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Texas Workers' Compensation Insurance Fund v. Simon8/26/1998
From the 79th Judicial District Court, Jim Wells County, Texas
Trial Court No. 95-12-34249
Honorable Terry Canales, Judge Presiding
Opinion on Appellant`s Motion for Rehearing
AFFIRM IN PART, REVERSE IN PART, AND REMAND
introduction
This court's opinion and judgment of June 3, 1998, are withdrawn, and the following opinion and judgment are substituted to clarify that, if appellee's claim is successful on remand, damages will be assessed, according to statute, by the Workers' Compensation Commission. We revise our original opinion also to emphasize that, because we find, as a matter of law, that appellant did not meet its summary judgment burden, appellee was not required to bring forward evidence raising a fact issue on causation.
The Texas Workers' Compensation Insurance Fund (TWCIF) complains of the denial of its Motion for Summary Judgment and of a summary judgment rendered in favor of appellee, Barbara Simon. We affirm the denial of TWCIF's motion, but reverse the summary judgment in favor of Mrs. Simon, and we remand the case for trial solely on the issue of whether William Simon's fatal injury from a bee sting arose from his employment.
Facts and Procedural History
William Simon was a mechanic for Damco Services, Inc., in Alice, Texas. On January 14, 1995, Simon was working in Damco's repair shop when he suffered a sting from a bee that had found its way into his Coke can. Simon, who had once been a bee keeper and had suffered many stings without incident, had an immediate and severe allergic reaction to this sting and was taken to the hospital, where he died shortly after arrival.
Barbara Simon claimed benefits under the Texas Workers' Compensation Act. After investigating the incident, TWCIF contested payment in the following language:
Investigation reveals no injury in course and scope of employment. Employee was stung by an insect. Employee was exposed to no greater risk of being stung by an insect than any other member of the general public (emphasis added).
After a Benefit Review Conference (BRC), and at the recommendation of the investigating officer, a Contested Case Hearing (CCH) was held. The issues presented at the CCH were (1) whether Mr. Simon had suffered a "compensable injury" that resulted in his death, and (2) who were the proper legal beneficiaries of Mr. Simon for workers' compensation purposes. After the hearing, the commission denied Mrs. Simon's claim because the injury did not "arise out of" Mr. Simon's employment.
Mrs. Simon appealed to an Appeals Panel of the Texas Workers' Compensation Commission, and the panel reversed. The panel noted that Texas courts have held that a bee sting is not an act of God, so Mrs. Simon was not required to prove that her husband had been at a greater risk of being so injured than any other member of the general public. Mrs. Simon was only required to show that the injury occurred in the course and scope of and arose from his employment. See Tex. Lab. Code Ann. ยง 406.031 (Vernon 1996).
The panel decision and a separate concurrence emphasized that the decision did not establish that stings were always coverable; a claimant would still have to demonstrate that the injury occurred during the course and scope of employment and that the injury would not have occurred but for the conditions and obligations of employment. One judge Dissented.
TWCIF appealed to the district court of Jim Wells County. In a Motion for Summary Judgment, TWCIF argued that Mr. Simon's injury did not arise from Simon's employment. TWCIF now conceded that the injury had occurr
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