American Motorists Insurance Co. v. Fodge
In American Motorists Insurance Co. v. Fodge, 63 S.W.3d 801 (Tex. 2001), a claimant sought benefits from her employer's insurance carrier after suffering a workplace injury.
The carrier denied that her injuries were work-related. After a contested case hearing, the carrier was ordered to pay temporary income benefits for a specified period.
Never in those proceedings did the claimant seek medical benefits or complain that the carrier had denied benefits.
Later, the claimant sued the carrier for denying the income benefits as well as denying payment for certain medical treatments.
The trial court dismissed the claims for lack of jurisdiction as Fodge had not yet exhausted her remedies with the TWCC.
On appeal, Fodge argued that because she was suing for damages resulting from the denial or delay of benefit payments--rather than payment of the benefits themselves--her claims were properly before the trial court, as opposed to the TWCC.
The Texas Supreme Court disagreed, saying that because her suit involved her entitlement to workers' compensation benefits, her claims were within the exclusive jurisdiction of the TWCC. Id.
Further, the court held that a trial court could have jurisdiction only over final orders of the TWCC, meaning that a court could not hear claims related to benefits which the TWCC had never ordered. Id. at 803-804.
Because the TWCC had never awarded medical benefits to Fodge, she could not sue for a delay or denial in paying them. Id. at 804.