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

Case No. 03 Civ. 0332(AKH)
Regular Panel Decision
Oct 29, 2004

In Re September 11th Liability Insurance Coverage Cases

This opinion and order addresses two Rule 12(c) motions regarding insurance coverage for the World Trade Center properties following the September 11, 2001, attacks. The Port Authority of New York and New Jersey sought a declaration that it is an "Additional Insured" under Zurich American Insurance Company's policies, while World Trade Center Properties LLC (WTCP) sought a declaration that Zurich is obligated to cover defense costs. The court, presided over by District Judge Hellerstein, denied both motions. It found ambiguity in the binder regarding the Port Authority's "Additional Insured" status, stating that the issue was premature without further discovery. Furthermore, the court held that New York Insurance Regulation 107 does not require rewriting Zurich's binder and policies to include defense costs, considering the unique circumstances, the sophistication of the insured, and the fact that Zurich explicitly excluded defense costs, which Silverstein (WTCP's affiliate) accepted after failing to secure conventional coverage. The court also affirmed supplemental jurisdiction over the insurance claims due to their close relation to the underlying September 11th liability cases.

Insurance CoverageSeptember 11 AttacksWorld Trade CenterRule 12(c) MotionDeclaratory ReliefAdditional Insured StatusDefense CostsInsurance BinderNew York Insurance LawRegulation 107
References
48
Case No. MISSING
Regular Panel Decision

Texas Farm Bureau Mutual Insurance Co v. Tatum

This case concerns an appeal by an unnamed insurance carrier (Appellant) against a trial court's decision in a one-car accident claim. The Appellant had denied underinsured motorist coverage to the Appellees (Cecil and Ida Tatum, Robert Powell, and Cherie Stanley), who were passengers in the Tatum's vehicle. The trial court had awarded damages, statutory penalties, and attorney's fees to the Appellees. On appeal, the Appellant argued that its policy specifically excluded the insured's vehicle from underinsured coverage, stacking of uninsured provisions was impermissible, and statutory penalties and attorney's fees were inapplicable. The appellate court sustained all three points of error, reversing the trial court's judgment regarding underinsured coverage, penalties, and fees, and rendering judgment that the Appellees take nothing on those claims. The judgment was affirmed in all other respects.

Underinsured motorist coverageinsurance policy exclusionstacking of benefitsstatutory penaltiesattorney's feesTexas Insurance Codeappellate reviewone-car accidentliability insuranceinsured vehicle
References
8
Case No. 03-07-00429-CV
Regular Panel Decision
Dec 12, 2008

Brandon Antony Rogers v. State

The Texas Health Insurance Risk Pool appealed a decision by the District Court of Travis County, which granted summary judgment in favor of Southwest Service Life Insurance Company and Regal Life of America Insurance Company. Southwest and Regal had sought a declaratory judgment to avoid paying assessments levied by the Pool, arguing their policies qualified as "other limited benefit coverage" under the Texas Insurance Code and were therefore exempt. The trial court agreed, denying the Pool's cross-motion for summary judgment and awarding attorney's fees to Southwest and Regal. On appeal, the Court affirmed the trial court's judgment, concluding that Southwest and Regal's policies fell within the statutory exception for limited benefit coverage and that the award of attorney's fees was not an abuse of discretion. The decision primarily revolved around the statutory construction of "other limited benefit coverage" and legislative intent.

Statutory InterpretationInsurance AssessmentsHealth Policy ExemptionsDeclaratory ReliefSummary Judgment AffirmationAttorney's Fees AwardTexas Appellate LawLegislative HistoryAdministrative RegulationsLimited Benefit Coverage
References
25
Case No. MISSING
Regular Panel Decision

Employers Casualty Co. v. Dyess

This case addresses the subrogation rights of a workers' compensation carrier (Employers Casualty Co.) in relation to the employer's uninsured motorist coverage provided by Northbrook Property and Casualty Co. Carl L. Dyess, Jr., an employee, received workers' compensation benefits from Employers after being struck by an uninsured driver, Felipe Mendoza, during his employment. Dyess then sought recovery under his employer's uninsured motorist policy with Northbrook. Employers intervened, asserting statutory, contractual, and equitable subrogation rights for the benefits paid. The trial court granted summary judgment against Employers, ruling its subrogation rights did not extend to uninsured motorist coverage. The appellate court reversed, holding that statutory subrogation rights are not limited to third-party tortfeasors and that policy clauses attempting to abrogate these statutory rights are invalid. The case was remanded for further proceedings consistent with the opinion, emphasizing the carrier's right to reimbursement to prevent double recovery by the employee.

Workers' CompensationSubrogation RightsUninsured Motorist CoverageSummary JudgmentStatutory InterpretationContractual LiabilityEquitable SubrogationInsurance LawTexas LawThird-Party Tortfeasor
References
38
Case No. MISSING
Regular Panel Decision

Lundstrom v. United Services Automobile Ass'n-CIC

The Lundstroms, insured by USAA, experienced continuous water intrusion and subsequent mold growth in their townhome, purchased in 1998. They initially notified the builder, Baker, but did not inform USAA until May 2000, after a severe rainstorm caused significant damage through a hole in the roof. USAA denied coverage for mold damage based on policy exclusions and resolved the initial water damage through a binding appraisal, awarding $4,226.19 ($1,666.19 after the deductible). The Lundstroms had previously settled a lawsuit with Baker for $400,000. They then sued USAA for breach of the insurance contract, breach of the duty of good faith and fair dealing, violations of the Deceptive Trade Practices Act (DTPA), and unfair insurance practices, arguing that mold damage should be covered under an "ensuing loss" provision due to water damage. The trial court granted summary judgment in favor of USAA on all claims. The appellate court affirmed the summary judgment, holding that the mold damage was excluded under the policy, the initial water damage was resolved by appraisal, and the Lundstroms' bad faith and statutory claims failed as a matter of law.

Homeowners insuranceInsurance coverage disputeWater damageMold exclusionEnsuing lossAppraisal clauseBad faith claimDeceptive Trade Practices Act (DTPA)Unfair insurance practicesSummary judgment
References
49
Case No. MISSING
Regular Panel Decision

Ben Bolt-Palito Blanco Consolidated Independent School District v. Texas Political Subdivisions Property/Casualty Joint Self-Insurance Fund

This case addresses an insurance coverage dispute between Ben Bolt-Palito Blanco Consolidated Independent School District (Ben Bolt) and the Texas Political Subdivisions Property/Casualty Joint Self-Insurance Fund (the Fund). Ben Bolt sued the Fund after a claim for extensive water and mold damage was denied, leading the Fund to assert governmental immunity. The Supreme Court of Texas determined that the Fund is a distinct governmental unit, thereby entitled to governmental immunity. However, the Court concluded that Section 271.152 of the Local Government Code provides a clear and unambiguous statutory waiver of the Fund’s immunity from suit for breach of contract claims in this context. Consequently, the Supreme Court reversed the court of appeals' judgment and remanded the case to the trial court for further proceedings.

Governmental ImmunityInsurance CoverageSelf-Insurance FundPolitical SubdivisionsInterlocal Cooperation ActBreach of ContractStatutory WaiverTrial Court JurisdictionDe Novo ReviewTexas Law
References
15
Case No. MISSING
Regular Panel Decision

McLaughlin v. Midrox Insurance

This case involves an appeal concerning an insurance coverage dispute. Plaintiffs sought to compel Midrox Insurance Company to indemnify the Blodgett Brothers Partnerships for a $1 million judgment in an underlying personal injury action. The accident involved a motorcycle operated by plaintiff Charles R. McLaughlin and a pickup truck driven by Ronald Blodgett. Midrox had disclaimed coverage, arguing the accident occurred off insured premises and involved a registered vehicle. The court affirmed the lower court's decision, ruling that the farmowner's policy did provide coverage. The court determined that public roadways used for transporting materials between farm parcels could be considered 'insured premises' and that the pickup truck's agricultural registration did not negate coverage given its exclusive use for farming purposes.

Personal InjuryFarmowner's InsuranceInsurance CoverageAgricultural TruckPolicy InterpretationOff-Premises AccidentPublic RoadwaysSummary JudgmentIndemnificationVehicle and Traffic Law
References
5
Case No. MISSING
Regular Panel Decision

In re the Liquidation of Midland Insurance

Policyholders New York Dock Railway (NYDR) and Brooklyn Eastern District Terminal (BEDT), joined by claimants Buividas and Romacho, moved to confirm a referee's report that found coverage for their claims by the Stock Workers' Compensation Security Fund. The Superintendent of Insurance, as liquidator of Midland Insurance Company, cross-moved to disaffirm the report, arguing against Security Fund coverage based on his interpretation of relevant statutes. The court reviewed the referee's decision, finding it erroneous due to a misinterpretation of legislative history and intent regarding security fund coverage limitations, particularly concerning Chapter 801 amendments. Upholding the Superintendent's rational interpretation, the court denied the motion to confirm and granted the cross-motion to disaffirm, affirming the denial of security fund coverage.

Workers' Compensation Security FundInsurance Coverage DisputeMidland Insurance Company LiquidationFederal Employers' Liability ActJones ActLongshoremen's and Harbor Workers' Compensation ActStatutory InterpretationLegislative HistoryThird-Party IndemnificationEmployer's Liability
References
6
Case No. 04-15-00473-CV
Regular Panel Decision
Nov 19, 2015

Texas Department of Insurance—Division of Workers' Compensation and Commissioner Ryan Brannan, in His Official Capacity v. Dale Brumfield

Dale Brumfield, an injured worker, seeks a declaratory judgment to properly interpret and enforce Texas statutes against the Texas Department of Insurance-Division of Workers’ Compensation (DWC), Commissioner Ryan Brannan, and insurance carrier Zurich. Brumfield alleges that the DWC and Commissioner have acted unlawfully by misinterpreting and failing to enforce laws, including Chapter 91 of the Texas Labor Code, regarding workers' compensation coverage, denying him statutory rights. He argues that fundamental rights of injured workers concerning coverage have been violated, and the state agency has acted beyond its power. Brumfield contends that his claims are ripe, administrative remedies are exhausted, and the District Court has jurisdiction to ensure the executive branch follows the law, preventing future legal errors and ensuring statutory compliance.

Workers' Compensation LawDeclaratory JudgmentsStatutory ConstructionSovereign Immunity DoctrineUltra Vires ActsTexas Courts of AppealsAdministrative LawJudicial ReviewInsurance Coverage DisputesProfessional Employer Organizations
References
55
Case No. MISSING
Regular Panel Decision

Doss v. United States

Tracy Doss and Múrice McCloskey, employees of Lear Siegler, Inc. (LSI), sustained severe burns and psychological trauma from an explosion at the Red River Army Depot. They initiated a lawsuit against the United States under the Federal Tort Claims Act (FTCA), alleging government negligence. The United States moved to dismiss, asserting immunity under the Texas Workers’ Compensation Act by claiming statutory employer status through its contract with LSI. The Court analyzed whether the United States "provided" workers' compensation coverage to LSI employees, considering the contractual requirement for LSI to obtain coverage and the government's reimbursement of premiums. Ultimately, the motion to dismiss was granted, with the Court concluding that the United States qualified as a general contractor and statutory employer, thus entitling it to the exclusive remedy defense under Texas law and barring the plaintiffs' claims.

Federal Tort Claims Act (FTCA)Workers' Compensation Act (Texas)Sovereign ImmunityMotion to DismissStatutory EmployerExclusive Remedy DefenseNegligencePremises LiabilityIndependent ContractorRule 12(b)(1)
References
17
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