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

Case No. 03-07-00429-CV
Regular Panel Decision
Dec 12, 2008

Texas Health Insurance Risk Pool v. Southwest Service Life Insurance Company and Regal Life of America Insurance Company

Southwest Service Life Insurance Company and Regal Life of America Insurance Company (Appellees) brought a declaratory-judgment action against the Texas Health Insurance Risk Pool (Appellant) to challenge assessments levied against them, arguing their policies qualified as 'other limited benefit coverage' under the Texas Insurance Code. The trial court granted summary judgment in favor of the Appellees and awarded attorney's fees. The Pool appealed, contending the summary judgment was erroneous and the attorney's fee award should be reversed. The appellate court affirmed the trial court's judgment, holding that the policies issued by Southwest and Regal were indeed covered by the 'limited benefit coverage' exception, and thus the summary judgment and attorney's fee award were proper.

Insurance LawHealth InsuranceStatutory ConstructionDeclaratory JudgmentSummary JudgmentAttorney's FeesTexas Insurance CodeLimited Benefit CoverageHIPAAAdministrative Law
References
15
Case No. 03-00-00427-CV
Regular Panel Decision
Aug 30, 2001

All American Life Insurance Company American General Life Insurance Company American National Insurance Company American National Life Insurance Company of Texas IDS Life Insurance Company And USLIFE Life Insurance Company v. Carole Keeton Rylander, Comptroller of Public Accounts of Texas And John Cornyn, Attorney General of Texas

Several insurance companies appealed a district court judgment affirming the Comptroller's assessment of premium and maintenance taxes on 'internal rollover' transactions, where policyholders transfer accumulation values within the same company for new policies. The Texas Court of Appeals, Third District, At Austin, reviewed the construction of Texas Insurance Code articles 4.11 and 4.17 de novo. The court determined that 'internal rollovers' do not involve funds being 'received' or 'collected' by the insurance companies, as the funds remain within the company. Therefore, these transactions are not subject to the premium and maintenance taxes. The judgment of the district court was reversed in part, and the case was remanded for a determination of the refund amounts owed to the companies.

Insurance LawTax LawPremium TaxInternal RolloversStatutory ConstructionTexas Court of AppealsInsurance CompaniesComptrollerGross PremiumsTax Refund
References
9
Case No. 14-07-00880-CV
Regular Panel Decision
Apr 21, 2009

Symetra National Life Insurance Company and Symetra Life Insurance Company v. Rapid Settlements, LTD

Symetra National Life Insurance Co. and Symetra Life Insurance Co. appealed a trial court's confirmation of an arbitration award that directed them to make structured settlement payments to Rapid Settlements, Ltd., instead of the original payee, Paul Patterson. Symetra argued that the transfer lacked the required court approval under the Texas Structured Settlement Protection Act (SSPA) and violated public policy, while Rapid Settlements asserted it was not a 'transfer' under SSPA, federal law preempted SSPA, and Symetra lacked standing. The court rejected Rapid's arguments, emphasizing that the SSPA mandates court preapproval for structured settlement payment transfers to protect payees and their dependents. Consequently, the court held that the arbitration award violated Texas public policy by effectuating an unapproved transfer. The trial court's judgment was reversed, and the arbitration award was vacated.

Structured Settlement Protection Act (SSPA)Arbitration AwardPublic PolicyFederal Arbitration Act (FAA)PreemptionStandingGarnishmentTransfer of PaymentsAnnuity IssuerTexas Law
References
20
Case No. MISSING
Regular Panel Decision
Dec 11, 2008

Texas Health Insurance Risk Pool v. Southwest Service Life Insurance Co.

Southwest Service Life Insurance Company and Regal Life of America Insurance Company initiated a declaratory-judgment action against the Texas Health Insurance Risk Pool, challenging their liability for certain assessments. The central legal question involved the interpretation of "other limited benefit coverage" under Texas Insurance Code Ann. § 1506.002(b)(7) to determine if the plaintiffs' policies were exempt from these assessments. The trial court granted summary judgment for the insurance companies and awarded attorney's fees. On appeal, the court affirmed, concluding that the policies did fall under the statutory exception, rejecting the Pool's arguments for a narrower interpretation and finding the attorney's fee award appropriate.

Declaratory JudgmentStatutory ConstructionInsurance LawHealth InsuranceRisk PoolLimited Benefit CoverageSummary JudgmentAttorney's FeesAppellate ReviewHIPAA
References
36
Case No. MISSING
Regular Panel Decision

Metropolitan Life Insurance v. Durkin

The plaintiff, Metropolitan Life Insurance Company, initiated an action seeking a declaration that sections 213 and 213-a of the New York State Insurance Law prohibited the retroactive payment of a wage increase. This increase of $2.85 per week was awarded by the National War Labor Board to its insurance agents, dating back to the start of arbitration proceedings. The plaintiff argued these statutes, designed to prevent excessive post-facto compensation, made such retroactive payments unlawful. However, the trial court and Appellate Division, whose decision was affirmed, concluded that the statutes were not intended to interfere with the common practice of collective bargaining and arbitration, which frequently involves retroactive wage adjustments. The court emphasized that the legislative intent behind the insurance laws was to curb abuses like bonuses and gratuities, not to hinder ordinary and orderly wage-fixing mechanisms, thereby affirming the legality of the retroactive wage increase.

Insurance RegulationRetroactive CompensationCollective Bargaining DisputesWage Arbitration AwardNew York Insurance LawLabor Relations BoardStatutory InterpretationAppellate Court RulingEmployee Benefits LitigationContractual Agreements
References
5
Case No. MISSING
Regular Panel Decision
Mar 28, 2000

Oil Heat Institute of Long Island Insurance Trust v. Gerber Life Insurance

Plaintiff Oil Heat Institute of Long Island Insurance Trust (OHI) sued Gerber Life Insurance Company (Gerber), Island Group Administration, Inc. (IGA), and RMTS Associates, alleging Gerber refused to reimburse stop-loss claims and issue a letter of certification to a lender. OHI had established a self-insurance program, and Gerber issued an aggregate stop-loss (ASL) policy. OHI commenced the action on the day the ASL policy expired, before the attachment point for reimbursement could be calculated and before submitting proper documentation. The Supreme Court denied Gerber's motion for summary judgment. The Appellate Division reversed, finding that OHI failed to demonstrate compliance with the ASL policy's reimbursement terms, lacked material facts to support its claims, and initiated the action prematurely. Both causes of action were dismissed against Gerber.

Insurance LawSummary JudgmentAggregate Stop-Loss PolicyContract DisputeReimbursementPolicy TermsAppellate ReviewGood FaithDocumentation RequirementsAgency
References
3
Case No. 13 Civ. 1580; 12 Civ. 6811
Regular Panel Decision
Jun 17, 2015

U.S. Bank National Ass'n v. PHL Variable Life Insurance

This decision and order by District Judge McMahon addresses numerous motions in limine filed by both U.S. Bank National Association (applicant) and PHL Variable Life Insurance Company (Phoenix, defendant). The court evaluates the admissibility of expert testimony, evidence relating to actuarial justifications for cost of insurance (COI) rate increases, and Phoenix's financial condition. Key rulings concern claims of breach of the covenant of good faith and fair dealing, the relevance of life settlement investments, and the application of hearsay and prejudice rules. The decision provides detailed findings on specific exhibits and types of testimony, balancing probative value against potential unfair prejudice.

Insurance LawContract LawCovenant of Good Faith and Fair DealingCost of Insurance RatesActuarial AnalysisExpert Witness AdmissibilityMotions in LimineHearsay EvidenceRule 403 Balancing TestLife Settlement Industry
References
48
Case No. MISSING
Regular Panel Decision

Davis v. Tennessee Life Insurance Co.

Nancy Kway Davis, administratrix of Charles M. Davis's estate, appealed a take-nothing judgment in her suit against Tennessee Life Insurance Company. She sought to recover life insurance proceeds, contending there was no valid beneficiary designation. Charles Davis, an employee of Reading and Bates, was insured under group policies provided by Tennessee Life. Davis had designated his mother, Bessie Carr, as beneficiary in 1966. Although policy 637 was superseded by policy 1264, the jury found that Reading and Bates, authorized by Tennessee Life, issued a certificate for policy 1264 to Charles Davis, naming Bessie Carr as beneficiary. The court found no error in denying Nancy Kway Davis any interest in the proceeds, affirming the judgment that Bessie Carr was the valid beneficiary.

Life InsuranceBeneficiary DesignationGroup Insurance PolicyInsurance ProceedsAdministratrix ClaimCommunity PropertyChose in ActionAppellate ReviewInsurance CertificateEmployer-Provided Insurance
References
5
Case No. 03-99-00719-CV
Regular Panel Decision
Jul 13, 2000

Southwestern Life Insurance Company v. Jose Montemayor, Commissioner of Insurance Carole Keeton Rylander, Comptroller of Public Accounts of the State of Texas John Cornyn, Attorney General of the State of Texas

Southwestern Life Insurance Company appealed a district court's summary judgment in favor of the State regarding insurance premium taxes. Southwestern sought to apply a 1989 tax credit, exceeding its premium tax liability for that year, against its 1990 premium tax liability, arguing the credit could be carried forward. The State contended the credit was only valid for the year the fees were paid. The Court of Appeals, focusing on statutory construction of Article 4.11 of the Texas Insurance Code, found no explicit carry-forward provision. The court affirmed the trial court's decision, ruling that the credit for examination and valuation fees may only be offset against premium tax liability for the year in which the fees are paid, and unused credit cannot be carried forward or backward.

Tax CreditInsurance Premium TaxStatutory InterpretationCarry-Forward ProvisionAdministrative LawLegislative IntentTexas Insurance CodeSummary JudgmentExamination FeesValuation Fees
References
14
Case No. 01-15-00147-CV
Regular Panel Decision
Apr 06, 2015

Metropolitan Insurance and Annuity Company and Metropolitan Life Insurance Company v. Peachtree Settlement Funding, LLC

This case involves an appeal by Metropolitan Life Insurance Company and Metropolitan Insurance & Annuity Company (Appellants) against Peachtree Settlement Funding, LLC and Sara Swain (Appellees) regarding a trial court's approval of a structured settlement payment rights transfer. Sara Swain, the payee, sought to transfer partial monthly payments to Peachtree, leading to a "Servicing Arrangement" approved by the trial court. This arrangement allowed Peachtree to receive the full monthly payments, retain its assigned portion, and remit the remainder to Swain, without requiring MetLife to directly divide payments. MetLife challenged this, asserting the arrangement improperly modified contracts, contravened the Texas Transfer Statute, and imposed an involuntary business relationship. The Appellee's brief argues for the affirmation of the trial court's decision, emphasizing the legality of the servicing arrangement under Texas's principles of contract assignability and principal-agency law, and affirming the transfer as being in Swain's best interest.

Structured SettlementPayment Rights TransferServicing ArrangementContract AssignabilityPrincipal-Agency LawBest Interest DeterminationAppellate ReviewTexas Transfer StatuteLegal PrecedentAnnuity Issuer Obligations
References
68
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