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

Case No. 03-08-00766-CV
Regular Panel Decision
Feb 25, 2010

Service Lloyds Insurance Company v. American Alternative Insurance Corporation

This workers' compensation case involves an appeal by Service Lloyds Insurance Company against American Alternative Insurance Corporation (AAIC). The Texas Department of Insurance, Division of Workers' Compensation, ordered Service Lloyds to reimburse AAIC for benefits erroneously paid to an injured employee, Emmit Hines, for whom Service Lloyds was the liable carrier. Service Lloyds argued that a workers' compensation carrier cannot be a 'subclaimant' under Texas Labor Code section 409.009 and that the Division lacked jurisdiction over such a claim. The district court affirmed the Division's decision. The Court of Appeals affirmed the district court's judgment, concluding that a workers' compensation carrier can indeed be a subclaimant and the Division has jurisdiction to resolve such independently-raised subclaims.

Workers' CompensationInsurance LawSubrogationStatutory InterpretationTexas CourtsAppellate ReviewAdministrative LawReimbursementInsurance DisputeJurisdiction
References
20
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. 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

Houston General Insurance Co. v. Association Casualty Insurance Co.

This case involves an appeal stemming from a dispute between two workers' compensation insurance carriers, Houston General Insurance Company (Appellant) and Association Casualty Insurance Company (Appellee), regarding which carrier is obligated to pay compensation benefits to an injured employee, Johnnie Featherston, of Mallory Propane, Inc. Houston General initially paid the benefits and then sought judicial review after adverse administrative rulings. The core issue is whether Houston General waived its right to contest coverage by not disputing the claim within 60 days, as per Tex. Lab. Code Ann. § 409.021(c). Houston General argued that the issue was "coverage" rather than "compensability" and that waiver and estoppel do not create an insurance contract where none existed. The trial court granted summary judgment in favor of Association Casualty. The appellate court reversed the trial court's summary judgment, concluding that the issue was one of coverage, not compensability, and that waiver or estoppel could not extend coverage. However, the appellate court also denied Houston General's motion for summary judgment regarding equitable subrogation due to a need for a balancing of equities. The case was reversed and remanded for further proceedings.

Workers' CompensationInsurance CarriersCoverage DisputeWaiverEstoppelEquitable SubrogationSummary JudgmentTexas LawAppellate ReviewRemand
References
10
Case No. 05-95-01259-CV
Regular Panel Decision
Feb 26, 1997

Lemke Concrete Construction v. Employers Mutual Casualty Company, Union Mutual Insurance Company of Providence, Emcasco Insurance Company, Patterson, Lamberty, Stanford, Walls & Dwyer, P.C. and John R. Robinson

Lemke Concrete Construction appealed the trial court's summary judgment in favor of Employers Mutual Casualty Company, Union Mutual Insurance Company of Providence, and Emcasco Insurance Company (carriers). Lemke alleged breach of contract, negligence, breach of good faith, and violations of the Texas Deceptive Trade Practices-Consumer Protection Act and Texas Insurance Code, stemming from the carriers' handling of a workers' compensation claim and a subsequent retaliatory discharge suit filed by Lemke's employee, Jesus Gonzalez. The carriers had settled the workers' compensation claim but denied coverage for the wrongful discharge claim, leading Lemke to incur legal fees and a settlement. The trial court granted summary judgment for the carriers, concluding that the policies did not cover wrongful discharge claims and, thus, the carriers owed no duty to defend or settle such claims. The appellate court affirmed the trial court's judgment, upholding that without coverage, Lemke's claims of bad faith and negligence were meritless, and estoppel could not create coverage.

Workers' CompensationSummary JudgmentBreach of ContractGood Faith and Fair DealingInsurance CoverageNegligenceTexas Deceptive Trade Practices-Consumer Protection ActTexas Insurance CodeVicarious LiabilityRetaliatory Discharge
References
31
Case No. 13-00-645-CV
Regular Panel Decision
Nov 01, 2001

Maurice Robbins, as of the Estate of Charles M. Robbins v. Reliance Insurance Company and Schneider National Carriers, Inc.

This case involves an appeal from a summary judgment concerning accidental death benefits. Maurice Robbins, as executor of Charles M. Robbins' estate, sued Reliance Insurance Company and Schneider National Carriers, Inc., seeking $250,000 in benefits. The dispute arose from conflicting terms in a 'renewal certificate' and a 'renewal rider' regarding the benefit amount. The court also addressed a motion to stay based on a Pennsylvania court order, which was denied due to lack of jurisdiction and non-compliance with Texas law. The appellate court found an ambiguity in the insurance documents, construing it against the insurer, and reversed the trial court's summary judgment, rendering judgment in favor of the appellant for the higher benefit amount. The case is remanded for a determination of attorney's fees.

Accidental Death BenefitsInsurance PolicySummary JudgmentRenewal RiderRenewal CertificateContract InterpretationAmbiguityFull Faith and CreditPennsylvania LawTexas Insurance Code
References
25
Case No. MISSING
Regular Panel Decision

Security National Insurance Co. v. Farmer

Roger Farmer sustained two on-the-job low back injuries in January 1995 and April 1998. Security National Insurance Company was the carrier for the first injury, and Hartford Fire Insurance Company for the second. Disputes arose regarding the compensability of Farmer's L4-5 and L5-S1 disc herniations after April 1998, and which carrier was liable. The Texas Workers’ Compensation Commission appeals panel affirmed the hearing officer's decision against Security National, finding the January 1995 injury was a producing cause. Security National appealed to the trial court, which applied a substantial evidence rule, limited discovery, and affirmed the appeals panel's decision. On appeal, the higher court determined the trial court erred by applying the incorrect standard of review, ruling that a modified de novo standard should have been used. The court reversed the trial court's judgment and remanded the case for proceedings consistent with a modified de novo review.

Standard of ReviewModified De Novo ReviewSubstantial Evidence ReviewCompensability DisputeEligibility for BenefitsDisc Herniation InjurySpinal Injury ClaimInsurance Carrier DisputeAdministrative Law AppealStatutory Interpretation
References
27
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

Levin v. Intercontinental Casualty Insurance

This case addresses whether a pre-answer motion to dismiss filed by an 'unauthorized foreign or alien' insurance carrier constitutes a 'pleading' under Insurance Law § 1213 (c), thereby requiring the carrier to post a bond. The New York State Superintendent of Insurance, as liquidator of Ideal Mutual Insurance Company, sued Intercontinental Casualty Insurance Company, a Cayman Islands carrier, for reinsurance proceeds. Intercontinental moved to dismiss on Statute of Limitations and documentary evidence grounds without posting a bond. The Supreme Court ordered a bond, which Intercontinental failed to provide, leading to a judgment against it. The Court of Appeals affirmed the lower courts' decisions, ruling that such motions, which address the merits of the case, fall within the definition of a 'pleading' for the purpose of ensuring funds are available to satisfy any potential judgment.

Insurance Law § 1213 (c)Unauthorized InsurerBond RequirementPleading DefinitionMotion to DismissStatute of LimitationsDocumentary EvidenceReinsurance AgreementLiquidation ProceedingForeign Carrier
References
2
Case No. MISSING
Regular Panel Decision
Feb 28, 1991

North River Insurance v. United National Insurance

This appellate decision addresses the apportionment of liability between North River Insurance Co. and United National Insurance Company arising from a settlement for an injured employee. The court clarified that North River, as the workers' compensation carrier, is solely responsible for its waived lien, reversing a lower court's finding. It further determined that both insurers' "other insurance" clauses called for pro rata contribution, not equal shares, for the $588,245 settlement payment and defense costs. The court calculated specific shares for each insurer and ruled that North River is entitled to interest from the original payment date in 1982. The Supreme Court's order was thus modified to reflect these findings.

Insurance disputePro rata contributionEquitable apportionmentWorkers' compensation lienDefense costsOther insurance clausesSettlement apportionmentInterest calculationAppellate decisionInsurer liability
References
10
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