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

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. 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

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
Case No. 03-05-00189-CV
Regular Panel Decision
Mar 21, 2008

Texas Department of Insurance, Division of Workers' Compensation v. Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, Inc.

The Texas Department of Insurance, Division of Workers' Compensation (the "Division") promulgated a rule (28 Tex. Admin. Code § 133.309) to create a less expensive alternative review procedure for workers' compensation claims concerning the necessity of medical treatment. The Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, L.P. (the "Joint Appellees") challenged the rule's validity in a declaratory judgment action. The district court granted the Joint Appellees' motion for summary judgment, declaring the rule invalid. The appellate court affirmed the district court's judgment, concluding that the rule was not in harmony with relevant governing statutes that allowed for judicial review of medical necessity disputes.

Workers' Compensation LawAdministrative LawJudicial ReviewStatutory InterpretationDeclaratory JudgmentSummary JudgmentMedical Necessity DisputesAlternative Dispute ResolutionAgency Rule ValidityTexas Court of Appeals
References
15
Case No. MISSING
Regular Panel Decision

Transcontinental Insurance v. State Insurance Fund

This case involves a dispute between two insurers, Transcontinental Insurance Company (plaintiff) and State Insurance Fund (defendant), regarding their contribution to the defense and settlement of an underlying personal injury action. Transcontinental, which insured the contractor Master, sought a declaration that State Insurance Fund, Master's workers' compensation insurer, should contribute as a co-insurer for expenses incurred defending and settling the action on behalf of NYPA. The Supreme Court dismissed the complaint, applying the antisubrogation rule. The Appellate Division modified the judgment, vacating the dismissal but affirming the application of the antisubrogation rule, declaring that State Insurance Fund is not obligated to reimburse Transcontinental for the expenses.

Insurance DisputeAntisubrogation RuleDeclaratory JudgmentCommercial General Liability PolicyWorkers' Compensation InsuranceIndemnificationCo-insurancePersonal Injury ActionAppellate ReviewContractual Obligation
References
5
Case No. MISSING
Regular Panel Decision

St. Paul Mercury Insurance v. Lexington Insurance

This case involves a declaratory judgment action between four insurance companies: St. Paul Mercury Insurance Company and Centennial Insurance Company (Applicants), and Lexington Insurance Company and Landmark Insurance Company (Defendants). The dispute centers on the priority of coverage and obligations for a $4.8 million settlement in an underlying personal injury case, the 'Foret Case'. The District Court adopted the Magistrate Judge's Recommendation, ruling that waiver and estoppel claims by the defendants were not applicable between insurers. It determined that both primary policies (Landmark and Centennial) must be exhausted first, with defense costs prorated. For the excess policies (Lexington and St. Paul), liability was also to be prorated. Additionally, the court granted summary judgment in favor of St. Paul and Centennial on the negligence claims brought by Landmark and Lexington.

Insurance Coverage DisputeSummary JudgmentDeclaratory JudgmentOther Insurance ClausesExcess InsurancePro Rata InsuranceEscape ClausesWaiver and EstoppelEquitable SubrogationProration of Liability
References
42
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. 03-05-00401-CV
Regular Panel Decision
Mar 31, 2006

Texas Property and Casualty Insurance Guaranty Association, for Paula Insurance Company, an Impaired Insurer v. National American Insurance Company and Clayton Mark Beck

This case involves an appeal from a workers' compensation decision concerning the employment status of two injured workers, Benjamin Brown and Clayton Mark Beck. The dispute centered on whether Jerry Gregory, Inc. or Hunter Trucking was their employer at the time of a trucking accident, which determines liability between National American Insurance Company (NAIC) and Texas Property and Casualty Guaranty Association (TPCIGA). The Workers' Compensation Commission initially found Gregory as the employer, making NAIC liable. However, the district court, after a jury trial under a 'modified de novo' standard, ruled that Hunter was the employer, thus making TPCIGA liable. TPCIGA appealed, arguing the dispute was a 'coverage' issue requiring substantial-evidence review, not modified de novo, and that the district court lacked subject-matter jurisdiction. The appellate court affirmed the district court's judgment, concluding that the dispute was one 'regarding compensability' and thus correctly governed by modified de novo review.

Workers' CompensationEmployer LiabilityInsurance Coverage DisputeModified De Novo ReviewSubstantial Evidence ReviewBorrowed Servant DoctrineJudicial ReviewTexas Court of AppealsTravis CountyTrucking Accident
References
60
Case No. 03-01-00448-CV
Regular Panel Decision
Dec 13, 2001

Western Clipper Inc., D/B/A Southwest Roofing Company v. Texas Department of Insurance Commissioner of Insurance of the State of Texas And Texas Workers' Compensation Insurance Facility

The appellant, Western Clipper Inc., doing business as Southwest Roofing Company, and the appellees, Texas Department of Insurance, Commissioner of Insurance of the State of Texas, and Texas Workers’ Compensation Insurance Facility, settled their disputes during oral argument. A joint motion to dismiss the appeal was filed by the parties. The court granted the motion, resulting in the dismissal of the appeal.

Texas LitigationAppellate CourtVoluntary DismissalSettlement AgreementInsurance LawState AgenciesCivil AppealsTravis CountyJudicial Decision
References
0
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
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