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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Feb 16, 2010

Vought Aircraft Industries, Inc. v. Falvey Cargo Underwriting, Ltd.

This case involves Vought Aircraft Industries' claim against its marine cargo insurers, Falvey Cargo Underwriting, Ltd., XL London Market, Limited, and Dornoch Limited, for breach of policy and other claims. A horizontal stabilizer manufactured by Vought was damaged during rail shipment, a peril covered by the marine cargo insurance policy. Vought repaired the stabilizer and sought reimbursement for direct repair costs, overhead expenses, and expediting costs for replacement stabilizers. The court largely dismissed Vought's claims for expediting costs and overhead expenses, finding most were not covered by the policy, though it noted ambiguity in certain policy clauses regarding some shipping costs and overhead. All of Vought's extra-contractual claims, including breach of good faith and fair dealing, unfair insurance practices, breach of repair agreement, promissory estoppel, quantum meruit, and unjust enrichment, were dismissed. XL London Market, Limited's defense asserting it acted solely as an agent for a disclosed principal was denied, indicating a factual dispute.

Marine Cargo InsuranceInsurance PolicyContract InterpretationBreach of ContractSummary JudgmentGood Faith and Fair DealingTexas Insurance CodePolicy AmbiguityOverhead CostsExpediting Costs
References
73
Case No. MISSING
Regular Panel Decision

American Home Assurance Co. v. McDonald

This declaratory judgment action involves American Home Assurance Company seeking to limit its liability under professional liability policies issued to social workers Rory M. McDonald and Helene Ina Anisfeld, who are defendants in an underlying malpractice action brought by Randy Kamhi. Kamhi alleges sexual misconduct and professional negligence against McDonald, and vicarious liability and direct negligence against Anisfeld as McDonald's partner. American Home sought summary judgment to limit indemnification to $25,000 for sexual misconduct claims and punitive damages. The court granted summary judgment in part, affirming the $25,000 limit for McDonald's sexual misconduct and for punitive damages for both McDonald and Anisfeld. However, the court denied the request to terminate American Home's duty to defend McDonald upon exhausting the $25,000 limit and granted Kamhi's cross-motion to stay further summary judgment applications until discovery in the underlying action is complete. Crucially, the court found that extending the sexual misconduct coverage limit to non-sexual malpractice claims violates New York public policy.

Professional Liability InsuranceSexual MisconductInsurance Coverage DisputeDeclaratory JudgmentSummary Judgment MotionPublic Policy ArgumentTherapist MalpracticeDuty to DefendDuty to IndemnifyUnconscionability Claim
References
22
Case No. 03-02-00439-CV
Regular Panel Decision
Feb 21, 2003

Texas Lottery Commission and Linda Cloud, Executive Director v. Scientific Games International, Inc. and Pollard Banknote Limited

The Texas Lottery Commission introduced a new policy in February 2002 to consider a vendor's anticipated economic impact on the state when awarding contracts over $100,000. Scientific Games International, Inc. and Pollard Banknote Limited, out-of-state companies manufacturing instant-ticket games, challenged this policy, arguing the Commission lacked the statutory authority to implement it. The trial court granted summary judgment in favor of SGI and Pollard. The appellate court affirmed the decision, holding that the Texas Lottery Commission is not authorized to consider a vendor's economic impact on the state in its procurement decisions, emphasizing that procurement should be based on quality and price to promote competition.

Procurement LawState ContractsEconomic Impact PolicyTexas Lottery CommissionGovernmental AuthorityStatutory InterpretationCompetitive BiddingSummary JudgmentStanding DoctrineAppellate Review
References
15
Case No. 07-05-00188-CV
Regular Panel Decision
Jun 20, 2007

Yorkshire Insurance Co., LTD. and Ocean Marine Insurance Co., LTD. v. Roy S. Seger, Individually and Shirley Faye Hoskins, Individually and as Administrator of the Estate of Randall Jay Seger

The case involves an appeal by Yorkshire Insurance Co., Ltd., and Ocean Marine Insurance Co., Ltd., against Roy Seger and Shirley Faye Hoskins. The insurers appealed a judgment of over $26 million in actual damages related to a "Stowers" action, stemming from the death of Randall Jay Seger in a drilling accident. The core issues involved whether the insurers were unauthorized, the applicability of a "leased-in worker" exclusion in their CGL policy, and whether the Segers' settlement demands were within policy limits. The court ruled that the 1993 amendments to the Insurance Code applied retroactively and affirmed that the Segers made a sufficient settlement demand within policy limits. However, it reversed the summary judgment on coverage, finding the "leased-in worker" exclusion unambiguous and potentially applicable, and also reversed the directed verdict on damages, as a fact issue remained regarding whether the underlying judgment was the result of a "fully adversarial trial." The case was thus largely remanded for a new trial.

Insurance disputeStowers actionNegligent failure to settleSurplus lines insuranceUnauthorized insurersContract defensesSummary judgmentDirected verdictDamagesFully adversarial trial
References
33
Case No. 13-0096
Regular Panel Decision
Aug 22, 2014

Tenet Hospitals Limited, a Texas Limited Partnership D/B/A Providence Memorial Hospital, and Michael D. Compton, M.D. v. Elizabeth Rivera, as Next Friend for M.R.

This case concerns a challenge to the constitutionality of the Medical Liability Act's ten-year statute of repose. Petitioners, Tenet Hospitals Limited and Michael D. Compton, M.D., sought summary judgment arguing the statute barred a medical negligence claim filed by Elizabeth Rivera on behalf of M.R. The alleged negligence occurred in 1996, and the suit was filed in 2011, five years after the 2003 repose statute's 2006 deadline. The trial court granted summary judgment, but the court of appeals reversed, finding the statute unconstitutional as applied to M.R. The Supreme Court of Texas reversed the court of appeals' judgment, holding that Rivera, acting as M.R.'s next friend, failed to demonstrate due diligence in filing the claim within the three-year grace period afforded by the statute. The Court also found the retroactivity challenge failed due to the compelling public interest in the Medical Liability Act and the sufficient grace period provided. Consequently, the Supreme Court rendered judgment that the plaintiff take nothing.

Medical MalpracticeStatute of ReposeOpen Courts ProvisionRetroactivityDue DiligenceMinor's ClaimConstitutional LawSummary JudgmentTexas Supreme CourtHealthcare Liability
References
26
Case No. MISSING
Regular Panel Decision

Mele v. General Accident Insurance

This appeal concerns an arbitration award where the arbitrators granted the petitioner an amount exceeding the underinsurance coverage limits of an automobile policy issued by the respondent. The petitioner had settled with a tortfeasor for $50,000 and sought additional recovery under a policy with $10,000 per person underinsurance coverage. Despite the policy's stated limit, arbitrators awarded $45,000. The Supreme Court confirmed this award, but the appellate court reversed, holding that arbitrators cannot exceed contractual policy limits. Citing Insurance Law § 3420 (f) (2), the court affirmed that optional supplementary coverage can be contractually limited, thereby reducing the award to the $10,000 policy limit.

Underinsurance CoverageArbitration Award ConfirmationInsurance Policy LimitsJudicial Review of ArbitrationAutomobile Liability PolicySupplementary Uninsured Motorist CoverageStatutory InterpretationContractual LimitationsDamages in ArbitrationAppellate Reversal
References
7
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

Catania v. Hartford Accident & Indemnity Co.

This case involves a submitted controversy under sections 546 to 548 of the Civil Practice Act, concerning whether a liability policy issued to John Schiro extends coverage to the plaintiff for injuries sustained by Schiro's wife. Schiro's wife alleged negligence against her spouse in the operation of his vehicle during his employment with the plaintiff. The court analyzed Insurance Law section 167 (subd. 3), which states that policies do not cover liability for spousal injuries unless expressly provided. Citing Morgan v. Greater New York Taxpayers Mut. Ins. Assn., the court treated the policy as if issued to the plaintiff alone, determining that Schiro's wife is not the plaintiff's spouse, thus making section 167 (subd. 3) inapplicable. The decision, supported by Manhattan Cas. Co. v. Cholakis, concluded that the insurer is liable. Therefore, judgment was granted in favor of the plaintiff, requiring the defendant to defend the pending negligence action and pay any judgment up to the policy limits.

Liability PolicyInsurance CoverageSpousal LiabilityCivil Practice ActInsurance LawNegligenceDeclaratory JudgmentAutomobile AccidentEmployer LiabilityInterspousal Immunity
References
2
Case No. 12-14-00123-CV
Regular Panel Decision
Jan 16, 2015

Liberty Mutual Insurance Company v. Rickie Sims

Liberty Mutual Insurance Company appeals the trial court's judgment regarding uninsured/underinsured motorist (UM/UIM) coverage for Rickie Sims. Liberty Mutual argues that the Chesapeake Policy unambiguously provides $250,000 in UM/UIM coverage, and the trial court erred by submitting the issue of policy limits to the jury and entering a $1 million judgment. Liberty Mutual asserts Sims waived reliance on a corrected admission by treating policy limits as a factual dispute. The appellant contends policy limits are a question of law, ripe only at judgment, and that injecting insurance limits into the trial was prejudicial, violating Texas Rule of Evidence 411. Liberty Mutual seeks reversal and rendition of judgment for $250,000, or in the alternative, a new trial solely on the policy limits.

Insurance LawUninsured Motorist (UIM)Underinsured Motorist (UIM)Policy LimitsContract InterpretationJury Charge ErrorEvidentiary ExclusionPrejudiceJudicial AdmissionsAppellate Procedure
References
40
Case No. 08-01-00442-CV
Regular Panel Decision
May 08, 2003

Denney, Ida Ramirez v. Dillard Texas Operating Limited Partnership D/B/A Dillard's

Appellant Ida Ramirez Denney sued Dillard's under the Texas Labor Code Ch. 451, alleging wrongful termination after filing a workers' compensation claim. Denney was terminated due to Dillard's policy of discharging employees absent for over six months, despite having complied with all leave regulations. The core issue on appeal was whether the trial court abused its discretion by excluding impeaching testimony that challenged Dillard's claim of uniformly applying its absence-control policy. The Court of Appeals found the exclusion of this evidence erroneous and prejudicial, especially given the jury's explicit question regarding exceptions to the leave policy. Consequently, the judgment of the trial court was reversed, and the cause remanded for a new trial.

Workers' CompensationWrongful TerminationEmployer RetaliationLeave of Absence PolicyImpeaching TestimonyEvidentiary ExclusionUniform Application of PolicyCircumstantial EvidenceAppellate ReviewAbuse of Discretion
References
22
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