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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
Jun 16, 2006

Fortis Benefits v. Cantu

Vanessa Cantu suffered severe injuries in a car accident and sued multiple parties. Her medical insurer, Fortis Benefits, intervened, seeking subrogation for medical benefits paid under the policy. After Cantu settled with the defendants, Fortis pursued recovery from Cantu. Cantu argued that the equitable "made whole" doctrine barred Fortis's claim because her total losses exceeded the settlement amount plus the benefits Fortis paid. The trial court and court of appeals sided with Cantu. The Texas Supreme Court reversed, holding that the "made whole" doctrine does not override an insurer's clear contractual subrogation rights. The Court affirmed the dismissal of Fortis's claims against Ford due to a pretrial agreement.

Insurance SubrogationMade Whole DoctrineContractual SubrogationEquitable SubrogationERISATexas LawInsurance Policy InterpretationPersonal InjuryAutomobile AccidentSettlement Proceeds
References
28
Case No. 2014-01-0002
Regular Panel Decision
Oct 16, 2015

Howard, Denita v. US Xpress Enterprises

Denita Howard, a trainee truck driver for USXpress Enterprises, Inc., filed for an expedited hearing seeking medical benefits for emergency treatment after a work injury and temporary partial disability benefits. The alleged injury occurred when her tractor-trailer overturned near Acadia, Louisiana. The Court found Ms. Howard entitled to the requested medical benefits for charges from Jefferson Davis Emergency Group, LLC, as the employer's carrier, Liberty Mutual, had already paid the bill. However, her claim for temporary partial disability benefits from January 7, 2015, to February 18, 2015, was denied, as she was deemed to have reached maximum medical improvement as of December 18, 2014, by Dr. Venugopal Gadipudi. The employer's request for reimbursement of temporary partial disability benefits paid after the MMI date was deferred.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Partial DisabilityMaximum Medical Improvement (MMI)Emergency TreatmentTruck Driver InjuryMotor Vehicle AccidentNeurological CareInsurance Carrier Liability
References
4
Case No. MISSING
Regular Panel Decision
Jul 13, 2001

A.I. Transport v. New York State Insurance Fund

The Supreme Court, New York County, denied a liability insurer’s application to stay an arbitration initiated by a workers’ compensation insurer. The workers’ compensation insurer sought to recover benefits paid to a bus passenger injured in an accident, where the bus was insured by the liability insurer. The court interpreted Insurance Law § 5105 (a) to allow a workers’ compensation provider, paying benefits in lieu of first party benefits, to recover amounts paid from the insurer of a liable party, even if one of the vehicles involved is a bus. It was determined that an exception for losses arising from the use of a motor vehicle (Insurance Law § 5103 [a] [1]) did not apply, as the respondent was a workers’ compensation insurer and not an automobile insurer. Consequently, the arbitration was allowed to proceed, and the petition to stay it was dismissed and unanimously affirmed.

Arbitration DisputeInsurance Law InterpretationNo-Fault BenefitsWorkers' Compensation SubrogationBus AccidentLiability CoverageStatutory ConstructionAppellate ReviewInsurer Recovery
References
4
Case No. MISSING
Regular Panel Decision

Cook v. Pension Benefit Guarantee Corp.

The Trustees of the Local 852 General Warehouseman’s Union Pension Fund sued the Pension Benefit Guarantee Corporation (PBGC) seeking reimbursement for pension benefits paid to retirees of two closed warehouses. The Fund argued for recovery based on equitable estoppel, asserting detrimental reliance on an initial PBGC determination that it would guarantee these benefits. The PBGC moved for summary judgment, contending that estoppel against a federal agency requires a showing of affirmative misconduct or manifest injustice. The Court found no evidence of affirmative misconduct by the PBGC and concluded that its change in determination, made to conform with Congressional intent, did not constitute manifest injustice. Consequently, the Court granted the PBGC's motion for summary judgment, ruling that equitable estoppel was inapplicable.

Equitable EstoppelFederal Agency EstoppelSummary JudgmentERISAPension BenefitsMulti-employer PlanPension Benefit Guarantee Corporation (PBGC)Affirmative MisconductManifest InjusticeDetrimental Reliance
References
10
Case No. 2020-05-0875
Regular Panel Decision
Aug 09, 2021

Summers, Sonney v. RTR Trans Services

Sonney Summers, as the surviving spouse of Christine Summers, filed a Petition for Benefit Determination after RTR Transportation initially denied his claim for death benefits. Christine Summers died tragically while working for RTR. After mediation, RTR accepted the claim and paid funeral expenses, but Mr. Summers sought a lump-sum commutation of death benefits. The Court denied the lump-sum request, citing that benefits for a sole dependent spouse cannot be commuted due to uncertainties like remarriage or death, and that Mr. Summers failed to demonstrate exceptional circumstances or a wise management plan. However, the Court awarded periodic death benefits of $558.23 weekly and granted attorneys' fees of twenty percent on the total award, excluding funeral expenses, to be paid periodically.

Death BenefitsSurviving SpouseLump Sum CommutationAttorney's FeesWorkers' Compensation ActStatutory InterpretationDependencyFuneral ExpensesPeriodic PaymentsTennessee Law
References
12
Case No. MISSING
Regular Panel Decision

Travelers Indemnity Co. of Rhode Island v. Starkey

The Travelers Indemnity Company of Rhode Island appealed a trial court's judgment that awarded death benefits to Lynn Edward Starkey and Hazel Dean Starkey under the Texas Workers’ Compensation Act. The case stemmed from Jonathan Starkey's work-related injuries in 1984, for which Travelers paid indemnity benefits until his death in 2001. His parents subsequently sought death benefits, which Travelers disputed, asserting a right to deduct previously paid benefits. The trial court found that Travelers had waived this credit in a third-party settlement agreement. The appellate court affirmed, concluding that the contractual language constituted a waiver of Travelers' rights to an offset and upheld the award of benefits, attorneys' fees, interest, and costs to the Starkeys.

Workers' CompensationDeath BenefitsIndemnity BenefitsThird-Party SettlementContractual WaiverCredit OffsetWage Rate DisputeAppellate CourtTexas LawEvidentiary Sufficiency
References
22
Case No. MISSING
Regular Panel Decision

Claim of Falkouski v. City of Rensselaer Fire Department

Decedent, who held a paid position as an assistant fire chief and was also a volunteer firefighter, died from a ruptured cerebral aneurysm while at a fire. His surviving spouse filed claims under both the Workers’ Compensation Law and the Volunteer Firefighters’ Benefit Law. Initially, a workers' compensation law judge found the death causally related to volunteer duties, but the Workers’ Compensation Board reversed, determining that the decedent was acting in his paid capacity as an assistant fire chief, thus falling under the Workers’ Compensation Law. The claimant appealed this decision. The appellate court affirmed the Board's determination, citing substantial evidence that at the time of death, the decedent was engaged as a paid employee due to his duties, pay, and supervisory role, which were beyond those of a volunteer firefighter.

Volunteer Firefighters' Benefit LawWorkers' Compensation LawDeath benefitsCerebral aneurysmAssistant fire chiefEmployee vs. Volunteer statusSubstantial evidenceAppellate reviewSupervisory roleCausal relationship
References
5
Case No. MISSING
Regular Panel Decision

State Farm Mutual Automobile Insurance Co. v. Pender

This case involves a subrogation action initiated by an unnamed plaintiff (subrogee) to recover $15,200 in additional personal injury protection (APIP) benefits paid to its subrogor, Darci Plumbing Co., Inc., for an employee, Kareem Atkins. The defendants moved to dismiss the complaint based on documentary evidence, collateral estoppel, and res judicata, arguing that a prior Workers’ Compensation Board decision from November 24, 2008, which awarded Atkins basic economic loss benefits, was determinative. The plaintiff cross-moved for sanctions. The court found that APIP benefits, defined by 11 NYCRR 65-1.3, are distinct from statutory basic economic loss benefits and that an insured's subrogation rights for APIP are equitable, existing under common law. Therefore, the workers' compensation award was not res judicata, and the plaintiff was not precluded from asserting its subrogation rights for amounts paid in addition to the statutory basic economic loss. Consequently, the defendants' motion to dismiss was denied, and the plaintiff's cross-motion for sanctions was also denied.

SubrogationAPIP BenefitsPersonal Injury ProtectionWorkers' CompensationCollateral EstoppelRes JudicataMotion to DismissSanctionsNo-Fault LawInsurance Law
References
1
Case No. MISSING
Regular Panel Decision

Liberty Mutual v. Kinser

The case addresses whether a workers' compensation carrier has a subrogation right to benefits paid to an employee under their personal uninsured/underinsured motorist (UIM) insurance coverage. Michael Kinser, injured in an automobile accident during employment, received workers' compensation benefits from Liberty Mutual. After receiving payment from the at-fault driver's insurer, Liberty Mutual sought subrogation from Kinser's personal UIM policy with State Farm. The trial court denied Liberty Mutual's claims, and the appellate court affirmed. The court held that the Texas Labor Code's subrogation provision applies to 'damages' from a third party liable in tort or contract, not to contractual UIM benefits, especially when the employee paid the premiums. Consequently, Kinser was not liable for conversion.

Workers' CompensationSubrogation RightsUninsured/Underinsured Motorist (UIM)Insurance LawTexas Labor CodeContractual BenefitsTortious ActSummary JudgmentAppellate AffirmationPersonal Insurance Policy
References
33
Case No. 2020-08-0309
Regular Panel Decision
Jan 26, 2021

Bryant, Joshua v. Malco Theaters, Inc.

Joshua Bryant requested additional medical and temporary disability benefits for a head injury sustained while working for Malco Theaters Inc. The employer argued that Bryant filed his Petition for Benefit Determination (PBD) outside the applicable statute of limitations and had already paid all entitled benefits. Bryant received initial medical evaluations from various providers, including neurologists Dr. Alan Nadel and Dr. Mohammed Assaf. Dr. Nadel eventually placed Bryant at maximum medical improvement with no impairment and returned him to regular duty. Malco's claim handler stated the last payment of medical benefits was on March 22, 2019. Bryant filed his PBD on March 26, 2020, which was more than one year after the last payment. The Court concluded that Bryant's claim was barred by the one-year statute of limitations and consequently denied his request for benefits.

Statute of LimitationsHead Injury ClaimMedical BenefitsTemporary Disability BenefitsPetition for Benefit DeterminationMaximum Medical ImprovementNeurological EvaluationWorkers' Compensation Claims CourtClosed-Head InjuryDizziness
References
0
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