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

Case No. 13-ev-3288; 13-cv-4244
Regular Panel Decision

Alzheimer's Disease Resource Center, Inc. v. Alzheimer's Disease & Related Disorders Ass'n

This case involves two related lawsuits stemming from the disaffiliation of the Alzheimer’s Disease Resource Center, Inc. (ADRC) from the Alzheimer’s Disease and Related Disorders Association (the Association). In case 13-ev-3288, ADRC alleged unfair competition, false advertising, and other claims. The Court denied dismissal for false advertising under the Lanham Act, New York General Business Law § 349, and unjust enrichment, but granted dismissal for trademark infringement, common law unfair competition, UCC violations, conversion, tortious interference, and fraud. In case 13-cv-4244, ADRC alleged breach of contract and misappropriation of trade secrets related to donor lists. The Court granted the Association's motion to dismiss this complaint in its entirety. Punitive damages were stricken for Lanham Act and unjust enrichment claims.

Unfair CompetitionLanham ActFalse AdvertisingTrademark InfringementNew York General Business Law § 349Unjust EnrichmentMotion to DismissBreach of ContractTrade Secret MisappropriationConversion
References
55
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. 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. ADJ1036120 (SDO 0330367)
Regular
Jul 08, 2013

JESSE SUMABAT vs. CALIFORNIA HIGHWAY PATROL

This case concerns whether the applicant's valley fever is an "insidious, progressive disease" for which jurisdiction over permanent disability can be reserved. The WCAB granted reconsideration, rescinded the initial award, and returned the matter to the trial level. This is because the medical evidence regarding the progressive nature of the applicant's condition was contradictory and required further development. The Board emphasized that the determination of a progressive disease must be supported by substantial medical evidence stating medical probability.

Valley FeverCoccidioidomycosisProgressive DiseaseInsidious DiseasePermanent DisabilityJurisdiction ReservationJackson DoctrineGeneral Foundry ServiceRuffin CaseMedical Probability
References
4
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. MISSING
Regular Panel Decision
Mar 23, 2000

Ramnarine v. Memorial Center for Cancer & Allied Diseases

Jagdeo Ramnarine, an employee of Memorial Sloan-Kettering Cancer Center, suffered a laceration at the Memorial Center for Cancer and Allied Diseases. He subsequently filed a negligence lawsuit. The defendant, Memorial Center, moved for summary judgment, arguing that the plaintiff's claim was barred by the Workers’ Compensation Law § 11, as both the Center and the Hospital operate as a single integrated employer despite their separate legal entities. The Supreme Court initially denied this motion. However, the appellate court reversed the decision, granting summary judgment to the defendant. The court found substantial evidence supporting the integrated employer argument, thereby limiting the plaintiff's remedy to workers' compensation benefits and dismissing the complaint and all cross-claims against the defendant.

Workers' Compensation ExclusivityIntegrated Employer DoctrineSummary Judgment ReversalNegligence ClaimCross Claims DismissedCorporate Alter EgoCommon ControlBronx CountyAppellate DivisionLabor Law
References
11
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
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