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Botts v. Hartford Underwriters Insurance Co.3/16/2001
ct.
Botts also filed a motion for new trial. Botts did not mention either the claim file or the administrative determination of her claim as grounds for granting her motion. Without any supporting argument, Botts simply contended her case should be reinstated because the trial court had jurisdiction. The motion was overruled, and this appeal ensued.
Discussion
Hartford's plea to the jurisdiction asserted that the question of whether it had wrongfully denied Botts's request for psychotherapy should have been initially submitted to the Texas Workers' Compensation Commission, the agency charged with deciding such matters. We agree. Applying the "primary jurisdiction" doctrine, we conclude the trial court had no jurisdiction to proceed with Botts's bad faith suit until after the Commission had determined whether Botts was entitled to the benefits Hartford had denied.
The doctrine of "primary jurisdiction" is a prudential doctrine under which trial courts refrain from exercising jurisdiction until after an administrative agency has determined some question or some aspect of some question arising in the proceeding before it. Southwestern Bell Tel. Co. v. Public Util. Comm'n of Texas, 735 S.W.2d 663, 669 n.3 (Tex. App._Austin 1987, no writ). The purpose of the doctrine is to assure that administrative agencies will not be bypassed on questions that have been especially committed to them and which demand the exercise of "sound administrative discretion requiring the special knowledge, experience, and services of the administrative tribunal to determine technical and intricate matters of fact." State Bar of Texas v. McGee, 972 S.W.2d 770, 773 (Tex. App._Corpus Christi 1998, no pet.); Kavanaugh v. Underwriters Life Ins. Co., 231 S.W.2d 753, 755 (Tex. Civ. App._Waco 1950, writ ref'd). The doctrine applies when the agency has the authority to make incidental findings necessary to granting relief in a later judicial action even if the agency is powerless to grant the relief sought. McGee, 972 S.W.2d at 773. Trial courts do not have jurisdiction to adjudicate controversies involving such administrative questions until after the questions have been resolved by the appropriate administrative agency. Kavanaugh, 231 S.W.2d at 755.
In this case, Botts's claims for breach of the duty of good faith and fair dealing and violations of the Texas Insurance Code were premised on Hartford's allegedly wrongful refusal to pre-authorize psychological treatment. A determination of whether Botts was entitled to workers' compensation coverage for the psychological treatment she requested necessarily required specific findings regarding her medical condition, how that condition related to her on-the-job accident, and the reasonableness of the medical services requested. This is exactly the type of determination the legislature committed to the Texas Workers' Compensation Commission for resolution because of the Commission's expertise in these areas. See Henry v. Dillard Dept. Stores Inc., 21 S.W.3d 414, 419 (Tex. App._San Antonio 2000, no pet.) (only the TWCC is authorized to resolve factual issues related to coverage). Although Botts's suit sought tort damages based on Hartford's conduct rather than compensation benefits, the central issue was still whether Botts was entitled to the benefits she requested. The trial court, therefore, was without jurisdiction until the Commission resolved the question of coverage. See id. at 418-19.
In her brief on appeal, Botts all but concedes that the primary jurisdiction doctrine applies in this case. Botts argues, however, that she met the requirements of the doctrine as shown by the workers' compensation claim file she filed with the t
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