Amputee Awarded Benefits in Rare Order

A woman who lost her leg in a car accident on the way back from a work meeting will start receiving her workers’ compensation benefits after all — at least for now.

The Texas Division of Workers’ Compensation ordered the insurer to start immediately paying Jane Hays temporary income benefits and cover the cost of her reasonable and necessary medical care.

The insurer, Texas Political Subdivisions, had denied the claims on the grounds that she wasn’t considered to be on the job while driving back from the meeting. Hays’ lawyer, Brad McClellan, called it “one of the most absurd denials” he’d seen in more than two decades in the workers’ compensation arena. The Texas Tribune reported on the case earlier this week

McLellan said the order issued Friday showed the state hearing officer “clearly agreed that there appears to be no reasonable basis to dispute this claim. It’s an absurd denial.”

Hays, who was making about $75,000 a year as director of employee benefits and risk management for the Temple Independent School District, will be entitled to receive up to $861 a week in temporary income benefits during the time she is off work, McClellan said.

Hays, 73, told the Tribune in a sometime emotional interview last week that she wanted to return to her job despite her multiple fractures and the amputation of her lower right leg. Without income, she said she was afraid she might have to sell her house. 

Normally the Division of Workers’ Compensation, or DWC, would wait until the two sides face off in a “contested case hearing,” the administrative equivalent of a trial, before ordering any benefits to be paid.

Instead, DWC issued a rare “interlocutory order,” requiring immediate action, after a pre-trial process known as a benefit review conference on Friday. McClellan attributed the quick action to the publicity her case generated, along with the lack of any legal basis to dispute the claim.

Randal Beach, executive director of Texas Political Subdivisions, or TPS, said McClellan's comments amounted to “politicking” about the case. He said he had no problem with Friday’s order but indicated he still planned to take the case to the contested case hearing, which is set for November. Friday's order could either be upheld or reversed at that time.

The dispute centers on whether Hays was deemed to be on the clock when she got in a car wreck in July. She had just left an out-of-town meeting, had her mileage expenses reimbursed and was listed as being on "school business" in the district's computer system. TPS argued that she was at work during the meeting but not on the way back from it. 

“From day one we’ve stood ready to pay this claim if it’s determined that there’s coverage,” Beach said. He said if he doesn’t take steps to dispute the claim Texas Political Subdivisions, which insures Temple ISD and other local government entities in Texas, could run into trouble with its excess insurer — which steps in to pay large claims after a certain amount is reached.

“They absolutely can deny coverage to us if they think we had a legal defense to the claim and didn’t exercise it,” Beach said.