Sign In
Events
Newsletters
Search

Close

Close Search

Cancel

SEARCH
MY LAW.COMNEW

Apollo Enterprises, Inc. v. ScripNet, Inc.

Under Texas Labor Code �413.031, one type of review of a medical service concerns "disputes over the amount of payment due for services determined to be medically necessary and appropriate for treatment of a compensable injury," commonly termed "medical fee disputes." Two of appellant's four claims present medical fee disputes and therefore implicate the Texas Department of Insurance's exclusive jurisdiction. Austin Court of Appeals, No. 03-07-00551-CV, 12-04-2009

X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.
OPINION

This appeal requires us to consider the breadth of the exclusive jurisdiction that the legislature has vested in the Division of Workers’ Compensation, Texas Department of Insurance (the Division)*fn1 to determine “disputes over the amount of payment due” from workers’ compensation insurance carriers to reimburse pharmacies for health care provided to workers’ compensation claimants. See Tex. Lab. Code Ann. § 413.031(c) (West Supp. 2009);*fn2 Texas Mut. Ins. Co. v. Eckerd Corp., 162 S.W.3d 261, 263-67 (Tex. App.–Austin 2005, pet. denied); Howell v. Texas Workers’ Comp. Comm’n, 143 S.W.3d 416, 428-29, 434-38 (Tex. App.–Austin 2004, pet. denied). Specifically, we must consider whether this jurisdiction extends to certain tort claims asserted against a pharmacy benefits manager by a pair of competitive rivals that contract with pharmacies to purchase assignments of workers’ compensation reimbursement claims. In response to a plea to the jurisdiction based on exclusive jurisdiction and exhaustion-of-remedies grounds, the district court dismissed all of these tort claims. While we agree that some of the tort claims fall within the Division’s exclusive jurisdiction and affirm the district court’s judgment to that extent, we conclude that others do not, and reverse and remand the judgment as to those claims.

BACKGROUND

Trending Stories

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

LEARN MORE

More From ALM

Premium Subscription
With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Team Accounts
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Bundle Subscriptions
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
Go to CLE Center
Complex Claims & Litigation Forum 2025
February 24, 2025 - February 26, 2025
Las Vegas, NV

This conference aims to help insurers and litigators better manage complex claims and litigation.


Learn More
Legalweek Leaders in Tech Law Awards 2025
March 24, 2025
New York, NY

Recognizing innovation in the legal technology sector for working on precedent-setting, game-changing projects and initiatives.


Learn More
Legalweek New York 2025
March 24, 2025 - March 27, 2025
New York, NY

Legalweek New York explores Business and Regulatory Trends, Technology and Talent drivers impacting law firms.


Learn More
Go to Events Go to Webcasts
Associate Attorneys

McManimon, Scotland & Baumann, LLC is seeking talented and motivated associate attorneys for several positions. Candidates must be admi...


Apply Now ›
Commercial Litigation Attorney Needed (2-4 yr.)

Lower Manhattan firm seeks a litigator with at least 2-4 years of experience in all aspects of commercial litigation (i.e., depositions and ...


Apply Now ›
MATRIMONIAL ASSOCIATE ATTORNEY - NEW YORK

A prestigious matrimonial law firm in Garden City is seeking a skilled Associate Attorney with 5 to 7 years of experience in family law. The...


Apply Now ›
Go to Lawjobs