Justice GREEN delivered the opinion of the Court, in which Chief Justice JEFFERSON, Justice HECHT, Justice WAINWRIGHT, Justice MEDINA, and Justice WILLETT joined, and in which Justice JOHNSON and Justice LEHRMANN joined as to Parts I, II, IV and V.
In this workers' compensation case, we decide three issues: (1) whether expert medical causation testimony from a treating physician relying on a differential diagnosis is reliable and, therefore, legally sufficient evidence to support the jury's verdict; (2) whether the trial court erred in submitting a jury charge that defined "producing cause" without including a but—for component; and (3) whether an insurance carrier that is unsuccessful on judicial review is entitled to a jury trial on the disputed amount of a claimant's attorney's fees under Texas Labor Code § 408.221(c). We hold that: (1) the treating physician's opinion was based on a reliable foundation and, therefore, legally sufficient evidence
Charles Crump received a kidney transplant in 1975 and began a lifelong regimen of immunosuppressant drug therapy to ensure his body would not reject the new kidney. Crump began working for Frito-Lay in the mid-1980s. In May 2000, while training another employee in the packaging department, Crump struck his right knee on a piece of machinery. The injury caused a contusion (bruise) and a hematoma (a collection of blood) at the wound site. He applied for and received workers' compensation benefits for the work-related injury. After a series of increasingly serious health complications which required repeated, lengthy hospitalizations, Crump died in January 2001 at age forty-three. His wife, Joyce Crump,
Frito-Lay's workers' compensation carrier, Transcontinental Insurance Company, sought judicial review of the administrative award of death benefits. See TEX. LAB. CODE §§ 410.301-.308 (providing for, and limiting scope of, judicial review of a death benefits award). As the party appealing the administrative decision, Transcontinental bore the burden of proving its only disputed issue—that the May 2000 injury was not a producing cause of Crump's death—by a preponderance of the evidence. See id. § 410.303. At trial, Transcontinental offered the testimony of Dr. Judson Hunt. Hunt reviewed Crump's medical records and testified that the May 2000 injury was not a producing cause of Crump's death, and that his death would have occurred without the work-related injury. To rebut Hunt's opinion, Crump offered Dr. John Daller, one of Crump's treating physicians, who testified that the May 2000 injury was a producing cause of Crump's death. The trial court overruled Transcontinental's objections that Daller's testimony was not based on a reliable foundation and allowed him to testify. After hearing the evidence, the jury answered in the affirmative the single question put before it, "Was Charles Crump's May 9, 2000 injury a producing cause of his death?" Crump submitted the issue of attorney's fees to the trial court. See id. § 408.221(c) (mandating payment of a claimant's attorney's fees by an insurance carrier that unsuccessfully seeks judicial review). Transcontinental had objected that those fees should also be submitted to the jury, rather than the trial court. The trial court disagreed with Transcontinental and awarded Crump attorney's fees, as well as fees for time spent pursuing those fees.
Transcontinental appealed. The court of appeals grouped Transcontinental's issues into three categories: (1) the trial court's acceptance of the reliability of Crump's expert's testimony on causation, as well as the legal and factual sufficiency of that testimony to support the verdict; (2) the trial court's definition of producing
We granted Transcontinental's petition for review. 53 Tex. Sup.Ct. J. 15 (Oct. 23, 2009). Finding the court of appeals' categorization of the issues useful, we address each in turn.
Producing cause was the only issue submitted to the jury at trial. Because this is an appeal of a Workers' Compensation Commission award of death benefits, Transcontinental acknowledges that it had the burden to prove that the May 2000 injury was not a producing cause of Crump's death. See TEX. LAB.CODE § 410.303 ("The party appealing the decision [of the appeals panel] on an issue [regarding compensability or eligibility for or the amount of income or death benefits] has the burden of proof by a preponderance of the evidence."); Morales v. Liberty Mut. Ins. Co., 241 S.W.3d 514, 516-17 (Tex.2007) (discussing the avenues of judicial review). Thus, Transcontinental, the insurance carrier, was the plaintiff at trial; Crump, the claimant, was the defendant.
The trial court asked the jury whether Crump's injury was a producing cause of his death, but to properly allocate the burden of proof, the court instructed the jury to answer "yes" unless they found by a preponderance of the evidence that the answer should be "no." In answering "yes," the jury thus failed to find that Crump's injury did not cause his death. On appeal, Transcontinental asserts that it conclusively established the lack of causality and is therefore entitled to judgment in its favor as a matter of law.
At trial, Transcontinental's expert, Hunt, testified that the natural complications of being immunosuppressed for twenty-five years had caused Crump's death—not the May 2000 injury. Crump's expert and treating physician, Daller, testified that the wound site of the May 2000 work-related injury became infected, the infection caused Crump's already-weakened organs to fail, and his organ failure in turn caused his death. Transcontinental objected to the admission of Daller's testimony on the ground that it was unreliable, but the trial court overruled that objection. Here, Transcontinental reasserts that Daller's testimony was unreliable and therefore legally insufficient evidence of causation. Without Daller's testimony, Transcontinental argues, Hunt's testimony establishes the lack of causation. Accordingly, we must decide whether Daller's testimony was reliable and, if so, whether it was some evidence of causation.
"An expert witness may testify regarding `scientific, technical, or other specialized' matters if the expert is qualified and if the expert's opinion is relevant and based on a reliable foundation." Mack Trucks, Inc. v. Tamez, 206 S.W.3d 572, 578 (Tex.2006) (citing TEX.R. EVID. 702). In determining whether expert testimony is reliable, a court should consider the factors we set out in E.I. du Pont de Nemours & Co. v. Robinson, 923 S.W.2d 549, 557 (Tex. 1995),
Whirlpool Corp. v. Camacho, 298 S.W.3d 631, 638 (Tex.2009); see also Mack Trucks, 206 S.W.3d at 579 ("[T]he criteria for assessing reliability must vary depending on the nature of the evidence.").
Here, we are considering the reliability of a treating physician's opinion based on a particular diagnostic methodology—differential diagnosis. This is a routine diagnostic method used in internal medicine whereby a treating physician formulates a hypothesis as to likely causes of a patient's presented symptoms and eliminates unlikely causes by a deductive process of elimination. See, e.g., Coastal Tankships, U.S.A., Inc. v. Anderson, 87 S.W.3d 591, 604-05 & n. 24 (Tex.App.-Houston [1st Dist.] 2002, pet. denied) (en banc) ("[Differential diagnosis] is a clinical process whereby a doctor determines which of several potential diseases or injuries is causing the patient's symptoms by ruling out possible causes—by comparing the patient's symptoms to symptoms associated with known diseases, conducting physical examinations, collecting data on the patient's history and illness, and analyzing that data—until a final diagnosis for proper treatment is reached."). If the physician's treatment of the suspected cause alleviates the patient's symptoms, the disease or condition treated can be said to have been the internal cause of the eliminated symptoms. See id. If the patient's symptoms remain after treatment of the suspected disease or condition, the physician rules out the suspected disease or condition as the internal cause of the patient's symptoms and formulates a new hypothesis as to the possible culprit. See id.
Crump asserts that because differential diagnosis is a reliable medical technique, the application of the Robinson factors is tempered, or less strict, when a treating physician using that technique is involved. This is the approach adopted by the court of appeals below, which refused to apply Robinson at all. See 274 S.W.3d at 96-97. We have held the opposite to be true: "[T]he relevance and reliability requirements of Rule 702 [apply] to all expert
Several of the Robinson factors apply to differential diagnosis as a method or technique, as well as its application and the conclusions reached in a particular case. "Differential diagnosis is `the basic method of internal medicine' and enjoys widespread acceptance in the medical community. Generally speaking, when properly conducted the technique has important non-judicial uses, is generally accepted as valid by the medical community, and has been subjected to use, peer review, and testing." Coastal Tankships, 87 S.W.3d at 604 (citations omitted). While these endorsements of the technique may hold "generally," we cannot say that they will always apply in every case in which a treating physician bases his opinion on differential diagnosis. Here, though, Daller's diagnostic methodology certainly had non-judicial uses in that it was used to treat Crump, write prescriptions, and perform surgery. Cf. Robinson, 923 S.W.2d at 559 ("[O]pinions formed solely for the purpose of testifying are more likely to be biased toward a particular result."). Hunt, Transcontinental's expert, acknowledged that differential diagnosis was used to treat Crump. Although Hunt would have reached different conclusions regarding Crump's infection, he stated that he agreed with the treatment methodology Daller employed. See Robinson, 923 S.W.2d at 557 (noting that the Robinson reliability inquiry focuses "solely on the underlying principles and methodology, not on the conclusions they generate"); cf. TXI Transp. Co. v. Hughes, 306 S.W.3d 230, 235 (Tex.2010) ("Rather than focus entirely on the reliability of the underlying technique used to generate the challenged opinion, as in Robinson, we have found it appropriate . . . [to] determine whether there are any significant analytical gaps in the expert's opinion that undermine its reliability.") (citations omitted). Moreover, there is no practical way peers could conduct objective, randomized experiments to test the validity of Daller's specific conclusion regarding Crump's injury. Thus, these factors support the reliability of Daller's expert testimony in this case.
Moving to the other Robinson factors, we note that, in some cases, a physician's differential diagnosis may be too dependent upon the physician's subjective guesswork or produce too great a rate of error—for example, when there are several consistent, possible causes for a particular set of symptoms. Related to these factors, Transcontinental contends that Daller's diagnostic technique is not reliable because he did not exclude the other possible causes of Crump's death with reasonable medical probability. See TXI Transp. Co., 306 S.W.3d at 237 ("An expert's failure to rule out alternative causes of an incident may render his opinion unreliable."); Robinson, 923 S.W.2d at 559 ("An expert who is trying to find a cause of something should carefully consider alternative
We conclude that Daller's testimony adequately excluded, with reasonable medical certainty, the other plausible causes raised by the evidence. Hunt testified that, in his opinion, Crump died from a combination of kidney failure, cirrhosis of the liver, and a fungal infection in the lungs exacerbated by preexisting diabetes and a history of immunosuppressant drug usage. There is no dispute that these conditions, except the fungal infection, all preceded Crump's May 2000 work-related injury. All of these were other plausible causes of Crump's death. But there was evidence that despite his long-term health problems dating from his kidney transplant twenty-five years earlier, Crump was generally in good health before his injury at work, and that within days after the injury he contracted an infection at the site of the injury. Even Hunt acknowledged that Crump's infection was a "co-morbid condition" that made his other health conditions "more difficult to deal with." Hunt disputed any connection between Crump's injury and the infection, and he believed that the injury contributed nothing toward Crump's death. He concluded that Crump would have died on January 23, 2001, regardless of the work-related injury of May 2000. But objective evidence of Crump's good health before his injury, his contraction of an infection at the site shortly afterward, and the deleterious effect of the infection on his health reasonably ruled out the possibility that he died solely from the other conditions he suffered. Based on Daller's experience and training as a transplant specialist and surgeon, his dealings with infection-susceptible immunosuppressed patients, and his direct dealings with Crump—which included taking cultures directly from the wound site for diagnostic purposes—he concluded that Crump's wound became infected, that the infection weakened his organs, and that the natural progression of these events caused his death. See Crye, 907 S.W.2d at 500 ("Reasonable [medical] probability is determined by the substance and context of the opinion, and does not turn on semantics or on the use of a particular term or phrase."). In other words, Daller's medical causation opinion provided a cause that excluded, with reasonable medical certainty, Hunt's suggested causes of death. The evidence was not conclusive, but it was not required to be. It was sufficiently reliable to be considered by the jury. Once Daller effectively responded to Hunt's other plausible causes of death with reliable testimony, the question was no longer one of legal sufficiency, but rather one of competing evidence to be weighed
In addition to applying the Robinson factors, Gammill also informs our reliability inquiry. There we concluded that the Robinson factors could not be applied to the plaintiffs' experts, "even though mechanical engineering, the expertise claimed by the witnesses, is scientific in nature." Gammill, 972 S.W.2d at 727. In that situation, we asked further whether there was "simply too great an analytical gap between the data and the opinion proffered." Id. "The `analytical gap' between the data. . . and [the expert]'s opinion was not shown to be due to his techniques in assessing the vehicle restraint system. . . . Rather, the `gap' in [the expert]'s analysis was his failure to show how his observations, assuming they were valid, supported his conclusions that [the passenger] was wearing her seat belt or that it was defective." Id.
The analysis set out in Gammill lends support to the reliability of Daller's expert opinion testimony in this case. Daller is board-certified in general surgery and critical care, specializes in multiple-organ transplantation, and has worked as a clinician in teaching hospitals across the country—including the University of Texas Medical Branch at Galveston, where he treated Crump. His educational and clinical qualifications to treat post-transplantation, immunosuppressed patients, such as Crump, are not in dispute. As explained above in addressing the Robinson factors, an analytical gap between the data and opinion is not shown here because of Daller's "techniques in assessing" Crump. See id. Rather, there must be "failure to show how his observations, assuming they were valid, supported his conclusions." Id. He directly treated or oversaw Crump's treatment on repeated occasions after Crump's work-related knee injury. Daller observed that Crump's wound was located in the same spot as the injury and that the wound site became symptomatic as being infected in a predictable time and manner after the injury for an immunosuppressed patient such as Crump.
From these observations, Daller concluded:
Thus, we cannot conclude that there was "too great an analytical gap" between the observed data and the proffered opinion. See Gammill, 972 S.W.2d at 727. At this point, any "gaps" that remain between the data and the conclusion drawn from it go to the weight of Daller's testimony—not its reliability. See Ledesma, 242 S.W.3d at 40-41.
We conclude that Daller's testimony was based on a sufficiently reliable foundation under the standards set out in Robinson and Gammill. Because Daller's expert medical causation testimony is based on a reliable foundation, it was admissible at trial as evidence to prove that the May 2000 injury was a producing cause of Crump's death. See TEX.R. EVID. 702. Consequently, on legal sufficiency review, we conclude that reasonable jurors could have believed his testimony. See City of Keller v. Wilson, 168 S.W.3d 802, 827 (Tex. 2005). Because Daller's expert testimony was sufficient evidence to support the jury's verdict on causation, we cannot disturb the jury's finding against Transcontinental on the issue of producing cause. Accordingly, Transcontinental's legal sufficiency challenge is denied.
In its second issue, Transcontinental argues that the trial court's definition of producing cause is legally incorrect and that, had its proposed definition been given, the verdict would not have been in Crump's favor. Transcontinental seeks a new trial. After refusing Transcontinental's proposed definition and overruling its objections that Crump's definition erroneously lacked a but-for component, the trial court charged the jury as follows:
Transcontinental contends that the trial court gave an erroneous definition of producing cause in its jury charge. We agree.
"The court shall submit such instructions and definitions as shall be proper to enable the jury to render a verdict." TEX.R. CIV. P. 277. "An instruction is proper if it (1) assists the jury, (2) accurately states the law, and (3) finds support in the pleadings and evidence." Union Pac. R.R. Co. v. Williams, 85 S.W.3d 162, 166 (Tex.2002) (citing TEX.R. CIV. P. 278). When, as here, the content of a trial court's definition is challenged as legally incorrect, our standard of review is de novo. See St. Joseph Hosp. v. Wolff, 94 S.W.3d 513, 525 (Tex.2002).
Though the Texas Workers' Compensation Act does not use the phrase "producing cause,"
Jones v. Traders & Gen. Ins. Co., 140 Tex. 599, 169 S.W.2d 160, 162 (Tex. 1943) (citation and quotation omitted). We have not addressed the matter since then.
In a recent products liability case, however, we held that what had been "a frequently submitted definition of `producing cause' should no longer be used." Ford Motor Co. v. Ledesma, 242 S.W.3d 32, 35 (Tex.2007). The trial court in that case had given the products liability pattern jury charge definition: "`Producing cause' means an efficient, exciting, or contributing cause that, in a natural sequence, produces the incident in question. There may be more than one producing cause." Id. at 45.
The definition submitted by Crump and accepted at trial—"`Producing Cause' means an efficient, exciting, or contributing cause that, in a natural sequence, produces the death in question. There may be more than one producing cause."—is the same as the pattern jury charge definition we rejected in Ledesma, substituting only "death" for "incident." Transcontinental urges us now to adopt for workers' compensation cases the same definition we approved in Ledesma for products liability cases. Crump asserts that the Ledesma definition of producing cause has no place in workers' compensation law. Because we have not addressed the "substantial factor" terminology from products liability law in the context of workers' compensation cases, we must decide whether our holding in Ledesma applies here.
In considering whether to apply Ledesma's definition, we first examine the causation standards for proximate cause and producing cause. "The two elements of proximate cause are cause in fact (or substantial factor) and foreseeability. . . . Cause in fact is established when the act
Having concluded that Ledesma applies to this case, we must determine whether the definition given here was erroneous. The definition of producing cause given by the trial court in this case is, in all relevant respects, the same as the pattern jury charge definition we rejected in Ledesma. See 242 S.W.3d at 45. Transcontinental cites Ledesma for the proposition that the use of the "efficient, exciting, or contributing cause" language is erroneous. We disagree. In Ledesma, we reasoned that those terms had no practical meaning to modern jurors in products liability cases. Id. at 46. We held that the use of those terms provides "little concrete guidance" to modern jurors, and a definition that omits either the substantial factor or but—for components "is incomplete." Id. But we did not go so far as to say that employing the terms "efficient, exciting, or contributing
Crump argues that the "substantial factor" component of the Ledesma definition imposes a higher causation burden upon workers' compensation claimants than what exists at present. We disagree. We have always required in workers' compensation cases a showing of "unbroken causal connection" between the compensable injury and the claimant's injury or death. Staggs, 134 S.W.2d at 1030; see Jones, 169 S.W.2d at 162; Burnett, 105 S.W.2d at 202. Although, as the dissent points out, our earlier cases did not address the "substantial factor" terminology, there is nothing in those opinions to suggest that cause in fact should not be part of the causal connection analysis. See Jones, 169 S.W.2d at 162; Staggs, 134 S.W.2d at 1030; Burnett, 105 S.W.2d at 202. In fact, we cannot conceive of causal connection analysis without consideration of cause in fact. The substantial factor language serves only to illustrate an essential aspect of causation to jurors, as we have noted:
Lear Siegler, Inc. v. Perez, 819 S.W.2d 470, 472 & n. 1 (Tex.1991) (quoting RESTATEMENT (SECOND) OF TORTS § 431 cmt. a (1965)); see also Borg-Warner Corp. v. Flores, 232 S.W.3d 765, 770 (Tex.2007). In other words, for an act or event to rise to the level of cause in the legal sense, the act or event must be such that reasonable jurors would identify it as being actually responsible for the ultimate harm. The cause must be more than one of the countless ubiquitous and insignificant causes that in some remote sense may have contributed to a given effect as, for example, simply getting up in the morning. That the term substantial factor is given to this commonsense aspect of legal causation simply makes plain to jurors that more than causation in this indirect, "philosophic sense" is required. See Staggs, 134 S.W.2d at 1030 (recognizing that but-for language repeated something already included in the usual and ordinary meaning of "cause" and draws juror attention to the importance of an unbroken causal connection). It does not demand, nor even imply, a higher standard of legal causation beyond the ordinary sense of the concept.
Transcontinental argues that the omission of but-for language in the charge submitted by the trial court renders the definition legally incorrect. We agree. As we discussed in one workers' compensation case, "to say of a cause of an injury that it is one `but for which the injury would not have happened' is to repeat something already included in the usual and ordinary meaning of the word `cause.'" Id. (quoting Tex. & Pac. Ry. Co. v. Short, 62 S.W.2d 995,
Having decided that the trial court's definition of producing cause was erroneous, we now consider whether this error requires reversal. Transcontinental asserts that the trial court's omission of the but-for component of the producing cause definition was reversible error. We agree.
"A judgment will not be reversed for charge error unless the error was harmful because it probably caused the rendition of an improper verdict. . . ." Columbia Rio Grande Healthcare, L.P. v. Hawley, 284 S.W.3d 851, 856 (Tex.2009) (citing TEX.R.APP. P. 61.1). "Charge error is generally considered harmful if it relates to a contested, critical issue." Id. (citing Bel-Ton Elec. Serv., Inc. v. Pickle, 915 S.W.2d 480, 481 (Tex.1996) (per curiam), and Sw. Bell Tel. Co. v. John Carlo Tex., Inc., 843 S.W.2d 470, 472 (Tex.1992)). "To determine whether the instruction probably caused an improper judgment, we examine the entire record." Quantum Chem. Corp. v. Toennies, 47 S.W.3d 473, 480 (Tex.2001).
Daller, one of Crump's treating physicians and Crump's sole expert, testified:
According to Daller, the site of the injury became infected, the infection caused Crump's already-weakened organs to fail, and his organ failure in turn caused his death. Further, on cross-examination he testified:
On the other hand, Transcontinental's expert, Hunt, testified that Crump died from the natural complications of being immunosuppressed for twenty-five years rather than from the May 9, 2000 injury:
Hunt testified on cross-examination, "Had [Crump] not had that contusion to his knee, he still would have had those other problems."
Transcontinental bore the burden of proving, by a preponderance of the evidence, the negative proposition that the May 2000 injury was not a producing cause of Crump's death. See TEX. LAB.CODE § 410.303; Morales v. Liberty Mut. Ins. Co., 241 S.W.3d 514, 516 (Tex.2007) ("[T]he appealing party bears the burden of proof by a preponderance of the evidence. The factfinder may consider, but is not bound by, the appeals panel's decision. The method of review that [the Labor Code] provides is known as modified de novo review.") (citations omitted). The but-for aspect of causation was squarely at issue in this case, and the sole question before the jury was whether the May 2000 injury was a producing cause of Crump's death. Here, the charge error "relate[d] to a contested, critical issue"—indeed, the sole issue—that of causation. See Hawley, 284 S.W.3d at 856; see also Toennies, 47 S.W.3d at 480 ("An improper instruction is especially likely to cause an unfair trial when the trial is contested and the evidence sharply conflicting, as it was in the present case [when the trial court gave an incorrect causation standard]."); Tex. Dep't of Human Servs. v. Hinds, 904 S.W.2d 629, 637 (Tex.1995) (finding harmful error where a jury instruction stated the standard of causation incorrectly and the evidence was "vigorously and convincingly disputed"); John Carlo Tex., Inc., 843 S.W.2d at 472 ("Virtually the entire factual dispute between the parties has been over whether Bell's conduct was justified. To ask the jury to resolve this dispute without a proper legal definition [of justification,] the essential legal issue[,] was reversible error."). Including the but—for component in the definition would have assisted the jury in resolving the disputed expert testimony at the crux of the case and, more importantly, would have stated the law accurately. See Williams, 85 S.W.3d at 166. In these circumstances, the absence of a proper definition of producing cause probably resulted in an improper judgment and, as such, was reversible error. See Hinds, 904 S.W.2d at 637.
Prior to trial, Transcontinental objected to Crump's definition, the one ultimately accepted by the trial court, asserting it was not a correct statement under Texas law. Transcontinental tendered its own definition in writing, including a but—for component: "that cause, which in a natural and continuous sequence, produces death and without which, the death would not have occurred." See TEX.R. CIV. P. 278 ("Failure to submit a definition or instruction shall not be deemed a ground for reversal of the judgment unless a substantially correct definition or instruction has been requested in writing and tendered by the party complaining of the judgment."). Because Transcontinental's definition included the critical but-for component, and was otherwise a correct statement of law, it was "substantially correct" and sufficed to preserve its complaint of charge error on appeal. See Hinds, 904 S.W.2d at 637-38 ("There should be but one test for
We hold that the definition of producing cause approved in Ledesma—a substantial factor in bringing about the injury or death and without which the injury or death would not have occurred—applies in workers' compensation cases. Because the definition submitted here lacked the but—for component, and because its omission in this case constitutes harmful error, we remand the case for new trial.
Transcontinental first argues that the trial court erred in denying it a jury trial on the amount of Crump's reasonable and necessary attorney's fees for which Transcontinental was statutorily liable, and second, in permitting Crump to recover attorney's fees incurred in pursuing those statutory attorney's fees. We address the first issue—whether a judge or jury decides attorney's fees under Texas Labor Code § 408.221(c)—to provide guidance for parties and trial courts. We leave the second question—whether fees can be awarded in the pursuit of fees—for another day.
Relying on this Court's precedent and the language of § 408.221, Transcontinental argues that the trial court erred when it refused to grant a jury trial and, instead, decided the disputed amount of Crump's attorney's fees for which Transcontinental was liable under § 408.221(c). Crump contends that the statute's plain language alone provides that the court, and not a jury, is to determine the amount of reasonable and necessary attorney's fees for which Transcontinental is liable. The court of appeals favored Crump's plain language argument and held that the trial court did not err in denying Transcontinental's request to submit the issue to a jury. 274 S.W.3d at 103. We hold that when a question of fact exists on the reasonableness and necessity of a claimant's attorney's fees under § 408.221(c), the carrier has a right to submit that question to a jury.
In construing another provision of the Workers' Compensation Act, we set out the scope of our inquiry:
Entergy Gulf States, Inc. v. Summers, 282 S.W.3d 433, 437 (Tex.2009) (citations, internal quotations, and italics omitted). We review de novo the trial court's denial of Transcontinental's request for a jury trial under subsection (c). See id.
We look first to the language of the statute.
TEX. LAB.CODE § 408.221. We review the plain language of the statute as written to decide whether Crump's or Transcontinental's interpretation—judge or jury—is supported.
According to Crump, subsection (c)'s instruction that the court is to award apportioned fees means that the court alone determines the reasonable and necessary amount of fees—according to criteria given in subsection (d). This interpretation, Crump argues, comports with subsection (b)'s general rule that attorney's fees under § 408.221 are based on written evidence of time and expenses presented to the court, which would have no use for this information if it were not deciding the amount to award. Crump correctly notes that § 408.221 makes no mention of a jury.
Transcontinental focuses on the first words in subsection (b): "Except as otherwise provided." Id. § 408.221(b). It argues that subsection (c) represents an exception to the general rule set out in subsections (a) and (b), where a claimant's
The statute is silent on the critical judge-or-jury question. Both parties offer legitimate, reasonable interpretations of § 408.221 and subsection (c)'s role within it. Because both interpretations are reasonable as to their applicability here, we conclude that the statute is ambiguous. See In re Mo. Pac. R.R. Co., 998 S.W.2d 212, 217 (Tex.1999) ("Beyond these preliminary observations, the statute is not entirely clear in all its particulars. The language of the statute could support more than one reasonable interpretation and therefore is ambiguous. Because it is ambiguous, we may turn to extratextual sources. . . ."). Because the plain language of the statute alone is unavailing, we look beyond it. See id.; see also TEX. GOV'T CODE § 311.023 ("In construing a statute, . . . a court may consider among other matters the . . . common law or former statutory provisions, including laws on the same or similar subjects. . . ."). Specifically, we are guided by prior decisions examining the issue of reasonable and necessary attorney's fees in the context of fee-shifting provisions in other statutory regimes and by the history of how § 408.221 has evolved over the years.
Section 408.221 provides two relevant possibilities in which an insurance carrier will pay a claimant's attorney's fees.
The second possibility is at issue in this case. Here, the insurance carrier pays the claimant's "reasonable and necessary attorney's fees" for representing the claimant on judicial review in the courts when the carrier is unsuccessful on an issue it appealed from the Division of Workers' Compensation. TEX. LAB.CODE § 408.221(c). These fees are not subtracted from the claimant's recovery, but are paid by the carrier on top of the claimant's benefits award. See id. § 408.221(b)-(c). In this situation, the claimant's attorney's fees are not limited to 25% of the claimant's recovery, but only by reasonableness and necessity. See id. § 408.221©, (I). This fee-shifting provision in § 408.221 did not exist until 2001.
While we have not previously examined the fee-shifting provision in subsection (c), we have discussed similar fee-shifting provisions in other cases. "In general, the reasonableness of statutory attorney's fees is a jury question." City of Garland v. Dallas Morning News, 22 S.W.3d 351, 367 (Tex.2000). In City of Garland, we considered the fees available to a substantially prevailing party under the Texas Public Information Act. Id. at 367-68. The Act provided:
Id. at 367 (quoting the former version of TEX. GOV'T CODE § 552.323). We reasoned that, from the plain language of the statute, "the trial judge decides whether to award attorney's fees under the Act." Id. (emphasis added). But we immediately noted that "section 552.323 does not dictate how to determine the attorney's fees amount, except that the award must be `reasonable.' In general, the reasonableness of statutory attorney's fees is a jury
As support for this "general" proposition, we cited Bocquet v. Herring, 972 S.W.2d 19, 21 (Tex.1998), which involved attorney's fee awards under the Declaratory Judgment Act. Id. In any proceeding under the Act, "the court may award costs and reasonable and necessary attorney's fees as are equitable and just." Bocquet, 972 S.W.2d at 20 (quoting TEX. CIV. PRAC. & REM.CODE § 37.009). We had to determine whether a judge or jury was to decide the amount of fees in order to answer another question: "[B]y what standard is such an award of attorney fees to be reviewed on appeal"? Id. Because the Act read "may," the trial court had discretion to decide whether to award fees at all. Id. We recognized that the Act limited this discretion in four ways: reasonableness, necessity, equity, and justice. Id. at 21. Each of those terms prescribed whether a judge or jury was to decide them. Id. Generally, reasonableness was a fact question for the jury's determination, as was necessity. Id. On the other hand, equity was within the trial court's discretion, as was justice. Id. Our examination of the Act's language led us to conclude:
Id. In concluding that reasonableness and necessity of attorney's fees were matters of fact committed to a jury, we also noted that there are "factors prescribed by law which guide the determination of whether attorney fees are reasonable and necessary." Id. (citing Arthur Andersen & Co. v. Perry Equip. Corp., 945 S.W.2d 812, 818 (Tex.1997) (listing factors "a factfinder should consider when determining the reasonableness of a fee")).
The principles established for construing statutory fee-shifting provisions in City of Garland and Bocquet assist the interpretation of § 408.221(c) of the Texas Labor Code. Crump has not pointed us to a reason to exempt § 408.221 from the general rule announced in those cases: "[T]he reasonableness of statutory attorney's fees is a jury question." City of Garland, 22 S.W.3d at 367. Nor do we see language in § 408.221 that distinguishes it from the language of the statutory regimes to which we applied the general rule in those cases. Applying that general rule here, we conclude that the carrier is entitled to submit the issue of the reasonableness and necessity of a claimant's attorney's fees, where disputed, to a jury, which will consider subsection (d)'s factors. See TEX. LAB. CODE § 408.221(c), (d). The next step depends on whether the claimant totally or partially prevails on the issues appealed by the insurance carrier. If the claimant prevails only on some issues, then after the jury's verdict is announced the court will apportion the fees per the factors in subsection (d), and will award reasonable and necessary attorney's fees to the claimant's attorney only for those issues on which the claimant prevails. See TEX. LAB.CODE § 408.221(c). If the claimant totally prevails, the jury's verdict as to the fee amount for which the carrier is liable is then subject only to the court's approval based on the factors in subsection (d). Id. § 408.221(a), (d); see also Bocquet, 972
Thus, we hold that an insurance carrier is entitled to have a jury determine the disputed amount of reasonable and necessary attorney's fees for which it is liable under § 408.221(c).
We hold that: (1) the treating physician's opinion is based on a reliable foundation and, therefore, legally sufficient evidence supports the jury's verdict; (2) the trial court's omission of the but-for component in the jury charge constitutes reversible error; and (3) an insurance carrier is entitled to have a jury determine the disputed amount of reasonable and necessary attorney's fees for which it is liable. We reverse the court of appeals' judgment and remand the case to the trial court for new trial.
Justice JOHNSON filed a concurring opinion, in which Justice LEHRMANN joined.
Justice GUZMAN did not participate in the decision.
Justice JOHNSON, joined by Justice LEHRMANN, concurring.
Although I agree the trial court erred by giving a definition of "producing cause" that did not include a "but for" element, I respectfully disagree with part of section III of the Court's opinion.
For three reasons, including both procedural and substantive matters, I do not agree with the Court's holding that the producing cause definition in worker's compensation cases must include "substantial factor" language.
First, Transcontinental did not procedurally preserve error regarding the "substantial factor" language because it did not request the language in the trial court. It requested the following definition: "`Producing Cause' means that cause which in a natural and continuous sequence, produces death, and without which, the death would not have occurred."
The Court's desire to deal with the "substantial factor" question is understandable; it is important. Nevertheless, given the record before us, I would not address the issue. See Gen. Chem. Corp. v. De La Lastra, 852 S.W.2d 916, 920-21 (Tex.1993) (appellate argument that maritime law preempted state law was not preserved because of failure to bring issue to trial court's attention, despite assertion that law changed during appellate process).
Worker's compensation claims are contractual in nature. See Maryland Cas. Co. v. Hendrick Mem'l Hosp., 141 Tex. 23, 169 S.W.2d 969, 973 (Tex.1943) ("[A] contractual relation arises under the Workmen's Compensation Law in which the employer, the employee and the insurer are the principal parties."). The terms of worker's compensation insurance policies include provisions of the worker's compensation statutes. Id. ("The provisions of the Workmen's Compensation Law become part of the contracts executed pursuant to it by those who bring themselves within the scope of its operation."). If an employee
When the first worker's compensation laws were enacted in 1913, they provided as to death claims:
Act of March 29, 1913, 33d Leg., R.S., ch. 179, § 8, 1913 Tex. Gen. Laws 429. The Legislature reenacted this provision without substantive change when it adopted the Workman's Compensation Act in 1917. Act approved March 28, 1917, 35th Leg., R.S., ch. 103, 1917 Tex. Gen. Laws 269. When the Court interpreted that statutory causation language in three death cases it noted—and implicitly approved—a causation instruction substantively the same as the instruction requested in this case by Transcontinental. See Tex. Emp. Ins. Ass'n v. Burnett, 129 Tex. 407, 105 S.W.2d 200 (Tex.1937); Tex. Indem. Ins. Co. v. Staggs, 134 Tex. 318, 134 S.W.2d 1026 (Tex.1940); Jones v. Traders & Gen. Ins. Co., 140 Tex. 599, 169 S.W.2d 160 (Tex. 1943).
In Burnett, the worker died over a year after he suffered a head injury while on the job. 105 S.W.2d at 200. He died from typhoid fever that he contracted shortly before he died. Id. at 201. Burnett's beneficiaries did not contend that the typhoid fever was related to his injury, nor that his death resulted from the injury. See id. Rather, they contended the injury lowered his resistance and the lowered resistance was a producing cause of death. Id. The jury found for Burnett's beneficiaries based on the instruction that "`producing cause' is [a cause] such as naturally resulted in the death of said J.W. Burnett." Id. The court of civil appeals reversed for a different charge error and remanded for a new trial. Id. In doing so, however, it suggested how the trial court should define producing cause:
Id. On further appeal, this Court rendered judgment for the carrier because
Id. at 202. The Court reversed for legal insufficiency of the evidence. Id. So even though it specifically stated that the trial court's submission of the causation question was improper, it did not address the definition the court of civil appeals suggested be given on retrial. Id.
Certain statements in Burnett could have left some question about the required causal connection. For example, the following could be read as requiring proof that death would have resulted from the injury absent any intervening cause in order to be compensable: "[T]he injury and the death [must be related], with no efficient intervening agency, with sufficient certainty that it may be reasonably concluded that death would have resulted from the injury, notwithstanding the subsequently intervening disease." Id. And the following could be read to require that the injury must have been more than a minor concurring cause of death: "There was . . . no positive proof that such reduced resistance, if any, materially contributed to his death." Id. (emphasis added). The Court also made the statement that
Id. (emphasis added).
Any question about the causal connection, however, was resolved in Staggs. See 134 Tex. 318, 134 S.W.2d 1026. H.T. Staggs was employed by Skelly Oil Company. Id. at 1027. He and his family lived on company property a short distance from the Skelly plant where he maintained the company machinery on a 24-hour-a-day basis. Id. His death occurred after he had worked nearly all night to repair an engine in the plant. Id. Early in the morning, he took a meal break and returned to the house where he and his family lived. Id. When he was leaving the house to return to work, he fell and hit his head on a concrete block, but still went to work where he later collapsed and died. Id. An autopsy showed Staggs had severe sclerosis of his carotid artery, degenerative brain tissue surrounding the artery, and death was caused by a cerebral hemorrhage following rupture of the carotid artery due to high blood pressure. Id. Staggs's beneficiaries contended, and the jury found, that both his head injury and an injury from inhaling carbon monoxide gas in Skelly's pumping station were in the course of his employment, they were producing causes of his death, and his death
134 S.W.2d at 1028. The appellate court held, and Staggs's beneficiaries conceded, there was no evidence carbon monoxide injured Staggs. Id. This Court determined that there was sufficient evidence to support the jury findings as to the head injury and those findings were sufficient to support awarding death benefits to Staggs's beneficiaries. Id. at 1030. The Court specifically addressed the causal relationship required for a death to be compensable:
Id. at 1028-29 (emphasis added) (citations omitted).
Three years after Staggs, the Court again addressed whether a worker's death resulted from a work-related injury. The evidence in Jones showed that Tom Jones stepped on a nail at work and his wound became infected and intensely painful. 169 S.W.2d at 161. Six months after the injury he committed suicide by drinking a mixture of concentrated lye, cleaning fluid, and insect poison. Id. Jones's beneficiaries claimed his death was caused by the injury because he took his life while in a delirium resulting from constant and intense pain his injury caused. Id. A jury found that the injury was a producing cause of Jones's death; the injury caused him to become mentally unbalanced to the extent he did not understand the consequences of his act in taking his own life; his mental condition was the producing cause of death; and Jones did not willfully
The court of civil appeals reversed and rendered judgment for the carrier, holding suicide was a new and independent agency that broke the chain of causation between Jones's injury and death because the evidence was insufficient to show his injury caused Jones to take his life "through an uncontrollable impulse or in a delirium of frenzy without conscious volition." Traders & Gen. Ins. Co. v. Jones, 160 S.W.2d 569, 571 (Tex.Civ.App.-Fort Worth 1942), aff'd 140 Tex. 599, 169 S.W.2d 160 (Tex. 1943). In affirming the judgment of the court of civil appeals, the Court again noted the definition of producing cause that was mentioned in Burnett and Staggs and requested by Transcontinental in this case. Jones, 169 S.W.2d at 162. The Court also relied on Burnett in holding that Jones's death was not compensable because it was caused by an independent cause unrelated to his injury:
Id. at 162 (emphasis added) (citations omitted).
After clarifying in Staggs that the causation standard was concurring cause, this Court has not interpreted the worker's compensation law to require any different level of causation in order for an injured employee's disability or death resulting from a work-related injury to be compensable.
The Court notes that the causation element in worker's compensation cases and the proximate cause element in negligence cases have been identified as being "in substance the same, except that there is added to the definition of proximate cause the element of foreseeableness." Staggs, 134 S.W.2d at 1028-29 (citations omitted). In Staggs, the Court relied on the concurrent cause aspect of negligence law to hold that compensation was recoverable for a work-related injury if it was a concurrent or contributing cause of disability or death. See id. at 1029. But that reliance did not inextricably tie worker's compensation and negligence claims together insofar as their causation elements are defined. Negligence is a common law cause of action; worker's compensation is not. Because a worker's compensation claim is based on provisions of the Worker's Compensation Act, the causation standard is established by the Act.
Once this Court has construed a statute and the Legislature re-enacts the statute without substantial change, it is presumed the Legislature has adopted our interpretation. See Tex. Dept. of Protective and Regulatory Servs. v. Mega Child Care, Inc., 145 S.W.3d 170, 176 (Tex.2004) ("If an ambiguous statute that has been interpreted by a court of last resort or given a longstanding construction by a proper administrative officer is re-enacted without substantial change, the Legislature is presumed to have been familiar with that interpretation and to have adopted it."). See also Grapevine Excavation, Inc. v. Maryland Lloyds, 35 S.W.3d 1, 5 (Tex. 2000) ("It is a firmly established statutory construction rule that once appellate
Through multiple amendments, the substance of the Act's causation standard has not changed since the Act was construed in Burnett, Staggs, and Jones. In 1973, the Act was amended to provide:
Former TEX.REV. CIV. STAT. art. 8306 § 8.
Id. art. 8308-4.41.
TEX. LABOR CODE § 408.181(a).
Consistency in the law is important, and applying the same definition of "producing cause" in all types of cases where it is part of the causation element will simplify certain matters, including the task of preparing jury charges.
Further, inclusion of the substantial factor language cannot but change the causation requirement from what it has been for seventy years. If it did not, there would
I would not require inclusion of the "substantial factor" term in the definition of producing cause in worker's compensation cases. Otherwise, I join the Court's opinion and holding.
923 S.W.2d at 557. "We emphasized in Robinson that these factors are non-exclusive and that [Texas] Rule [of Evidence] 702 contemplates a flexible inquiry." Cooper Tire & Rubber Co. v. Mendez, 204 S.W.3d 797, 801 (Tex. 2006).
Id.
Id. (citations omitted).
To the extent the Court's decision results in an increased level of proof for an injury to be proved a producing cause of death or disability, the decision correspondingly decreases the burden on a carrier in the position of Transcontinental to prove that an injury was not a producing cause of death or disability. For convenience, I address the issue only from the viewpoint of an injured employee or the employee's beneficiaries.
