Worker not required to file comp claim before suing employer: Texas high court

The Texas Supreme Court on Friday ruled the Division of Workers’ Compensation does not have exclusive jurisdiction to determine whether an injury was work-related in a dispute arising outside of the context of compensability and when the relief requested by the injured worker does not depend on entitlement to comp benefits.

Rita Oteka was a faculty member at the University of Texas Rio Grande Valley and attended a commencement ceremony in May 2019. While walking back to her car, she was injured when a university police officer hit her with a vehicle, according to University of Texas Rio Grande Valley v. Rita Oteka.

The self-insured university reported the injury to its third-party claims administrator, which ultimately said Ms. Oteka was not entitled to benefits because she wasn’t seeking them and was using personal insurance for medical treatment; no medical evidence was presented; and the claims administrator determined that the injury wasn’t related to her employment.

Ms. Oteka did not contest the denial, saying she never filed a work comp claim because the administrator confirmed that she was not injured during the course and scope of her employment.

More than a year later, she sued the police officer for negligence. The university, substituted as the defendant, argued that workers comp was the exclusive remedy, as Ms. Oteka was expected to attend at least one ceremony a year. Ms. Oteka argued that she voluntarily attended the ceremony and had already left the event when she was injured.

Following the filing of an exclusivity defense, a claims administrator reversed course and sent a letter to Ms. Oteka, saying her injury “has been accepted as compensable” under workers comp. The next day, the university challenged the district court’s jurisdiction, arguing that only the Division of Workers’ Compensation can determine whether a covered worker was injured in the course and scope of employment.

The university argued that Ms. Oteka’s suit must be dismissed without consideration of whether her injury was work-related because she was first required to file a work comp claim and obtain a ruling on the course-and-scope issue from the division before she could sue.

The district court denied the request, and the university appealed. The court of appeals affirmed. The high court also affirmed, writing “no one disputes that the district court would have jurisdiction over Oteka’s lawsuit if her injury is not work-related, as she has pleaded. …Nor are the personal-injury damages she seeks predicated on an entitlement to workers compensation benefits. And when Oteka filed suit, it was contested that her injury was outside the course and scope of her employment.”

The court said the Workers’ Compensation Act does not provide a way for an injured worker or an employer to obtain a course-and-scope finding from the DWC without filing a claim.

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