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Botts v. Hartford Underwriters Insurance Co.3/16/2001
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.
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 A
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