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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Jun 18, 1992

Shelton Insurance Agency v. St. Paul Mercury Insurance Co.

This case involves an appeal by Shelton Insurance Agency and John M. Roberts against St. Paul Mercury Insurance Company regarding the alleged mishandling of an insurance claim. Shelton Agency initially sued St. Paul for violations of the DTPA, Texas Insurance Code, breach of contract, and breach of the duty of good faith and fair dealing after St. Paul denied coverage to its customer, Frio Drilling Company. A jury found in favor of Shelton Agency, awarding actual and exemplary damages, but the trial court granted St. Paul's motion for judgment n.o.v. The appellate court affirmed the trial court's judgment on the DTPA, insurance code, breach of good faith, and punitive damages claims. However, it reversed and rendered the judgment on the breach of contract claim, ruling that Shelton Agency was entitled to recover $34,000 for premiums it wrote off.

Insurance LawAgency LiabilityBreach of ContractGood Faith and Fair DealingDTPATexas Insurance CodeDenial of CoverageInsurance Bad FaithPunitive DamagesJudgment N.O.V.
References
30
Case No. MISSING
Regular Panel Decision
Aug 16, 2006

Superior Ice Rink, Inc. v. Nescon Contracting Corp.

The plaintiff contracted with Nescon Contracting Corp. for painting services and required to be named an additional insured under Nescon's liability policy. Nescon's insurance broker, Seigerman-Mulvey Company, Inc., issued a certificate indicating plaintiff was an additional insured, but the insurer, Merchants Mutual Insurance Company, later disclaimed coverage after workers were injured on the plaintiff's premises. The plaintiff sued Seigerman-Mulvey for breach of contract, alleging third-party beneficiary status. The Supreme Court denied Seigerman-Mulvey's motion to dismiss the complaint. However, the appellate court reversed, granting the motion to dismiss, holding that the plaintiff was not in privity of contract with Seigerman-Mulvey, was owed no duty by them, and failed to establish itself as an intended third-party beneficiary or demonstrate fraud, collusion, or other special circumstances for recovery.

Breach of ContractInsurance Broker LiabilityThird-Party BeneficiaryMotion to DismissAdditional InsuredPrivity of ContractAppellate ReviewInsurance Coverage DisclaimerCPLR 3211(a)(7)Pecuniary Loss
References
4
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. 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
Case No. MISSING
Regular Panel Decision
Aug 01, 2007

Utica Mutual Insurance v. Johnston

Utica Mutual Insurance Company, the plaintiff, sued several corporate entities and William Johnston for breach of contract and on an account stated. The lawsuit stemmed from alleged unpaid additional premiums on general liability and worker's compensation insurance policies issued by Utica National Assurance Company and Graphic Arts Mutual Insurance Co., respectively, both affiliated with Utica Mutual. The defendants moved for summary judgment, contending that Utica Mutual was not a direct party to the insurance contracts. The Supreme Court initially denied this motion. However, the appellate court reversed the decision, granting the defendants' motion for summary judgment and dismissing the complaint, finding that Utica Mutual lacked standing as it was not the issuer or a party to the subject insurance contracts.

Breach of ContractAccount StatedSummary JudgmentAppellate ReversalInsurance DisputesUnpaid PremiumsCorporate OwnershipStanding (Law)Insurance LawCivil Procedure
References
6
Case No. CA 10-00545
Regular Panel Decision
Feb 10, 2011

HAHN AUTOMOTIVE WAREHOUSE, INC. v. AMERICAN ZURICH INSURANCE COMPANY

Hahn Automotive Warehouse, Inc. (plaintiff) initiated a breach of contract action against American Zurich Insurance Company and Zurich American Insurance Company (defendants), contending that bills issued under insurance contracts were time-barred. Defendants counterclaimed for damages stemming from plaintiff's alleged breach of these contracts. The Supreme Court partially granted plaintiff's cross-motion, deeming counterclaims for debts arising over six years prior as time-barred. Concurrently, it permitted defendants to utilize a $400,000 letter of credit to satisfy any outstanding debt, including those deemed time-barred. On appeal, the Appellate Division affirmed the use of the letter of credit for time-barred debts, reasoning that the statute of limitations only bars the remedy, not the underlying obligation. The court also affirmed that defendants' counterclaims for debts over six years old were time-barred, as the right to demand payment accrued earlier. Finally, the court modified the order to dismiss plaintiff's second through fourth causes of action. A dissenting opinion argued that the counterclaims were not time-barred, asserting that the cause of action accrued upon demand and refusal of payment, not merely when the right to demand payment existed.

Breach of contractInsurance contractsStatute of limitationsLetter of creditSummary judgmentAppellate reviewContract interpretationTime-barred claimsAccrual of cause of actionRetrospective premiums
References
23
Case No. 2016 NY Slip Op 04185
Regular Panel Decision
Jun 01, 2016

Mecca Contracting, Inc. v. Scottsdale Insurance

Mecca Contracting, Inc., a general contractor, sought a declaratory judgment against Scottsdale Insurance Company after Scottsdale disclaimed coverage for an underlying personal injury action. Mecca, designated as an additional insured under a policy issued by Scottsdale to subcontractor Salcora Construction Corp., sought defense and indemnity, arguing the Scottsdale policy was primary. The Supreme Court granted summary judgment to Mecca, a decision affirmed by the Appellate Division, Second Department. The Appellate Division found Mecca was entitled to the declaration that Scottsdale was obligated to defend and indemnify it, and that the Scottsdale policy was primary, based on the contract between Mecca and Salcora and the 'Blanket Additional Insured Endorsement.' The matter was remitted to the Supreme Court, Kings County, for the entry of a formal judgment.

Insurance CoverageDeclaratory JudgmentAdditional Insured EndorsementPrimary CoverageGeneral Contractor LiabilitySubcontractor AgreementConstruction LawIndemnityDefense ObligationBreach of Contract
References
6
Case No. MISSING
Regular Panel Decision

Taylor v. Allstate Insurance Co.

Appellants Robert B. Taylor and R.B.T. Investments, Inc. (collectively, "Taylor") appealed a summary judgment in favor of appellees Allstate Insurance Company and Allstate County Mutual Insurance Company (collectively, "Allstate"). Taylor sued Allstate for negligence, vicarious liability, tortious interference, breach of contract, and statutory claims related to Allstate's handling of an automobile accident defense that resulted in a settlement exceeding Taylor's insurance coverage. The appellate court affirmed the summary judgment on Taylor’s claims for negligence, vicarious liability, and tortious interference, concluding that Texas law does not recognize these causes of action in this context outside of a Stowers claim. However, the court reversed and remanded the summary judgment regarding Taylor’s breach of contract and statutory claims, holding that the Stowers doctrine does not negate an insured's contractual and statutory rights. The denial of Taylor's motion to replead was also affirmed as he had already amended his pleadings.

Insurance DisputeSummary JudgmentNegligence ClaimsVicarious LiabilityTortious InterferenceBreach of ContractStatutory ClaimsStowers DoctrineInsurer DutiesAppellate Review
References
23
Case No. 2015 NY Slip Op 07554 [132 AD3d 500]
Regular Panel Decision
Oct 15, 2015

Bridge Street Contracting Inc. v. Everest National Insurance

This case addresses an insurer's disclaimer of coverage due to late notice of claims. The Appellate Division, First Department, modified a lower court order, declaring that Everest National Insurance Company has no duty to defend or indemnify Bridge Street Contracting Inc. in the underlying action. The court ruled that Everest properly disclaimed coverage without needing to demonstrate prejudice, as it was not participating in the defense when Bridge Street was served with the claims. Arguments regarding waiver of the late notice defense and antisubrogation were rejected. CastlePoint Insurance Company's motion to intervene was also denied as academic.

Insurance CoverageLate NoticeDisclaimer of CoverageSummary JudgmentDuty to DefendDuty to IndemnifyAntisubrogationInterventionAppellate DivisionContract Law
References
4
Case No. 03-17-0081-CV
Regular Panel Decision
Dec 29, 2017

PHI Air Medical, LLC v. 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

This letter serves as a reply from Insurer Appellees Texas Mutual Insurance Company, et al. to the Third District Court of Appeals. It addresses arguments made by PHI Air Medical, LLC regarding the definition of the 'business of insurance' under the McCarran-Ferguson Act, particularly concerning payments made to third parties versus directly to insureds. The Insurers contend that PHI's proposed distinction lacks common sense and is contrary to established Supreme Court authority, citing cases such as U.S. Treasury v. Fabe. They argue that the actual performance of an insurance contract, including paying medical benefits to providers, is an essential part of the 'business of insurance' and that state laws prescribing contract terms directly regulate this business. The letter concludes by asserting that PHI’s arguments are inconsistent with both the practical workings of insurance and Supreme Court precedent.

McCarran-Ferguson ActBusiness of InsuranceThird-Party PaymentsInsurance Contract PerformanceWorkers' Compensation LawSupreme Court PrecedentAppellate ReviewTexas Workers' CompensationStatutory InterpretationInsurance Regulation
References
4
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