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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

Progressive County Mutual Insurance Co. v. Kelley

Regan Kelley, injured in a car accident, sought underinsured motorist benefits from Progressive County Mutual Insurance Company. The central issue was whether Progressive issued one or two insurance policies covering Kelley's family, as she had claims exceeding the limits of the initial policy. Progressive denied a second policy, leading Kelley to file a lawsuit for breach of contract and Insurance Code violations. While the trial court ruled for Progressive and the court of appeals for Kelley, this Court ultimately determined that the insurance documents were ambiguous regarding the number of policies. The Court concluded that whether one or two policies exist is a question of fact requiring resolution by a fact finder. Therefore, the court of appeals' judgment was reversed, and the case was remanded for further proceedings.

Insurance PolicyUnderinsured MotoristBreach of ContractAnti-Stacking ProvisionContract AmbiguityFact QuestionSummary JudgmentAppellate ReviewRemandTexas Law
References
9
Case No. 2018 NY Slip Op 07432 [166 AD3d 621]
Regular Panel Decision
Nov 07, 2018

Matter of Progressive Advanced Ins. Co. v. New York City Tr. Auth.

This case involves an appeal by Progressive Advanced Insurance Company (Progressive) against the New York City Transit Authority (NYCTA) concerning an arbitration award. The dispute arose under Insurance Law § 5105 regarding a loss transfer claim, where NYCTA sought reimbursement from Progressive for workers' compensation benefits paid to its employee after a collision involving Progressive's insured. The central issue was whether a 20% no-fault offset applied to the workers' compensation wages, with the arbitrator ruling it did not, as a one-third offset had already been applied. Progressive's petition to vacate the award was denied by the Supreme Court, Queens County. The Appellate Division affirmed this denial, concluding that the arbitrator's determination was supported by a reasonable hypothesis and was not arbitrary or capricious.

Arbitration AwardLoss TransferInsurance LawWorkers' Compensation BenefitsNo-Fault OffsetAppellate ReviewStatutory InterpretationEvidentiary SupportArbitrary and CapriciousReasonable Hypothesis
References
9
Case No. 08-0073
Regular Panel Decision
Mar 27, 2009

Progressive County Mutual Insurance Company v. Regan Kelley

This case addresses whether two documents from an insurance company constitute one or two separate insurance policies. Regan Kelley, injured in a car accident, sought underinsured benefits from Progressive County Mutual Insurance Company after exhausting the motorist's insurer's limits. Progressive paid benefits under one policy but denied a claim under an alleged second policy, arguing the documents formed a single policy. The trial court granted summary judgment for Progressive, which the court of appeals reversed. The Supreme Court of Texas held that the documents are ambiguous as to whether one or two policies were issued, creating a fact question. Consequently, the Supreme Court reversed the court of appeals' judgment and remanded the case to the trial court for further proceedings to resolve this ambiguity.

Insurance Policy InterpretationMulti-Car PolicyContract AmbiguitySummary JudgmentAnti-Stacking ProvisionExtrinsic EvidenceLatent AmbiguityFact QuestionTexas Supreme CourtAuto Insurance
References
10
Case No. MISSING
Regular Panel Decision

Izen v. Commission for Lawyer Discipline

The case concerns attorney Joe Alfred Izen Jr.'s challenge to disciplinary actions taken by the State Bar of Texas. He was disciplined by the Advertising Review Committee and the Commission for Lawyer Discipline for alleged violations of professional conduct rules related to lawyer advertising. Izen contended that these entities violated his fundamental constitutional right to due process by failing to adhere to their own procedures, expanding their investigation without notice, and initiating disciplinary proceedings without allowing him an opportunity to rectify perceived issues, despite accepting his fees. The dissenting justice concurred, arguing that the application of former Rule 7.07 was unconstitutional, as it deprived Izen of fair notice and a chance to cure violations. Consequently, the dissenting justice advocated for vacating the district court's judgment, which had favored the Commission, and dismissing all proceedings against Izen.

Due ProcessAttorney DisciplineLawyer AdvertisingFirst AmendmentFourteenth AmendmentTexas ConstitutionState Bar of TexasProfessional Conduct RulesSafe HarborProcedural Due Process
References
18
Case No. 03-99-00846-CV
Regular Panel Decision
Sep 13, 2001

Antonio Cortez v. Progressive County Mutual Insurance Company

Antonio Cortez appealed a summary judgment against him in an insurance discrimination case, alleging that Progressive County Mutual Insurance Co.'s variable commission program violated Texas Insurance Code article 21.21-8 by charging consumers of the same risk different rates based on agent commission levels. The trial court had granted summary judgment for Progressive, concluding that 'unfair discrimination' was defined by article 21.21-6 and that Cortez had not shown evidence of discrimination or economic damages. The appellate court reversed, holding that article 21.21-8 contains its own definition of unfair discrimination, distinct from article 21.21-6, and that Cortez had presented more than a scintilla of probative evidence to create a genuine issue of material fact regarding unfair discrimination and economic damages. The case was remanded for further proceedings.

Insurance discriminationVariable commission programSummary judgment appealStatutory interpretationTexas Insurance CodeUnfair discrimination definitionEconomic damagesAppellate court decisionRemand for further proceedingsAgent commission rates
References
21
Case No. MISSING
Regular Panel Decision

Loncar v. Progressive Cnty. Mut. Ins. Co.

This is an insurance coverage dispute where appellants, the Loncars, sought uninsured motorist benefits from appellees, Progressive and Chubb, after Brian Loncar was injured in a traffic accident. Recovery from the City of Dallas fire truck operator was barred by official immunity. The trial court granted summary judgment for the insurance companies, concluding that the policy's "legally entitled to recover" clause did not provide coverage when the other driver is legally protected by immunity. The appellate court affirmed the summary judgment, agreeing that the unambiguous policy terms preclude coverage in such circumstances. The court also denied claims under the Texas Insurance Code, as no policy coverage was established.

Insurance CoverageUninsured MotoristOfficial ImmunityGovernmental ImmunitySummary JudgmentContract InterpretationAppellate DecisionTexas LawAutomobile AccidentPolicy Language
References
19
Case No. MISSING
Regular Panel Decision
Oct 26, 1992

Tatum v. Progressive Polymers, Inc.

Michael Tatum, a former employee of Progressive Polymers, sued the company for discrimination after they failed to re-hire him following a workers' compensation claim he filed in 1990 for a back injury. Tatum had settled his claim and was medically released to work in December 1990 but was not re-employed until an offer was made in October 1991, which he rejected due to lack of compensation for lost wages. The trial court admitted evidence of this job offer, which Tatum argued was an inadmissible compromise attempt, but the appellate court found no abuse of discretion as it was a straightforward offer without conditions. Furthermore, Tatum appealed the jury's failure to find discrimination, arguing it was against the great weight of the evidence. The appellate court reviewed the conflicting testimonies regarding job availability and Tatum's employment interests and concluded that the jury's finding was not manifestly unjust, thus affirming the trial court's judgment.

DiscriminationRe-employmentWorkers' CompensationBack InjuryLost WagesSettlement OfferEvidence AdmissibilityFactual SufficiencyJury VerdictAppellate Review
References
5
Case No. 03-05-00413-CV
Regular Panel Decision
Jun 29, 2007

Raul Garcia v. Commission for Lawyer Discipline

This disciplinary action was initiated by the Commission for Lawyer Discipline against attorney Raul Garcia for alleged violations of the Texas Disciplinary Rules of Professional Conduct. The district court found Garcia in violation of rules concerning fee-splitting with a non-lawyer, assisting in the unauthorized practice of law, and practicing under a trade name, while ruling in his favor on a charge of forming a partnership with a non-lawyer. Garcia appealed the district court's partial summary judgment against him. The appellate court reviewed the case de novo and affirmed the district court's judgment, concluding that Garcia indeed violated rules 5.04(a), 5.05(b), and 7.01(a) as an employee of a non-profit organization providing legal services.

Legal EthicsAttorney DisciplineUnauthorized Practice of LawFee SplittingTrade NameProfessional MisconductSummary JudgmentAppellate ReviewNon-profit OrganizationImmigration Law
References
16
Case No. 14-22-00450-CV
Regular Panel Decision
May 14, 2024

Progressive County Mutual Insurance Company v. Artemiz Freeman

This is a dissenting opinion in a case appealed from the 113th District Court, Harris County, Texas. The majority reversed the trial court's summary judgment, which was granted to Artemiz Freeman. The central issue revolves around the validity of a 'regular use exclusion' in an insurance contract by Progressive County Mutual Insurance Company, and whether it contravenes Texas public policy regarding uninsured/underinsured motorist (UM/UIM) benefits. The dissenting justice argues the majority erred by requiring Freeman to prove worker's compensation benefits, ignoring agreed damages, and subverting UM/UIM coverage's purpose. It asserts that the regular use exclusion, especially for employer-owned vehicles, conflicts with the Texas Insurance Code and public policy, which mandates UM/UIM coverage to 'follow the person' and place the injured claimant in a position as if the financially irresponsible motorist had been insured. The dissent also highlights that worker's compensation benefits are inapplicable for altering the underinsured nature of the claim and are not intended to make an injured party whole.

Uninsured Motorist CoverageUnderinsured Motorist CoverageRegular Use ExclusionTexas Public PolicyInsurance Contract InterpretationSummary Judgment AppealWorkers' Compensation ReimbursementDamages CalculationAppellate Court DecisionInsurance Law
References
38
Case No. MISSING
Regular Panel Decision

Kelley v. Progressive County Mutual Insurance Co.

Regan Kelley sued Progressive County Mutual Insurance Company for breach of contract and Insurance Code violations after Progressive refused to pay for underinsured benefits under a second policy, claiming only one policy existed and stacking was prohibited. Kelley was injured while riding her horse after being struck by a motorist, receiving $100,000 from the motorist's insurer and $500,025 from Progressive. Progressive sought a declaratory judgment that stacking was prohibited. The trial court granted Progressive's summary judgment motion. The appellate court reversed and rendered in part, and reversed and remanded in part, finding that Progressive issued two separate policies and that its 'Two or More Auto Policies' provision, which prohibited stacking, violated public policy under Texas uninsured/underinsured motorist statutes. Kelley is entitled to recover under the second policy.

Insurance LawUnderinsured MotoristUninsured MotoristPolicy StackingSummary JudgmentBreach of ContractPublic PolicyTexas LawAppellate ReviewInsurance Policies
References
20
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