AAa     partner   in   a     partnership            or     a       member     of   the

partner ’s family;    or

             (3)AAa     shareholder         of       a    corporation              in    which     all

shareholders are family members or a member of the shareholder ’s

family.

                                        28
      (d)AAThis       subchapter        does        not   affect      the   application      or

interpretation of this subtitle as it relates to persons engaged in

activities determined before January 1, 1985, not to be farm or

ranch labor.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.041, eff.

September 1, 2005.

      Sec.A406.163.AALIABILITY OF LABOR AGENT;                          JOINT AND SEVERAL

LIABILITY.     (a)    A labor agent who furnishes a migrant or seasonal

worker is liable under this subtitle as if the labor agent were the

employer of the worker, without regard to the right of control or

other factors used to determine an employer-employee relationship.

      (b)AAIf the labor agent does not have workers ’ compensation

insurance coverage, the person with whom the labor agent contracts

for the services of the migrant or seasonal worker is jointly and

severally    liable       with   the    labor       agent   in   an    action   to    recover

damages for personal injuries or death suffered by the migrant or

seasonal    worker    as     provided        by     this    subtitle,       and,   for     that

purpose, the migrant or seasonal worker is considered the employee

of the person with whom the labor agent contracts and that person

may obtain workers ’ compensation insurance coverage for that worker

as provided by this subtitle.                If a migrant or seasonal worker is

covered by workers ’ compensation insurance coverage, the person

with whom the labor agent contracts is not liable in a separate

action for injury or death except to the extent provided by this

subtitle.

      (c)AAA labor agent shall notify each person with whom the

agent contracts of whether the agent has workers ’ compensation

insurance coverage.          If the agent does have workers ’ compensation

insurance     coverage,      the       agent      shall     present     evidence      of    the

coverage to each person with whom the agent contracts.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A406.164.AAELECTIVE                COVERAGE       OF     EMPLOYER     AND   FAMILY

MEMBERS.      (a)     A    person      who   purchases       a   workers ’ compensation

                                               29
insurance policy covering farm or ranch employees may cover the

person, a partner, a corporate officer, or a family member in that

policy.    The insurance policy must specifically name the individual

to be covered.

         (b)AAThe elective coverage continues while the policy is in

effect and the named individual is endorsed on the policy.

         (c)AAA member of an employer ’s family is exempt from coverage

under the policy unless an election for that coverage is made under

this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec.A406.165.AANOT    APPLICABLE      TO   INDEPENDENT   CONTRACTORS.

(a)   A farm or ranch employee who performs work or provides a

service for a farm or ranch employer subject to this subchapter is

an employee of that employer unless the employee is hired to perform

the work or provide the service as an employee of an independent

contractor.

         (b)AAIn   this    section,   "independent     contractor"    means   a

person, other than a labor agent, who contracts with a farm or ranch

employer to perform work or provide a service for the benefit of the

employer and who ordinarily:

              (1)AAacts as the employer of the employee by paying

wages,     directing      activities,    and    performing    other   similar

functions characteristic of an employer-employee relationship;

              (2)AAis free to determine the manner in which the work

or service is performed, including the hours of labor or the method

of payment;

              (3)AAis required to furnish necessary tools, supplies,

or materials to perform the work or service;          and

              (4)AApossesses skills required for the specific work or

service.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                        30
                                 LABOR CODE

                      TITLE 5. WORKERS ’ COMPENSATION

              SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

              CHAPTER 408. WORKERS ’ COMPENSATION BENEFITS

                     SUBCHAPTER A. GENERAL PROVISIONS

       Sec.A408.001.AAEXCLUSIVE REMEDY;             EXEMPLARY DAMAGES.             (a)

Recovery of workers ’ compensation benefits is the exclusive remedy

of an employee covered by workers ’ compensation insurance coverage

or a legal beneficiary against the employer or an agent or employee

of the employer for the death of or a work-related injury sustained

by the employee.

       (b)AAThis section does not prohibit the recovery of exemplary

damages by the surviving spouse or heirs of the body of a deceased

employee whose death was caused by an intentional act or omission of

the employer or by the employer ’s gross negligence.

       (c)AAIn   this   section,    "gross    negligence"     has   the     meaning

assigned by Section 41.001, Civil Practice and Remedies Code.

       (d)AAA    determination     under   Section       406.032,   409.002,        or

409.004   that   a   work-related   injury     is   noncompensable         does    not

adversely affect the exclusive remedy provisions under Subsection

(a).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.077, eff.

September 1, 2005.

       Sec.A408.002.AASURVIVAL       OF    CAUSE    OF   ACTION.      A    right    of

action survives in a case based on a compensable injury that results

in the employee ’s death.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1991.

       Sec.A408.003.AAREIMBURSABLE           EMPLOYER     PAYMENTS;             SALARY

CONTINUATION;    OFFSET AGAINST INCOME BENEFITS;            LIMITS.       (a)   After

an injury, an employer may:

              (1)AAinitiate    benefit       payments,      including       medical

                                      1
benefits;    or

              (2)AAon     the      written        request     or    agreement       of   the

employee, supplement income benefits paid by the insurance carrier

by an amount that does not exceed the amount computed by subtracting

the amount of the income benefit payments from the employee ’s net

preinjury wages.

       (b)AAIf an injury is found to be compensable and an insurance

carrier     initiates     compensation,            the   insurance       carrier     shall

reimburse    the   employer       for   the    amount    of   benefits     paid     by   the

employer to which the employee was entitled under this subtitle.

Payments that are not reimbursed or reimbursable under this section

may be reimbursed under Section 408.127.

       (c)AAThe employer shall notify the division and the insurance

carrier on forms prescribed by the commissioner of the initiation

of and amount of payments made under this section.

       (d)AAEmployer payments made under this section:

              (1)AAmay       not     be      construed        as    an    admission       of

compensability;     and

              (2)AAdo not affect the payment of benefits from another

source.

       (e)AAIf an employer does not notify the insurance carrier of

the injury in compliance with Section 409.005, the employer waives

the right to reimbursement under this section.

       (f)AASalary continuation payments made by an employer for an

employee ’s disability resulting from a compensable injury shall be

considered     payment       of    income         benefits    for    the       purpose    of

determining the accrual date of any subsequent income benefits

under this subtitle.

       (g)AAIf an employer is subject to a contractual obligation

with   an   employee    or   group      of    employees,      such   as    a    collective

bargaining agreement or a written agreement or policy, under which

the employer is required to make salary continuation payments, the

employer is not eligible for reimbursement under this section for

those payments.

       (h)AAPayments         made       as    salary     continuation          or   salary

supplementation do not affect the exclusive remedy provisions of

Section 408.001.

                                              2
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                        Amended

by Acts 1999, 76th Leg., ch. 954, Sec. 5, eff. Sept. 1, 1999;                           Acts

1999, 76th Leg., ch. 1003, Sec. 1, 2, eff. Sept. 1, 1999.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.078, eff.

September 1, 2005.

       Sec.A408.004.AAREQUIRED                     MEDICAL               EXAMINATIONS;

ADMINISTRATIVE VIOLATION.            (a)        The commissioner may require an

employee to submit to medical examinations to resolve any question

aboutAAthe     appropriateness       of    the    health    care       received    by    the

employee.

       (a-1)AAA doctor, other than a chiropractor, who performs a

required     medical     examination      under    this    section       is    subject    to

Section 408.0043.AAA chiropractor who performs a required medical

examination under this section is subject to Section 408.0045.

       (b)AAThe commissioner may require an employee to submit to a

medical examination at the request of the insurance carrier, but

only   after    the    insurance     carrier      has    attempted       and   failed     to

receive the permission and concurrence of the employee for the

examination.AAExcept as otherwise provided by this subsection, the

insurance carrier is entitled to the examination only once in a

180-day period.AAThe commissioner may adopt rules that require an

employee to submit to not more than three medical examinations in a

180-day      period      under   specified        circumstances,         including        to

determine      whether     there    has    been    a    change    in    the    employee ’s

condition and whether it is necessary to change the employee ’s

diagnosis.AAThe       commissioner        by    rule    shall    adopt    a    system    for

monitoring      requests     made    under       this    subsection       by    insurance

carriers.AAThat system must ensure that good cause exists for any

additional medical examination allowed under this subsection that

is not requested by the employee.AAA subsequent examination must be

performed     by   the    same   doctor    unless       otherwise      approved    by    the

commissioner.

       (c)AAThe insurance carrier shall pay for:

               (1)AAan examination required under Subsection (a) or

(b);   and

                                            3
                (2)AAthe reasonable expenses incident to the employee

in submitting to the examination.

        (d)AAAn injured employee is entitled to have a doctor of the

employee ’s     choice     present   at   an   examination         required     by    the

division at the request of an insurance carrier.AAThe insurance

carrier shall pay a fee set by the commissioner to the doctor

selected by the employee.

        (e)AAAn employee who, without good cause as determined by the

commissioner, fails or refuses to appear at the time scheduled for

an     examination       under    Subsection            (a)   or   (b)    commits      an

administrative violation.AA The commissioner by rule shall ensure

that an employee receives reasonable notice of an examination and

that    the     employee    is   provided      a    reasonable      opportunity        to

reschedule an examination missed by the employee for good cause.

        (f)AAThis section does not apply to health care provided

through a workers ’ compensation health care network established

under Chapter 1305, Insurance Code.

        (g)AAAn insurance carrier who makes a frivolous request for a

medical examination under Subsection (b), as determined by the

commissioner, commits an administrative violation.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 1997, 75th Leg., ch. 1133, Sec. 1, 2, eff. Sept. 1, 1999;

Acts 1999, 76th Leg., ch. 1426, Sec. 8, eff. Jan. 1, 2000;                           Acts

2001, 77th Leg., ch. 1456, Sec. 5.01, eff. June 17, 2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.079, eff.

September 1, 2005.

        Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 2, eff.

September 1, 2007.

        Sec. 408.0041.AADESIGNATED DOCTOR EXAMINATION.                    (a)    At the

request    of    an   insurance      carrier       or    an   employee,   or    on    the

commissioner ’s own order, the commissioner may order a medical

examination to resolve any question about:

                (1)AAthe impairment caused by the compensable injury;

                (2)AAthe attainment of maximum medical improvement;

                (3)AAthe extent of the employee ’s compensable injury;

                                          4
                   (4)AAwhether      the    injured   employee ’s    disability       is   a

direct result of the work-related injury;

                   (5)AAthe ability of the employee to return to work; or

                   (6)AAissues similar to those described by Subdivisions

(1)-(5).

        (b)AAExcept as provided by Section 408.1225(f), a medical

examination requested under Subsection (a) shall be performed by

the    next   available       doctor   on    the    division ’s    list    of   certified

designated doctors whose credentials are appropriate for the area

of    the   body    affected    by    the    injury   and   the   injured       employee ’s

diagnosis as determined by commissioner rule.AA The division shall

assign a designated doctor not later than the 10th day after the

date on which the request under Subsection (a) is approved, and the

examination must be conducted not later than the 21st day after the

date on which the commissioner issues the order under Subsection

(a).AAAn examination under this section may not be conducted more

frequently than every 60 days, unless good cause for more frequent

examinations exists, as defined by commissioner rules.

        (b-1)AAA designated doctor, other than a chiropractor, is

subject       to    Section    408.0043.AAA        designated      doctor       who   is   a

chiropractor is subject to Section 408.0045.AATo the extent of a

conflict between this section and Section 408.0043 or 408.0045,

this section controls.

        (c)AAThe treating doctor and the insurance carrier are both

responsible for sending to the designated doctor all of the injured

employee ’s medical records relating to the issue to be evaluated by

the designated doctor that are in their possession.AAThe treating

doctor and insurance carrier may send the records without a signed

release from the employee.AAThe designated doctor is authorized to

receive the employee ’s confidential medical records to assist in

the   resolution       of   disputes.AAThe         treating     doctor    and   insurance

carrier may also send the designated doctor an analysis of the

injured employee ’s medical condition, functional abilities, and

return-to-work opportunities.

        (d)AATo       avoid   undue    influence      on    a   person    selected    as   a

designated doctor under this section, and except as provided by

Subsection (c), only the injured employee or an appropriate member

                                              5
of the division ’s staff may communicate with the designated doctor

about the case regarding the injured employee ’s medical condition

or history before the examination of the injured employee by the

designated        doctor.AAAfter              that        examination             is     completed,

communication       with    the    designated            doctor         regarding       the    injured

employee ’s medical condition or history may be made only through

appropriate       division       staff     members.AAThe                designated      doctor          may

initiate communication with any doctor or health care provider who

has previously treated or examined the injured employee for the

work-related       injury    or    with           peer   reviewers            identified       by       the

insurance carrier.

         (e)AAThe       designated            doctor           shall           report         to        the

division.AAThe      report       of   the         designated        doctor       has    presumptive

weight    unless     the     preponderance               of    the       evidence       is     to       the

contrary.AAAn employer may make a bona fide offer of employment

subject    to     Sections       408.103(e)            and     408.144(c)          based       on       the

designated doctor ’s report.

         (f)AAUnless       otherwise          ordered         by        the   commissioner,             the

insurance carrier shall pay benefits based on the opinion of the

designated      doctor     during       the        pendency         of    any    dispute.          If    an

insurance carrier is not satisfied with the opinion rendered by a

designated doctor under this section, the insurance carrier may

request    the     commissioner          to       order       an    employee       to    attend          an

examination by a doctor selected by the insurance carrier.

         (f-1)AAThe      subsequent           injury          fund        shall     reimburse            an

insurance    carrier       for    any    overpayment               of    benefits      made    by       the

insurance carrier under Subsection (f) based on an opinion rendered

by a designated doctor if that opinion is reversed or modified by a

final    arbitration       award      or      a    final      order       or    decision       of       the

commissioner or a court.AAThe commissioner shall adopt rules to

provide     for     a    periodic          reimbursement                  schedule,       providing

reimbursement at least annually.

         (f-2)AAAn employee required to be examined by a designated

doctor    may    request    a     medical         examination            to    determine       maximum

medical improvement and the employee ’s impairment rating from the

treating doctor or from another doctor to whom the employee is

referred by the treating doctor if:

                                                   6
              (1)AAthe designated doctor ’s opinion is the employee ’s

first   evaluation    of   maximum   medical    improvement        and   impairment

rating; and

              (2)AAthe employee is not satisfied with the designated

doctor ’s opinion.

        (f-3)AAThe commissioner shall provide the insurance carrier

and the employee with reasonable time to obtain and present the

opinion of a doctor selected under Subsection (f) or (f-2) before

the commissioner makes a decision on the merits of the issue.

        (f-4)AAThe    commissioner     by     rule    shall     adopt    guidelines

prescribing the circumstances under which an examination by the

employee ’s treating doctor or another doctor to whom the employee

is referred by the treating doctor to determine any issue under

Subsection (a), other than an examination under Subsection (f-2),

may be appropriate.

        (g)AAExcept   as   otherwise       provided   by    this   subsection,    an

injured employee is entitled to have a doctor of the employee ’s

choice present at an examination requested by an insurance carrier

under Subsection (f).AAThe insurance carrier shall pay a fee set by

the commissioner to the doctor selected by the employee.AAIf the

injured employee is subject to a workers ’ compensation health care

network under Chapter 1305, Insurance Code, the doctor must be the

employee ’s treating doctor.

        (h)AAThe insurance carrier shall pay for:

              (1)AAan examination required under Subsection (a), (f),

or (f-2), unless otherwise prohibited by this subtitle or by an

order or rule of the commissioner; and

              (2)AAthe reasonable expenses incident to the employee

in submitting to the examination.

        (i)AAAn employee who, without good cause as determined by the

commissioner, fails or refuses to appear at the time scheduled for

an   examination      under    Subsection       (a)     or      (f)     commits   an

administrative violation.AAAn injured employee may not be fined

more than $10,000 for a violation of this subsection.

        (j)AAAn   employee    is     not    entitled       to   temporary    income

benefits, and an insurance carrier is authorized to suspend the

payment of temporary income benefits, during and for a period in

                                       7
which the employee fails to submit to an examination required by

Subsection (a) or (f) unless the commissioner determines that the

employee      had       good    cause     for     the    failure       to    submit    to     the

examination.AAThe commissioner may order temporary income benefits

to be paid for the period for which the commissioner determined that

the employee had good cause.AAThe commissioner by rule shall ensure

that:

                  (1)AAan       employee    receives       reasonable         notice    of     an

examination and the insurance carrier ’s basis for suspension; and

                  (2)AAthe employee is provided a reasonable opportunity

to reschedule an examination for good cause.

        (k)AAIf the report of a designated doctor indicates that an

employee has reached maximum medical improvement or is otherwise

able    to   return      to    work   immediately,        the    insurance      carrier       may

suspend      or    reduce       the   payment       of   temporary          income    benefits

immediately.

        (l)AAA person who makes a frivolous request for a medical

examination        under       Subsection     (a)   or   (f),    as    determined       by    the

commissioner, commits an administrative violation.

Added by Acts 2001, 77th Leg., ch. 1456, Sec. 5.02, eff. June 17,

2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.080, eff.

September 1, 2005.

        Acts 2007, 80th Leg., R.S., Ch. 1150 (S.B. 1169), Sec. 1, eff.

September 1, 2007.

        Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 3, eff.

September 1, 2007.

        Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 11,

eff. September 1, 2011.

        Sec. 408.0042.AAMEDICAL EXAMINATION BY TREATING DOCTOR TO

DEFINE COMPENSABLE INJURY.                  (a)     The division shall require an

injured      employee      to    submit    to   a   single      medical      examination      to

define the compensable injury on request by the insurance carrier.

        (b)AAA         medical    examination       under       this    section       shall    be

performed         by    the     employee ’s     treating        doctor.AAThe         insurance

                                                8
carrier shall pay the costs of the examination.

      (c)AAAfter        the     medical      examination          is     performed,       the

treating doctor shall submit to the insurance carrier a report that

details    all   injuries      and   diagnoses       related      to   the   compensable

injury, on receipt of which the insurance carrier shall:

             (1)AAaccept all injuries and diagnoses as related to

the compensable injury; or

             (2)AAdispute the determination of specific injuries and

diagnoses.

      (d)AAAny treatment for an injury or diagnosis that is not

accepted    by    the    insurance         carrier       under    Subsection       (c)      as

compensable at the time of the medical examination under Subsection

(a) must be preauthorized before treatment is rendered. If the

insurance carrier denies preauthorization because the treatment is

for an injury or diagnosis unrelated to the compensable injury, the

injured    employee     or    affected     health     care      provider     may   file     an

extent of injury dispute.

      (e)AAAny     treatment         for    an    injury     or    diagnosis       that     is

accepted    by    the    insurance         carrier       under    Subsection       (c)      as

compensable at the time of the medical examination under Subsection

(a) may not be reviewed for compensability, but may be reviewed for

medical necessity.

      (f)AAThe        commissioner          may      adopt       rules      relating        to

requirements      for    a     report       under        this     section,     including

requirements regarding the contents of a report.

      (g)AAThis       section    does      not    limit    an     injured    employee       or

insurance carrier ’s ability to request an examination under Section

408.004 or 408.0041, as provided by those sections.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.0805, eff.

September 1, 2005.

      Sec.       408.0043.AAPROFESSIONAL                 SPECIALTY         CERTIFICATION

REQUIRED FOR CERTAIN REVIEW.           (a)       This section applies to a person,

other than a chiropractor or a dentist, who performs health care

services under this title as:

             (1)AAa doctor performing peer review;

             (2)AAa     doctor       performing      a    utilization        review    of    a

                                             9
health care service provided to an injured employee;

              (3)AAa doctor performing an independent review of a

health care service provided to an injured employee;

              (4)AAa designated doctor;

              (5)AAa     doctor     performing       a      required          medical

examination; or

              (6)AAa doctor serving as a member of the medical quality

review panel.

      (b)AAA    person    described    by   Subsection      (a)    who   reviews     a

specific    workers ’   compensation    case   must       hold    a    professional

certification in a health care specialty appropriate to the type of

health care that the injured employee is receiving.

Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1,

eff. September 1, 2007.

Amended by:

      Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 14,

eff. September 1, 2009.

      Sec. 408.0044.AAREVIEW OF DENTAL SERVICES.                 (a)   This section

applies to a dentist who performs dental services under this title

as:

              (1)AAa    doctor    performing       peer    review        of    dental

services;

              (2)AAa    doctor   performing    a   utilization         review   of   a

dental service provided to an injured employee;

              (3)AAa doctor performing an independent review of a

dental service provided to an injured employee; or

              (4)AAa doctor performing a required dental examination.

      (b)AAA    person    described    by   Subsection      (a)    who   reviews     a

dental service provided in conjunction with a specific workers ’

compensation case must be licensed to practice dentistry.

Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1,

eff. September 1, 2007.

Amended by:

      Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 15,

eff. September 1, 2009.

                                       10
      Sec. 408.0045.AAREVIEW OF CHIROPRACTIC SERVICES.                            (a)    This

section    applies     to    a    chiropractor         who   performs      chiropractic

services under this title as:

              (1)AAa doctor performing peer review of chiropractic

services;

              (2)AAa    doctor      performing         a   utilization     review        of   a

chiropractic service provided to an injured employee;

              (3)AAa doctor performing an independent review of a

chiropractic service provided to an injured employee;

              (4)AAa        designated      doctor          providing      chiropractic

services;

              (5)AAa        doctor      performing           a    required          medical

examination; or

              (6)AAa chiropractor serving as a member of the medical

quality review panel.

      (b)AAA     person      described     by    Subsection       (a)   who       reviews     a

chiropractic     service      provided      in    conjunction       with      a    specific

workers ’ compensation           case   must    be   licensed      to   engage      in    the

practice of chiropractic.

Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1,

eff. September 1, 2007.

Amended by:

      Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 16,

eff. September 1, 2009.

      Sec. 408.0046.AARULES.              The commissioner may adopt rules as

necessary   to   determine        which    professional          health    practitioner

specialties are appropriate for treatment of certain compensable

injuries.AAThe rules adopted under this section must require an

entity requesting a peer review to obtain and provide to the doctor

providing peer review services all relevant and updated medical

records.

Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1,

eff. September 1, 2007.

      Sec.A408.005.AASETTLEMENTS                 AND       AGREEMENTS.            (a)         A

settlement may not provide for payment of benefits in a lump sum

                                           11
except as provided by Section 408.128.

       (b)AAAn employee ’s right to medical benefits as provided by

Section 408.021 may not be limited or terminated.

       (c)AAA   settlement         or    agreement    resolving          an    issue      of

impairment:

              (1)AAmay      not    be   made     before    the    employee         reaches

maximum medical improvement;            and

              (2)AAmust      adopt       an    impairment        rating       using      the

impairment rating guidelines described by Section 408.124.

       (d)AAA settlement must be signed by the commissioner and all

parties to the dispute.

       (e)AAThe      commissioner       shall    approve    a    settlement         if   the

commissioner is satisfied that:

              (1)AAthe settlement accurately reflects the agreement

between the parties;

              (2)AAthe      settlement          reflects        adherence          to    all

appropriate provisions of law and the policies of the division; and

              (3)AAunder the law and facts, the settlement is in the

best interest of the claimant.

       (f)AAA settlement that is not approved or rejected before the

16th   day   after    the   date    the       settlement   is     submitted        to    the

commissioner is considered to be approved by the commissioner on

that date.

       (g)AAA settlement takes effect on the date it is approved by

the commissioner.

       (h)AAA party to a settlement may withdraw acceptance of the

settlement at any time before its effective date.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.081, eff.

September 1, 2005.

       Sec.A408.006.AAMENTAL            TRAUMA    INJURIES.        (a)        It    is   the

express intent of the legislature that nothing in this subtitle

shall be construed to limit or expand recovery in cases of mental

trauma injuries.

       (b)AAA mental or emotional injury that arises principally

                                          12
from    a   legitimate   personnel     action,        including      a   transfer,

promotion, demotion, or termination, is not a compensable injury

under this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A408.007.AADATE OF INJURY FOR OCCUPATIONAL DISEASE.                       For

purposes of this subtitle, the date of injury for an occupational

disease is the date on which the employee knew or should have known

that the disease may be related to the employment.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A408.008.AACOMPENSABILITY           OF   HEART    ATTACKS.       A    heart

attack is a compensable injury under this subtitle only if:

              (1)AAthe attack can be identified as:

                    (A)AAoccurring at a definite time and place;                   and

                    (B)AAcaused by a specific event occurring in the

course and scope of the employee ’s employment;

              (2)AAthe    preponderance         of    the     medical    evidence

regarding the attack indicates that the employee ’s work rather than

the natural progression of a preexisting heart condition or disease

was a substantial contributing factor of the attack; and

              (3)AAthe attack was not triggered solely by emotional

or mental stress factors, unless it was precipitated by a sudden

stimulus.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                      SUBCHAPTER B. MEDICAL BENEFITS

        Sec.A408.021.AAENTITLEMENT         TO   MEDICAL      BENEFITS.       (a)       An

employee    who   sustains   a   compensable     injury      is   entitled       to   all

health care reasonably required by the nature of the injury as and

when needed.      The employee is specifically entitled to health care

that:

              (1)AAcures or relieves the effects naturally resulting

from the compensable injury;

              (2)AApromotes recovery;       or

              (3)AAenhances the ability of the employee to return to

                                      13
or retain employment.

       (b)AAMedical      benefits      are      payable     from       the    date     of    the

compensable injury.

       (c)AAExcept in an emergency, all health care must be approved

or recommended by the employee ’s treating doctor.

       (d)AAAn insurance carrier ’s liability for medical benefits

may not be limited or terminated by agreement or settlement.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A408.022.AASELECTION            OF    DOCTOR.         (a)         Except     in    an

emergency,   the      division     shall     require      an    employee          to   receive

medical   treatment     from   a    doctor      chosen    from     a   list       of   doctors

approved by the commissioner.AAA doctor may perform only those

procedures that are within the scope of the practice for which the

doctor is licensed.AAThe employee is entitled to the employee ’s

initial choice of a doctor from the division ’s list.

       (b)AAIf an employee is dissatisfied with the initial choice

of a doctor from the division ’s list, the employee may notify the

division and request authority to select an alternate doctor.AAThe

notification must be in writing stating the reasons for the change,

except notification may be by telephone when a medical necessity

exists for immediate change.

       (c)AAThe commissioner shall prescribe criteria to be used by

the   division   in    granting     the    employee       authority          to    select    an

alternate doctor.AAThe criteria may include:

             (1)AAwhether          treatment      by     the     current          doctor     is

medically inappropriate;

             (2)AAthe professional reputation of the doctor;

             (3)AAwhether        the   employee        is      receiving       appropriate

medical care to reach maximum medical improvement; and

             (4)AAwhether a conflict exists between the employee and

the doctor to the extent that the doctor-patient relationship is

jeopardized or impaired.

       (d)AAA change of doctor may not be made to secure a new

impairment rating or medical report.

       (e)AAFor purposes of this section, the following is not a

selection of an alternate doctor:

                                           14
              (1)AAa   referral   made       by    the    doctor    chosen     by    the

employee if the referral is medically reasonable and necessary;

              (2)AAthe receipt of services ancillary to surgery;

              (3)AAthe obtaining of a second or subsequent opinion

only on the appropriateness of the diagnosis or treatment;

              (4)AAthe selection of a doctor because the original

doctor:

                   (A)AAdies;

                   (B)AAretires;       or

                   (C)AAbecomes        unavailable        or   unable    to    provide

medical care to the employee;      or

              (5)AAa change of doctors required because of a change of

residence by the employee.

       (f)AAThis section does not apply to requirements regarding

the selection of a doctor under a workers ’ compensation health care

network established under Chapter 1305, Insurance Code, except as

provided by that chapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.082, eff.

September 1, 2005.

       Sec. 408.0221.AAREQUEST FOR DESCRIPTION OF EMPLOYMENT.                        (a)

This section applies only to an employee of an employer who has 10

or more employees.

       (b)AATo    facilitate      an     injured         employee ’s     return       to

employment as soon as it is considered safe and appropriate by the

injured employee ’s treating doctor, the treating doctor may request

that the injured employee ’s employer provide the treating doctor

with   the   information   described        by    Subsection    (d)     on    the   form

adopted under that subsection.

       (c)AAInformation     provided         to    a     treating     doctor        under

Subsection (b) does not constitute:

              (1)AAa   request    by    the       employer     that     the    injured

employee return to the employment;

              (2)AAan offer of employment by the employer for the

injured employee to return to employment; or

                                        15
             (3)AAan admission of the compensability of the injury

of the employee.

        (d)AAThe    commissioner       shall      prescribe            a    form    to    provide

information from an employer to a treating doctor concerning the

functions and physical responsibilities of an injured employee ’s

job.AATo    the    extent    possible,      the        form     prescribed          under       this

subsection shall be one page, use a check box format as appropriate,

and be compatible with electronic mail.AAThe form must include:

             (1)AAthe       name   and     address         of    the       employer      and    the

contact     information       and         availability            of        the     individual

representing      the     employer    who       has     knowledge           of     the    injured

employee ’s job;

             (2)AAthe scope of the injured employee ’s employment,

including any specific tasks, job duties, or work activities that

the    injured    employee   was     required         to   perform         at    the     time   the

employee sustained the injury; and

             (3)AAan area for additional comments or informationAAby

the employer or individual representing the employer concerning:

                     (A)AAthe injured employee ’s job; or

                     (B)AAthe availability, if any, of other jobs that

the employer may have that the employer would like the treating

doctor to consider in determining whether an injured employee is

able to return to work.

        (e)AAThe    commissioner          may    adopt        rules        as    necessary       to

implement this section and to facilitate communication between the

employer    and     the     treating       doctor          regarding            return-to-work

opportunities.

Added by Acts 2009, 81st Leg., R.S., Ch. 456 (H.B. 2547), Sec. 1,

eff. September 1, 2009.

        Sec. 408.023.AALIST OF APPROVED DOCTORS; DUTIES OF TREATING

DOCTORS.   (a)    The division shall develop a list of doctors licensed

in this state who are approved to provide health care services under

this    subtitle.AAA      doctor     is    eligible         to    be       included       on    the

division ’s list of approved doctors if the doctor:

             (1)AAregisters          with        the       division         in     the     manner

prescribed by commissioner rules; and

                                            16
               (2)AAcomplies        with    the   requirements          adopted    by   the

commissioner under this section.

        (b)AAThe    commissioner       by    rule      shall   establish       reasonable

requirements     for     training     for    doctors      as    a     prerequisite      for

inclusion   on     the   list.AAExcept       as     otherwise         provided    by    this

section, the requirements adopted under this subsection apply to

doctors and other health care providers who:

               (1)AAprovide health care services as treating doctors;

               (2)AAprovide health care services as authorized by this

chapter;

               (3)AAperform medical peer review under this subtitle;

               (4)AAperform        utilization      review      of    medical     benefits

provided under this subtitle; or

               (5)AAprovide health care services on referral from a

treating doctor, as provided by commissioner rule.

        (c)AAThe division shall issue to a doctor who is approved by

the commissioner a certificate of registration.AAIn determining

whether to issue a certificate of registration, the commissioner

may consider and condition approval on any practice restrictions

applicable to the applicant that are relevant to services provided

under   this    subtitle.AAThe        commissioner        may       also   consider     the

practice restrictions of an applicant when determining appropriate

sanctions under Section 408.0231.

        (d)AAA certificate of registration issued under this section

is valid, unless revoked, suspended, or revised, for the period

provided by commissioner rule and may be renewed on application to

the division.AAThe division shall provide notice to each doctor on

the approved doctor list of the pending expiration of the doctor ’s

certificate of registration not later than the 60th day before the

date of expiration of the certificate.

        (e)AANotwithstanding         other       provisions      of    this   section,    a

doctor not licensed in this state but licensed in another state or

jurisdiction who treats employees or performs utilization review of

health care for an insurance carrier may apply for a certificate of

registration under this section to be included on the division ’s

list of approved doctors.

        (f)AAExcept      in   an   emergency      or    for    immediate      post-injury

                                            17
medical care as defined by commissioner rule, or as provided by

Subsection (h), (i), or (j), each doctor who performs functions

under this subtitle, including examinations under this chapter,

must hold a certificate of registration and be on the division ’s

list of approved doctors in order to perform services or receive

payment for those services.

        (g)AAThe commissioner by rule shall modify registration and

training requirements for doctors who infrequently provide health

care or who perform utilization review or peer review functions for

insurance carriers as necessary to ensure that those doctors are

informed    of   the    regulations     that    affect     health      care   benefit

delivery under this subtitle.

        (h)AANotwithstanding        Section    4201.152,        Insurance     Code,   a

utilization review agent or an insurance carrier that uses doctors

to perform reviews of health care services provided under this

subtitle,   including       utilization      review,      may   only    use   doctors

licensed to practice in this state.

        (i)AAThe       commissioner     may     grant      exceptions         to   the

requirement imposed under Subsection (f) as necessary to ensure

that:

             (1)AAemployees have access to health care; and

             (2)AAinsurance carriers have access to evaluations of

an   employee ’s   health    care     and    income    benefit     eligibility        as

provided by this subtitle.

        (j)AAA   doctor    who   contracts     with   a   workers ’ compensation

health care network certified under Chapter 1305, Insurance Code,

is not subject to the registration requirements of Subsections

(a)-(i) for the purpose of providing health care services under

that network contract.AAThe doctor is subject to the requirements

of Subsections (l)-(p), and Subsection (q) applies to health care

services and functions provided by a doctor who contracts with a

certified workers ’ compensation health care network.

        (k)AAThe requirements of Subsections (a)-(g) and Subsection

(i) expire September 1, 2007.AABefore that date, the commissioner

may waive the application of the provisions of Subsections (a)-(g)

and Subsection (i) that require doctors to hold a certificate of

registration and to be on the list of approved doctors if the

                                        18
commissioner determines that:

               (1)AAinjured employees have adequate access to health

care   providers       who    are    willing      to     treat    injured       employees      for

compensable         injuries    through      workers ’ compensation              health     care

networks certified under Chapter 1305, Insurance Code; or

               (2)AAinjured employees who are not covered by a workers ’

compensation        health     care   network         certified     under       Chapter   1305,

Insurance      Code,    do     not    have       adequate        access    to    health     care

providers      who     are     willing       to       treat      injured     employees         for

compensable injuries.

        (l)AAThe injured employee ’s treating doctor is responsible

for the efficient management of medical care as required by Section

408.025(c)     and     commissioner         rules.AAThe          division       shall   collect

information regarding:

               (1)AAreturn-to-work outcomes;

               (2)AApatient satisfaction; and

               (3)AAcost and utilization of health care provided or

authorized by a treating doctor on the list of approved doctors.

        (m)AAThe commissioner may adopt rules to define the role of

the    treating      doctor    and    to    specify       outcome       information       to   be

collected for a treating doctor.

        (n)AAThe      commissioner          by    rule    shall    establish       reasonable

requirements for doctors, and health care providers financially

related to those doctors, regarding training, impairment rating

testing,      and    disclosure       of    financial      interests        as   required       by

Section 413.041, and for monitoring of those doctors and health

care providers as provided by Sections 408.0231, 413.0511, and

413.0512.

        (o)AAA       doctor,    including         a    doctor     who     contracts     with     a

workers ’ compensation health care network, shall:

               (1)AAcomply           with    the       requirements         established         by

commissioner rule under Subsections (l) and (m) and with Section

413.041 regarding the disclosure of financial interests; and

               (2)AAif the doctor intends to provide certifications of

maximum medical improvement or assign impairment ratings, comply

with    the   impairment        rating      training       and     testing       requirements

established by commissioner rule under Subsection (n).

                                                 19
         (p)AAA    person    required       to    comply         with     Subsection         (o),

including    a    doctor    who    contracts      with       a   workers ’ compensation

health care network, who does not comply with that section commits

an administrative violation.

         (q)AAAn insurance carrier may not use, for the purpose of

suspending       temporary    income       benefits         or    computing          impairment

income benefits, a certification of maximum medical improvement or

an impairment rating assigned by a doctor, including a doctor who

contracts     with    a     workers ’     compensation            health       care       network

certified under Chapter 1305, Insurance Code, who fails to comply

with Subsection (o)(2).

         (r)AANotwithstanding the waiver or expiration of Subsections

(a)-(g) and (i), there may be no direct or indirect provision of

health    care     under   this    subtitle      and     rules         adopted      under    this

subtitle, and no direct or indirect receipt of remuneration under

this subtitle and rules adopted under this subtitle by a doctor who:

              (1)AAbefore September 1, 2007:

                      (A)AAwas      removed       or    deleted         from    the      list   of

approved     doctors       either    by     action          of    the     Texas          Workers ’

Compensation Commission or the division or by agreement with the

doctor;

                      (B)AAwas      not    admitted         to   the     list       of   approved

doctors    either     by    action    of    the    Texas         Workers ’      Compensation

Commission or the division or by agreement with the doctor;

                      (C)AAwas      suspended          from      the    list     of      approved

doctors    either     by    action    of    the    Texas         Workers ’      Compensation

Commission or the division or by agreement with the doctor; or

                      (D)AAhad       the     doctor ’s           license        to       practice

suspended     by    the    appropriate       licensing            agency,        including       a

suspension that was stayed, deferred, or probated, or voluntarily

relinquished the license to practice; and

              (2)AAwas       not    reinstated         or     restored         by    the    Texas

Workers ’ Compensation Commission or the division to the list of

approved doctors before September 1, 2007.

         (s)AAThe waiver or expiration of Subsections (a)-(g) and (i)

do not limit the division ’s ability to impose sanctions as provided

by this subtitle and commissioner rules.

                                            20
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.25, eff. Sept. 1, 1995;

Acts 2001, 77th Leg., ch. 1456, Sec. 1.01, eff. Sept. 1, 2001.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.083, eff.

September 1, 2005.

      Acts 2007, 80th Leg., R.S., Ch. 134 (H.B. 1006), Sec. 2, eff.

September 1, 2007.

      Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 17,

eff. September 1, 2009.

      Sec.    408.0231.AAMAINTENANCE          OF     LIST    OF    APPROVED    DOCTORS;

SANCTIONS    AND   PRIVILEGES     RELATING      TO    HEALTH       CARE.      (a)     The

commissioner    shall    delete   from    the      list     of    approved    doctors    a

doctor:

              (1)AAwho    fails    to    register         with      the    division     as

provided by this chapter and commissioner rules;

              (2)AAwho is deceased;

              (3)AAwhose    license      to     practice          in   this   state     is

revoked, suspended, or not renewed by the appropriate licensing

authority; or

              (4)AAwho requests to be removed from the list.

      (b)AAThe commissioner by rule shall establish criteria for:

              (1)AAdeleting or suspending a doctor from the list of

approved doctors;

              (2)AAimposing sanctions on a doctor or an insurance

carrier as provided by this section;

              (3)AAmonitoring      of     utilization            review    agents,      as

provided by a memorandum of understanding between the division and

the Texas Department of Insurance; and

              (4)AAauthorizing      increased          or        reduced   utilization

review and preauthorization controls on a doctor.

      (c)AARules adopted under Subsection (b) are in addition to,

and do not affect, the rules adopted under Section 415.023(b).AAThe

criteria for deleting a doctor from the list or for recommending or

imposing sanctions may include anything the commissioner considers

relevant, including:

                                         21
               (1)AAa sanction of the doctor by the commissioner for a

violation of Chapter 413 or Chapter 415;

               (2)AAa sanction by the Medicare or Medicaid program

for:

                      (A)AAsubstandard medical care;

                      (B)AAovercharging;

                      (C)AAoverutilization of medical services; or

                      (D)AAany    other    substantive       noncompliance          with

requirements of those programs regarding professional practice or

billing;

               (3)AAevidence from the division ’s medical records that

the applicable insurance carrier ’s utilization review practices or

the doctor ’s charges, fees, diagnoses, treatments, evaluations, or

impairment     ratings    are    substantially      different        from   those    the

commissioner finds to be fair and reasonable based on either a

single determination or a pattern of practice;

               (4)AAa     suspension       or      other     relevant        practice

restriction of the doctor ’s license by an appropriate licensing

authority;

               (5)AAprofessional      failure       to     practice     medicine      or

provide health care, including chiropractic care, in an acceptable

manner consistent with the public health, safety, and welfare;

               (6)AAfindings of fact and conclusions of law made by a

court,    an   administrative       law    judge    of     the   State      Office   of

Administrative Hearings, or a licensing or regulatory authority; or

               (7)AAa criminal conviction.

         (d)AAThe   commissioner     by    rule    shall    establish       procedures

under which a doctor may apply for:

               (1)AAreinstatement to the list of approved doctors; or

               (2)AArestoration of doctor practice privileges removed

by the commissioner based on sanctions imposed under this section.

         (e)AAThe commissioner shall act on a recommendation by the

medical advisor selected under Section 413.0511 and, after notice

and the opportunity for a hearing, may impose sanctions under this

section on a doctor or an insurance carrier or may recommend action

regarding a utilization review agent.AAThe commissioner and the

commissioner     of     insurance   shall       enter    into    a    memorandum     of

                                          22
understanding to coordinate the regulation of insurance carriers

and utilization review agents as necessary to ensure:

               (1)AAcompliance with applicable regulations; and

               (2)AAthat appropriate health care decisions are reached

under this subtitle and under Chapter 4201, Insurance Code.

         (f)AAThe sanctions the commissioner may recommend or impose

under this section include:

               (1)AAreduction of allowable reimbursement;

               (2)AAmandatory       preauthorization           of   all   or   certain

health care services;

               (3)AArequired peer review monitoring, reporting, and

audit;

               (4)AAdeletion or suspension from the approved doctor

list and the designated doctor list;

               (5)AArestrictions on appointment under this chapter;

               (6)AAconditions or restrictions on an insurance carrier

regarding actions by insurance carriers under this subtitle in

accordance     with    the    memorandum    of    understanding        adopted   under

Subsection (e); and

               (7)AAmandatory       participation        in    training   classes     or

other courses as established or certified by the division.

         (g)AAThe commissioner shall adopt rules regarding doctors

who perform peer review functions for insurance carriers.AAThose

rules    may   include       standards     for    peer   review,       imposition     of

sanctions on doctors performing peer review functions, including

restriction, suspension, or removal of the doctor ’s ability to

perform peer review on behalf of insurance carriers in the workers ’

compensation system, and other issues important to the quality of

peer    review,   as   determined     by    the   commissioner.AAA        doctor    who

performs peer review under this subtitle must hold the appropriate

professional license issued by this state.AAA doctor, other than a

chiropractor or a dentist, who performs peer review is subject to

Section 408.0043.AAA dentist who performs a peer review of a dental

service    provided    to    an   injured   employee      is    subject   to   Section

408.0044.AAA      chiropractor       who    performs      a     peer   review    of   a

chiropractic service provided to an injured employee is subject to

Section 408.0045.

                                           23
Added by Acts 2001, 77th Leg., ch. 1456, Sec. 1.01, eff. June 17,

2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.084, eff.

September 1, 2005.

        Acts 2007, 80th Leg., R.S., Ch. 134 (H.B. 1006), Sec. 3, eff.

September 1, 2007.

        Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 4, eff.

September 1, 2007.

        Sec.   408.024.AANONCOMPLIANCE              WITH   SELECTION   REQUIREMENTS.

Except as otherwise provided, and after notice and an opportunity

for hearing, the commissioner may relieve an insurance carrier of

liability      for     health   care   that    is   furnished    by    a   health   care

provider or another person selected in a manner inconsistent with

the requirements of this subchapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.085, eff.

September 1, 2005.

        Sec.A408.025.AAREPORTS AND RECORDS REQUIRED FROM HEALTH CARE

PROVIDERS.       (a)    The commissioner by rule shall adopt requirements

for reports and records that are required to be filed with the

division    or    provided      to    the   injured    employee,      the    employee ’s

attorney, or the insurance carrier by a health care provider.

        (b)AAThe commissioner by rule shall adopt requirements for

reports and records that are to be made available by a health care

provider to another health care provider to prevent unnecessary

duplication of tests and examinations.

        (c)AAThe       treating      doctor    is   responsible    for      maintaining

efficient utilization of health care.

        (d)AAOn the request of an injured employee, the employee ’s

attorney, or the insurance carrier, a health care provider shall

furnish records relating to treatment or hospitalization for which

compensation is being sought.AAThe division may regulate the charge

for furnishing a report or record, but the charge may not be less

                                              24
than the fair and reasonable charge for furnishing the report or

record.AAA    health     care   provider    may   disclose    to    the   insurance

carrier of an affected employer records relating to the diagnosis

or treatment of the injured employee without the authorization of

the injured employee to determine the amount of payment or the

entitlement to payment.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                 Amended

by Acts 1999, 76th Leg., ch. 1426, Sec. 9, eff. Sept. 1, 1999.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.086, eff.

September 1, 2005.

        Sec. 408.0251.AAELECTRONIC BILLING REQUIREMENTS.                  (a)     The

commissioner, by rule and in cooperation with the commissioner of

insurance, shall adopt rules regarding the electronic submission

and   processing    of   medical    bills    by   health     care   providers     to

insurance carriers.

        (b)AAInsurance carriers shall accept medical bills submitted

electronically      by   health    care     providers    in    accordance       with

commissioner rule.

        (c)AAThe commissioner shall by rule establish criteria for

granting exceptions to insurance carriers and health care providers

who are unable to submit or accept medical bills electronically.

        (d)AAOn or after January 1, 2008, the commissioner may adopt

rules   regarding      the   electronic     payment     of    medical     bills   by

insurance carriers to health care providers.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.087, eff.

September 1, 2005.

        Sec. 408.0252.AAUNDERSERVED AREAS.          The commissioner by rule

may identify areas of this state in which access to health care

providers is less available and may adopt appropriate standards,

guidelines, and rules regarding the delivery of health care in

those areas.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.087, eff.

September 1, 2005.

                                      25
         Sec.    408.026.AASPINAL            SURGERY.            Except       in     a    medical

emergency, an insurance carrier is liable for medical costs related

to    spinal     surgery       only    as    provided       by    Section          413.014       and

commissioner rules.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                                Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 4.01, eff. June 17, 2001.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.088, eff.

September 1, 2005.

         Sec.   408.027.AAPAYMENT            OF   HEALTH    CARE       PROVIDER.           (a)     A

health    care       provider    shall      submit   a   claim         for   payment       to    the

insurance carrier not later than the 95th day after the date on

which    the    health        care    services     are     provided          to    the    injured

employee.AAFailure by the health care provider to timely submit a

claim for payment constitutes a forfeiture of the provider ’s right

to reimbursement for that claim for payment.

         (b)AAThe      insurance       carrier       must      pay,        reduce,       deny,    or

determine to audit the health care provider ’s claim not later than

the   45th     day    after    the    date   of    receipt       by    the   carrier       of    the

provider ’s          claim.AAThe         carrier         may          request        additional

documentation necessary to clarify the provider ’s charges at any

time during the 45-day period.AAIf the insurance carrier requests

additional documentation under this subsection, the health care

provider must provide the requested documentation not later than

the 15th day after the date of receipt of the carrier ’s request.AAIf

the insurance carrier elects to audit the claim, the carrier must

complete the audit not later than the 160th day after the date of

receipt by the carrier of the health care provider ’s claim, and, not

later than the 160th day after the receipt of the claim, must make a

determination         regarding       the    relationship             of   the     health       care

services provided to the compensable injury, the extent of the

injury, and the medical necessity of the services provided.AAIf the

insurance carrier chooses to audit the claim, the insurance carrier

must pay to the health care provider not later than the 45th day

after the date of receipt by the carrier of the provider ’s claim 85

percent of:

                                              26
                (1)AAthe amount for the health care service established

under the fee guidelines authorized under this subtitle if the

health care service is not provided through a workers ’ compensation

health care network under Chapter 1305, Insurance Code; or

                (2)AAthe amount of the contracted rate for that health

care   service       if   the   health    care      service   is   provided       through    a

workers ’ compensation           health      care    network    under   Chapter        1305,

Insurance Code.

         (c)AAIf the health care services provided are determined to

be appropriate, the insurance carrier shall pay the health care

provider the remaining 15 percent of the claim not later than the

160th day after the date of receipt by the carrier of the health

care provider ’s documentation of the claim.AAAn insurance carrier

commits an administrative violation if the carrier, in violation of

Subsection (b), fails to:

                (1)AApay,       reduce,      deny,    or   notify    the     health      care

provider of the intent to audit the claim by the 45th day after the

date of receipt by the carrier of the health care provider ’s claim;

or

                (2)AApay, reduce, or deny an audited claim by the 160th

day after the date of receipt of the claim.

         (d)AAIf an insurance carrier contests the compensability of

an injury and the injury is determined not to be compensable, the

carrier may recover the amounts paid for health care services from

the employee ’s accident or health benefit plan, or any other person

who may be obligated for the cost of the health care services.AAIf

an accident or health insurance carrier or other person obligated

for the cost of health care services has paid for health care

services       for   an   employee     for     an    injury    for   which    a    workers ’

compensation         insurance    carrier        denies    compensability,         and   the

injury    is    later     determined      to   be    compensable,     the    accident       or

health insurance carrier or other person may recover the amounts

paid for such services from the workers ’ compensation insurance

carrier.AAIf         an   accident   or    health      insurance     carrier      or   other

person obligated for the cost of health care services has paid for

health care services for an employee for an injury for which the

workers ’ compensation insurance carrier or the employer has not

                                               27
disputed compensability, the accident or health insurance carrier

or    other      person     may    recover    reimbursement          from   the       insurance

carrier in the manner described by Section 409.009 or 409.0091, as

applicable.

         (e)AAIf an insurance carrier disputes the amount of payment

or the health care provider ’s entitlement to payment, the insurance

carrier shall send to the division, the health care provider, and

the    injured      employee       a     report    that    sufficiently      explains       the

reasons for the reduction or denial of payment for health care

services         provided    to     the    employee.AAThe          insurance   carrier       is

entitled to a hearing as provided by Section 413.031(d).

         (f)AAExcept as provided by Section 408.0281 or 408.0284, any

payment made by an insurance carrier under this section shall be in

accordance with the fee guidelines authorized under this subtitle

if    the    health   care    service       is    not    provided    through      a    workers ’

compensation        health        care    network      under   Chapter   1305,        Insurance

Code, or at a contracted rate for that health care service if the

health care service is provided through a workers ’ compensation

health care network under Chapter 1305, Insurance Code.

         (g)AANotwithstanding any other provision in this subtitle or

Chapter 1305, Insurance Code, this section and Section 408.0271

apply       to   health   care      provided       through     a   workers ’ compensation

health       care   network       established          under   Chapter   1305,        Insurance

Code.AAThe commissioner shall adopt rules as necessary to implement

the provisions of this section and Section 408.0271.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                             Amended

by Acts 1999, 76th Leg., ch. 1426, Sec. 10, eff. Sept. 1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.089, eff.

September 1, 2005.

         Acts 2007, 80th Leg., R.S., Ch. 1007 (H.B. 724), Sec. 4, eff.

September 1, 2007.

         Acts 2011, 82nd Leg., R.S., Ch. 705 (H.B. 528), Sec. 1, eff.

June 17, 2011.

         Acts 2013, 83rd Leg., R.S., Ch. 1202 (S.B. 1322), Sec. 1, eff.

September 1, 2013.

                                                  28
        Sec. 408.0271.AAREIMBURSEMENT BY HEALTH CARE PROVIDER.                        (a)

If the health care services provided to an injured employee are

determined    by    the    insurance      carrier     to    be    inappropriate,      the

insurance carrier shall:

              (1)AAnotify the health care provider in writing of the

carrier ’s decision; and

              (2)AAdemand a refund by the health care provider of the

portion of payment on the claim that was received by the health care

provider for the inappropriate services.

        (b)AAThe     health      care   provider      may    appeal    the     insurance

carrier ’s   determination        under    Subsection       (a).AAThe       health    care

provider     must   file    an    appeal    under     this       subsection    with   the

insurance carrier not later than the 45th day after the date of the

insurance carrier ’s request for the refund.AAThe insurance carrier

must act on the appeal not later than the 45th day after the date on

which the provider files the appeal.

        (c)AAA health care provider shall reimburse the insurance

carrier for payments received by the provider for inappropriate

charges not later than the 45th day after the date of the carrier ’s

notice.AAThe failure by the health care provider to timely remit

payment to the carrier constitutes an administrative violation.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.0895, eff.

September 1, 2005.

        Sec. 408.0272.AACERTAIN EXCEPTIONS FOR UNTIMELY SUBMISSION

OF CLAIM. (a)       In this section:

              (1)AA"Group        accident       and   health      insurance"    has   the

meaning assigned by Chapter 1251, Insurance Code.

              (2)AA"Health maintenance organization" has the meaning

assigned by Chapter 843, Insurance Code.

        (b)AANotwithstanding Section 408.027, a health care provider

who fails to timely submit a claim for payment to the insurance

carrier under Section 408.027(a) does not forfeit the provider ’s

right   to   reimbursement        for   that     claim     for    payment    solely   for

failure to submit a timely claim if:

              (1)AAthe     provider       submits     proof      satisfactory    to   the

commissioner that the provider, within the period prescribed by

                                           29
Section 408.027(a), erroneously filed for reimbursement with:

                      (A)AAan    insurer          that   issues       a    policy     of   group

accident and health insurance under which the injured employee is a

covered insured;

                      (B)AAa     health       maintenance             organization          that

issues an evidence of coverage under which the injured employee is a

covered enrollee; or

                      (C)AAa    workers ’ compensation                insurance          carrier

other than the insurance carrier liable for the payment of benefits

under this title; or

               (2)AAthe       commissioner         determines         that      the      failure

resulted from a catastrophic event that substantially interfered

with the normal business operations of the provider.

        (c)AANotwithstanding Subsection (b), a health care provider

who erroneously submits a claim for payment to an entity described

by Subdivision (1) of that subsection forfeits the provider ’s right

to reimbursement for that claim if the provider fails to submit the

claim to the correct workers ’ compensation insurance carrier within

95 days after the date the provider is notified of the provider ’s

erroneous submission of the claim.

        (d)AANotwithstanding any other provision of this section or

Section 408.027, the period for submitting a claim for payment may

be extended by agreement of the parties.

Added by Acts 2007, 80th Leg., R.S., Ch. 459 (H.B. 1005), Sec. 1,

eff. September 1, 2007.

        Sec.A408.028.AAPHARMACEUTICAL SERVICES.                           (a)   A physician

providing care to an employee under this subchapter shall prescribe

for    the   employee    any    necessary         prescription            drugs,    and    order

over-the-counter        alternatives         to     prescription            medications         as

clinically      appropriate       and     applicable,            in       accordance        with

applicable state law and as provided by Subsection (b).                                  A doctor

providing      care     may    order    over-the-counter                  alternatives          to

prescription       medications,         when        clinically            appropriate,          in

accordance with applicable state law and as provided by Subsection

(b).

        (b)AAThe      commissioner      by    rule       shall    require          the    use   of

                                             30
generic      pharmaceutical          medications         and    clinically             appropriate

over-the-counter alternatives to prescription medications unless

otherwise specified by the prescribing doctor, in accordance with

applicable      state       law.AAThe      commissioner         by       rule       shall    adopt    a

closed      formulary       under    Section       413.011.AARules                 adopted    by    the

commissioner shall allow an appeals process for claims in which a

treating doctor determines and documents that a drug not included

in    the    formulary      is     necessary      to    treat       an    injured       employee ’s

compensable injury.

         (c)AAExcept         as    otherwise      provided      by        this       subtitle,       an

insurance carrier may not require an employee to use pharmaceutical

services designated by the carrier.

         (d)AAThe commissioner shall adopt rules to allow an employee

to     purchase          over-the-counter             alternatives             to     prescription

medications prescribed or ordered under Subsection (a) or (b) and

to    obtain    reimbursement            from    the    insurance         carrier       for       those

medications.

         (e)AANotwithstanding             Subsection       (b),      the           commissioner      by

rule shall allow an employee to purchase a brand name drug rather

than    a    generic       pharmaceutical          medication            or    over-the-counter

alternative to a prescription medication if a health care provider

prescribes           a     generic        pharmaceutical             medication              or      an

over-the-counter alternative to a prescription medication.AAThe

employee shall be responsible for paying the difference between the

cost    of     the       brand    name    drug     and    the       cost       of     the    generic

pharmaceutical medication or of an over-the-counter alternative to

a     prescription           medication.AAThe             employee             may      not        seek

reimbursement for the difference in cost from an insurance carrier

and    is    not     entitled       to    use     the    medical         dispute        resolution

provisions      of       Chapter    413    with    regard      to    the       prescription.AAA

payment described by this subsection by an employee to a health care

provider does not violate Section 413.042.AAThis subsection does

not affect the duty of a health care provider to comply with the

requirements         of    Subsection      (b)    when    prescribing               medications      or

ordering        over-the-counter                 alternatives                 to      prescription

medications.

         (f)AANotwithstanding any other provision of this title, the

                                                 31
commissioner by rule shall adopt a fee schedule for pharmacy and

pharmaceutical services that will:

                (1)AAprovide    reimbursement        rates     that    are   fair   and

reasonable;

                (2)AAassure adequate access to medications and services

for injured workers;

                (3)AAminimize      costs      to    employees         and    insurance

carriers; and

                (4)AAtake into consideration the increased security of

payment afforded by this subtitle.

           (g)AASection 413.011(d) and the rules adopted to implement

that subsection do not apply to the fee schedule adopted by the

commissioner under Subsection (f).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 6.01, eff. June 17, 2001;

Acts 2003, 78th Leg., ch. 468, Sec. 1, eff. Sept. 1, 2003.

Amended by:

           Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.090, eff.

September 1, 2005.

           Acts 2011, 82nd Leg., R.S., Ch. 705 (H.B. 528), Sec. 2, eff.

June 17, 2011.

           Sec. 408.0281.AAREIMBURSEMENT FOR PHARMACEUTICAL SERVICES;

ADMINISTRATIVE VIOLATION.          (a)AAIn this section:

                (1)AA"Informal network" means a network that:

                        (A)AAis established under a contract between an

insurance carrier or an insurance carrier ’s authorized agent and a

health care provider for the provision of pharmaceutical services;

and

                        (B)AAincludes a specific fee schedule.

                (2)AA"Voluntary     network"       means   a   voluntary      workers ’

compensation health care delivery network established under former

Section 408.0223, as that section existed before repeal by Chapter

265 (H.B. 7), Acts of the 79th Legislature, Regular Session, 2005,

by    an    insurance    carrier   for   the    provision       of    pharmaceutical

services.

           (b)AANotwithstanding      any      provision        of     Chapter     1305,

                                         32
Insurance    Code,       or    Section       504.053    of    this   code,       prescription

medication or services, as defined by Section 401.011(19)(E):

              (1)AAmay         be     reimbursed       in    accordance       with     the     fee

guidelines adopted by the commissioner or at a contract rate in

accordance with this section; and

              (2)AAmay not be delivered through:

                         (A)AAa workers ’ compensation health care network

under Chapter 1305, Insurance Code; or

                         (B)AAa        contract             described           by      Section

504.053(b)(2).

       (c)AANotwithstanding              any    other       provision      of    this     title,

including Section 408.028(f), or any provision of Chapter 1305,

Insurance Code, an insurance carrier may pay a health care provider

fees for pharmaceutical services that are inconsistent with the fee

guidelines adopted by the commissioner only if the carrier has a

contract with the health care provider and that contract includes a

specific     fee   schedule.AAAn             insurance      carrier     or    the    carrier ’s

authorized agent may use an informal or voluntary network to obtain

a contractual agreement that provides for fees different from the

fees   authorized         under        the     fee     guidelines       adopted         by     the

commissioner       for    pharmaceutical           services.AAIf       a     carrier      or   the

carrier ’s authorized agent chooses to use an informal or voluntary

network to obtain a contractual fee arrangement, there must be a

contractual arrangement between:

              (1)AAthe carrier or authorized agent and the informal

or voluntary network that authorizes the network to contract with

health care providers for pharmaceutical services on the carrier ’s

behalf; and

              (2)AAthe informal or voluntary network and the health

care provider that includes a specific fee schedule and complies

with the notice requirements of this section.

       (d)AAAn informal or voluntary network, or the carrier or the

carrier ’s    authorized            agent,    as     appropriate,       shall,       at      least

quarterly, notify each health care provider of any person, other

than an injured employee, to which the network ’s contractual fee

arrangements       with       the    health    care    provider       are     sold,     leased,

transferred, or conveyed.AANotice to each health care provider:

                                               33
              (1)AAmust include:

                    (A)AAthe   contact        information    for     the   network,

including    the   name,   physical      address,   and    toll-free       telephone

number at which a health care provider with which the network has a

contract may contact the network; and

                    (B)AAin the body of the notice:

                           (i)AAthe        name,    physical        address,     and

telephone number of any person, other than an injured employee, to

which the network ’s contractual fee arrangement with the health

care provider is sold, leased, transferred, or conveyed; and

                           (ii)AAthe start date and any end date of the

period during which any person, other than an injured employee, to

which the network ’s contractual fee arrangement with the health

care provider is sold, leased, transferred, or conveyed; and

              (2)AAmay be provided:

                    (A)AAin an electronic format, if a paper version

is available on request by the division; and

                    (B)AAthrough an Internet website link, but only if

the website:

                           (i)AAcontains the information described by

Subdivision (1); and

                           (ii)AAis      updated    at     least    monthly     with

current and correct information.

       (e)AAAn informal or voluntary network, or the carrier or the

carrier ’s   authorized    agent,   as     appropriate,     shall    document    the

delivery of the notice required under Subsection (d), including the

method of delivery, to whom the notice was delivered, and the date

of   delivery.AAFor    purposes       of      Subsection    (d),    a   notice    is

considered to be delivered on, as applicable:

              (1)AAthe fifth day after the date the notice is mailed

via United States Postal Service; or

              (2)AAthe date the notice is faxed or electronically

delivered.

       (f)AAAn insurance carrier, or the carrier ’s authorized agent

or an informal or voluntary network at the carrier ’s request, shall

provide copies of each contract described by Subsection (c) to the

division on the request of the division.AAInformation included in a

                                         34
contract under Subsection (c) is confidential and is not subject to

disclosure under Chapter 552, Government Code.AANotwithstanding

Subsection (c), the insurance carrier may be required to pay fees in

accordance with the division ’s fee guidelines if:

                (1)AAthe contract:

                     (A)AAis     not   provided      to   the    division    on   the

division ’s request;

                     (B)AAdoes     not    include    a    specific    fee   schedule

consistent with Subsection (c); or

                     (C)AAdoes not clearly state that the contractual

fee arrangement is between the health care provider and the named

insurance carrier or the carrier ’s authorized agent; or

                (2)AAthe carrier or the carrier ’s authorized agent does

not comply with the notice requirements under Subsection (d).

       (g)AAFailure       to     provide        documentation        described     by

Subsection (e) to the division on the request of the division or

failure to provide notice as required under Subsection (d) creates

a   rebuttable     presumption    in     an    enforcement      action   under    this

subtitle and in a medical fee dispute under Chapter 413 that a

health care provider did not receive the notice.

       (h)AAAn insurance carrier or the carrier ’s authorized agent

commits    an    administrative       violation     if    the   carrier     or   agent

violates    any    provision     of    this      section.AAAny       administrative

penalty assessed under this subsection shall be assessed against

the carrier, regardless of whether the carrier or agent committed

the violation.

       (i)AANotwithstanding Section 1305.003(b), Insurance Code, in

the event of a conflict between this section and Section 413.016 or

any other provision of Chapter 413 of this code or Chapter 1305,

Insurance Code, this section prevails.

Added by Acts 2011, 82nd Leg., R.S., Ch. 705 (H.B. 528), Sec. 3,

eff. June 17, 2011.

       Sec.      408.0282.AAREQUIREMENTS           FOR    CERTAIN     INFORMAL     OR

VOLUNTARY     NETWORKS.        (a)AAEach       informal   or    voluntary    network

described by Section 408.0281 or 408.0284 shall, not later than the

30th day after the date the network is established, report the

                                          35
following information to the division:

              (1)AAthe name of the informal or voluntary network and

federal employer identification number;

              (2)AAan executive contact for official correspondence

for the informal or voluntary network;

              (3)AAa toll-free telephone number by which a health

care provider may contact the informal or voluntary network;

              (4)AAa list of each insurance carrier with whom the

informal or voluntary network contracts, including the carrier ’s

federal employer identification number; and

              (5)AAa   list   of,    and    contact    information     for,   each

entity with which the informal or voluntary network has a contract

or other business relationship that benefits or is entered into on

behalf of an insurance carrier, including an insurance carrier ’s

authorized agent or a subsidiary or other affiliate of the network.

      (b)AAEach    informal    or    voluntary   network     shall   report   any

changes to the information provided under Subsection (a) to the

division not later than the 30th day after the effective date of the

change.

      (c)AAAn informal or voluntary network shall submit a report

required under this section, including a report of changes required

under Subsection (b), to the division through the division ’s online

reporting     system   available      through    the     division ’s     Internet

website.

      (d)AAAn     informal      or     voluntary       network    commits      an

administrative    violation    if    the    informal    or   voluntary   network

violates any provision of this section.

Added by Acts 2011, 82nd Leg., R.S., Ch. 705 (H.B. 528), Sec. 3,

eff. June 17, 2011.

Amended by:

      Acts 2013, 83rd Leg., R.S., Ch. 1202 (S.B. 1322), Sec. 2, eff.

September 1, 2013.

      Sec. 408.0284.AAREIMBURSEMENT FOR DURABLE MEDICAL EQUIPMENT

AND HOME HEALTH CARE SERVICES; ADMINISTRATIVE VIOLATION.                  (a)AAIn

this section:

              (1)AA"Durable medical equipment" includes prosthetics

                                       36
and     orthotic        devices      and     related       medical           equipment     and

supplies.AAThe term does not include:

                        (A)AAan      object       or    device       that    is   surgically

implanted, embedded, inserted, or otherwise applied;

                        (B)AArelated        equipment       necessary          to    operate,

program, or recharge the object or device described by Paragraph

(A); or

                        (C)AAan intrathecal pump.

                (2)AA"Informal network" means a network that:

                        (A)AAis established under a contract between an

insurance carrier or an insurance carrier ’s authorized agent and a

health care provider for the provision of durable medical equipment

or home health care services; and

                        (B)AAincludes a specific fee schedule.

                (3)AA"Voluntary         network"        means    a     voluntary     workers ’

compensation health care delivery network established under former

Section 408.0223, as that section existed before repeal by Chapter

265    (House    Bill    No.   7),   Acts    of    the   79th     Legislature,         Regular

Session, 2005, by an insurance carrier for the provision of durable

medical equipment or home health care services.

        (b)AANotwithstanding               any    provision          of      Chapter     1305,

Insurance Code, or Section 504.053 of this code, durable medical

equipment       and   home     health   care      services       may    be   reimbursed     in

accordance with the fee guidelines adopted by the commissioner or

at a voluntarily negotiated contract rate in accordance with this

section.

        (c)AANotwithstanding any other provision of this title or any

provision of Chapter 1305, Insurance Code, an insurance carrier may

pay a health care provider fees for durable medical equipment or

home    health    care    services      that      are    inconsistent         with   the   fee

guidelines adopted by the commissioner only if the carrier or the

carrier ’s authorized agent has a contract with the health care

provider and that contract includes a specific fee schedule.AAAn

insurance carrier or the carrier ’s authorized agent may use an

informal or voluntary network to obtain a contractual agreement

that provides for fees different from the fees authorized under the

fee guidelines adopted by the commissioner for durable medical

                                             37
equipment   or    home   health   care    services.AAIf     a   carrier    or   the

carrier ’s authorized agent chooses to use an informal or voluntary

network to obtain a contractual fee arrangement, there must be a

contractual arrangement between:

            (1)AAthe carrier or authorized agent and the informal

or voluntary network that authorizes the network to contract with

health care providers for durable medical equipment or home health

care services on the carrier ’s behalf; and

            (2)AAthe informal or voluntary network and the health

care provider that includes a specific fee schedule and complies

with the notice requirements of this section.

      (d)AAAn informal or voluntary network, or the carrier or the

carrier ’s authorized agent shall, at least quarterly, notify each

health care provider of any person, other than an injured employee,

to which the network ’s contractual fee arrangements with the health

care provider are sold, leased, transferred, or conveyed.AANotice

to each health care provider:

            (1)AAmust include:

                    (A)AAthe      contact     information   for    the   network,

including   the   name,   physical    address,     and   toll-free       telephone

number at which a health care provider with which the network has a

contract may contact the network; and

                    (B)AAin the body of the notice:

                           (i)AAthe       name,    physical       address,      and

telephone number of any person, other than an injured employee, to

which the network ’s contractual fee arrangement with the health

care provider is sold, leased, transferred, or conveyed; and

                           (ii)AAthe start date and any end date of the

period during which the network ’s contractual fee arrangement with

the health care provider is sold, leased, transferred, or conveyed;

and

            (2)AAmay be provided:

                    (A)AAin an electronic format, if a paper version

is available on request by the division; and

                    (B)AAthrough an Internet website link, but only if

the website:

                           (i)AAcontains the information described by

                                         38
Subdivision (1); and

                          (ii)AAis         updated    at     least    monthly      with

current and correct information.

        (e)AAAn informal or voluntary network, or the carrier or the

carrier ’s   authorized   agent,      as    appropriate,      shall    document    the

delivery of the notice required under Subsection (d), including the

method of delivery, to whom the notice was delivered, and the date

of    delivery.AAFor   purposes       of        Subsection    (d),    a   notice    is

considered to be delivered on, as applicable:

              (1)AAthe fifth day after the date the notice is mailed

via United States Postal Service; or

              (2)AAthe date the notice is faxed or electronically

delivered.

        (f)AAAn insurance carrier, or the carrier ’s authorized agent

or an informal or voluntary network at the carrier ’s request, shall

provide copies of each contract described by Subsection (c) to the

division on the request of the division.AAInformation included in a

contract under Subsection (c) is confidential and is not subject to

disclosure under Chapter 552, Government Code.AANotwithstanding

Subsection (c), the insurance carrier may be required to pay fees in

accordance with the division ’s fee guidelines if:

              (1)AAthe contract:

                    (A)AAis     not   provided       to    the    division    on   the

division ’s request;

                    (B)AAdoes    not       include    a   specific     fee   schedule

consistent with Subsection (c); or

                    (C)AAdoes not clearly state that the contractual

fee arrangement is between the health care provider and the named

insurance carrier or the carrier ’s authorized agent; or

              (2)AAthe carrier or the carrier ’s authorized agent does

not comply with the notice requirements under Subsection (d).

        (g)AAFailure      to    provide          documentation        described     by

Subsection (e) to the division on the request of the division or

failure to provide notice as required under Subsection (d) creates

a    rebuttable   presumption    in    an       enforcement      action   under    this

subtitle and in a medical fee dispute under Chapter 413 that a

health care provider did not receive the notice.

                                           39
      (h)AAAn insurance carrier or the carrier ’s authorized agent

commits    an   administrative            violation    if    the    carrier    or     agent

violates    any    provision         of    this     section.AAAny      administrative

penalty assessed under this subsection shall be assessed against

the carrier, regardless of whether the carrier or agent committed

the violation.

      (i)AANotwithstanding Section 1305.003(b), Insurance Code, in

the event of a conflict between this section and Section 413.016 or

any other provision of Chapter 413 of this code or Chapter 1305,

Insurance Code, this section prevails.

Added by Acts 2013, 83rd Leg., R.S., Ch. 1202 (S.B. 1322), Sec. 3,

eff. September 1, 2013.

      Sec.A408.029.AANURSE FIRST ASSISTANT SERVICES.                       An insurance

carrier may not refuse to reimburse a health care practitioner

solely because that practitioner is a nurse first assistant, as

defined    by   Section   301.1525,          Occupations      Code,    for     a    covered

service that a physician providing health care services under this

subtitle has requested the nurse first assistant to perform.

Added by Acts 2001, 77th Leg., ch. 812, Sec. 9, eff. Sept. 1, 2001.

      Sec.      408.030.AAREPORTS          OF     PHYSICIAN   VIOLATIONS.           If    the

division   discovers      an   act    or    omission    by    a    physician       that   may

constitute a felony, a misdemeanor involving moral turpitude, a

violation of a state or federal narcotics or controlled substance

law, an offense involving fraud or abuse under the Medicare or

Medicaid program, or a violation of this subtitle, the division

shall immediately report that act or omission to the Texas State

Board of Medical Examiners.

Added by Acts 2003, 78th Leg., ch. 202, Sec. 38, eff. June 10, 2003.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.091, eff.

September 1, 2005.

      Sec. 408.031.AAWORKERS ’ COMPENSATION HEALTH CARE NETWORKS.

(a)   Notwithstanding          any    other       provision   of    this   chapter,        an

injured employee may receive benefits under a workers ’ compensation

                                             40
health care network established under Chapter 1305, Insurance Code,

in the manner provided by that chapter.

        (b)AAIn       the    event   of    a   conflict          between     this   title      and

Chapter       1305,   Insurance      Code,      as       to    the   provision      of   medical

benefits for injured employees, the establishment and regulation of

fees    for    medical      treatments      and     services,        the   time     frames     for

payment of medical bills, the operation and regulation of workers ’

compensation health care networks, the regulation of the health

care providers who contract with those networks, or the resolution

of    disputes    regarding        medical      benefits         provided      through      those

networks, Chapter 1305, Insurance Code, prevails.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.092, eff.

September 1, 2005.

        Sec.          408.032.AASTUDY               ON         INTERDISCIPLINARY               PAIN

REHABILITATION         PROGRAM     AND     FACILITY           ACCREDITATION      REQUIREMENT.

The division shall study the issue of required accreditation of

interdisciplinary                pain          rehabilitation                programs           or

interdisciplinary pain rehabilitation treatment facilities that

provide     services        to   injured    employees          and   shall     report     to   the

legislature       regarding        any   statutory            changes   that    the      division

considers necessary to require that accreditation.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.093, eff.

September 1, 2005.

              SUBCHAPTER C. COMPUTATION OF AVERAGE WEEKLY WAGE

        Sec.A408.041.AAAVERAGE WEEKLY WAGE.                      (a)    Except as otherwise

provided by this subtitle, the average weekly wage of an employee

who has worked for the employer for at least the 13 consecutive

weeks immediately preceding an injury is computed by dividing the

sum    of   the   wages     paid   in    the   13    consecutive         weeks    immediately

preceding the date of the injury by 13.

        (b)AAThe average weekly wage of an employee whose wage at the

time of injury has not been fixed or cannot be determined or who has

worked for the employer for less than the 13 weeks immediately

preceding the injury equals:

                                               41
              (1)AAthe usual wage that the employer pays a similar

employee for similar services;         or

              (2)AAif a similar employee does not exist, the usual

wage paid in that vicinity for the same or similar services provided

for remuneration.

       (c)AAIf Subsection (a) or (b) cannot reasonably be applied

because the employee ’s employment has been irregular or because the

employee   has   lost    time   from    work   during      the   13-week   period

immediately preceding the injury because of illness, weather, or

another cause beyond the control of the employee, the commissioner

may determine the employee ’s average weekly wage by any method that

the   commissioner   considers    fair,      just,   and    reasonable     to   all

parties and consistent with the methods established under this

section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.094, eff.

September 1, 2005.

       Sec.A408.042.AAAVERAGE WEEKLY WAGE FOR PART-TIME EMPLOYEE OR

EMPLOYEE WITH MULTIPLE EMPLOYMENT.          (a)   The average weekly wage of

a part-time employee who limits the employee ’s work to less than a

full-time workweek as a regular course of that employee ’s conduct

is computed as provided by Section 408.041.

       (b)AAFor part-time employees not covered by Subsection (a),

the average weekly wage:

              (1)AAfor   determining        temporary   income     benefits     is

computed as provided by Section 408.041; and

              (2)AAfor    determining       impairment       income   benefits,

supplemental income benefits, lifetime income benefits, and death

benefits is computed as follows:

                   (A)AAif the employee has worked for the employer

for at least the 13 weeks immediately preceding the date of the

injury, the average weekly wage is computed by dividing the sum of

the wages paid in the 13 consecutive weeks immediately preceding

the date of the injury by 13 and adjusting that amount to the weekly

wage level the employee would have attained by working a full-time

                                       42
workweek at the same rate of pay;           or

                      (B)AAif the employee has worked for the employer

for less than 13 weeks immediately preceding the date of the injury,

the average weekly wage is equal to:

                            (i)AAthe weekly wage that the employer pays a

similar    employee     for      similar   services         based    on     a    full-time

workweek;     or

                            (ii)AAif a similar employee does not exist,

the   usual   wage   paid   in    that    vicinity     for    the    same       or   similar

services based on a full-time workweek.

         (c)AAFor    employees     with    multiple        employment,      the      average

weekly wage for determining temporary income benefits, impairment

income    benefits,    supplemental        income     benefits,        lifetime      income

benefits, and death benefits, is computed as follows:

              (1)AAthe      average      weekly      wage   for     an    employee      with

multiple employment is equal to the sum of the average weekly wages

computed under Subdivisions (2) and (3);

              (2)AAfor each of the employers for whom the employee has

worked for at least the 13 weeks immediately preceding the date of

injury, the average weekly wage is equal to the sum of the wages

paid by that employer to the employee in the 13 weeks immediately

preceding the injury divided by 13;

              (3)AAfor each of the employers for whom the employee has

worked for less than the 13 weeks immediately preceding the date of

the injury, the average weekly wage is equal to:

                      (A)AAthe weekly wage that employer pays similar

employees for similar services;            or

                      (B)AAif a similar employee does not exist, the

usual weekly wage paid in that vicinity for the same or similar

services;     and

              (4)AAthe      average      weekly      wage    of   an      employee      with

multiple employment who limits the employee ’s work to less than a

full-time workweek, but does not do so as a regular course of that

employee ’s   conduct,      is   adjusted       to   the    weekly       wage   level    the

employee would have attained by working a full-time workweek at the

employee ’s average rate of pay.

         (d)AAThe commissioner shall:

                                           43
              (1)AAprescribe a form to collect information regarding

the wages of employees with multiple employment; and

              (2)AAby    rule,        determine         the   manner     by    which     the

division collects and distributes wage information to implement

this section.

      (e)AAFor    an    employee       with       multiple       employment,     only    the

employee ’s   wages    that     are    reportable          for    federal     income     tax

purposes may be considered.           The employee shall document and verify

wage payments subject to this section.

      (f)AAIf    the    commissioner              determines      that   computing       the

average weekly wage for an employee as provided by Subsection (c) is

impractical or unreasonable, the commissioner shall set the average

weekly wage in a manner that more fairly reflects the employee ’s

average weekly wage and that is fair and just to both parties or is

in the manner agreed to by the parties.AAThe commissioner by rule

may define methods to determine a fair and just average weekly wage

consistent with this section.

      (g)AAAn    insurance       carrier          is    entitled    to   apply    for    and

receive reimbursement at least annually from the subsequent injury

fund for the amount of income and death benefits paid to a worker

under this section that are based on employment other than the

employment    during    which     the    compensable          injury     occurred.AAThe

commissioner    may     adopt    rules       that       govern     the   documentation,

application     process,        and     other          administrative       requirements

necessary to implement this subsection.

      (h)AAIn this section:

              (1)AA"Employee          with    multiple        employment"        means   an

employee who has more than one employer.

              (2)AA"Full-time workweek" means a 40-hour workweek.

              (3)AA"Part-time employee" means an employee who, at the

time of the injury, was working less than a full-time workweek for

the employer for whom the employee was working when the compensable

injury occurred.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                        Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 10.03, eff. June 17, 2001.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.095, eff.

                                             44
September 1, 2005.

       Acts 2007, 80th Leg., R.S., Ch. 1150 (S.B. 1169), Sec. 2, eff.

September 1, 2007.

       Sec.A408.043.AAAVERAGE WEEKLY WAGE FOR SEASONAL EMPLOYEE.

(a)   For determining the amount of temporary income benefits of a

seasonal    employee,   the   average      weekly    wage      of   the   employee   is

computed as provided by Section 408.041 and is adjusted as often as

necessary to reflect the wages the employee could reasonably have

expected to earn during the period that temporary income benefits

are paid.

       (b)AAFor     determining      the     amount       of    impairment     income

benefits, supplemental income benefits, lifetime income benefits,

or death benefits of a seasonal employee, the average weekly wage of

the employee is computed by dividing the amount of total wages

earned by the employee during the 12 months immediately preceding

the date of the injury by 50.

       (c)AAIf, for good reason, the commissioner determines that

computing    the   average    weekly   wage    for    a    seasonal       employee   as

provided by this section is impractical, the commissioner shall

compute the average weekly wage as of the time of the injury in a

manner that is fair and just to both parties.

       (d)AAIn this section, "seasonal employee" means an employee

who, as a regular course of the employee ’s conduct, engages in

seasonal or cyclical employment that does not continue throughout

the entire year.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.096, eff.

September 1, 2005.

       Sec.A408.044.AAAVERAGE WEEKLY WAGE FOR MINOR, APPRENTICE,

TRAINEE,    OR   STUDENT.      (a)      For   computing         impairment     income

benefits, supplemental income benefits, lifetime income benefits,

or death benefits, the average weekly wage of an employee shall be

adjusted to reflect the level of expected wages during the period

that the benefits are payable if:

                                        45
            (1)AAthe employee is a minor, apprentice, trainee, or

student at the time of the injury;

            (2)AAthe employee ’s employment or earnings at the time

of the injury are limited primarily because of apprenticeship,

continuing formal training, or education intended to enhance the

employee ’s future wages; and

            (3)AAthe employee ’s wages would reasonably be expected

to change because of a change of employment during that period.

      (b)AAAn     adjustment   under       Subsection      (a)    may   not   consider

expected   wage   levels    for     a    period     occurring     after     the    third

anniversary of the date of the injury.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A408.0445.AAAVERAGE            WEEKLY     WAGE   FOR    MEMBERS     OF   STATE

MILITARY   FORCES    AND   TEXAS    TASK    FORCE    1.    (a)AAFor     purposes      of

computing income benefits or death benefits under Section 437.227,

Government Code, the average weekly wage of a member of the state

military forces as defined by Section 437.001, Government Code, who

is engaged in authorized training or duty is an amount equal to the

sum of the member ’s regular weekly wage at any employment the member

holds in addition to serving as a member of the state military

forces, disregarding any period during which the member is not

fully compensated for that employment because the member is engaged

in authorized military training or duty, and the member ’s regular

weekly wage as a member of the state military forces, except that

the amount may not exceed 100 percent of the state average weekly

wage as determined under Section 408.047.

      (b)AAFor      purposes   of       computing    income      benefits     or   death

benefits under Section 88.303, Education Code, the average weekly

wage of a Texas Task Force 1 member, as defined by Section 88.301,

Education Code, who is engaged in authorized training or duty is an

amount equal to the sum of the member ’s regular weekly wage at any

employment, including self-employment, that the member holds in

addition to serving as a member of Texas Task Force 1, except that

the amount may not exceed 100 percent of the state average weekly

wage as determined under Section 408.047.AAA member for whom an

average weekly wage cannot be computed shall be paid the minimum

                                          46
weekly benefit established by the division.

Added by Acts 1999, 76th Leg., ch. 1205, Sec. 4, eff. Sept. 1, 1999.

Amended by Acts 2003, 78th Leg., ch. 644, Sec. 2, eff. June 20,

2003.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.097, eff.

September 1, 2005.

         Acts 2013, 83rd Leg., R.S., Ch. 1217 (S.B. 1536), Sec. 3.14,

eff. September 1, 2013.

         Sec.A408.0446.AAAVERAGE            WEEKLY       WAGE;         SCHOOL    DISTRICT

EMPLOYEE.        (a)     For determining the amount of temporary income

benefits    of    a    school    district    employee      under       Chapter   504,    the

average weekly wage is computed on the basis of wages earned in a

week rather than on the basis of wages paid in a week.                           The wages

earned in any given week are equal to the amount that would be

deducted from an employee ’s salary if the employee were absent from

work for one week and the employee did not have personal leave

available to compensate the employee for lost wages for that week.

         (b)AAAn       insurance    carrier       may   adjust    a     school   district

employee ’s average weekly wage as often as necessary to reflect the

wages    the   employee        reasonably    could      expect    to   earn   during    the

period for which temporary income benefits are paid.                      In adjusting a

school     district          employee ’s   average       weekly       wage    under     this

subsection, the insurance carrier may consider any evidence of the

employee ’s reasonable expectation of earnings.

         (c)AAFor       determining        the    amount    of     impairment         income

benefits, supplemental income benefits, lifetime income benefits,

or death benefits of a school district employee under Chapter 504,

the average weekly wage of the employee is computed by dividing the

total amount of wages earned by the employee during the 12 months

immediately preceding the date of the injury by 50.

         (d)AAIf       the    commissioner        determines     that     computing      the

average weekly wage of a school district employee as provided by

this section is impractical because the employee did not earn wages

during the 12 months immediately preceding the date of the injury,

the commissioner shall compute the average weekly wage in a manner

                                             47
that is fair and just to both parties.

        (e)AAThe     commissioner    shall     adopt    rules    as    necessary   to

implement this section.

Added by Acts 2001, 77th Leg., ch. 1456, Sec. 10.04, eff. June 17,

2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.098, eff.

September 1, 2005.

        Sec.    408.045.AANONPECUNIARY         WAGES.     The    division   may    not

include    nonpecuniary     wages    in   computing     an   employee ’s    average

weekly wage during a period in which the employer continues to

provide the nonpecuniary wages.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.099, eff.

September 1, 2005.

        Sec.A408.046.AASIMILAR EMPLOYEES, SERVICES, OR EMPLOYMENT.

For purposes of this subchapter and Subchapter D, the determination

as to whether employees, services, or employment are the same or

similar must include consideration of:

                (1)AAthe training and experience of the employees;

                (2)AAthe nature of the work; and

                (3)AAthe number of hours normally worked.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec. 408.047.AASTATE AVERAGE WEEKLY WAGE.                (a)   On and after

October 1, 2006, the state average weekly wage is equal to 88

percent of the average weekly wage in covered employment computed

by the Texas Workforce Commission under Section 207.002(c).

        (b)    Expired.

        (c)AANotwithstanding        Subsection     (a),    the    commissioner     by

rule may increase the state average weekly wage to an amount not to

exceed 100 percent of the average weekly wage in covered employment

computed       by   the   Texas   Workforce       Commission       under    Section

207.002(c).

                                          48
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.        Amended

by Acts 2003, 78th Leg., ch. 963, Sec. 6, eff. June 20, 2003.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.100, eff.

September 1, 2005.

                SUBCHAPTER D. COMPUTATION OF BENEFITS

        Sec.A408.061.AAMAXIMUM   WEEKLY   BENEFIT.     (a)    A    weekly

temporary income benefit may not exceed 100 percent of the state

average weekly wage under Section 408.047 rounded to the nearest

whole dollar.

        (b)AAA weekly impairment income benefit may not exceed 70

percent of the state average weekly wage rounded to the nearest

whole dollar.

        (c)AAA weekly supplemental income benefit may not exceed 70

percent of the state average weekly wage rounded to the nearest

whole dollar.

        (d)AAA weekly death benefit may not exceed 100 percent of the

state average weekly wage rounded to the nearest whole dollar.

        (e)AAA weekly lifetime income benefit may not exceed 100

percent of the state average weekly wage rounded to the nearest

whole dollar.

        (f)AAThe division shall compute the maximum weekly income

benefits for each state fiscal year not later than October 1 of each

year.

        (g)AAThe maximum weekly income benefit in effect on the date

of injury is applicable for the entire time that the benefit is

payable.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.101, eff.

September 1, 2005.

        Sec.A408.062.AAMINIMUM   WEEKLY   INCOME   BENEFIT.   (a)     The

minimum weekly income benefit is 15 percent of the state average

weekly wage as determined under Section 408.047, rounded to the

                                  49
nearest whole dollar.

        (b)AAThe division shall compute the minimum weekly income

benefit for each state fiscal year not later than October 1 of each

year.

        (c)AAThe minimum weekly income benefit in effect on the date

of injury is applicable for the entire time that income benefits are

payable.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.102, eff.

September 1, 2005.

        Sec.A408.063.AAWAGE            PRESUMPTIONS;                  ADMINISTRATIVE

VIOLATION.       (a)    To expedite the payment of income benefits, the

commissioner      may    by     rule   establish       reasonable        presumptions

relating    to    the   wages    earned    by    an    employee,        including    the

presumption that an employee ’s last paycheck accurately reflects

the employee ’s usual wage.

        (b)AANot later than the 30th day after the date the employer

receives notice of an injury to the employee, the employer shall

file a wage statement showing the amount of all wages paid to the

employee.

        (c)AAAn    employer     who    fails    to    file   a   wage    statement    in

accordance       with    Subsection       (b)    commits         an   administrative

violation.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.103, eff.

September 1, 2005.

        Sec.A408.064.AAINTEREST ON ACCRUED BENEFITS.                    (a)   An order

to pay income or death benefits accrued but unpaid must include

interest on the amount of compensation due at the rate provided by

Section 401.023.

        (b)AAAccrued but unpaid compensation and interest shall be

paid in a lump sum.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                          50
                SUBCHAPTER E. INCOME BENEFITS IN GENERAL

       Sec.A408.081.AAINCOME            BENEFITS.        (a)AAAn    employee       is

entitled to timely and accurate income benefits as provided in this

chapter.

       (b)AAExcept as otherwise provided by this section or this

subtitle, income benefits shall be paid weekly as and when they

accrue without order from the commissioner.AAInterest on accrued

but   unpaid    benefits     shall      be     paid,   without     order    of    the

commissioner, at the time the accrued benefits are paid.

       (c)AAThe commissioner by rule shall establish requirements

for   agreements     under     which         income    benefits    may     be    paid

monthly.AAIncome benefits may be paid monthly only:

               (1)AAon the request of the employee and the agreement of

the employee and the insurance carrier; and

               (2)AAin compliance with the requirements adopted by the

commissioner.

       (d)AAAn employee ’s entitlement to income benefits under this

chapter terminates on the death of the employee.                   An interest in

future income benefits does not survive after the employee ’s death.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                  Amended

by Acts 1999, 76th Leg., ch. 1426, Sec. 11, eff. Sept. 1, 1999.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.104, eff.

September 1, 2005.

       Acts 2011, 82nd Leg., R.S., Ch. 1153 (H.B. 2089), Sec. 1, eff.

September 1, 2011.

       Sec. 408.0815.AARESOLUTION OF OVERPAYMENT OR UNDERPAYMENT OF

INCOME BENEFITS.     (a)AAThe commissioner by rule shall establish a

procedure by which an insurance carrier:

               (1)AAmay recoup an overpayment of income benefits from

future income benefit payments that are not reimbursable under

Section 410.209; and

               (2)AAshall    pay   an    underpayment     of   income      benefits,

including interest on accrued but unpaid benefits, in accordance

                                         51
with this subtitle.

      (b)AAThe procedure under Subsection (a) must include:

              (1)AAa process by which an injured employee may notify

the insurance carrier of an underpayment;

              (2)AAthe    time   frame      and    methodology        by   which   an

insurance carrier shall pay to an injured employee an underpayment;

              (3)AAa   process   by    which      an    insurance     carrier    shall

notify an injured employee of an overpayment of income benefits;

              (4)AAthe    time   frame      and    methodology        by   which   an

insurance carrier may recoup an overpayment through the reduction

of a future income benefit payment; and

              (5)AAa method for coordinating overpayments that may be

recouped from future income benefits and reimbursements described

by Section 410.209.

      (c)AAThe     procedure     for        recouping         overpayments       under

Subsection (a)(1) must take into consideration the cause of the

overpayment and minimize the financial hardship to the injured

employee.

Added by Acts 2011, 82nd Leg., R.S., Ch. 1153 (H.B. 2089), Sec. 2,

eff. September 1, 2011.

      Sec.A408.082.AAACCRUAL          OF   RIGHT       TO   INCOME   BENEFITS.     (a)

Income benefits may not be paid under this subtitle for an injury

that does not result in disability for at least one week.

      (b)AAIf the disability continues for longer than one week,

weekly income benefits begin to accrue on the eighth day after the

date of the injury.      If the disability does not begin at once after

the injury occurs or within eight days of the occurrence but does

result subsequently, weekly income benefits accrue on the eighth

day after the date on which the disability began.

      (c)AAIf the disability continues for two weeks or longer

after the date it begins, compensation shall be computed from the

date the disability begins.

      (d)AAThis section does not preclude the recovery of medical

benefits as provided by Subchapter B.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

                                       52
        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.105, eff.

September 1, 2005.

        Sec.A408.083.AATERMINATION             OF    RIGHT    TO   TEMPORARY          INCOME,

IMPAIRMENT INCOME, AND SUPPLEMENTAL INCOME BENEFITS.                            (a)    Except

as   provided      by    Subsection    (b),    an    employee ’s      eligibility           for

temporary        income    benefits,    impairment           income       benefits,         and

supplemental income benefits terminates on the expiration of 401

weeks after the date of injury.

        (b)AAIf     an    employee    incurs    an    occupational         disease,         the

employee ’s eligibility for temporary income benefits, impairment

income benefits, and supplemental income benefits terminates on the

expiration of 401 weeks after the date on which benefits began to

accrue.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                            Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.26, eff. Sept. 1, 1995.

        Sec.A408.084.AACONTRIBUTING INJURY.                  (a)    At the request of

the insurance carrier, the commissioner may order that impairment

income benefits and supplemental income benefits be reduced in a

proportion equal to the proportion of a documented impairment that

resulted from earlier compensable injuries.

        (b)AAThe commissioner shall consider the cumulative impact

of the compensable injuries on the employee ’s overall impairment in

determining a reduction under this section.

        (c)AAIf the combination of the compensable injuries results

in an injury compensable under Section 408.161, the benefits for

that injury shall be paid as provided by Section 408.162.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.106, eff.

September 1, 2005.

        Sec. 408.085.AAADVANCE OF BENEFITS FOR HARDSHIP.                              (a)    If

there   is   a    likelihood    that   income       benefits       will    be    paid,      the

commissioner may grant an employee suffering financial hardship

advances as provided by this subtitle against the amount of income

                                         53
benefits to which the employee may be entitled.AAAn advance may be

ordered    before      or   after    the        employee     attains    maximum     medical

improvement.AAAn insurance carrier shall pay the advance ordered.

        (b)AAAn employee must apply to the division for an advance on

a   form   prescribed        by    the    commissioner.AAThe           application       must

describe the hardship that is the grounds for the advance.

        (c)AAAn advance under this section may not exceed an amount

equal to four times the maximum weekly benefit for temporary income

benefits as computed in Section 408.061.AAThe commissioner may not

grant more than three advances to a particular employee based on the

same injury.

        (d)AAThe commissioner may not grant an advance to an employee

who is receiving, on the date of the application under Subsection

(b), at least 90 percent of the employee ’s net preinjury wages under

Section 408.003 or 408.129.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.107, eff.

September 1, 2005.

        Sec.      408.086.AADIVISION                 DETERMINATION         OF       EXTENDED

UNEMPLOYMENT      OR   UNDEREMPLOYMENT.                (a)   During     the   period     that

impairment     income       benefits      or    supplemental      income      benefits    are

being paid to an employee, the commissioner shall determine at

least      annually         whether         any        extended      unemployment          or

underemployment is a direct result of the employee ’s impairment.

        (b)AATo     make      this       determination,        the     commissioner       may

require    periodic     reports          from    the    employee     and   the   insurance

carrier    and,   at    the       insurance       carrier ’s   expense,       may    require

physical or other examinations, vocational assessments, or other

tests or diagnoses necessary to perform the commissioner ’s duty

under this section and Subchapter H.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.108, eff.

September 1, 2005.

                                                54
                 SUBCHAPTER F. TEMPORARY INCOME BENEFITS

       Sec.A408.101.AATEMPORARY INCOME BENEFITS.                (a)   An employee

is entitled to temporary income benefits if the employee has a

disability and has not attained maximum medical improvement.

       (b)AAOn the initiation of compensation as provided by Section

409.021, the insurance carrier shall pay temporary income benefits

as provided by this subchapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A408.102.AADURATION OF TEMPORARY INCOME BENEFITS.                  (a)

Temporary   income    benefits      continue   until    the    employee   reaches

maximum medical improvement.

       (b)AAThe commissioner by rule shall establish a presumption

that maximum medical improvement has been reached based on a lack of

medical improvement in the employee ’s condition.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.109, eff.

September 1, 2005.

       Sec.A408.103.AAAMOUNT        OF   TEMPORARY     INCOME   BENEFITS.      (a)

Subject to Sections 408.061 and 408.062, the amount of a temporary

income benefit is equal to:

               (1)AA70 percent of the amount computed by subtracting

the employee ’s weekly earnings after the injury from the employee ’s

average weekly wage;     or

               (2)AAfor the first 26 weeks, 75 percent of the amount

computed by subtracting the employee ’s weekly earnings after the

injury from the employee ’s average weekly wage if the employee

earns less than $8.50 an hour.

       (b)AAA temporary income benefit under Subsection (a)(2) may

not   exceed    the   employee ’s    actual    earnings       for   the   previous

year.AAIt is presumed that the employee ’s actual earnings for the

previous year are equal to:

               (1)AAthe sum of the employee ’s wages as reported in the

most recent four quarterly wage reports to the Texas Workforce

                                         55
Commission divided by 52;

                (2)AAthe employee ’s wages in the single quarter of the

most recent four quarters in which the employee ’s earnings were

highest,      divided    by     13,    if    the     commissioner        finds      that       the

employee ’s     most   recent      four     quarters ’ earnings          reported        in    the

Texas Workforce Commission wage reports are not representative of

the employee ’s usual earnings; or

                (3)AAthe amount the commissioner determines from other

credible evidence to be the actual earnings for the previous year if

the   Texas     Workforce       Commission         does   not     have    a    wage      report

reflecting at least one quarter ’s earnings because the employee

worked outside the state during the previous year.

         (c)AAA presumption under Subsection (b) may be rebutted by

other credible evidence of the employee ’s actual earnings.

         (d)AAThe       Texas      Employment          Commission         shall       provide

information       required      under       this     section     in     the    manner         most

efficient for transferring the information.

         (e)AAFor      purposes     of    Subsection       (a),    if    an    employee         is

offered a bona fide position of employment that the employee is

reasonably capable of performing, given the physical condition of

the employee and the geographic accessibility of the position to

the employee, the employee ’s weekly earnings after the injury are

equal to the weekly wage for the position offered to the employee.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.110, eff.

September 1, 2005.

         Sec.A408.104.AAMAXIMUM              MEDICAL      IMPROVEMENT         AFTER      SPINAL

SURGERY.        (a)     On    application       by    either     the     employee     or      the

insurance       carrier,     the    commissioner          by    order    may    extend         the

104-week period described by Section 401.011(30)(B) if the employee

has had spinal surgery, or has been approved for spinal surgery

under    Section      408.026    and     commissioner          rules,    within     12    weeks

before    the    expiration      of    the    104-week     period.AAIf         an   order       is

issued under this section, the order shall extend the statutory

period for maximum medical improvement to a date certain, based on

                                              56
medical evidence presented to the commissioner.

      (b)AAEither the employee or the insurance carrier may dispute

an application for extension made under this section.                    A dispute

under this subsection is subject to Chapter 410.

      (c)AAThe commissioner shall adopt rules to implement this

section, including rules establishing procedures for requesting

and disputing an extension.

Added by Acts 1997, 75th Leg., ch. 1443, Sec. 5, eff. Jan. 1, 1998.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.111, eff.

September 1, 2005.

      Sec.A408.105.AASALARY      CONTINUATION          IN   LIEU    OF    TEMPORARY

INCOME BENEFITS.      (a)     In lieu of payment of temporary income

benefits under this subchapter, an employer may continue to pay the

salary of an employee who sustains a compensable injury under a

contractual obligation between the employer and employee, such as a

collective bargaining agreement, written agreement, or policy.

      (b)AASalary continuation may include wage supplementation

if:

              (1)AAemployer    reimbursement      is    not   sought      from      the

carrier as provided by Section 408.127;       and

              (2)AAthe supplementation does not affect the employee ’s

eligibility for any future income benefits.

Added by Acts 1999, 76th Leg., ch. 1003, Sec. 3, eff. Sept. 1, 1999.

               SUBCHAPTER G. IMPAIRMENT INCOME BENEFITS

      Sec.A408.121.AAIMPAIRMENT          INCOME    BENEFITS.             (a)        An

employee ’s entitlement to impairment income benefits begins on the

day after the date the employee reaches maximum medical improvement

and ends on the earlier of:

              (1)AAthe date of expiration of a period computed at the

rate of three weeks for each percentage point of impairment;                   or

              (2)AAthe date of the employee ’s death.

      (b)AAThe    insurance    carrier   shall    begin     to     pay   impairment

income benefits not later than the fifth day after the date on which

                                    57
the    insurance    carrier     receives    the    doctor ’s   report    certifying

maximum medical improvement.            Impairment income benefits shall be

paid for a period based on the impairment rating, unless that rating

is disputed under Subsection (c).

        (c)AAIf the insurance carrier disputes the impairment rating

used    under   Subsection    (a),    the   carrier    shall    pay    the   employee

impairment income benefits for a period based on the carrier ’s

reasonable assessment of the correct rating.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec. 408.122.AAELIGIBILITY FOR IMPAIRMENT INCOME BENEFITS.

A    claimant   may   not   recover     impairment     income    benefits      unless

evidence of impairment based on an objective clinical or laboratory

finding exists.AAIf the finding of impairment is made by a doctor

chosen by the claimant and the finding is contested, a designated

doctor or a doctor selected by the insurance carrier must be able to

confirm the objective clinical or laboratory finding on which the

finding of impairment is based.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                   Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.27, eff. Sept. 1, 1995;

Acts 2001, 77th Leg., ch. 1456, Sec. 5.03, eff. June 17, 2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.112, eff.

September 1, 2005.

        Sec. 408.1225.AADESIGNATED DOCTOR.              (a)AATo be eligible to

serve as a designated doctor, a doctor must maintain an active

certification by the division.

        (a-1)AAThe commissioner by rule shall develop a process for

the certification of a designated doctor.

        (a-2)AAThe      rules     adopted     by     the   commissioner         under

Subsection (a-1) must:

                (1)AArequire the division to evaluate the qualification

of     designated     doctors     for    certification         using    eligibility

requirements, including:

                      (A)AAeducational experience;

                      (B)AAprevious training; and

                                         58
                      (C)AAdemonstrated ability to perform the specific

designated doctor duties described by Section 408.0041; and

              (2)AArequire        standard      training       and     testing     to    be

completed in accordance with policies and guidelines developed by

the division.

         (a-3)AAThe     division         shall      develop          guidelines         for

certification training programs for certification of a designated

doctor    under   Subsection      (a-1)    to    ensure    a    designated       doctor ’s

competency    and     continued    competency       in     providing        assessments,

including:

              (1)AAa standard curriculum;

              (2)AAstandard course materials; and

              (3)AAtesting criteria.

         (a-4)AAThe division shall develop and implement a procedure

to periodically review and update the guidelines developed under

Subsection (a-3).

         (a-5)AAThe division may authorize an independent training

and testing provider to conduct the certification program for the

division under the guidelines developed under Subsection (a-3).

         (b)AAThe commissioner shall ensure the quality of designated

doctor    decisions    and   reviews      through      active       monitoring    of    the

decisions and reviews, and may take action as necessary to:

              (1)AArestrict the participation of a designated doctor;

              (2)AAdeny       renewal          of      a    designated           doctor ’s

certification; or

              (3)AArevoke a designated doctor ’s certification under

Section 413.044.

         (c)AAThe   report   of    the    designated       doctor     has   presumptive

weight, and the division shall base its determination of whether

the employee has reached maximum medical improvement on the report

unless the preponderance of the other medical evidence is to the

contrary.

         (d)AAThe commissioner shall develop rules to ensure that a

designated doctor called on to conduct an examination under Section

408.0041 has no conflict of interest in serving as a designated

doctor in performing any examination.

         (e)AAA   designated      doctor,      other   than     a    chiropractor,       is

                                          59
subject    to     Section     408.0043.AAA         designated        doctor     who    is    a

chiropractor is subject to Section 408.0045.AATo the extent of a

conflict between this section and Section 408.0043 or 408.0045,

this section controls.

         (f)AAA designated doctor shall continue providing services

related to a case assigned to the designated doctor, including

performing subsequent examinations or acting as a resource for

division disputes, unless the division authorizes the designated

doctor    to   discontinue      providing       services.AAThe           commissioner       by

rule shall prescribe the circumstances under which a designated

doctor is permitted to discontinue providing services, including:

                (1)AAthe     doctor    decides        to    stop     practicing       in   the

workers ’ compensation system; or

                (2)AAthe     doctor    relocates        the   doctor ’s      residence      or

practice.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.112, eff.

September 1, 2005.

Amended by:

         Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 5, eff.

September 1, 2007.

         Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 12,

eff. September 1, 2011.

         Sec. 408.123.AACERTIFICATION OF MAXIMUM MEDICAL IMPROVEMENT;

EVALUATION OF IMPAIRMENT RATING.                (a)     After an employee has been

certified       by    a    doctor     as   having          reached       maximum     medical

improvement, the certifying doctor shall evaluate the condition of

the employee and assign an impairment rating using the impairment

rating     guidelines         described       by      Section        408.124.AAIf          the

certification and evaluation are performed by a doctor other than

the employee ’s treating doctor, the certification and evaluation

shall be submitted to the treating doctor, and the treating doctor

shall indicate agreement or disagreement with the certification and

evaluation.

         (b)AAA      certifying     doctor      shall       issue    a     written    report

certifying      that      maximum   medical     improvement          has    been   reached,

stating the employee ’s impairment rating, and providing any other

                                           60
information required by the commissioner to:

              (1)AAthe division;

              (2)AAthe employee; and

              (3)AAthe insurance carrier.

       (c)AAThe commissioner shall adopt a rule that provides that,

at   the   conclusion    of   any   examination     in    which     maximum   medical

improvement is certified and any impairment rating is assigned by

the treating doctor, written notice shall be given to the employee

that the employee may dispute the certification of maximum medical

improvement    and     assigned     impairment     rating.AAThe      notice    to    the

employee must state how to dispute the certification of maximum

medical improvement and impairment rating.

       (d)AAIf    an    employee     is   not    certified     as   having    reached

maximum medical improvement before the expiration of 102 weeks

after the date income benefits begin to accrue, the division shall

notify the treating doctor of the requirements of this subchapter.

       (e)AAExcept       as   otherwise        provided   by   this       section,   an

employee ’s    first      valid      certification        of      maximum     medical

improvement and first valid assignment of an impairment rating is

final if the certification or assignment is not disputed before the

91st day after the date written notification of the certification

or   assignment   is    provided     to   the    employee    and    the    carrier   by

verifiable means.

       (f)AAAn employee ’s first certification of maximum medical

improvement or assignment of an impairment rating may be disputed

after the period described by Subsection (e) if:

              (1)AAcompelling medical evidence exists of:

                     (A)AAa significant error by the certifying doctor

in    applying    the     appropriate          American     Medical       Association

guidelines or in calculating the impairment rating;

                     (B)AAa clearly mistaken diagnosis or a previously

undiagnosed medical condition; or

                     (C)AAimproper        or    inadequate     treatment      of     the

injury before the date of the certification or assignment that

would render the certification or assignment invalid; or

              (2)AAother        compelling         circumstances           exist      as

prescribed by commissioner rule.

                                          61
       (g)AAIf an employee has not been certified as having reached

maximum medical improvement before the expiration of 104 weeks

after the date income benefits begin to accrue or the expiration

date   of   any    extension      of    benefits     under    Section   408.104,        the

impairment rating assigned after the expiration of either of those

periods is final if the impairment rating is not disputed before the

91st day after the date written notification of the certification

or   assignment        is   provided    to   the   employee    and    the   carrier      by

verifiable means.AAA certification or assignment may be disputed

after the 90th day only as provided by Subsection (f).

       (h)AAIf         an   employee ’s    disputed    certification        of   maximum

medical improvement or assignment of impairment rating is finally

modified,     overturned,        or    withdrawn,    the   first     certification       or

assignment made after the date of the modification, overturning, or

withdrawal becomes final if the certification or assignment is not

disputed before the 91st day after the date notification of the

certification or assignment is provided to the employee and the

carrier by verifiable means.AAA certification or assignment may be

disputed after the 90th day only as provided by Subsection (f).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                       Amended

by Acts 2003, 78th Leg., ch. 278, Sec. 1, eff. June 18, 2003;                          Acts

2003, 78th Leg., ch. 1190, Sec. 1, eff. June 20, 2003;                      Acts 2003,

78th Leg., ch. 1323, Sec. 2, eff. June 21, 2003.

Reenacted and amended by Acts 2005, 79th Leg., Ch. 265 (H.B. 7),

Sec. 3.113, eff. September 1, 2005.

       Sec. 408.124.AAIMPAIRMENT RATING GUIDELINES.                     (a)      An award

of an impairment income benefit, whether by the commissioner or a

court, must be based on an impairment rating determined using the

impairment rating guidelines described by this section.

       (b)AAFor         determining       the     existence    and     degree     of     an

employee ’s    impairment,        the     division    shall    use    "Guides     to    the

Evaluation        of    Permanent       Impairment,"       third     edition,     second

printing, dated February 1989, published by the American Medical

Association.

       (c)AANotwithstanding             Subsection     (b),    the   commissioner        by

rule may adopt the fourth edition of the "Guides to the Evaluation

                                             62
of    Permanent     Impairment,"         published       by      the   American     Medical

Association,        or    a   subsequent        edition       of    those    guides,       for

determining the existence and degree of an employee ’s impairment.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                          Amended

by Acts 1999, 76th Leg., ch. 1426, Sec. 12, eff. Sept. 1, 1999.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.114, eff.

September 1, 2005.

        Sec.A408.125.AADISPUTE AS TO IMPAIRMENT RATING.                        (a)     If an

impairment rating is disputed, the commissioner shall direct the

employee to the next available doctor on the division ’s list of

designated doctors, as provided by Section 408.0041.

        (b)AAThe designated doctor shall report in writing to the

division.

        (c)AAThe         report    of    the        designated     doctor     shall       have

presumptive weight, and the division shall base the impairment

rating on that report unless the preponderance of the other medical

evidence is to the contrary.AAIf the preponderance of the medical

evidence contradicts the impairment rating contained in the report

of the designated doctor chosen by the division, the division shall

adopt the impairment rating of one of the other doctors.

        (d)AATo     avoid     undue     influence       on   a   person     selected      as   a

designated doctor under this section, only the injured employee or

an appropriate member of the staff of the division may communicate

with the designated doctor about the case regarding the injured

employee ’s medical condition or history before the examination of

the    injured      employee      by    the     designated         doctor.AAAfter         that

examination is completed, communication with the designated doctor

regarding the injured employee ’s medical condition or history may

be    made   only   through       appropriate         division     staff    members.AAThe

designated doctor may initiate communication with any doctor who

has previously treated or examined the injured employee for the

work-related injury.

        (e)AANotwithstanding Subsection (d), the treating doctor and

the   insurance     carrier       are   both    responsible        for    sending    to    the

designated doctor all the injured employee ’s medical records that

                                               63
are in their possession and that relate to the issue to be evaluated

by the designated doctor.          The treating doctor and the insurance

carrier may send the records without a signed release from the

employee.      The   designated    doctor     is   authorized        to   receive    the

employee ’s confidential medical records to assist in the resolution

of disputes.     The treating doctor and the insurance carrier may also

send the designated doctor an analysis of the injured employee ’s

medical     condition,     functional        abilities,    and        return-to-work

opportunities.

        (f)AAA   violation   of    Subsection      (d)    is    an    administrative

violation.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                     Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.28, eff. Sept. 1, 1995;

Acts 2001, 77th Leg., ch. 1456, Sec. 5.04, eff. June 17, 2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.115, eff.

September 1, 2005.

        Sec.A408.126.AAAMOUNT        OF      IMPAIRMENT         INCOME       BENEFITS.

Subject   to   Sections    408.061    and    408.062,     an    impairment         income

benefit is equal to 70 percent of the employee ’s average weekly

wage.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A408.127.AAREDUCTION OF IMPAIRMENT INCOME BENEFITS.                      (a)

An insurance carrier shall reduce impairment income benefits to an

employee by an amount equal to employer payments made under Section

408.003 that are not reimbursed or reimbursable under that section.

        (b)AAThe     insurance    carrier     shall   remit     the       amount    of   a

reduction under this section to the employer who made the payments.

        (c)AAThe commissioner shall adopt rules and forms to ensure

the     full   reporting     and     the     accuracy      of        reductions      and

reimbursements made under this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.116, eff.

September 1, 2005.

                                        64
       Sec.A408.128.AACOMMUTATION          OF    IMPAIRMENT    INCOME   BENEFITS.

(a)    An   employee   may   elect    to    commute     the    remainder    of   the

impairment income benefits to which the employee is entitled if the

employee has returned to work for at least three months, earning at

least 80 percent of the employee ’s average weekly wage.

       (b)AAAn    employee   who   elects       to   commute   impairment   income

benefits is not entitled to additional income benefits for the

compensable injury.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A408.129.AAACCELERATION OF IMPAIRMENT INCOME BENEFITS.

(a)   On approval by the commissioner of a written request received

from an employee, an insurance carrier shall accelerate the payment

of impairment income benefits to the employee.AAThe accelerated

payment may not exceed a rate of payment equal to that of the

employee ’s net preinjury wage.

       (b)AAThe commissioner shall approve the request and order the

acceleration of the benefits if the commissioner determines that

the acceleration is:

              (1)AArequired to relieve hardship; and

              (2)AAin the overall best interest of the employee.

       (c)AAThe duration of the impairment income benefits to which

the employee is entitled shall be reduced to offset the increased

payments caused by the acceleration taking into consideration the

discount for present payment computed at the rate provided under

Section 401.023.

       (d)AAThe    commissioner      may    prescribe      forms   necessary      to

implement this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.117, eff.

September 1, 2005.

              SUBCHAPTER H. SUPPLEMENTAL INCOME BENEFITS

       Sec. 408.141.AAAWARD OF SUPPLEMENTAL INCOME BENEFITS.                      An

                                      65
award of a supplemental income benefit, whether by the commissioner

or a court, shall be made in accordance with this subchapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.118, eff.

September 1, 2005.

         Sec. 408.1415.AAWORK SEARCH COMPLIANCE STANDARDS.                                (a)   The

commissioner     by         rule    shall       adopt       compliance         standards        for

supplemental income benefit recipients that require each recipient

to   demonstrate       an    active       effort     to     obtain      employment.AATo           be

eligible    to   receive           supplemental           income    benefits         under      this

chapter, a recipient must provide evidence satisfactory to the

division of:

              (1)AAactive             participation                in         a       vocational

rehabilitation program conducted by the Department of Assistive and

Rehabilitative     Services          or    a   private      vocational            rehabilitation

provider;

              (2)AAactive           participation            in    work       search      efforts

conducted through the Texas Workforce Commission; or

              (3)AAactive           work       search      efforts      documented         by    job

applications submitted by the recipient.

         (b)AAIn adopting rules under this section, the commissioner

shall:

              (1)AAestablish the level of activity that a recipient

should have with the Texas Workforce Commission and the Department

of Assistive and Rehabilitative Services;

              (2)AAdefine the number of job applications required to

be   submitted     by        a     recipient         to    satisfy       the       work    search

requirements; and

              (3)AAconsider           factors        affecting       the      availability       of

employment, including recognition of access to employment in rural

areas,    economic      conditions,            and    other       appropriate         employment

availability factors.

         (c)AAThe commissioner may consult with the Texas Workforce

Commission,      the        Department         of    Assistive          and       Rehabilitative

Services, and other appropriate entities in adopting rules under

                                                66
this section.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.119, eff.

September 1, 2005.

      Sec.A408.142.AASUPPLEMENTAL         INCOME      BENEFITS.    (a)       An

employee is entitled to supplemental income benefits if on the

expiration of the impairment income benefit period computed under

Section 408.121(a)(1) the employee:

              (1)AAhas an impairment rating of 15 percent or more as

determined by this subtitle from the compensable injury;

              (2)AAhas not returned to work or has returned to work

earning less than 80 percent of the employee ’s average weekly wage

as a direct result of the employee ’s impairment;

              (3)AAhas   not   elected    to   commute   a   portion   of   the

impairment income benefit under Section 408.128; and

              (4)AAhas complied with the requirements adopted under

Section 408.1415.

      (b)AAIf an employee is not entitled to supplemental income

benefits at the time of payment of the final impairment income

benefit because the employee is earning at least 80 percent of the

employee ’s average weekly wage, the employee may become entitled to

supplemental income benefits at any time within one year after the

date the impairment income benefit period ends if:

              (1)AAthe employee earns wages for at least 90 days that

are less than 80 percent of the employee ’s average weekly wage;

              (2)AAthe employee meets the requirements of Subsections

(a)(1), (3), and (4);    and

              (3)AAthe decrease in earnings is a direct result of the

employee ’s impairment from the compensable injury.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.1195, eff.

September 1, 2005.

      Sec.A408.143.AAEMPLOYEE        STATEMENT.          (a)      After     the

commissioner ’s   initial      determination     of    supplemental    income

benefits, the employee must file a statement with the insurance

                                     67
carrier stating:

              (1)AAthat the employee has earned less than 80 percent

of the employee ’s average weekly wage as a direct result of the

employee ’s impairment;

              (2)AAthe amount of wages the employee earned in the

filing period provided by Subsection (b); and

              (3)AAthat       the    employee     has   complied   with    the

requirements adopted under Section 408.1415.

       (b)AAThe statement required under this section must be filed

quarterly     on   a   form    and    in    the   manner   provided   by   the

commissioner.AAThe commissioner may modify the filing period as

appropriate to an individual case.

       (c)AAFailure to file a statement under this section relieves

the insurance carrier of liability for supplemental income benefits

for the period during which a statement is not filed.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.120, eff.

September 1, 2005.

       Sec.A408.144.AACOMPUTATION OF SUPPLEMENTAL INCOME BENEFITS.

(a)   Supplemental income benefits are calculated quarterly and paid

monthly.

       (b)AASubject to Section 408.061, the amount of a supplemental

income benefit for a week is equal to 80 percent of the amount

computed by subtracting the weekly wage the employee earned during

the reporting period provided by Section 408.143(b) from 80 percent

of the employee ’s average weekly wage determined under Section

408.041, 408.042, 408.043, 408.044, 408.0445, or 408.0446.

       (c)AAFor the purposes of this subchapter, if an employee is

offered a bona fide position of employment that the employee is

capable of performing, given the physical condition of the employee

and the geographic accessibility of the position to the employee,

the employee ’s weekly wages are considered to be equal to the weekly

wages for the position offered to the employee.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

                                       68
         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.1205, eff.

September 1, 2005.

         Sec.A408.145.AAPAYMENT OF SUPPLEMENTAL INCOME BENEFITS.                          An

insurance carrier shall pay supplemental income benefits beginning

not later than the seventh day after the expiration date of the

employee ’s impairment income benefit period and shall continue to

pay the benefits in a timely manner.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec.A408.146.AATERMINATION OF SUPPLEMENTAL INCOME BENEFITS;

REINITIATION.            (a)   If an employee earns wages that are at least 80

percent of the employee ’s average weekly wage for at least 90 days

during    a       time    that    the     employee    receives    supplemental       income

benefits, the employee ceases to be entitled to supplemental income

benefits for the filing period.

         (b)AASupplemental              income    benefits      terminated      under   this

section shall be reinitiated when the employee:

                   (1)AAsatisfies the conditions of Section 408.142(b);

and

                   (2)AAfiles         the    statement       required     under    Section

408.143.

         (c)AANotwithstanding any other provision of this section, an

employee who is not entitled to supplemental income benefits for 12

consecutive months ceases to be entitled to any additional income

benefits for the compensable injury.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec.A408.147.AACONTEST OF SUPPLEMENTAL INCOME BENEFITS BY

INSURANCE CARRIER;             ATTORNEY ’S FEES.       (a)     An insurance carrier may

request       a    benefit       review     conference    to    contest   an    employee ’s

entitlement         to    supplemental        income   benefits     or    the    amount   of

supplemental income benefits.

         (b)AAIf an insurance carrier fails to make a request for a

benefit review conference within 10 days after the date of the

expiration of the impairment income benefit period or within 10

days   after       receipt       of   the   employee ’s      statement,   the     insurance

                                                 69
carrier waives the right to contest entitlement to supplemental

income benefits and the amount of supplemental income benefits for

that period of supplemental income benefits.

       (c)AAIf     an   insurance      carrier      disputes   the    commissioner ’s

determination that an employee is entitled to supplemental income

benefits or the amount of supplemental income benefits due and the

employee prevails on any disputed issue, the insurance carrier is

liable for reasonable and necessary attorney ’s fees incurred by the

employee as a result of the insurance carrier ’s dispute and for

supplemental income benefits accrued but not paid and interest on

that   amount,     according      to    Section      408.064.AAAttorney ’s        fees

awarded   under       this    subsection      are    not    subject     to   Sections

408.221(b), (f), and (i).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                   Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 9.53, eff. Sept. 1, 1995;                   Acts

2001, 77th Leg., ch. 1456, Sec. 8.02, eff. June 17, 2001.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.121, eff.

September 1, 2005.

       Sec. 408.148.AAEMPLOYEE DISCHARGE AFTER TERMINATION.                          The

commissioner     may    reinstate      supplemental        income    benefits   to    an

employee who is discharged within 12 months of the date of losing

entitlement      to     supplemental      income       benefits      under   Section

408.146(c)    if      the    commissioner     finds     that   the     employee      was

discharged at that time with the intent to deprive the employee of

supplemental income benefits.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.122, eff.

September 1, 2005.

       Sec.   408.149.AASTATUS         REVIEW;      BENEFIT    REVIEW    CONFERENCE.

(a)    Not more than once in each period of 12 calendar months, an

employee and an insurance carrier each may request the commissioner

to review the status of the employee and determine whether the

employee ’s unemployment or underemployment is a direct result of

                                         70
impairment from the compensable injury.

        (b)AAEither party may request a benefit review conference to

contest a determination of the commissioner at any time, subject

only    to   the   limits     placed    on   the    insurance        carrier      by   Section

408.147.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.123, eff.

September 1, 2005.

        Sec. 408.150.AAVOCATIONAL REHABILITATION.                      (a)      The division

shall    refer     an    employee      to    the    Department        of   Assistive          and

Rehabilitative          Services     with    a    recommendation        for     appropriate

services     if    the   division      determines     that      an   employee         could   be

materially assisted by vocational rehabilitation or training in

returning to employment or returning to employment more nearly

approximating the employee ’s preinjury employment.AAThe division

shall also notify insurance carriers of the need for vocational

rehabilitation or training services.AAThe insurance carrier may

provide      services        through    a    private       provider        of     vocational

rehabilitation services under Section 409.012.

        (b)AAAn employee who refuses services or refuses to cooperate

with services provided under this section by the Department of

Assistive and Rehabilitative Services or a private provider loses

entitlement to supplemental income benefits.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                             Amended

by Acts 1999, 76th Leg., ch. 956, Sec. 1, eff. Sept. 1, 1999;                             Acts

1999, 76th Leg., ch. 1426, Sec. 13, eff. Sept. 1, 1999.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.124, eff.

September 1, 2005.

        Sec. 408.151.AAMEDICAL EXAMINATIONS FOR SUPPLEMENTAL INCOME

BENEFITS.      (a)      On or after the second anniversary of the date the

commissioner         makes    the    initial       award   of    supplemental           income

benefits, an insurance carrier may not require an employee who is

receiving     supplemental          income   benefits      to   submit       to   a    medical

                                             71
examination    more    than   annually    if,   in   the   preceding   year,   the

employee ’s medical condition resulting from the compensable injury

has not improved sufficiently to allow the employee to return to

work.

        (b)AAIf a dispute exists as to whether the employee ’s medical

condition has improved sufficiently to allow the employee to return

to work, the commissioner shall direct the employee to be examined

by a designated doctor chosen by the division.AAThe designated

doctor shall report to the division.AAThe report of the designated

doctor has presumptive weight, and the division shall base its

determination    of    whether   the   employee ’s     medical   condition     has

improved sufficiently to allow the employee to return to work on

that report unless the preponderance of the other medical evidence

is to the contrary.

Added by Acts 1999, 76th Leg., ch. 850, Sec. 1, eff. Sept. 1, 1999.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.125, eff.

September 1, 2005.

                SUBCHAPTER I. LIFETIME INCOME BENEFITS

        Sec.A408.161.AALIFETIME        INCOME    BENEFITS.       (a)     Lifetime

income benefits are paid until the death of the employee for:

              (1)AAtotal and permanent loss of sight in both eyes;

              (2)AAloss of both feet at or above the ankle;

              (3)AAloss of both hands at or above the wrist;

              (4)AAloss of one foot at or above the ankle and the loss

of one hand at or above the wrist;

              (5)AAan injury to the spine that results in permanent

and complete paralysis of both arms, both legs, or one arm and one

leg;

              (6)AAa    physically       traumatic     injury    to    the   brain

resulting in incurable insanity or imbecility;              or

              (7)AAthird degree burns that cover at least 40 percent

of the body and require grafting, or third degree burns covering the

majority of either both hands or one hand and the face.

        (b)AAFor purposes of Subsection (a), the total and permanent

                                         72
loss of use of a body part is the loss of that body part.

       (c)AASubject      to    Section    408.061,      the    amount    of    lifetime

income benefits is equal to 75 percent of the employee ’s average

weekly wage.     Benefits being paid shall be increased at a rate of

three percent a year notwithstanding Section 408.061.

       (d)AAAn insurance carrier may pay lifetime income benefits

through an annuity if the annuity agreement meets the terms and

conditions for annuity agreements adopted by the commissioner by

rule.AAThe establishment of an annuity under this subsection does

not relieve the insurance carrier of the liability under this title

for ensuring that the lifetime income benefits are paid.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 1997, 75th Leg., ch. 1443, Sec. 7, eff. Sept. 1, 1997;                      Acts

1999, 76th Leg., ch. 1426, Sec. 14, eff. Sept. 1, 1999;                   Acts 2001,

77th Leg., ch. 1456, Sec. 9.01, eff. June 17, 2001.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.126, eff.

September 1, 2005.

       Sec.A408.162.AASUBSEQUENT INJURY FUND BENEFITS.                        (a)   If a

subsequent     compensable      injury,    with   the    effects    of    a    previous

injury, results in a condition for which the injured employee is

entitled to lifetime income benefits, the insurance carrier is

liable for the payment of benefits for the subsequent injury only to

the   extent   that    the    subsequent    injury    would     have    entitled     the

employee to benefits had the previous injury not existed.

       (b)AAThe       subsequent    injury     fund      shall     compensate        the

employee for the remainder of the lifetime income benefits to which

the employee is entitled.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                 SUBCHAPTER J. DEATH AND BURIAL BENEFITS

       Sec.A408.181.AADEATH BENEFITS.             (a)         An insurance carrier

shall pay death benefits to the legal beneficiary if a compensable

injury to the employee results in death.

       (b)AASubject      to    Section     408.061,     the    amount    of    a    death

                                          73
benefit is equal to 75 percent of the employee ’s average weekly

wage.

        (c)AAThe commissioner by rule shall establish requirements

for     agreements   under      which      death    benefits      may     be     paid

monthly.AADeath benefits may be paid monthly only:

              (1)AAon the request of the legal beneficiary and the

agreement of the legal beneficiary and the insurance carrier; and

              (2)AAin compliance with the requirements adopted by the

commissioner.

        (d)AAAn insurance carrier may pay death benefits through an

annuity if the annuity agreement meets the terms and conditions for

annuity    agreements     adopted    by    the   commissioner     by    rule.AAThe

establishment of an annuity under this subsection does not relieve

the   insurance   carrier      of   the   liability      under   this   title        for

ensuring that the death benefits are paid.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                 Amended

by Acts 1999, 76th Leg., ch. 1426, Sec. 15, eff. Sept. 1, 1999.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.127, eff.

September 1, 2005.

        Sec.A408.182.AADISTRIBUTION OF DEATH BENEFITS.              (a)    If there

is an eligible child or grandchild and an eligible spouse, half of

the death benefits shall be paid to the eligible spouse and half

shall be paid in equal shares to the eligible children.                         If an

eligible child has predeceased the employee, death benefits that

would have been paid to that child shall be paid in equal shares per

stirpes to the children of the deceased child.

        (b)AAIf there is an eligible spouse and no eligible child or

grandchild, all the death benefits shall be paid to the eligible

spouse.

        (c)AAIf   there   is   an   eligible     child   or   grandchild       and   no

eligible spouse, the death benefits shall be paid to the eligible

children or grandchildren.

        (d)AAIf there is no eligible spouse, no eligible child, and

no eligible grandchild, the death benefits shall be paid in equal

shares to surviving dependents of the deceased employee who are

                                          74
parents, stepparents, siblings, or grandparents of the deceased.

      (d-1)AAIf there is no eligible spouse, no eligible child, and

no eligible grandchild, and there are no surviving dependents of

the deceased employee who are parents, siblings, or grandparents of

the deceased, the death benefits shall be paid in equal shares to

surviving eligible parents of the deceased.AAA payment of death

benefits made under this subsection may not exceed one payment per

household.AATotal payments under this section may not exceed 104

weeks regardless of the number of surviving eligible parents.

      (d-2)AAExcept as otherwise provided by this subsection,AAto

be eligible to receive death benefits under Subsection (d-1), an

eligible   parent   must   file   with    the     division    a   claim         for   those

benefits not later than the first anniversary of the date of the

injured employee ’s death from the compensable injury.AAThe claim

must designate all eligible parents and necessary information for

payment to the eligible parents.AAThe insurance carrier is not

liable for payment to any eligible parent not designated on the

claim.AAFailure to file a claim in the time required bars the claim

unless good cause exists for the failure to file a claim under this

section.

      (e)AAIf an employee is not survived by legal beneficiaries or

eligible   parents,    the   death    benefits        shall       be    paid      to       the

subsequent injury fund under Section 403.007.

      (f)AAIn this section:

            (1)AA"Eligible        child"      means   a   child        of   a    deceased

employee if the child is:

                    (A)AAa minor;

                    (B)AAenrolled        as   a    full-time       student            in    an

accredited educational institution and is less than 25 years of

age; or

                    (C)AAa dependent of the deceased employee at the

time of the employee ’s death.

            (2)AA"Eligible        grandchild"       means    a    grandchild           of    a

deceased employee who is a dependent of the deceased employee and

whose parent is not an eligible child.

            (3)AA"Eligible spouse" means the surviving spouse of a

deceased employee unless the spouse abandoned the employee for

                                      75
longer than the year immediately preceding the death without good

cause, as determined by the division.

              (4)AA"Eligible parent" means the mother or the father

of   a   deceased    employee,        including       an     adoptive   parent      or   a

stepparent.AAThe term does not include a parent whose parental

rights have been terminated.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.128, eff.

September 1, 2005.

         Acts 2007, 80th Leg., R.S., Ch. 1007 (H.B. 724), Sec. 5, eff.

September 1, 2007.

         Acts 2007, 80th Leg., R.S., Ch. 1007 (H.B. 724), Sec. 6, eff.

September 1, 2007.

         Acts 2009, 81st Leg., R.S., Ch. 344 (H.B. 1058), Sec. 1, eff.

September 1, 2009.

         Sec.A408.183.AADURATION OF DEATH BENEFITS.                   (a)   Entitlement

to death benefits begins on the day after the date of an employee ’s

death.

         (b)AAAn eligible spouse is entitled to receive death benefits

for life or until remarriage.AAOn remarriage, the eligible spouse

is entitled to receive 104 weeks of death benefits, commuted as

provided by commissioner rule.

         (c)AAA child who is eligible for death benefits because the

child is a minor on the date of the employee ’s death is entitled to

receive benefits until the child attains the age of 18.

         (d)AAA child eligible for death benefits under Subsection (c)

who at age 18 is enrolled as a full-time student in an accredited

educational      institution     or    a    child     who    is   eligible   for   death

benefits because on the date of the employee ’s death the child is

enrolled    as   a   full-time    student        in   an     accredited     educational

institution is entitled to receive or to continue to receive, as

appropriate, benefits until the earliest of:

              (1)AAthe    date        the     child         ceases,   for    a     second

consecutive semester, to be enrolled as a full-time student in an

accredited educational institution;

                                            76
              (2)AAthe date the child attains the age of 25;          or

              (3)AAthe date the child dies.

      (e)AAA child who is eligible for death benefits because the

child is a dependent of the deceased employee on the date of the

employee ’s death is entitled to receive benefits until the earlier

of:

              (1)AAthe date the child dies; or

              (2)AAif the child is dependent:

                      (A)AAbecause the child is an individual with a

physical or mental disability, the date the child no longer has the

disability;    or

                      (B)AAbecause of a reason other than a physical or

mental disability, the date of the expiration of 364 weeks of death

benefit payments.

      (f)AAAn       eligible   grandchild   is   entitled    to   receive   death

benefits until the earlier of:

              (1)AAthe date the grandchild dies; or

              (2)AAif the grandchild is:

                      (A)AAa minor at the time of the employee ’s death,

the date the grandchild ceases to be a minor;           or

                      (B)AAnot a minor at the time of the employee ’s

death, the date of the expiration of 364 weeks of death benefit

payments.

      (f-1)AAAn eligible parent who is not a surviving dependent of

the deceased employee is entitled to receive death benefits until

the earlier of:

              (1)AAthe date the eligible parent dies; or

              (2)AAthe date of the expiration of 104 weeks of death

benefit payments.

      (g)AAAny other person entitled to death benefits is entitled

to receive death benefits until the earlier of:

              (1)AAthe date the person dies;       or

              (2)AAthe date of the expiration of 364 weeks of death

benefit payments.

      (h)AASection 401.011(16) does not apply to the use of the

term "disability" in this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                      77
Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.129, eff.

September 1, 2005.

        Acts 2007, 80th Leg., R.S., Ch. 1007 (H.B. 724), Sec. 7, eff.

September 1, 2007.

        Sec.A408.184.AAREDISTRIBUTION OF DEATH BENEFITS.                   (a)   If a

legal beneficiary dies or otherwise becomes ineligible for death

benefits, benefits shall be redistributed to the remaining legal

beneficiaries as provided by Sections 408.182 and 408.183.

        (b)AAIf a spouse ceases to be eligible because of remarriage,

the benefits payable to the remaining legal beneficiaries remain

constant for 104 weeks.       After the 104th week, the spouse ’s share of

benefits shall be redistributed as provided by Sections 408.182 and

408.183.

        (c)AAIf all legal beneficiaries, other than the subsequent

injury fund, cease to be eligible and the insurance carrier has not

made    364   weeks   of   full   death   benefit   payments,    including         the

remarriage     payment,     the   insurance      carrier     shall    pay   to     the

subsequent injury fund an amount computed by subtracting the total

amount paid from the amount that would be paid for 364 weeks of

death benefits.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A408.185.AAEFFECT OF BENEFICIARY DISPUTE;                  ATTORNEY ’S

FEES.   On settlement of a case in which the insurance carrier admits

liability for death benefits but a dispute exists as to the proper

beneficiary     or    beneficiaries,      the   settlement    shall   be    paid    in

periodic payments as provided by law, with a reasonable attorney ’s

fee not to exceed 25 percent of the settlement, paid periodically,

and based on time and expenses.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A408.186.AABURIAL BENEFITS.             (a)    If the death of an

employee results from a compensable injury, the insurance carrier

shall pay to the person who incurred liability for the costs of

burial the lesser of:

                                          78
              (1)AAthe actual costs incurred for reasonable burial

expenses;   or

              (2)AA$6,000.

       (b)AAIf the employee died away from the employee ’s usual

place of employment, the insurance carrier shall pay the reasonable

cost   of   transporting     the       body,    not    to     exceed   the    cost      of

transporting the body to the employee ’s usual place of employment.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                     Amended

by Acts 1999, 76th Leg., ch. 1426, Sec. 16, eff. Sept. 1, 1999.

       Sec.A408.187.AAAUTOPSY.             (a)        If   in   a   claim    for   death

benefits based on an occupational disease an autopsy is necessary

to   determine    the   cause     of     death,      the   commission       may,   after

opportunity      for   hearing,    order       the    legal     beneficiaries      of    a

deceased employee to permit an autopsy.

       (b)AAA legal beneficiary is entitled to have a representative

present at an autopsy ordered under this section.

       (c)AAThe commissioner shall require the insurance carrier to

pay the costs of a procedure ordered under this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.130, eff.

September 1, 2005.

            SUBCHAPTER K. PROTECTION OF RIGHTS TO BENEFITS

       Sec.A408.201.AABENEFITS EXEMPT FROM LEGAL PROCESS.                     Benefits

are exempt from:

              (1)AAgarnishment;

              (2)AAattachment;

              (3)AAjudgment;       and

              (4)AAother actions or claims.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec. 408.202.AAASSIGNABILITY OF BENEFITS.                    Benefits are not

assignable, except a legal beneficiary may, with the commissioner ’s

approval, assign the right to death benefits.

                                          79
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.131, eff.

September 1, 2005.

      Sec.A408.203.AAALLOWABLE LIENS.           (a)     An income or death

benefit is subject only to the following lien or claim, to the

extent the benefit is unpaid on the date the insurance carrier

receives written notice of the lien or claim, in the following order

of priority:

              (1)AAan attorney ’s fee for representing an employee or

legal beneficiary in a matter arising under this subtitle;

              (2)AAcourt-ordered child support;        or

              (3)AAa   subrogation   interest       established    under   this

subtitle.

      (b)AAA benefit that is subject to a lien or claim for payment

of court-ordered child support shall be paid as required by an order

or writ of income withholding under Chapter 158, Family Code.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.            Amended

by Acts 1997, 75th Leg., ch. 165, Sec. 7.53, eff. Sept. 1, 1997;

Acts 2003, 78th Leg., ch. 610, Sec. 22, eff. Sept. 1, 2003.

  SUBCHAPTER L. ATTORNEY ’S FEES IN WORKERS ’ COMPENSATION BENEFIT

                                   MATTERS

      Sec.A408.221.AAATTORNEY ’S FEES PAID TO CLAIMANT ’S COUNSEL.

(a)    An     attorney ’s   fee,   including    a    contingency    fee,   for

representing a claimant before the division or court under this

subtitle must be approved by the commissioner or court.

      (b)AAExcept as otherwise provided, an attorney ’s fee under

this section is based on the attorney ’s time and expenses according

to written evidence presented to the division or court.AAExcept as

provided by Subsection (c) or Section 408.147(c), the attorney ’s

fee shall be paid from the claimant ’s recovery.

      (c)AAAn insurance carrier that seeks judicial review under

Subchapter G, Chapter 410, of a final decision of the appeals panel

regarding compensability or eligibility for, or the amount of,

                                     80
income or death benefits is liable for reasonable and necessary

attorney ’s   fees      as   provided       by   Subsection        (d)    incurred     by   the

claimant     as    a   result    of   the   insurance        carrier ’s       appeal   if   the

claimant prevails on an issue on which judicial review is sought by

the insurance carrier in accordance with the limitation of issues

contained     in    Section     410.302.AAIf        the      carrier     appeals      multiple

issues and the claimant prevails on some, but not all, of the issues

appealed,     the      court     shall      apportion        and      award    fees    to   the

claimant ’s   attorney        only    for    the   issues        on   which    the    claimant

prevails.AAIn making that apportionment, the court shall consider

the factors prescribed by Subsection (d).AAThis subsection does not

apply to attorney ’s fees for which an insurance carrier may be

liable under Section 408.147.AAAn award of attorney ’s fees under

this subsection is not subject to commissioner rules adopted under

Subsection (f).

        (d)AAIn approving an attorney ’s fee under this section, the

commissioner or court shall consider:

              (1)AAthe time and labor required;

              (2)AAthe         novelty      and    difficulty          of     the    questions

involved;

              (3)AAthe skill required to perform the legal services

properly;

              (4)AAthe fee customarily charged in the locality for

similar legal services;

              (5)AAthe amount involved in the controversy;

              (6)AAthe benefits to the claimant that the attorney is

responsible for securing; and

              (7)AAthe          experience        and    ability         of   the     attorney

performing the services.

        (e)AAThe commissioner by rule or the court may provide for

the commutation of an attorney ’s fee, except that the attorney ’s fee

shall   be   paid      in   periodic     payments       in   a   claim      involving    death

benefits if the only dispute is as to the proper beneficiary or

beneficiaries.

        (f)AAThe commissioner by rule shall provide guidelines for

maximum attorney ’s fees for specific services in accordance with

this section.

                                             81
         (g)AAAn attorney ’s fee may not be allowed in a case involving

a fatal injury or lifetime income benefit if the insurance carrier

admits    liability    on   all   issues   and   tenders     payment     of   maximum

benefits in writing under this subtitle while the claim is pending

before the division.

         (h)AAAn   attorney ’s    fee   shall    be   paid   to   the   attorney    by

separate draft.

         (i)AAExcept as provided by Subsection (c) or Section 408.

147(c),    an    attorney ’s   fee   may   not    exceed     25   percent     of   the

claimant ’s recovery.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                    Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 8.01, eff. June 17, 2001.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.132, eff.

September 1, 2005.

         Sec. 408.222.AAATTORNEY ’S FEES PAID TO DEFENSE COUNSEL.                  (a)

The amount of an attorney ’s fee for defending an insurance carrier

in a workers ’ compensation action brought under this subtitle must

be approved by the division or court and determined by the division

or court to be reasonable and necessary.

         (b)AAIn determining whether a fee is reasonable under this

section, the division or court shall consider issues analogous to

those listed under Section 408.221(d).AAThe defense counsel shall

present written evidence to the division or court relating to:

                (1)AAthe time spent and expenses incurred in defending

the case; and

                (2)AAother     evidence       considered     necessary        by   the

division or court in making a determination under this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                    Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 8.03, eff. June 17, 2001.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.133, eff.

September 1, 2005.

                                         82
                                    LABOR CODE

                        TITLE 5. WORKERS ’ COMPENSATION

                SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

                   CHAPTER 409. COMPENSATION PROCEDURES

             SUBCHAPTER A. INJURY REPORTS, CLAIMS, AND RECORDS

        Sec.A409.001.AANOTICE         OF       INJURY    TO   EMPLOYER.        (a)      An

employee or a person acting on the employee ’s behalf shall notify

the employer of the employee of an injury not later than the 30th

day after the date on which:

               (1)AAthe injury occurs; or

               (2)AAif    the    injury    is    an     occupational     disease,      the

employee knew or should have known that the injury may be related to

the employment.

        (b)AAThe notice required under Subsection (a) may be given

to:

               (1)AAthe employer;         or

               (2)AAan     employee        of    the     employer       who    holds     a

supervisory or management position.

        (c)AAIf the injury is an occupational disease, for purposes

of    this   section,    the    employer    is    the    person   who    employed      the

employee on the date of last injurious exposure to the hazards of

the disease.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec. 409.002.AAFAILURE TO FILE NOTICE OF INJURY.                      Failure to

notify an employer as required by Section 409.001(a) relieves the

employer and the employer ’s insurance carrier of liability under

this subtitle unless:

               (1)AAthe employer, a person eligible to receive notice

under Section 409.001(b), or the employer ’s insurance carrier has

actual knowledge of the employee ’s injury;

               (2)AAthe division determines that good cause exists for

failure to provide notice in a timely manner; or

               (3)AAthe employer or the employer ’s insurance carrier

does not contest the claim.

                                           1
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.134, eff.

September 1, 2005.

       Sec. 409.003.AACLAIM FOR COMPENSATION.                     An employee or a

person acting on the employee ’s behalf shall file with the division

a claim for compensation for an injury not later than one year after

the date on which:

              (1)AAthe injury occurred; or

              (2)AAif     the   injury    is   an    occupational     disease,   the

employee knew or should have known that the disease was related to

the employee ’s employment.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.135, eff.

September 1, 2005.

       Sec.    409.004.AAEFFECT          OF    FAILURE      TO    FILE   CLAIM   FOR

COMPENSATION.     Failure to file a claim for compensation with the

division as required under Section 409.003 relieves the employer

and   the   employer ’s   insurance      carrier      of   liability     under   this

subtitle unless:

              (1)AAgood cause exists for failure to file a claim in a

timely manner; or

              (2)AAthe employer or the employer ’s insurance carrier

does not contest the claim.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.136, eff.

September 1, 2005.

       Sec.A409.005.AAREPORT        OF    INJURY;          MODIFIED   DUTY   PROGRAM

NOTICE;     ADMINISTRATIVE VIOLATION.          (a)   An employer shall report to

the employer ’s insurance carrier if:

              (1)AAan injury results in the absence of an employee of

that employer from work for more than one day;               or

                                          2
               (2)AAan employee of the employer notifies that employer

of an occupational disease under Section 409.001.

         (b)AAThe report under Subsection (a) must be made not later

than the eighth day after:

               (1)AAthe employee ’s absence from work for more than one

day due to an injury;        or

               (2)AAthe     day   on     which   the     employer      receives   notice

under    Section     409.001      that     the    employee       has    contracted      an

occupational disease.

         (c)AAThe employer shall deliver a written copy of the report

under Subsection (a) to the injured employee at the time that the

report is made to the insurance carrier.

         (d)AAThe   insurance       carrier      shall    file   the    report    of    the

injury    on   behalf   of    the   policyholder.AAExcept              as   provided     by

Subsection (e), the insurance carrier must electronically file the

report with the division not later than the seventh day after the

date on which the carrier receives the report from the employer.

         (e)AAThe    commissioner         may    waive     the   electronic       filing

requirement under Subsection (d) and allow an insurance carrier to

mail or deliver the report to the division not later than the

seventh day after the date on which the carrier receives the report

from the employer.

         (f)AAA    report    required      under       this   section       may   not   be

considered to be an admission by or evidence against an employer or

an insurance carrier in a proceeding before the division or a court

in which the facts set out in the report are contradicted by the

employer or insurance carrier.

         (g)AAIn    addition        to    any     information          required    under

Subsection (h), the report provided to the injured employee under

Subsection (c) must contain a summary written in plain language of

the employee ’s statutory rights and responsibilities under this

subtitle.

         (h)AAThe commissioner may adopt rules relating to:

               (1)AAthe information that must be contained in a report

required under this section, including the summary of rights and

responsibilities required under Subsection (g); and

               (2)AAthe      development          and     implementation          of     an

                                            3
electronic filing system for injury reports under this section.

       (i)AAAn employer and insurance carrier shall file subsequent

reports as required by commissioner rule.

       (j)AAThe    employer      shall,       on       the   written       request    of   the

employee, a doctor, the insurance carrier, or the division, notify

the   employee,   the     employee ’s    treating            doctor    if    known    to   the

employer, and the insurance carrier of the existence or absence of

opportunities for modified duty or a modified duty return-to-work

program available through the employer.AAIf those opportunities or

that program exists, the employer shall identify the employer ’s

contact person and provide other information to assist the doctor,

the employee, and the insurance carrier to assess modified duty or

return-to-work options.

       (k)AAThis section does not prohibit the commissioner from

imposing   requirements         relating         to    return-to-work         under       other

authority granted to the division in this subtitle.

       (l)AAA    person      commits    an    administrative           violation      if    the

person fails to comply with this section unless good cause exists.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                           Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.29, eff. Sept. 1, 1995;

Acts 2001, 77th Leg., ch. 1456, Sec. 3.01, eff. June 17, 2001.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.137, eff.

September 1, 2005.

       Sec.A409.006.AARECORD             OF           INJURIES;             ADMINISTRATIVE

VIOLATION.      (a)     An    employer       shall      maintain       a   record    of    each

employee injury as reported by an employee or otherwise made known

to the employer.

       (b)AAThe    record       shall    be      available        to   the    division       at

reasonable      times     and    under        conditions          prescribed         by     the

commissioner.

       (c)AAThe    commissioner         may       adopt      rules     relating      to     the

information that must be contained in an employer record under this

section.

       (d)AAInformation contained in a record maintained under this

section is not an admission by the employer that:

                                             4
              (1)AAthe injury did in fact occur;                   or

              (2)AAa fact maintained in the record is true.

         (e)AAA   person    commits    an       administrative          violation      if    the

person fails to comply with this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.138, eff.

September 1, 2005.

         Sec.A409.007.AADEATH BENEFIT CLAIMS.                 (a)       A person must file

a claim for death benefits with the division not later than the

first anniversary of the date of the employee ’s death.

         (b)AAFailure to file in the time required by Subsection (a)

bars the claim unless:

              (1)AAthe person is a minor or incompetent;                        or

              (2)AAgood cause exists for the failure to file a claim

under this section.

         (c)AAA    separate       claim     must      be     filed       for    each     legal

beneficiary       unless    the    claim   expressly         includes      or    is   made   on

behalf of another person.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.139, eff.

September 1, 2005.

         Sec.A409.008.AAFAILURE TO FILE EMPLOYER REPORT OF INJURY;

LIMITATIONS TOLLED.          If an employer or the employer ’s insurance

carrier has been given notice or has knowledge of an injury to or

the death of an employee and the employer or insurance carrier

fails,    neglects,    or    refuses       to    file   the    report      under       Section

409.005,    the    period    for    filing       a   claim   for    compensation         under

Sections 409.003 and 409.007 does not begin to run against the claim

of an injured employee or a legal beneficiary until the day on which

the report required under Section 409.005 has been furnished.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec. 409.009.AASUBCLAIMS.              A person may file a written claim

                                             5
with the division as a subclaimant if the person has:

              (1)AAprovided        compensation,         including        health      care

provided by a health care insurer, directly or indirectly, to or for

an employee or legal beneficiary; and

              (2)AAsought        and    been   refused   reimbursement         from   the

insurance carrier.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.140, eff.

September 1, 2005.

       Sec.     409.0091.AAREIMBURSEMENT              PROCEDURES       FOR      CERTAIN

ENTITIES.     (a)      In this section, "health care insurer" means an

insurance carrier and an authorized representative of an insurance

carrier, as described by Section 402.084(c-1).

       (b)AAThis section applies only to a request for reimbursement

by a health care insurer.

       (c)AAHealth       care    paid    by    a   health    care    insurer    may     be

reimbursable as a medical benefit.

       (d)AAExcept as provided by Subsection (e), this section does

not   prohibit      or   limit    a     substantive      defense     by    a   workers ’

compensation insurance carrier that the health care paid for by the

health care insurer was not a medical benefit or not a correct

payment.AAA subclaimant may not be reimbursed for payment for any

health care that was previously denied by a workers ’ compensation

insurance carrier under:

              (1)AAa preauthorization review of the specific service

or medical procedure; or

              (2)AAa     medical       necessity    review    that    determined      the

service   was    not     medically      necessary     for    the     treatment     of   a

compensable injury.

       (e)AAIt is not a defense to a subclaim by a health care

insurer that:

              (1)AAthe subclaimant has not sought reimbursement from

a health care provider or the subclaimant ’s insured;

              (2)AAthe subclaimant or the health care provider did

not request preauthorization under Section 413.014 or rules adopted

                                           6
under that section; or

              (3)AAthe health care provider did not bill the workers ’

compensation insurance carrier, as provided by Section 408.027,

before the 95th day after the date the health care for which the

subclaimant paid was provided.

       (f)AASubject to the time limits under Subsection (n), the

health care insurer shall provide, with any reimbursement request,

the tax identification number of the health care insurer and the

following to the workers ’ compensation insurance carrier, in a form

prescribed by the division:

              (1)AAinformation identifying the workers ’ compensation

case, including:

                     (A)AAthe division claim number;

                     (B)AAthe name of the patient or claimant;

                     (C)AAthe social security number of the patient or

claimant; and

                     (D)AAthe date of the injury; and

              (2)AAinformation describing the health care paid by the

health care insurer, including:

                     (A)AAthe name of the health care provider;

                     (B)AAthe tax identification number of the health

care provider;

                     (C)AAthe date of service;

                     (D)AAthe place of service;

                     (E)AAthe ICD-9 code;

                     (F)AAthe CPT, HCPCS, NDC, or revenue code;

                     (G)AAthe      amount   charged     by   the    health   care

provider; and

                     (H)AAthe amount paid by the health care insurer.

       (g)AAThe     workers ’     compensation    insurance        carrier   shall

reduce the amount of the reimbursable subclaim by any payments the

workers ’ compensation insurance carrierAApreviously made to the

same health care provider for the provision of the same health care

on   the   same   dates   of    service.AAIn   making    such   a   reduction   in

reimbursement      to     the   subclaimant,     the    workers ’   compensation

insurance carrier shall provide evidence of the previous payments

made to the provider.

                                        7
        (h)AAFor      each     medical          benefit      paid,     the     workers ’

compensation insurance carrier shall pay to the health care insurer

the lesser of the amount payable under the applicable fee guideline

as of the date of service or the actual amount paid by the health

care insurer.AAIn the absence of a fee guideline for a specific

service paid, the amount per service paid by the health care insurer

shall be considered in determining a fair and reasonable payment

under   rules   under    this    subtitle        defining     fair    and    reasonable

medical reimbursement.AAThe health care insurer may not recover

interest as a part of the subclaim.

        (i)AAOn receipt of a request for reimbursement under this

section, the workers ’ compensation insurance carrier shall respond

to the request in writing not later than the 90th day after the date

on which the request is received.AAIf additional information is

requested     under     Subsection       (j),      the    workers ’        compensation

insurance carrier shall respond not later than the 120th day unless

the time is extended under Subsection (j).

        (j)AAIf the workers ’ compensation insurance carrier requires

additional information from the health care insurer, the workers ’

compensation insurance carrier shall send notice to the health care

insurer   requesting     the    additional        information.       The    health   care

insurer     shall     have      30    days        to   provide        the     requested

information.AAThe workers ’ compensation insurance carrier and the

health care insurer may establish additional periods for compliance

with this subsection by written mutual agreement.

        (k)AAUnless the parties have agreed to an extension of time

under Subsection (j), the health care insurer must file a written

subclaim under this section not later than the 120th day after:

              (1)AAthe workers ’ compensation insurance carrier fails

to respond to a request for reimbursement; or

              (2)AAreceipt      of    the   workers ’ compensation            insurance

carrier ’s notice of denial to pay or reduction in reimbursement.

        (l)AAAny dispute that arises from a failure to respond to or a

reduction or denial of a request for reimbursement of services that

form the basis of the subclaim must go through the appropriate

dispute   resolution      process      under      this    subtitle     and     division

rules.AAThe     commissioner     of    insurance       and    the    commissioner     of

                                            8
workers ’ compensation shall modify rules under this subtitle as

necessary to allow the health care insurer access as a subclaimant

to the appropriate dispute resolution process.AARules adopted or

amended by the commissioner of insurance and the commissioner of

workers ’ compensation must recognize the status of a subclaimant as

a   party   to    the   dispute.AARules           modified     or    adopted     under   this

section     should      ensure   that   the       workers ’ compensation          insurance

carrier is not penalized, including not being held responsible for

costs of obtaining the additional information, if the workers ’

compensation insurance carrier denies payment in order to move to

dispute resolution to obtain additional information to process the

request.

       (m)AAIn a dispute filed under Chapter 410 that arises from a

subclaim under this section, a hearing officer may issue an order

regarding compensability or eligibility for benefits and order the

workers ’ compensation insurance carrier to reimburse health care

services paid by the health care insurer as appropriate under this

subtitle.AAAny dispute over the amount of medical benefits owed

under this section, including medical necessity issues, shall be

determined by medical dispute resolution under Sections 413.031 and

413.032.

       (n)AAExcept as provided by Subsection (s), a health care

insurer must file a request for reimbursement with the workers ’

compensation insurance carrier not later than six months after the

date on which the health care insurer received information under

Section 402.084(c-3) and not later than 18 months after the health

care insurer paid for the health care service.

       (o)AAThe         commissioner    and       the     commissioner      of    insurance

shall amend or adopt rules to specify the process by which an

employee who has paid for health care services described by Section

408.027(d) may seek reimbursement.

       (p)AAUntil         September     1,        2011,    a    workers ’   compensation

insurance carrier is exempt from any department and division data

reporting requirements affected by a lack of information caused by

reimbursement requests or subclaims under this section.AAIf data

reporting        is   required    after       that      date,       the   requirement     is

prospective only and may not require any data to be reported between

                                              9
September    1,     2007,       and     the    date       required     reporting     is

reinstated.AAThe department and the division may make legislative

recommendations      to   the    82nd    Legislature       for   the   collection    of

reimbursement request and subclaim data.

      (q)AAAn action or failure to act by a workers ’ compensation

insurance carrier under this section may not serve as the basis for

an examination or administrative action by the department or the

division, or for any cause of action by any person, except for

judicial review under this subtitle.

      (r)AAThe commissioner of insurance and the commissioner of

workers ’ compensation may adopt additional rules to clarify the

processes    required     by,    fulfill      the   purpose      of,   or   assist   the

parties in the proper adjudication of subclaims under this section.

      (s)AAOn or after September 1, 2007, from information provided

to a health care insurer before January 1, 2007, under Section

402.084(c-3), the health care insurer may file not later than March

1, 2008:

             (1)AAa subclaim with the division under Subsection (l)

if a request for reimbursement has been presented and denied by a

workers ’ compensation insurance carrier; or

             (2)AAa request for reimbursement under Subsection (f)

if a request for reimbursement has not previously been presented

and denied by the workers ’ compensation insurance carrier.

Added by Acts 2007, 80th Leg., R.S., Ch. 1007 (H.B. 724), Sec. 8,

eff. September 1, 2007.

      Sec.   409.010.AAINFORMATION             PROVIDED     TO   EMPLOYEE     OR   LEGAL

BENEFICIARY.      Immediately on receiving notice of an injury or death

from any person, the division shall mail to the employee or legal

beneficiary a clear and concise description of:

             (1)AAthe services provided by:

                     (A)AAthe division; and

                     (B)AAthe     office       of   injured      employee     counsel,

including the services of the ombudsman program;

             (2)AAthe division ’s procedures; and

             (3)AAthe     person ’s      rights     and    responsibilities        under

this subtitle.

                                          10
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.141, eff.

September 1, 2005.

       Sec.A409.011.AAINFORMATION PROVIDED TO EMPLOYER;                     EMPLOYER ’S

RIGHTS.   (a)   Immediately on receiving notice of an injury or death

from   any   person,   the   division      shall   mail       to    the   employer     a

description of:

              (1)AAthe   services     provided     by    the       division    and    the

office of injured employee counsel;

              (2)AAthe division ’s procedures; and

              (3)AAthe employer ’s rights and responsibilities under

this subtitle.

       (b)AAThe information must include a clear statement of the

following rights of the employer:

              (1)AAthe   right   to   be    present      at   all    administrative

proceedings relating to an employee ’s claim;

              (2)AAthe right to present relevant evidence relating to

an employee ’s claim at any proceeding;

              (3)AAthe right to report suspected fraud;

              (4)AAthe   right   to   contest      the    compensability         of    an

injury if the insurance carrier accepts liability for the payment

of benefits;

              (5)AAthe   right   to    receive      notice,         after     making   a

written request to the insurance carrier, of:

                   (A)AAa proposal to settle a claim;                or

                   (B)AAan administrative or a judicial proceeding

relating to the resolution of a claim;         and

              (6)AAthe right to contest the failure of the insurance

carrier to provide accident prevention services under Subchapter E,

Chapter 411.

       (c)AAThe division is not required to provide the information

to an employer more than once during a calendar year.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.142, eff.

                                       11
September 1, 2005.

      Sec. 409.012.AAVOCATIONAL REHABILITATION INFORMATION.                           (a)

The division shall analyze each report of injury received from an

employer   under   this    chapter     to    determine       whether       the   injured

employee would be assisted by vocational rehabilitation.

      (b)AAIf    the    division   determines         that   an   injured        employee

would be assisted by vocational rehabilitation, the division shall

notify:

              (1)AAthe injured employee in writing of the services

and facilities available through the Department of Assistive and

Rehabilitative     Services      and   private          providers     of    vocational

rehabilitation; and

              (2)AAthe    Department      of    Assistive       and   Rehabilitative

Services   and   the    affected   insurance         carrier      that     the   injured

employee   has   been    identified    as      one   who   could      be   assisted    by

vocational rehabilitation.

      (c)AAThe division shall cooperate with the office of injured

employee counsel, the Department of Assistive and Rehabilitative

Services, and private providers of vocational rehabilitation in the

provision of services and facilities to employees by the Department

of Assistive and Rehabilitative Services.

      (d)AAA     private       provider      of      vocational       rehabilitation

services may register with the division.

      (e)AAThe commissioner by rule may require that a private

provider of vocational rehabilitation services maintain certain

credentials and qualifications in order to provide services in

connection with a workers ’ compensation insurance claim.

      (f)AARepealed by Acts 2011, 82nd Leg., R.S., Ch. 1083, Sec.

25(127), eff. June 17, 2011.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                       Amended

by Acts 1999, 76th Leg., ch. 956, Sec. 2, eff. Sept. 1, 1999.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.143, eff.

September 1, 2005.

      Acts    2011,     82nd   Leg.,   R.S.,      Ch.    1083   (S.B.      1179),    Sec.

25(127), eff. June 17, 2011.

                                        12
        Sec. 409.013.AAPLAIN LANGUAGE INFORMATION; NOTIFICATION OF

INJURED EMPLOYEE.      (a)     The division shall develop information for

public dissemination about the benefit process and the compensation

procedures established under this chapter.AAThe information must

be written in plain language and must be available in English and

Spanish.

        (b)AAOn     receipt   of    a    report      under    Section      409.005,       the

division    shall    contact       the   affected      employee       by    mail     or   by

telephone     and    shall    provide       the     information       required       under

Subsection     (a)    to     that    employee,        together       with    any     other

information that may be prepared by the office of injured employee

counsel or the division for public dissemination that relates to

the employee ’s situation, such as information relating to back

injuries or occupational diseases.

Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.30, eff. Sept. 1,

1995.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.144, eff.

September 1, 2005.

                     SUBCHAPTER B. PAYMENT OF BENEFITS

        Sec.A409.021.AAINITIATION OF BENEFITS;                  INSURANCE CARRIER ’S

REFUSAL;     ADMINISTRATIVE VIOLATION.                (a)     An insurance carrier

shall   initiate     compensation        under      this   subtitle     promptly.AANot

later than the 15th day after the date on which an insurance carrier

receives written notice of an injury, the insurance carrier shall:

              (1)AAbegin the payment of benefits as required by this

subtitle; or

              (2)AAnotify the division and the employee in writing of

its refusal to pay and advise the employee of:

                     (A)AAthe       right      to    request     a    benefit      review

conference; and

                     (B)AAthe means to obtain additional information

from the division.

        (a-1)AAAn     insurance      carrier        that     fails   to     comply    with

                                          13
Subsection (a) does not waive the carrier ’s right to contest the

compensability of the injury as provided by Subsection (c) but

commits an administrative violation subject to Subsection (e).

       (a-2)AAAn insurance carrier is not required to comply with

Subsection (a) if the insurance carrier has accepted the claim as a

compensable    injury    and   income    or    death      benefits         have   not   yet

accrued but will be paid by the insurance carrier when the benefits

accrue and are due.

       (b)AAAn     insurance    carrier      shall       notify      the    division    in

writing of the initiation of income or death benefit payments in the

manner prescribed by commissioner rules.

       (c)AAIf      an   insurance      carrier          does     not      contest      the

compensability of an injury on or before the 60th day after the date

on   which   the   insurance   carrier    is    notified        of   the    injury,     the

insurance carrier waives its right to contest compensability.                           The

initiation of payments by an insurance carrier does not affect the

right of the insurance carrier to continue to investigate or deny

the compensability of an injury during the 60-day period.

       (d)AAAn     insurance    carrier       may    reopen     the      issue    of    the

compensability of an injury if there is a finding of evidence that

could not reasonably have been discovered earlier.

       (e)AAAn      insurance    carrier        commits         an      administrative

violation if the insurance carrier does not initiate payments or

file a notice of refusal as required by this section.

A

Text of subsec. (f) as added by Acts 2003, 78th Leg., ch. 939, Sec. 1

A

       (f)AAFor purposes of this section, "written notice" to a

certified     self-insurer     occurs    only       on    written       notice    to    the

qualified claims servicing contractor designated by the certified

self-insurer under Section 407.061(c).

A

Text of subsec. (f) as added by Acts 2003, 78th Leg., ch. 1100, Sec.

                                         1

A

       (f)AAFor purposes of this section:

              (1)AAa certified self-insurer receives notice on the

                                        14
date the qualified claims servicing contractor designated by the

certified self-insurer under Section 407.061(c) receives notice;

and

               (2)AAa political subdivision that self-insures under

Section   504.011,     either   individually      or   through   an    interlocal

agreement with other political subdivisions, receives notice on the

date the intergovernmental risk pool or other entity responsible

for administering the claim for the political subdivision receives

notice.

      (j)AAEach insurance carrier shall establish a single point of

contact in the carrier ’s office for an injured employee for whom the

carrier receives a notice of injury.

Added by Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by Acts 2003, 78th Leg., ch. 939, Sec. 1, eff. Sept. 1,

2003; Acts 2003, 78th Leg., ch. 1100, Sec. 1, eff. Sept. 1, 2003.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.145, eff.

September 1, 2005.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 13,

eff. September 1, 2011.

      Sec.A409.022.AAREFUSAL              TO   PAY     BENEFITS;         NOTICE;

ADMINISTRATIVE VIOLATION.           (a)    An insurance carrier ’s notice of

refusal to pay benefits under Section 409.021 must specify the

grounds for the refusal.

      (b)AAThe grounds for the refusal specified in the notice

constitute the only basis for the insurance carrier ’s defense on

the issue of compensability in a subsequent proceeding, unless the

defense   is   based   on   newly    discovered      evidence   that   could   not

reasonably have been discovered at an earlier date.

      (c)AAAn      insurance        carrier    commits    an     administrative

violation if the insurance carrier does not have reasonable grounds

for a refusal to pay benefits, as determined by the commissioner.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.146, eff.

September 1, 2005.

                                          15
        Sec.A409.023.AAPAYMENT                    OF     BENEFITS;               ADMINISTRATIVE

VIOLATION.       (a)      An insurance carrier shall continue to pay benefits

promptly as and when the benefits accrue without a final decision,

order, or other action of the commissioner, except as otherwise

provided.

        (b)AABenefits             shall     be    paid     solely    to    the      order     of    the

employee or the employee ’s legal beneficiary.

        (c)AAAn        insurance            carrier        commits        an     administrative

violation      if     the       insurance        carrier    fails    to    comply          with    this

section.

        (d)AAAn insurance carrier that commits multiple violations

of this section commits an additional administrative violation and

is subject to:

                (1)AAthe sanctions provided under Section 415.023; and

                (2)AArevocation of the right to do business under the

workers ’ compensation laws of this state.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.147, eff.

September 1, 2005.

        Sec.A409.0231.AAPAYMENT BY ELECTRONIC FUNDS TRANSFER.                                       (a)

An insurance carrier shall offer employees entitled to the payment

of    benefits      for     a   period      of    sufficient    duration            the    option   of

receiving the payments by electronic funds transfer.                                The insurance

carrier    shall       provide        the    necessary       forms    to       an    employee       who

requests that benefits be paid by electronic funds transfer.

        (b)AAThe commissioner shall adopt rules in consultation with

the    Texas    Department           of   Information        Resources         as    necessary       to

implement this section, including rules prescribing a period of

benefits       that    is       of   sufficient         duration     to    allow          payment   by

electronic funds transfer.

Added by Acts 1999, 76th Leg., ch. 690, Sec. 1, eff. Sept. 1, 1999.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.148, eff.

September 1, 2005.

                                                   16
      Sec.A409.0232.AATIMELINESS             OF    PAYMENTS.       An   insurance

carrier is considered to have paid benefits in a timely manner if a

payment:

              (1)AAis    made   by    electronic        funds   transfer    and   is

deposited   in   the    employee ’s   account      on   or   before   the   benefit

payment due date;

              (2)AAis made by mail and is mailed in time for the

payment to be postmarked on or before the benefit payment due date;

or

              (3)AAis to be picked up by the employee and the payment

is made available to the employee during regular business hours not

later than the opening of business on the benefit payment due date.

Added by Acts 1999, 76th Leg., ch. 690, Sec. 1, eff. June 18, 1999.

      Sec. 409.024.AATERMINATION OR REDUCTION OF BENEFITS; NOTICE;

ADMINISTRATIVE VIOLATION.         (a)    An insurance carrier shall file

with the division a notice of termination or reduction of benefits,

including the reasons for the termination or reduction, not later

than the 10th day after the date on which benefits are terminated or

reduced.

      (b)AAAn     insurance      carrier          commits    an   administrative

violation if the insurance carrier does not have reasonable grounds

to terminate or reduce benefits, as determined by the commissioner.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.149, eff.

September 1, 2005.

                                        17
                                    LABOR CODE

                       TITLE 5. WORKERS ’ COMPENSATION

                 SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

                    CHAPTER 410. ADJUDICATION OF DISPUTES

                      SUBCHAPTER A. GENERAL PROVISIONS

         Sec.    410.002.AALAW      GOVERNING      LIABILITY       PROCEEDINGS.        A

proceeding before the division to determine the liability of an

insurance carrier for compensation for an injury or death under

this subtitle is governed by this chapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.150, eff.

September 1, 2005.

         Sec.A410.003.AAAPPLICATION OF ADMINISTRATIVE PROCEDURE AND

TEXAS REGISTER ACT.         Except as otherwise provided by this chapter,

Chapter 2001, Government Code does not apply to a proceeding under

this chapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                     Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995.

         Sec.A410.005.AAVENUE FOR ADMINISTRATIVE PROCEEDINGS.                         (a)

Unless    the    division   determines      that   good   cause      exists    for   the

selection of a different location, a benefit review conference or a

contested case hearing may not be conducted at a site more than 75

miles from the claimant ’s residence at the time of the injury.

         (b)AAUnless    the    assigned     arbitrator     determines        that    good

cause exists for the selection of a different location, arbitration

may   not   be    conducted    at   a    site   more   than   75     miles    from   the

claimant ’s residence at the time of the injury.

         (c)AAAll    appeals   panel     proceedings      shall    be   conducted     in

Travis County.

         (d)AANotwithstanding           Subsection     (a),    the      division     may

conduct a benefit review conference telephonically on agreement by

the injured employee.

                                           1
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.151, eff.

September 1, 2005.

      Sec.A410.006.AAREPRESENTATION            AT         ADMINISTRATIVE

PROCEEDINGS.    (a)   A claimant may be represented at a benefit review

conference, a contested case hearing, or arbitration by an attorney

or may be assisted by an individual of the claimant ’s choice who

does not work for an attorney or receive a fee.      An employee of an

attorney may represent a claimant if that employee:

              (1)AAis a relative of the claimant;   and

              (2)AAdoes not receive a fee.

      (b)AAAn insurance carrier may be represented by an attorney

or adjuster.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec. 410.007.AAINFORMATION LIST.        (a)   The division shall

determine the type of information that is most useful to parties to

help resolve disputes regarding income benefits. That information

may include:

              (1)AAreports regarding the compensable injury;

              (2)AAmedical    information    regarding     the   injured

employee; and

              (3)AAwage records.

      (b)AAThe division shall publish a list developed from the

information described under Subsection (a) in appropriate media,

including the division ’s Internet website, to provide guidance to a

party to a dispute regarding the type of information the party

should have available at a benefit review conference or a contested

case hearing.

      (c)AAAt the time a benefit review conference or contested

case hearing is scheduled, the division shall make available a copy

of the list developed under Subsection (b) to each party to the

dispute.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.152, eff.

September 1, 2005.

                                    2
                 SUBCHAPTER B. BENEFIT REVIEW CONFERENCE

        Sec. 410.021.AAPURPOSE.              A benefit review conference is a

nonadversarial, informal dispute resolution proceeding designed

to:

              (1)AAexplain, orally and in writing, the rights of the

respective     parties      to   a    workers ’    compensation         claim   and     the

procedures necessary to protect those rights;

              (2)AAdiscuss the facts of the claim, review available

information     in    order   to     evaluate     the   claim,    and    delineate     the

disputed issues; and

              (3)AAmediate and resolve disputed issues by agreement

of the parties in accordance with this subtitle and the policies of

the division.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.153, eff.

September 1, 2005.

        Sec.A410.022.AABENEFIT           REVIEW     OFFICERS;         QUALIFICATIONS.

(a)     A   benefit    review      officer    shall     conduct   a     benefit      review

conference.

        (b)AAA benefit review officer must:

              (1)AAbe an employee of the division;

              (2)AAbe trained in the principles and procedures of

dispute mediation; and

              (3)AAhave          documentation           satisfactory           to      the

commissioner that evidences the completion by the officer of at

least   40    classroom       hours    of    training     in     dispute    resolution

techniques     from    an   alternative       dispute    resolution       organization

recognized by the commissioner.

        (c)AAThe division shall institute and maintain an education

and training program for benefit review officers and shall consult

or contract with the Federal Mediation and Conciliation Service or

other appropriate organizations for this purpose.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                             3
Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.154, eff.

September 1, 2005.

       Sec. 410.023.AAREQUEST FOR BENEFIT REVIEW CONFERENCE.                     (a)

On receipt of a request from a party or on its own motion, the

division may direct the parties to a disputed workers ’ compensation

claim to meet in a benefit review conference to attempt to reach

agreement on disputed issues involved in the claim.

       (b)AAThe   division   shall    require       the    party   requesting    the

benefit review conference to provide documentation of efforts made

to resolve the disputed issues before the request was submitted.

       (c)AAThe commissioner by rule shall:

              (1)AAadopt guidelines regarding the type of information

necessary to satisfy the requirements of Subsection (b); and

              (2)AAestablish    a   process       through    which   the   division

evaluates   the   sufficiency    of   the        documentation     provided   under

Subsection (b).

       (d)AAThe division may deny a request for a benefit review

conference if the party requesting the benefit review conference

does not provide the documentation required under Subsection (b).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.155, eff.

September 1, 2005.

       Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 14,

eff. September 1, 2011.

       Sec. 410.024.AABENEFIT REVIEW CONFERENCE AS PREREQUISITE TO

FURTHER PROCEEDINGS ON CERTAIN CLAIMS.               (a)     Except as otherwise

provided by law or commissioner rule, the parties to a disputed

compensation claim are not entitled to a contested case hearing or

arbitration on the claim unless a benefit review conference is

conducted as provided by this subchapter.

       (b)AAThe    commissioner       by     rule    shall     adopt    guidelines

relating to claims that do not require a benefit review conference

and   may   proceed   directly      to       a   contested    case     hearing   or

                                         4
arbitration.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.156, eff.

September 1, 2005.

        Sec.   410.025.AASCHEDULING                OF   BENEFIT   REVIEW     CONFERENCE;

NOTICE.     (a)        The commissioner by rule shall prescribe the time

within which a benefit review conference must be scheduled.

        (b)AAThe division shall schedule a contested case hearing to

be held not later than the 60th day after the date of the benefit

review conference if the disputed issues are not resolved at the

benefit review conference.

        (c)AAThe division shall send written notice of the benefit

review conference to the parties to the claim and the employer.

        (d)AAThe commissioner by rule shall provide for expedited

proceedings       in    cases     in   which   compensability       or   liability    for

essential medical treatment is in dispute.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.157, eff.

September 1, 2005.

        Sec.A410.026.AAPOWERS AND DUTIES OF BENEFIT REVIEW OFFICER.

(a)   A benefit review officer shall:

               (1)AAmediate disputes between the parties and assist in

the adjustment of the claim consistent with this subtitle and the

policies of the division;

               (2)AAthoroughly inform all parties of their rights and

responsibilities under this subtitle, especially in a case in which

the    employee        is   not    represented          by   an   attorney    or    other

representative;

               (3)AAensure that all documents and information relating

to    the   employee ’s      wages,      medical        condition,    and     any   other

information pertinent to the resolution of disputed issues are

contained in the claim file at the conference, especially in a case

in which the employee is not represented by an attorney or other

                                               5
representative; and

              (4)AAprepare a written report that details each issue

that is not resolved at the benefit review conference, as required

under Section 410.031, including any issue raised for the first

time at the conclusion of an additional benefit review conference

conducted under Subsection (b).

      (b)AAA      benefit     review        officer       may   schedule       an

additionalAAbenefit review conference if:

              (1)AAthe   benefit   review       officer   determines    that   any

available   information     pertinent      to   the   resolution   of   disputed

issues was not produced at the initial benefit review conference;

and

              (2)AAa second benefit review conference has not already

been conducted.

      (c)AAA benefit review officer may not take testimony but may

direct questions to an employee, an employer, or a representative

of an insurance carrier to supplement or clarify information in a

claim file.

      (d)AAA benefit review officer may not make a formal record.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.158, eff.

September 1, 2005.

      Sec.A410.027.AARULES.        (a)      The    commissioner    shall   adopt

rules for conducting benefit review conferences.

      (b)AAA benefit review conference is not subject to common law

or statutory rules of evidence or procedure.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.159, eff.

September 1, 2005.

      Sec. 410.028.AAFAILURE TO ATTEND; ADMINISTRATIVE VIOLATION.

(a)AAA scheduled benefit review conference shall be conducted even

though a party fails to attend unless the benefit review officer

determines that good cause, as defined by commissioner rule, exists

                                       6
to reschedule the conference.

        (b)AAIf a party to a benefit review conference under Section

410.023 requests that the benefit review conference be rescheduled

under this section, the party must submit a request in the same

manner as an initial request under Section 410.023.AAThe division

shall   evaluate       a   request       for       a    rescheduled         benefit     review

conference received under this section in the same manner as an

initial request received under Section 410.023.

        (c)AAIf    a   party     fails    to       request      that    a   benefit     review

conference be rescheduled in the time required by commissioner rule

or fails to attend a benefit review conference without good cause as

defined   by    commissioner       rule,       the      party    forfeits         the   party ’s

entitlement to attend a benefit review conference on the issue in

dispute, unless a benefit review officer is authorized to schedule

an additional benefit review conference under Section 410.026(b).

        (d)AAThe       commissioner       shall         adopt     rules      necessary       to

implement and enforce this section, including rules that:

               (1)AAdefine good cause; and

               (2)AAestablish deadlines for requesting that a benefit

review conference be rescheduled under Subsection (b).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.160, eff.

September 1, 2005.

        Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 15,

eff. September 1, 2011.

        Sec.A410.029.AARESOLUTION                  AT   BENEFIT    REVIEW         CONFERENCE;

WRITTEN AGREEMENT.         (a)   A dispute may be resolved either in whole

or in part at a benefit review conference.

        (b)AAIf the conference results in the resolution of some

disputed issues by agreement or in a settlement, the benefit review

officer shall reduce the agreement or the settlement to writing.

The   benefit     review    officer      and        each   party       or   the    designated

representative of the party shall sign the agreement or settlement.

        (c)AAA settlement takes effect on the date it is approved by

the director in accordance with Section 408.005.

                                               7
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec.     410.030.AABINDING         EFFECT        OF   AGREEMENT.               (a)      An

agreement signed in accordance with Section 410.029 is binding on

the    insurance        carrier   through        the     conclusion        of     all    matters

relating to the claim, unless the division or a court, on a finding

of fraud, newly discovered evidence, or other good and sufficient

cause,      relieves      the    insurance        carrier      of    the    effect       of     the

agreement.

         (b)AAThe agreement is binding on the claimant, if represented

by an attorney, to the same extent as on the insurance carrier.AAIf

the claimant is not represented by an attorney, the agreement is

binding     on    the    claimant    through       the   conclusion         of    all    matters

relating     to    the    claim     while   the     claim      is    pending       before       the

division,        unless   the    commissioner       for     good     cause       relieves       the

claimant of the effect of the agreement.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.161, eff.

September 1, 2005.

         Sec. 410.031.AAINCOMPLETE RESOLUTION; REPORT.                             (a)         If a

dispute is not entirely resolved at a benefit review conference,

the benefit review officer shall prepare a written report that

details each issue that is not resolved at the conference.

         (b)AAThe report must also include:

                 (1)AAa statement of each resolved issue;

                 (2)AAa statement of each issue raised but not resolved;

                 (3)AAa    statement        of     the    position         of    the     parties

regarding each unresolved issue;

                 (4)AA a statement of the procedures required to request

a contested case hearing or arbitration and a complete explanation

of    the   differences     in    those     proceedings        and    the       rights    of    the

parties to subsequent review of the determinations made in those

proceedings; and

                 (5)AAthe date of the contested case hearing scheduled

in accordance with Section 410.025(b).

                                              8
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.162, eff.

September 1, 2005.

 Text of section as amended by Acts 2007, 80th Leg., R.S., Ch. 1177

                                 (H.B. 473), Sec. 1

 For text of section as amended by Acts 2007, 80th Leg., R.S., Ch.

            1150 (S.B. 1169), Sec. 4, see other Sec. 410.032.

         Sec. 410.032. PAYMENT OF BENEFITS UNDER INTERLOCUTORY ORDER.

(a)   The benefit review officer who presides at the benefit review

conference shall consider a request for an interlocutory order and

shall give the opposing party the opportunity to respond before

issuing an interlocutory order.

         (b)AAThe      interlocutory    order      may   address   the   payment   or

suspension of accrued benefits, future benefits, or both accrued

benefits and future benefits.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                   Amended

by Acts 1999, 76th Leg., ch. 955, Sec. 2, eff. Sept. 1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.162, eff.

September 1, 2005.

         Acts 2007, 80th Leg., R.S., Ch. 1177 (H.B. 473), Sec. 1, eff.

September 1, 2007.

 Text of section as amended by Acts 2007, 80th Leg., R.S., Ch. 1150

                                 (S.B. 1169), Sec. 4

 For text of section as amended by Acts 2007, 80th Leg., R.S., Ch.

            1177 (H.B. 473), Sec. 1, see other Sec. 410.032.

         Sec.    410.032.AAPAYMENT       OF      BENEFITS    UNDER   INTERLOCUTORY

ORDER.    (a)    The benefit review officer who presides at the benefit

review conference shall:

                (1)AAconsider      a   written      or   verbal    request   for   an

interlocutory order for the payment of benefits; and

                (2)AAif    the    benefit       review   officer   determines    that

issuance    of    an    interlocutory    order      is   appropriate,    issue     the

interlocutory order not later than the third day after the date of

                                            9
receipt of the request under Subdivision (1).

          (b)AAThe interlocutory order may address accrued benefits,

future benefits, or both accrued benefits and future benefits.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                             Amended

by Acts 1999, 76th Leg., ch. 955, Sec. 2, eff. Sept. 1, 1999.

Amended by:

          Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.162, eff.

September 1, 2005.

          Acts 2007, 80th Leg., R.S., Ch. 1150 (S.B. 1169), Sec. 4, eff.

September 1, 2007.

          Sec.A410.033.AAMULTIPLE CARRIERS.                  (a)    If there is a dispute

as   to    which    of    two   or   more    insurance          carriers      is    liable    for

compensation for one or more compensable injuries, the commissioner

may issue an interlocutory order directing each insurance carrier

to   pay   a   proportionate         share       of    benefits    due     pending     a   final

decision       on   liability.AAThe         proportionate          share      is   computed    by

dividing the compensation due by the number of insurance carriers

involved.

          (b)AAOn     final     determination           of   liability,        an    insurance

carrier determined to be not liable for the payment of benefits is

entitled       to   reimbursement      for       the    share    paid    by    the   insurance

carrier from any insurance carrier determined to be liable.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

          Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.163, eff.

September 1, 2005.

          Sec. 410.034.AAFILING OF AGREEMENT AND REPORT.                             (a)      The

benefit review officer shall file the signed agreement and the

report with the division.

          (b)AAThe       commissioner       by    rule    shall     prescribe        the   times

within which the agreement and report must be filed.

          (c)AAThe division shall furnish a copy of the file-stamped

report to:

                (1)AAthe claimant;

                (2)AAthe employer; and

                                                 10
              (3)AAthe insurance carrier.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.164, eff.

September 1, 2005.

                        SUBCHAPTER C. ARBITRATION

      Sec.A410.101.AAPURPOSE. The purpose of arbitration is to:

              (1)AAenter into formal, binding stipulations on issues

on which the parties agree;

              (2)AAresolve issues on which the parties disagree;           and

              (3)AArender a final award with respect to all issues in

dispute.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.     410.102.AAARBITRATORS;        QUALIFICATIONS.       (a)      An

arbitrator must be an employee of the division, except that the

division may contract with qualified arbitrators on a determination

of special need.

      (b)AAAn arbitrator must:

              (1)AAbe     a   member    of   the    National     Academy    of

Arbitrators;

              (2)AAbe on an approved list of the American Arbitration

Association or Federal Mediation and Conciliation Service; or

              (3)AAmeet       qualifications       established     by      the

commissioner by rule.

      (c)AAThe division shall require that each arbitrator have

appropriate training in the workers ’ compensation laws of this

state.AAThe commissioner shall establish procedures to carry out

this subsection.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.165, eff.

September 1, 2005.

      Sec. 410.103.AADUTIES OF ARBITRATOR.          An arbitrator shall:

                                       11
              (1)AAprotect the interests of all parties;

              (2)AAensure     that    all     relevant         evidence     has    been

disclosed to the arbitrator and to all parties; and

              (3)AArender an award consistent with this subtitle and

the policies of the division.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.166, eff.

September 1, 2005.

      Sec.A410.104.AAELECTION OF ARBITRATION;                    EFFECT.     (a)       If

issues remain unresolved after a benefit review conference, the

parties, by agreement, may elect to engage in arbitration in the

manner provided by this subchapter.           Arbitration may be used only to

resolve   disputed    benefit      issues     and   is    an     alternative      to   a

contested case hearing.       A contested case hearing scheduled under

Section   410.025(b)     is   canceled        by    an    election        under    this

subchapter.

      (b)AATo elect arbitration, the parties must file the election

with the division not later than the 20th day after the last day of

the benefit review conference.AAThe commissioner shall prescribe a

form for that purpose.

      (c)AAAn      election   to     engage    in    arbitration          under    this

subchapter    is   irrevocable     and   binding     on    all    parties    for   the

resolution of all disputes arising out of the claims that are under

the jurisdiction of the division.

      (d)AAAn agreement to elect arbitration binds the parties to

the provisions of Chapter 408 relating to benefits, and any award,

agreement, or settlement after arbitration is elected must comply

with that chapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.167, eff.

September 1, 2005.

      Sec. 410.105.AALISTS OF ARBITRATORS.                (a)    The division shall

establish regional lists of arbitrators who meet the qualifications

                                         12
prescribed under Sections 410.102(a) and (b).AAEach regional list

shall be initially prepared in a random name order, and subsequent

additions to a list shall be added chronologically.

         (b)AAThe commissioner shall review the lists of arbitrators

annually and determine if each arbitrator is fair and impartial and

makes awards that are consistent with and in accordance with this

subtitle and the rules of the commissioner.AAThe commissioner shall

remove    an    arbitrator      if,   after    the       review,    the    commissioner

determines that the arbitrator is not fair and impartial or does not

make awards consistent with this subtitle and commissioner rules.

         (c)AAThe   division ’s       lists    are       confidential      and    are     not

subject    to   disclosure      under   Chapter      552,    Government         Code.AAThe

lists may not be revealed by any division employee to any person who

is not a division employee.AAThe lists are exempt from discovery in

civil litigation unless the party seeking the discovery establishes

reasonable cause to believe that a violation of the requirements of

this section or Section 410.106, 410.107, 410.108, or 410.109(b)

occurred    and   that    the   violation      is    relevant      to     the    issues   in

dispute.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                         Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(88), eff. Sept. 1, 1995.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.168, eff.

September 1, 2005.

         Sec. 410.106.AASELECTION OF ARBITRATOR.                   The division shall

assign the arbitrator for a particular case by selecting the next

name after the previous case ’s selection in consecutive order.AAThe

division    may   not    change   the   order       of    names    once    the    order   is

established under this subchapter, except that once each arbitrator

on the list has been assigned to a case, the names shall be randomly

reordered.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.169, eff.

September 1, 2005.

                                          13
      Sec.A410.107.AAASSIGNMENT OF ARBITRATOR.             (a)     The division

shall assign an arbitrator to a pending case not later than the 30th

day after the date on which the election for arbitration is filed

with the division.

      (b)AAWhen an arbitrator has been assigned to a case under

Subsection (a), the parties shall be notified immediately.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.170, eff.

September 1, 2005.

      Sec.A410.108.AAREJECTION OF ARBITRATOR.              (a)     Each party is

entitled,     in   its   sole   discretion,     to   one   rejection       of   the

arbitrator in each case.AAIf a party rejects the arbitrator, the

division shall assign another arbitrator as provided by Section

410.106.

      (b)AAA rejection must be made not later than the third day

after the date of notification of the arbitrator ’s assignment.

      (c)AAWhen all parties have exercised their right of rejection

or if no rejection is registered, the assignment is final.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.171, eff.

September 1, 2005.

      Sec.     410.109.AASCHEDULING        OF   ARBITRATION.         (a)        The

arbitrator shall schedule arbitration to be held not later than the

30th day after the date of the arbitrator ’s assignment and shall

notify the parties and the division of the scheduled date.

      (b)AAIf an arbitrator is unable to schedule arbitration in

accordance with Subsection (a), the division shall appoint the next

arbitrator    on   the   applicable   list.AAEach     party   is    entitled     to

reject the arbitrator appointed under this subsection in the manner

provided under Section 410.108.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.172, eff.

                                      14
September 1, 2005.

       Sec.A410.110.AACONTINUANCE.            (a)    A request by a party for a

continuance of the arbitration to another date must be directed to

the director.      The director may grant a continuance only if the

director determines, giving due regard to the availability of the

arbitrator, that good cause for the continuance exists.

       (b)AAIf the director grants a continuance under this section,

the rescheduled date may not be later than the 30th day after the

original date of the arbitration.

       (c)AAWithout     regard     to    whether     good     cause   exists,   the

director may not grant more than one continuance to each party.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec. 410.111.AARULES.       The commissioner shall adopt rules for

arbitration     consistent   with       generally      recognized     arbitration

principles and procedures.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.173, eff.

September 1, 2005.

       Sec.A410.112.AAEXCHANGE           AND        FILING     OF     INFORMATION;

ADMINISTRATIVE VIOLATION.          (a)    Not later than the seventh day

before the first day of arbitration, the parties shall exchange and

file with the arbitrator:

              (1)AAall medical reports and other documentary evidence

not   previously   exchanged     or     filed   that    are    pertinent   to   the

resolution of the claim;     and

              (2)AAinformation relating to their proposed resolution

of the disputed issues.

       (b)AAA   party   commits    an    administrative        violation   if   the

party, without good cause as determined by the arbitrator, fails to

comply with Subsection (a).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.174, eff.

                                         15
September 1, 2005.

       Sec.A410.113.AADUTIES             OF      PARTIES       AT     ARBITRATION;

ATTENDANCE;     ADMINISTRATIVE       VIOLATION.         (a)    Each   party   shall

attend the arbitration prepared to set forth in detail its position

on unresolved issues and the issues on which it is prepared to

stipulate.

       (b)AAA party commits an administrative violation if the party

does not attend the arbitration unless the arbitrator determines

that the party had good cause not to attend.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.175, eff.

September 1, 2005.

       Sec.A410.114.AATESTIMONY;              RECORD.   (a)   The arbitrator may

require witnesses to testify under oath and shall require testimony

under oath if requested by a party.

       (b)AAThe division shall make an electronic recording of the

proceeding.

       (c)AAAn official stenographic record is not required, but any

party may at the party ’s expense make a stenographic record of the

proceeding.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.176, eff.

September 1, 2005.

       Sec.A410.115.AAEVIDENCE.          (a)    The parties may offer evidence

as   they   desire    and   shall   produce      additional     evidence   as   the

arbitrator     considers       necessary         to     an    understanding     and

determination of the dispute.

       (b)AAThe      arbitrator     is   the    judge    of   the   relevance   and

materiality of the evidence offered.              Conformity to legal rules of

evidence is not required.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                                         16
       Sec.A410.116.AACLOSING STATEMENTS;                BRIEFS.      The parties may

present closing statements as they desire, but the record may not

remain open for written briefs unless requested by the arbitrator.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A410.117.AAEX PARTE CONTACTS PROHIBITED.                    A party and an

arbitrator may not communicate outside the arbitration unless the

communication is in writing with copies provided to all parties or

relates to procedural matters.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A410.118.AAAWARD.            (a)    The arbitrator shall enter the

arbitrator ’s award not later than the seventh day after the last day

of arbitration.

       (b)AAThe    arbitrator       shall      base    the    award    on    the   facts

established at arbitration, including stipulations of the parties,

and on the law as properly applied to those facts.

       (c)AAThe award must:

              (1)AAbe in writing;

              (2)AAbe signed and dated by the arbitrator;                   and

              (3)AAinclude a statement of the arbitrator ’s decision

on    the   contested     issues    and        the    parties ’    stipulations       on

uncontested issues.

       (d)AAThe arbitrator shall file a copy of the award as part of

the   permanent   claim   file     at   the    division      and   shall    notify   the

parties in writing of the decision.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.177, eff.

September 1, 2005.

       Sec.A410.119.AAEFFECT OF AWARD.                (a)    An arbitrator ’s award

is final and binding on all parties.             Except as provided by Section

410.121, there is no right to appeal.

       (b)AAAn arbitrator ’s award is a final order of the division.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

                                          17
        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.178, eff.

September 1, 2005.

        Sec.A410.120.AACLERICAL        ERROR.       For      the   purpose     of

correcting a clerical error, an arbitrator retains jurisdiction of

the award for 20 days after the date of the award.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A410.121.AACOURT VACATING AWARD.           (a)   On application of

an aggrieved party, a court of competent jurisdiction shall vacate

an arbitrator ’s award on a finding that:

              (1)AAthe award was procured by corruption, fraud, or

misrepresentation;

              (2)AAthe decision of the arbitrator was arbitrary and

capricious; or

              (3)AAthe   award   was   outside   the    jurisdiction     of    the

division.

        (b)AAIf an award is vacated, the case shall be remanded to the

division for another arbitration proceeding.

        (c)AAA suit to vacate an award must be filed not later than

the 30th day after:

              (1)AAthe date of the award; or

              (2)AAthe date the appealing party knew or should have

known of a basis for suit under this section, but in no event later

than 12 months after an order denying compensation or after the

expiration of the income or death benefit period.

        (d)AAVenue for a suit to vacate an award is in the county in

which the arbitration was conducted.

        (e)AAIn a suit to vacate an arbitrator ’s award, only the

court   may   make   determinations,    including      findings    of   fact   or

conclusions of law.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.179, eff.

September 1, 2005.

                 SUBCHAPTER D. CONTESTED CASE HEARING

                                       18
      Sec.A410.151.AACONTESTED         CASE   HEARING;       SCOPE.    (a)       If

arbitration is not elected under Section 410.104, a party to a claim

for which a benefit review conference is held or a party eligible to

proceed directly to a contested case hearing as provided by Section

410.024 is entitled to a contested case hearing.

      (b)AAAn    issue    that   was   not    raised   at    a   benefit    review

conference or that was resolved at a benefit review conference may

not be considered unless:

              (1)AAthe parties consent; or

              (2)AAif    the   issue   was   not   raised,   the   commissioner

determines that good cause existed for not raising the issue at the

conference.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.180, eff.

September 1, 2005.

      Sec.A410.152.AAHEARING OFFICERS;              QUALIFICATIONS.        (a)    A

hearing officer shall conduct a contested case hearing.

      (b)AAA hearing officer must be licensed to practice law in

this state.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec. 410.153.AAAPPLICATION OF ADMINISTRATIVE PROCEDURE ACT.

Chapter 2001, Government Code, applies to a contested case hearing

to the extent that the commissioner finds appropriate, except that

the following do not apply:

              (1)AASection 2001.054;

              (2)AASections 2001.061 and 2001.062;

              (3)AASection 2001.202; and

              (4)AASubchapters F, G, I, and Z, except for Section

2001.141(c).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                 Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 5.93, eff. Sept. 1, 1995.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.181, eff.

                                       19
September 1, 2005.

      Sec. 410.154.AASCHEDULING OF HEARING.                   The division shall

schedule    a    contested   case    hearing       in   accordance     with   Section

410.024 or 410.025(b).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.182, eff.

September 1, 2005.

      Sec. 410.155.AACONTINUANCE.                 (a)    A written request by a

party for a continuance of a contested case hearing to another date

must be directed to the division.

      (b)AAThe        division   may    grant      a    continuance    only   if   the

division determines that there is good cause for the continuance.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.183, eff.

September 1, 2005.

      Sec.A410.156.AAATTENDANCE                  REQUIRED;            ADMINISTRATIVE

VIOLATION.      (a)   Each party shall attend a contested case hearing.

      (b)AAA      party   commits      an   administrative      violation     if   the

party, without good cause as determined by the hearing officer,

does not attend a contested case hearing.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.184, eff.

September 1, 2005.

      Sec. 410.157.AARULES.             The commissioner shall adopt rules

governing       procedures   under     which      contested   case     hearings    are

conducted.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.185, eff.

September 1, 2005.

                                            20
       Sec.A410.158.AADISCOVERY.            (a)    Except as provided by Section

410.162, discovery is limited to:

              (1)AAdepositions        on    written     questions      to   any    health

care provider;

              (2)AAdepositions of other witnesses as permitted by the

hearing officer for good cause shown; and

              (3)AAinterrogatories                as     prescribed           by        the

commissioner.

       (b)AADiscovery under Subsection (a) may not seek information

that may readily be derived from documentary evidence described in

Section 410.160.       Answers to discovery under Subsection (a) need

not   duplicate    information        that       may   readily    be   derived         from

documentary evidence described in Section 410.160.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.186, eff.

September 1, 2005.

       Sec.    410.159.AASTANDARD               INTERROGATORIES.            (a)         The

commissioner      by   rule   shall    prescribe         standard      form      sets   of

interrogatories to elicit information from claimants and insurance

carriers.

       (b)AAStandard     interrogatories            shall    be   answered        by   each

party and served on the opposing party within the time prescribed by

commissioner rule, unless the parties agree otherwise.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.187, eff.

September 1, 2005.

       Sec.   410.160.AAEXCHANGE           OF    INFORMATION.      Within     the      time

prescribed by commissioner rule, the parties shall exchange:

              (1)AAall    medical          reports     and    reports       of     expert

witnesses who will be called to testify at the hearing;

              (2)AAall medical records;

              (3)AAany witness statements;

                                           21
              (4)AAthe identity and location of any witness known to

the parties to have knowledge of relevant facts; and

              (5)AAall photographs or other documents that a party

intends to offer into evidence at the hearing.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.188, eff.

September 1, 2005.

      Sec. 410.161.AAFAILURE TO DISCLOSE INFORMATION.       A party who

fails to disclose information known to the party or documents that

are in the party ’s possession, custody, or control at the time

disclosure    is   required   by   Sections   410.158-410.160   may    not

introduce the evidence at any subsequent proceeding before the

division or in court on the claim unless good cause is shown for not

having disclosed the information or documents under those sections.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.189, eff.

September 1, 2005.

      Sec.A410.162.AAADDITIONAL DISCOVERY.        For good cause shown,

a party may obtain permission from the hearing officer to conduct

additional discovery as necessary.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A410.163.AAPOWERS AND DUTIES OF HEARING OFFICER.       (a)   At

a contested case hearing the hearing officer shall:

              (1)AAswear witnesses;

              (2)AAreceive testimony;

              (3)AAallow   examination    and    cross-examination      of

witnesses;

              (4)AAaccept documents and other tangible evidence;      and

              (5)AAallow the presentation of evidence by affidavit.

      (b)AAA hearing officer shall ensure the preservation of the

rights of the parties and the full development of facts required for

the determinations to be made.     A hearing officer may permit the use

                                    22
of   summary     procedures,     if     appropriate,        including     witness

statements,    summaries,      and    similar    measures       to   expedite    the

proceedings.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A410.164.AARECORD.          (a)     The proceedings of a contested

case hearing shall be recorded electronically.              A party may request

a transcript of the proceeding and shall pay the reasonable cost of

the transcription.

      (b)AAA     party   may    request     that     the   proceedings     of    the

contested case hearing be recorded by a court reporter.                 The party

making the request shall bear the cost.

      (c)AAAt    each    contested     case    hearing,    as    applicable,     the

insurance carrier shall file with the hearing officer and shall

deliver   to   the   claimant    a    single    document     stating     the    true

corporate name of the insurance carrier and the name and address of

the insurance carrier ’s registered agent for service of process.

The document is part of the record of the contested case hearing.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 11.01, eff. June 17, 2001.

      Sec.A410.165.AAEVIDENCE.           (a)     The hearing officer is the

sole judge of the relevance and materiality of the evidence offered

and of the weight and credibility to be given to the evidence.

Conformity to legal rules of evidence is not necessary.

      (b)AAA hearing officer may accept a written statement signed

by a witness and shall accept all written reports signed by a health

care provider.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A410.166.AASTIPULATIONS.               A   written     stipulation      or

agreement of the parties that is filed in the record or an oral

stipulation or agreement of the parties that is preserved in the

record is final and binding.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

      Sec.A410.167.AAEX PARTE CONTACTS PROHIBITED.                   A party and a

                                       23
hearing officer may not communicate outside the contested case

hearing unless the communication is in writing with copies provided

to all parties or relates to procedural matters.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

         Sec.A410.168.AADECISION.          (a)    The    hearing   officer   shall

issue a written decision that includes:

              (1)AAfindings of fact and conclusions of law;

              (2)AAa determination of whether benefits are due;               and

              (3)AAan award of benefits due.

         (b)AAThe   decision   may    address     accrued     benefits,      future

benefits, or both accrued benefits and future benefits.

         (c)AAThe hearing officer may enter an interlocutory order for

the payment of all or part of medical benefits or income benefits.

The order may address accrued benefits, future benefits, or both

accrued benefits and future benefits.             The order is binding during

the pendency of an appeal to the appeals panel.

         (d)AAOn a form that the commissioner by rule prescribes, the

hearing officer shall issue a separate written decision regarding

attorney ’s fees and any matter related to attorney ’s fees.AAThe

decision regarding attorney ’s fees and the form may not be made

known to a jury in a judicial review of an award, including an

appeal.

         (e)AAThe   commissioner     by    rule   shall   prescribe   the    times

within which the hearing officer must file the decisions with the

division.

         (f)AAThe division shall send a copy of the decision to each

party.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                Amended

by Acts 1999, 76th Leg., ch. 955, Sec. 3, eff. Sept. 1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.190, eff.

September 1, 2005.

         Sec.A410.169.AAEFFECT OF DECISION.             A decision of a hearing

officer regarding benefits is final in the absence of a timely

appeal by a party and is binding during the pendency of an appeal to

                                          24
the appeals panel.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

                     SUBCHAPTER E. APPEALS PANEL

      Sec.A410.201.AAAPPEALS      JUDGES;        QUALIFICATIONS.          (a)

Appeals   judges,    in   a   three-member      panel,      shall     conduct

administrative appeals proceedings.

      (b)AAAn appeals judge must be licensed to practice law in

this state.

      (c)AAAn   appeals   judge   may   not   conduct   a   benefit    review

conference or a contested case hearing.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.191, eff.

September 1, 2005.

      Sec.A410.202.AAREQUEST FOR APPEAL;        RESPONSE.    (a)    To appeal

the decision of a hearing officer, a party shall file a written

request for appeal with the appeals panel not later than the 15th

day after the date on which the decision of the hearing officer is

received from the division and shall on the same date serve a copy

of the request for appeal on the other party.

      (b)AAThe respondent shall file a written response with the

appeals panel not later than the 15th day after the date on which

the copy of the request for appeal is served and shall on the same

date serve a copy of the response on the appellant.

      (c)AAA request for appeal or a response must clearly and

concisely rebut or support the decision of the hearing officer on

each issue on which review is sought.

      (d)AASaturdays and Sundays and holidays listed in Section

662.003, Government Code, are not included in the computation of

the time in which a request for an appeal under Subsection (a) or a

response under Subsection (b) must be filed.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.            Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 12.01, eff. June 17, 2001.

                                   25
         Sec. 410.203.AAPOWERS AND DUTIES OF APPEALS PANEL; PRIORITY

OF HEARING ON REMAND. (a)         The appeals panel shall consider:

               (1)AAthe     record    developed      at   the    contested        case

hearing; and

               (2)AAthe written request for appeal and response filed

with the appeals panel.

         (b)AAThe appeals panel may:

               (1)AAreverse the decision of the hearings officer and

render a new decision;

               (2)AAreverse the decision of the hearings officer and

remand the case to the hearing officer for further consideration

and development of evidence; or

               (3)AAaffirm the decision of the hearings officer in a

case described by Section 410.204(a-1).

         (c)AAThe appeals panel may not remand a case under Subsection

(b)(2) more than once.

         (d)AAA   hearing    on   remand     shall   be   accelerated       and    the

commissioner shall adopt rules to give priority to the hearing over

other proceedings.

         (e)AAThe appeals panel shall issue and maintain a precedent

manual.AAThe       precedent         manual     shall      be       composed        of

precedent-establishing decisions and may include other information

as identified by the appeals panel.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.192, eff.

September 1, 2005.

         Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 16,

eff. September 1, 2011.

         Sec.A410.204.AADECISION.            (a)AAThe     appeals    panel     shall

review each request and issue a written decision on each reversed or

remanded case.AAThe appeals panel may issue a written decision on

an affirmed case as described by Subsection (a-1). The decision

must be in writing and shall be issued not later than the 45th day

after the date on which the written response to the request for

appeal    is   filed.AAThe    appeals   panel    shall    file   a   copy    of   the

                                        26
decision with the commissioner.

      (a-1)AAAn appeals panel may only issue a written decision in

a case in which the panel affirms the decision of a hearings officer

if the case:

              (1)AAis a case of first impression;

              (2)AAinvolves a recent change in law; or

              (3)AAinvolves errors at the contested case hearing that

require correction but do not affect the outcome of the hearing,

including:

                   (A)AAfindings     of     fact    for    which       insufficient

evidence exists;

                   (B)AAincorrect conclusions of law;

                   (C)AAfindings      of    fact    or    conclusions         of   law

regarding    matters   that   were   not   properly       before       the   hearings

officer; and

                   (D)AAlegal errors not otherwise described by this

subdivision.

      (b)AAA copy of the decision of the appeals panel shall be sent

to each party not later than the seventh day after the date the

decision is filed with the division.

      (c)AAIf    the   appeals   panel     does    not    issue    a    decision   in

accordance with this section, the decision of the hearing officer

becomes final and is the final decision of the appeals panel.

      (d)AAEach final decision of the appeals panel shall conclude

with a separate paragraph stating:         "The true corporate name of the

insurance carrier is (NAME IN BOLD PRINT) and the name and address

of its registered agent for service of process is (NAME AND ADDRESS

IN BOLD PRINT)."

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                   Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 11.02, eff. June 17, 2001.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.193, eff.

September 1, 2005.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 17,

eff. September 1, 2011.

      Sec.A410.205.AAEFFECT OF DECISION.             (a)     A decision of the

                                      27
appeals panel regarding benefits is final in the absence of a timely

appeal for judicial review.

         (b)AAThe decision of the appeals panel regarding benefits is

binding during the pendency of an appeal under Subchapter F or G.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 1999, 76th Leg., ch. 955, Sec. 4, eff. Sept. 1, 1999.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.194, eff.

September 1, 2005.

         Sec. 410.206.AACLERICAL ERROR.             The division may revise a

decision in a contested case hearing on a finding of clerical error.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.195, eff.

September 1, 2005.

         Sec.   410.207.AACONTINUATION            OF     DIVISION      JURISDICTION.

During    judicial    review    of    the   appeals      panel      decision    on     any

disputed    issue    relating   to    a    workers ’ compensation            claim,    the

division retains jurisdiction of all other issues related to the

claim.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.196, eff.

September 1, 2005.

         Sec. 410.208.AAJUDICIAL ENFORCEMENT OF ORDER OR DECISION;

ADMINISTRATIVE VIOLATION.            (a)    If a person refuses or fails to

comply with an interlocutory order, final order, or decision of the

commissioner,    the   division      may    bring      suit    in   Travis    County    to

enforce the order or decision.

         (b)AAIf an insurance carrier refuses or fails to comply with

an   interlocutory     order,   a    final      order,    or    a   decision    of     the

commissioner, the claimant may bring suit in the county of the

claimant ’s residence at the time of the injury, or death if the

employee is deceased, or, in the case of an occupational disease, in

                                           28
the county in which the employee resided on the date disability

began or any county agreed to by the parties.

       (c)AAIf the division brings suit to enforce an interlocutory

order, final order, or decision of the commissioner, the division

is   entitled   to   reasonable     attorney ’s     fees      and   costs   for     the

prosecution and collection of the claim, in addition to a judgment

enforcing the order or decision and any other remedy provided by

law.

       (d)AAA claimant who brings suit to enforce an interlocutory

order, final order, or decision of the commissioner is entitled to a

penalty equal to 12 percent of the amount of benefits recovered in

the judgment, interest, and reasonable attorney ’s fees for the

prosecution and collection of the claim, in addition to a judgment

enforcing the order or decision.

       (e)AAA   person    commits   an    administrative        violation     if    the

person fails or refuses to comply with an interlocutory order,

final order, or decision of the commissioner within 20 days after

the date the order or decision becomes final.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                    Amended

by Acts 2003, 78th Leg., ch. 397, Sec. 1, eff. Sept. 1, 2003.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.197, eff.

September 1, 2005.

       Sec.     410.209.AAREIMBURSEMENT            FOR       OVERPAYMENT.           The

subsequent injury fund shall reimburse an insurance carrier for any

overpayments    of   benefits   made     under    an     interlocutory      order    or

decision if that order or decision is reversed or modified by final

arbitration,     order,    or   decision      of       the    commissioner     or    a

court.AAThe     commissioner    shall     adopt     rules      to   provide    for   a

periodic reimbursement schedule, providing for reimbursement at

least annually.

Added by Acts 1999, 76th Leg., ch. 955, Sec. 5, eff. Sept. 1, 1999.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.198, eff.

September 1, 2005.

                                         29
           SUBCHAPTER F. JUDICIAL REVIEW--GENERAL PROVISIONS

       Sec.A410.251.AAEXHAUSTION            OF   REMEDIES.        A   party    that      has

exhausted its administrative remedies under this subtitle and that

is aggrieved by a final decision of the appeals panel may seek

judicial     review    under   this    subchapter           and   Subchapter       G,    if

applicable.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec.A410.252.AATIME FOR FILING PETITION;                       VENUE.       (a)    A

party may seek judicial review by filing suit not later than the

45th day after the date on which the division mailed the party the

decision of the appeals panel.AAFor purposes of this section, the

mailing date is considered to be the fifth day after the date the

decision of the appeals panel was filed with the division.

       (b)AAThe party bringing suit to appeal the decision must file

a petition with the appropriate court in:

              (1)AAthe county where the employee resided at the time

of the injury or death, if the employee is deceased; or

              (2)AAin the case of an occupational disease, in the

county where the employee resided on the date disability began or

any county agreed to by the parties.

       (c)AAIf a suit under this section is filed in a county other

than   the   county    described      by    Subsection        (b),    the    court,      on

determining that it does not have jurisdiction to render judgment

on the merits of the suit, shall transfer the case to a proper court

in a county described by Subsection (b).               Notice of the transfer of

a suit shall be given to the parties.             A suit transferred under this

subsection shall be considered for all purposes the same as if

originally filed in the court to which it is transferred.

       (d)AAIf a suit is initially filed within the 45-day period in

Subsection (a), and is transferred under Subsection (c), the suit

is   considered   to   be   timely    filed      in   the   court     to   which    it   is

transferred.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                      Amended

by Acts 2003, 78th Leg., ch. 663, Sec. 1, eff. Sept. 1, 2003.

Amended by:

                                           30
      Acts 2009, 81st Leg., R.S., Ch. 1200 (H.B. 4545), Sec. 1, eff.

September 1, 2009.

      Acts 2011, 82nd Leg., R.S., Ch. 1066 (S.B. 809), Sec. 1, eff.

September 1, 2011.

      Sec.    410.253.AASERVICE;      NOTICE.     (a)      A   party   seeking

judicial review shall simultaneously:

              (1)AAfile a copy of the party ’s petition with the court;

              (2)AAserve any opposing party to the suit; and

              (3)AAprovide written notice of the suit or notice of

appeal to the division.

      (b)AAA    party   may   not   seek   judicial   review   under   Section

410.251 unless the party has provided written notice of the suit to

the division as required by this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.             Amended

by Acts 2003, 78th Leg., ch. 397, Sec. 2, eff. Sept. 1, 2003.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.199, eff.

September 1, 2005.

      Sec. 410.254.AAINTERVENTION.          On timely motion initiated by

the commissioner, the division shall be permitted to intervene in

any judicial proceeding under this subchapter or Subchapter G.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.200, eff.

September 1, 2005.

      Sec.A410.255.AAJUDICIAL         REVIEW    OF    ISSUES      OTHER     THAN

COMPENSABILITY OR INCOME OR DEATH BENEFITS.              (a)   For all issues

other than those covered under Section 410.301(a), judicial review

shall be conducted in the manner provided for judicial review of a

contested case under Subchapter G, Chapter 2001, Government Code.

      (b)AAJudicial      review     conducted    under     this   section    is

governed by the substantial evidence rule.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.             Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(53), eff. Sept. 1, 1995.

                                      31
      Sec.A410.256.AACOURT APPROVAL OF SETTLEMENT.            (a)   A claim or

issue may not be settled contrary to the provisions of the appeals

panel decision issued on the claim or issue unless a party to the

proceeding has filed for judicial review under this subchapter or

Subchapter G.AAThe trial court must approve a settlement made by

the parties after judicial review of an award is sought and before

the court enters judgment.

      (b)AAThe   court   may    not   approve   a    settlement   except   on   a

finding that:

           (1)AAthe settlement accurately reflects the agreement

between the parties;

           (2)AAthe      settlement        adheres     to   all   appropriate

provisions of the law;    and

           (3)AAunder the law and facts, the settlement is in the

best interest of the claimant.

      (c)AAA settlement may not provide for:

           (1)AApayment of any benefits in a lump sum except as

provided by Section 408.128; or

           (2)AAlimitation or termination of the claimant ’s right

to medical benefits under Section 408.021.

      (d)AAA settlement or agreement that resolves an issue of

impairment may not be made before the claimant reaches maximum

medical improvement and must adopt one of the impairment ratings

under Subchapter G, Chapter 408.

      (e)AAA    party   proposing     a    settlement    before   judgment      is

entered by the trial court may petition the court orally or in

writing for approval of the settlement.

      (f)AASettlement of a claim or issue under this section does

not constitute a modification or reversal of the decision awarding

benefits for the purpose of Section 410.209.

      (g)AASettlement of a claim or issue must be in compliance

with all appropriate provisions of the law, including this section

and Section 410.258 of this subchapter.             A settlement which on its

face does not comply with this section is void.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.            Amended

by Acts 1997, 75th Leg., ch. 1267, Sec. 1, eff. Sept. 1, 1997;             Acts

                                      32
2003, 78th Leg., ch. 397, Sec. 3, eff. Sept. 1, 2003.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.2001, eff.

September 1, 2005.

        Sec.A410.257.AAJUDGMENT       AFTER   JUDICIAL    REVIEW.           (a)    A

judgment entered by a court on judicial review of the appeals panel

decision under this subchapter or Subchapter GAAmust comply with

all appropriate provisions of the law.

        (b)AAA judgment under this section may not provide for:

               (1)AApayment   of   benefits    in   a   lump    sum   except      as

provided by Section 408.128; or

               (2)AAthe limitation or termination of the claimant ’s

right to medical benefits under Section 408.021.

        (c)AAA judgment that resolves an issue of impairment may not

be entered before the date the claimant reaches maximum medical

improvement.      The judgment must adopt an impairment rating under

Subchapter G, Chapter 408, except to the extent Section 410.307

applies.

        (d)AAA    judgment    under    this    section     may        not     order

reimbursement from the subsequent injury fund.

        (e)AAA judgment under this section based on default or on an

agreement of the parties does not constitute a modification or

reversal of a decision awarding benefits for the purpose of Section

410. 209.

        (f)AAA judgment that on its face does not comply with this

section is void.

Added by Acts 1997, 75th Leg., ch. 1267, Sec. 2, eff. Sept. 1, 1997.

Amended by Acts 2003, 78th Leg., ch. 397, Sec. 4, eff. Sept. 1,

2003.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.2002, eff.

September 1, 2005.

        Sec.     410.258.AANOTIFICATION       OF    DIVISION     OF     PROPOSED

JUDGMENTS AND SETTLEMENTS; RIGHT TO INTERVENE.            (a)    The party who

initiated a proceeding under this subchapter or Subchapter G must

                                      33
file any proposed judgment or settlement made by the parties to the

proceeding,       including    a    proposed         default    judgment,    with      the

division not later than the 30th day before the date on which the

court    is     scheduled     to    enter        the   judgment      or   approve      the

settlement.AAThe proposed judgment or settlement must be mailed to

the division by certified mail, return receipt requested.

        (b)AAThe     division       may    intervene      in    a    proceeding     under

Subsection (a) not later than the 30th day after the date of receipt

of the proposed judgment or settlement.

        (c)AAThe commissioner shall review the proposed judgment or

settlement to determine compliance with all appropriate provisions

of the law.AAIf the commissioner determines that the proposal is

not in compliance with the law, the division may intervene as a

matter of right in the proceeding not later than the 30th day after

the date of receipt of the proposed judgment or settlement.AAThe

court    may    limit   the   extent      of   the     division ’s    intervention      to

providing the information described by Subsection (e).

        (d)AAIf the division does not intervene before the 31st day

after the date of receipt of the proposed judgment or settlement,

the court shall enter the judgment or approve the settlement if the

court determines that the proposed judgment or settlement is in

compliance with all appropriate provisions of the law.

        (e)AAIf    the     division       intervenes      in   the    proceeding,      the

commissioner shall inform the court of each reason the commissioner

believes the proposed judgment or settlement is not in compliance

with    the    law.AAThe    court   shall      give    full    consideration      to   the

information provided by the commissioner before entering a judgment

or approving a settlement.

        (f)AAA     judgment    entered         or   settlement       approved   without

complying with the requirements of this section is void.

Added by Acts 1997, 75th Leg., ch. 1267, Sec. 2, eff. Sept. 1, 1997.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.201, eff.

September 1, 2005.

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.202, eff.

September 1, 2005.

                                            34
SUBCHAPTER G. JUDICIAL REVIEW OF ISSUES REGARDING COMPENSABILITY OR

                            INCOME OR DEATH BENEFITS

        Sec.A410.301.AAJUDICIAL              REVIEW         OF        ISSUES     REGARDING

COMPENSABILITY OR INCOME OR DEATH BENEFITS.                     (a)   Judicial review of

a final decision of the appeals panel regarding compensability or

eligibility for or the amount of income or death benefits shall be

conducted as provided by this subchapter.

        (b)AAA determination of benefits before a court shall be in

accordance with this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.203, eff.

September 1, 2005.

        Sec.   410.302.AAADMISSIBILITY               OF    RECORDS;       LIMITATION      OF

ISSUES.    (a)    The records of a contested case hearing conducted

under this chapter are admissible in a trial under this subchapter

in accordance with the Texas Rules of Evidence.

        (b)AAA   trial     under      this   subchapter         is    limited    to   issues

decided   by   the   appeals      panel      and    on    which      judicial    review   is

sought.AAThe      pleadings           must     specifically            set      forth     the

determinations       of    the   appeals          panel    by    which    the    party    is

aggrieved.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.204, eff.

September 1, 2005.

        Sec.A410.303.AABURDEN           OF   PROOF.        The    party      appealing    the

decision on an issue described in Section 410.301(a) has the burden

of proof by a preponderance of the evidence.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec. 410.304.AACONSIDERATION OF APPEALS PANEL DECISION.                           (a)

In a jury trial, the court, before submitting the case to the jury,

shall   inform   the      jury   in   the    court ’s     instructions,         charge,    or

                                             35
questions to the jury of the appeals panel decision on each disputed

issue described by Section 410.301(a) that is submitted to the

jury.

        (b)AAIn a trial to the court without a jury, the court in

rendering its judgment on an issue described by Section 410.301(a)

shall consider the decision of the appeals panel.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.205, eff.

September 1, 2005.

        Sec.A410.305.AACONFLICT WITH RULES OF CIVIL PROCEDURE.                   (a)

To the extent that this subchapter conflicts with the Texas Rules of

Civil Procedure or any other rules adopted by the supreme court,

this subchapter controls.

        (b)AANotwithstanding Section 22.004, Government Code, or any

other law, the supreme court may not adopt rules in conflict with or

inconsistent with this subchapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

        Sec.A410.306.AAEVIDENCE.          (a)    Evidence shall be adduced as

in other civil trials.

        (b)AAThe division on payment of a reasonable fee shall make

available   to    the    parties    a    certified      copy   of   the   division ’s

record.AAAll facts and evidence the record contains are admissible

to the extent allowed under the Texas Rules of Evidence.

        (c)AAExcept      as   provided    by    Section   410.307,    evidence    of

extent of impairment shall be limited to that presented to the

division.AAThe court or jury, in its determination of the extent of

impairment,      shall   adopt     one   of    the   impairment     ratings    under

Subchapter G, Chapter 408.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.206, eff.

September 1, 2005.

        Sec.A410.307.AASUBSTANTIAL             CHANGE     OF   CONDITION.        (a)

                                          36
Evidence     of   the   extent    of    impairment            is   not    limited       to    that

presented to the division if the court, after a hearing, finds that

there is a substantial change of condition.AAThe court ’s finding of

a substantial change of condition may be based only on:

               (1)AAmedical evidence from the same doctor or doctors

whose testimony or opinion was presented to the division;

               (2)AAevidence that has come to the party ’s knowledge

since the contested case hearing;

               (3)AAevidence          that   could       not       have   been       discovered

earlier with due diligence by the party; and

               (4)AAevidence that would probably produce a different

result if it is admitted into evidence at the trial.

        (b)AAIf     substantial       change      of    condition         is    disputed,      the

court shall require the designated doctor in the case to verify the

substantial       change   of   condition,        if    any.        The   findings       of   the

designated doctor shall be presumed to be correct, and the court

shall base its finding on the medical evidence presented by the

designated doctor in regard to substantial change of condition

unless the preponderance of the other medical evidence is to the

contrary.

        (c)AAThe substantial change of condition must be confirmable

by recognized laboratory or diagnostic tests or signs confirmable

by physical examination.

        (d)AAIf the court finds a substantial change of condition

under   this      section,      new    medical         evidence      of        the   extent    of

impairment must be from and is limited to the same doctor or doctors

who   made   impairment      ratings     before         the    division         under   Section

408.123.

        (e)AAThe court ’s finding of a substantial change of condition

may not be made known to the jury.

        (f)AAThe court or jury in its determination of the extent of

impairment shall adopt one of the impairment ratings made under

this section.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.207, eff.

September 1, 2005.

                                             37
      Sec.A410.308.AACERTIFIED            COPY    OF      NOTICE    SECURING

COMPENSATION.    (a)   The division shall furnish any interested party

in the claim with a certified copy of the notice of the employer

securing compensation with the insurance carrier, filed with the

division.

      (b)AAThe    certified   copy   of    the   notice   is   admissible   in

evidence on trial of the claim pending and is prima facie proof of

the facts stated in the notice unless the facts are denied under

oath by the opposing party.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.208, eff.

September 1, 2005.

                                     38
                                   LABOR CODE

                      TITLE 5. WORKERS ’ COMPENSATION

               SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

 CHAPTER 414.      ENFORCEMENT OF COMPLIANCE AND PRACTICE REQUIREMENTS

        Sec.A414.002.AAMONITORING DUTIES.              (a)    The division shall

monitor for compliance with commissioner rules, this subtitle, and

other laws relating to workers ’ compensation the conduct of persons

subject to this subtitle.AAPersons to be monitored include:

               (1)AApersons claiming benefits under this subtitle;

               (2)AAemployers;

               (3)AAinsurance carriers;

               (4)AAattorneys and other representatives of parties;

and

               (5)AAhealth care providers.

        (b)AAThe     division    shall       monitor    conduct     described    by

Sections 415.001, 415.002, and 415.003 and refer persons engaging

in that conduct to the division of hearings.

        (c)AAThe division shall monitor payments made to health care

providers on behalf of workers ’ compensation claimants who receive

medical services to ensure that the payments are made on time as

required by Section 408.027.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.260, eff.

September 1, 2005.

        Sec. 414.003.AACOMPILATION AND USE OF INFORMATION.                 (a)   The

division    shall     compile    and     maintain      statistical       and   other

information as necessary to detect practices or patterns of conduct

by persons subject to monitoring under this chapter that:

               (1)AAviolate this subtitle, commissioner rules, or a

commissioner order or decision; or

               (2)AAotherwise       adversely          affect     the      workers ’

compensation system of this state.

        (b)AAThe    commissioner    shall     use   the   information      compiled

under   this   section   to     impose   appropriate         penalties   and   other

                                         1
sanctions under Chapters 415 and 416.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.261, eff.

September 1, 2005.

       Sec.A414.004.AAPERFORMANCE             REVIEW       OF    INSURANCE         CARRIERS.

(a)   The division shall review regularly the workers ’ compensation

records of insurance carriers as required to ensure compliance with

this subtitle.

       (b)AAEach insurance carrier, the carrier ’s agents, and those

with whom the carrier has contracted to provide, review, or monitor

services under this subtitle shall:

              (1)AAcooperate with the division;

              (2)AAmake     available      to      the    division      any       records   or

other necessary information;        and

              (3)AAallow the division access to the information at

reasonable times at the person ’s offices.

       (c)AAThe     insurance     carrier,          other       than    a    governmental

entity,   shall    pay    the    reasonable         expenses,          including      travel

expenses,    of   an   auditor    who   audits        the    workers ’ compensation

records at the office of the insurance carrier.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

       Sec. 414.005.AAINVESTIGATION UNIT.                   (a)AAThe division shall

maintain an investigation unit to conduct investigations relating

to alleged violations of this subtitle, commissioner rules, or a

commissioner      order   or    decision,          with   particular          emphasis      on

violations of Chapters 415 and 416.

       (b)AAAs often as the commissioner considers necessary, the

commissioner or the investigation unit may review the operations of

a person regulated by the division, including an agent of the person

performing    functions     regulated         by    the    division,         to    determine

compliance with this subtitle.

       (c)AAThe    review      described      by    Subsection         (b)    may    include

on-site visits to the person ’s premises.AAThe commissioner is not

required to announce an on-site visit in advance.

                                          2
          (d)AADuring    an    on-site   visit,      a    person    regulated     by   the

division shall make available to the division all records relating

to the person ’s participation in the workers ’ compensation system.

          (e)AAThe commissioner by rule shall prescribe the procedures

to   be   used   for    both   announced       and   unannounced        on-site   visits

authorized under this section, including specifying the types of

records subject to inspection.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

          Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.262, eff.

September 1, 2005.

          Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 26,

eff. September 1, 2011.

          Sec. 414.006.AAREFERRAL TO OTHER AUTHORITIES.                    For further

investigation or the institution of appropriate proceedings, the

division may refer the persons involved in a case subject to an

investigation          toAAother     appropriate          authorities,         including

licensing agencies, district and county attorneys, or the attorney

general.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

          Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.263, eff.

September 1, 2005.

          Sec. 414.007.AAMEDICAL REVIEW.                 The division shall review

information        concerning      alleged      violations         of   this   subtitle

regarding the provision of medical benefits, commissioner rules, or

a commissioner order or decision, and, under Sections 414.005 and

414.006 and Chapters 415 and 416, may conduct investigations, make

referrals     to    other      authorities,      and      initiate      administrative

violation proceedings.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

          Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.264, eff.

September 1, 2005.

                                           3
                                  LABOR CODE

                       TITLE 5. WORKERS ’ COMPENSATION

              SUBTITLE A. TEXAS WORKERS ’ COMPENSATION ACT

                 CHAPTER 415. ADMINISTRATIVE VIOLATIONS

                       SUBCHAPTER A. PROHIBITED ACTS

         Sec. 415.001.AAADMINISTRATIVE VIOLATION BY REPRESENTATIVE OF

EMPLOYEE OR LEGAL BENEFICIARY.           A representative of an employee or

legal    beneficiary    commits    an    administrative         violation          if   the

person:

              (1)AAfails    without      good    cause    to    attend    a    dispute

resolution proceeding within the division;

              (2)AAattends a dispute resolution proceeding within the

division without complete authority or fails to exercise authority

to effectuate an agreement or settlement;

              (3)AAcommits an act of barratry under Section 38.12,

Penal Code;

              (4)AAwithholds       from        the      employee ’s       or        legal

beneficiary ’s    weekly    benefits      or     from    advances     amounts           not

authorized to be withheld by the division;

              (5)AAenters into a settlement or agreement without the

knowledge,    consent,     and    signature      of     the    employee       or    legal

beneficiary;

              (6)AAtakes a fee or withholds expenses in excess of the

amounts authorized by the division;

              (7)AArefuses or fails to make prompt delivery to the

employee or legal beneficiary of funds belonging to the employee or

legal beneficiary as a result of a settlement, agreement, order, or

award;

              (8)AAviolates       the     Texas       Disciplinary        Rules          of

Professional Conduct of the State Bar of Texas;

              (9)AAmisrepresents the provisions of this subtitle to

an   employee,   an   employer,    a    health    care    provider,      or    a    legal

beneficiary;

              (10)AA violates a commissioner rule; or

              (11)AAfails to comply with this subtitle.

                                         1
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.265, eff.

September 1, 2005.

      Sec.        415.002.AAADMINISTRATIVE                 VIOLATION       BY       INSURANCE

CARRIER.    (a)    An insurance carrier or its representative commits an

administrative violation if that person:

              (1)AAmisrepresents a provision of this subtitle to an

employee,     an    employer,    a     health        care       provider,      or    a    legal

beneficiary;

              (2)AAterminates             or         reduces       benefits           without

substantiating       evidence        that      the    action       is    reasonable           and

authorized by law;

              (3)AAinstructs         an     employer       not    to    file    a   document

required to be filed with the division;

              (4)AAinstructs or encourages an employer to violate a

claimant ’s right to medical benefits under this subtitle;

              (5)AAfails to tender promptly full death benefits if a

legitimate    dispute    does    not      exist      as    to    the    liability        of   the

insurance carrier;

              (6)AAallows       an    employer,        other      than    a    self-insured

employer, to dictate the methods by which and the terms on which a

claim is handled and settled;

              (7)AAfails to confirm medical benefits coverage to a

person or facility providing medical treatment to a claimant if a

legitimate    dispute    does    not      exist      as    to    the    liability        of   the

insurance carrier;

              (8)AAfails, without good cause, to attend a dispute

resolution proceeding within the division;

              (9)AAattends a dispute resolution proceeding within the

division without complete authority or fails to exercise authority

to effectuate agreement or settlement;

              (10)AAadjusts a workers ’ compensation claim in a manner

contrary    to     license   requirements            for    an    insurance         adjuster,

including the requirements of Chapter 4101, Insurance Code, or the

rules of the commissioner of insurance;

                                             2
               (11)AAfails to process claims promptly in a reasonable

and prudent manner;

               (12)AAfails to initiate or reinstate benefits when due

if a legitimate dispute does not exist as to the liability of the

insurance carrier;

               (13)AAmisrepresents the reason for not paying benefits

or terminating or reducing the payment of benefits;

               (14)AAdates documents to misrepresent the actual date

of the initiation of benefits;

               (15)AAmakes a notation on a draft or other instrument

indicating     that   the    draft    or       instrument        represents      a    final

settlement of a claim if the claim is still open and pending before

the division;

               (16)AAfails or refuses to pay benefits from week to week

as and when due directly to the person entitled to the benefits;

               (17)AAfails to pay an order awarding benefits;

               (18)AAcontroverts       a    claim      if       the   evidence    clearly

indicates liability;

               (19)AAunreasonably          disputes        the    reasonableness         and

necessity of health care;

               (20)AAviolates a commissioner rule;

               (21)AAmakes a statement denying all future medical care

for a compensable injury; or

               (22)AAfails     to    comply         with    a     provision      of     this

subtitle.

         (b)AAAn   insurance   carrier         or   its    representative        does   not

commit    an   administrative       violation       under       Subsection    (a)(6)     by

allowing an employer to:

               (1)AAfreely discuss a claim;

               (2)AAassist in the investigation and evaluation of a

claim; or

               (3)AAattend     a     proceeding            of     the    division        and

participate at the proceeding in accordance with this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                        Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.45, eff. Sept. 1, 1995.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.266, eff.

                                           3
September 1, 2005.

       Sec.   415.003.AAADMINISTRATIVE                  VIOLATION         BY   HEALTH        CARE

PROVIDER.       A    health   care    provider          commits      an     administrative

violation if the person:

              (1)AAsubmits      a    charge       for    health      care      that    was    not

furnished;

              (2)AAadministers improper, unreasonable, or medically

unnecessary treatment or services;

              (3)AAmakes an unnecessary referral;

              (4)AAviolates          the        division ’s     fee        and    treatment

guidelines;

              (5)AAviolates a commissioner rule; or

              (6)AAfails to comply with a provision of this subtitle.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                             Amended

by Acts 1995, 74th Leg., ch. 980, Sec. 1.45, eff. Sept. 1, 1995.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.267, eff.

September 1, 2005.

       Sec.A415.0035.AAADDITIONAL VIOLATIONS BY INSURANCE CARRIER

OR   HEALTH   CARE    PROVIDER.           (a)      An    insurance        carrier      or    its

representative commits an administrative violation if that person:

              (1)AAfails to submit to the division a settlement or

agreement of the parties;

              (2)AAfails       to    timely        notify      the    division         of    the

termination     or    reduction      of    benefits      and    the    reason         for    that

action; or

              (3)AAdenies preauthorization in a manner that is not in

accordance with rules adopted by the commissioner under Section

413.014.

       (b)AAA       health    care    provider          commits      an     administrative

violation if that person:

              (1)AAfails or refuses to timely file required reports

or records; or

              (2)AAfails       to    file       with     the   division          the    annual

disclosure statement required by Section 413.041.

                                            4
        (c)AARepealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec.

37(2), eff. September 1, 2011.

        (d)AARepealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec.

37(2), eff. September 1, 2011.

        (e)AAA person regulated by the division under this title

commits an administrative violation if the person violates this

subtitle or a rule, order, or decision of the commissioner.

        (f)AARepealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec.

37(2), eff. September 1, 2011.

Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.45, eff. Sept. 1,

1995.   Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.06, eff.

June 17, 2001.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.268, eff.

September 1, 2005.

        Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 27,

eff. September 1, 2011.

        Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(2),

eff. September 1, 2011.

        Sec.        415.0036.AAADMINISTRATIVE                  VIOLATION           BY         PERSON

PERFORMING CERTAIN CLAIM SERVICES.                      (a)   This section applies to an

insurance adjuster, case manager, or other person who has authority

under this title to request the performance of a service affecting

the delivery of benefits to an injured employee or who actually

performs such a service, including peer reviews, performance of

required medical examinations, or case management.

        (b)AAA      person    described            by    Subsection          (a)   commits          an

administrative        violation         if    the   person          offers    to   pay,       pays,

solicits,      or   receives       an   improper         inducement        relating       to    the

delivery of benefits to an injured employee or improperly attempts

to   influence      the   delivery       of   benefits         to    an   injured       employee,

including through the making of improper threats. This section

applies   to     each     person    described           by    Subsection       (a)      who    is   a

participant in the workers ’ compensation system of this state and

to an agent of such a person.

        (c)AARepealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec.

                                               5
37(3), eff. September 1, 2011.

Added by Acts 2007, 80th Leg., R.S., Ch. 198 (H.B. 34), Sec. 1, eff.

September 1, 2007.

Amended by:

       Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(3),

eff. September 1, 2011.

       Sec.A415.005.AAOVERCHARGING             BY    HEALTH      CARE     PROVIDERS

PROHIBITED;      ADMINISTRATIVE VIOLATION.          (a)   A health care provider

commits a violation if the person charges an insurance carrier an

amount greater than that normally charged for similar treatment to

a   payor   outside   the    workers ’ compensation         system,     except    for

mandated or negotiated charges.

       (b)AAA    violation    under     this   section    is    an   administrative

violation.AAA      health     care      provider    may    be    liable     for   an

administrative penalty regardless of whether a criminal action is

initiated under Section 413.043.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.269, eff.

September 1, 2005.

       Sec.A415.006.AAEMPLOYER                 CHARGEBACKS              PROHIBITED;

ADMINISTRATIVE VIOLATION.        (a)     An employer may not collect from an

employee, directly or indirectly, a premium or other fee paid by the

employer    to    obtain    workers ’    compensation      insurance      coverage,

except as provided by Sections 406.123 and 406.144.

       (b)AAAn employee or legal beneficiary of an employee has a

right of action to recover damages against an employer who violates

Subsection (a).

       (c)AAA    person    commits    an   administrative       violation   if    the

person violates Subsection (a).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.270, eff.

September 1, 2005.

                                           6
        Sec.A415.007.AALOANS          BY    ATTORNEYS         PROHIBITED.           (a)    An

attorney who represents a claimant before the division may not lend

money   to    the   claimant     during          the   pendency        of     the    workers ’

compensation claim.

        (b)AAThe     attorney    may       assist      the    claimant        in    obtaining

financial assistance from another source if the attorney is not

personally liable for the credit extended to the claimant.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

        Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.271, eff.

September 1, 2005.

        Sec.A415.008.AAFRAUDULENTLY OBTAINING OR DENYING BENEFITS;

ADMINISTRATIVE VIOLATION.         (a)AAA person commits an administrative

violation if the person, to obtain or deny a payment of a workers ’

compensation benefit or the provision of a benefit for the person or

another, knowingly or intentionally:

              (1)AAmakes a false or misleading statement;

              (2)AAmisrepresents or conceals a material fact;

              (3)AAfabricates,         alters,         conceals,         or    destroys     a

document; or

              (4)AAconspires          to     commit          an    act       described     by

Subdivision (1), (2), or (3).

        (b)AARepealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec.

37(5), eff. September 1, 2011.

        (c)AAA person who has obtained an excess payment in violation

of this section is liable for full repayment plus interest computed

at the rate prescribed by Section 401.023.                         If the person is an

employee or person claiming death benefits, the repayment may be

redeemed from future income or death benefits to which the person is

otherwise entitled.

        (d)AAAn     employer    who    has       committed        an   act    described    by

Subsection (a) that results in denial of payments is liable for the

past benefit payments that would otherwise have been payable by the

insurance    carrier    during    the       period      of    denial,        plus   interest

computed at the rate prescribed by Section 401.023.                           The insurance

carrier is not liable for benefit payments during the period of

                                             7
denial.

      (e)AAIf an administrative violation proceeding is pending

under this section against an employee or person claiming death

benefits, the division may not take final action on the person ’s

benefits.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.272, eff.

September 1, 2005.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 28,

eff. September 1, 2011.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(5),

eff. September 1, 2011.

      Sec.            415.009.AAFRIVOLOUS             ACTIONS;       ADMINISTRATIVE

VIOLATION.AA A person commits an administrative violation if the

person brings, prosecutes, or defends an action for benefits under

this subtitle or requests initiation of an administrative violation

proceeding that does not have a basis in fact or is not warranted by

existing    law       or   a   good      faith    argument   for    the   extension,

modification, or reversal of existing law.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.273, eff.

September 1, 2005.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 29,

eff. September 1, 2011.

      Sec.        415.010.AABREACH           OF      AGREEMENT;      ADMINISTRATIVE

VIOLATION.AA      A    party   to   an    agreement    approved    by   the   division

commits    an   administrative           violation    if   the   person   breaches   a

provision of the agreement.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.274, eff.

September 1, 2005.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 29,

                                             8
eff. September 1, 2011.

      Sec. 415.011.AANOTICE OF PROFESSIONAL EMPLOYER ORGANIZATION

WORKERS ’     COMPENSATION       CLAIM       AND      PAYMENT      INFORMATION;

ADMINISTRATIVE VIOLATION.        (a)AAIn this section, "license holder"

has the meaning assigned by Section 91.001.

      (a-1)AAExcept as provided by Subsection (c), a license holder

commits a violation if the license holder fails to provide the

information required by Sections 91.042(g) and (h).

      (b)AAA violation under Subsection (a) is an administrative

violation.

      (c)AAA     license    holder   does   not    commit   an   administrative

violation under this section if the license holder requested the

information required by Sections 91.042(g) and (h) from the license

holder ’s workers ’ compensation insurance provider and the provider

does not provide the information to the license holder within the

required time.AAA license holder shall notify the Texas Department

of   Insurance    of   a    provider ’s     failure    to   comply   with   the

requirements of Section 2051.151, Insurance Code.

Added by Acts 2011, 82nd Leg., R.S., Ch. 477 (H.B. 625), Sec. 3,

eff. September 1, 2011.

Amended by:

      Acts 2013, 83rd Leg., R.S., Ch. 117 (S.B. 1286), Sec. 20, eff.

September 1, 2013.

      Acts 2013, 83rd Leg., R.S., Ch. 117 (S.B. 1286), Sec. 21, eff.

September 1, 2013.

                           SUBCHAPTER B.    SANCTIONS

      Sec.     415.021.AAASSESSMENT         OF    ADMINISTRATIVE     PENALTIES.

(a)AAIn addition to any other provisions in this subtitle relating

to violations, a person commits an administrative violation if the

person violates, fails to comply with, or refuses to comply with

this subtitle or a rule, order, or decision of the commissioner,

including an emergency cease and desist order issued under Section

415.0211.AAIn addition to any sanctions, administrative penalty,

or other remedy authorized by this subtitle, the commissioner may

                                       9
assess an administrative penalty against a person who commits an

administrative violation.AAThe administrative penalty shall not

exceed $25,000 per day per occurrence.AAEach day of noncompliance

constitutes a separate violation.AAThe commissioner ’s authority

under this chapter is in addition to any other authority to enforce

a   sanction,   penalty,   fine,     forfeiture,   denial,     suspension,     or

revocation otherwise authorized by law.

       (b)AAThe commissioner may enter a cease and desist order

against a person who:

              (1)AAcommits repeated administrative violations;

              (2)AAallows, as a business practice, the commission of

repeated administrative violations; or

              (3)AAviolates an order or decision of the commissioner.

       (c)AAIn assessing an administrative penalty:

              (1)AAthe commissioner shall consider:

                   (A)AAthe seriousness of the violation, including

the nature, circumstances, consequences, extent, and gravity of the

prohibited act;

                   (B)AAthe     history      and      extent    of      previous

administrative violations;

                   (C)AAthe demonstrated good faith of the violator,

including     actions   taken   to    rectify   the    consequences      of   the

prohibited act;

                   (D)AAthe     penalty     necessary     to    deter    future

violations; and

                   (E)AAother matters that justice may require; and

              (2)AAthe commissioner shall, to the extent reasonable,

consider the economic benefit resulting from the prohibited act.

       (d)AAA penalty may be assessed only after the person charged

with an administrative violation has been given an opportunity for

a hearing under Subchapter C.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.              Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 6.07, eff. June 17, 2001.

Amended by:

       Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.275, eff.

September 1, 2005.

       Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 31,

                                       10
eff. September 1, 2011.

        Sec. 415.0211.AAEMERGENCY CEASE AND DESIST ORDER.                              (a)AAThe

commissioner ex parte may issue an emergency cease and desist order

if:

               (1)AAthe commissioner believes a person regulated by

the division under this title is engaging in conduct violating a

law, rule, or order; and

               (2)AAthe commissioner believes that the alleged conduct

under Subdivision (1) will result in harm to the health, safety, or

welfare of another person.

        (b)AAOn    issuance        of    an    order      under     Subsection         (a),       the

commissioner      shall      serve      on    the   affected       person      an    order       that

contains   a    statement         of    the    charges       and   requires          the    person

immediately      to    cease      and    desist       from    the       acts,       methods,       or

practices stated in the order.AAThe commissioner shall serve the

order by registered or certified mail, return receipt requested, to

the affected person ’s last known address.AAThe order is final on

the 31st day after the date the affected person receives the order,

unless the affected person requests a hearing under Subsection (c).

        (c)AAA person affected by an order is entitled to request a

hearing to contest the order.AAThe affected person must request the

hearing not later than the 30th day after the date the person

receives   the    order      required         by    Subsection       (b).AAA         request       to

contest an order must:

               (1)AAbe in writing;

               (2)AAbe directed to the commissioner; and

               (3)AAstate the grounds for the request to set aside or

modify the order.

        (d)AAOn receiving a request for a hearing, the commissioner

shall   serve    notice      of   the    time       and   place    of    the    hearing.AAThe

hearing is subject to the procedures for a contested case under

Chapter 2001, Government Code.AAThe hearing shall be held not later

than the 10th day after the date the commissioner receives the

request for a hearing unless the parties mutually agree to a later

hearing date.AAAt the hearing, the person requesting the hearing is

entitled    to        show     cause         why     the     order        should           not    be

                                               11
affirmed.AAFollowing receipt of the proposal for decision from the

State Office of Administrative Hearings regarding the hearing, the

commissioner shall wholly or partly affirm, modify, or set aside

the order.

       (e)AAPending a hearing under this section, an order continues

in effect unless the order is stayed by the commissioner.

Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 32,

eff. September 1, 2011.

       Sec.   415.0215.AASANCTIONS.          (a)AAThe      division      may    impose

sanctions against any person regulated by the division under this

subtitle.

       (b)AAOnly the commissioner may impose:

              (1)AAa sanction that deprives a person of the right to

practice     before   the   division    or     of    the     right       to    receive

remuneration under this subtitle for a period exceeding 30 days; or

              (2)AAanother sanction suspending for more than 30 days

or   revoking   a   license,   certification,        or    permit    required       for

practice in the field of workers ’ compensation.

       (c)AAA sanction imposed by the division is binding pending

appeal.

Transferred and redesignated from Labor Code, Section 402.072 by

Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 33, eff.

September 1, 2011.

       Sec.A415.023.AACOMMISSION        OF    WRONGFUL      ACT     AS    MATTER     OF

PRACTICE;     ADMINISTRATIVE VIOLATION.        (a)    A person who commits an

administrative violation under Section 415.001, 415.002, 415.003,

or 415.0035 as a matter of practice is subject to an applicable rule

adopted under Subsection (b) in addition to the penalty assessed

for the violation.

       (b)AAThe commissioner may adopt rules providing for:

              (1)AAa reduction or denial of fees;

              (2)AApublic or private reprimand by the commissioner;

              (3)AAsuspension from practice before the division;

              (4)AArestriction,    suspension,        or    revocation         of   the

right to receive reimbursement under this subtitle; or

                                       12
              (5)AAreferral and petition to the appropriate licensing

authority     for    appropriate    disciplinary         action,    including     the

restriction, suspension, or revocation of the person ’s license.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                  Amended

by Acts 2001, 77th Leg., ch. 1456, Sec. 6.08, eff. June 17, 2001.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.276, eff.

September 1, 2005.

      Sec.          415.024.AABREACH        OF        SETTLEMENT       AGREEMENT;

ADMINISTRATIVE VIOLATION.          A material and substantial breach of a

settlement    agreement    that    establishes       a   compliance   plan   is   an

administrative       violation.AAIn     determining        the     amount   of    the

penalty, the commissioner shall consider the total volume of claims

handled by the insurance carrier.

Added by Acts 1997, 75th Leg., ch. 1443, Sec. 9, eff. Sept. 1, 1997.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.277, eff.

September 1, 2005.

      Sec.     415.025.AAREFERENCES         TO   A    CLASS   OF    VIOLATION     OR

PENALTY.AAA reference in this code or other law, or in rules of the

former Texas Workers ’ Compensation Commission or the commissioner,

to a particular class of violation, administrative violation, or

penalty shall be construed as a reference to an administrative

penalty.AAAn administrative penalty may not exceed $25,000 per day

per occurrence.AAEach day of noncompliance constitutes a separate

violation.

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.278, eff.

September 1, 2005.

Amended by:

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34,

eff. September 1, 2011.

                          SUBCHAPTER C. PROCEDURES

      Sec.     415.031.AAINITIATION         OF       ADMINISTRATIVE     VIOLATION

                                       13
PROCEEDINGS.       Any   person       may   request   the    initiation    of

administrative     violation     proceedings     by    filing    a   written

allegation with the division.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.279, eff.

September 1, 2005.

      Sec. 415.032.AANOTICE OF POSSIBLE ADMINISTRATIVE VIOLATION;

RESPONSE.   (a)AAIf investigation by the division indicates that an

administrative violation has occurred, the division shall notify

the person alleged to have committed the violation in writing of:

              (1)AAthe charge;

              (2)AAthe proposed sanction;

              (3)AAthe   right   to    consent   to   the   charge   and   the

sanction; and

              (4)AAthe right to request a hearing.

      (b)AANot later than the 20th day after the date on which

notice is received, the charged party shall:

              (1)AAremit the amount of the sanction to the division or

otherwise consent to the imposed sanction; or

              (2)AAsubmit to the division a written request for a

hearing.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.280, eff.

September 1, 2005.

      Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34,

eff. September 1, 2011.

      Sec. 415.033.AAFAILURE TO RESPOND.AAIf, without good cause,

a charged party fails to respond as required under Section 415.032,

the division shall initiate enforcement proceedings.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.281, eff.

September 1, 2005.

                                       14
         Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34,

eff. September 1, 2011.

         Sec. 415.034.AAHEARING PROCEDURES.AA On the request of the

charged     party    or    the    commissioner,         the   State      Office       of

Administrative Hearings shall set a hearing.AAThe hearing shall be

conducted in the manner provided for a contested case under Chapter

2001, Government Code (the administrative procedure law).

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                     Amended

by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995;

Acts 1995, 74th Leg., ch. 980, Sec. 1.46, eff. Sept. 1, 1995.

Amended by:

         Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.282, eff.

September 1, 2005.

         Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34,

eff. September 1, 2011.

         Sec.A415.035.AAJUDICIAL         REVIEW.    (a)       A   decision       under

Section    415.034   is    subject      to   judicial    review     in   the    manner

provided for judicial review under Chapter 2001, Government Code.

         (b)AAIf an administrative penalty is assessed, the person

charged shall:

              (1)AAforward the amount of the penalty to the division

for deposit in an escrow account; or

              (2)AApost with the division a bond for the amount of the

penalty, effective until all judicial review of the determination

is final.

         (c)AAFailure     to   comply   with   Subsection     (b)    results     in    a

waiver of all legal rights to contest the violation or the amount of

the penalty.

         (d)AAIf the court determines that the penalty should not have

been assessed or reduces the amount of the penalty, the division

shall:

              (1)AAremit       the   appropriate        amount,     plus       accrued

interest, if the administrative penalty was paid; or

              (2)AArelease the bond.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.                     Amended

                                         15
by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995.

Amended by:

      Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.283, eff.

September 1, 2005.

      Sec. 415.036.AASTANDARD OF JUDICIAL REVIEW OF COMMISSIONER ’S

ORDER.AAAn order of the commissioner is subject to judicial review

under the substantial evidence rule.

Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 35,

eff. September 1, 2011.

                                 16