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

Case No. 04-24-00386-CV
Regular Panel Decision
Feb 26, 2025

In Re Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance v. the State of Texas

Edward Santos filed a lawsuit against Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance, alleging liability for his injuries being compensated through workers' compensation benefits, thereby limiting liability under other coverages. Texas Mutual and Bond challenged the trial court's denial of their pleas to the jurisdiction, arguing that the Texas Department of Insurance, Division of Workers' Compensation (the Division) had exclusive jurisdiction over Santos's claims. The Fourth Court of Appeals found that Santos's claims against Texas Mutual and Bond, predicated on the improper investigation, handling, or settlement of his workers' compensation claim, fell within the Division's exclusive jurisdiction, and he failed to exhaust administrative remedies. Consequently, the Court conditionally granted the petition for a writ of mandamus for Texas Mutual and Bond, directing the trial court to dismiss claims against them. However, the Court denied Allstate's petition, as Santos's claims against Allstate involved a liability claim against a non-workers' compensation carrier, which did not abrogate the Division's exclusive jurisdiction by re-litigating the course and scope of employment question.

MandamusWorkers' CompensationExclusive JurisdictionAdministrative RemediesPlea to the JurisdictionInsurance CodeDeceptive Trade Practices ActFraudConspiracyEmployer Liability
References
25
Case No. MISSING
Regular Panel Decision

Graphic Arts Mutual Insurance v. Bakers Mutual Insurance

This case concerns a dispute between Graphic Arts Mutual, an automobile liability insurer, and Bakers Mutual, a workers' compensation carrier, over which policy covers an employer's derivative liability in a third-party personal injury action. An employee of Chimes Cake Co. was injured by a co-employee's negligence, leading to a third-party claim against the employer under the Dole-Dow doctrine. Graphic disclaimed responsibility, citing policy exclusions for employee bodily injury and workers' compensation obligations. The court affirmed that Graphic's automobile policy covered the employer's vicarious liability to a third-party tort-feasor, as this obligation did not fall within the stated exclusions. The decision emphasizes a functional analysis of separate insurance lines, concluding that automobile liability should cover obligations arising from vehicle operation.

Insurance disputeAutomobile liabilityWorkers' compensationThird-party actionDeclaratory judgmentEmployer's liabilityVicarious liabilityDole-Dow doctrinePolicy exclusionsCo-employee negligence
References
4
Case No. 03-03-00704-CV
Regular Panel Decision
Jan 21, 2005

Texas Mutual Insurance Company// Eckerd Corporation H.E. Butt Grocery Company Third-Party Solutions, Inc. Wal-Mart Stores, Inc. Apollo Enterprises, Inc. And Walgreen Company v. Eckerd Corporation H.E. Butt Grocery Company Third-Party Solutions, Inc. Wal-Mart Stores, Inc. Apollo Enterprises, Inc. And Walgreen Company//Cross-Appellee,Texas Mutual Insurance Company

This case involves cross-appeals concerning whether an insurance company must first exhaust administrative remedies under the Texas Workers' Compensation Act before filing a lawsuit for alleged overcharges by health care providers. Appellant Texas Mutual Insurance Company sued several pharmacies and billing companies for negligent misrepresentation and money had and received, claiming they over-billed for prescription drugs. The district court denied the defendants' motion to dismiss for lack of subject matter jurisdiction but granted partial summary judgment against Texas Mutual. The Court of Appeals, relying on prior precedent, determined that the Texas Workers' Compensation Commission holds exclusive jurisdiction over medical fee disputes within the Act's pervasive regulatory scheme. Consequently, the appellate court reversed the district court's judgment, concluding that the trial court lacked jurisdiction as Texas Mutual had not exhausted its administrative remedies.

Workers' Compensation ActAdministrative RemediesExclusive JurisdictionMedical Fee DisputesPharmaceutical Fee GuidelineOverbillingNegligent MisrepresentationMoney Had and ReceivedStatutory InterpretationAppellate Review
References
10
Case No. No. 11-12-00339-CV
Regular Panel Decision
Nov 26, 2014

Alfred Elwess v. Farm Bureau County Mutual Insurance Company of Texas and Texas Farm Bureau Mutual Insurance Company

Alfred Elwess, injured in an auto accident, sought to recover under his underinsured motorist (UIM) coverage from Farm Bureau County Mutual Insurance Company of Texas and Texas Farm Bureau Mutual Insurance Company (Appellees). The Appellees filed a motion for summary judgment, arguing Elwess failed to obtain permission to settle with the tortfeasor and that his damages were covered by workers' compensation. The trial court granted summary judgment for the Appellees. The Eleventh Court of Appeals reversed, finding insufficient evidence that Elwess's failure to obtain permission materially prejudiced the Appellees' subrogation rights and that his damages were payable under workers' compensation, especially since his employer did not have such coverage. The court remanded the case for further proceedings.

Summary JudgmentUnderinsured Motorist (UIM)Insurance Coverage DisputeSettlement Without Consent ExclusionSubrogation RightsWorkers' Compensation ExclusionMaterial BreachActual PrejudiceAppellate ReviewDe Novo Review
References
7
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. MISSING
Regular Panel Decision

Rose v. Northwestern Mutual Life Insurance Co.

Joseph Rose (plaintiff) filed a class action against Northwestern Mutual Life Insurance Company and Northwestern Mutual Investment Securities LLC (defendants), alleging minimum wage and overtime violations under New York Labor Law. Defendants moved for summary judgment, arguing Rose was an independent contractor and thus exempt from state labor laws, and that there was no relationship with NMIS. The court found that Rose was an independent contractor, not an employee, based on factors such as his contract designation, lack of fixed work schedule or supervision by Northwestern Mutual, and absence of fringe benefits or hourly wages. The court also determined there was no relationship between Rose and NMIS. Consequently, the defendants' motion for summary judgment was granted, and all of plaintiff's claims were dismissed.

Independent Contractor StatusEmployment LawSummary JudgmentNew York Labor LawMinimum WageOvertime ViolationsInsurance AgentsClass ActionControl TestFringe Benefits
References
35
Case No. MISSING
Regular Panel Decision

Long v. Liberty Mutual Insurance

A claimant, a member of the Buffalo Destroyers football team, was injured and filed a workers' compensation claim with Liberty Mutual Insurance Company. Liberty Mutual denied coverage, arguing the claimant was not an employee of its insured, Source One Group, and that the policy could not cover a New York entity. The Workers' Compensation Board initially found the claimant a dual employee, then a special employee of the Destroyers and a general employee of Source One, entitling him to coverage. The court determined that while the claimant was not a de facto employee of Source One, Liberty Mutual was estopped from denying coverage due to its conduct, including issuing a certificate of insurance and accepting premiums. Therefore, the court affirmed the Board's decision, holding Liberty Mutual responsible for the claimant's workers' compensation benefits.

Insurance Coverage DisputeEmployer LiabilityProfessional Employee OrganizationSpecial Employment DoctrineEstoppel in InsuranceAssigned-Risk Insurance PolicySports Athlete InjuryAppellate DecisionPayroll Audit DisputeCertificate of Insurance Validity
References
11
Case No. Court File No. 2
Regular Panel Decision

Swafford v. Forestry Mutual Insurance

Plaintiff Danny Swafford, operating Swafford Farms, held a workers' compensation and employer's liability insurance policy with Defendant Forestry Mutual Insurance Company. An underlying complaint was filed against Swafford by Albert Wayne Capshaw, an alleged independent contractor, for injuries sustained. Swafford then filed a declaratory judgment action seeking a ruling that Forestry Mutual had a duty to defend him in the Capshaw complaint. Forestry Mutual moved for summary judgment, arguing its policy only covered employees, not independent contractors, and thus it had no duty to defend. The Court, applying Tennessee law, found no ambiguity in the policy's terms or the allegations of the Capshaw complaint regarding Capshaw's status. Consequently, the Court granted Forestry Mutual's motion for summary judgment, concluding that no duty to defend existed.

Workers' Compensation PolicyDuty to DefendSummary JudgmentIndependent ContractorEmployer LiabilityDeclaratory JudgmentInsurance Coverage DisputeContract InterpretationTennessee LawSixth Circuit
References
20
Case No. MISSING
Regular Panel Decision

Texas Mutual Insurance Co. v. Ledbetter

This case is a wrongful-death action on appeal concerning a work-related electrocution. The trial court approved a settlement agreement and struck Texas Mutual Insurance Company's petition in intervention, which sought reimbursement for workers' compensation benefits paid to Charles Wade Ledbetter's estate. Texas Mutual appealed, arguing the trial court abused its discretion by striking its petition, denying its statutory subrogation right, and ordering it to continue benefit payments. The appellate court reversed the trial court's judgment, finding that Texas Mutual's petition in intervention was improperly struck and that the allocation of settlement proceeds solely to conscious pain and suffering was erroneous, thus circumventing Texas Mutual's subrogation rights. The case is remanded for further proceedings.

Wrongful DeathWorkers' CompensationSubrogation RightsInterventionSettlement AgreementConscious Pain and SufferingEstate LawAppellate ReviewRemandTrial Court Discretion
References
21
Case No. 13-06-060-CV; 13-06-118-CV
Regular Panel Decision
Aug 17, 2006

in Re: Texas Mutual Insurance Company and Diane Thiele

This case involves an original proceeding and an interlocutory appeal concerning Texas Mutual Insurance Company's efforts to pay workers' compensation benefits to Denise Guzman and Tito Marines, survivors of David Marines. Guzman and Marines filed suit seeking injunctive relief to prevent these payments, arguing they were independent contractors and not employees, thereby wishing to avoid an election of remedies under the Texas Labor Code. The trial court denied Texas Mutual's plea to the jurisdiction and issued an injunction halting benefit payments, finding the plaintiffs likely to prevail on their independent contractor claim. Subsequently, Guzman and Marines requested and were granted a non-suit. As a result, the appellate court dismissed the appeal and all related motions.

Workers' Compensation BenefitsInterlocutory AppealWrit of MandamusPlea to the JurisdictionIndependent Contractor StatusElection of RemediesNon-suitInjunctive ReliefAppellate ProcedureTexas Labor Law
References
2
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