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

Case No. 09-17-00364-CV
Regular Panel Decision
Nov 16, 2017

in Re Texas Alliance of Energy Producers – Workers' Compensation Self-Insured Group Trust

Texas Alliance of Energy Producers – Workers’ Compensation Self-Insured Group Trust (Texas Alliance) sought mandamus relief after a trial court denied its plea to the jurisdiction. Texas Alliance contended that John Bennett's claims fell within the exclusive jurisdiction of the Division of Workers’ Compensation. Bennett had filed a new suit alleging negligence, intentional infliction of emotional distress, and fraud against Texas Alliance regarding his workers' compensation claim. The Court of Appeals concluded that all of Bennett's claims arose from the workers' compensation claims-handling process, which is exclusively governed by the Workers’ Compensation Act. Therefore, the trial court abused its discretion by denying the plea to the jurisdiction, and the mandamus relief was conditionally granted, directing the trial court to dismiss Bennett's lawsuit.

MandamusPlea to JurisdictionExclusive JurisdictionWorkers' Compensation ActClaims Handling ProcessAbuse of DiscretionTexas Court of AppealsSelf-Insured Group TrustJudicial ReviewAdministrative Remedies
References
1
Case No. MISSING
Regular Panel Decision
Aug 30, 2006

State ex. rel. Flowers v. Tennessee Trucking Ass'n Self Insurance Group Trust

This appeal involves three members of a workers’ compensation self-insured group trust, Ocoee River Transport, Western Express, Inc., and DCI Transportation, LLC, challenging two trial court orders. The appellants were held in contempt and sanctioned for failing to make periodic payments of assessments as ordered by the court. Additionally, one appellant contested the assessment of the Liquidator’s administrative fees, arguing they were denied the opportunity for discovery regarding the reasonableness and necessity of these fees. The appellate court affirmed the trial court's finding of contempt and the imposition of sanctions. However, the court reversed the decision regarding administrative fees, remanding the issue for further proceedings to allow for appropriate discovery and a determination of the applicability of privilege or work product doctrine to the Liquidator's records.

contemptworkers' compensationself-insured group trustliquidationadministrative feesdiscoverydue processwillfulnesssanctionsappellate review
References
66
Case No. 09-16-00437-CV
Regular Panel Decision
May 17, 2018

Texas Alliance of Energy Producers - Workers Compensation Self-Insured Group Trust v. John Bennett

This case involves an appeal concerning a workers' compensation claim filed by John Bennett against Texas Alliance of Energy Producers – Workers’ Compensation Self-Insured Group Trust. Bennett suffered a work-related injury and received a summary judgment in his favor in April 2016 for supplemental income benefits. Later, in October 2016, the trial court issued another order substantially increasing Bennett's awards. Texas Alliance appealed the October order, arguing the trial court lacked plenary jurisdiction. The Court of Appeals agreed, concluding that the trial court's plenary power had expired before signing the October order, rendering it void as the changes were judicial rather than clerical. As Texas Alliance failed to timely appeal the final April 2016 order, the Court of Appeals vacated the October 2016 order and dismissed Texas Alliance's appeal.

Workers' CompensationPlenary JurisdictionSummary JudgmentFinal OrderVoid OrderAppellate ProcedureClerical ErrorJudicial ErrorTimely AppealJurisdiction
References
21
Case No. 2017 NY Slip Op 07909 [155 AD3d 1208]
Regular Panel Decision
Nov 09, 2017

NYAHSA Services, Inc., Self-Insurance Trust v. People Care Inc.

Plaintiff, a self-insured trust, commenced a collection action against defendant, a former member, for unpaid assessments related to workers' compensation claims. Defendant counterclaimed and filed a third-party action against Cool Insuring Agency, the trust's administrators, alleging mismanagement. During discovery, a dispute arose over a report commissioned by defendant's counsel from a consultant, which Cool and plaintiff sought to compel. Defendant asserted attorney-client privilege, attorney work product, and material prepared in anticipation of litigation. The Supreme Court partially granted the motions to compel, a decision largely affirmed by the Appellate Division, Third Department, with a modification regarding a specific email exchange found to be protected attorney work product.

Discovery DisputeAttorney-Client PrivilegeAttorney Work ProductMaterial Prepared for LitigationSelf-Insurance TrustWorkers' Compensation BenefitsBreach of ContractUnjust EnrichmentThird-Party ActionClaims Administration
References
20
Case No. 2018 NY Slip Op 08737
Regular Panel Decision
Dec 20, 2018

NYAHSA Servs., Inc., Self-Insurance Trust v. Recco Home Care Servs., Inc.

This case concerns an appeal from an order of the Supreme Court in Albany County. Plaintiff NYAHSA Services, Inc., Self-Insurance Trust, a self-insured trust providing workers' compensation coverage, sued defendant Recco Home Care Services, Inc. for unpaid adjustments after the defendant terminated its membership. Following an amendment to the complaint adding individual trustees as plaintiffs, the defendant asserted counterclaims for fraud, breach of fiduciary duty, and negligence against these trustees, which the Supreme Court dismissed as time-barred. The defendant also sought to amend its answer to include a counterclaim under General Business Law, which was denied. The Appellate Division, Third Department, found that the Supreme Court erred in dismissing the counterclaims for fraud and breach of fiduciary duty and in denying the cross-motion to amend for the General Business Law claim. Consequently, the Appellate Division modified the Supreme Court's order, reversing parts of the dismissal and denial, and affirmed the order as modified.

Workers' Compensation CoverageSelf-Insurance TrustFraud AllegationsBreach of Fiduciary DutyGeneral Business LawStatute of LimitationsAmended PleadingsCounterclaimsAppellate ReviewMotion to Dismiss
References
2
Case No. MISSING
Regular Panel Decision

NYAHSA Servs., Inc., Self-Insurance Trust v. People Care Inc.

This case involves an appeal from an order of the Supreme Court, which granted the plaintiff's motions for leave to amend complaints. The plaintiff, a group self-insured trust, initiated collection actions against former member employers, People Care Incorporated and Recco Home Care Services, Inc., for unpaid workers' compensation adjustment bills. The plaintiff sought to add its trustees as party plaintiffs and to update allegations to include subsequently accrued unpaid bills. The appellate court affirmed the Supreme Court's decision, clarifying that an evidentiary showing of merit is not required for leave to amend pleadings under CPLR 3025 (b) unless there is prejudice, surprise, palpable insufficiency, or patent lack of merit. The court found no such grounds for denial and also rejected the defendants' statute of limitations arguments, affirming that for contracts requiring continuing performance, each breach can restart the limitations period.

Workers' Compensation CoverageSelf-Insured TrustBreach of ContractUnjust EnrichmentPleading AmendmentCPLR 3025 (b)Statute of LimitationsPrejudiceAppellate ReviewSupreme Court Order
References
18
Case No. MISSING
Regular Panel Decision
Mar 28, 2000

Oil Heat Institute of Long Island Insurance Trust v. Gerber Life Insurance

Plaintiff Oil Heat Institute of Long Island Insurance Trust (OHI) sued Gerber Life Insurance Company (Gerber), Island Group Administration, Inc. (IGA), and RMTS Associates, alleging Gerber refused to reimburse stop-loss claims and issue a letter of certification to a lender. OHI had established a self-insurance program, and Gerber issued an aggregate stop-loss (ASL) policy. OHI commenced the action on the day the ASL policy expired, before the attachment point for reimbursement could be calculated and before submitting proper documentation. The Supreme Court denied Gerber's motion for summary judgment. The Appellate Division reversed, finding that OHI failed to demonstrate compliance with the ASL policy's reimbursement terms, lacked material facts to support its claims, and initiated the action prematurely. Both causes of action were dismissed against Gerber.

Insurance LawSummary JudgmentAggregate Stop-Loss PolicyContract DisputeReimbursementPolicy TermsAppellate ReviewGood FaithDocumentation RequirementsAgency
References
3
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. MISSING
Regular Panel Decision

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
Case No. MISSING
Regular Panel Decision
Apr 18, 2006

State Ex Rel. Flowers v. TENNESSEE TRUCKING ASSN.

This case involves an appeal by seven members of the Tennessee Trucking Association Self-Insurance Group Trust against a post-liquidation assessment. The Trust was declared insolvent by the Chancery Court, and the Commissioner of Commerce and Insurance was appointed Liquidator. The Liquidator made assessments against the members to cover a $2.8 million deficit, using a methodology that modified their proportionate financial obligations due to identified errors in the original premium structure. Appellants contended this modification was impermissible, arguing the original premium structure should have been maintained. The trial court approved the assessment, finding the Commissioner had the authority to make equitable assessments and that the methodology used was equitable as it corrected previous errors. The Court of Appeals affirmed the trial court's decision, finding no legal prohibition against the Liquidator correcting premium errors and confirming the equitable nature of the assessment.

Self-Insurance GroupWorkers' Compensation ActInsolvencyAssessment MethodologyEquitable AssessmentPremium Structure ErrorsLiquidator AuthorityJoint and Several LiabilityTennessee LawAppellate Review
References
18
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