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

Case No. 03-15-00314-CV
Regular Panel Decision
Aug 07, 2015

California Insurance Guarantee Association, Oklahoma Property and Casualty Insurance Guaranty Association, and Texas Property and Casualty Insurance Guaranty Association v. Hill Brothers Transportation, Inc.

The appellants, California Insurance Guarantee Association (CIGA), Oklahoma Property and Casualty Insurance Guaranty Association (OPCIGA), and Texas Property and Casualty Insurance Guaranty Association (TPCIGA), collectively "Guaranty Associations," are appealing a summary judgment granted in favor of the appellee, Hill Brothers Transportation, Inc. ("Hill Bros."). The suit was filed on March 31, 2009, alleging Hill Bros. failed to reimburse the Guaranty Associations for payments of workers' compensation benefits and claim handling expenses within the deductible limits of a policy issued by the insolvent Legion Insurance Company ("Legion"). The District Court granted summary judgment to Hill Bros. based on the statute of limitations, ruling that the cause of action accrued on April 1, 2002. The Guaranty Associations argue that the accrual date is incorrect, as their statutory obligations had not been triggered, payments had not been made, and demand for reimbursement had not occurred by that date. They also contend that their compliance with Pennsylvania law (the "Pennsylvania Act") in seeking reimbursement through Legion in Liquidation constitutes a mitigating circumstance for any delay, making reasonableness a fact question. Furthermore, they assert the policy was a continuing contract, and the statute of limitations should not have accrued until full performance on April 28, 2009. Alternatively, they argue that claims for deductible payments made within four years of filing suit (March 31, 2005) are not barred.

Workers' CompensationInsurance Guaranty AssociationStatute of LimitationsBreach of ContractDeductible ReimbursementInsolvencyInsurance PolicyContinuing ContractPennsylvania ActTravis County
References
21
Case No. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
Case No. AHM 90917 AHM 90918
Regular
Jul 11, 2007

ANGEL SOSA vs. D.W. FOODS, EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, VILLANOVA INSURANCE

This case concerns a dispute over reimbursement between an insurer, Everest, and the California Insurance Guarantee Association (CIGA), which is handling claims for a liquidated insurer, Villanova. The Board denied Everest's petition, upholding a prior award for reimbursement from Everest to CIGA. However, the Board granted CIGA's petition to amend the award to include Villanova Insurance as a party defendant.

CIGAEverest National Insurance CompanyVillanova Insuranceliquidationreconsiderationreimbursementbill review chargesjoint and several liabilitycumulative traumadenied due process
References
0
Case No. MISSING
Regular Panel Decision

California Insurance Guarantee Ass'n v. Hill Bros. Transportation, Inc.

This appellate court opinion addresses a dispute between several state insurance guaranty associations (CIGA, OPCIGA, TPCIGA) and Hill Brothers Transportation, Inc., concerning the reimbursement of workers' compensation deductibles. Hill Brothers' insurer, Legion Insurance Company, became insolvent, leading the Guaranty Associations to pay claims on Legion's behalf. The associations then sought reimbursement from Hill Brothers for deductibles. The trial court granted summary judgment for Hill Brothers, citing the statute of limitations. On appeal, the court ruled that the California Insurance Guarantee Association (CIGA) lacked standing and dismissed its claims. However, the court found that the Oklahoma Property and Casualty Insurance Guaranty Association (OPCIGA) and Texas Property and Casualty Insurance Guaranty Association (TPCIGA) did have standing. Furthermore, the appellate court reversed the trial court's decision regarding limitations, holding that the cause of action for reimbursement accrued upon demand and refusal, not earlier. The case was remanded for further proceedings for OPCIGA and TPCIGA's claims.

Insurance Guaranty FundsInsurer InsolvencyWorkers' Compensation DeductiblesContract BreachLegal StandingStatute of Limitations DefenseAppellate ReversalJudicial RemandInsurance ReimbursementPolicy Obligations
References
30
Case No. 03-97-00567-CV
Regular Panel Decision
Jul 30, 1998

Memorial Medical Center of East Texas v. James A. Howard, Special Deputy Receiver of Texas Employers' Insurance Association and Texas Property and Casualty Insurance Guaranty Association

Memorial Medical Center of East Texas appealed a summary judgment granted in favor of James A. Howard, Special Deputy Receiver of Texas Employers' Insurance Association, and Texas Property and Casualty Insurance Guaranty Association. Memorial sought a declaration that the appellees were obligated to reimburse defense costs incurred in a separate suit brought by its employees. The trial court granted the appellees' motions for summary judgment without specifying the grounds. The appellate court affirmed the trial court's judgment, holding that both the Receiver and the Association were statutorily precluded from defending Memorial or reimbursing its defense costs under relevant provisions of the Texas Insurance Code.

Summary judgmentInsurance CodeDuty to defendReimbursementImpaired insurerReceivershipGuaranty AssociationAppellate reviewStatutory interpretationWorkers' compensation insurance
References
11
Case No. 03-10-00385-CV
Regular Panel Decision
Aug 26, 2011

John H. Carney & Associates v. Texas Property and Casualty Insurance Guaranty Association

John H. Carney & Associates (Carney) sued the Texas Property and Casualty Insurance Guaranty Association (the Association) to recover damages from a judgment against an insolvent insurer, Texas Select Lloyds Insurance Company. Carney asserted the judgment was a 'covered claim' under the Texas Property and Casualty Insurance Guaranty Act, arising from an assigned interest in a first-party homeowners policy claim of their former client, Joy Lincoln. The Association moved for summary judgment, arguing Carney was not an 'insured' or 'third-party claimant' as defined by the Act, among other grounds. The trial court granted summary judgment without stating the specific grounds. The appellate court affirmed the trial court's decision, concluding that the Guaranty Act's remedy is limited to 'insureds' and 'third-party claimants' and does not extend to assignees, based on statutory construction and comparison with similar laws.

Insurance LawGuaranty ActAssignee RightsSummary JudgmentStatutory ConstructionAppellate ReviewInsurer InsolvencyCovered ClaimAttorney's FeesProperty Damage
References
91
Case No. 03-13-00300-CV
Regular Panel Decision
Feb 26, 2015

Adrian Tijerina v. Texas Property Casualty Insurance Guaranty Association as Receiver for SIR Lloyd's Insurance Company and the Texas Department of Insurance, Division of Workers' Compensation

Adrian Tijerina appealed the dismissal of his case against the Texas Property Casualty Insurance Guaranty Association (Association) and the Texas Department of Insurance, Division of Workers’ Compensation (Division). Tijerina, who sustained a back injury in 1987, sought to enforce a 1989 judgment for future medical benefits, alleging the Association refused to pay for back surgery and the Division improperly refused jurisdiction. The Ector County court transferred the case to Travis County, and the Travis County district court dismissed it for lack of jurisdiction. The appellate court affirmed the trial court's order, ruling that the venue transfer was proper, Tijerina's claim against the Division was barred by sovereign immunity and failure to exhaust administrative remedies, and his claim against the Association was not ripe because the compensability of the desired surgery had not been determined by the Division.

Workers' CompensationJurisdictionPlea to the JurisdictionVenue TransferAdministrative RemediesRipeness DoctrineSovereign ImmunityDeclaratory JudgmentMedical BenefitsBack Surgery
References
17
Case No. B167017
Significant
Nov 18, 2004

General Casualty Insurance and Regent Insurance, Joseph A. Lane, American Home Assurance Company vs. Workers' Compensation Appeals Board and California Insurance Guarantee Association

The court has requested responses from the Workers' Compensation Insurance Rating Bureau (WCIRB) and the California Insurance Commissioner regarding the exclusion of special employees from a special employer's workers' compensation policy, specifically questioning the use and requirements of Form No. 11 for this purpose.

WCIRBForm No. 11limiting endorsementsrestricting endorsementsspecial employeesgeneral employerstemporary employeesleased employeesInsurance CommissionerCalifornia Code of Regulations
References
1
Case No. 03-97-00192-CV
Regular Panel Decision
Feb 05, 1998

Texas Property and Casualty Insurance Guaranty Association v. Texas Association of School Boards Workers' Compensation Self-Insurance Fund, Individually and on Behalf of the Independent School Districts of Aransas Pass, El Paso, Irving, Houston,and Hico

This case involves an appeal from the District Court of Travis County between the Texas Property and Casualty Insurance Guaranty Association (Appellant) and the Texas Association of School Boards Workers' Compensation Self-Insurance Fund, Individually and on Behalf of several Independent School Districts (Appellee). The parties jointly moved the Court of Appeals to vacate the trial court's judgment and render a judgment stating that the appellee should take nothing against the appellant. Citing precedent from *Starnes v. Chapman*, the Court noted that reversing the trial court's judgment effectively vacates it and aligns with their practice when rendering a new judgment. The Court granted the motion, reversed the trial court's judgment, and rendered judgment that the appellee take nothing against the appellant. The decision was rendered per curiam by Justices Powers, Kidd, and B. A. Smith.

Texas Court of AppealsJoint MotionVacate JudgmentRender JudgmentTake NothingWorkers' CompensationSelf-Insurance FundInsurance Guaranty AssociationAppellate PracticePer Curiam
References
1
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
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