Injured man's comp benefits turn on definition of 'offensive' legal standard

A Texas man who suffered a traumatic brain injury at work could be eligible for lifetime workers compensation benefits if his condition fits an expanded standard of “imbecility” used in Texas workers comp law, a state appellate court ruled.

Francisco Chamul was working as a brick mason for Houston-based Camarata Masonry Systems Ltd. in November 2008 when he fell from a scaffold onto a concrete slab more than 10 feet below, court records show. He suffered severe injuries, including multiple skull fractures, spinal cord injuries and fractured ribs, and he remained in a coma for 36 days after the accident.

Mr. Chamul was transferred in January 2009 to a neurological rehabilitation center, according to records. His treating physician at the facility determined that Mr. Chamul's brain injuries had affected his memory, thinking, organization ability and balance, and that he would be unable to manage his own medications or live independently. The doctor also found that Mr. Chamul was “permanently mentally incapacitated.”

Another doctor who examined Mr. Chamul two years later found that Mr. Chamul functions at the level of an 11- or 12-year-old, would need care for the rest of his life and that his condition likely would not improve, court filings show.

Amerisure Mutual Insurance Co., the workers comp insurer for Camarata Masonry, later retained a neuropsychiatrist to examine Mr. Chamul, filings show. That specialist found that while Mr. Chamul suffered a significant traumatic brain injury, he “did not sustain any type of irreversible brain injury which would rise to the level of rendering him permanently unemployable.”

The doctor also diagnosed Mr. Chamul with “malingering,” and opined that Mr. Chamul should receive treatment to help him “reintegrate into the workforce,” according to records.

Texas workers comp law allows lifetime workers comp benefits to be paid for “a physically traumatic injury to the brain resulting in incurable insanity or imbecility,” records show. The term “imbecility” is not defined in Texas law, but prior Texas case law has defined the term as having a mental age of 3 to 7 years.

A Texas workers comp hearing officer found that Mr. Chamul was not entitled to lifetime workers comp benefits because a doctor had previously found Mr. Chamul to have a mental age of 11 or 12 years.

Attorneys for Mr. Chamul appealed, arguing that imbecility should mean “an irreversible brain injury, which renders the employee permanently unemployable and so affects the non-vocational quality of his life by eliminating his ability to engage in a range of usual cognitive processes,” according to court filings.

However, a Harris County, Texas, court issued summary judgment in favor of Farmington Hills, Michigan-based Amerisure in 2012 after applying the 3- to 7-year mental age standard.

A three-judge panel of the Texas 1st District Court of Appeal unanimously reversed the summary judgment on Tuesday, finding that the lower court applied a too-strict definition of imbecility in Mr. Chamul's case.

The appellate court noted that the imbecility standard was incorporated into Texas law in 1917 and that it was based on the “now-repudiated eugenics movement” of the late-19th to mid-20th century. The court's opinion also acknowledged that the term is “now outdated and considered offensive.”

Previous case law used the 1991 edition of Webster's Ninth New Collegiate Dictionary to define “imbecile” as “a mentally deficient person, especially a feebleminded person having a mental age of three to seven years,” the court said. However, the court said that such a definition would include people outside of the noted mental age range.

“The definition does not limit the term to only those with a mental age of three to seven; it says, instead, especially those of that category, suggesting that others also would fit within the description,” the ruling reads.

The lower court erred by using a narrow definition of “imbecility” to define Mr. Chamul's mental condition, the appellate court said.

“First, the 1991 dictionary from which the narrow definition was obtained was not an appropriate source to discern the meaning of a term incorporated into a statute more than 70 years earlier,” the ruling reads. “Second, the mandate that the workers' compensation statute be liberally construed to confer benefits upon injured workers suggests that ... the Labor Code should not be read to require proof of a mid-range mental age — a result achieved only through the most narrow reading of the statute and the definition possible. Third, applying the 1991 dictionary definition would lead to absurd results and, therefore, must be rejected.”

Mr. Chamul's case was remanded to the Harris County court to determine whether his condition meets a broader definition of imbecility.