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

Case No. 01-09-00457-CV
Regular Panel Decision
Mar 31, 2011

Robert B. Taylor and R.B.T. Investments, Inc. F/K/A/ Gulf Oxygen Company, Inc. v. Allstate Insurance Company and Allstate County Mutual Insurance Company

Robert B. Taylor and R.B.T Investments, Inc. (collectively, “Taylor”) appealed a summary judgment rendered in favor of Allstate Insurance Company and Allstate County Mutual Insurance Company (collectively, “Allstate”). Taylor's claims stemmed from Allstate's handling of his defense in a prior automobile accident suit. The Court of Appeals affirmed the summary judgment on Taylor’s tort claims, including negligence, vicarious liability, and tortious interference, concluding that Texas law does not recognize these causes of action against an insurer in this context. However, the court reversed and remanded the summary judgment regarding Taylor's breach of contract and statutory claims, stating that Allstate failed to provide sufficient analysis or evidence to support summary judgment on these specific grounds. The trial court's denial of Taylor's motion for leave to replead was also affirmed.

Insurance disputeSummary judgmentAppellate reviewBreach of contractStatutory claimsNegligenceVicarious liabilityTortious interferenceAttorney-client relationshipTexas law
References
21
Case No. NO. 03-98-00566-CV
Regular Panel Decision
Jul 29, 1999

Texas Department of Insurance Jose Montemayor, Commissioner of Insurance John Cornyn, Texas Attorney General Carole Keeton Rylander, Texas Comptroller of Public Accounts And Texas Public Finance Authority v. American Home Assurance Company and the Insurance Company of the State of Pennsylvania

The Texas Court of Appeals affirmed a district court's judgment in a tax refund case involving workers' compensation insurance. Appellees, two insurance companies, sued the State for a partial refund of taxes paid under protest, contending that a 1993 amendment to the Texas Insurance Code, Article 5.68(b), which expanded the tax base for certain maintenance taxes, did not apply to a separate surcharge tax. The amendment explicitly stated its application to Article 5.68 and Labor Code Section 403.002, but made no mention of the surcharge statute, Article 5.76-5. The appellate court found the language clear and unambiguous, concluding that the legislature's omission of the surcharge statute was deliberate and that the expanded definition of 'gross workers' compensation insurance premiums' applied only to the specified articles. Therefore, the State's assessment of the surcharge based on modified premiums was incorrect, and the district court's order for a refund was upheld.

Workers' CompensationInsurance TaxStatutory InterpretationTax BaseDeductible PlansTexas Insurance CodeTexas Labor CodeSummary JudgmentAppellate ReviewGross Premiums
References
28
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. 03-99-00606-CV
Regular Panel Decision
Dec 21, 2000

Stan Stumph, D/B/A Concrete Concepts/Dallas Fire Insurance Company v. Dallas Fire Insurance Company/Stan Stumph, D/B/A Concrete Concepts

Stan Stumph, d/b/a Concrete Concepts, initiated a lawsuit against Dallas Fire Insurance Company due to their refusal to defend and indemnify him in a prior suit. A jury ruled in Stumph's favor, awarding damages. Both parties appealed: Stumph sought treble damages, and Dallas Fire contested the actual damages. The Court of Appeals found Dallas Fire liable for unfair insurance practices and unconscionable conduct, stemming from misrepresentations by its agent regarding Stumph's policy and the agent's authority. The court concluded that coverage should have existed under the original policy, imposing a duty to defend and indemnify on Dallas Fire. Consequently, the appellate court modified the judgment to grant Stumph two times his actual damages and affirmed the modified judgment.

Insurance coverage disputeUnfair insurance practicesDeceptive Trade Practices Act (DTPA)Insurance agent misrepresentationDuty to defendDuty to indemnifyActual damagesTreble damagesAppellate reviewContract law
References
25
Case No. 3-94-122-CV
Regular Panel Decision
Jan 18, 1995

Texas Workers' Compensation Insurance Facility v. State Board of Insurance, Aetna Casualty & Surety Company, Hartford Accident & Indemnity Company, Houston General Insurance Company, Liberty Mutual Fire Insurance Company, United States Fire Insurance Company

The Texas Workers' Compensation Insurance Facility (Facility) appealed a district court judgment that affirmed an order by the State Board of Insurance. The Board had ordered the Facility to indemnify several servicing companies for legal expenses incurred in litigation brought by Standard Financial Indemnity Company (SFIC). The Facility argued that Article 5.76-2, section 2.05(i) of the Texas Insurance Code, which states the Facility 'may not indemnify the servicing companies,' terminated the servicing companies' right to indemnification. The appellate court affirmed the trial court's judgment, holding that the servicing companies had a vested contractual right to indemnification which arose when they entered into servicing company agreements, and that section 2.05(i) could not be applied retroactively to impair these vested rights. The court found that the law existing at the time the contracts were made, which included the Facility's bylaws allowing for indemnification, was incorporated into the agreements.

Workers' CompensationInsurance LawContractual RightsVested RightsRetroactive Application of LawIndemnificationStatutory InterpretationAdministrative LawAppellate ReviewTexas Insurance Code
References
32
Case No. 14-02-00860-CV
Regular Panel Decision
Feb 23, 2006

Lennar Corporation, Lennar Homes of Texas Land and Construction, Limited, and Lennar Homes of Texas Sales and Marketing, Limited, D/B/A Village Builders v. Great American Insurance Company, American Dynasty Surplus Lines Insurance Company, Markel American Insurance Company Gerling America Insurance Company, RLI Insurance Company, Insurance Company of the State of Pennsylvania and Westchester Fire Ins Company

This case concerns an insurance coverage dispute between homebuilder Lennar Corporation and its CGL insurance carriers over damages caused by defective stucco (EIFS) applied to homes. The court analyzed whether negligently defective construction constitutes an "occurrence" and distinguished between covered costs (repairing actual water damage) and non-covered costs (preventative EIFS replacement, overhead). While affirming summary judgment for several insurers due to unmet self-insured retentions based on individual homes as separate occurrences, the court reversed for American Dynasty and Markel, citing unresolved factual issues regarding "known loss" and policy conditions. Lennar's extra-contractual claims against American Dynasty were ultimately denied for lack of proven damages or statutory violations.

Insurance Policy InterpretationConstruction DefectsCommercial Liability InsuranceProperty Damage ClaimsStucco DefectsDuty to IndemnifySelf-Insured RetentionsKnown Loss PrincipleSubcontractor LiabilityTexas Law
References
96
Case No. ADJ6699348
Regular
Mar 17, 2016

KANON MONKIEWICZ vs. RM STORE FIXTURES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) issued a Notice of Intention to find that Labor Code section 4903.8(a) does not preclude awards to lien claimants Rx Funding Solutions, LLC and PharmaFinance, LLC. This is because the 2014 amendments to section 4903.8(a)(2) specify that it does not apply to assignments completed prior to January 1, 2013. Both of the lien claimants' assignments were made before this date, thus exempting them from the preclusion. The WCAB is amending its previous order and returning the case to the trial level for further proceedings on the merits of the liens.

Labor Code 4903.8Lien claimantsAssignment of receivablesCessation of businessPharmacy lienMedical lienSB 863AB 2732Prospective vs. retrospective applicationWCAB rules
References
10
Case No. MISSING
Regular Panel Decision

Hunt, Hopkins & Mitchell, Inc. D/B/A Hunt & Associates, Inc. v. Facility Insurance Corporation and Texas Department of Insurance

Hunt, an insurance agent for workers' compensation policies, appealed two summary judgments granted in favor of Facility Insurance Corporation and the Texas Department of Insurance. Hunt sought additional commissions on premiums recovered by the Facility through a settlement with Mobley Industrial Painters, Inc. The core dispute was whether TDI's Rules and Regulations entitled Hunt to commissions on funds obtained via collection actions. The district court found against Hunt, a decision upheld by the appellate court, which affirmed that Section XI of the Rules and Regulations does not mandate such commission payments. The appellate court also found no abuse of discretion in denying Hunt's request for a continuance.

Workers' CompensationInsurance CommissionsSummary Judgment AppealBreach of Contract ClaimDeclaratory JudgmentRegulatory InterpretationAccord and Satisfaction DefenseAppellate ReviewTexas LawInsurance Agent Liability
References
10
Case No. MISSING
Regular Panel Decision

Southwestern Life Insurance Co. v. Montemayor

Southwestern Life Insurance Company appealed a district court's summary judgment in favor of the State of Texas regarding insurance premium taxes. The core dispute centered on whether Southwestern could carry forward unused tax credits from 1989 to offset its 1990 premium tax liability, based on Article 4.11, Section 8 of the Texas Insurance Code. Southwestern argued that legislative changes implied a carry-forward provision. The appellate court affirmed the trial court's decision, ruling that the credit could only be applied in the year the fees were paid, citing statutory construction principles, consistency with other code provisions, and long-standing agency interpretation.

Insurance premium taxtax creditstatutory interpretationlegislative intentadministrative constructionsummary judgmentTexas Insurance Codeexamination feesvaluation feescarry-forward provision
References
14
Case No. 13-11-00005-CV AND 13-11-00013-CV
Regular Panel Decision
Jul 25, 2013

Brannan Paving Gp, LLC D/B/A Brannan Paving Company v. Pavement Markings, Inc., San Juan Insurance Agency, Inc. D/B/A Valley Insurance Providers and Leicht General Agency

This case involves an appeal from a breach of contract dispute between a contractor, Brannan Paving, and its subcontractor, Pavement Markings. Brannan Paving alleged Pavement Markings breached a subcontract by failing to obtain additional insured coverage. Pavement Markings joined its insurance agents, VIP and LGA, for negligence in procuring insurance. The appellate court found the trial court erred by including a waiver instruction in the jury question, as there was insufficient evidence of Brannan Paving's intent to waive. Consequently, the breach of contract claims were reversed and remanded. However, the take-nothing judgments on Brannan Paving's negligence claims against VIP and LGA were affirmed due to lack of privity, and Pavement Markings' cross-appeal for attorney's fees under the DTPA was denied due to the absence of actual damages.

Breach of ContractSubcontractor AgreementAdditional Insured CoverageWaiver InstructionJury Charge ErrorNegligence ClaimsInsurance Agent LiabilityPrivity of ContractDeceptive Trade Practices ActAttorney's Fees
References
60
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