Insurer, not employer, to pay workers' comp benefits

Worker alleges negligence and failure to provide safe workplace or tools

Insurer, not employer, to pay workers' comp benefits

An employee filing a personal injury claim can seek his exclusive remedy of recovery of workers’ compensation benefits from the insurance carrier, not the employer, the Texas Court of Appeals said in a recent case.

The plaintiff in the case was working when he fell from a ladder, fractured his left heel bone, and injured his left knee and ankle. He filed a lawsuit seeking damages from the defendant, which was doing business as Lopez Carpets, based on negligence and gross negligence.

The suit alleged that the plaintiff was an “on-duty employee” of the defendant, that he suffered injuries within the business premises, and that the defendant failed to provide a safe workplace or safe tools for employees.

The defendant argued that the trial court would not have jurisdiction over the case until the completion of the plaintiff’s administrative proceeding before the Texas Division of Workers’ Compensation, which had exclusive jurisdiction to determine the plaintiff’s employment status at the time of the injury.

Read more: The difference between a specific injury and cumulative injury

The trial court decided to hold off from dealing with the case until the workers’ compensation division determined the plaintiff’s employment status.

The hearing between the plaintiff and the defendant’s workers’ compensation insurer, Texas Mutual Insurance Company, took place. An administrative law judge found that the plaintiff was an employee of the defendant.

The plaintiff filed against the defendant a petition asking for a judicial review of the administrative law judge’s decision. He again made claims of negligence and gross negligence. He alleged that he was a contracted worker rather than an employee.

The defendant argued that it was not a party to the proceedings before the workers’ compensation division and that the plaintiff should have instead filed his petition for judicial review against the insurance company.

The trial court agreed with the defendant and dismissed it from the judicial review petition.

Next, the defendant asked the trial court to summarily dismiss the plaintiff’s remaining claims against it. The defendant made the following arguments:

  • Workers’ compensation was the plaintiff’s exclusive remedy
  • The plaintiff could not sue the defendant for his injuries
  • The administrative law judge’s decision that the plaintiff was an employee bound him because he did not properly challenge this finding

Negligence claims denied

The trial court ruled in the defendant’s favor and summarily dismissed the plaintiff’s claims of negligence and gross negligence.

The plaintiff appealed. He argued that summary judgment was improper because there was a remaining factual issue about whether he was an employee or an independent contractor when the injuries occurred.

In the case of Oscar Gonzalez v. Santiago Lopez d/b/a Lopez Carpets, the Court of Appeals for the 13th District of Texas affirmed the judgment of the trial court. The trial court properly dismissed the plaintiff’s personal injury claims against the defendant, the appellate court held.

The administrative law judge’s determination that the plaintiff was an employee bound him because he failed to timely file a petition for judicial review against the proper party, the appellate court said. The plaintiff could not file his tort claims against the defendant, the appellate court added.

If an employer subscribing to workers’ compensation insurance benefits was facing a lawsuit filed by a covered employee, the employer generally had no tort-based liability for job-related injuries, given that the employee’s exclusive remedy should be against the insurance carrier, the appellate court explained.

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