Court of Appeals of Texas, Dallas.

Deirdre BOTTS, Appellant,

v.

HARTFORD UNDERWRITERS INSURANCE COMPANY, Appellee.

No. 05-00-00613-CV.

|

March 16, 2001.

Before MORRIS, MOSELEY, and FITZGERALD, JJ.

OPINION

MORRIS.

*1 In this workers’ compensation insurance case, Deirdre Botts appeals the trial court’s dismissal of her suit for want of jurisdiction. In a single point of error, Botts contends the trial court erred in dismissing her case because administrative review of her compensation claim was not a prerequisite to her filing suit for breach of the duty of good faith and fair dealing and violations of the Texas Insurance Code. In the alternative, she argues that if such an administrative determination was necessary, she complied by obtaining one. We conclude it was necessary for Botts to obtain an administrative determination of her compensation claim before filing suit and that she failed to provide evidence in a timely manner that she had done so. We affirm the trial court’s dismissal.

Factual Background

The relevant facts are undisputed. On April 24, 1997, Deirdre Botts was injured at work when she fell from her office chair. Hartford Underwriters Insurance Company was the workers’ compensation insurance carrier for Botts’s employer. Hartford accepted Botts’s injury claim and began paying workers’ compensation benefits.

Approximately ten months after the accident, a request was submitted to Hartford for pre-authorization of psychotherapy sessions to treat problems Botts allegedly suffered due to her fall and resulting injuries. Hartford denied the request. Botts later took an overdose of prescription medication, which she claimed was a suicide attempt. Botts then submitted a second request for preauthorization of psychotherapy sessions.

Before Hartford responded to the second request for psychotherapy, Botts filed this suit against Hartford seeking extra-contractual damages for breach of the duty of good faith and fair dealing and violations of the Texas Insurance Code. Botts alleged she suffered severe emotional distress caused by Hartford’s unreasonable delay, denial and refusal to authorize psychological treatment and other health care services. Botts further alleged this emotional distress led to her attempted suicide. Three weeks after Botts filed suit, Hartford denied her second request for preauthorization of psychotherapy.

Hartford filed a plea to the trial court’s jurisdiction contending that under either the doctrine of primary jurisdiction or the doctrine of exhaustion of remedies, the trial court should dismiss Botts’s suit for want of jurisdiction. Hartford argued that Botts was required to submit the issue of whether Hartford had wrongfully denied her claim for psychological treatment to the Workers’ Compensation Commission before filing suit in district court. Because Botts failed to pursue her administrative remedies before filing suit, Hartford contended the case should be dismissed.

In her response to the plea, Botts argued that her bad faith suit was not governed by the Workers’ Compensation Act and, therefore, it was unnecessary for her to obtain an administrative decision on her compensation claim before filing suit. Because she was seeking tort damages rather than compensation benefits, Botts contended the Workers’ Compensation Commission had no power to grant her any of the relief she sought. The trial court granted Hartford’s plea to the jurisdiction.

*2 One week after the trial court signed its order dismissing the case, Botts filed a verified copy of her workers’ compensation claim file. The file shows that Botts obtained a ruling from the Worker’s Compensation Commission on Hartford’s second denial for preauthorization. The Commission found that the medical necessity for psychotherapy treatments had been substantiated and the requested treatment was reasonably required under the Workers’ Compensation Act.

Botts also filed a motion for new trial. Botts did not mention either the claim file or the administrative determination of her claim as grounds for granting her motion. Without any supporting argument, Botts simply contended her case should be reinstated because the trial court had jurisdiction. The motion was overruled, and this appeal ensued.

Discussion

Hartford’s plea to the jurisdiction asserted that the question of whether it had wrongfully denied Botts’s request for psychotherapy should have been initially submitted to the Texas Workers’ Compensation Commission, the agency charged with deciding such matters. We agree. Applying the “primary jurisdiction” doctrine, we conclude the trial court had no jurisdiction to proceed with Botts’s bad faith suit until after the Commission had determined whether Botts was entitled to the benefits Hartford had denied.

The doctrine of “primary jurisdiction” is a prudential doctrine under which trial courts refrain from exercising jurisdiction until after an administrative agency has determined some question or some aspect of some question arising in the proceeding before it. Southwestern Bell Tel. Co. v. Public Util. Comm’n of Texas, 735 S.W.2d 663, 669 n. 3 (Tex.App.-Austin 1987, no writ). The purpose of the doctrine is to assure that administrative agencies will not be bypassed on questions that have been especially committed to them and which demand the exercise of “sound administrative discretion requiring the special knowledge, experience, and services of the administrative tribunal to determine technical and intricate matters of fact.” State Bar of Texas v. McGee, 972 S.W.2d 770, 773 (Tex.App.-Corpus Christi 1998, no pet.); Kavanaugh v. Underwriters Life Ins. Co., 231 S.W.2d 753, 755 (Tex.Civ.App.-Waco 1950, writ ref’d). The doctrine applies when the agency has the authority to make incidental findings necessary to granting relief in a later judicial action even if the agency is powerless to grant the relief sought. McGee, 972 S.W.2d at 773. Trial courts do not have jurisdiction to adjudicate controversies involving such administrative questions until after the questions have been resolved by the appropriate administrative agency. Kavanaugh, 231 S.W.2d at 755.

In this case, Botts’s claims for breach of the duty of good faith and fair dealing and violations of the Texas Insurance Code were premised on Hartford’s allegedly wrongful refusal to pre-authorize psychological treatment. A determination of whether Botts was entitled to workers’ compensation coverage for the psychological treatment she requested necessarily required specific findings regarding her medical condition, how that condition related to her on-the-job accident, and the reasonableness of the medical services requested. This is exactly the type of determination the legislature committed to the Texas Workers’ Compensation Commission for resolution because of the Commission’s expertise in these areas. See Henry v. Dillard Dept. Stores Inc., 21 S.W.3d 414, 419 (Tex .App.-San Antonio 2000, no pet.) (only the TWCC is authorized to resolve factual issues related to coverage). Although Botts’s suit sought tort damages based on Hartford’s conduct rather than compensation benefits, the central issue was still whether Botts was entitled to the benefits she requested. The trial court, therefore, was without jurisdiction until the Commission resolved the question of coverage. See id. at 418-19.¹

*3 In her brief on appeal, Botts all but concedes that the primary jurisdiction doctrine applies in this case. Botts argues, however, that she met the requirements of the doctrine as shown by the workers’ compensation claim file she filed with the trial court. What Botts fails to recognize is that the claim file is not relevant to our review of the trial court’s decision because it was not filed until well after the trial court signed its order of dismissal. Furthermore, Botts did not raise her pursuit of an administrative decision as a ground to deny the plea in either her response or her motion for new trial.

As an alternative to dismissal, Botts argues the trial court should have abated the case pending administrative review of her claims. Whether to abate a pending case is a discretionary decision resting with the trial court. Here, there was no evidence before the trial court at the time it made its decision that any administrative review had been pursued or would ever be pursued. On the contrary, Botts’s sole argument to the trial court was that such a review was unnecessary. Under those circumstances, we cannot conclude the trial court erred in dismissing Botts’s suit.

We affirm the trial court’s order of dismissal.

	Footnotes
1		We note that Henry was decided based on the exhaustion of remedies doctrine. The exhaustion of remedies doctrine is sometimes confused with the doctrine of primary jurisdiction. See Kavanaugh, 231 S.W.2d at 755-56. The primary jurisdiction doctrine applies in cases that fall within the original jurisdiction of the district court. Southwestern Bell, 735 S.W.2d at 669 n. 3. In contrast, the exhaustion of remedies doctrine applies in cases that fall within the appellate jurisdiction that some courts are given by statute to review the actions of administrative agencies. Id. Because the trial court’s jurisdiction over Botts’s bad faith suit would have been original, rather than appellate, the applicable doctrine is that of primary jurisdiction.