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

Case No. 03-22-00241-CV
Regular Panel Decision
Oct 31, 2023

Texas Political Subdivisions Joint Self-Insurance Fund v. Texas Department of Insurance - Division of Workers' Compensation and Commissioner Cassie Brown in Her Official Capacity

The Texas Political Subdivisions Joint Self-Insurance Fund (TPS Fund) appealed the denial of its plea to the jurisdiction and summary-judgment motion by the 455th District Court of Travis County. The TPS Fund, a self-insured governmental entity, was assessed administrative penalties totaling $132,500 by the Texas Department of Insurance–Division of Workers’ Compensation for violations of the Texas Labor Code related to nonpayment or late payment of workers’ compensation benefits. The TPS Fund asserted governmental immunity from these penalties. The Court of Appeals reviewed the legislative history and prior common law, including Texas Workers’ Comp. Comm’n v. City of Eagle Pass, to determine if immunity was waived. It concluded that the 2019 amendment to Labor Code Section 504.053(e) merely codified existing law, which had already established a clear waiver of immunity for such regulatory actions against self-insured political subdivisions. Therefore, the appellate court affirmed the trial court’s order, holding that the TPS Fund’s governmental immunity is waived for the administrative penalties.

Workers' CompensationGovernmental ImmunityAdministrative PenaltiesTexas Labor CodeSelf-InsurancePolitical SubdivisionsStatutory InterpretationAppellate ReviewRegulatory AuthoritySovereign Immunity
References
13
Case No. 03-97-00192-CV
Regular Panel Decision
Feb 05, 1998

Texas Property and Casualty Insurance Guaranty Association v. Texas Association of School Boards Workers' Compensation Self-Insurance Fund, Individually and on Behalf of the Independent School Districts of Aransas Pass, El Paso, Irving, Houston,and Hico

This case involves an appeal from the District Court of Travis County between the Texas Property and Casualty Insurance Guaranty Association (Appellant) and the Texas Association of School Boards Workers' Compensation Self-Insurance Fund, Individually and on Behalf of several Independent School Districts (Appellee). The parties jointly moved the Court of Appeals to vacate the trial court's judgment and render a judgment stating that the appellee should take nothing against the appellant. Citing precedent from *Starnes v. Chapman*, the Court noted that reversing the trial court's judgment effectively vacates it and aligns with their practice when rendering a new judgment. The Court granted the motion, reversed the trial court's judgment, and rendered judgment that the appellee take nothing against the appellant. The decision was rendered per curiam by Justices Powers, Kidd, and B. A. Smith.

Texas Court of AppealsJoint MotionVacate JudgmentRender JudgmentTake NothingWorkers' CompensationSelf-Insurance FundInsurance Guaranty AssociationAppellate PracticePer Curiam
References
1
Case No. MISSING
Regular Panel Decision

County of Maverick v. Texas Ass'n of Counties Workers' Compensation Self-Insurance Fund

The County of Maverick (County) appealed a trial court's judgment that Nutmeg Insurance Company (Nutmeg) and the Texas Association of Counties Workers’ Compensation Self-Insurance Fund (the Fund) did not owe the County a duty to defend or indemnify in a wrongful discharge lawsuit. Four former employees had sued the County after being terminated for filing workers' compensation claims. Both Nutmeg and the Fund refused to defend the County, which subsequently lost the wrongful discharge suit and was ordered to pay damages and reinstate employees. The appellate court affirmed the trial court's judgment, finding that neither Nutmeg's public entity liability policy nor the Fund's interlocal agreement covered damages for wrongful discharge, and upheld the award of attorneys' fees to Nutmeg and the Fund.

Workers' CompensationWrongful DischargeInsurance CoverageDuty to DefendDuty to IndemnifyInterlocal AgreementPublic Entity LiabilityTexas LawStatutory InterpretationAppellate Review
References
18
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. 2017 NY Slip Op 07909 [155 AD3d 1208]
Regular Panel Decision
Nov 09, 2017

NYAHSA Services, Inc., Self-Insurance Trust v. People Care Inc.

Plaintiff, a self-insured trust, commenced a collection action against defendant, a former member, for unpaid assessments related to workers' compensation claims. Defendant counterclaimed and filed a third-party action against Cool Insuring Agency, the trust's administrators, alleging mismanagement. During discovery, a dispute arose over a report commissioned by defendant's counsel from a consultant, which Cool and plaintiff sought to compel. Defendant asserted attorney-client privilege, attorney work product, and material prepared in anticipation of litigation. The Supreme Court partially granted the motions to compel, a decision largely affirmed by the Appellate Division, Third Department, with a modification regarding a specific email exchange found to be protected attorney work product.

Discovery DisputeAttorney-Client PrivilegeAttorney Work ProductMaterial Prepared for LitigationSelf-Insurance TrustWorkers' Compensation BenefitsBreach of ContractUnjust EnrichmentThird-Party ActionClaims Administration
References
20
Case No. 2018 NY Slip Op 08737
Regular Panel Decision
Dec 20, 2018

NYAHSA Servs., Inc., Self-Insurance Trust v. Recco Home Care Servs., Inc.

This case concerns an appeal from an order of the Supreme Court in Albany County. Plaintiff NYAHSA Services, Inc., Self-Insurance Trust, a self-insured trust providing workers' compensation coverage, sued defendant Recco Home Care Services, Inc. for unpaid adjustments after the defendant terminated its membership. Following an amendment to the complaint adding individual trustees as plaintiffs, the defendant asserted counterclaims for fraud, breach of fiduciary duty, and negligence against these trustees, which the Supreme Court dismissed as time-barred. The defendant also sought to amend its answer to include a counterclaim under General Business Law, which was denied. The Appellate Division, Third Department, found that the Supreme Court erred in dismissing the counterclaims for fraud and breach of fiduciary duty and in denying the cross-motion to amend for the General Business Law claim. Consequently, the Appellate Division modified the Supreme Court's order, reversing parts of the dismissal and denial, and affirmed the order as modified.

Workers' Compensation CoverageSelf-Insurance TrustFraud AllegationsBreach of Fiduciary DutyGeneral Business LawStatute of LimitationsAmended PleadingsCounterclaimsAppellate ReviewMotion to Dismiss
References
2
Case No. 11-06-00187-CV
Regular Panel Decision
Aug 21, 2008

Law Offices of Miller & Bicklein v. Deep East Texas Self-Insurance Fund and Risk Management Services

The Law Offices of Miller & Bicklein sued Deep East Texas Self-Insurance Fund and Risk Management Services over attorney's fees under Tex. Lab. Code Ann. § 417.003, along with claims for unfair insurance practices and Deceptive Trade Practices-Consumer Protection Act violations. The trial court awarded Miller & Bicklein a partial amount for attorney's fees under Section 417.003 but granted summary judgment against them on the other claims. Miller & Bicklein appealed, arguing error in the summary judgment and refusal to award additional attorney's fees. The Eleventh Court of Appeals affirmed the trial court's orders, finding no error in the summary judgment regarding DTPA and insurance practices claims, and no abuse of discretion in denying additional attorney's fees under the Declaratory Judgments Act.

Workers' CompensationAttorney's FeesSummary JudgmentDTPAUnfair Insurance PracticesDeclaratory Judgments ActAppellate ReviewSubrogation InterestLegal EthicsTexas Jurisprudence
References
24
Case No. 12-19-00032-CV
Regular Panel Decision
Jun 28, 2019

City of Dallas, a Self-Insured Employer, Appellant/Cross-Appellee v. Gregory D. Thompson, Appellee/Cross-Appellant

This is an interlocutory appeal from a trial court’s ruling on a plea to the jurisdiction in a suit for judicial review of a Texas Department of Insurance, Division of Workers’ Compensation (DWC) decision. The City of Dallas, a self-insured employer, challenged counterclaims filed by Gregory D. Thompson, a former employee who claimed workers’ compensation benefits. Dallas asserted the trial court lacked jurisdiction over Thompson’s counterclaims due to untimely filing. Thompson cross-appealed the dismissal of his counterclaim for attorney’s fees based on governmental immunity. The Court of Appeals affirmed the trial court's decision, ruling that the forty-five-day deadline for judicial review is not jurisdictional and upholding governmental immunity for the City of Dallas regarding attorney's fees.

Workers' Compensation BenefitsJudicial Review of Administrative DecisionsPlea to JurisdictionTimeliness of FilingsGovernmental Immunity DoctrineAttorney's Fees ClaimInterlocutory Appeal TexasLabor Code ViolationsSelf-Insured EntitiesAppellate Court Rulings
References
11
Case No. 05-22-00898-CV
Regular Panel Decision
Dec 12, 2023

City of Euless, Self-Insured v. Marta Danylyk, Helmut Hofer, Sofija Hofer and the Texas Subsequent Injury Fund

This case involves a dispute over an informal marriage and the proper recipient of worker's compensation death benefits. David Hofer, a police officer for the City of Euless, was killed in the line of duty. The Texas Department of Insurance, Division of Workers’ Compensation (DWC) determined Marta Danylyk was Hofer's surviving spouse and entitled to death benefits. Appellant City of Euless, Hofer's self-insured employer, unsuccessfully challenged this determination in the district court. Euless appealed the trial court’s judgment, asserting legal and factual insufficiency of the evidence to support the jury’s finding of an informal marriage and challenging refused jury instructions. The Court of Appeals affirmed the trial court's judgment, concluding the evidence was sufficient to establish Danylyk and Hofer agreed to be married and represented themselves to others as married.

Informal MarriageCommon-law MarriageWorker's Compensation Death BenefitsSpousal EligibilitySufficiency of EvidenceAppellate ReviewTexas Family LawTexas Labor LawPolice Officer DeathSelf-Insured Employer
References
28
Case No. 03-11-00179-CV
Regular Panel Decision
Aug 29, 2013

the Attorney General of Texas and the Commissioner of Insurance v. Farmers Insurance Exchange, Fire Insurance Exchange, Mid-Century Insurance Company of Texas, Texas Farmers Insurance Company, and Farmers Texas County Mutual Insurance Company

This case involves an appeal concerning public-information requests made to the Texas Department of Insurance (TDI) for rate-filing information submitted by a group of appellee insurers. The central issue was whether this information, declared "open to public inspection" by the Insurance Code, was subject to exceptions under the Public Information Act (PIA). The district court initially ruled that the PIA's exceptions applied. However, the Court of Appeals reversed this decision, holding that the clear and unambiguous language of former section 2251.107 of the Insurance Code mandated public inspection without regard to the PIA's exceptions. The court emphasized plain-meaning statutory construction and dismissed arguments based on legislative history and constitutional challenges.

Statutory InterpretationPublic Information ActInsurance CodeOpen RecordsTrade SecretsRate FilingsTexas Department of InsuranceAppellate ReviewGovernment TransparencyTakings Clause
References
50
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