This case arises under the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on June 29, 1994, in (City), Texas, with (hearing officer) presiding, to determine whether the appellant (claimant) is entitled to reimbursement for medical treatment rendered before __________, the date of injury for her repetitive motion injury. The hearing officer found that claimant’s date of injury was __________, that she paid $724.28 for medical treatment before __________, and that Section 408.021(b) of the 1989 Act provides that medical benefits are payable from the date of the compensable injury. Accordingly, the hearing officer concluded that claimant is not entitled to reimbursement for medical treatment rendered before __________, for her repetitive motion injury and ordered that the respondent (self-insured) was not liable to reimburse her for such treatment. Claimant has appealed the decision. Her contention remains that the __________, date of injury for her occupational disease was merely the date her doctor determined that her medical condition was caused by her job, a determination which then enabled her to have a verifiable workers’ compensation claim and which started her times for reporting the injury and filing a claim. However, she had actually been treated for the condition since October 1991 and had herself paid $724.28 representing deductible amounts and co-payments not paid by her group health insurance carrier. The self-insured urged the correctness of the hearing officer’s application to the facts of Section 408.021(b) providing that medical benefits are payable “from the date of the compensable injury.”
DECISION
Reversed and a new decision rendered for claimant.
Claimant, the sole witness, testified that she had been a computer programmer for the self-insured, a job which involved the repetitive movements of typing at a computer keyboard and using a “mouse.” Her claim form indicated she commenced this employment on April 16, 1990. She began to see Dr. H, a neurologist, in October 1991 with complaints of pain and numbness in her arms and shoulders, tight muscles, and difficulty in grasping. She said she was diagnosed with cumulative stress syndrome and was treated for about five months. Dr. H’s December 1, 1991, report stated his impression as intermittent muscle spasm in the shoulder and intermittent trigger point pain. He recommended massage therapy. Claimant stated that upon returning from a vacation, her symptoms flared up and she visited Dr. H on __________. She said he then advised her that her condition must be work related; that it had been all along but that the relationship is now obvious given the return of symptoms following her vacation; and that she needed to file for a work-related injury. Dr. H’s __________, report stated the following: “I feel that this is definitely now a work-related injury. I think that this has been all along but it is now obvious that this is indeed secondary to her repetitive motion of her typing.”
Claimant also stated that she has reached maximum medical improvement with an impairment rating of zero percent and now works for the self-insured in a different section. She said she filed her claim in __________ and that prior thereto she herself had paid $724.28 for deductible and co-payment amounts not paid by her group health insurance carrier. The carrier did not contest the amount claimed but rather her entitlement thereto. Claimant’s position was that notwithstanding the provisions of Sections 408.007 and 408.021(b), set forth below, she obviously had sustained and required treatment for her occupational disease before __________, a date she regarded as simply giving her a verifiable claim and starting the periods for providing timely notice of her occupational disease and for filing a timely claim. There were no disputed issues concerning these latter matters. Claimant said she regarded it as unfair that she should be required to pay for any portion of her medical treatment for the occupational disease her doctor eventually connected up to her employment. The self-insured argued that Section 408.021(b) makes clear that medical benefits are payable from the date of injury and not earlier, that a workers’ compensation carrier would have had no ability to question the reasonableness or necessity of past treatments, and that to credit claimant’s notion would risk the possibility that a workers’ compensation carrier (but not the self-insured in this case) could be required to pay for prior medical benefits for which another carrier should be liable.
The issue on appeal in this case involves a matter of statutory interpretation and the reconciliation of seemingly conflicting provisions of the 1989 Act. Section 408.007 provides that “[f]or purposes of this subtitle [Texas Labor Code, Title 5, Subtitle A], the date of injury for an occupational disease is the date on which the employee knew or should have known that the disease may be related to the employment.”
Sections 408.021(a) and (b) provide as follows:
(a)An employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed. The employee is specifically entitled to health care that:
(1)cures or relieves the effects naturally resulting from the compensable injury;
(2)promotes recovery; or
(3)enhances the ability of the employee to return to or retain employment.
(b)Medical benefits are payable from the date of the compensable injury. [Emphasis supplied.]
The term “medical benefit” is defined in Section 401.011(31), in part, as follows:
`Medical benefit’ means payment for health care reasonably required by the nature of the compensable injury and intended to:
(a)cure or relieve the effects naturally resulting from the compensable injury, including reasonable expenses incurred by the employee for necessary treatment to cure and relieve the employee from the effects of an occupational disease before and after the employee knew or should have known the nature of the disability and its relationship to the employment;. . . [Emphasis supplied.]
We are aided in this decision by the application of certain principles of statutory construction. See generally TEX. GOV’T CODE ANN. § 311.001 et seq. (Code Construction Act). Section 311.021 of the Code Construction Act provides, in part, that it is presumed that the entire statute is to be effective, that a just and reasonable result is intended, and that a result feasible of execution is intended, and Section 312.002 provides that words in a statute are to be given their ordinary meaning. We read Section 408.021(b) not as a limitation on the provision of medical benefits as defined in Section 401.011(31), but rather as a proscription on the time such benefits are payable. Section 401.011(31) quite clearly includes treatment for the effects of an occupational disease both before and after the date of injury for such occupational disease. We regard this provision as indicating a legislative intent not to limit the provision of medical benefits for an occupational disease to the vagaries associated with the eventual establishment of the date of injury as provided for by Section 408.007. The date of injury for an occupational disease–the marker for the time periods in which notice of injury must be provided and a claim filed–is commonly a date later in time than the date treatment for the condition is commenced. It does not appear inconsistent with the various other provisions for benefits in the 1989 Act that the legislature intended that employees who sustain occupational disease injuries obtain medical benefits which bear some relationship to the commencement of treatment for such disease, albeit that the payment for such medical benefits is not provided for prior to the date established to be the date of the occupational disease injury. Our interpretation of the above provisions of the 1989 Act, a matter of law, necessitates the reversal of the hearing officer’s decision and the rendition of a new decision.
The decision and order of the hearing officer are reversed and a new decision is rendered that the self-insured is liable to claimant for reimbursement for medical expenses in the amount of $724.28.
Philip F. O’Neill – Appeals Judge
CONCUR:
Stark O. Sanders, Jr. – Chief Appeals Judge
Tommy W. Lueders – Appeals Judge