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Merrill v. Travis County

Court of Appeals of Texas, Fourteenth District

October 31, 2019


          On Appeal from the 353rd District Court Travis County, Texas Trial Court Cause No. D-1-GN-17-006402

          Panel consists of Justices Christopher, Spain, and Poissant.


          Tracy Christopher Justice

         This appeal from the dismissal of a suit on jurisdictional grounds arises from a dispute over eligibility to receive death benefits under the Texas Workers' Compensation Act ("the Act").[1] After the death of Travis County flight nurse Kristin McLain in a fall from a helicopter during a medivac rescue, appellant Ralph Winston Merrill III claimed a right to death benefits as McLain's common-law husband. As the self-insured carrier, the County denied there was a valid marriage and maintained that only McLain's parents were eligible for death benefits. Merrill prevailed at the administrative level, and while the County appealed the ruling to the 419th District Court in Travis County, Merrill filed his own suit for judicial review in the 353rd District Court.[2] The County challenged the latter court's jurisdiction on the ground, among others, that Merrill lacks standing, because as the prevailing party, he is not aggrieved by the administrative decision. The trial court presumably agreed, as do we. Thus, we affirm the judgment.

         I. Governing Law

         To provide context for the factual background of the case, we begin with the governing law. To place the dispute and its history in context, the identity of McLain's beneficiary likely will significantly affect the length of time that the County must pay death benefits, and thus, the total amount it must pay. McLain died while performing her job as a first responder, and if Merrill is her surviving spouse, then he is entitled to death benefits for the remainder of his life.[3] If, as the County contends, McLain and Merrill were not validly married, then McLain's parents are her beneficiaries, and the County is required to pay them death benefits for no more than 104 weeks.

         To resolve disputes about a person's eligibility for death benefits, a case passes through three administrative stages in the Workers' Compensation Division[4]-a benefit-review conference, a contested-case hearing, and an appeal to a Division appeals panel-before the case is subject to judicial review.

         First, the parties attend a benefit-review conference to discuss the claim's facts, review available information, delineate disputed issues, and if possible, resolve those disputed issues by agreement. See Tex. Lab. Code Ann. § 410.021. After the conference, the benefit-review officer prepares a written report detailing each issue that was raised but not resolved, "including any issue raised for the first time at the conclusion of [a second] benefit review conference," if one was held. See id. § 410.026(a)(4). The benefit-review officer also identifies each issue that was resolved and states each party's position on every unresolved issue. See id. § 410.031. The Division then schedules a contested-case hearing on those unresolved issues. See id. § 410.025.

         In the second stage, the parties attend the contested-case hearing before an administrative law judge ("the ALJ").[5] The ALJ generally may consider only those issues that were raised, but not resolved, at the benefit-review conference. See id. § 410.051. The ALJ may consider an issue that was not raised at the benefit-review conference only if the parties consent or "good cause existed for not raising the issue at the conference." Id. § 410.151(b); see also 28 Tex. Admin. Code § 142.7(d), (e). Unless one of these exceptions applies, "the 'issues' that the review officer identifies remain the same through hearing, appeal, and judicial review." State Office of Risk Mgmt. v. Martinez, 539 S.W.3d 266, 274 (Tex. 2017). The ALJ's decision regarding benefits is final in the absence of a party's timely request for appeal. Tex. Lab. Code Ann. § 410.169.

         The third stage begins with a party's request for appeal to a Division appeals panel, to which the opposing party must file a response. See id. § 410.202. The request and response "must clearly and concisely rebut or support the decision of the ALJ on each issue on which review is sought." Id. To decide the issues for which the appeal was requested, the appeals panel reviews the request, the response, and the record developed at the contested-case hearing. Id. § 410.203. When affirming an ALJ's decision, the panel does not issue its own written decision except in cases (a) of first impression, (b) involving a recent change in the law, or (c) involving errors at the contested-case hearing requiring correction but that do not affect the hearing's outcome. Id. § 410.204(a-1). If the appeals panel does not issue its own decision, then the ALJ's decision is the appeals panel's decision. Id. § 410.204(c). The panel's decision is final absent a timely a timely suit for judicial review. Id. § 410.205(a).

         Judicial review is available only as to certain matters and parties. Review "is limited to issues decided by the appeals panel and on which judicial review is sought." Id. § 410.302(b); see also id. § 410.301(a). Only a party who has exhausted administrative remedies under the Act and "is aggrieved by a final decision of the appeals panel" may seek judicial review. Id. § 410.251.

         II. Factual Background

         Both Merrill and McLain's parents initially claimed to be the proper beneficiaries of McLain's death benefits, but McLain's parents later withdrew their claim. In its capacity as carrier, the County disputed that Merrill was McLain's beneficiary because it denied he was her common-law husband. The parties reached no agreement on the issue at the benefit-review conference, and the benefit-review officer reported a single unresolved issue-"Identity of Legal Beneficiaries"-to be decided at a contested-case hearing.

         Before the contested-case hearing, Merrill filed a "Response to BRC Report and Request to Add Issues," in which he asserted that "[four] issues were omitted from the BRC report and should be added." See 28 Tex. Admin. Code § 142.7(e) ("A party may request the administrative law judge to include in the statement of disputes one or more disputes not identified as unresolved in the benefit review officer's report. The administrative law judge will allow such amendment only on a determination of good cause."). Merrill identified these matters as follows:

1. Does Travis County have standing to dispute [Merrill's] entitlement to death benefits?
2. Has Travis County waived its right (if any) to dispute [Merrill's] entitlement to death benefits?
3. Does 409.011(b)(4)[6] or any law or rule allow Travis County to dispute [Merrill's] entitlement to death benefits?
4. Is Travis County barred by the doctrines of collateral estoppel and/or res judicata from disputing [Merrill's] entitlement to death benefits?

         The ALJ responded, "This request to add issues is denied for lack of ...

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