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A Texas appellate court has ruled that exclusive remedy provisions under the state's workers compensation law do not apply to health care providers who billed an employer for the care of an injured worker.
The decision was based on the case of Daniel Contreras, who worked for Maintenance Supply Headquarters L.P., court records show. When he injured his hand at work in 2009, a manager took him to the Hand & Wrist Center of Houston, which worked with the Houston Hospital for Specialized Surgery to treat Mr. Contreras.
The manager signed a letter of guarantee with the Hand & Wrist Center and Houston Hospital that Maintenance Supply would pay for medical care provided to Mr. Contreras if his treatment were not paid for by workers comp, records show. The centers billed $22,750 for Mr. Contreras' treatment.
Maintenance Supply's workers comp insurer, Hartford Financial Services Group Inc., denied Mr. Contreras' claim for workers comp because he had a positive drug test at the time of his injury, records show. The Texas Department of Insurance Division of Workers' Compensation also ruled that Mr. Contreras' positive drug screen made his injury noncompensable.
Maintenance Supply did not pay for Mr. Contreras' medical bills, and the facilities that treated Mr. Contreras sued Maintenance Supply for breach of contract based on the letter of guarantee, records show. A district court in Harris County, Texas, ruled in Maintenance Supply's favor after finding that workers comp was the exclusive remedy for Mr. Contreras' case.
A three-judge panel of the Texas 1st District Court of Appeals unanimously reversed that decision Tuesday. In its ruling, the court found that workers comp exclusive remedy provisions only prevent injured workers from pursuing tort cases against their employers, but do not prevent health care providers from suing outside of the comp system.
We “conclude that the 'exclusive remedies' provision of (Texas workers comp law) does not apply to health care providers, and therefore appellants are not barred from bringing suit against Maintenance Supply to recover payment for the medical services rendered in this case,” the ruling reads.
The case was remanded for further proceedings.