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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

Employers Insurance v. General Accident, Fire & Life Assurance Corp.

Employers Insurance of Wausau (Wausau) sought summary judgment for 50% reimbursement of a $500,000 settlement and defense costs. The settlement stemmed from an underlying personal injury action where Frank Rayno, an employee of Sage Garage, was injured on a construction site in 1976. Wausau provided workers' compensation and employer's liability insurance to Sage Garage, while General Accident provided general liability coverage. Wausau paid the full settlement and then pursued General Accident for contribution. General Accident argued for a pro rata contribution based on policy limits. The court granted Wausau's motion for summary judgment, ruling that both insurers should contribute equally up to the limit of the smaller policy, which was General Accident's $500,000 policy, meaning General Accident owed $250,000. The defendants' cross-motion was denied.

Insurance disputeSummary judgmentDeclaratory judgmentContribution among insurersReimbursementPolicy limitsEmployer's liability insuranceGeneral liability insuranceWorkers' compensationPro rata contribution
References
0
Case No. 3-94-122-CV
Regular Panel Decision
Jan 18, 1995

Texas Workers' Compensation Insurance Facility v. State Board of Insurance, Aetna Casualty & Surety Company, Hartford Accident & Indemnity Company, Houston General Insurance Company, Liberty Mutual Fire Insurance Company, United States Fire Insurance Company

The Texas Workers' Compensation Insurance Facility (Facility) appealed a district court judgment that affirmed an order by the State Board of Insurance. The Board had ordered the Facility to indemnify several servicing companies for legal expenses incurred in litigation brought by Standard Financial Indemnity Company (SFIC). The Facility argued that Article 5.76-2, section 2.05(i) of the Texas Insurance Code, which states the Facility 'may not indemnify the servicing companies,' terminated the servicing companies' right to indemnification. The appellate court affirmed the trial court's judgment, holding that the servicing companies had a vested contractual right to indemnification which arose when they entered into servicing company agreements, and that section 2.05(i) could not be applied retroactively to impair these vested rights. The court found that the law existing at the time the contracts were made, which included the Facility's bylaws allowing for indemnification, was incorporated into the agreements.

Workers' CompensationInsurance LawContractual RightsVested RightsRetroactive Application of LawIndemnificationStatutory InterpretationAdministrative LawAppellate ReviewTexas Insurance Code
References
32
Case No. 13-21-00361-CV
Regular Panel Decision
Oct 12, 2023

Accident Fund General Insurance Company v. Rodrigo Mendiola

Rodrigo Mendiola, a truck driver, suffered severe burns in an accident, leading to an above-the-knee amputation and significant injury to his left hand. His employer's workers' compensation insurer, Accident Fund General Insurance Company, disputed his claim for lifetime income benefits based on the total loss of use of his left hand. The trial court, applying the Travelers Insurance Co. v. Seabolt standard, found sufficient evidence that Mendiola's hand lacked substantial utility, entitling him to benefits. The Court of Appeals affirmed the trial court's judgment, upholding the application of the Seabolt standard and concluding the evidence factually supported the finding of total loss of use.

Workers' CompensationLifetime Income BenefitsTotal Loss of UseBurn InjuriesHand InjuryAmputationMedical EvidenceFactual SufficiencyAppellate ReviewStare Decisis
References
29
Case No. MISSING
Regular Panel Decision

Hartford Accident & Indemnity Co. v. Commercial Union Insurance

This case involves a dispute between two insurance companies, Hartford Accident and Indemnity Company (excess insurer) and Commercial Union Insurance Company (primary insurer), concerning liability for an injury claim. Michael Jutt, an employee of Minuteman Press International, Inc., was injured while on a Minuteman-owned boat. Commercial Union, the primary insurer, denied coverage and refused to defend Minuteman, leading Hartford, the excess insurer, to provide defense and settle Jutt's claim for $135,000. Hartford subsequently sued Commercial Union for breach of fiduciary duty. The District Court affirmed Hartford's standing to sue, recognizing a direct fiduciary duty owed by a primary insurer to an excess insurer, and found that the "paid employees" exclusion in Commercial Union's policy was ambiguous. Consequently, the Court ruled in favor of Hartford, ordering Commercial Union to pay $135,000 plus interest.

Insurance LawExcess InsurancePrimary InsuranceFiduciary DutyEquitable SubrogationPolicy ExclusionAmbiguous Contract TermDeclaratory Judgment ActionStanding to SueMarine Insurance
References
5
Case No. MISSING
Regular Panel Decision
Jun 30, 1992

National General Insurance v. Hartford Accident & Indemnity Co.

This case concerns a declaratory judgment action regarding insurance coverage following a fatal airplane crash. Warren Geddes, president of American Investor Services, Inc. (AIS), was piloting a plane carrying Gary Conway, an AIS employee, when it crashed, killing both. National General Insurance Company, insurer of the plane owner, sought for Hartford Accident and Indemnity Company, AIS's workers' compensation insurer, to defend and indemnify AIS and Geddes' Estate in a wrongful death action. Hartford denied coverage for Geddes' Estate, arguing he was not a named or additional insured under their policy. The court modified the initial judgment, declaring that Hartford has no duty to defend or indemnify the Estate of Geddes, while otherwise affirming the judgment.

Insurance CoverageDeclaratory JudgmentWrongful DeathDuty to DefendDuty to IndemnifyNamed InsuredAdditional InsuredWorkers' Compensation PolicyAirplane CrashEstate Liability
References
5
Case No. W2008-01771-COA-R3-CV
Regular Panel Decision
Jan 26, 2011

Shelby County Health Care Corporation, d/b/a Regional Medical Center v. John Baumgartner, Elizabeth Baumgartner, a/k/a Daray Baumgartner, Nationwide Mutual Insurance Company, and Hartford Accident and Indemnity

This appeal concerns the impairment of a hospital lien by Shelby County Health Care Corporation (The MED) against John Baumgartner and his insurance providers, Nationwide Mutual Insurance Company and Hartford Accident and Indemnity. Mr. Baumgartner received extensive medical treatment at The MED following an automobile accident, incurring over $500,000 in expenses, for which The MED filed a hospital lien. Subsequently, Nationwide and Hartford settled with the Baumgartners, paying out policy limits of $25,000 and $100,000 respectively, without remitting any funds to The MED. The trial court initially granted partial summary judgment, finding impairment of the lien and awarding damages. On appeal, the Court of Appeals affirmed the finding of lien impairment but reversed the damage awards, concluding that The MED's recovery is limited to one-third of the amounts the insurers paid to the Baumgartners, and remanded the case for further proceedings consistent with this interpretation.

Hospital Lien ActInsurance LawAutomobile AccidentSubrogationMade-Whole DoctrineStatutory InterpretationDamages for ImpairmentConstructive NoticeMedical ExpensesSettlement Agreements
References
33
Case No. MISSING
Regular Panel Decision

Home Life & Accident Insurance Co. v. Phillips-Dupre Hospital

The case revolves around a venue dispute in Hockley County, Texas, under Exception 28 to Article 1995, Vernon’s Texas Civil Statutes. Phillips-Dupre Hospital (appellee) sued Home Life and Accident Insurance Company (appellant) for nonpayment of medical services provided to Mexican Nationals, who were insured under a policy issued by Home Life to Texas Producers Cooperative, Inc. The core issue was whether Phillips-Dupre Hospital qualified as a "beneficiary" under the insurance policy, which would allow the suit to be heard in Hockley County. The court analyzed the policy terms, finding that it stipulated payments for medical expenses were to be made directly to the service provider, effectively designating the hospital as a beneficiary when Mexican Nationals received treatment there. The court affirmed the trial court's judgment, overruling the appellant's point of error regarding venue.

Venue DisputeInsurance Policy InterpretationBeneficiary RightsMexican NationalsMigrant Labor AgreementTexas Civil StatutesMedical Services PaymentContract LawAppellate Review
References
2
Case No. MISSING
Regular Panel Decision

O'Keefe v. General Accident Insurance

Plaintiff Violet O'Keefe initiated an action against General Accident Insurance Company, alleging disparate treatment and retaliation based on age and sex, violating Title VII, ADEA, and New York Human Rights Law. O'Keefe claimed a discriminatory work environment and unlawful termination following her refusal of a proposed job transfer. The defendant argued O'Keefe's performance was poor and the transfer was a lateral move. The District Court denied the defendant's motion for summary judgment regarding the federal discrimination and retaliation claims, finding a genuine issue of material fact existed as to whether General Accident's reasons for termination were pretextual. However, the Court granted summary judgment for the defendant on the state law claims, declining to exercise pendent jurisdiction.

DiscriminationAge DiscriminationSex DiscriminationTitle VIIADEARetaliationSummary JudgmentEmployment LawPretextPrima Facie Case
References
19
Case No. MISSING
Regular Panel Decision

Salameh v. Provident Life & Accident Insurance

Dr. Raja N. Salameh, a urologist, sued Provident Life & Accident Insurance Company for denying disability benefits after a fall. The court determined that Salameh's disability policy was part of an ERISA-governed employee benefit plan due to the involvement of another physician, Dr. Gary Hurwitz, as an employee of Salameh's practice, Urology Associates. This finding negated the "safe-harbor" exemption from ERISA coverage, and Salameh, despite being a partner, had standing as a plan beneficiary. Consequently, all his state law claims under the Texas Insurance Code were preempted by ERISA, establishing ERISA as his exclusive remedy. Furthermore, the court ruled that Salameh was not entitled to a jury trial because ERISA claims are considered equitable in nature.

ERISADisability InsuranceERISA PreemptionJury TrialEmployee BenefitsIndependent ContractorPartnershipTexas Insurance CodeFederal Common LawWelfare Benefit Plan
References
82
Case No. M2012-00331-COA-R3-CV
Regular Panel Decision
Jan 30, 2013

Erie Insurance Exchange v. Columbia National Insurance Company

This is a declaratory judgment action between two insurance companies. Erie Insurance Exchange, a general liability insurer, sought a declaration that Columbia National Insurance Company, an automobile insurer, had the primary duty to defend and indemnify an insured in a third-party tort action. The tort action stemmed from a construction site accident where an employee was electrocuted by a crane on a 'boom truck' owned by Nashville Building Systems (NBS) and listed under Columbia's auto policy. The trial court denied Erie's motion for summary judgment and granted Columbia's, holding Erie liable. The Court of Appeals affirmed the trial court's decision, finding that the Workers' Compensation Statute provided an exclusive remedy and that the boom truck, when used as a stationary crane, qualified as 'mobile equipment' and was thus excluded from coverage under Columbia's auto policy at the time of the injury.

Declaratory JudgmentInsurance Coverage DisputeAutomobile Insurance PolicyGeneral Liability PolicyWorkers' Compensation ActMobile Equipment ExclusionStatutory EmployerThird-Party TortfeasorBoom Truck AccidentSummary Judgment
References
45
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