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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

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. MISSING
Regular Panel Decision

Hudson v. Hudson Municipal Contractors, Inc.

This case examines whether a workers' compensation carrier can assert a subrogation lien against proceeds from an uninsured motorist settlement, particularly when the settlement has already been reduced by workers' compensation benefits. The plaintiff-appellant, Connie Hudson, widow of a deceased worker, settled her wrongful death claim with Grange Mutual Casualty Company, the uninsured motorist carrier. The defendant-appellee, Maryland Casualty Company, the workers' compensation carrier, sought to enforce a subrogation lien against these proceeds. The Supreme Court of Tennessee ruled that the uninsured motorist insurer's liability is contractual, not a "legal liability" from a tortfeasor, and therefore, the workers' compensation carrier's statutory subrogation rights, which are no greater than the insured's, do not extend to these contractual settlement proceeds. Consequently, the Court reversed the lower court's judgment, granting the appellant's motion for partial summary judgment.

Workers' Compensation SubrogationUninsured Motorist SettlementContractual vs. Tort LiabilityInsurance OffsetsWrongful Death ClaimsAppellate ReversalWorkers' Compensation BenefitsCarrier Recovery RightsStatutory InterpretationPolicy Limitations
References
7
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Fund v. Knight

The Texas Workers’ Compensation Insurance Fund (The Fund) appealed an order denying its subrogation rights concerning funds paid into the court registry by Safeguard Insurance Company. The individuals Susannah Knight, Susana Maldonado, and Houston R. Ewing received workers' compensation benefits from the Fund after an accident with an uninsured driver. The Fund sought reimbursement from uninsured motorist proceeds. The trial court denied the Fund's subrogation claim, prompting this appeal. The appellate court reversed, holding that the Fund had a statutory right of subrogation against the uninsured motorist policy proceeds. The court rejected arguments that the trial court could use its equitable powers to deny subrogation or that the funds should be treated as an advance against future benefits, emphasizing that the carrier is to be reimbursed first.

workers' compensationsubrogation rightsuninsured motoriststatutory interpretationTexas Labor Codeappellate reviewreimbursementequitable powersinsurance lawthird-party action
References
7
Case No. Sumner Circuit No. 15078-C, C.A. No. 01A01-9709-CV-00492
Regular Panel Decision
Jul 29, 1998

Benny Blankenship v. Estate of Joshua Bain

The central issue in this case is whether the Tennessee TennCare Program's statutory subrogation and/or assignment provisions are subject to the common law 'made whole' doctrine. Plaintiffs Benny and Sheila Blankenship, TennCare enrollees, were involved in an automobile accident, incurring substantial medical expenses, partially paid by TennCare. After settling with the at-fault party's insurer for less than their total damages, the Blankenships successfully argued in the trial court that TennCare's subrogation claim was barred by the 'made whole' doctrine. However, the Court of Appeals reversed this decision, asserting that statutory subrogation, unlike contractual subrogation, does not implicitly incorporate the 'made whole' doctrine unless explicitly stated in the statute. The court further clarified that while the state's right of subrogation is not subject to the 'made whole' doctrine, it is subject to the ordinary and reasonable attorney's fees incurred by the recipients.

SubrogationTennCareMade Whole DoctrineStatutory InterpretationMedicaidWorkers' CompensationAutomobile AccidentMedical ExpensesAttorney FeesEquitable Principles
References
7
Case No. MISSING
Regular Panel Decision

Mejia v. Trustees of Net Realty Holding Trust

The third-party defendant, Plaster Master, appealed an order and judgment from the Supreme Court, Queens County, which had denied its motion for judgment as a matter of law on a contractual indemnification claim. The lower court had found Plaster Master contractually obligated to indemnify Kimco Realty Services, Inc., the general contractor, in a case stemming from a personal injury lawsuit by a Plaster Master employee. The appellate court found the indemnification provision in the contract, drafted by Kimco, to be ambiguous. Due to the ambiguity and lack of clarifying parol evidence, the court resolved the ambiguity against Kimco. Consequently, the appellate court reversed the lower court's order, granted Plaster Master's motion, and dismissed Kimco's third-party claim for contractual indemnification.

Contractual IndemnificationAmbiguity in ContractParol EvidenceConstruction LawAppellate ReviewWorkers' Compensation LawGeneral ContractorSubcontractor LiabilityMeeting of the MindsThird-Party Action
References
6
Case No. 03-11-00688-CV
Regular Panel Decision
Jul 03, 2012

Approach Operating, LLC v. Resolution Oversight Corporation, as Special Deputy Receiver of Financial Insurance Company of America And the Texas Property and Casualty Insurance Guaranty Association

This case concerns an appeal from a summary judgment regarding a workers' compensation carrier's subrogation rights. Appellant Approach Operating, LLC, a general contractor, argued that the carrier had waived its subrogation rights through a Master Service Agreement (MSA) with subcontractor Lilly Construction, Inc. An employee of Lilly, Rodolfo Martinez, was injured and received workers' compensation benefits from Financial Insurance Company of America (FICA) and later The Texas Property and Casualty Insurance Guaranty Association (TPCIGA). The district court found no waiver of subrogation and granted summary judgment for FICA and TPCIGA. The Texas Court of Appeals, Third District, affirmed the lower court's judgment, emphasizing that explicit contractual language is required for a waiver of subrogation, which was absent in the MSA.

Workers' CompensationSubrogation WaiverMaster Service AgreementContract InterpretationSummary JudgmentTexas Court of AppealsInsurance LawOil and Gas IndustryExplicitness RuleThird-Party Claim
References
24
Case No. MISSING
Regular Panel Decision

Employers Casualty Co. v. Dyess

This case addresses the subrogation rights of a workers' compensation carrier (Employers Casualty Co.) in relation to the employer's uninsured motorist coverage provided by Northbrook Property and Casualty Co. Carl L. Dyess, Jr., an employee, received workers' compensation benefits from Employers after being struck by an uninsured driver, Felipe Mendoza, during his employment. Dyess then sought recovery under his employer's uninsured motorist policy with Northbrook. Employers intervened, asserting statutory, contractual, and equitable subrogation rights for the benefits paid. The trial court granted summary judgment against Employers, ruling its subrogation rights did not extend to uninsured motorist coverage. The appellate court reversed, holding that statutory subrogation rights are not limited to third-party tortfeasors and that policy clauses attempting to abrogate these statutory rights are invalid. The case was remanded for further proceedings consistent with the opinion, emphasizing the carrier's right to reimbursement to prevent double recovery by the employee.

Workers' CompensationSubrogation RightsUninsured Motorist CoverageSummary JudgmentStatutory InterpretationContractual LiabilityEquitable SubrogationInsurance LawTexas LawThird-Party Tortfeasor
References
38
Case No. 07-11-0038-CV
Regular Panel Decision
Oct 23, 2012

Westminster Falcon/Trinity L.L.P. v. Chong Shin

This case involves an appeal from an order granting summary judgment in a subrogation lawsuit. American Zurich Insurance Company (AZIC), as subrogee of The University of Texas Golf Club (UT), sued Barker Roofing, L.P. (Barker) for damages caused by a fire allegedly due to Barker's negligence during the construction of a clubhouse. Barker asserted the affirmative defense of waiver of subrogation, based on a clause in the original construction contract between UT and the prime contractor, Harvey-Cleary Builders (HCB). AZIC argued that two clauses in the subcontract modified the waiver, that the waiver did not apply to business interruption losses, and that the trial court erred by denying AZIC’s motion for partial summary judgment and granting summary judgment for Barker. The appellate court affirmed the summary judgment, concluding that the contractual waiver of subrogation applied to subcontractors like Barker and encompassed UT's business interruption losses, as AZIC's policy covered fire damages to the clubhouse. The court held that AZIC's subrogation claim was barred as a matter of law.

Subrogation WaiverConstruction ContractBusiness InterruptionSummary JudgmentInsurance CoverageAppellate ReviewContract InterpretationFire DamageNegligence ClaimThird-Party Beneficiary
References
36
Case No. MISSING
Regular Panel Decision

PIERCE & WEISS, LLP. v. Subrogation Partners LLC

Plaintiff Pierce & Weiss, LLP sued Subrogation Partners LLC, AON Recovery, Inc., and AON Re, Inc. for unpaid legal fees related to a breach of an attorney-client retainer contract. The central issue revolved around a motion for admission pro hac vice filed by attorneys Brian Letofsky and Daniel Watkins, seeking to represent Pierce & Weiss. Defendants opposed, arguing a conflict of interest due to Mr. Letofsky's prior and ongoing representation of Subrogation and AON in other matters. The Court determined that AON was a current client and Subrogation a former client of Mr. Letofsky, thus creating a conflict of interest due to divided loyalties. Consequently, the Court denied the motions for admission pro hac vice for both Mr. Letofsky and his partner, Mr. Watkins, disqualifying their firm, Watkins & Letofsky, from representing the plaintiff.

Attorney DisqualificationConflict of InterestPro Hac Vice MotionAttorney-Client RelationshipLegal EthicsLaw Firm RepresentationFee DisputeSubrogationRetainer AgreementProfessional Conduct Rules
References
32
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
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