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Case Law Database

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

Case No. MISSING
Regular Panel Decision

State Farm Mutual Automobile Insurance v. Aetna Casualty & Surety Co.

This case concerns a dispute between insurance carriers following a workers' compensation claim. Douglas K. Ellsmore was injured while unloading a hospital bed when Shirley S. Miller, insured by State Farm Mutual Automobile Insurance Company, backed her car into him. Ellsmore's employer's workers' compensation carrier, Aetna Casualty and Surety Company, paid over $65,000 in benefits and then sought reimbursement from State Farm via a loss transfer claim and demanded arbitration under Insurance Law § 5105. State Farm initiated a special proceeding to permanently stay arbitration, arguing that Aetna's claim lacked legal basis. Special Term denied the stay, but the appellate court reversed this decision. The court clarified that the "for hire" provision in Insurance Law § 5105 modifies "vehicle," limiting its application to vehicles hired for transporting people (like taxis) or livery vehicles for property, and does not extend to commercial deliveries by an owner's vehicle. Consequently, Aetna was not entitled to recover compensation payments under this statute.

Insurance LawWorkers' CompensationAutomobile InsuranceLoss Transfer ClaimArbitration StayStatutory Interpretation"For Hire" ClauseCommercial DeliveryVehicle InsuranceFirst-Party Payments
References
1
Case No. MISSING
Regular Panel Decision

Scarbrough v. Murrow Transfer Co.

This case consolidates two wrongful death lawsuits filed by Mrs. Alberta Scarbrough and Claud Nolan against Murrow Transfer Company and Billy Ray Burge, stemming from a fatal motor vehicle accident on September 17, 1966. The accident, which resulted in the deaths of Randolph Scarbrough and Jimmy Ray Nolan, occurred when Burge, driving a tractor-trailer for Murrow Transfer, negligently crossed into the opposing lane, causing a collision with a United States Job Corps bus. The court found Burge and Murrow Transfer liable for negligence. Additionally, a third-party action for indemnity or contribution by the defendants against the United States of America was dismissed, with the court ruling that the Federal Employees Compensation Act provided the exclusive remedy for claims against the U.S. related to the Job Corps members' deaths. The plaintiffs were each awarded $28,000 in damages.

Motor Vehicle AccidentWrongful DeathNegligenceRespondeat SuperiorThird-Party ActionIndemnityContributionFederal Employees Compensation ActJob CorpsDamages
References
3
Case No. 03-97-00448-CV
Regular Panel Decision
Jan 14, 1999

Jeane Laurence v. State Farm Mutual Automobile Insurance Company

This appeal examines the validity of an automobile insurance policy provision. The provision allows for the reduction of uninsured motorist (UM) benefits by the amount of personal injury protection (PIP) benefits already paid to the insured. Appellant Jeane Laurence argued that this offset provision was invalid and unenforceable under Texas law and public policy, challenging the trial court's summary judgment in favor of appellee State Farm Mutual Automobile Insurance Company. The appellate court analyzed relevant Texas Insurance Code statutes and prior case law concerning UM and PIP coverages, particularly regarding the prevention of double recovery. The court ultimately affirmed the trial court's decision, concluding that the offset clause was valid when the insured's actual damages were less than the combined PIP and UM coverages.

Automobile InsuranceUninsured Motorist CoveragePersonal Injury ProtectionPIP OffsetInsurance Policy ValiditySummary JudgmentCollateral Source RuleDouble RecoveryStatutory InterpretationTexas Insurance Law
References
19
Case No. 19-0791, 19-0792
Regular Panel Decision
Mar 19, 2021

in Re State Farm Mutual Automobile Insurance Company and Todd Joseph Dauper

This case from the Supreme Court of Texas consolidates two petitions for writ of mandamus concerning underinsured motorist (UIM) insurance claims. Relators State Farm Mutual Automobile Insurance Company, Terecina Shahan, and Todd Joseph Dauper sought to overturn trial court denials of their motions for bifurcated trials. The underlying suits, brought by real parties in interest Al Dodds and Alexander Nicastro, alleged only extracontractual violations of the Texas Insurance Code, seeking UIM benefits as damages, but did not include breach-of-contract claims. State Farm argued that an insured must first establish legal entitlement to policy benefits by proving the underinsured motorist's liability and damages in an initial "car crash" trial, even if only statutory claims are pleaded. The Court agreed, holding that such a showing is a prerequisite for recovering on Insurance Code claims when damages are predicated on policy benefits. It found that denying bifurcation was an abuse of discretion, citing the need to preserve judicial resources and prevent prejudice from the admission of settlement offers. The Court conditionally granted the petitions, directing the trial courts to bifurcate the trials.

Underinsured Motorist InsuranceInsurance Code ClaimsBifurcation of TrialsWrit of MandamusExtracontractual ClaimsPolicy BenefitsTexas Civil ProcedureJudicial DiscretionTrial AbatementSettlement Offers
References
34
Case No. 13-99-814-CV
Regular Panel Decision
Feb 01, 2001

State Farm Mutual Automobile Insurance Co. v. Lopez, Alicia

This is an interlocutory appeal challenging a trial court's order certifying a class action. The appellees, Alicia Lopez, Adan Munoz, Jr., Juan Llanes, Diana Moreno, and Albert Alaniz, sued their automobile insurance carriers, State Farm Mutual Automobile Insurance Company, alleging wrongful failure to pay adequate dividends to policyholders despite significant corporate surpluses, breach of contract, and fraud. Appellants, State Farm and Wendy L. Gramm, contested the class certification on grounds of lack of jurisdiction, absence of a viable cause of action (challenging typicality), and antagonistic interests among class members (challenging adequate representation). The Court of Appeals affirmed the trial court's class certification order, ruling that the trial court had jurisdiction and did not abuse its discretion in finding that the class met the typicality and adequate representation requirements.

Class ActionInterlocutory AppealInsurance LawDividendsPolicyholdersJurisdictionTypicalityAdequate RepresentationAbuse of DiscretionTexas Law
References
37
Case No. MISSING
Regular Panel Decision

Lynch v. United States Automobile Ass'n

Plaintiff William Lynch initiated an action against the United States Automobile Association (USAA) for unpaid overtime wages, citing violations of the Fair Labor Standards Act (FLSA) and New York Labor Law. Lynch sought to amend his complaint to include other similarly situated employees who had opted into the collective action and to introduce California state-law claims for nine California-based plaintiffs. USAA opposed the amendment, primarily arguing that the court should decline supplemental jurisdiction over the California claims due to their purported novelty, complexity, potential to predominate over federal claims, or risk of jury confusion. Magistrate Judge Kevin Nathaniel Fox evaluated USAA's objections under 28 U.S.C. § 1367(c) and determined that the California state-law claims were not novel or complex, would not substantially predominate, and that jury confusion did not constitute an exceptional circumstance compelling a denial of jurisdiction. Consequently, the court granted Lynch's motion for leave to amend the complaint.

FLSAOvertime WagesFair Labor Standards ActNew York Labor LawCalifornia Labor LawRule 15(a)Supplemental JurisdictionMotion to Amend ComplaintCollective ActionClass Certification
References
11
Case No. 01-19-00821-CV
Regular Panel Decision
Mar 17, 2020

in Re State Farm Mutual Automobile Insurance Company

State Farm Mutual Automobile Insurance Company, the relator, sought mandamus relief after the trial court refused to abate extra-contractual claims filed by Amanda Marie Sanchez Garza, the real party in interest. Garza had sued State Farm for uninsured/underinsured motorist (UIM) benefits, a declaratory judgment, breach of the duty of good faith and fair dealing, and violations of the Texas Insurance Code and the Texas Deceptive Trade Practices-Consumer Protection Act (DTPA). While the trial court severed the extra-contractual claims, it denied State Farm's motion to abate them. The Court of Appeals for the First District of Texas determined that extra-contractual claims in UIM cases are predicated on the insured's entitlement to UIM benefits, which had not yet been established. Thus, litigating these claims prematurely would cause undue burden and expense to State Farm. The court conditionally granted the petition for writ of mandamus, directing the trial court to abate the extra-contractual claims until the declaratory action is resolved.

MandamusAbatementExtra-contractual ClaimsUninsured/Underinsured MotoristUIM BenefitsInsurance LawTexas LawAppellate ReviewAbuse of DiscretionDeclaratory Relief
References
27
Case No. MISSING
Regular Panel Decision

Duffy v. State Farm Mutual Automobile Insurance

Plaintiff Mary Duffy sued her former employer, State Farm Mutual Automobile Insurance Company, alleging age discrimination and retaliation after she was terminated at age 59. Duffy claimed harassment and a vendetta by supervisors, while State Farm maintained she was incompetent, accommodated her performance issues repeatedly, and fired her for poor work and bad attitude. The court reviewed her Age Discrimination in Employment Act (ADEA) claim and her retaliation claim, applying the McDonnell Douglas burden-shifting analysis. Though Duffy established a prima facie case, she failed to demonstrate that State Farm's legitimate, non-discriminatory reasons for termination were a pretext for discrimination or retaliation. Consequently, the court granted summary judgment in favor of State Farm on both claims.

Age DiscriminationRetaliation ClaimSummary JudgmentADEA (Age Discrimination in Employment Act)McDonnell Douglas AnalysisPrima Facie CasePretext for DiscriminationJob PerformanceEmployee TerminationWorkplace Harassment
References
17
Case No. 2014 NY Slip Op 06183 [120 AD3d 1315]
Regular Panel Decision
Sep 17, 2014

McDonald v. Winter Bros. Transfer Station Corp.

The plaintiff, Andrew McDonald, appealed from an order of the Supreme Court, Suffolk County, which granted the defendant Winter Bros. Transfer Station Corp.'s motion for summary judgment dismissing the complaint in an action to recover damages for personal injuries. The Appellate Division, Second Department, affirmed the order, holding that the defendant established a prima facie defense under the Workers' Compensation Law. The court found that the defendant and the plaintiff's employer, Winter Bros. Waste Systems, Inc., operate as a single integrated entity, thereby extending workers' compensation protection to the defendant as an alter ego of the employer. The plaintiff failed to raise a triable issue of fact in opposition to this defense, leading to the proper dismissal of the complaint.

Alter Ego DoctrineWorkers' Compensation DefenseSummary JudgmentPersonal InjuryEmployer LiabilityIntegrated EntityAppellate DivisionSuffolk CountyTriable Issue of FactRespondent
References
8
Case No. MISSING
Regular Panel Decision

State Farm Mutual Automobile Insurance Companies v. Brooks

This action arises from an alleged overpayment of no-fault benefits by State Farm to James Brooks. Brooks, injured in an automobile accident, received lost earnings benefits from State Farm, but was later furloughed from his job due to lack of work, not his injury, yet continued to receive full benefits. State Farm sought to recover the alleged overpayment, arguing an insurance regulation (11 NYCRR 65.6 (n) (2) (vi)) required a reduction to unemployment benefits if the position would have been lost regardless of the accident. The court, in a case of first impression, found this regulation invalid as applied to Brooks, conflicting with the Insurance Law's purpose of compensating for actual economic loss. Consequently, summary judgment was granted in favor of the defendant, James Brooks.

No-fault insuranceAutomobile accidentOverpayment of benefitsLost earningsUnemployment benefitsInsurance Law interpretationSummary judgmentStatutory conflictRegulation validityEconomic loss
References
13
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