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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

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. 03-22-00241-CV
Regular Panel Decision
Oct 31, 2023

Texas Political Subdivisions Joint Self-Insurance Fund v. Texas Department of Insurance - Division of Workers' Compensation and Commissioner Cassie Brown in Her Official Capacity

The Texas Political Subdivisions Joint Self-Insurance Fund (TPS Fund) appealed the denial of its plea to the jurisdiction and summary-judgment motion by the 455th District Court of Travis County. The TPS Fund, a self-insured governmental entity, was assessed administrative penalties totaling $132,500 by the Texas Department of Insurance–Division of Workers’ Compensation for violations of the Texas Labor Code related to nonpayment or late payment of workers’ compensation benefits. The TPS Fund asserted governmental immunity from these penalties. The Court of Appeals reviewed the legislative history and prior common law, including Texas Workers’ Comp. Comm’n v. City of Eagle Pass, to determine if immunity was waived. It concluded that the 2019 amendment to Labor Code Section 504.053(e) merely codified existing law, which had already established a clear waiver of immunity for such regulatory actions against self-insured political subdivisions. Therefore, the appellate court affirmed the trial court’s order, holding that the TPS Fund’s governmental immunity is waived for the administrative penalties.

Workers' CompensationGovernmental ImmunityAdministrative PenaltiesTexas Labor CodeSelf-InsurancePolitical SubdivisionsStatutory InterpretationAppellate ReviewRegulatory AuthoritySovereign Immunity
References
13
Case No. 14-07-00103-CV
Regular Panel Decision
Aug 27, 2008

Sonic Systems International, Inc. v. Randy Croix, Eddie Croix Insurance Agency, Inc., and Texas Mutual Insurance Company F/K/A Texas Worker's Compensation Insurance Fund

Appellant, Sonic Systems International, Inc. (Sonic), sued appellee, Texas Mutual Insurance Company f/k/a Texas Worker=s Compensation Insurance Fund (TMI), based on TMI=s denial of insurance coverage relative to a work-related injury sustained by a Sonic employee. Sonic also sued appellees, Randy Croix and Eddie Croix Insurance Agency, Inc. (collectively the Croix Parties), based on their alleged failure to properly procure insurance to cover the employee=s claims. The trial court granted separate motions for summary judgment filed by TMI and the Croix Parties. The trial court rendered a final judgment that Sonic take nothing from all appellees. Sonic presents four appellate issues, challenging both summary judgments. The appellate court reverses the portions of the judgment ordering that Sonic take nothing on all its contractual and extra-contractual causes of action against TMI to the extent they are based on TMI=s denial of the claim for Texas workers= compensation benefits at issue in this suit. It affirms the portions of the judgment ordering that Sonic take nothing on all its contractual and extra-contractual causes of action to the extent they are not based on TMI=s denial of the Texas workers= compensation claim. It also affirms the summary judgment on Sonic=s request for declaratory relief and the judgment in favor of the Croix Parties.

Workers' Compensation InsuranceInsurance Coverage DisputeEmployer ClaimsInsurance Agent NegligenceSummary Judgment AppealTexas Labor LawDeceptive Trade Practices ActBad Faith ClaimsOut-of-State Workers' InjuryElection of Remedies
References
21
Case No. MISSING
Regular Panel Decision
Oct 06, 2000

Royal Insurance Co. of America v. Commissioners of the State Insurance Fund

The claimant sought 50% reimbursement of defense costs from the State Insurance Fund (Fund) for litigation related to a bridge collapse, after the Fund ceased contributions. The Court of Claims granted summary judgment to the claimant, finding an implied contract. On appeal, the Fund argued State Finance Law § 112 (2) (a) precluded such a contract without Comptroller approval and that factual issues existed. The appellate court affirmed, holding the Fund acts as a private insurer in litigation and is estopped from denying the implied contract, also finding no material factual issues precluding summary judgment.

Reimbursement of Defense CostsImplied ContractState Insurance FundCo-insuranceSummary JudgmentEstoppelState Finance LawWorkers' Compensation LawAppellate ReviewGovernmental Immunity
References
6
Case No. CA 11-00156
Regular Panel Decision
Jun 17, 2011

MERCHANTS MUTUAL INSURANCE COMPANY v. NEW YORK STATE INSURANCE FUND

Plaintiff, Merchants Mutual Insurance Company, initiated an action against New York State Insurance Fund to recover funds related to an underlying wrongful death lawsuit. The core issue was the defendant's obligation to indemnify Jerrick Waterproofing Co., Inc. for a construction accident. The Supreme Court granted summary judgment to the plaintiff, which the defendant appealed. The Appellate Division, Fourth Judicial Department, affirmed the lower court's decision, ruling that the defendant was indeed obligated to provide unlimited coverage to Jerrick Waterproofing, despite a policy exclusion, as a common-law right to indemnity existed. Consequently, the plaintiff's excess coverage was not triggered.

Insurance disputeWorkers' CompensationIndemnificationExcess coverageSummary judgmentAppellate reviewNew York lawEmployer liabilityPolicy exclusionCommon-law indemnity
References
4
Case No. MISSING
Regular Panel Decision

Commissioners of the State Insurance Fund v. Hermitage Insurance

The State Insurance Fund (SIF) initiated a declaratory judgment action to determine its obligation to defend and indemnify Frank Tricarico Contractors, Inc. (FTC) in a separate personal injury lawsuit. Frank Tricarico, FTC's sole stockholder, had previously opted out of Workers' Compensation coverage but was injured in a job-related accident. In the underlying action, Tricarico sued a third party, who then impleaded FTC. SIF initially provided a defense for FTC, but questioned its duty after Tricarico alleged he was not an employee. Hermitage Insurance Company, FTC's general liability insurer, disclaimed coverage. While the Supreme Court initially ruled that SIF was obligated to defend, the appellate court reversed this decision. The appellate court concluded that SIF had no duty to defend or indemnify FTC because Frank Tricarico was not an employee, and the failure to disclaim coverage cannot create coverage where the policy itself does not apply.

Workers' CompensationInsurance Coverage DisputeDeclaratory JudgmentSummary JudgmentEmployer LiabilityEmployee ExclusionDuty to DefendDuty to IndemnifyAppellate Review
References
3
Case No. 07-01-0322-CV
Regular Panel Decision
Sep 19, 2002

Texas Worker's Compensation Insurance Fund v. Alisha Byrd, Beneficiary of Melvin R. Byrd, Richard Walters and Pacific Employers Insurance Company

The Texas Workers’ Compensation Insurance Fund appealed a summary judgment that favored Alisha Byrd, Richard Walters, and Pacific Employers Insurance Company. The Fund sought to overturn decisions by the Texas Workers’ Compensation Commission’s Appeals Panel regarding the employment status of Melvin Byrd and Richard Walters at the time of their injuries. The core dispute revolved around whether Elliott Machine Shop or Entergy/Gulf States was the employer under the "borrowed servant" doctrine. The trial court affirmed the Commission’s finding that Elliott was the employer. The Court of Appeals found no inconsistency in the contractual provisions concerning employer control and deemed PEIC’s summary judgment evidence sufficient to negate the "borrowed servant" claim. Consequently, the appellate court affirmed the trial court’s judgment, overruling all of the Fund’s issues.

Borrowed Servant DoctrineSummary Judgment ReviewEmployer Liability DisputeInsurance Coverage ClaimAppeals Panel DecisionsContract InterpretationRight of Control TestEmployee Status DeterminationAppellate AffirmationTexas Civil Procedure
References
7
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. 01-02-00807-CV
Regular Panel Decision
Mar 16, 2006

Texas Mutual Insurance Co. F/K/A/ Texas Workers' Compansation Ins. Fund v. Ray Ferguson Interest, Inc., RFI Brazos Paving Co., Inc.

Texas Mutual Insurance Company (the Fund) appealed a judgment from a jury verdict in favor of Ray Ferguson Interests, Inc. (RFI), awarding RFI over $2.2 million in actual damages, $3.5 million in statutory damages for Insurance Code violations, and attorney's fees. The dispute arose from the Fund's investigation into RFI's workers' compensation premiums, alleging premium fraud related to RFI's subcontractor, Brazos. RFI counter-sued, alleging breach of contract and violations of the Insurance Code for the Fund's actions. The appellate court found errors in the trial court's denial of pre-judgment interest to the Fund and in the jury's damage awards for 'lost time' due to litigation and for 'loss of value' or 'credit reputation' resulting from statements protected by judicial immunity or lacking direct causation to the Fund's alleged contract breaches or deceptive acts. Consequently, the court reversed RFI's recovery, affirmed parts of the judgment, and remanded the case with instructions, including entering a take-nothing judgment on RFI's claims.

Workers' CompensationInsurance FraudBreach of ContractUnfair Insurance PracticesTexas Insurance CodeJudicial ImmunityDamagesAttorney's FeesPre-judgment InterestCausation
References
26
Case No. MISSING
Regular Panel Decision
Jan 13, 1995

National Union Fire Insurance Co. of Pittsburgh, PA v. State Insurance Fund

Plaintiff National Union Fire Insurance Company of Pittsburgh, PA (National Union) initiated a declaratory judgment action against The State Insurance Fund (SIF) to recover defense and settlement costs. These costs were expended on behalf of Regional Scaffolding and Hoisting Co., Inc., a mutually insured party in an underlying personal injury action. The Supreme Court initially denied National Union's motion for summary judgment and ruled in favor of SIF. However, the appellate court reversed this decision, concluding that the antisubrogation rule did not apply in this context. Consequently, it determined that National Union and SIF were co-insurers for Regional Scaffolding's common-law liability. The court granted National Union's motion for summary judgment in part, declaring SIF's duty to reimburse National Union for one-half of the reasonable settlement and defense costs, and remanded for a trial to ascertain these amounts.

Antisubrogation RuleDeclaratory JudgmentSummary JudgmentInsurance Coverage DisputeCo-Insurer LiabilityDefense Costs ReimbursementSettlement CostsEmployer's LiabilityComprehensive General LiabilityThird-Party Action
References
8
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