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

Case No. 03-21-00086-CV
Regular Panel Decision
Aug 25, 2022

Texas Mutual Insurance Company v. Hofer Builders, Inc. and Hartford Underwriters Insurance Company

This workers' compensation case involves an appeal by Texas Mutual Insurance Company against Hofer Builders, Inc. (HBI) and Hartford Underwriters Insurance Company regarding the reimbursement of Louisiana workers' compensation benefits paid to HBI's employee, David Hope. The core legal question is whether Texas Mutual is liable under an endorsement for 'Texas Employees Injured in other Jurisdictions,' which requires the employee to have 'significant contacts' with Texas or for their employment to be 'principally located' in Texas under Labor Code sections 406.071 and 406.072. The court found that Hope was neither hired nor recruited in Texas and that his employment was not principally located in Texas, as he worked exclusively in Louisiana. Consequently, the appellate court reversed the trial court's decision, ruling that Texas Mutual is not liable for the Louisiana workers' compensation benefits.

Insurance LiabilityExtraterritorial CoverageSummary JudgmentAppellate ReviewTexas Labor CodeSignificant ContactsPrincipal Location of EmploymentLouisiana Compensation BenefitsDeclaratory JudgmentContractual Reimbursement
References
25
Case No. 04-24-00386-CV
Regular Panel Decision
Feb 26, 2025

In Re Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance v. the State of Texas

Edward Santos filed a lawsuit against Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance, alleging liability for his injuries being compensated through workers' compensation benefits, thereby limiting liability under other coverages. Texas Mutual and Bond challenged the trial court's denial of their pleas to the jurisdiction, arguing that the Texas Department of Insurance, Division of Workers' Compensation (the Division) had exclusive jurisdiction over Santos's claims. The Fourth Court of Appeals found that Santos's claims against Texas Mutual and Bond, predicated on the improper investigation, handling, or settlement of his workers' compensation claim, fell within the Division's exclusive jurisdiction, and he failed to exhaust administrative remedies. Consequently, the Court conditionally granted the petition for a writ of mandamus for Texas Mutual and Bond, directing the trial court to dismiss claims against them. However, the Court denied Allstate's petition, as Santos's claims against Allstate involved a liability claim against a non-workers' compensation carrier, which did not abrogate the Division's exclusive jurisdiction by re-litigating the course and scope of employment question.

MandamusWorkers' CompensationExclusive JurisdictionAdministrative RemediesPlea to the JurisdictionInsurance CodeDeceptive Trade Practices ActFraudConspiracyEmployer Liability
References
25
Case No. 03-04-00105-CV
Regular Panel Decision
Mar 03, 2006

Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company, and Liberty Insurance Corporation v. Texas Department of Insurance and Jose Montemayor, as Commissioner of Insurance Amber, Inc., Champagne-Webber, Inc. Churchill Truck Lines, Inc. And Royal Seating Corp.

Liberty Mutual Insurance Company and its affiliates appealed a district court judgment requiring them to issue rebates to workers' compensation policyholders for 1991 and 1992 surpluses. The appellants argued that a rule from the Texas Department of Insurance, which mandated these pass-throughs, unconstitutionally impaired their contractual rights, deprived them of property without due process, and constituted an impermissible retroactive law. The appeals court affirmed the district court's decision, finding that the Department's rule was a valid exercise of legislative power, served a legitimate public purpose by preventing insurers from retaining unforeseen windfalls, and did not violate constitutional prohibitions regarding retroactive legislation, contract impairment, or due process rights.

Insurance LawWorkers' Compensation InsuranceRetrospective Rating PlanInsurance RegulationConstitutional ChallengesContractual ObligationsDue ProcessRetroactive LegislationAppellate Court DecisionTexas Department of Insurance
References
35
Case No. 05-95-01259-CV
Regular Panel Decision
Feb 26, 1997

Lemke Concrete Construction v. Employers Mutual Casualty Company, Union Mutual Insurance Company of Providence, Emcasco Insurance Company, Patterson, Lamberty, Stanford, Walls & Dwyer, P.C. and John R. Robinson

Lemke Concrete Construction appealed the trial court's summary judgment in favor of Employers Mutual Casualty Company, Union Mutual Insurance Company of Providence, and Emcasco Insurance Company (carriers). Lemke alleged breach of contract, negligence, breach of good faith, and violations of the Texas Deceptive Trade Practices-Consumer Protection Act and Texas Insurance Code, stemming from the carriers' handling of a workers' compensation claim and a subsequent retaliatory discharge suit filed by Lemke's employee, Jesus Gonzalez. The carriers had settled the workers' compensation claim but denied coverage for the wrongful discharge claim, leading Lemke to incur legal fees and a settlement. The trial court granted summary judgment for the carriers, concluding that the policies did not cover wrongful discharge claims and, thus, the carriers owed no duty to defend or settle such claims. The appellate court affirmed the trial court's judgment, upholding that without coverage, Lemke's claims of bad faith and negligence were meritless, and estoppel could not create coverage.

Workers' CompensationSummary JudgmentBreach of ContractGood Faith and Fair DealingInsurance CoverageNegligenceTexas Deceptive Trade Practices-Consumer Protection ActTexas Insurance CodeVicarious LiabilityRetaliatory Discharge
References
31
Case No. No. 11-12-00339-CV
Regular Panel Decision
Nov 26, 2014

Alfred Elwess v. Farm Bureau County Mutual Insurance Company of Texas and Texas Farm Bureau Mutual Insurance Company

Alfred Elwess, injured in an auto accident, sought to recover under his underinsured motorist (UIM) coverage from Farm Bureau County Mutual Insurance Company of Texas and Texas Farm Bureau Mutual Insurance Company (Appellees). The Appellees filed a motion for summary judgment, arguing Elwess failed to obtain permission to settle with the tortfeasor and that his damages were covered by workers' compensation. The trial court granted summary judgment for the Appellees. The Eleventh Court of Appeals reversed, finding insufficient evidence that Elwess's failure to obtain permission materially prejudiced the Appellees' subrogation rights and that his damages were payable under workers' compensation, especially since his employer did not have such coverage. The court remanded the case for further proceedings.

Summary JudgmentUnderinsured Motorist (UIM)Insurance Coverage DisputeSettlement Without Consent ExclusionSubrogation RightsWorkers' Compensation ExclusionMaterial BreachActual PrejudiceAppellate ReviewDe Novo Review
References
7
Case No. 04-25-00040-CV
Regular Panel Decision
Nov 26, 2025

Enrique Cantu and Bridgefield Casualty Insurance Company v. Javier A. Libson, Nosbil, Inc., Jose Luis Ramirez, Utica National Insurance Group, Utica National Insurance Company of Texas, Utica Mutual Insurance Company, and Republic Franklin Insurance Company

Appellants Enrique Cantu and Bridgefield Casualty Insurance Company appealed a no-evidence summary judgment. Cantu's claims of negligence per se, negligent hiring, training, retention, and negligent entrustment were affirmed. However, the summary judgment for Cantu's ordinary negligence claims was reversed and remanded. Additionally, the judgment favoring the insurance defendants (Utica National Insurance Group, Utica National Insurance Company of Texas, Utica Mutual Insurance Company, and Republic Franklin Insurance Company) was also reversed, as their motion for summary judgment was not properly heard. The case involved a collision between Cantu and Jose Luis Ramirez, an employee of Nosbil, Inc., in foggy conditions, leading to Cantu suing for negligence and insurance claims.

NegligenceAutomobile AccidentSummary JudgmentAppellate ReviewProximate CauseDuty of CareBreach of DutyCausationInsurance ClaimsVicarious Liability
References
36
Case No. 03-03-00704-CV
Regular Panel Decision
Jan 21, 2005

Texas Mutual Insurance Company// Eckerd Corporation H.E. Butt Grocery Company Third-Party Solutions, Inc. Wal-Mart Stores, Inc. Apollo Enterprises, Inc. And Walgreen Company v. Eckerd Corporation H.E. Butt Grocery Company Third-Party Solutions, Inc. Wal-Mart Stores, Inc. Apollo Enterprises, Inc. And Walgreen Company//Cross-Appellee,Texas Mutual Insurance Company

This case involves cross-appeals concerning whether an insurance company must first exhaust administrative remedies under the Texas Workers' Compensation Act before filing a lawsuit for alleged overcharges by health care providers. Appellant Texas Mutual Insurance Company sued several pharmacies and billing companies for negligent misrepresentation and money had and received, claiming they over-billed for prescription drugs. The district court denied the defendants' motion to dismiss for lack of subject matter jurisdiction but granted partial summary judgment against Texas Mutual. The Court of Appeals, relying on prior precedent, determined that the Texas Workers' Compensation Commission holds exclusive jurisdiction over medical fee disputes within the Act's pervasive regulatory scheme. Consequently, the appellate court reversed the district court's judgment, concluding that the trial court lacked jurisdiction as Texas Mutual had not exhausted its administrative remedies.

Workers' Compensation ActAdministrative RemediesExclusive JurisdictionMedical Fee DisputesPharmaceutical Fee GuidelineOverbillingNegligent MisrepresentationMoney Had and ReceivedStatutory InterpretationAppellate Review
References
10
Case No. 03-05-00189-CV
Regular Panel Decision
Mar 21, 2008

Texas Department of Insurance, Division of Workers' Compensation v. Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, Inc.

The Texas Department of Insurance, Division of Workers' Compensation (the "Division") promulgated a rule (28 Tex. Admin. Code § 133.309) to create a less expensive alternative review procedure for workers' compensation claims concerning the necessity of medical treatment. The Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, L.P. (the "Joint Appellees") challenged the rule's validity in a declaratory judgment action. The district court granted the Joint Appellees' motion for summary judgment, declaring the rule invalid. The appellate court affirmed the district court's judgment, concluding that the rule was not in harmony with relevant governing statutes that allowed for judicial review of medical necessity disputes.

Workers' Compensation LawAdministrative LawJudicial ReviewStatutory InterpretationDeclaratory JudgmentSummary JudgmentMedical Necessity DisputesAlternative Dispute ResolutionAgency Rule ValidityTexas Court of Appeals
References
15
Case No. 03-17-0081-CV
Regular Panel Decision
Dec 29, 2017

PHI Air Medical, LLC v. Texas Mutual Insurance Company, Hartford Underwriters Insurance Company, TASB Risk Management Fund, Transportation Insurance Company, Truck Insurance Exchange, Twin City Fire Insurance Company, Valley Forge Insurance Company

This letter serves as a reply from Insurer Appellees Texas Mutual Insurance Company, et al. to the Third District Court of Appeals. It addresses arguments made by PHI Air Medical, LLC regarding the definition of the 'business of insurance' under the McCarran-Ferguson Act, particularly concerning payments made to third parties versus directly to insureds. The Insurers contend that PHI's proposed distinction lacks common sense and is contrary to established Supreme Court authority, citing cases such as U.S. Treasury v. Fabe. They argue that the actual performance of an insurance contract, including paying medical benefits to providers, is an essential part of the 'business of insurance' and that state laws prescribing contract terms directly regulate this business. The letter concludes by asserting that PHI’s arguments are inconsistent with both the practical workings of insurance and Supreme Court precedent.

McCarran-Ferguson ActBusiness of InsuranceThird-Party PaymentsInsurance Contract PerformanceWorkers' Compensation LawSupreme Court PrecedentAppellate ReviewTexas Workers' CompensationStatutory InterpretationInsurance Regulation
References
4
Case No. 14-09-00860-CV
Regular Panel Decision
May 26, 2011

Weingarten Realty Management Company and Scottsdale Insurance Company v. Liberty Mutual Fire Insurance Company

This case involves an appeal from a trial court's summary judgment in an insurance-coverage dispute. Appellants Weingarten Realty Management Company and Scottsdale Insurance Company sought to compel appellee Liberty Mutual Fire Insurance Company to defend Weingarten Management in an underlying lawsuit where it was mistakenly identified as a lessor. The appellate court affirmed the trial court's decision, allowing the consideration of extrinsic evidence as a narrow exception to the eight-corners rule. This exception applies when an insurer proves, using extrinsic evidence, that the party seeking defense is a stranger to the policy and could not be entitled to coverage under any circumstances, without touching on the merits of the underlying claim. The court concluded that Weingarten Management was not an actual lessor and therefore not an insured under Liberty Mutual's policy.

Insurance CoverageDuty to DefendEight-Corners Rule ExceptionExtrinsic EvidenceSummary Judgment ReviewAppellate Court DecisionInsurance Policy InterpretationLessor StatusContractual DisputesTexas Civil Procedure
References
30
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