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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. 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. M2003-02647-COA-R3-CV
Regular Panel Decision
Jun 10, 2005

Tennessee Insurance Guaranty Association v. Centre Insurance Company

The Tennessee Insurance Guaranty Association (TIGA) sued Centre Insurance Company, seeking to be exonerated from workers' compensation obligations it assumed after Commercial Compensation Insurance Company's insolvency. TIGA contended that Centre was liable due to its predecessor's name appearing on Form I-1 certificates of insurance, despite Commercial Compensation issuing the actual policies. The trial court granted summary judgment to Centre, a decision affirmed by the Court of Appeals. The appellate court distinguished the case from controlling precedent, holding that TIGA, as a statutory successor to an insolvent insurer, could not assert claims against Centre that the insolvent insurer itself did not possess. The court emphasized that TIGA inherits the rights and obligations of the insolvent insurer, and since Commercial Compensation Insurance Company had no claim against BICO/Centre, TIGA also had none.

Workers' Compensation InsuranceInsurance Company InsolvencyGuaranty AssociationsSummary Judgment AffirmationStatutory InterpretationAppellate Court DecisionInsurance Policy CertificationSuccessor Rights and ObligationsEmployer Insurance LiabilityTennessee Workers' Compensation Law
References
9
Case No. MISSING
Regular Panel Decision
Feb 26, 1998

Texas Property & Casualty Insurance Guaranty Ass'n v. Southwest Aggregates, Inc.

This appeal addresses an insurer's (Alliance) duty to defend its insured (Southwest Aggregates) in silicosis lawsuits and the Texas Property and Casualty Insurance Guaranty Association's (Guaranty Association) obligations after another insurer (ECC) became insolvent. Key issues included whether an insurer's defense duty is pro rata for occurrences spanning multiple policy periods, if the right to a defense must be exhausted against solvent insurers before the Guaranty Association's duty triggers, and the availability of attorney's fees. The court affirmed that an insurer owes a complete, not pro rata, defense and that the right to defense must be exhausted against solvent insurers. However, the court reversed the denial of attorney's fees to the Guaranty Association, holding they are recoverable for a subrogated breach of contract claim.

Insurance LawDuty to DefendPro Rata AllocationExhaustion DoctrineImpaired InsurerGuaranty AssociationSubrogation RightsAttorney's FeesSummary Judgment AppealContract Breach
References
42
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. 14-04-00651-CV
Regular Panel Decision
Mar 08, 2007

Coastal Refining & Marketing, Inc., Coastal Offshore Insurance Limited, and Lexington Insurance Company v. United States Fidelity and Guaranty Company

This insurance coverage dispute centers on whether United States Fidelity and Guaranty Company (USF&G) had a duty to reimburse its insured, Coastal Refining & Marketing, Inc., and two other carriers, Coastal Offshore Insurance Limited and Lexington Insurance Company, for costs incurred in settling a personal injury lawsuit. USF&G moved for summary judgment, arguing late notice, settlement without consent, and failure to cooperate by its insured. The appellate court reversed the trial court's summary judgment, finding that USF&G failed to produce evidence of actual prejudice resulting from the insured's actions. The court clarified that for bodily injury and property damage claims, actual, not merely speculative, prejudice must be demonstrated to void coverage. The case was remanded for further proceedings consistent with this opinion.

Insurance CoverageSummary JudgmentPrejudice (Insurance Law)Late Notice (Insurance)Voluntary Payment ClauseDuty to Cooperate (Insurance)IndemnificationContract LawAppellate ReviewTexas Law
References
41
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. 03-99-00293-CV
Regular Panel Decision
Feb 10, 2000

Texas Property and Casualty Insurance Guaranty Association v. Jack M. Webb, as Special Deputy Receiver of Employers Casualty Co. Jack M. Webb, as Special Deputy Receiver of Employers National Insurance Co.

This case involves an appeal from a summary judgment concerning the claims priority scheme within the Texas Insurance Code's liquidation statute. The appellant, Texas Property and Casualty Insurance Guaranty Association (TPCIGA), challenged the classification of its claims for defense costs incurred in defending liability and workers' compensation claims under policies of insolvent insurers. TPCIGA argued these costs should receive Class 1 priority as claims-handling expenses, while appellees contended they were Class 2 payments of policyholder claims. The court concluded that, prior to a 1995 amendment to the statute, such defense costs were properly classified as Class 2 claims. Therefore, the district court's judgment classifying them as Class 2 was affirmed.

Insurance LawClaims PriorityLiquidation StatuteTexas Insurance CodeGuaranty ActPolicyholder ClaimsDefense CostsStatutory InterpretationSummary JudgmentReceivership
References
22
Case No. 03-01-00084-CV
Regular Panel Decision
Nov 07, 2002

John W. Berkel and John W. Berkel, P.C./Texas Property and Casualty Insurance Guaranty Association v. Texas Property and Casualty Insurance Guaranty Association/John W. Berkel and John W. Berkel, P.C.

This case involves cross-appeals from a judgment by the District Court of Travis County. John W. Berkel and John W. Berkel, P.C. (Berkel) sued the Texas Property and Casualty Insurance Guaranty Association (TPCIGA) and a receiver, seeking to enforce a contract for $6,306, which represented a previously approved "covered claim" for legal services. The trial court awarded Berkel the $6,306 but denied claims for statutory attorney's fees, prejudgment, and postjudgment interest. TPCIGA appealed the $6,306 award, arguing the claim was not a covered claim, but the appellate court affirmed this part, holding the Receiver's prior determination was binding. Berkel appealed the denial of attorney's fees and interest, and the appellate court reversed and remanded this part for further proceedings.

Insurance LawReceivershipImpaired InsurerCovered ClaimsStatutory InterpretationAttorney's FeesPrejudgment InterestPostjudgment InterestSummary JudgmentContract Enforcement
References
9
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
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