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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. 03-10-00385-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. 03-97-00567-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. 03-13-00300-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. 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. 03-97-00192-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
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

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. 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
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