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Case Law Database

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

Case No. 12-05-00309-CV
Regular Panel Decision
Feb 28, 2006

in Re: Kemper Lloyds Insurance Company

Kemper Lloyds Insurance Company, as relator, filed an original mandamus proceeding challenging a discovery order by Judge Campbell Cox. The underlying dispute involved Tim and Lynn Howell, who sued Kemper for breach of contract and bad faith settlement practices after their homeowner's insurance claim was partially denied following an inspection by Gary Whightsil. The Howells sought discovery of other claims Whightsil investigated for Kemper to assess potential bias. Judge Cox ordered Kemper to disclose the names and addresses of policyholders whose claims were listed in Whightsil's summary, subject to a confidentiality agreement. The Court of Appeals denied Kemper's petition for writ of mandamus, concluding that the trial court did not abuse its discretion in ordering the disclosure of information relevant to expert bias, and Kemper failed to establish a constitutionally protected privacy interest sufficient to preclude discovery.

Mandamus ProceedingDiscovery OrderAbuse of DiscretionExpert Witness BiasRelevance of EvidencePrivacy RightsConfidentiality ProvisionInsurance ClaimHomeowner PolicyProperty Damage
References
23
Case No. MISSING
Regular Panel Decision
Apr 22, 2001

Epstein v. Kemper Insurance Companies

Plaintiffs, including Joel Epstein, James Glenn, Marina Dushas, Lawrence Miles, and Julia Porper, brought an action against Kemper Insurance Companies, alleging age discrimination and retaliation under the Age Discrimination in Employment Act (ADEA) and the New York City Human Rights Law (NYCHRL). Plaintiffs, who were attorneys in Kemper's New York City litigation department and all over 40 years old, claimed that new Managing Attorney Anne Pope systematically harassed them, leading to lowered performance ratings, terminations, or diminished responsibilities. Defendant moved for summary judgment, to strike portions of plaintiffs' affidavits, and to sever the claims. The court partially granted the motion to strike, finding some submissions inappropriate. However, the court denied defendant's motion for summary judgment, determining that material questions of fact existed regarding whether the defendant's non-discriminatory justifications were a pretext for age discrimination and retaliation. The court also denied the motion to sever, concluding that the plaintiffs' claims arose from the same series of occurrences and shared common questions of law and fact.

Age DiscriminationRetaliationSummary JudgmentMotion to StrikeMotion to SeverADEA ClaimNYCHRL ClaimEmployment LawPrima Facie CasePretext
References
40
Case No. MISSING
Regular Panel Decision

In re the Arbitration between Basch & Kemper Insurance

This case details an appeal concerning an arbitration award for no-fault benefits following an alleged injury. The petitioner sought benefits for lost wages from Kemper Insurance Company. The Special Term confirmed the arbitrator's award, which included benefits exceeding statutory limits and incorrectly calculated interest. On appeal, the court found that the arbitrator exceeded their authority by awarding benefits over $800 per month for an accident preceding the *Kurcsics* decision and by compounding interest from the first day of the period. Consequently, the appellate court reversed the order, vacated the arbitration award, and remitted the matter for recomputation, while affirming the arbitrator's decision not to offset Social Security and unemployment benefits.

Arbitration Award ReviewNo-Fault InsuranceLost Wages BenefitsExceeding Arbitrator AuthorityStatutory Benefit LimitsInterest CalculationSocial Security OffsetUnemployment Insurance OffsetRetroactivity of Legal DecisionsAppellate Reversal
References
6
Case No. 03-11-00179-CV
Regular Panel Decision
Aug 29, 2013

the Attorney General of Texas and the Commissioner of Insurance v. Farmers Insurance Exchange, Fire Insurance Exchange, Mid-Century Insurance Company of Texas, Texas Farmers Insurance Company, and Farmers Texas County Mutual Insurance Company

This case involves an appeal concerning public-information requests made to the Texas Department of Insurance (TDI) for rate-filing information submitted by a group of appellee insurers. The central issue was whether this information, declared "open to public inspection" by the Insurance Code, was subject to exceptions under the Public Information Act (PIA). The district court initially ruled that the PIA's exceptions applied. However, the Court of Appeals reversed this decision, holding that the clear and unambiguous language of former section 2251.107 of the Insurance Code mandated public inspection without regard to the PIA's exceptions. The court emphasized plain-meaning statutory construction and dismissed arguments based on legislative history and constitutional challenges.

Statutory InterpretationPublic Information ActInsurance CodeOpen RecordsTrade SecretsRate FilingsTexas Department of InsuranceAppellate ReviewGovernment TransparencyTakings Clause
References
50
Case No. E2001-00154-WC-R3-CV
Regular Panel Decision
Dec 07, 2001

Johnny Jenkins v. Kemper Insurance Co.

The plaintiff, Johnny Jenkins, suffered a right knee injury on October 24, 1998, while working for Solutions to Environmental Problems, leading to multiple reconstructive surgeries and physical therapy. The trial court found an 80 percent permanent partial disability to his right leg. The defendant, Kemper Insurance Company, appealed, arguing that the trial court erred in considering the impairment rating and the plaintiff's vocational factors. The Special Workers' Compensation Appeals Panel of the Supreme Court affirmed the trial court's judgment, finding no error in its assessment of the disability or its consideration of the plaintiff's background.

Workers' Compensation AppealKnee InjuryPermanent Partial DisabilityMedical Impairment RatingVocational DisabilityOrthopedic SurgeryAppeals Panel DecisionTennessee LawTrial Court AffirmationScheduled Member Injury
References
4
Case No. 04-25-00040-CV
Regular Panel Decision
Nov 26, 2025

Enrique Cantu and Bridgefield Casualty Insurance Company v. Javier A. Libson, Nosbil, Inc., Jose Luis Ramirez, Utica National Insurance Group, Utica National Insurance Company of Texas, Utica Mutual Insurance Company, and Republic Franklin Insurance Company

Appellants Enrique Cantu and Bridgefield Casualty Insurance Company appealed a no-evidence summary judgment. Cantu's claims of negligence per se, negligent hiring, training, retention, and negligent entrustment were affirmed. However, the summary judgment for Cantu's ordinary negligence claims was reversed and remanded. Additionally, the judgment favoring the insurance defendants (Utica National Insurance Group, Utica National Insurance Company of Texas, Utica Mutual Insurance Company, and Republic Franklin Insurance Company) was also reversed, as their motion for summary judgment was not properly heard. The case involved a collision between Cantu and Jose Luis Ramirez, an employee of Nosbil, Inc., in foggy conditions, leading to Cantu suing for negligence and insurance claims.

NegligenceAutomobile AccidentSummary JudgmentAppellate ReviewProximate CauseDuty of CareBreach of DutyCausationInsurance ClaimsVicarious Liability
References
36
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. 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. 14-02-00860-CV
Regular Panel Decision
Feb 23, 2006

Lennar Corporation, Lennar Homes of Texas Land and Construction, Limited, and Lennar Homes of Texas Sales and Marketing, Limited, D/B/A Village Builders v. Great American Insurance Company, American Dynasty Surplus Lines Insurance Company, Markel American Insurance Company Gerling America Insurance Company, RLI Insurance Company, Insurance Company of the State of Pennsylvania and Westchester Fire Ins Company

This case concerns an insurance coverage dispute between homebuilder Lennar Corporation and its CGL insurance carriers over damages caused by defective stucco (EIFS) applied to homes. The court analyzed whether negligently defective construction constitutes an "occurrence" and distinguished between covered costs (repairing actual water damage) and non-covered costs (preventative EIFS replacement, overhead). While affirming summary judgment for several insurers due to unmet self-insured retentions based on individual homes as separate occurrences, the court reversed for American Dynasty and Markel, citing unresolved factual issues regarding "known loss" and policy conditions. Lennar's extra-contractual claims against American Dynasty were ultimately denied for lack of proven damages or statutory violations.

Insurance Policy InterpretationConstruction DefectsCommercial Liability InsuranceProperty Damage ClaimsStucco DefectsDuty to IndemnifySelf-Insured RetentionsKnown Loss PrincipleSubcontractor LiabilityTexas Law
References
96
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
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