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

Case No. A-16-CA-060-SS
Regular Panel Decision
Mar 20, 2019

Air Evac EMS, Inc. v. Sullivan

This case addresses whether the Airline Deregulation Act (ADA) preempts provisions of the Texas Workers' Compensation Act (TWCA) that regulate the reimbursement rates for air ambulance services. Plaintiff Air Evac EMS, Inc. argued that the TWCA's restrictions on its charges for services to workers' compensation patients are preempted by the ADA. The State Defendants (Texas Commissioner of Insurance and Texas Commissioner of Workers' Compensation) and Intervenor Defendants (multiple workers' compensation insurers) contended against preemption, citing a presumption against federal interference with state police powers and the McCarran-Ferguson Act. The court found that the ADA's preemption provision, which broadly prohibits state laws related to an air carrier's prices, routes, or services, applies to the TWCA's compensation scheme for air ambulance providers. Furthermore, the court determined that the McCarran-Ferguson Act does not shield the TWCA provisions because they regulate the 'business of insurance companies' rather than the 'business of insurance.' As a result, the court granted Air Evac's motion for summary judgment, denied the defendants' motions, and issued a permanent injunction prohibiting the State Defendants from enforcing the challenged TWCA provisions against Air Evac.

Airline Deregulation ActTexas Workers' Compensation ActFederal PreemptionAir Ambulance ServicesPrice RegulationMcCarran-Ferguson ActSummary JudgmentDeclaratory JudgmentPermanent InjunctionWorkers' Compensation Insurance
References
49
Case No. MISSING
Regular Panel Decision

Matter of Monarch Consulting, Inc v. National Union Fire Insurance Company of Pittsburgh, PA

This case addresses whether disputes concerning workers' compensation insurance Payment Agreements should be submitted to arbitration. The central question is if the McCarran-Ferguson Act prevents the application of the Federal Arbitration Act (FAA) in connection with California Insurance Code § 11658, which mandates the filing of insurance documents. The Court determined that the McCarran-Ferguson Act is not activated because the FAA's application would not 'invalidate, impair, or supersede' California Insurance Code § 11658, given that California law at the time did not regulate arbitration clauses in insurance contracts. Consequently, the FAA governs the Payment Agreements. Furthermore, under FAA principles of severability, the enforceability of the Payment Agreements and their arbitration clauses, including questions of arbitrability, must be resolved through arbitration.

ArbitrationFederal Arbitration Act (FAA)McCarran-Ferguson ActInsurance LawWorkers' Compensation InsuranceCalifornia Insurance Code § 11658Reverse PreemptionContract LawArbitrabilityDelegation Clauses
References
43
Case No. CIV.A.H-98-1484
Regular Panel Decision
Aug 28, 2000

Sandwich Chef of Texas v. Reliance Nat. Indemnity Ins. Co.

Sandwich Chef of Texas, Inc. (d/b/a Wall Street Deli), as plaintiff, filed a class action against numerous insurance carriers, including Reliance National Indemnity Insurance Company, alleging that they defrauded employers by charging excessive workers' compensation premiums between May 1988 and January 1990. The plaintiff claims that the defendants utilized the National Council on Compensation Insurance, Inc. (NCCI) as a racketeering enterprise to commit mail and wire fraud. This was allegedly done by improperly factoring 'residual market charges' (RMLs) into premiums, which were purportedly unfiled and unapproved. The defendants moved for a Supplemental Motion for Summary Judgment, arguing that the plaintiff's claims failed to allege indictable acts of racketeering, lacked a basis for proving injury 'by reason of' alleged misrepresentations due to a 'presumption of knowledge' of filed rates, and were precluded by the McCarran-Ferguson Act. The United States District Court, S.D. Texas, Houston Division, denied the defendants' motion for summary judgment, finding that overbilling can constitute RICO mail fraud, that claims to enforce filed rates are not barred by the 'presumption of knowledge,' and that the McCarran-Ferguson Act did not preclude RICO's application as it complemented state regulations. The court also allowed the plaintiff's 'fraud-on-the-regulator' theory and conspiracy claims to proceed.

RICO ActWorkers' Compensation InsuranceMail FraudWire FraudClass ActionSummary JudgmentFiled Rate DoctrineInsurance FraudRetrospectively Rated InsuranceResidual Market Charges
References
15
Case No. Claim #4179
Regular Panel Decision
Jul 20, 2006

In Re Agway, Inc.

Reliance Insurance Company (in liquidation) filed a motion on March 23, 2006, requesting that the U.S. Bankruptcy Court for the Northern District of New York declare it lacked jurisdiction over Reliance's claim against Agway, Inc. (the Debtors) or, alternatively, abstain from hearing the Liquidating Trustee's motion to expunge Reliance's claim #4179. Reliance argued that the McCarran-Ferguson Act reverse-preempted federal jurisdiction and that the Pennsylvania Commonwealth Court had primary jurisdiction under the 'first assuming jurisdiction' doctrine, or that Burford abstention was appropriate. The Liquidating Trustee opposed the motion, challenging Reliance's interpretation of the McCarran-Ferguson Act and the applicability of the abstention doctrines. The court denied Reliance's motion, affirming its core jurisdiction over the claim and finding Reliance's arguments for reverse-preemption, abstention, and first assuming jurisdiction to be without merit.

Bankruptcy LawJurisdictionMcCarran-Ferguson ActAbstention DoctrineInsurance LiquidationClaim ExpungementFederal PreemptionState LawCore ProceedingsStatutory Interpretation
References
20
Case No. MISSING
Regular Panel Decision

Combs v. STP Nuclear Operating Co.

This case concerns an appeal by the Comptroller of Public Accounts and the Attorney General of Texas from a trial court's grant of summary judgment in favor of STP Nuclear Operating Company (STP). The core dispute revolves around the State's ability to collect independently procured insurance tax from STP, an operator of a nuclear power plant required to carry insurance from a Bermuda-incorporated, non-Texas-licensed insurer (NEIL). STP had paid these taxes under protest, asserting they violated Due Process, Equal Protection, and the McCarran-Ferguson Act. The appellate court reversed the trial court's judgment, ruling that the independently procured insurance tax, as applied to STP, does not violate Due Process or the McCarran-Ferguson Act due to STP's significant in-state activities related to procuring the insurance. The court also rejected STP's arguments regarding equal protection and the vagueness of the statutory scheme, thereby rendering judgment in favor of the Comptroller.

Independently Procured Insurance TaxMcCarran-Ferguson ActDue ProcessEqual ProtectionSummary JudgmentState TaxationInsurance RegulationNuclear Power PlantForeign CorporationsTexas Insurance Code
References
44
Case No. MISSING
Regular Panel Decision

Wesby v. Act Pipe & Supply, Inc.

Glenn Wesby was injured while working on Act Pipe & Supply, Inc.'s premises, employed by Labor Express Temporary Services. He sued Act Pipe for negligence. Act Pipe sought summary judgment, arguing that Wesby's claims were barred by Texas Workers’ Compensation statutes under either the Staff Leasing Services Act or the borrowed servant doctrine. The trial court granted summary judgment without specifying the grounds. On appeal, the court affirmed the summary judgment, finding that Wesby was Act Pipe’s borrowed servant and Act Pipe's workers’ compensation insurance applied, thus barring his common law claims, irrespective of whether notice of coverage was provided.

Personal InjurySummary JudgmentBorrowed Servant DoctrineStaff Leasing Services ActWorkers' Comp ExclusivityTemporary EmploymentNegligence ClaimsAppellate AffirmationEmployer Affirmative DefenseTexas Labor Law
References
28
Case No. 13-02-230-CV
Regular Panel Decision
Nov 27, 2002

Nueces County and Larry Olivarez, Sheriff v. Gayle C. Ferguson

Gayle Ferguson, an employee of the Nueces County Sheriff's Department, filed a grievance after being denied a training officer position in 1996, which was awarded to Stanley Repka despite the Civil Service Commission ruling in Ferguson's favor. Subsequently, Ferguson was terminated in 2001 and appealed this decision, resulting in a reduction to a ninety-day suspension by the Commission. Ferguson then amended his lawsuit against Nueces County and Sheriff Larry Olivarez, seeking various forms of relief including placement in the training officer position, reinstatement, back pay, and damages for intentional infliction of emotional distress and negligent violation of employment policies. The appellants, Nueces County and Sheriff Larry Olivarez, filed a plea to the jurisdiction, arguing sovereign immunity and Ferguson's failure to comply with statutory appeal requirements. The trial court denied this plea, leading to the current interlocutory appeal where the appellate court reversed and rendered the trial court's order, dismissing Ferguson's claims for lack of subject matter jurisdiction due to sovereign immunity.

Sovereign ImmunityPlea to the JurisdictionInterlocutory AppealEmployment LawCivil Service CommissionPublic Official ImmunityDamagesIntentional Infliction of Emotional DistressNegligent Employment PoliciesGovernmental Immunity
References
65
Case No. 01-02-00807-CV
Regular Panel Decision
Mar 16, 2006

Texas Mutual Insurance Co. F/K/A/ Texas Workers' Compansation Ins. Fund v. Ray Ferguson Interest, Inc., RFI Brazos Paving Co., Inc.

Texas Mutual Insurance Company (the Fund) appealed a judgment from a jury verdict in favor of Ray Ferguson Interests, Inc. (RFI), awarding RFI over $2.2 million in actual damages, $3.5 million in statutory damages for Insurance Code violations, and attorney's fees. The dispute arose from the Fund's investigation into RFI's workers' compensation premiums, alleging premium fraud related to RFI's subcontractor, Brazos. RFI counter-sued, alleging breach of contract and violations of the Insurance Code for the Fund's actions. The appellate court found errors in the trial court's denial of pre-judgment interest to the Fund and in the jury's damage awards for 'lost time' due to litigation and for 'loss of value' or 'credit reputation' resulting from statements protected by judicial immunity or lacking direct causation to the Fund's alleged contract breaches or deceptive acts. Consequently, the court reversed RFI's recovery, affirmed parts of the judgment, and remanded the case with instructions, including entering a take-nothing judgment on RFI's claims.

Workers' CompensationInsurance FraudBreach of ContractUnfair Insurance PracticesTexas Insurance CodeJudicial ImmunityDamagesAttorney's FeesPre-judgment InterestCausation
References
26
Case No. 07-14-00405-CV
Regular Panel Decision
Aug 20, 2014

City of Plainview Texas, William Mull, in His Official Capacity as Chief of Police of the City of Plainview Police Department, and Ken Coughlin, Capacity as Chief of Police of the City of Plainview Police Department v. Korey Ferguson

Korey Ferguson, a police officer for the City of Plainview, Texas, was terminated after an alleged incident of excessive force involving citizen Amber Washington. Ferguson contended that the City violated Texas Government Code Sections 614.023(a) and (b) by failing to provide him with a copy of Washington's signed complaint before taking disciplinary action. The Trial Court ruled in favor of Ferguson, ordering his reinstatement with back pay, based on the belief that noncompliance with the statute mandated this remedy. The City of Plainview is appealing this decision, arguing that reinstatement is not a mandatory remedy for the statutory violation, that the evidence at trial was insufficient to support Ferguson's reinstatement given his unfitness as an officer, and that the order to reinstate him is against public policy.

Police MisconductExcessive ForceReinstatementDue ProcessStatutory ComplianceTexas Government CodeCivil ServiceAdministrative LawPublic PolicyAppellate Review
References
33
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
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