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Texas Court of Appeals Rules That Third Party Hospital Can Sue Employer to Pay For Employee’s Medical Care

Recently, the Texas Court of Appeals overturned a trial court’s judgment against the medical center that provided care to an injured worker in Hand and Wrist Center of Houston v. Maintenance Supply Headquarters.

Daniel Contreras was an employee for Maintenance Supply when he injured his hand in June 2009. The assistant operations manager took him to one clinic for treatment before being directed to the Hand and Wrist Center. The assistant operations manager then signed a letter of guarantee, which stated that the employer agreed to pay the Center the “usual and customary fees” for medical care rendered to Contraras, and that payment would be made regardless of whether the injury occurred at work, or if the patient tested positive for drugs or alcohol at the time of injury.

Contraras had wrist surgery and the Hand and Wrist Center billed the employer $3,612.62 and $19,138.30 for his care. Soon after, Contraras received notice from his employer’s workers compensation insurance carrier that his claim had been denied due to the discovery that he had tested positive for drugs at the time of injury. The denial was later upheld by the Texas Department of Insurance Division of Workers Compensation.

After the employer’s refusal to pay for Contraras’s care, the Hand and Wrist Center sued for breach of contract based on the letter of guarantee. Maintenance Supply countered that the Center could not sue because the company had workers compensation insurance at the time of injury and that recovery of workers compensation benefits is the exclusive remedy available. After the trial court granted Maintenance Supply’s Motion for Final Summary Judgment, the Hand and Wrist Center appealed.

While injured workers are generally estopped from filing a lawsuit against their employers when they are injured on the job and the employer has workers compensation insurance, the Texas Court of Appeals found that the circumstances here were different. The Court noted that Texas Labor Code section 408.001 applied to employees or a legal beneficiary against the employer. Further analysis of the language found that the definition of employee was “each person in the service of another under a contract of hire, whether express or implied, or oral or written.” Therefore, the plain language of the statute stated that the “exclusive remedy” provision applied only to the employees themselves, not to health care providers. The Court of Appeals determined that the Hand and Wrist Center did not first need to exhaust administrative remedies, the way an employee would, before bringing a lawsuit against Maintenance Supply.

The ruling is good news for any employee who is injured on the job and must undergo extensive treatment. Even if the employee’s claim is denied, as long as the employer guaranteed that it would pay the medical facility’s bills, hopefully no employee will be stuck having to pay for extensive treatment.
Those who have been injured in a workplace accident could be entitled to workers compensation, as well as compensation from any third party responsible. The experienced San Antonio personal injury attorneys at Carabin Shaw may be able to help. Call our office today for more information at 1-800-862-1260.

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