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

Case No. 03-03-00176-CV
Regular Panel Decision
Dec 04, 2003

Texas Workers' Compensation Insurance Fund/Texas Workers' Compensation Commission and Leonard D. Watts v. Texas Workers' Compensation Commission and Leonard D. Watts/Texas Workers' Compensation Insurance Fund

This case involves a cross-appeal stemming from a workers' compensation claim by Leonard D. Watts, who sought lifetime income benefits for injuries sustained as a truck driver. The Texas Workers' Compensation Commission (appeals panel) initially reversed a hearing officer's decision and awarded Watts benefits, but this decision was later set aside by a Travis County district court. In this appeal, the Texas Workers' Compensation Insurance Fund (Texas Mutual) and the Commission challenged the district court's ruling. The Court of Appeals addressed arguments regarding the appeals panel's statutory authority for factual-sufficiency review and the interpretation of "issue" under the labor code, including legal doctrines of res judicata and collateral estoppel. The court ultimately reversed the judgment of the district court, thereby affirming the decision of the Commission's appeals panel which granted Watts lifetime income benefits.

Workers' CompensationLifetime Income BenefitsAppeals Panel ReviewFactual SufficiencyStatutory AuthorityCross-AppealRes JudicataCollateral EstoppelCausationMaximum Medical Improvement
References
17
Case No. 07-02-0169-CV
Regular Panel Decision
Jan 14, 2003

Texas Workers' Compensation Commission v. Texas Workers' Compensation Insurance Fund

The Texas Workers' Compensation Commission (Commission) appealed a summary judgment that relieved the Texas Worker's Compensation Insurance Fund (Insurance Fund) of liability for workers' compensation benefits to Glenn Everett, the real party of interest. The Commission contended that the Texas Workers' Compensation Act abrogates the common law defense of election of remedies and that Everett did not make an election. Everett had previously settled a personal injury suit for $37,500 and later pursued a worker's compensation claim. The Court of Appeals affirmed the trial court's decision, finding that the Act does not abrogate the election of remedies defense and that Everett made an informed choice to elect remedies by settling his claim after consulting with attorneys, thus barring his right to workers' compensation benefits.

Workers' CompensationElection of RemediesSummary JudgmentTexas Appellate CourtStatutory InterpretationCommon Law DefenseIndemnificationSettlement AgreementEmployee StatusInsurance Fund Liability
References
18
Case No. 2023 NY Slip Op 00139 [212 AD3d 972]
Regular Panel Decision
Jan 12, 2023

Matter of Ceja v. Manetta Enters., Inc.

Claimant Pablo Figueroa Ceja filed for workers' compensation benefits after being injured while working for Manetta Enterprises, Inc. The State Insurance Fund (SIF) disputed coverage, claiming policy cancellation for nonpayment. However, both the Workers' Compensation Law Judge and the Workers' Compensation Board found SIF liable, ruling that SIF failed to strictly adhere to Workers' Compensation Law § 54 (5) by not sending a separate cancellation notice to Manetta, despite sharing an address with a related entity, Manco Enterprises of NY, Inc. The Appellate Division affirmed this decision, emphasizing the statutory requirement for individual notice to each insured entity unless a specific designee is appointed, and rejected SIF's new arguments regarding claimant's employment status as not properly preserved for appeal.

Workers' CompensationInsurance Policy CancellationNotice RequirementsStrict ComplianceAppellate DivisionEmployer LiabilityCarrier LiabilityStatutory InterpretationDual Entity PolicyAdministrative Appeal
References
6
Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission/East Side Surgical Center Clinic for Special Surgery And Surgical and Diagnostic Center, L.P. v. East Side Surgical Center Clinic for Special Surgery/Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. MISSING
Regular Panel Decision
May 21, 2015

Jamie Harvel and the Austin Police Association v. Texas Department of Insurance - Division of Workers' Compensation, and Commissioner Rod Borderlon, in His Official Capacity

Officer Jamie Harvel, an Austin Police Officer, was injured in a car accident while traveling to a temporary work assignment. The City of Austin, a self-insured entity, denied his workers' compensation claim, a decision upheld by the Division of Workers' Compensation. Harvel and the Austin Police Association sought judicial review and declaratory judgments regarding the scope of employment for peace officers and employer-directed travel. Appellees (the Division and Commissioner) filed a plea to the jurisdiction, which the trial court granted, leading to this interlocutory appeal. The appellate court affirmed the trial court's decision, finding that sovereign immunity barred the declaratory relief claims as they sought interpretation of rights under a statute rather than challenging a statute's validity, and the declaratory judgment claims were duplicative of the judicial review action. The Association's claims also lacked a justiciable controversy.

Workers' CompensationSovereign ImmunityPlea to the JurisdictionDeclaratory Judgment ActScope of EmploymentJudicial ReviewInterlocutory AppealTexas LawPolice OfficerTravel
References
17
Case No. 2017 NY Slip Op 04184 [150 AD3d 1589]
Regular Panel Decision
May 25, 2017

New York State Workers' Compensation Board v. Program Risk Management, Inc.

The New York State Workers' Compensation Board, acting as administrator and successor to the Community Residence Insurance Savings Plan, initiated legal action against various entities and individuals after the trust became severely underfunded. Defendants include Program Risk Management, Inc. (administrator), PRM Claims Services, Inc. (claims administrator), individual officers of PRM, the Board of Trustees, and Thomas Gosdeck (trust counsel). The plaintiff sought damages for claims such as breach of contract, breach of fiduciary duty, and legal malpractice. The Supreme Court's order partially dismissed some claims and denied others. On cross-appeal, the Appellate Division, Third Department, modified the Supreme Court's order, notably reversing the dismissal of several breach of fiduciary duty claims and common-law indemnification against PRMCS, while affirming denials of motions to dismiss breach of contract, legal malpractice, and unjust enrichment claims. The court's decision was influenced by recent rulings in State of N.Y. Workers' Compensation Bd. v Wang.

Workers' Compensation LawGroup Self-Insured TrustBreach of ContractBreach of Fiduciary DutyLegal MalpracticeUnjust EnrichmentStatute of LimitationsEquitable EstoppelAlter Ego LiabilityCommon-Law Indemnification
References
20
Case No. 2017 NY Slip Op 27428
Regular Panel Decision
Dec 14, 2017

New York State Workers' Compensation Bd. v. Compensation Risk Mgrs., LLC

This action was brought by the New York State Workers' Compensation Board (WCB), as an assignee of former members of the Healthcare Industry Trust of New York (HITNY), against Compensation Risk Managers, LLC (CRM), HITNY trustees, and auditing firm UHY LLP. The WCB alleged mismanagement, breach of fiduciary duty, and negligent auditing, leading to the Trust's insolvency. Defendants moved to dismiss on grounds of standing, statute of limitations, and pleading particularity. The court dismissed certain derivative claims and negligent misrepresentation claims against some trustees due to standing issues and statute of limitations. All claims against UHY LLP were dismissed for lack of a near-privity relationship or prior precedent. An implied indemnity claim against the trustees was sustained. The WCB's cross-motion to consolidate related actions was denied.

Workers' Compensation LawGroup Self-Insured Trust (GSIT)Fiduciary DutyNegligenceNegligent MisrepresentationStatute of LimitationsStandingDerivative ActionImplied IndemnityAuditing Firm Liability
References
46
Case No. MISSING
Regular Panel Decision

Workers' Compensation Board v. Met-Impro Services, Inc.

This case involves four related actions under Workers' Compensation Law § 26 concerning the enforcement of a Workers' Compensation award. The Supreme Court had erroneously granted defendant Robert San Miguel's motion to vacate judgments against him. San Miguel, identified as the president of the corporate employers, was held personally liable for unpaid benefits under Workers’ Compensation Law § 26-a (1) (a). The court clarified that personal liability for corporate officers does not depend on active management or involvement in the underlying accident. Furthermore, there is no statutory basis to vacate a judgment merely because an officer was not specifically named in the initial administrative determination. Consequently, San Miguel's vague denial of involvement was insufficient, and his motion to vacate the judgments against him was denied.

Workers' CompensationPersonal LiabilityCorporate OfficerJudgment VacationAdministrative LawAppellate ReviewStatutory InterpretationEmployer LiabilityUnpaid BenefitsNew York Law
References
3
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Fund v. Del Industrial, Inc.

The case involves a dispute between the Texas Workers' Compensation Insurance Fund and DEL Industrial, Inc. regarding workers' compensation insurance premiums for employees leased by DEL from Administrative Resources, Ltd. (ARL). ARL did not provide coverage for its leased employees. The Fund argued that DEL's policy should cover these workers based on the "coemployer" provision of the Staff Leasing Services Act (SLSA). The trial court initially sided with the Fund, but the court of appeals reversed. The Supreme Court affirmed the court of appeals' decision, holding that under the SLSA, the staff leasing company (ARL) has the exclusive right to elect or deny workers' compensation coverage for leased employees. The court clarified that the "coemployer" status only pertains to sharing the consequences of the staff leasing company's election, and the SLSA supersedes the common law right-of-control test for determining employer status in such situations. Consequently, DEL was not liable for the premiums for the leased workers.

Workers' Compensation InsuranceStaff Leasing Services ActCoemployer RelationshipLeased EmployeesInsurance PremiumsStatutory InterpretationRight-of-Control TestEmployer LiabilityTexas Labor CodeAppellate Review
References
12
Case No. 03-05-00494-CV
Regular Panel Decision
Feb 24, 2006

Mid-Century Insurance Company v. Texas Workers' Compensation Commission

This case concerns a dispute over the retroactive payment of lifetime income benefits (LIBs) under the Texas Workers' Compensation Act. Appellant Mid-Century Insurance Company challenged an administrative rule by the Texas Workers’ Compensation Commission (now Division of Workers’ Compensation) that required LIBs to be paid from the original date of disability. Mid-Century contended this rule exceeded the Division's statutory authority, making it liable for benefits before some employees were eligible. Although the district court ruled in favor of the Division, the Court of Appeals reversed this decision. The appellate court found that the rule indeed exceeded the Division's statutory powers, concluding that LIBs should be payable only when an employee becomes eligible for such benefits, not necessarily from the initial date of disability.

Workers' Compensation LawLifetime Income BenefitsAdministrative LawStatutory ConstructionRetroactive PaymentsTexas Appellate CourtsInsurance DisputeJudicial ReviewAgency AuthorityTravis County District Court
References
17
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