The Texas Division of Workers' Compensation stepped into the case of Jane Hays last Friday, issuing an Interlocutory Order requiring Texas Political Subdivisions (TPS) to start paying her benefits, including indemnity payments and “reasonable and necessary medical care”. The extremely rare order was given after the TPS denial of her claim received national media attention.
Last week I wrote about Hays’ situation, where TPS had denied her claim after she was severely injured in a car accident while returning home from an overnight trip attending meetings held by the same company. Hays serves on the Board of Trustees for TPS, which insures local government entities in Texas. TPS took the position that it was a “gray area”, and transport to any board meeting is considered by them a standard commute. The workplace is wherever the meetings are scheduled to be held. Therefore they opted to decline the claim, saying it “had to be denied so that the Texas Division of Workers Compensation and possibly the state courts can rule on whether TPS should pay the claim”. The notice of denial was issued the same day doctors cut off her right leg below the knee.
Texas DWC ordered the company to start paying after a pre-trial benefit review conference last Friday. This is a rare event in the state, as normally the parties would have to go through a contested case hearing, which will not likely occur until November. Hays attorney, Brad McClellan credits the quick response to the publicity her case has generated.
Oh, and he also thinks, along with most of the rational world, that the “lack of any legal basis to dispute the claim” might have had something to do with it.
So, on the surface it seems TPS has their answer; Texas DWC has indeed initially ruled on whether or not they should pay the claim. One would think that would be the end of it, but alas, that is not to be. Executive Director Randal Beach has indicated they still plan to take the case to the contested case hearing. He now says the issue is making sure the excess carrier is on board. He told the Texas Tribune, “From day one we've stood ready to pay this claim if it's determined that there's coverage”, but their excess carrier, which steps in to cover high dollar losses, “can deny coverage to us if they think we had a legal defense to the claim and didn't exercise it.”
So TPS has their answer from DWC, but it is apparently not the answer they were looking for; or it just came far too early in the process for their preference and comfort level. I certainly wonder what discussions they have had with their excess carrier regarding this claim. Perhaps that carrier would like to publicly weigh in now, and share all of the rousing publicity this case has generated for the industry. I cannot for the life of me see why they wouldn’t want a piece of that action
So, at least Ms. Hays has, for the short term, some level of comfort that her medical costs and payment benefits will be forthcoming. I applaud the Texas Division of Workers' Compensation for seeing what only a select few apparently could not, and for acting quickly and decisively in restoring those benefits. Kudos to them for showing that the system can indeed respond quickly in grievous situations
We will continue to hope that Ms. Hays prevails in her fight against the company for whom she volunteered her time and ultimately sacrificed so much. A company that for purposes of the board meetings provided her workers’ comp, paid her mileage, hotel and other travel related expenses, and then wrote the accident off, calling it a standard commute. It seems they would call it just another day at (or on the way from) the office. I would call it a mistake; a blunder, and the early intervention of Texas DWC lends credence to my view. I think the denial was a gargantuan error of epic proportions.
I’ll be damned. It turns out everything really is bigger in Texas.