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

Case No. 07-05-00188-CV
Regular Panel Decision
Jun 20, 2007

Yorkshire Insurance Co., LTD. and Ocean Marine Insurance Co., LTD. v. Roy S. Seger, Individually and Shirley Faye Hoskins, Individually and as Administrator of the Estate of Randall Jay Seger

The case involves an appeal by Yorkshire Insurance Co., Ltd., and Ocean Marine Insurance Co., Ltd., against Roy Seger and Shirley Faye Hoskins. The insurers appealed a judgment of over $26 million in actual damages related to a "Stowers" action, stemming from the death of Randall Jay Seger in a drilling accident. The core issues involved whether the insurers were unauthorized, the applicability of a "leased-in worker" exclusion in their CGL policy, and whether the Segers' settlement demands were within policy limits. The court ruled that the 1993 amendments to the Insurance Code applied retroactively and affirmed that the Segers made a sufficient settlement demand within policy limits. However, it reversed the summary judgment on coverage, finding the "leased-in worker" exclusion unambiguous and potentially applicable, and also reversed the directed verdict on damages, as a fact issue remained regarding whether the underlying judgment was the result of a "fully adversarial trial." The case was thus largely remanded for a new trial.

Insurance disputeStowers actionNegligent failure to settleSurplus lines insuranceUnauthorized insurersContract defensesSummary judgmentDirected verdictDamagesFully adversarial trial
References
33
Case No. MISSING
Regular Panel Decision

State Insurance Fund v. American Hardware Mutual Insurance

The State Insurance Fund (SIF) initiated an action seeking a declaratory judgment that the defendants were obligated to pay their proportionate share of settlement and defense costs from an underlying personal injury action. In the underlying case, an employee of World of Hitches N Rental, Inc., sustained injuries and settled for $1,475,000, with SIF, as World of Hitches' workers' compensation insurer, paying $750,000 and waiving a $225,000 lien. The defendants, who had issued commercial general liability and garage policies to World of Hitches, disclaimed coverage due to policy exclusions for employee bodily injury. However, the court found their disclaimer, issued over four months after notification, was untimely under Insurance Law § 3420 (d). The court also rejected the defendants' argument that the garage policy didn't cover the injury. Consequently, the defendants were obligated to defend and indemnify World of Hitches. The judgment was modified, reducing the defendants' required contribution to the settlement from $650,000 to $300,000, consistent with the policy limits and the mutual exclusivity clause.

Insurance coverageDisclaimer of coverageUntimely noticeInsurance policy exclusionsWorkers' compensation insurerCommercial general liability policyGarage policyPolicy limitsContributionIndemnification
References
12
Case No. M2012-00331-COA-R3-CV
Regular Panel Decision
Jan 30, 2013

Erie Insurance Exchange v. Columbia National Insurance Company

This is a declaratory judgment action between two insurance companies. Erie Insurance Exchange, a general liability insurer, sought a declaration that Columbia National Insurance Company, an automobile insurer, had the primary duty to defend and indemnify an insured in a third-party tort action. The tort action stemmed from a construction site accident where an employee was electrocuted by a crane on a 'boom truck' owned by Nashville Building Systems (NBS) and listed under Columbia's auto policy. The trial court denied Erie's motion for summary judgment and granted Columbia's, holding Erie liable. The Court of Appeals affirmed the trial court's decision, finding that the Workers' Compensation Statute provided an exclusive remedy and that the boom truck, when used as a stationary crane, qualified as 'mobile equipment' and was thus excluded from coverage under Columbia's auto policy at the time of the injury.

Declaratory JudgmentInsurance Coverage DisputeAutomobile Insurance PolicyGeneral Liability PolicyWorkers' Compensation ActMobile Equipment ExclusionStatutory EmployerThird-Party TortfeasorBoom Truck AccidentSummary Judgment
References
45
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. 03-05-00776-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
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. MISSING
Regular Panel Decision

National Union Fire Insurance Co. of Pittsburgh v. American Re-Insurance Co.

The case revolves around a dispute between National Union Fire Insurance Company and American Re-Insurance Company regarding a pollution exclusion clause in a reinsurance policy. National Union sought reimbursement from American Re after settling claims where employees were exposed to metalworking fluids. American Re denied coverage, arguing its pollution exclusion applied. The court, applying Ohio law, found American Re's pollution exclusion ambiguous due to its broad language and its intended purpose of covering environmental contamination. Consequently, American Re's motion for summary judgment was denied, and National Union's motion to strike American Re's defense was granted, requiring American Re to "follow the fortunes" of National Union.

ReinsurancePollution Exclusion ClauseContract InterpretationFollow the Fortunes DoctrineSummary JudgmentInsurance CoverageAmbiguity in ContractsOhio State LawDiversity JurisdictionIndustrial Contamination
References
31
Case No. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
Case No. 09-22-00174-CV
Regular Panel Decision
Apr 03, 2025

Lexington Insurance Company v. Exxon Mobil Corporation and ExxonMobil Oil Corporation

This case from the Ninth District of Texas at Beaumont addresses an appeal by Lexington Insurance Company against Exxon Mobil Corporation and ExxonMobil Oil Corporation. Lexington challenged a summary judgment that awarded Exxon $25 million under an umbrella insurance policy. The dispute centered on whether Exxon qualified as an additional insured under a policy issued to Brock Services, LTD, and if specific policy exclusions for workers' compensation and employer's liability applied. The court affirmed the arbitration finding that Exxon was an additional insured but ultimately reversed the trial court's judgment. It ruled that the employer's liability exclusion applied, given Exxon's status as a statutory employer of Brock's injured employees through its Owner Controlled Insurance Program (OCIP), thus entitling Exxon to the exclusive remedy defense under the Texas Workers' Compensation Act. Consequently, Lexington was found to have no duty to defend or indemnify Exxon, and the awards for damages, attorney's fees, and interest were reversed.

Insurance Policy CoverageUmbrella InsuranceWorkers' Compensation ActEmployer's Liability ExclusionExclusive RemedyOCIPStatutory EmployerAdditional Insured StatusArbitration ReviewSummary Judgment Reversal
References
33
Case No. MISSING
Regular Panel Decision

General Accident Insurance v. United States Fidelity & Guarantee Insurance

Plaintiff, an insurer, sought recovery from defendant, another insurer, after defending its insured in an underlying action and paying the resulting judgment. The plaintiff had failed to give timely notice of disclaimer based on an exclusion in its policy, while the defendant refused to assume defense, claiming its policy did not cover the accident. The underlying action stemmed from injuries caused by a water softener tank falling from a push cart. Supreme Court determined both insurers were coinsurers, responsible for pro rata shares based on policy limits. The appellate court affirmed this decision, rejecting both insurers' arguments regarding policy exclusions by strictly construing the exclusions and citing prior case law, concluding that both policies provided primary coverage.

Insurance LawCoverage DisputeExclusion ClauseDuty to DefendPro Rata ContributionCoinsuranceWaiverEstoppelSummary JudgmentAppellate Review
References
12
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