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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

Ramirez v. United States Fidelity & Guarantee Co.

Anthony Ramirez was killed in an accident while working for Leisure Pool Service, leading his estate and property owner Samuel Hillman to sue his employers for wrongful death. Hillman subsequently cross-claimed against the employers for indemnification and contribution. USF&G, the employers' insurer, disclaimed coverage for Hillman's cross-claim based on an employee bodily injury exclusion in their general liability policy. The Supreme Court granted summary judgment for USF&G, upholding the exclusion. On appeal, the court dismissed Ramirez's appeal, modified Hillman's appeal by explicitly declaring the exclusion applied, and affirmed the judgment, finding the policy's exclusionary language clear and unambiguous regarding employee injuries and related contribution claims.

Insurance policyDeclaratory judgmentSummary judgmentEmployee exclusionBodily injuryContributionIndemnificationAppellate reviewPolicy interpretationAmbiguity
References
10
Case No. MISSING
Regular Panel Decision

Pesta v. City of Johnstown

This appeal concerns the applicability of the antisubrogation rule. Plaintiff, an employee of Peter Luizzi & Brothers Contracting (Luizzi), suffered severe injuries in a construction accident involving a Luizzi dump truck. Plaintiff sued defendant, who then filed a third-party action against Luizzi for common-law indemnification. The Supreme Court initially ruled defendant was entitled to indemnification for damages exceeding Luizzi's existing insurance policies. Upon reargument, the court granted defendant's motion in full, concluding the antisubrogation rule did not apply because Luizzi's commercial general liability, commercial automobile, and commercial liability umbrella policies had applicable exclusions, and the owners and contractors protective liability (OCP) policy named only the defendant as an insured. Luizzi appealed this decision. The appellate court affirmed, finding that the dump truck was an 'auto' under the CGL policy's exclusion, the co-employee exclusion in the automobile policy was valid, thus the umbrella policy was not implicated, and the antisubrogation rule was inapplicable to the OCP policy as it only insured the defendant.

AntisubrogationInsurance ExclusionIndemnificationSummary JudgmentWorkers' CompensationCommercial General LiabilityCommercial Automobile PolicyUmbrella PolicyOCP PolicyAppellate Review
References
9
Case No. MISSING
Regular Panel Decision

General Accident Insurance v. United States Fidelity & Guarantee Insurance

Plaintiff, an insurer, sought recovery from defendant, another insurer, after defending its insured in an underlying action and paying the resulting judgment. The plaintiff had failed to give timely notice of disclaimer based on an exclusion in its policy, while the defendant refused to assume defense, claiming its policy did not cover the accident. The underlying action stemmed from injuries caused by a water softener tank falling from a push cart. Supreme Court determined both insurers were coinsurers, responsible for pro rata shares based on policy limits. The appellate court affirmed this decision, rejecting both insurers' arguments regarding policy exclusions by strictly construing the exclusions and citing prior case law, concluding that both policies provided primary coverage.

Insurance LawCoverage DisputeExclusion ClauseDuty to DefendPro Rata ContributionCoinsuranceWaiverEstoppelSummary JudgmentAppellate Review
References
12
Case No. MISSING
Regular Panel Decision

Purkey v. American Home Assurance Co.

The Tennessee Supreme Court addressed three certified questions from the U.S. District Court for the Eastern District of Tennessee concerning the validity of household or family exclusion clauses in automobile insurance liability policies under Tennessee law and public policy. Petitioner Janice W. Purkey argued that these exclusions were void following amendments to the Tennessee Financial Responsibility Act and the abolition of intrafamily tort immunity. However, the Court referenced its prior consistent rulings upholding such clauses and emphasized Tennessee Code Annotated § 56-7-121, which explicitly permits contractual exclusions 'notwithstanding any other provision of law to the contrary.' The Court concluded that such exclusions do not violate Tennessee law or public policy, thereby answering the first certified question in the negative and declining to address the remaining questions.

Automobile InsuranceLiability CoverageHousehold Exclusion ClauseFamily Exclusion ClauseTennessee LawPublic PolicyFinancial Responsibility ActContract InterpretationIntrafamily Tort ImmunityCertified Questions
References
18
Case No. MISSING
Regular Panel Decision

Fagnani v. American Home Assurance Co.

This case involves an appeal concerning an insurance policy's exclusionary clause. Plaintiffs' decedents, Stephen Fagnani and Brandon Young, were killed in a helicopter crash while working for ODECO. The defendant insurance carrier disclaimed liability, citing a policy exclusion for 'Flying in any Rotocraft being used for transportation of Oil Rig Crews to and from such rigs.' Special Term granted summary judgment for the plaintiffs, interpreting ambiguities against the insurer. Justice Titone, however, dissents, arguing that both sides presented extrinsic evidence, which creates a question of fact regarding the meaning of 'oil rig' that necessitates a trial. He recommends reversing the judgment, vacating the order, and remitting the matter for trial.

Insurance PolicyExclusionary ClauseSummary JudgmentContract InterpretationExtrinsic EvidenceAmbiguityHelicopter CrashAccidental DeathOil Rig CrewsAppellate Dissent
References
10
Case No. MISSING
Regular Panel Decision

Truck Insurance Exchange v. Musick

Truck Insurance Exchange (Truck) sought a declaratory judgment against Calvin Musiek regarding the validity of a 'fellow employee' exclusion in Musiek's Texas Business Auto Policy. Musiek, an employee of J.D. Abrams, Inc., accidentally backed his truck over a fellow employee, Luis Melesio Quilo, causing his death. Truck denied coverage for the subsequent personal injury suit against Musiek, citing the exclusion. The trial court found the exclusion partially unenforceable and ordered Truck to defend and pay. On appeal, the court examined Texas law requiring stringent construction of insurance exceptions. The court found the exclusion clear and unambiguous. It distinguished the 'fellow employee' exclusion from the 'family member' exclusion previously deemed invalid, noting that the former is authorized by the Texas Motor Vehicle Safety Responsibility Act and aligns with the Worker's Compensation Act, which provides an exclusive remedy for fellow employee injuries. The appellate court reversed the trial court's judgment, holding the fellow employee exclusion valid and enforceable, thus relieving Truck of its duty to defend Musiek or make payments under the policy.

Declaratory JudgmentInsurance Policy ExclusionFellow EmployeeMotor Vehicle LiabilityWorkers' Compensation ActTexas LawStatutory InterpretationDuty to DefendDuty to IndemnifyPersonal Injury
References
12
Case No. MISSING
Regular Panel Decision

Mid-Continent Casualty Co. v. Global Enercom Management, Inc.

This case addresses an insurance dispute between Global Enercom Management, Inc. and Mid-Continent Casualty Company concerning coverage for workers who died after a fall from a cell tower. The accident involved a rope-and-pulley system powered by a pickup truck. The court analyzed two insurance policy exclusions: an 'auto-use' exclusion and a 'subsequent-to-execution' clause. The Texas Supreme Court held that the 'auto-use' exclusion in the Commercial General Liability (CGL) policy precluded coverage, reversing the appellate court's decision on this point. However, the court affirmed that the 'subsequent-to-execution' clause in both the CGL and Commercial Auto Policy (CAP) did not bar coverage, as the subcontract was considered 'executed' prior to the incident, despite Global's delayed signature.

Insurance CoverageAuto Use ExclusionSubsequent-to-Execution ClauseSummary JudgmentContract InterpretationCommercial General Liability PolicyCommercial Auto PolicyWorkers' CompensationCell Tower AccidentDeclaratory Judgment
References
22
Case No. MISSING
Regular Panel Decision

Certain Underwriters at Lloyd's v. KKM INC.

This appeal concerns an insurance claim for a building that collapsed due to corrosion. Appellee KKM, Inc. d/b/a Strand Surplus, the building owner, sought coverage from appellants, Certain Underwriters of Lloyd’s London, after its claim was denied. The trial court deemed the policy terms 'corrosion' and 'decay' ambiguous, submitting the coverage issue to a jury, which found for KKM, Inc. On appeal, the court upheld the trial court's finding of ambiguity and the interpretation that 'Additional Coverage' for hidden decay could override general exclusions. However, the judgment was reversed and remanded because the trial court erred in refusing to instruct the jury on the 'fortuity doctrine,' specifically regarding whether the insured knew or should have known of the ongoing corrosion before the policy was purchased.

Insurance claimBuilding collapsePolicy ambiguityContract interpretationCorrosionHidden decayFortuity doctrineKnown lossLoss in progressJury instructions
References
39
Case No. 09-22-00174-CV
Regular Panel Decision
Apr 03, 2025

Lexington Insurance Company v. Exxon Mobil Corporation and ExxonMobil Oil Corporation

This case from the Ninth District of Texas at Beaumont addresses an appeal by Lexington Insurance Company against Exxon Mobil Corporation and ExxonMobil Oil Corporation. Lexington challenged a summary judgment that awarded Exxon $25 million under an umbrella insurance policy. The dispute centered on whether Exxon qualified as an additional insured under a policy issued to Brock Services, LTD, and if specific policy exclusions for workers' compensation and employer's liability applied. The court affirmed the arbitration finding that Exxon was an additional insured but ultimately reversed the trial court's judgment. It ruled that the employer's liability exclusion applied, given Exxon's status as a statutory employer of Brock's injured employees through its Owner Controlled Insurance Program (OCIP), thus entitling Exxon to the exclusive remedy defense under the Texas Workers' Compensation Act. Consequently, Lexington was found to have no duty to defend or indemnify Exxon, and the awards for damages, attorney's fees, and interest were reversed.

Insurance Policy CoverageUmbrella InsuranceWorkers' Compensation ActEmployer's Liability ExclusionExclusive RemedyOCIPStatutory EmployerAdditional Insured StatusArbitration ReviewSummary Judgment Reversal
References
33
Case No. MISSING
Regular Panel Decision

Celestino v. Mid-American Indemnity Insurance Co.

The case involves an appeal by the family members of Arturo Celestino, deceased, and Sebastian Cotton & Grain (collectively, the Celestinos) against Mid-American Indemnity Insurance (Mid-American) regarding a summary judgment. The Celestinos alleged breach of contract, fraud, negligence, and violations of the Insurance Code and DTPA, claiming Mid-American's umbrella policy, intended for employer's liability, provided no actual coverage due to extensive exclusions. The appellate court affirmed the summary judgment concerning fraud, negligence, and DTPA § 17.46 violations, reasoning that the policy's plain language, including clear warnings and exclusions, negated claims of misrepresentation and duty to disclose. However, the court reversed and remanded the claims for breach of contract and unconscionability under DTPA § 17.50(a)(3), finding Mid-American failed to demonstrate the policy offered any employer's liability coverage under Texas law and noting potential repugnancy between the general coverage provision and its exclusions.

Insurance Coverage DisputeSummary Judgment AppealBreach of ContractDeceptive Trade Practices ActInsurance Code ViolationsUnconscionabilityEmployer's Liability InsurancePolicy ExclusionsFraudulent MisrepresentationNegligence Claim
References
32
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