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

Case No. 03-04-00050-CV
Regular Panel Decision
Jul 29, 2004

Al Boenker Insurance Agency, Inc. v. the Texas FAIR Plan Association The Texas Department of Insurance And Jose Montemayor, Commissioner of Insurance

Appellant Al Boenker Insurance Agency, Inc. appealed a summary judgment ruling in favor of the Texas FAIR Plan Association (FAIR Plan). Al Boenker had challenged a bulletin issued by FAIR Plan, which restricted fees insurance agencies could charge for homeowners insurance applications and allowed for termination of agencies violating the contract. Al Boenker argued that FAIR Plan violated the separation-of-powers doctrine and exceeded its statutory authority. The Court of Appeals affirmed the district court's judgment, concluding that FAIR Plan is not a state agency subject to the Texas Administrative Procedure Act's rulemaking provisions and acted within its authority derived from the FAIR Plan Act and its Plan of Operation by contractually limiting agent compensation and establishing conditions for agent termination.

Administrative LawInsurance LawContract LawSummary JudgmentDeclaratory JudgmentInjunctionAgency AuthoritySeparation of PowersStatutory ConstructionTexas Court of Appeals
References
16
Case No. 15-24-00114-CV
Regular Panel Decision
Oct 04, 2024

Cecile Erwin Young, in Her Official Capacity as the Executive Commissioner of the Texas Health and Human Services Commission; Molina Healthcare of Texas, Inc.; And Aetna Better Health of Texas, Inc. v. Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company

This case involves an appeal concerning a temporary injunction and the denial of a plea to the jurisdiction issued by the 353rd Judicial District of Travis County. The appellants, including Cecile Erwin Young (Executive Commissioner of HHSC), Molina Healthcare of Texas, Inc., and Aetna Better Health of Texas, Inc., are challenging the lower court's decision. The appellees (Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company) had sought to enjoin the Texas Health and Human Services Commission (HHSC) from proceeding with STAR & CHIP and STAR Kids managed care procurements. The core legal arguments revolve around whether HHSC's procurement processes violated Texas law, thereby rendering the intended contract awards unlawful ultra vires acts, and whether the appellees' claims are barred by sovereign immunity or failure to exhaust administrative remedies. The appellants contend that the district court abused its discretion by granting the injunction and denying the plea.

Appellate CourtTemporary InjunctionPlea to the JurisdictionSovereign ImmunityUltra Vires ClaimsProcurement DisputeManaged Care ContractsMedicaidCHIPTexas Health and Human Services Commission
References
95
Case No. 03-19-00185-CV
Regular Panel Decision
Mar 05, 2020

Texas Department of Insurance v. Texas Association of Health Plans

The Texas Department of Insurance appealed the denial of its plea to the jurisdiction against the Texas Association of Health Plans. The Association filed claims challenging Department rules under the Administrative Procedure Act (APA) and the constitutionality of Texas Insurance Code provisions under the Uniform Declaratory Judgments Act (UDJA). The Department argued sovereign immunity barred both claims. The appellate court affirmed the trial court's decision, ruling that the APA's waiver of immunity extends to associational plaintiffs and that the UDJA claim constituted a viable constitutional challenge not precluded by the redundant remedies doctrine.

Sovereign immunityAdministrative Procedure ActDeclaratory Judgments ActAssociational standingConstitutional challengePlea to the jurisdictionTexas Insurance CodeHealth plans regulationAppellate reviewStatutory interpretation
References
39
Case No. 16 NY3d 706
Regular Panel Decision
Dec 13, 2011

Federal Insurance v. International Business MacHines Corp.

Federal Insurance Company (Federal) sought a declaration that its excess insurance policy did not cover attorneys' fees paid by International Business Machines Corporation and the IBM Personal Pension Plan (collectively, IBM) in a class action lawsuit (*Cooper v IBM Personal Pension Plan*). The *Cooper* action alleged violations of ERISA pertaining to age discrimination. IBM sought reimbursement from Federal after exhausting an underlying Zurich policy. The core dispute revolved around whether the disputed language in Federal's "follow form" policy extended coverage to IBM's actions as a plan settlor, which are not considered fiduciary acts under ERISA. The Supreme Court initially denied Federal's motion, but the Appellate Division reversed, granting summary judgment to Federal. The New York Court of Appeals affirmed the Appellate Division's decision, holding that the policy's plain language limited coverage to acts of an insured undertaken in its capacity as an ERISA fiduciary, which IBM was not in this instance.

Insurance Policy InterpretationERISAFiduciary DutyExcess InsuranceSummary JudgmentPlan SettlorEmployee Benefit PlansContract LawPolicy CoverageAge Discrimination
References
18
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. 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

Cate v. CNA Insurance Companies

Jeffrey L. Cate sued CNA Insurance Companies for wrongful denial of long-term disability benefits under an ERISA plan. Cate, a computer analyst/manager, developed health issues and filed a disability claim after exhausting short-term benefits. CNA denied long-term benefits, contending physicians indicated Cate could perform his occupation in a different work setting, thus not meeting the "total disability" definition. Cate appealed, asserting his inability to perform his specific occupational duties due to his severe condition. The District Court denied both parties' summary judgment motions, finding a genuine issue of material fact regarding Cate's disability status due to the lack of evidence on his specific job duties and his ability to perform them, and thus remanded the case to the plan administrator for further development of the record.

ERISA BenefitsLong-term DisabilityDisability Claim DenialSummary JudgmentRemandMedical EvidenceOccupational DutiesMental Health DisabilityPlan Administrator ReviewDe Novo Review
References
15
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