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

Case No. MISSING
Regular Panel Decision

Old Republic Insurance Co. v. Wuensche

This worker's compensation case examines whether Texas Rule of Civil Procedure 93's requirement for verified denials to be filed "not less than seven days before... trial" is absolute or can be modified by Rule 4's provisions for extending deadlines that fall on weekends or holidays. Jo Ann Wuensche, injured at Piccadilly Cafeteria, appealed an IAB award, seeking total disability benefits and asserting a specific daily wage rate. Old Republic, the opposing party, attempted to deny her wage rate claim six days before trial. The trial court disallowed the amendment, citing Rule 93. Old Republic argued for Rule 4's application due to intervening holidays. The appellate court affirmed the trial court, ruling that Rule 93's backward-calculated seven-day period is absolute and not subject to Rule 4's forward-calculated extensions, as applying Rule 4 would shorten, not lengthen, the required notice period.

Workers' CompensationRule 93Verified DenialsTimelinessRule 4Time ComputationTexas LawCivil ProcedureHolidaysTrial Deadlines
References
2
Case No. 08-03-00055-CV
Regular Panel Decision
Apr 29, 2004

Old Republic Insurance Co. v. Inez Rodriguez

Old Republic Insurance Company appealed a judgment in favor of Inez Rodriguez regarding supplemental income benefits (SIBs). Rodriguez sustained several on-the-job injuries and was awarded an impairment rating. The core issues were the timely filing of SIB applications under Section 408.143 of the Texas Labor Code and the sufficiency of evidence to prove Rodriguez's total inability to work. The court found that Rodriguez failed to timely file his SIB applications for twenty quarters and that there was legally insufficient evidence to prove total inability to work for the later quarters. Consequently, the appellate court reversed the trial court's judgment and affirmed the Appeals Panel's decision, relieving Old Republic of liability for the SIBs.

Workers' CompensationSupplemental Income BenefitsTimely FilingImpairment RatingAbility to WorkTexas Labor CodeAppellate ReviewLegal SufficiencyMedical EvidenceOn-the-job Injury
References
12
Case No. SDO 0323941
Regular
Aug 20, 2007

CAPRICE SMITH vs. KINDERCARE LEARNING CENTER, SPECIALTY RISK SERVICES, AIG

This case concerns whether the old or new workers' compensation permanent disability rating schedule applies to an injury predating the 2005 schedule changes. The Board affirmed the WCJ's prior determination that the 1997 schedule applies due to a final, unchallenged finding on the matter. However, the Board granted reconsideration to amend the award, deferring the issue of permanent disability and attorney's fees for further proceedings at the trial level due to the WCJ's insufficient explanation of the disability rating and apportionment.

Workers' Compensation Appeals BoardKindercare Learning CenterSpecialty Risk ServicesAIGCaprice SmithSDO 0323941Petition for ReconsiderationAmended Findings and AwardPreschool TeacherIndustrial Injury
References
7
Case No. MISSING
Regular Panel Decision

Alvarado v. Old Republic Insurance

Appellants Steve Alvarado, Homero Torres, and Alejandro Martinez appealed a summary judgment granted in favor of Old Republic Insurance Company. Appellants were injured in a vehicle collision in 1989 and filed workers' compensation claims, which Old Republic denied, asserting they were not employees of its insured, U.S. Home Corporation, but independent contractors. Appellants sued for breach of good faith and fair dealing. Old Republic sought summary judgment arguing no breach existed due to a reasonable basis for denial, claims were barred, and no valid exemplary damages claim. The appellate court examined whether a reasonable basis existed for Old Republic's denial, specifically focusing on the employee vs. independent contractor status of the appellants. The court found that competent summary judgment evidence conclusively established appellants were independent contractors, thus not entitled to workers' compensation benefits, and Old Republic did not deny claims in bad faith. Therefore, the trial court's grant of summary judgment was affirmed.

Summary JudgmentWorkers' CompensationIndependent ContractorEmployee StatusBad Faith ClaimDuty of Good Faith and Fair DealingAffirmative DefenseExemplary DamagesAppellate ReviewTexas Law
References
42
Case No. 2-02-364-CV
Regular Panel Decision
Jun 26, 2003

Old Republic Insurance Company v. Donna Fagan

Old Republic Insurance Company appealed a summary judgment granted in favor of Donna Fagan in a workers' compensation case. Fagan claimed a neck injury suffered during her employment and sought benefits. Old Republic disputed the claim, but a contested case hearing officer and appeals panel ruled in Fagan's favor. The trial court then granted Fagan's motion for summary judgment. Old Republic appealed this decision and also argued the trial court erred by not filing findings of fact and conclusions of law. The Court of Appeals affirmed the trial court's judgment, stating that Old Republic failed to provide sufficient evidence to create a genuine issue of material fact regarding a compensable injury. The court also clarified that findings of fact and conclusions of law are not appropriate in summary judgment proceedings.

Workers' CompensationSummary JudgmentAppellate ReviewNo-Evidence Summary JudgmentBurden of ProofCompensable InjuryCourse and Scope of EmploymentFindings of FactConclusions of LawTexas Law
References
9
Case No. 2018 NY Slip Op 07419 [166 AD3d 599]
Regular Panel Decision
Nov 07, 2018

Khan v. Old Navy

In this personal injury action, plaintiff Asghar Khan sued Old Navy after a clothing rack allegedly fell on him in 2012. The parties entered a stipulation in 2016 requiring Khan to provide medical authorizations and records related to a prior 2008 accident, for which he had a workers' compensation claim, within 21 days. Failure to comply would result in preclusion of evidence. Khan failed to comply, leading Old Navy to move for summary judgment. The Supreme Court conditionally granted Old Navy's motion and Khan's cross-motion for summary judgment on liability. The Appellate Division reversed, holding that Khan failed to demonstrate a reasonable excuse for non-compliance with the so-ordered stipulation, making the conditional order of preclusion absolute. Consequently, the defendant's motion for summary judgment dismissing the complaint was granted, and the plaintiff's cross-motion for summary judgment on the issue of liability was denied.

Personal InjurySummary Judgment MotionConditional Order of PreclusionWorkers' Compensation ClaimDiscovery SanctionsStipulationAppellate DivisionMedical RecordsEvidence PreclusionNegligence Action
References
5
Case No. BAK 0142744
Regular
Apr 01, 2008

DARIN SLOAN vs. WASCO STATE PRISON, STATE COMPENSATION INSURANCE FUND

This case concerns whether the old or new permanent disability rating schedule applies. The Board affirmed the WCJ's decision to use the old schedule, finding that medical reports in 2004 indicated permanent disability, even if not explicitly stating the condition was permanent and stationary. This ruling aligns with the more recent *Zavala* precedent, superseding the stricter interpretation in *Vera*.

Workers' Compensation Appeals BoardDarin SloanWasco State PrisonState Compensation Insurance FundOpinion and Decision After ReconsiderationWCJindustrial injurypermanent disabilityapportionment1997 Schedule for Rating Permanent Disabilities
References
8
Case No. ADJ2239874 (STK 0170112) ADJ472994 (STK 0198041) ADJ3391005 (STK0208641)
Regular
Dec 15, 2008

MITCHELL PACHECO vs. INNOVATIVE STEEL SYSTEMS and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT COMPENSATION INSURANCE COMPANY, in liquidation, LENNAR CORPORATION and OLD REPUBLIC INSURANCE COMPANY, RICHMOND AMERICAN HOMES and AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to the trial level. The Board found that the WCJ erred by applying the wrong disability rating schedule and by issuing a combined award for three separate successive injuries. The matter is remanded for separate determinations of permanent disability for each injury, with the 2005 and 2006 injuries to be rated under the 2005 Schedule.

CIGAFremont Compensation Insurance CompanyliquidationInnovative Steel SystemsLennar CorporationOld Republic Insurance CompanyRichmond American HomesAmerican Home Assurance Companyindustrial injuriesneck
References
8
Case No. 02-17-00269-CV
Regular Panel Decision
Sep 28, 2017

in Re Old Republic Insurance Company

In this workers' compensation case, Relator Old Republic Insurance Company sought mandamus relief after the trial court denied its plea to the jurisdiction. Old Republic argued that the real party in interest, Trena Jones, had not exhausted her administrative remedies with the Division of Workers’ Compensation (DWC) regarding her claim for lifetime-income benefits (LIBs). Jones, who sustained severe work-related injuries in 2006, had her LIB claim denied by a DWC hearing officer and subsequently by an appeals panel. She then sought judicial review. The appellate court found that the DWC had not fully resolved the extent of Jones's compensable injury for LIB purposes, a prerequisite for trial court jurisdiction. Therefore, the appellate court concluded that the trial court abused its discretion by denying Old Republic's plea to the jurisdiction and conditionally granted mandamus relief, directing the trial court to vacate its order and abate proceedings until the DWC resolves the underlying administrative issues.

Workers' CompensationLifetime Income Benefits (LIBs)Plea to the JurisdictionExhaustion of Administrative RemediesMandamus ReliefJudicial ReviewAppellate ProcedureTexas Court of AppealsContested Case HearingDWC (Division of Workers’ Compensation)
References
16
Case No. 14-09-00456-CV
Regular Panel Decision
Aug 12, 2010

Jose A. Perez and Nancy C. Perez v. Old American County Mutual Fire Insurance Company

In this insurance coverage dispute, the owners of a vehicle damaged in a collision appeal the trial court’s judgment that the insurer has no duty to defend the insured or pay damages arising from the accident. On October 4, 2007, Maria Nambo, an unlicensed driver, was involved in an accident. Her father, Mario Nambo, had an automobile insurance policy with Old American County Fire Insurance Company. Old American rescinded the policy after learning Maria resided with Mario and was not disclosed. Mario had warranted that he and Virginia were the only drivers and residents over fifteen, and later, deemed admissions showed he intentionally failed to disclose Maria's residence and unlicensed status to deceive Old American. The trial court ruled in favor of Old American, declaring the policy properly rescinded and Old American had no duty to defend or pay damages to the Nambos or Jose Perez. The trial court also dismissed the Perezes' claims with prejudice for failure to appear. The Perezes appealed, challenging the denial of their summary judgment motion, the notice of trial setting, the legal sufficiency of the evidence, and the trial court's failure to provide a licensed translator for Mario Nambo. The appellate court overruled all issues and affirmed the trial court's judgment.

Automobile InsuranceInsurance CoveragePolicy RescissionMaterial MisrepresentationDeceptive Trade Practices ActSummary JudgmentTrial NoticeLegal Sufficiency of EvidenceInterpreter RightsDue Process
References
4
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