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

Case No. 03-05-00189-CV
Regular Panel Decision
Mar 21, 2008

Texas Department of Insurance, Division of Workers' Compensation v. Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, Inc.

The Texas Department of Insurance, Division of Workers' Compensation (the "Division") promulgated a rule (28 Tex. Admin. Code § 133.309) to create a less expensive alternative review procedure for workers' compensation claims concerning the necessity of medical treatment. The Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, L.P. (the "Joint Appellees") challenged the rule's validity in a declaratory judgment action. The district court granted the Joint Appellees' motion for summary judgment, declaring the rule invalid. The appellate court affirmed the district court's judgment, concluding that the rule was not in harmony with relevant governing statutes that allowed for judicial review of medical necessity disputes.

Workers' Compensation LawAdministrative LawJudicial ReviewStatutory InterpretationDeclaratory JudgmentSummary JudgmentMedical Necessity DisputesAlternative Dispute ResolutionAgency Rule ValidityTexas Court of Appeals
References
15
Case No. 03-97-00567-CV
Regular Panel Decision
Jul 30, 1998

Memorial Medical Center of East Texas v. James A. Howard, Special Deputy Receiver of Texas Employers' Insurance Association and Texas Property and Casualty Insurance Guaranty Association

Memorial Medical Center of East Texas appealed a summary judgment granted in favor of James A. Howard, Special Deputy Receiver of Texas Employers' Insurance Association, and Texas Property and Casualty Insurance Guaranty Association. Memorial sought a declaration that the appellees were obligated to reimburse defense costs incurred in a separate suit brought by its employees. The trial court granted the appellees' motions for summary judgment without specifying the grounds. The appellate court affirmed the trial court's judgment, holding that both the Receiver and the Association were statutorily precluded from defending Memorial or reimbursing its defense costs under relevant provisions of the Texas Insurance Code.

Summary judgmentInsurance CodeDuty to defendReimbursementImpaired insurerReceivershipGuaranty AssociationAppellate reviewStatutory interpretationWorkers' compensation insurance
References
11
Case No. MISSING
Regular Panel Decision

Rowden v. Texas Catastrophe Property Insurance Ass'n

Ruby Rowden, d/b/a The Aloha Motel, filed suit against Texas Catastrophe Property Insurance Association (TCPIA) in Nueces County, Texas, after sustaining property loss during Hurricane Allen and rejecting TCPIA's settlement offer. TCPIA responded with a Plea to the Jurisdiction, arguing that the case should have been filed in Travis County and that Rowden had not exhausted her administrative remedies under the Texas Catastrophe Property Insurance Pool Act, TEX.INS.CODE ANN. art. 21.49. The trial court dismissed the suit without prejudice. Rowden appealed, contending the trial court had jurisdiction and venue in Nueces County, that the statute's language was permissive, and that her due process rights were violated. The appellate court affirmed the trial court's judgment, ruling that the statutory procedure for review in Travis County was mandatory and jurisdictional, and that Rowden had failed to exhaust administrative remedies and provide proper briefing for all points of error.

Insurance LawJurisdictionAdministrative RemediesStatutory InterpretationAppellate ProcedureDue ProcessProperty InsuranceHurricane AllenTexas Insurance CodeExhaustion of Remedies
References
20
Case No. 03-02-00611-CV
Regular Panel Decision
Jun 05, 2003

Texas Building Owners and Managers Association, Inc. Building Owners and Managers Association International Tanglewood Property Management Company Emissary Group 5599 San Felipe, Ltd. And the Real Access Alliance v. the Public Utility Commission of Texas and the State of Texas

This case concerns the scope of the Public Utility Commission's power to enforce the Building Access Statutes (Texas Utilities Code §§ 54.259-.261). Appellants, consisting of property management organizations and trade groups, sued the Commission, seeking a declaratory judgment that the Statutes are unconstitutional on their face and a permanent injunction. They argued the statutes cause a taking of their property without adequate compensation and that the Commission lacks delegated power to determine compensation. The district court declared the Statutes facially constitutional and denied injunctive relief. The Court of Appeals affirmed the judgment, holding that the legislature constitutionally delegated to the Commission the power to determine 'reasonable' and 'nondiscriminatory' compensation, providing sufficient guidance and an adequate process for obtaining compensation.

Telecommunications regulationPublic Utility CommissionBuilding Access StatutesConstitutional lawTakings clauseDelegation of powerProperty rightsTelecommunications utilitiesCompetitive marketplaceFacial unconstitutionality
References
30
Case No. 03-01-00084-CV
Regular Panel Decision
Nov 07, 2002

John W. Berkel and John W. Berkel, P.C./Texas Property and Casualty Insurance Guaranty Association v. Texas Property and Casualty Insurance Guaranty Association/John W. Berkel and John W. Berkel, P.C.

This case involves cross-appeals from a judgment by the District Court of Travis County. John W. Berkel and John W. Berkel, P.C. (Berkel) sued the Texas Property and Casualty Insurance Guaranty Association (TPCIGA) and a receiver, seeking to enforce a contract for $6,306, which represented a previously approved "covered claim" for legal services. The trial court awarded Berkel the $6,306 but denied claims for statutory attorney's fees, prejudgment, and postjudgment interest. TPCIGA appealed the $6,306 award, arguing the claim was not a covered claim, but the appellate court affirmed this part, holding the Receiver's prior determination was binding. Berkel appealed the denial of attorney's fees and interest, and the appellate court reversed and remanded this part for further proceedings.

Insurance LawReceivershipImpaired InsurerCovered ClaimsStatutory InterpretationAttorney's FeesPrejudgment InterestPostjudgment InterestSummary JudgmentContract Enforcement
References
9
Case No. 03-00-00467-CV
Regular Panel Decision
Feb 28, 2001

Texas Property and Casualty Insurance Guaranty Association, as Receiver for Employers' Casualty v. Texas Workers' Compensation Commission, Subsequent Injury Fund

The Texas Property and Casualty Insurance Guaranty Association (Association) appealed a summary judgment ruling against it in favor of the Texas Workers' Compensation Commission, Subsequent Injury Fund (Fund). The Fund sought to recover death benefits under the Texas Workers' Compensation Act after the Association, acting as receiver for an impaired insurer, terminated payments to the Fund. The Association argued that the Fund's claim was not a 'covered claim', that it was not an 'insurance company' liable for such payments, and that there was no evidence to support a conversion claim. The appellate court rejected all of the Association's contentions, affirming that the Fund had a covered claim and the Association had the obligations of the impaired insurer. The trial court's judgment was affirmed.

Workers' CompensationDeath BenefitsInsurance Guaranty AssociationSubsequent Injury FundStatutory InterpretationSummary Judgment AppealAppellate Court DecisionImpaired Insurer ObligationsCovered ClaimTexas Law
References
15
Case No. 04-08-00105-CV
Regular Panel Decision
Nov 19, 2008

Killam Ranch Properties, Ltd. v. Webb County, Texas

Killam Ranch Properties, Ltd. appealed a trial court order awarding attorney's fees to Webb County, Texas. The dispute arose after Killam Ranch filed a nonsuit in its declaratory judgment action against the County, leading the County to seek attorney's fees under the Texas Civil Practice and Remedies Code. Killam Ranch contested the award, arguing the County had abandoned its claim through discovery failures and lacked proper pleading for fees. The appellate court addressed these issues, affirming the trial court's decision. It ruled that the County's claim for attorney's fees survived the nonsuit, its discovery disclosures were timely due to a trial reset, and its general request for fees was sufficient.

Declaratory JudgmentAttorney's FeesNonsuitDiscovery DisputesTexas Civil ProcedureAppellate ReviewTrial Court DiscretionAffirmative ReliefStatutory InterpretationCivil Practice and Remedies Code
References
16
Case No. MISSING
Regular Panel Decision

Memorial Medical Center of East Texas v. Howard

Memorial Medical Center of East Texas (Memorial) appealed a summary judgment ruling that favored James A. Howard, Special Deputy Receiver of Texas Employers’ Insurance Association, and the Texas Property and Casualty Insurance Guaranty Association. Memorial sought a declaration that the appellees were obligated to reimburse it for defense costs in an underlying lawsuit (*Allen v. Memorial Medical Center of East Texas*) concerning employee exposure to ethylene oxide gas. The appellate court affirmed the trial court's decision, concluding that the Texas Insurance Code explicitly removed the duty to defend or reimburse defense costs for a receiver of a delinquent insurer and a guaranty association in such proceedings. Therefore, appellees had no obligation to defend or reimburse Memorial.

Workers' Compensation InsuranceInsurance ReceivershipGuaranty AssociationDuty to DefendReimbursement of Defense CostsSummary Judgment ReviewTexas Insurance LawDelinquent InsurerEmployer LiabilityEthylene Oxide Exposure
References
11
Case No. 03-13-00300-CV
Regular Panel Decision
Feb 26, 2015

Adrian Tijerina v. Texas Property Casualty Insurance Guaranty Association as Receiver for SIR Lloyd's Insurance Company and the Texas Department of Insurance, Division of Workers' Compensation

Adrian Tijerina appealed the dismissal of his case against the Texas Property Casualty Insurance Guaranty Association (Association) and the Texas Department of Insurance, Division of Workers’ Compensation (Division). Tijerina, who sustained a back injury in 1987, sought to enforce a 1989 judgment for future medical benefits, alleging the Association refused to pay for back surgery and the Division improperly refused jurisdiction. The Ector County court transferred the case to Travis County, and the Travis County district court dismissed it for lack of jurisdiction. The appellate court affirmed the trial court's order, ruling that the venue transfer was proper, Tijerina's claim against the Division was barred by sovereign immunity and failure to exhaust administrative remedies, and his claim against the Association was not ripe because the compensability of the desired surgery had not been determined by the Division.

Workers' CompensationJurisdictionPlea to the JurisdictionVenue TransferAdministrative RemediesRipeness DoctrineSovereign ImmunityDeclaratory JudgmentMedical BenefitsBack Surgery
References
17
Case No. 03-15-00314-CV
Regular Panel Decision
Aug 07, 2015

California Insurance Guarantee Association, Oklahoma Property and Casualty Insurance Guaranty Association, and Texas Property and Casualty Insurance Guaranty Association v. Hill Brothers Transportation, Inc.

The appellants, California Insurance Guarantee Association (CIGA), Oklahoma Property and Casualty Insurance Guaranty Association (OPCIGA), and Texas Property and Casualty Insurance Guaranty Association (TPCIGA), collectively "Guaranty Associations," are appealing a summary judgment granted in favor of the appellee, Hill Brothers Transportation, Inc. ("Hill Bros."). The suit was filed on March 31, 2009, alleging Hill Bros. failed to reimburse the Guaranty Associations for payments of workers' compensation benefits and claim handling expenses within the deductible limits of a policy issued by the insolvent Legion Insurance Company ("Legion"). The District Court granted summary judgment to Hill Bros. based on the statute of limitations, ruling that the cause of action accrued on April 1, 2002. The Guaranty Associations argue that the accrual date is incorrect, as their statutory obligations had not been triggered, payments had not been made, and demand for reimbursement had not occurred by that date. They also contend that their compliance with Pennsylvania law (the "Pennsylvania Act") in seeking reimbursement through Legion in Liquidation constitutes a mitigating circumstance for any delay, making reasonableness a fact question. Furthermore, they assert the policy was a continuing contract, and the statute of limitations should not have accrued until full performance on April 28, 2009. Alternatively, they argue that claims for deductible payments made within four years of filing suit (March 31, 2005) are not barred.

Workers' CompensationInsurance Guaranty AssociationStatute of LimitationsBreach of ContractDeductible ReimbursementInsolvencyInsurance PolicyContinuing ContractPennsylvania ActTravis County
References
21
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