In re Accident Fund General Insurance Company and Kriste Henderson, Relators
Petition for Writ of Mandamus
Texas Workers' Compensation Act "provides the
exclusive process and remedies for claims arising out of a
carrier's investigation, handling, or settling of a claim
for workers' compensation benefits." In re
Crawford & Co., 458 S.W.3d 920, 925-26 (Tex. 2015)
(orig. proceeding); see Tex. Mut. Ins. Co. v.
Ruttiger, 381 S.W.3d 430, 444, 456 (Tex. 2012). In this
original proceeding, we determine whether the Division of
Workers' Compensation has exclusive jurisdiction over
statutory and tort claims alleging the Act's "bona
fide offer of employment" process was misused to
fabricate grounds for firing a covered employee. Because we
conclude the trial court lacks subject-matter jurisdiction
over the employee's retaliation, conspiracy, and
tortious-interference claims against the workers'
compensation carrier and its agent, we conditionally grant
mandamus relief. The employer's mandamus petition,
seeking dismissal or abatement of both related and distinct
claims, is not properly before us. See Tex. R. App.
P. 52.3(e); see also Tex. R. App. P. 52.1,
52.3(k)(1)(B), 52.7. Accordingly, we deny the employer's
petition without regard to the merits.
Sayaz suffered a serious injury in the course and scope of
his employment with Coil Tubing Solutions, LLC, a
workers' compensation subscriber. Coil Tubing notified
its carrier, Accident Fund General Insurance Company, who
assigned the claim to an insurance adjuster, Kriste
Henderson. Accident Fund accepted coverage and paid income
and medical benefits to Sayaz.
Sayaz was recuperating, Coil Tubing sent him two offers for
modified-duty work labeled "Bona Fide Offer of
Employment." Both letters contained details of the work
locations, responsibilities, and hours. The second letter
provided (1) a beginning date of either three days after the
letter's issuance or immediately after acceptance and (2)
an expiration date eleven days after the letter's
issuance. The offer purported to be consistent with a
physician's work-status report stating that, with certain
restrictions, Sayaz could return to work.
neither explicitly accepted nor rejected either modified-duty
offer, but his wife, Nelda Ramirez, emailed Coil Tubing with
concerns about his ability to work and attached information
from other doctors. When Sayaz did not accept the offers or
return to his former job, Coil Tubing terminated his
sued Coil Tubing for (1) wrongful discharge and retaliation
under Labor Code section 451.001 and (2) defamation. Ramirez
sued Coil Tubing for injuries sustained while caring for
Sayaz, as well as loss of household services, pain and
suffering, and loss of consortium. Sayaz also sued Accident
Fund and Henderson, alleging they aided and abetted Coil
Tubing's section 451.002 violation, tortiously interfered
with Sayaz's employment relationship, and conspired with
Coil Tubing to unlawfully discharge and retaliate against
him. According to Sayaz, Accident Fund was complicit in
procuring modified-duty job offers that were not legitimate
and which served as a pretext for retaliatory discharge.
Ramirez asserted no claims against Accident Fund and
on our opinions in Crawford and Ruttiger,
Accident Fund and Henderson (collectively Accident Fund)
filed a plea to the jurisdiction, asserting exclusive
jurisdiction lies with the Division of Workers'
Compensation. The trial court denied the plea, and the court
of appeals summarily denied Accident Fund's petition for
agency has exclusive jurisdiction and the plaintiff has not
exhausted administrative remedies, the trial court lacks
subject-matter jurisdiction and must dismiss any claim within
the agency's exclusive jurisdiction. In re Entergy
Corp., 142 S.W.3d 316, 321-22 (Tex. 2004) (orig.
proceeding). Whether exclusive jurisdiction is vested in the
Division as to the claims against Accident Fund is a question
of law we review de novo. Id.
Workers' Compensation Act "provides the exclusive
procedures and remedies for claims alleging that a
workers' compensation carrier has improperly
investigated, handled, or settled a workers' claim for
benefits." Crawford, 458 S.W.3d at 923-24;
see Ruttiger, 381 S.W.3d at 443, 445, 451. In
Ruttiger, we applied that rule to preclude certain
Insurance Code and common-law bad-faith claims against the
compensation carrier because those claims were at odds with
the workers' compensation system's dispute-resolution
process. 381 S.W.3d at 443, 445, 450-51. For the same reason,
we concluded in Crawford that a host of tort,
contract, and statutory claims could not go forward against
the carrier in the trial court. 458 S.W.3d at 922, 929. As
both Crawford and Ruttiger explain,
allowing parties to pursue remedies that circumvent the
Division's exclusive jurisdiction would undermine the
workers' compensation system's careful
benefits-determination and claims-resolution processes.
See id. at 924; Ruttiger, 381 S.W.3d at
statutory and common-law claims against a carrier run counter
to the Act, but at the same time, neither a claim's label
nor the relief requested is determinative of the
jurisdictional inquiry. Crawford, 458 S.W.3d at 926.
Rather, the substance of the claim controls whether the
Workers' Compensation Act provides the exclusive process
and remedies and, thus, vests exclusive jurisdiction with the
Division. The dispositive issue in this case is whether
Sayaz's claims against Accident Fund-which are all
premised on the existence of sham modified-duty offers-arise
out of Accident Fund's investigation, handling, or
settling of a claim for workers' compensation benefits.
Id. at 925-26. We agree with Accident Fund that,
necessarily, they do.
advance the workers' compensation system's goal of
returning injured employees to work as soon as is safe and
appropriate, the Legislature enacted a process that
encourages employers to offer injured employees "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." Tex. Lab. Code § 408.103(e); see
id. §§ 402.021(a)(4), .021(b)(2), .021(d). As
part of this process, either the employer or the carrier can
request a work-status report from the treating physician by
providing information about available modified-duty
positions. 28 Tex. Admin. Code § 129.6(a). The employer
may then offer the employee a modified-duty position based on
the employee's existing work abilities as determined by
the treating physician. Id. § 129.6(b).
addition to facilitating a speedy return to work, the
bona-fide-employment-offer process is a benefits-determining
mechanism. After a modified-duty job offer is made, the
carrier may deem it bona fide based on a detailed set of
criteria. Id. § 129.6(d)-(f). If the carrier
deems the offer bona fide, it may then treat the offered
wages as the employee's post-injury earnings, whether the
employee accepts the offer or not. Id. §§
129.2(c)(3), 129.6(g). This is significant because
post-injury earnings are deducted from the employee's
lost-wages benefits. Id. §§ 129.2(a), (b),
(c)(3), 129.3(d). If a dispute concerning an offer of
modified-duty employment arises, either the employee or the
carrier may initiate the administrative dispute-resolution
process, and the Division will determine if the offer is bona
fide under the statutorily prescribed criteria. See
id. § 129.6(h).
dissatisfied with the terms of the modified-duty job offers,
Sayaz did not seek resolution through the workers'
compensation administrative process. Rather, Sayaz sued Coil
Tubing and Accident Fund, characterizing the job offers as
"bogus" because they "were extended during
times that Sayaz was not permitted to work" and the
short response deadline given was "arbitrary." He
claimed Coil Tubing terminated him for failing to accept the
job offers as pretext for workers' compensation
retaliation and that Accident Fund "aided and abetted
Coil Tubing in orchestrating a pretext for terminating"
him by "direct[ing] Coil Tubing on how to create a
pretext for ...