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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

Employers Insurance v. General Accident, Fire & Life Assurance Corp.

Employers Insurance of Wausau (Wausau) sought summary judgment for 50% reimbursement of a $500,000 settlement and defense costs. The settlement stemmed from an underlying personal injury action where Frank Rayno, an employee of Sage Garage, was injured on a construction site in 1976. Wausau provided workers' compensation and employer's liability insurance to Sage Garage, while General Accident provided general liability coverage. Wausau paid the full settlement and then pursued General Accident for contribution. General Accident argued for a pro rata contribution based on policy limits. The court granted Wausau's motion for summary judgment, ruling that both insurers should contribute equally up to the limit of the smaller policy, which was General Accident's $500,000 policy, meaning General Accident owed $250,000. The defendants' cross-motion was denied.

Insurance disputeSummary judgmentDeclaratory judgmentContribution among insurersReimbursementPolicy limitsEmployer's liability insuranceGeneral liability insuranceWorkers' compensationPro rata contribution
References
0
Case No. MISSING
Regular Panel Decision

Houston General Insurance Co. v. Association Casualty Insurance Co.

This case involves an appeal stemming from a dispute between two workers' compensation insurance carriers, Houston General Insurance Company (Appellant) and Association Casualty Insurance Company (Appellee), regarding which carrier is obligated to pay compensation benefits to an injured employee, Johnnie Featherston, of Mallory Propane, Inc. Houston General initially paid the benefits and then sought judicial review after adverse administrative rulings. The core issue is whether Houston General waived its right to contest coverage by not disputing the claim within 60 days, as per Tex. Lab. Code Ann. § 409.021(c). Houston General argued that the issue was "coverage" rather than "compensability" and that waiver and estoppel do not create an insurance contract where none existed. The trial court granted summary judgment in favor of Association Casualty. The appellate court reversed the trial court's summary judgment, concluding that the issue was one of coverage, not compensability, and that waiver or estoppel could not extend coverage. However, the appellate court also denied Houston General's motion for summary judgment regarding equitable subrogation due to a need for a balancing of equities. The case was reversed and remanded for further proceedings.

Workers' CompensationInsurance CarriersCoverage DisputeWaiverEstoppelEquitable SubrogationSummary JudgmentTexas LawAppellate ReviewRemand
References
10
Case No. MISSING
Regular Panel Decision

Zurich General Accident & Liability Insurance Co. v. Holmes

This is an appeal in a workmen's compensation case from a District Court judgment in Jefferson County, Texas. The appellant, Zurich General Accident & Liability Insurance Company, Ltd., appealed a judgment for the injured employee, Holmes, regarding the nature and extent of his injury and wage rate. The jury found Holmes suffered a 17.5% partial permanent loss of his right leg's use due to an injury in July 1952 while working for Pure Oil Company. The trial court set his wage rate at $90 per week, leading to a compensation award of $9.45 per week for 200 weeks, less $125 already paid. The appellate court affirmed the trial court's judgment, but reformed it to credit the appellant for the $125 already paid to the appellee.

Wage Rate CalculationPartial Permanent DisabilityLeg Injury CompensationInsurance Carrier AppealJudicial Notice of Employment ConditionsStatutory Wage Computation (Article 8309)Evidence SufficiencyMotion for Instructed VerdictCredit for Advance PaymentsAppellate Judgment Reformation
References
6
Case No. 03-00-00427-CV
Regular Panel Decision
Aug 30, 2001

All American Life Insurance Company American General Life Insurance Company American National Insurance Company American National Life Insurance Company of Texas IDS Life Insurance Company And USLIFE Life Insurance Company v. Carole Keeton Rylander, Comptroller of Public Accounts of Texas And John Cornyn, Attorney General of Texas

Several insurance companies appealed a district court judgment affirming the Comptroller's assessment of premium and maintenance taxes on 'internal rollover' transactions, where policyholders transfer accumulation values within the same company for new policies. The Texas Court of Appeals, Third District, At Austin, reviewed the construction of Texas Insurance Code articles 4.11 and 4.17 de novo. The court determined that 'internal rollovers' do not involve funds being 'received' or 'collected' by the insurance companies, as the funds remain within the company. Therefore, these transactions are not subject to the premium and maintenance taxes. The judgment of the district court was reversed in part, and the case was remanded for a determination of the refund amounts owed to the companies.

Insurance LawTax LawPremium TaxInternal RolloversStatutory ConstructionTexas Court of AppealsInsurance CompaniesComptrollerGross PremiumsTax Refund
References
9
Case No. 05-16-00875-CV
Regular Panel Decision
Jul 20, 2018

Peerless Indemnity Insurance Company, America First Insurance Company, the Netherlands Insurance Company, and America First Lloyds Insurance Company A.K.A. America First Insurance Company v. GLS Masonry, Inc.

The case involves an appeal by several insurance companies (Appellants) against GLS Masonry, Inc. (Appellee) after a take-nothing judgment in their suit to collect unpaid insurance premiums. The dispute centered on whether GLS's masonry workers were independent contractors or employees for premium calculation purposes, particularly for workers' compensation and general liability policies. The Appellants argued that GLS owed additional premiums due to audits reclassifying workers as employees and based on a lack of liability insurance for subcontractors. The trial court sided with GLS, finding that the insurance companies failed to establish the applicability of certain labor code provisions and did not sufficiently prove that GLS owed additional premiums, especially considering evidence that the workers were independent contractors and payments were made on policies. The Court of Appeals affirmed the trial court's judgment.

Insurance DisputeUnpaid PremiumsCommercial General LiabilityPremium AuditIndependent Contractor StatusEmployee ClassificationBreach of ContractTexas Appellate LawFactual Sufficiency ReviewSworn Account Claim
References
12
Case No. 01-19-00852-CV
Regular Panel Decision
Sep 21, 2021

National Union Fire Insurance Company of Pittsburgh, PA v. Exxon Mobil Corporation

This case involves two related appeals concerning insurance coverage for bodily injury claims against Exxon Mobil Corporation by its contractor's employees, Kevin Roberts and Arturo Munoz. National Union Fire Insurance Company of Pittsburgh, Pa. challenged a trial court's summary judgment in favor of Exxon and Starr Indemnity and Liability Insurance Company, arguing its umbrella policy did not provide coverage beyond its CGL policy, as dictated by the Exxon-Savage Contract. Exxon also challenged a summary judgment favoring Starr. The appeals court reversed the judgment against National Union, finding that 'Commercial General Liability insurance' in the contract referred only to primary coverage, not umbrella or excess policies. Consequently, Exxon was not entitled to coverage under National Union's umbrella policy. The court affirmed the summary judgment in favor of Starr, as its bumbershoot policy was also considered an umbrella policy. The case was remanded for reconsideration of attorney's fees and costs.

Insurance Policy InterpretationCommercial General LiabilityUmbrella Liability InsuranceExcess Liability InsuranceAdditional Insured EndorsementSummary Judgment ReviewBreach of ContractDeclaratory JudgmentAppellate ProcedurePersonal Injury Claims
References
34
Case No. 03-99-00719-CV
Regular Panel Decision
Jul 13, 2000

Southwestern Life Insurance Company v. Jose Montemayor, Commissioner of Insurance Carole Keeton Rylander, Comptroller of Public Accounts of the State of Texas John Cornyn, Attorney General of the State of Texas

Southwestern Life Insurance Company appealed a district court's summary judgment in favor of the State regarding insurance premium taxes. Southwestern sought to apply a 1989 tax credit, exceeding its premium tax liability for that year, against its 1990 premium tax liability, arguing the credit could be carried forward. The State contended the credit was only valid for the year the fees were paid. The Court of Appeals, focusing on statutory construction of Article 4.11 of the Texas Insurance Code, found no explicit carry-forward provision. The court affirmed the trial court's decision, ruling that the credit for examination and valuation fees may only be offset against premium tax liability for the year in which the fees are paid, and unused credit cannot be carried forward or backward.

Tax CreditInsurance Premium TaxStatutory InterpretationCarry-Forward ProvisionAdministrative LawLegislative IntentTexas Insurance CodeSummary JudgmentExamination FeesValuation Fees
References
14
Case No. 03-11-00179-CV
Regular Panel Decision
Aug 29, 2013

the Attorney General of Texas and the Commissioner of Insurance v. Farmers Insurance Exchange, Fire Insurance Exchange, Mid-Century Insurance Company of Texas, Texas Farmers Insurance Company, and Farmers Texas County Mutual Insurance Company

This case involves an appeal concerning public-information requests made to the Texas Department of Insurance (TDI) for rate-filing information submitted by a group of appellee insurers. The central issue was whether this information, declared "open to public inspection" by the Insurance Code, was subject to exceptions under the Public Information Act (PIA). The district court initially ruled that the PIA's exceptions applied. However, the Court of Appeals reversed this decision, holding that the clear and unambiguous language of former section 2251.107 of the Insurance Code mandated public inspection without regard to the PIA's exceptions. The court emphasized plain-meaning statutory construction and dismissed arguments based on legislative history and constitutional challenges.

Statutory InterpretationPublic Information ActInsurance CodeOpen RecordsTrade SecretsRate FilingsTexas Department of InsuranceAppellate ReviewGovernment TransparencyTakings Clause
References
50
Case No. MISSING
Regular Panel Decision
Apr 05, 2007

North Country Insurance v. Jandreau

This appeal concerns an insurer's motion for summary judgment, seeking a declaration that it is not obligated to defend or indemnify a general contractor in a personal injury lawsuit. The underlying action arose when an employee of a roofing subcontractor fell from a roof on a construction site. The insurer disclaimed coverage, alleging the general contractor failed to provide timely notice of the occurrence as per the policy. However, the general contractor claimed a good-faith belief of non-liability, citing the subcontractor's responsibility, notification to the subcontractor's insurer, and the injured worker's disregard for instructions not to access the roof. The Supreme Court denied the insurer's motion, determining that the reasonableness of the general contractor's delayed notice was a factual question suitable for a jury, a decision which the appellate court affirmed.

Insurance CoverageTimely NoticeSummary JudgmentGood-Faith Belief of NonliabilityAppellate ReviewConstruction AccidentGeneral ContractorSubcontractor LiabilityDuty to DefendDuty to Indemnify
References
5
Case No. MISSING
Regular Panel Decision

United States Fire Insurance Co. v. Scottsdale Insurance Co.

This case details a dispute between a primary insurer, United States Fire Insurance Company (U.S. Fire), and an excess insurer, Scottsdale Insurance Company, regarding liability coverage for LTC Healthcare, Inc., a nursing home operator. Scottsdale, acting as LTC's subrogee, sued U.S. Fire, alleging that U.S. Fire failed to meet its contractual obligations under the primary policy by not paying the full amount owed. Key issues included the interpretation of aggregate limits under Commercial General Liability (CGL) and Care Providers Professional Liability (CPPL) coverage forms, and the applicability of self-insured retention (SIR) provisions. The trial court initially granted summary judgment for Scottsdale, but the appellate court, while largely affirming that the CGL's higher aggregate limit applied and rejecting U.S. Fire's reformation counterclaim, found that the SIR provisions should have been applied. Consequently, the judgment was modified to reduce Scottsdale's award and the case was remanded for recalculation of prejudgment interest.

Insurance DisputeLiability CoveragePrimary InsuranceExcess InsuranceSubrogation ClaimSummary Judgment AppealContract InterpretationPolicy AmbiguityCGL CoverageProfessional Liability Coverage
References
29
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