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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

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. 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. 03-11-00688-CV
Regular Panel Decision
Jul 03, 2012

Approach Operating, LLC v. Resolution Oversight Corporation, as Special Deputy Receiver of Financial Insurance Company of America And the Texas Property and Casualty Insurance Guaranty Association

This case concerns an appeal from a summary judgment regarding a workers' compensation carrier's subrogation rights. Appellant Approach Operating, LLC, a general contractor, argued that the carrier had waived its subrogation rights through a Master Service Agreement (MSA) with subcontractor Lilly Construction, Inc. An employee of Lilly, Rodolfo Martinez, was injured and received workers' compensation benefits from Financial Insurance Company of America (FICA) and later The Texas Property and Casualty Insurance Guaranty Association (TPCIGA). The district court found no waiver of subrogation and granted summary judgment for FICA and TPCIGA. The Texas Court of Appeals, Third District, affirmed the lower court's judgment, emphasizing that explicit contractual language is required for a waiver of subrogation, which was absent in the MSA.

Workers' CompensationSubrogation WaiverMaster Service AgreementContract InterpretationSummary JudgmentTexas Court of AppealsInsurance LawOil and Gas IndustryExplicitness RuleThird-Party Claim
References
24
Case No. 03-04-00105-CV
Regular Panel Decision
Mar 03, 2006

Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company, and Liberty Insurance Corporation v. Texas Department of Insurance and Jose Montemayor, as Commissioner of Insurance Amber, Inc., Champagne-Webber, Inc. Churchill Truck Lines, Inc. And Royal Seating Corp.

Liberty Mutual Insurance Company and its affiliates appealed a district court judgment requiring them to issue rebates to workers' compensation policyholders for 1991 and 1992 surpluses. The appellants argued that a rule from the Texas Department of Insurance, which mandated these pass-throughs, unconstitutionally impaired their contractual rights, deprived them of property without due process, and constituted an impermissible retroactive law. The appeals court affirmed the district court's decision, finding that the Department's rule was a valid exercise of legislative power, served a legitimate public purpose by preventing insurers from retaining unforeseen windfalls, and did not violate constitutional prohibitions regarding retroactive legislation, contract impairment, or due process rights.

Insurance LawWorkers' Compensation InsuranceRetrospective Rating PlanInsurance RegulationConstitutional ChallengesContractual ObligationsDue ProcessRetroactive LegislationAppellate Court DecisionTexas Department of Insurance
References
35
Case No. 14-03-01023-CV
Regular Panel Decision
May 10, 2005

the Insurance Company of the State of Pennsylvania v. Hartford UnderWriters Insurance Company

This is an appeal from a summary judgment regarding a workers’ compensation claim. Tomasa Serpas was injured while working for Tandem Staffing at an Igloo Products Corporation facility. ICSP provided workers’ compensation insurance to Igloo, and Hartford was the carrier for Tandem. Hartford began paying benefits but disputed compensability over three years after the injury, arguing Igloo was Serpas’s employer under the borrowed servant doctrine. The Texas Workers’ Compensation Commission determined Tandem and Igloo were co-employers and Hartford had waived its right to contest compensability by not doing so within 60 days. The district court reversed, ordering both carriers to pay 50% of benefits. The appellate court reversed the district court’s decision, holding that Hartford waived its right to contest compensability under Texas Labor Code Ann. § 409.021(c) and Texas Administrative Code § 124.3, and is therefore solely responsible for payment of benefits.

Workers CompensationInsurance DisputeWaiver of CompensabilitySummary Judgment AppealCo-employmentTexas Labor CodeAdministrative LawAppellate DecisionInsurance LiabilityStatutory Interpretation
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

Aetna Casualty & Surety Co. v. Tennessee Farmers Mutual Insurance Co.

Aetna Casualty and Surety Company, an excess uninsured motorist carrier, initiated an action seeking contribution from Tennessee Farmers Mutual Insurance Company, the primary uninsured motorist carrier, for payments made to their shared insured, Larry A. Walker. The core dispute arose because Aetna and the Walkers, without Tennessee Farmers' consent, issued a full release to the tortfeasor, Nancy C. Childress, thereby extinguishing Tennessee Farmers’ subrogation rights. The trial court dismissed Aetna's complaint, concluding that the release prejudiced Tennessee Farmers' rights. The appellate court affirmed this decision, holding that an insured or their assignee forfeits recovery against the insurer if they destroy the insurer's subrogation rights, citing both statutory provisions (T.C.A. § 56-7-1204) and policy terms.

Uninsured Motorist CoverageSubrogation RightsRelease of ClaimsInsurance ContributionExcess InsurancePrimary InsuranceBreach of ContractStatutory InterpretationAssignee RightsAppellate Affirmation
References
5
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Fund v. Knight

The Texas Workers’ Compensation Insurance Fund (The Fund) appealed an order denying its subrogation rights concerning funds paid into the court registry by Safeguard Insurance Company. The individuals Susannah Knight, Susana Maldonado, and Houston R. Ewing received workers' compensation benefits from the Fund after an accident with an uninsured driver. The Fund sought reimbursement from uninsured motorist proceeds. The trial court denied the Fund's subrogation claim, prompting this appeal. The appellate court reversed, holding that the Fund had a statutory right of subrogation against the uninsured motorist policy proceeds. The court rejected arguments that the trial court could use its equitable powers to deny subrogation or that the funds should be treated as an advance against future benefits, emphasizing that the carrier is to be reimbursed first.

workers' compensationsubrogation rightsuninsured motoriststatutory interpretationTexas Labor Codeappellate reviewreimbursementequitable powersinsurance lawthird-party action
References
7
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. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Facility v. Aetna Casualty & Surety Co.

The Texas Workers’ Compensation Insurance Facility (TWCIF) appealed a take-nothing judgment in its suit against Aetna Casualty & Surety Company (Aetna). TWCIF, a workers' compensation carrier, paid benefits to an employee injured in a car accident and sought to assert its subrogation right against Aetna, the employer’s uninsured/underinsured motorist insurance carrier, after Aetna settled with the employee. The trial court ruled against TWCIF, stating it had no viable claim. On appeal, the court determined that TWCIF’s statutory subrogation right extends to claims against an uninsured/underinsured motorist insurance carrier, rejecting Aetna’s arguments regarding the scope of 'third party' and contractual limitations. Consequently, the appellate court reversed the trial court's judgment and remanded the case, holding that TWCIF is entitled to recover stipulated damages and interest.

Workers' CompensationSubrogationUninsured MotoristUnderinsured MotoristInsurance CarrierStatutory InterpretationTexas LawAppellate ReviewReimbursementDamages
References
4
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