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

Case No. 13-16-00315-CV
Regular Panel Decision
Jun 14, 2016

in Re Accidental Fund General Insurance Company

The relators, Accident Fund General Insurance Company and Kriste Henderson, filed a petition for writ of mandamus and a motion for temporary relief. They seek to compel the trial court to grant their plea to the jurisdiction, arguing that the claims fall under the exclusive jurisdiction of the Texas Department of Insurance, Division of Workers’ Compensation. The Court of Appeals for the Thirteenth District of Texas granted their motion for temporary relief, staying all trial court proceedings pending further order or final decision of the Court. The real parties in interest, Ricky Sayaz, Nelda Ramirez, and Coil Tubing Solutions, LLC, are requested to file a response to the petition for writ of mandamus within ten days.

MandamusTemporary ReliefStay OrderJurisdictionWorkers' CompensationTexas Court of AppealsPlea to the JurisdictionOriginal ProceedingRelatorReal Party in Interest
References
4
Case No. 13-21-00361-CV
Regular Panel Decision
Oct 12, 2023

Accident Fund General Insurance Company v. Rodrigo Mendiola

Rodrigo Mendiola, a truck driver, suffered severe burns in an accident, leading to an above-the-knee amputation and significant injury to his left hand. His employer's workers' compensation insurer, Accident Fund General Insurance Company, disputed his claim for lifetime income benefits based on the total loss of use of his left hand. The trial court, applying the Travelers Insurance Co. v. Seabolt standard, found sufficient evidence that Mendiola's hand lacked substantial utility, entitling him to benefits. The Court of Appeals affirmed the trial court's judgment, upholding the application of the Seabolt standard and concluding the evidence factually supported the finding of total loss of use.

Workers' CompensationLifetime Income BenefitsTotal Loss of UseBurn InjuriesHand InjuryAmputationMedical EvidenceFactual SufficiencyAppellate ReviewStare Decisis
References
29
Case No. MISSING
Regular Panel Decision

Second Injury Fund v. American Motorists Insurance Co.

This case addresses whether a 1971 amendment to Texas workers' compensation law (Article 8306, Sections 12c and 12c-l) permits an insurance carrier to be reimbursed from the Second Injury Fund when an employee's total and permanent incapacity results from a combination of general, rather than specific, injuries. The trial court had granted a $16,000 judgment for the carrier, American Motorist Insurance Company, but the Second Injury Fund appealed. Citing the precedent set in Second Injury Fund v. Keaton, the appellate court clarified that the 1971 amendment did not expand the fund's liability beyond specific injuries. The court emphasized that legislative intent to alter this established rule was not evident in the amendment. Consequently, the appellate court reversed the trial court's judgment, ruling against reimbursement for general injuries.

Second Injury FundWorkers' CompensationGeneral InjuriesSpecific InjuriesReimbursementStatutory InterpretationArticle 8306Vernon’s Ann.Civ.St.Appellate ReviewLegislative Intent
References
6
Case No. MISSING
Regular Panel Decision

O'Hare v. General Marine Transport Corp.

In this opinion, the District Court denied General Marine Transport Corporation's motion to amend a prior judgment that awarded damages to the Trustees of the New York Marine Towing and Transportation Industry Pension Fund and Insurance Fund. General Marine sought to amend the judgment based on the recent Supreme Court ruling in DelCostello v. International Brotherhood of Teamsters, arguing for the application of a six-month limitations period. The court determined that DelCostello specifically applies to "hybrid 301/fair representation" claims and does not necessitate a departure from the previously applied six-year New York state statute of limitations for breach of contract actions, citing Auto Workers v. Hoosier Corp. Therefore, the motion was denied, reaffirming the earlier decision.

Motion to Amend JudgmentStatute of LimitationsLabor LawBreach of ContractFederal Rules of Civil ProcedureNational Labor Relations ActLabor Management Relations ActHybrid 301/Fair Representation ClaimsPension FundInsurance Fund
References
16
Case No. MISSING
Regular Panel Decision

Bryam Hills Central School District No. 1 v. State Insurance Fund

This case involves an appeal concerning the obligations of the State Insurance Fund under insurance policies. The Bryam Hills Central School District No. 1 sought a declaratory judgment to compel the State Insurance Fund to defend actions initiated by Dorothy G. Caruolo. The initial Supreme Court judgment had granted summary judgment to the school district, mandating the State Insurance Fund to provide a defense. The appellate court modified this judgment, affirming the State Insurance Fund's duty to defend the first Caruolo action due to sufficient general negligence allegations, thereby invoking policy coverage. However, the court reversed the requirement to defend two other actions seeking salary and benefits, as these claims were rooted in contract and expressly excluded by the policy, negating any duty to defend in those specific instances.

Insurance Policy ObligationsDuty to DefendDeclaratory JudgmentSummary JudgmentAppellate ReviewContract ExclusionWorkers' Compensation ImplicationsNegligence ClaimsInsurance Coverage DisputeSupreme Court Appeal
References
4
Case No. 03-01-00631-CV
Regular Panel Decision
Jun 21, 2002

Everest National Insurance Company v. Texas Workers' Compensation Commission Subsequent Injury Fund Leonard W. Riley, Jr., in His Official Capacity as Director of Texas Workers' Compensation Commission And John Casseb, in His Official Capacity as Administrator of Subsequent Injury Fund

Everest National Insurance Company (Everest) sought reimbursement from the Subsequent Injury Fund for overpaid workers' compensation benefits after district court judgments reversed prior agency decisions. The Fund denied a portion of the requested amount, leading Everest to file a declaratory judgment suit in district court. The district court dismissed the suit, citing lack of subject-matter jurisdiction due to Everest's alleged failure to exhaust administrative remedies. The Texas Court of Appeals reversed this decision, holding that Everest was not required to exhaust administrative remedies because the Fund had previously stated no such remedies existed. The appellate court found Everest was authorized to bring a direct suit for declaratory relief under the Uniform Declaratory Judgments Act to enforce the Fund's statutory obligation, remanding the case for a decision on the merits.

Workers' CompensationInsurance ReimbursementSubsequent Injury FundAdministrative Procedure ActDeclaratory JudgmentExhaustion of Administrative RemediesSubject-Matter JurisdictionStatutory InterpretationTexas Court of AppealsJudicial Review
References
8
Case No. MISSING
Regular Panel Decision

Cicatello v. Brewery Workers Pension Fund

This case addresses an action brought by employees and retired employees of the New York State Teamsters Conference Pension and Retirement Fund (Teamsters Fund) seeking to enjoin the merger of the Teamsters Fund with the Brewery Workers Pension Fund. Plaintiffs alleged multiple violations of the Employee Retirement Income Security Act of 1974 (ERISA), including insufficient employee notification of the proposed merger, potential reduction in benefits, and failure to meet minimum funding standards. Chief Judge Curtin of the federal court determined that ERISA provisions cited by plaintiffs were either inapplicable to multiemployer plans at the time or had established mechanisms to address the concerns. The court also found the claim regarding the merger not being in the best interests of Teamsters Fund participants to be barred by res judicata due to prior state court decisions. Consequently, the court denied the request for preliminary injunctive relief and dismissed the complaint for failure to state a claim.

Employee Retirement Income Security Act (ERISA)Pension FundsFund MergerPreliminary InjunctionDeclaratory JudgmentRes JudicataMulti-employer PlansFiduciary DutyMinimum Funding StandardsTax Qualification
References
12
Case No. MISSING
Regular Panel Decision

Methodist Hospital v. State Insurance Fund

This case concerns the constitutionality of a $190 million transfer from the State Insurance Fund (SIF) to New York State's general fund, as directed by chapter 55 of the Laws of 1982. Plaintiffs, employers insured by the SIF, challenged the transfer on multiple state and federal constitutional grounds, including impairment of contractual obligations, deprivation of property without due process, unlawful taking, and improper legislative intrusion. The defendants included the SIF, its officials, the State Comptroller, and the State. Special Term and the Appellate Division both ruled the transfer constitutional. The Court of Appeals affirmed, holding that the SIF is a State agency for which the State is responsible, not a mutual insurance pool, thereby negating any property or contractual interest of policyholders in its surplus. The Court also dismissed other constitutional challenges related to separation of powers, loan of state credit, creation of debt, and appropriation bills.

State Insurance FundConstitutional LawFund TransferState AgencyMutual InsuranceProperty RightsContract ImpairmentDue ProcessJust CompensationSeparation of Powers
References
17
Case No. MISSING
Regular Panel Decision

General Electric Co. v. Kunze

Appellee Curtis T. Kunze was awarded damages by a jury after being discharged from his employment with General Electric Company and General Electric Supply Company in violation of Texas Worker’s Compensation Statutes, article 8307c. The damages included lost past and future wages and benefits, and exemplary damages for willful and malicious termination. General Electric appealed, contending that Kunze was fired for poor performance, not for filing a worker's compensation claim, and challenged the sufficiency of evidence for damages and the recoverability of exemplary damages. The appellate court affirmed the lower court's judgment, finding ample evidence to support the jury's findings of wrongful termination and the awarded damages. It also clarified that future lost wages are recoverable under the statute and that prejudgment interest was already factored into the damage awards.

Worker's CompensationWrongful TerminationRetaliatory DischargeExemplary DamagesLost WagesLost BenefitsFuture DamagesPrejudgment InterestEvidence AdmissibilityExpert Witness
References
9
Case No. 10-93-224-CV
Regular Panel Decision
May 18, 1994

Subsequent Injury Fund of the State of Texas (Formerly the Second Injury Fund) v. Larry Milligan

The Subsequent Injury Fund appeals a judgment awarding Larry Milligan lifetime benefits for injuries sustained at work. Milligan suffered two ankle injuries in 1987 and a third in 1989, leading to the total loss of use of both feet. He sued the Fund for lifetime benefits after settling with the workers' compensation carrier. The jury found permanent, total loss of use of both feet. The Fund challenged its statutory liability for lifetime benefits and the court's refusal to submit a jury question on total and permanent incapacity. The appellate court affirmed, finding the first issue unpreserved and the second resolved by a statutory conclusive presumption of total and permanent incapacity for the loss of both feet.

Workers' Compensation LawSubsequent Injury FundLifetime BenefitsTotal Permanent IncapacityAnkle InjuriesStatutory InterpretationAppellate ReviewJury InstructionsConclusive PresumptionOccupational Injuries
References
6
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