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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

Universe Life Insurance v. Giles

Justice Hecht's concurring opinion addresses the complex issues surrounding insurance bad-faith liability in Texas. He critiques the existing 'no reasonable basis' standard for its difficulty in appellate review, particularly due to the limitations of no-evidence review which prevents weighing conflicting evidence. He advocates for defining bad faith as 'unscrupulous, arbitrary conduct' and for treating the 'reasonably clear' liability standard as a legal question rather than a factual one. This approach, he argues, would provide clearer guidelines for insurers and enable meaningful judicial review, preventing juries from arbitrarily defining bad faith. Furthermore, he emphasizes that the requisite mental state for bad-faith liability should involve intentional or reckless conduct, not mere negligence. He concurs with the judgment that Universe Life wrongfully delayed Giles' claim (thus implying the claim for benefits was granted) but finds no evidence for punitive damages.

Insurance bad faithTexas lawtort liabilitycontractual disputesappellate reviewevidentiary standardsjudicial roleinsurer conductdamagespunitive damages
References
152
Case No. MISSING
Regular Panel Decision

Maryland Insurance Co. v. Head Industrial Coatings & Services, Inc.

This is an appeal in a bad faith insurance case involving Head Industrial Coatings and Services, Inc. (Head) and Maryland Insurance Company (Maryland). Head sued Maryland for denying a contractual liability claim, which was missing from its policy due to an agent's clerical error. The appellate court upheld the cause of action for bad faith, ruling that the agent's knowledge was imputable to Maryland, making the conduct knowingly wrongful. However, the court reduced Head's damage award to policy limits and reversed a statutory penalty. The case also involves a third-party action by Maryland against Gans & Smith Insurance Agency, which was remanded for a new trial due to issues with the jury's finding on breach of fiduciary duty.

Bad Faith InsuranceInsurance Code ViolationsContractual LiabilityAgent ErrorClerical ErrorIndemnity AgreementUnfair Claims Settlement PracticesDuty of Good Faith and Fair DealingImputed KnowledgeDamages Calculation
References
59
Case No. 6:09-CV-853
Regular Panel Decision

Utica Mutual Insurance Co. v. Fireman's Fund Insurance Co.

This case details a dispute between Utica Mutual Insurance Company (Utica) and Fireman’s Fund Insurance Company (FFIC) concerning reinsurance contracts, with Utica seeking substantial damages for alleged breach of contract and bad faith. FFIC counterclaimed for rescission of the reinsurance agreements. A central contention revolves around whether Utica's primary liability policies issued to Goulds from 1966-1972 contained aggregate limits for bodily injury, a condition critical to triggering FFIC's reinsurance obligations. The court dismissed Utica's bad faith claim (Count II) and its request for declaratory relief (Count III) but denied all other motions for summary judgment by both parties, including those regarding the 'follow the settlement' doctrine, FFIC's rescission counterclaim, and the timeliness of notice. Consequently, the core breach of contract claim (Count I) and FFIC's counterclaims for rescission are slated to proceed to trial.

Reinsurance DisputeBreach of ContractSummary JudgmentFollow the Settlement DoctrineAggregate LimitsBad Faith ClaimRescissionNotice of ClaimInsurance LawAsbestos Claims
References
56
Case No. MISSING
Regular Panel Decision

Chandler v. Prudential Insurance Co.

Plaintiff Dorothy G. Chandler sued Prudential Insurance Company of America after the termination of her long-term disability benefits. She alleged bad faith, outrageous conduct, and violations of the Tennessee Consumer Protection Act. The trial court granted partial summary judgment to Prudential on the outrageous conduct, tort of bad faith, and Consumer Protection Act claims. Plaintiff later nonsuited her claim for the statutory bad-faith penalty. The appellate court affirmed the trial court's decision, ruling that the statutory bad-faith penalty (T.C.A. § 56-7-105) provides the exclusive remedy for bad faith actions against insurers in Tennessee. The court also found that the plaintiff failed to state a cause of action for outrageous conduct and that the Tennessee Consumer Protection Act was not applicable based on the facts presented.

Disability BenefitsInsurance PolicyBad Faith ClaimOutrageous ConductConsumer Protection ActSummary JudgmentExclusive RemedyAppellate ReviewInsurance LawTort Law
References
17
Case No. MISSING
Regular Panel Decision

Fulton Bellows, LLC v. Federal Insurance

This case involves Fulton Bellows, LLC (FBLLC) suing Federal Insurance Company for breach of contract, violation of the Tennessee Consumer Protection Act (TCPA), and bad faith refusal to pay an insurance claim. FBLLC sought defense coverage under its Employment Practices Liability (EPL) policy for an age discrimination lawsuit (Gaskey v. Fulton Bellows, LLC) filed against it. Federal Insurance denied coverage, citing a prior acts exclusion and untimely notice of the claim. The court denied Federal Insurance's motion for summary judgment on the breach of contract claim, finding a genuine issue of material fact regarding whether the discriminatory acts occurred after the policy effective date and whether the late notice prejudiced the insurer, given it was within the policy period. However, the court granted summary judgment for Federal Insurance on the bad faith failure to pay claim and the TCPA claim, concluding that Federal Insurance asserted good faith defenses and its denial was not deceptive or unfair.

Insurance Policy InterpretationEmployment Practices Liability (EPL)Prior Acts ExclusionNotice ProvisionClaims-Made PolicyOccurrence PolicyPrejudice RuleBad Faith ClaimTennessee Consumer Protection Act (TCPA)Summary Judgment
References
42
Case No. 05-95-01259-CV
Regular Panel Decision
Feb 26, 1997

Lemke Concrete Construction v. Employers Mutual Casualty Company, Union Mutual Insurance Company of Providence, Emcasco Insurance Company, Patterson, Lamberty, Stanford, Walls & Dwyer, P.C. and John R. Robinson

Lemke Concrete Construction appealed the trial court's summary judgment in favor of Employers Mutual Casualty Company, Union Mutual Insurance Company of Providence, and Emcasco Insurance Company (carriers). Lemke alleged breach of contract, negligence, breach of good faith, and violations of the Texas Deceptive Trade Practices-Consumer Protection Act and Texas Insurance Code, stemming from the carriers' handling of a workers' compensation claim and a subsequent retaliatory discharge suit filed by Lemke's employee, Jesus Gonzalez. The carriers had settled the workers' compensation claim but denied coverage for the wrongful discharge claim, leading Lemke to incur legal fees and a settlement. The trial court granted summary judgment for the carriers, concluding that the policies did not cover wrongful discharge claims and, thus, the carriers owed no duty to defend or settle such claims. The appellate court affirmed the trial court's judgment, upholding that without coverage, Lemke's claims of bad faith and negligence were meritless, and estoppel could not create coverage.

Workers' CompensationSummary JudgmentBreach of ContractGood Faith and Fair DealingInsurance CoverageNegligenceTexas Deceptive Trade Practices-Consumer Protection ActTexas Insurance CodeVicarious LiabilityRetaliatory Discharge
References
31
Case No. E2003-02892-COA-R3-CV
Regular Panel Decision
Nov 29, 2004

Fred Simmons Trucking, Inc. v. United States Fidelity and Guaranty Company, and its successors in interest, Hartford Fire Insurance, Co.

This case concerns a breach of contract and bad faith action brought by Fred Simmons Trucking, Inc. against its insurer, Hartford Fire Insurance Company, for failing to pay workers\' compensation benefits to an injured employee. The trial court initially awarded both compensatory and punitive damages to Simmons. On appeal, the Tennessee Court of Appeals found the insurance policy was not ambiguous but upheld the findings of breach of contract and bad faith on Hartford\'s part. The appellate court vacated the original damage awards, instructing the lower court to determine compensatory damages based on the Tennessee workers\' compensation statute, incorporating factual findings from a Kentucky court regarding the employee\'s disability, and to assess a statutory bad faith penalty rather than punitive damages. The case was ultimately affirmed in part, reversed in part, vacated, and remanded for recalculation of damages.

Breach of ContractInsurance Policy DisputeBad Faith InsurancePunitive DamagesCompensatory DamagesAppellate ProcedureStatutory InterpretationPolicy AmbiguityMaximum Medical Improvement (MMI)Tennessee Workers' Comp Law
References
7
Case No. 03-04-00374-CV
Regular Panel Decision
Jul 26, 2007

Mark Pickett and Barbara Pickett v. Texas Mutual Insurance Co., F/K/A Texas Workers' Compensation Insurance Fund

This appeal addresses the necessity of exhausting administrative remedies at the Texas Workers' Compensation Commission before filing a lawsuit for bad faith denial or delay of medical benefits. Appellants Mark and Barbara Pickett sued Texas Mutual Insurance Company, alleging bad faith in delaying or denying benefits to Barbara Pickett following a work-related injury. The trial court dismissed most of their claims for lack of jurisdiction due to unexhausted administrative remedies and granted a take-nothing summary judgment on claims arising from three medical disputes for which remedies had been exhausted. The appellate court affirmed the trial court's decision, holding that the exhaustion requirement is constitutional and applies broadly, and that Texas Mutual was not liable for collection notices received by the Picketts for benefits ultimately ordered to be paid to Dr. Kiser.

Workers' CompensationAdministrative RemediesExhaustion DoctrineBad Faith InsuranceMedical BenefitsSubject Matter JurisdictionAppellate ProcedureConstitutional LawDue ProcessRetroactivity
References
44
Case No. M2011-00264-COA-R3-CV
Regular Panel Decision
Mar 04, 2013

Wendy Leverett v. Tennessee Farmers Mutual Insurance Company

A woman severely injured in a collision with an unlicensed minor sued the minor. The minor's parents' insurer denied coverage, leading to a $1 million default judgment against the minor. The injured party and the minor's parents then jointly sued the insurance company, alleging breach of contract, bad faith, and violations of the Tennessee Consumer Protection Act (TCPA). The trial court found coverage, breach of contract, bad faith, and TCPA violations, awarding compensatory, punitive, and trebled damages. On appeal, the Court of Appeals affirmed the breach of contract and the TCPA violation finding, but reversed the bad faith liability and vacated the punitive and treble damages, while modifying the attorney fees.

Insurance CoverageAutomobile PolicyMinor DriverPermissive UseBreach of ContractBad FaithTennessee Consumer Protection ActTCPA ViolationTreble DamagesPunitive Damages
References
135
Case No. MISSING
Regular Panel Decision

Price v. Texas Employers' Insurance Ass'n

Appellant Bonnie F. Price appealed a summary judgment granted in favor of Texas Employers’ Insurance Association (TEIA) concerning her claim of bad faith in handling two workers' compensation claims. Price's initial workers' compensation claims were settled in March 1988, after which she initiated a separate bad faith claim against TEIA. TEIA successfully moved for summary judgment in the trial court, asserting that Price's bad faith claim was barred by res judicata/collateral estoppel due to the prior settlement judgment, that her previous agreements constituted judicial admissions, and that evidence negated essential elements of her bad faith claim. The appellate court reviewed the summary judgment, focusing on the applicability of collateral estoppel and judicial admissions stemming from the prior workers' compensation settlement. Ultimately, the appellate court affirmed the trial court's summary judgment, concluding that TEIA had successfully proven its affirmative defenses and negated elements of Price's bad faith claim.

Summary JudgmentWorkers' CompensationBad Faith ClaimDuty of Good Faith and Fair DealingRes JudicataCollateral EstoppelJudicial AdmissionSettlement AgreementAppellate ReviewInsurance Carrier Liability
References
11
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