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

Case No. 04-08-00311-CV
Regular Panel Decision
May 06, 2009

FIRE AND CAS. INS. CO. OF CONN. v. Miranda

Javier Miranda, an appellee, was diagnosed with Hepatitis C after two minor work-related injuries and claimed it as an occupational disease. The Texas Worker's Compensation Commission (TWCC) and the trial court found that Fire & Casualty Insurance Company of Connecticut, the appellant, waived its right to contest compensability by failing to dispute the claim within the statutory period, based on previous case law. The Court of Appeals, however, noted that the relied-upon precedent, *Continental Cas. Co. v. Downs*, was overruled by *Southwestern Bell Tel. Co., L.P. v. Mitchell*. Crucially, the court distinguished between accidental injuries and occupational diseases regarding notice requirements. It ruled that Fire & Casualty's waiver for the initial laceration claim did not extend to the occupational disease claim, for which it had timely disputed after receiving notice of the Hepatitis C diagnosis. Consequently, the court reversed the trial court's judgment and rendered a take-nothing judgment in favor of Fire & Casualty, also dismissing Miranda's untimely cross-appeal for judicial review.

Workers' CompensationOccupational DiseaseHepatitis CWaiver of CompensabilityStatutory DeadlinesTexas Labor CodeAppellate ReviewInjury ClaimNotice RequirementJudicial Review Timeliness
References
10
Case No. 01-08-00487-CV
Regular Panel Decision
Feb 11, 2010

United Fire & Casualty Company v. Boring & Tunneling Company of America D/B/A Bortunco

On cross motions for summary judgment in a suit to collect on a McGregor Act payment bond, the trial court granted summary judgment in favor of appellee, Boring & Tunneling Company of America ("Bortunco"), and denied the motion of appellant, United Fire & Casualty Company ("United Fire"). United Fire appealed, arguing that Bortunco failed to substantially comply with the notice provisions of the McGregor Act due to a missing notary signature and seal on its sworn statement. Bortunco, a subcontractor, contended that its notice substantially complied as the omission was merely a clerical error. The appellate court affirmed the trial court's judgment, emphasizing the remedial nature of the McGregor Act and that substantial compliance is adequate for notice provisions, especially when actual notice was received. The court concluded that Bortunco's document met the essential requirements of the statute and protected all parties from undue liability.

McGregor ActPayment BondSubstantial ComplianceNotice ProvisionsSuretySubcontractorClerical ErrorSummary JudgmentTexas Government CodeAppellate Review
References
14
Case No. MISSING
Regular Panel Decision

Westchester Fire Insurance Co. v. American General Fire & Casualty Co.

American General Fire and Casualty Insurance (American General) secured a summary judgment, asserting no obligation to defend or pay a claim against Masonry Products, Inc. (Masonry) following the electrocution death of its employee, Joseph A. Mireles. The employee's family sued the City of Austin, which subsequently joined Masonry, seeking indemnity under a statutory cause of action related to operations near high voltage lines. American General refused Masonry's request for defense, citing a policy exclusion for employee bodily injuries or obligations to indemnify others due to such injuries. The appellate court affirmed the trial court's decision, concluding that the policy exclusion was unambiguous and clearly applied to the City's indemnity claim, as it originated from Mireles's bodily injuries, rather than solely from Masonry's statutory violation.

Insurance LawPolicy ExclusionIndemnity ClaimEmployee InjuryWorkers' CompensationSummary JudgmentStatutory LiabilityHigh Voltage LinesAppellate ReviewBodily Injury
References
3
Case No. ADJ7531724, ADJ7531690
Regular
Dec 01, 2017

AURORA LEMUS vs. FREEBIRDS WORLD BURRITO, GRANITE STATE INSURANCE COMPANY, MARK ORFALIA, REDWOOD FIRE AND CASUALTY COMPANY

This case involves a dispute between Granite State Insurance Company and Redwood Fire and Casualty Company regarding contribution for workers' compensation benefits paid to applicant Aurora Lemus. Granite, initially denied contribution by the WCJ, petitioned for reconsideration. The parties subsequently settled the contribution claim for $22,500.00 through mediation, which has been approved by the Board. This stipulation fully resolves Granite's claims against Redwood.

Workers' Compensation Appeals BoardReconsiderationContributionReimbursementJoint Findings of FactCompromise and ReleaseStipulationVoluntary MediationCommissioners' Settlement ConferenceInsurer
References
0
Case No. ADJ2813255 (STK 0210632)
Regular
Nov 08, 2011

JONA DUNCAN vs. J.M. KECKLER MEDICAL COMPANY INC, REDWOOD FIRE AND CASUALTY, BERKSHIRE HATHAWAY (ENDURANCE INSURANCE)

This case involves a workers' compensation claim for cumulative trauma injury to the lower back and right leg. The applicant, Jona Duncan, claims injury while employed by J.M. Keckler Medical Company, Inc. The insurer, Redwood Fire and Casualty, filed a petition for removal, arguing that the issuance of an arbitrator panel by the WCJ would prematurely cut off discovery. The WCAB denied removal, finding the petition premature and lacking a showing of significant prejudice or irreparable harm. The Board adopted the WCJ's report, which stated that Redwood's fears of lost discovery were unsubstantiated and that Endurance had indicated contribution proceedings would only commence after the case-in-chief was resolved.

Workers' Compensation Appeals BoardPetition for RemovalWorkers' Compensation Administrative Law JudgeMandatory ArbitrationCumulative TraumaInsurerContribution ProceedingsCase-in-ChiefDiscovery RightsPrejudice
References
2
Case No. MISSING
Regular Panel Decision

State Farm Fire & Casualty Co. v. Morua

This case, Morua v. State Farm Fire and Casualty Company, addresses whether supplemental interrogatory answers must be verified under Texas Rules of Civil Procedure. Francisco Morua sued State Farm for workers' compensation benefits. State Farm's unverified supplemental responses identified an expert, Jeffrey C. Siegel, whose testimony Morua objected to at trial. The Texas Supreme Court resolved conflicting appellate court decisions, ruling that supplemental interrogatory answers must indeed be verified. However, the Court found Morua waived his objection due to a thirteen-month delay in raising it. Consequently, the court of appeals' judgment was reversed, and the case remanded for further proceedings.

DiscoveryInterrogatoriesVerificationExpert Witness TestimonyWaiverTexas Civil ProcedureAppellate Court ConflictWorkers' Compensation BenefitsTimeliness of ObjectionTrial Procedure
References
23
Case No. MISSING
Regular Panel Decision

Vandewater v. American General Fire & Casualty Co.

Leslie Vandewater, individually and as 'next friend' of her minor son, Jordan Vandewater, appealed a summary judgment in a declaratory relief suit initiated by American General Fire and Casualty Company. The case involved Jordan's consequential bodily injury—mental retardation—contracted in utero due to his mother's employment-related viral exposure at Vandewater Construction Company, an entity insured by American General. The central dispute was over the applicable policy limit for 'bodily injury by disease.' The trial court had set the limit at $100,000 per employee, which Leslie and Jordan challenged, advocating for a $500,000 policy limit. The appellate court affirmed the trial court's decision, ruling that the policy's $100,000 limit for bodily injury by disease to one employee unambiguously extended to consequential injuries to an employee's child.

Insurance LawPolicy LimitsWorkers CompensationEmployers LiabilityConsequential Bodily InjurySummary Judgment AppealDeclaratory ReliefContract InterpretationTexas Appellate LawMinor Plaintiff
References
18
Case No. MISSING
Regular Panel Decision

Carey v. American General Fire & Casualty Co.

Garry Wayne Carey, a laborer, sustained a left knee injury during employment and sued his employer's carrier, American General Fire and Casualty Company. The jury found a period of total and partial loss of use of his left leg but also attributed a significant percentage of this loss to a prior, noncompensable football injury. The trial court entered judgment reducing Carey's recovery based on the prior injury. On appeal, the court determined that the jury questions inquiring about the contribution of a non-compensable prior injury were immaterial and that the trial court erred in failing to disregard these findings. Consequently, the appellate court reversed the trial court's judgment and remanded the case for entry of judgment consistent with its opinion.

Worker's CompensationNoncompensable InjuryPrior InjuryJury VerdictLoss of UseAppellate ReviewImmaterial Jury QuestionsReversed and RemandedTexas LawStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Arrellano v. State Farm Fire & Casualty Com.

Jamie Arrellano died in a trench collapse while working for Southwest Plumbing, which lacked worker's compensation insurance. His family and estate filed a wrongful death action against Southwest Plumbing and secured a money judgment. State Farm Fire & Casualty Co., Southwest Plumbing's insurer, then brought a declaratory judgment action to deny coverage, arguing an exclusion applied because Arrellano's death occurred within the course and scope of his employment. The trial court sided with State Farm, declaring no coverage. On appeal, Arrellano's family challenged this judgment, but the appellate court affirmed, finding sufficient circumstantial evidence to support the trial court's finding that Arrellano was acting within the course and scope of his employment at the time of the accident.

Declaratory judgmentInsurance coverage denialEmployment exclusion clauseCourse and scope of employmentWrongful death actionTrench collapse accidentAppellate review TexasLegal sufficiency of evidenceFactual sufficiency of evidenceCircumstantial evidence ruling
References
14
Case No. ADJ4005250 (LAO 0885426) ADJ1477978 (LAO 0885427)
Regular
May 05, 2014

TRINIDAD HERNANDEZ vs. PRODUCTS SOLUTIONS, REDWOOD FIRE AND CASUALTY INSURANCE

This Workers' Compensation Appeals Board case, ADJ4005250, involved applicant Trinidad Hernandez and defendants Products Solutions and Redwood Fire and Casualty Insurance. The Board issued an order dismissing the Petition for Reconsideration. This dismissal occurred because the petitioner voluntarily withdrew their petition. Therefore, the Board officially closed the reconsideration process for this matter.

Petition for ReconsiderationDismissedWithdrawnWorkers' Compensation Appeals BoardApplicantDefendantsCase NumberLAO District OfficeOrder DismissingTrinidad Hernandez
References
0
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