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Dr. Eric Vanderwerff, D.C. v. The Travelers Indemnity Company of Connecticut

Court of Appeals of Texas, Fifth District, Dallas

June 28, 2018


          On Appeal from the 14th Judicial District Court Dallas County, Texas Trial Court Cause No. DC-14-02886

          Before Justices Bridges, Evans, and Whitehill.



         Appellant Dr. Eric Vanderwerff appeals the trial court's judgments granting appellee Commissioner Ryan Brannan's plea to the jurisdiction and appellee Travelers Indemnity Company of Connecticut's motion for summary judgment and plea to the jurisdiction. In three issues, appellant argues (1) a website link to a list of current network doctors accepting new patients is not "written notice" as required under the Texas Insurance Code; (2) an insurance carrier cannot avoid liability after preauthorization is provided when the Texas Workers' Compensation Act creates liability no longer subject to dispute; and (3) declaratory judgment is necessary regarding issues one and two so as to avoid multiplicity and duplicity of identical issues. We affirm the trial court's judgments.

         Procedural and Factual Background

         Appellant, a chiropractor, provided medical services to a workers' compensation claimant. Travelers was the workers' compensation carrier. Appellant was denied full reimbursement by Travelers because he was not a member of its healthcare network; however, he believed he was entitled to full payment because claimant was not properly provided the information required under insurance code section 1305.451. See Tex. Ins. Code Ann. § 1305.451 (West Supp. 2017).

         Appellant requested a medical fee dispute resolution through the Division seeking determination of whether he was entitled to reimbursement. The Texas Department of Insurance-Division of Workers' Compensation (the Division) abated the medical fee dispute. However, the Division determined Travelers did not properly provide claimant with the information required under section 1305.451 because a link to a website listing participating network providers, instead of a printed copy, was not proper written notice under the statute.

         Travelers appealed the decision to the Division Appeals Panel, which issued an opinion reversing the hearing officer and holding that claimant was provided the required statutory information. The decision stated the following:

The evidence establishes that the claimant was hired by the employer on June 11, 2010. The evidence further indicates that on the date of hire, the claimant signed a Workers' Compensation Health Care Network Employee Acknowledgement Form and received an information packet entitled Important Information for Employees Regarding Medical Treatment for a Work-Related Injury or Illness which contained all of the information required by Insurance Code Section 1305.451. The hearing officer, in the Background Information section of her decision, stated that the evidence did not establish that the information provided to the claimant contained a list of network providers as required in Insurance Code Section 1305.451(b)(12). However, the evidence shows that an electronic link to the provider list is provided to the claimant on page two of the information packet. Furthermore, 28 TEX. ADMIN. CODE § 10.60(c)(3) (Rule 10.60(c)(3)) provides that the notice of network requirements may be in an electronic format provided a paper version is available upon request. The evidence does not indicate that the claimant requested a paper version from the carrier or the employer.

         No other issues were appealed or decided by the Division Appeals Panel.

         Appellant subsequently filed an original petition in district court in which he sought a declaration that he was entitled to full payment of disputed medical benefits because providing a web link with a list of providers was not sufficient information under section 1305.451. He also sought declarations that (1) an insurance carrier is limited to grounds timely raised in its written denial of payments absent newly discovered evidence that could not reasonably be discovered earlier; (2) preauthorization of health care treatment is no longer subject to dispute; and (3) an insurance carrier must timely raise a network issue to dispute medical care not performed in a network.

         Travelers answered and filed a plea to the jurisdiction. It argued the trial court was without subject matter jurisdiction to determine any issue beyond that decided by the Division Appeals Panel; therefore, the trial court was limited to deciding only whether "the employer provided the claimant with the information required by Insurance Code Section 1305.451."

         The Division, after filing a plea in intervention, also filed a plea to the jurisdiction essentially making the same arguments as Travelers. Appellant then amended his petition, naming the Division and Commissioner of Workers' Compensation, Ryan Brannan, in his official capacity, as defendants to his claims for declaratory relief.

         The trial court determined it had jurisdiction to review the Division Appeals Panel's decision regarding notice under section 1305.451; however, it granted Travelers' plea to the jurisdiction on appellant's remaining requests for declarations and dismissed them. The trial court also granted the Division's plea to the jurisdiction, ...

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