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

Case No. 03-17-0081-CV
Regular Panel Decision
Dec 29, 2017

PHI Air Medical, LLC v. 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

This letter serves as a reply from Insurer Appellees Texas Mutual Insurance Company, et al. to the Third District Court of Appeals. It addresses arguments made by PHI Air Medical, LLC regarding the definition of the 'business of insurance' under the McCarran-Ferguson Act, particularly concerning payments made to third parties versus directly to insureds. The Insurers contend that PHI's proposed distinction lacks common sense and is contrary to established Supreme Court authority, citing cases such as U.S. Treasury v. Fabe. They argue that the actual performance of an insurance contract, including paying medical benefits to providers, is an essential part of the 'business of insurance' and that state laws prescribing contract terms directly regulate this business. The letter concludes by asserting that PHI’s arguments are inconsistent with both the practical workings of insurance and Supreme Court precedent.

McCarran-Ferguson ActBusiness of InsuranceThird-Party PaymentsInsurance Contract PerformanceWorkers' Compensation LawSupreme Court PrecedentAppellate ReviewTexas Workers' CompensationStatutory InterpretationInsurance Regulation
References
4
Case No. MISSING
Regular Panel Decision

PHI Air Med., LLC v. Tex. Mut. Ins. Co.

This case concerns PHI Air Medical, LLC's dispute with various insurers over reimbursement rates for air ambulance services for workers' compensation in Texas. The central issue is whether the Airline Deregulation Act (ADA) preempts state laws and rules that regulate these rates. The court concludes that the ADA indeed preempts these state provisions because they relate to the price of an air carrier's services. Furthermore, the court found that the McCarran-Ferguson Act does not "reverse-preempt" the ADA, as the state regulations primarily aim to control insurers' costs rather than regulate the "business of insurance" itself. Consequently, the trial court's judgment is reversed, and the case is remanded for further proceedings consistent with the finding that the state's rate-setting provisions are preempted.

Airline Deregulation ActPreemptionAir Ambulance ServicesWorkers' CompensationReimbursement RatesMcCarran-Ferguson ActInsurance RegulationState LawFederal LawTexas Labor Code
References
31
Case No. 17-0818
Regular Panel Decision
Dec 22, 2017

in Re Vcc, LLC, Vratsinas Construction Co., Nato Garcia D/B/A Nato Garcia Company, and Phi Service Agency, Inc.

This Supplemental Mandamus Record concerns a dispute over construction projects for two schools in the Pharr-San Juan-Alamo Independent School District (PSJA ISD), where PSJA ISD is suing VCC and its subcontractors for $48 million in damages. The Relators (VCC and subcontractors) filed a mandamus petition and an emergency motion for temporary relief with the Supreme Court of Texas, primarily challenging trial court orders related to discovery, especially the onerous process of reviewing 49 million emails, and seeking a continuance due to disruptions caused by Hurricane Harvey. The Supreme Court of Texas granted the Relators' emergency motion for temporary relief and stayed specific trial court orders, including a Third Amended Discovery Control Order and an Order on Motion to Compel, pending further orders from the Supreme Court.

Construction DefectsDiscovery DisputeMandamus PetitionTemporary ReliefHurricane Harvey ImpactElectronic DiscoveryTrial ContinuanceSchool ConstructionTexas Supreme CourtJudicial Discretion
References
29
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. MISSING
Regular Panel Decision

Barger v. Petroleum Helicopters, Inc.

A helicopter piloted by Walter Barger crashed into the Gulf of Mexico, killing all on board. His family, led by Mary Elizabeth Barger, sued his employer, Petroleum Helicopters, Inc. (PHI), and the helicopter manufacturer, Bell Helicopters/Textron (Bell), alleging negligence, unseaworthiness, and product defect. The court found PHI negligent for inadequate maintenance and inspection, and Bell liable for defective design. The ruling affirmed that the helicopter was a "vessel" and Barger a "seaman" under maritime law, denying PHI's attempt to limit its liability. Damages were awarded for lost earnings, household services, and loss of parental guidance for Barger's children, with PHI bearing 80% and Bell 20% of the comparative fault.

Aviation AccidentHelicopter CrashMaritime LawJones ActDeath on the High Seas Act (DOHSA)NegligenceProduct LiabilityDefective DesignUnseaworthinessLimitation of Liability Act
References
92
Case No. ADJ7534500; ADJ7534814
Regular
Jul 19, 2012

ESTELA GRANADIO vs. ALPHA PHI INTERNATIONAL FRATERNITY, NATIONAL FIRE INSURANCE COMPANY OF HARTFORD, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board denied reconsideration of a decision that found Applicant Estela Granadino did not sustain injury arising out of and occurring in the course of employment. The Board adopted the Administrative Law Judge's report, which concluded the Labor Code §5402(b) presumption of compensability did not apply because the claim forms were not properly filed with the employer. Furthermore, the Judge found Applicant's medical evidence insufficient and her testimony not credible, thus failing to meet her burden of proof. The denial of reconsideration also upheld the specific injury claim's bar by the post-termination defense.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeGarza v. Workers' Comp. Appeals Bd.Joint Findings and AwardAOE/COELabor Code §5402(b)Northstar at Tahoe v. Workers' Comp. Appeals Bd.Honeywell v. Workers' Comp. Appeals Bd. (Wagner)State Compensation Insurance Fund v. Workers' Comp. Appeals Bd. (Welcher)
References
5
Case No. MISSING
Regular Panel Decision

Hamilton v. City College of the City University of New York

Plaintiff Keith Hamilton, a student with dyslexia, sued City College of New York, Professor Phi-Sheng Ding, Professor J. Bar-shay, and Professor Alberto Guzman for alleged violations of the ADA, Rehabilitation Act, and the Fourteenth Amendment, along with a state contract claim. Hamilton asserted that defendants failed to provide reasonable academic accommodations, specifically denying calculator use on a final exam despite his disability. Defendants moved for summary judgment, arguing Eleventh Amendment immunity for the federal claims and lack of discriminatory animus. The court granted summary judgment to defendants on all federal claims, finding no evidence of discriminatory animus or ill will required to overcome Eleventh Amendment immunity, and dismissed the state contract claim without prejudice, declining supplemental jurisdiction.

Americans with Disabilities ActRehabilitation ActEleventh Amendment ImmunitySummary JudgmentAcademic AccommodationsDyslexiaHigher EducationDue ProcessEqual ProtectionState Contract Law
References
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