Court of Appeals of Texas, Dallas.

Michael JONES and General Accident Insurance Company, Appellants

v.

Sindee ROSENAUER, Appellee

No. 05-95-01192-CV.

|

Feb. 9, 1996.

Before Justices MALONEY, MORRIS and HANKINSON

OPINION

MALONEY, Justice.

*1 Appellants Michael Jones and General Accident Insurance Company (collectively, the Insurer) appeal a temporary injunction granted in favor of Sindee Rosenauer. In seven points of error, the Insurer alleges the trial court abused its discretion in issuing the temporary injunction. Because the trial court had no jurisdiction over Rosenauer’s claim for medical benefits, we order the temporary injunction dissolved.

BACKGROUND

In 1988, Rosenauer suffered an on-the-job injury. The workers’ compensation carrier for her employer, General Accident, began paying Rosenauer medical and indemnity benefits.¹

In November 1991, the Insurer filed a Notice of Controversion of Right to Medical Benefits with the Industrial Accident Board² (IAB) challenging Rosenauer’s Dilaudid prescription as medically unnecessary. The Insurer stopped paying for Rosenauer’s Dilaudid prescriptions on May 24, 1994.

In November 1994, the Insurer filed a second Notice of Controversion with the IAB challenging Rosenauer’s Dilaudid prescription as medically unnecessary. The IAB held a prehearing conference in November 1994, but issued no administrative ruling. In February 1995, the Insurer filed a third Notice of Controversion with the IAB challenging Rosenauer’s Dilaudid prescription as medically unnecessary. At the time of submission to this Court, the IAB had not issued any administrative ruling.³

Rosenauer sued the Insurer, alleging: (1) violation of section 21.21 of the insurance code; (2) violations of the duty of good faith and fair dealing; (3) breach of contract; and (4) intentional infliction of emotional distress. The trial court temporarily enjoined the Insurer from:

1. refusing authorization and/or payment for [Rosenauer’s] prescription medication including, but not limited to, Dilaudid;

2. prohibiting [Rosenauer] from seeking medical treatment from her treating physicians; and

3. failing to pay [Rosenauer] her weekly benefits as they become due.⁴

THE TRIAL COURT’S JURISDICTION

In its first point of error, the Insurer argues that the trial court had no jurisdiction to issue a temporary injunction because Rosenauer did not exhaust her administrative remedies. Rosenauer responds that because she alleged other causes of action over which the trial court had jurisdiction, the trial court had jurisdiction to enter the temporary injunction.

1. Applicable Law

Workers’ Compensation Act

Article 8306, section 7a provided that, after holding a hearing, the IAB could order a change in medicines if reasonable grounds existed for believing that the present medication endangered or impaired a claimant’s life, health, or recovery.⁵ Article 8306, section 18a(b) provided that if the insurer suspended payment of medical benefits, the insurer must file with the IAB, within ten days of payment suspension, a statement which fully sets out the reasons why it had suspended the benefits.⁶

Trial courts have no original jurisdiction over claims and disputes arising out of on-the-job injuries. See Employers’ Indem. Corp. v. Woods, 243 S.W. 1085, 1087 (Tex. Comm’n App.1922); Starnes v. Texas Employers’ Ins. Ass’n, 549 S.W.2d 46, 47 (Tex.Civ.App.-Dallas 1977, writ ref’d n.r.e.). Before seeking relief in the district court, a party must exhaust its administrative remedies. See Johnson v. American Gen. Ins. Co., 464 S.W.2d 83, 84 (Tex.1971). A district court’s jurisdiction over workers’ compensation suits is appellate in nature, although the trial is de novo. Paradissis v. Royal Indem. Co., 507 S.W.2d 526, 529 (Tex.1974) (quoting Industrial Accident Bd. v. Glenn, 144 Tex. 378, 190 S.W.2d 805, 807 (1945)). A party’s failure to obtain an administrative ruling under the workers’ compensation statute prevents a party from invoking the district court’s jurisdiction. See Paradissis, 507 S.W.2d at 529; Pacific Indemn. Ins. Co. v. Liberty Mut. Ins. Co., 834 S.W.2d 91, 93 (Tex.App.-Austin 1992, no writ).

*2 When the workers’ compensation statute directs that action be taken in a certain way, it may be performed in no other manner. See Truck Ins. Exch. v. Seelbach, 161 Tex. 250, 339 S.W.2d 521, 523 (1960). The successive steps in the progress and maturity of a claim are mandatory. A party, who does not comply with the statute’s provisions, cannot invoke the district court’s jurisdiction. See Sanchez v. Aetna Casualty & Sur. Co., 543 S.W.2d 888, 889 (Tex.Civ.App.-San Antonio 1976, writ ref’d n.r.e.); Castillo v. Allied Ins. Co., 537 S.W.2d 486, 487 (Tex.Civ.App.-Amarillo 1976, writ ref’d n.r.e.).

2. Application of Law to Facts

Here, the Insurer’s controversion of Rosenauer’s Dilaudid prescription related to medical services governed exclusively by the Act. The Insurer followed the statutory procedures when it challenged the necessity of Rosenauer’s medication and the Insurer’s continuing obligation to pay those benefits. The IAB held a prehearing conference, but never ruled, on the Insurer’s challenge.

While we can understand Rosenauer’s frustration, the statutes required an IAB ruling before the trial court had any jurisdiction to review the Insurer’s handling of compensation for an on-the-job injury. Because the trial court had no jurisdiction over the medical necessity controversy, it had no authority to enjoin the Insurer from not paying Rosenauer’s benefits. We sustain the Insurer’s first point of error.

Because of our disposition of appellant’s first point of error, we need not consider points of error two through six. Tex.R.App. P. 90(a).

We reverse the trial court’s order granting the temporary injunction and dissolve the temporary injunction.

	Footnotes
1		Michael Jones is General Accident’s employee who administers Rosenauer worker’s compensation claim.
2		The IAB is now the Workers’ Compensation Commission. See Act of December 12, 1989, 71st Leg., 2nd C.S., ch. 1, Sec. 17.01, 1989 Tex. Gen. Laws 1, 115, repealed by Act of May 12, 1993, 73rd Leg. R.S., ch. 269, Sec. 5(2), 1993 Tex.Gen.Laws 987, 1273; 28 Tex. Admin. Code § 41.1 (West 1993) (Texas Workers’ Compensation Commission, Name Change).
3		At oral argument, both sides conceded that the IAB had still not issued any award, order, or determination on the medical necessity of Rosenauer’s Dilaudid prescriptions.
4		Rosenauer included these claims in her complaints under section 21.21 of the insurance code.
5		Act of May 10, 1973, 63rd Leg., R.S., ch. 88, Sec. 3, 1973 Tex. Gen. Laws 187, 188, (Tex.Rev.Civ.Stat.Ann. art. 8306, Sec.7a), repealed by Act of December 12, 1989, 71st Leg., 2nd C.S., ch. 1, Sec. 16.01(7), 1989 Tex. Gen. Laws 1, 114. Unless otherwise noted, all statutory references are to the version of the Workers’ Compensation Act in effect at the time of Rosenauer’s injury, 1988. Harris v. Varo, Inc, 814 S.W.2d 520, 523 (Tex.App.-Dallas 1991, no writ).
6		Act of May 29, 1983, 68th Leg., R.S., ch. 989, Sec. 1, 1983 Tex. Gen. Laws 5379, 5379-82, (Tex.Rev.Civ.Stat.Ann. art. 8306, Sec.18a), repealed by Act of December 12, 1989, 71st Leg., 2nd C.S., ch. 1, Sec. 16.01(7), 1989 Tex. Gen. Laws 1, 114.