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

Case No. 03-05-00776-CV
Regular Panel Decision
Dec 15, 2006

Texas Mutual Insurance Company v. Texas Department of Insurance, Division of Workers' Compensation

This interlocutory appeal addresses whether the Texas Department of Insurance, Division of Workers' Compensation, holds exclusive jurisdiction over disputes concerning employers' liability insurance coverage periods and if a challenge to a Division rule was ripe for adjudication. The case originated from a wrongful death claim against AJ Commercial, whose insurance carrier, Texas Mutual, sought a declaratory judgment that the employers' liability policy had expired. The district court had granted the Division's plea to the jurisdiction, finding exclusive jurisdiction and lack of ripeness for the rule challenge. The appellate court reversed, ruling that the Division does not have exclusive jurisdiction over employers' liability coverage disputes when no worker's compensation benefits claim is pending and that the rule challenge was indeed ripe, remanding the case for further proceedings.

Workers' Compensation LawEmployer Liability InsuranceExclusive JurisdictionRipeness DoctrineDeclaratory JudgmentAdministrative LawInsurance Coverage DisputeStatutory InterpretationAppellate ReviewTexas Court of Appeals
References
25
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. 04-24-00386-CV
Regular Panel Decision
Feb 26, 2025

In Re Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance v. the State of Texas

Edward Santos filed a lawsuit against Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance, alleging liability for his injuries being compensated through workers' compensation benefits, thereby limiting liability under other coverages. Texas Mutual and Bond challenged the trial court's denial of their pleas to the jurisdiction, arguing that the Texas Department of Insurance, Division of Workers' Compensation (the Division) had exclusive jurisdiction over Santos's claims. The Fourth Court of Appeals found that Santos's claims against Texas Mutual and Bond, predicated on the improper investigation, handling, or settlement of his workers' compensation claim, fell within the Division's exclusive jurisdiction, and he failed to exhaust administrative remedies. Consequently, the Court conditionally granted the petition for a writ of mandamus for Texas Mutual and Bond, directing the trial court to dismiss claims against them. However, the Court denied Allstate's petition, as Santos's claims against Allstate involved a liability claim against a non-workers' compensation carrier, which did not abrogate the Division's exclusive jurisdiction by re-litigating the course and scope of employment question.

MandamusWorkers' CompensationExclusive JurisdictionAdministrative RemediesPlea to the JurisdictionInsurance CodeDeceptive Trade Practices ActFraudConspiracyEmployer Liability
References
25
Case No. MISSING
Regular Panel Decision

Wheeler v. Employers Mutual Liability Insurance Co. of Wisconsin

This case concerns an appeal filed by Cecil Wheeler, as guardian for Edward N. Prince, Jr., challenging an order from the Shelby County District Court. The lower court had denied Prince's motion for summary judgment and abated his lawsuit, which sought to mature a worker's compensation award from the Industrial Accident Board. This action was taken pending the final determination of a prior suit filed by the insurance carrier, Employers Mutual Liability Insurance Company of Wisconsin, in Madison County to set aside the same IAB award. Employers Mutual moved to dismiss the current appeal, arguing the Shelby County order was interlocutory and non-appealable. The appellate court affirmed, stating that a court's authority to abate an action on its own motion does not render the order void, especially when made aware of a prior pending suit with identical parties and issues. The court also reiterated that interlocutory appeals from orders denying summary judgment are prohibited in Texas, thus dismissing the appeal for lack of jurisdiction.

Interlocutory OrderSummary Judgment DenialAbatement of ActionJurisdiction DisputeWorkers' Compensation ClaimAppeal DismissalMultiplicity of SuitsPrior Pending ActionDominant JurisdictionTexas Civil Procedure
References
5
Case No. MISSING
Regular Panel Decision
Feb 28, 1991

North River Insurance v. United National Insurance

This appellate decision addresses the apportionment of liability between North River Insurance Co. and United National Insurance Company arising from a settlement for an injured employee. The court clarified that North River, as the workers' compensation carrier, is solely responsible for its waived lien, reversing a lower court's finding. It further determined that both insurers' "other insurance" clauses called for pro rata contribution, not equal shares, for the $588,245 settlement payment and defense costs. The court calculated specific shares for each insurer and ruled that North River is entitled to interest from the original payment date in 1982. The Supreme Court's order was thus modified to reflect these findings.

Insurance disputePro rata contributionEquitable apportionmentWorkers' compensation lienDefense costsOther insurance clausesSettlement apportionmentInterest calculationAppellate decisionInsurer liability
References
10
Case No. MISSING
Regular Panel Decision
Jul 13, 2001

A.I. Transport v. New York State Insurance Fund

The Supreme Court, New York County, denied a liability insurer’s application to stay an arbitration initiated by a workers’ compensation insurer. The workers’ compensation insurer sought to recover benefits paid to a bus passenger injured in an accident, where the bus was insured by the liability insurer. The court interpreted Insurance Law § 5105 (a) to allow a workers’ compensation provider, paying benefits in lieu of first party benefits, to recover amounts paid from the insurer of a liable party, even if one of the vehicles involved is a bus. It was determined that an exception for losses arising from the use of a motor vehicle (Insurance Law § 5103 [a] [1]) did not apply, as the respondent was a workers’ compensation insurer and not an automobile insurer. Consequently, the arbitration was allowed to proceed, and the petition to stay it was dismissed and unanimously affirmed.

Arbitration DisputeInsurance Law InterpretationNo-Fault BenefitsWorkers' Compensation SubrogationBus AccidentLiability CoverageStatutory ConstructionAppellate ReviewInsurer Recovery
References
4
Case No. MISSING
Regular Panel Decision

Continental Insurance v. State

Thomas Murray, an executive officer and co-owner of T & T Murray Company, Inc., sustained severe injuries while working, having previously elected to be excluded from Workers’ Compensation coverage under Workers’ Compensation Law § 54 (6). Following a successful lawsuit against the general contractor, Concept Construction Corp., and subsequent indemnification from T & T, Concept's liability carrier, Continental Insurance Company, sought coverage from T & T's insurer, State Insurance Fund. The State Fund denied the claim, asserting the exclusion applied to both Workers’ Compensation and Employers’ Liability coverage. The Court of Appeals affirmed the denial, ruling that the two types of coverage are inextricably linked, and the election to exclude executive officers from Workers’ Compensation coverage also eliminates Employers’ Liability coverage for injuries to those officers.

Workers' Compensation Law § 54(6)Employers' Liability CoverageExecutive Officer ExclusionCorporate OfficersStock OwnershipInsurance Policy InterpretationThird-Party IndemnificationSubrogation ClaimStatutory InterpretationNew York Court of Appeals
References
6
Case No. 18-0216
Regular Panel Decision
Jun 26, 2020

Texas Mutual Insurance Company, Hartford Underwriters Insurance Company, Tasb Risk Management Fund, Transportation Insurance Company, Truck Insurance Exchange, Twin City Fire Insurance Company, Valley Forge Insurance Company v. Phi Air Medical, LLC

This concurring opinion addresses whether the Texas Workers' Compensation Act is shielded from federal preemption by the McCarran–Ferguson Act. The core issue is whether the Texas Act, which dictates how insurance carriers pay claimants like air-ambulance services, constitutes the 'business of insurance.' Justice Bland argues that the Act was indeed enacted for regulating the business of insurance, particularly given Texas's reliance on private insurers for workers' compensation. Therefore, its provisions should be protected from federal encroachment, leading to the reversal of the court of appeals' judgment.

McCarran-Ferguson ActFederal PreemptionState Insurance RegulationTexas Workers' Compensation ActBusiness of InsuranceAir-ambulance ServicesInsurance CarriersPolicyholder RiskThird-Party BeneficiaryAntitrust Exemption
References
19
Case No. MISSING
Regular Panel Decision

Anzaldua v. American Guarantee & Liability Insurance Co.

This worker's compensation case involves an appeal by Esther Anzaldua against American Guarantee & Liability Insurance Company, the compensation carrier. Anzaldua was injured on the job and sued after rejecting an award from the Texas Industrial Accident Board. A jury awarded her damages for partial incapacity and medical expenses, but Anzaldua appealed, alleging the medical award was insufficient, that certain medical reports were improperly admitted due to hearsay, and that a supplemental jury charge was coercive. The court affirmed the lower court's judgment, finding the jury's verdict supported by evidence, the medical reports properly admitted, and the supplemental charge not coercive.

Workers' CompensationMedical ExpensesJury VerdictEvidence AdmissibilitySupplemental Jury ChargeCoercionIncapacityAppealTexas LawInsurance
References
7
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