Court of Appeals of Texas, Fifth District, Dallas
DR. ERIC VANDERWERFF, D.C., Appellant
THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT AND TEXAS DEPARTMENT OF INSURANCE-DIVISION OF WORKERS' COMPENSATION AND COMMISSIONER RYAN BRANNAN, IN HIS OFFICIAL CAPACITY, Appellees
Appeal from the 14th Judicial District Court Dallas County,
Texas Trial Court Cause No. DC-14-02886
Justices Bridges, Evans, and Whitehill.
L. BRIDGES JUSTICE.
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.
and Factual Background
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).
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.
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.
other issues were appealed or decided by the Division Appeals
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.
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
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.
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, ...