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

Case No. MISSING
Regular Panel Decision
Oct 31, 2003

Coregis Insurance v. McQuade

The petitioner appealed an order from the Supreme Court, Westchester County, which denied a petition to permanently stay arbitration of an underinsured motorist claim. The respondent, Kevin A. McQuade, a sanitation worker, was injured by an underinsured vehicle. The Supreme Court initially held that McQuade was 'occupying' the sanitation truck, thus qualifying him as an insured under the supplementary underinsured motorists endorsement (SUM). However, the appellate court reversed this decision, finding that McQuade was not 'occupying' the vehicle at the time of the accident, as his departure was not incidental to a temporary interruption, nor was he in the immediate vicinity or entering the truck. Consequently, McQuade did not qualify as an insured for the SUM endorsement, and the Supreme Court should have granted the petition to stay arbitration.

Arbitration StayUnderinsured MotoristInsurance PolicyVehicle Occupancy DefinitionAppellate Court DecisionNew York LawSUM EndorsementStatutory InterpretationPersonal Injury ClaimTemporary Interruption
References
4
Case No. 3562
Regular Panel Decision

American Motorists Insurance Co. v. Simecek

This case concerns an appeal by American Motorists Insurance Company against Bobby J. Simecek regarding the timely filing of an appeal to set aside an Industrial Accident Board award. The trial court initially ruled in favor of Simecek, maturing the award, as it found American Motorists had failed to timely file its appeal. On appeal, the central question was whether American Motorists' petition was timely filed under Tex.Rev.Civ.Stat.Ann. art. 8307, § 5, considering it was mailed within the statutory twenty-day period but received later. The appellate court extended the 'Ward' rule, which applies to notices of intent not to abide by an award, to the 'bring suit' provision, thereby deeming a petition timely filed if mailed before the deadline and received within ten days after the deadline. Consequently, the appellate court reversed the trial court's judgment and ruled that Simecek should take nothing by his suit to mature the award.

Worker's CompensationAppellate ProcedureTimely FilingStatutory InterpretationTexas LawIndustrial Accident BoardJurisdictionMailbox RuleNotice of AppealTexas Rules of Civil Procedure
References
6
Case No. MISSING
Regular Panel Decision
Sep 13, 2000

AIU Insurance v. American Motorists Insurance

This case concerns an appeal regarding primary liability coverage for HRH Construction Corp. and Hotel Grand Central in an underlying personal injury action. Plaintiffs, including their excess insurer AIU Insurance Co., sought to compel American Motorists Insurance Co. and St. Paul Fire & Marine Ins. Co. to provide primary defense and reimbursement. The court found American Motorists obligated to defend HRH and the Hotel, as their policy covered them as additional insureds for claims "arising out of" work performed by American Motorists' primary insured, Cord Contracting Co. However, St. Paul was not similarly obligated, as the injury did not "arise out of" work by its insured, Forest Electric Corp. Consequently, the court modified the prior declaration, vacating the plaintiffs' favor against St. Paul and dismissing Cord Contracting Co.'s cross-appeal.

Insurance DisputePrimary Liability CoverageExcess InsuranceAdditional InsuredPersonal InjuryConstruction SiteSubcontractorContractual ObligationDuty to DefendIndemnification
References
1
Case No. MISSING
Regular Panel Decision

American Motorists Insurance Co. v. Occidental Chemical Corp.

Houston Scale Company, Inc. purchased a comprehensive general liability (CGL) policy and a commercial catastrophe liability policy from American Motorists Insurance Company. Houston Scale failed to name Occidental Chemical Corporation as an additional insured on the CGL policy, despite a contractual obligation. When a personal injury suit was filed against Occidental, it sought coverage under the commercial catastrophe policy, arguing it qualified as an insured due to the contractual obligation. The trial court granted summary judgment for Occidental, awarding damages and attorney's fees. American Motorists appealed, challenging Occidental's status as an insured under the catastrophe policy and the award of attorney's fees. The appellate court affirmed the trial court's judgment, holding that Occidental was indeed an insured under the replacement CGL coverage provisions of the commercial catastrophe policy and that attorney's fees were properly awarded.

Insurance LawCGL PolicyCommercial Catastrophe PolicyAdditional InsuredContractual ObligationSummary JudgmentAttorney's FeesBreach of ContractExcess CoverageReplacement Coverage
References
15
Case No. MISSING
Regular Panel Decision

United Services Automobile Ass'n v. Hestilow

This case involves an appeal by USAA challenging a judgment that permitted the Hestilows to stack underinsured motorist coverages from two separate USAA policies. Scott Hestilow was injured in an accident caused by an underinsured motorist, Alvino Casarez, who had $15,000 in liability coverage. The Hestilows sought to combine their two $15,000/30,000 USAA policies, resulting in $30,000 in coverage, from which they deducted Casarez's $15,000 payment, claiming USAA owed $15,000. USAA argued against stacking, asserting that the settlement offset each policy separately, leaving no obligation. The trial court ruled in favor of the Hestilows, allowing stacking. The appellate court affirmed, holding that all available underinsured motorist policies must be aggregated to determine if a tortfeasor is underinsured, thereby upholding the trial court's judgment.

Underinsured Motorist CoverageInsurance Policy StackingAutomobile InsuranceTexas Insurance LawAppellate ReviewLegislative IntentStatutory Interpretation"Other Insurance" ClausesDouble OffsetInter-policy Stacking
References
18
Case No. E2012-02213-COA-R3-CV
Regular Panel Decision
Jul 10, 2013

Dennis Michael Harris, et ux v. Mickey Deanne Haynes

Dennis Michael Harris, a patrolman, was injured when struck by a vehicle. He and his wife sued the driver, vehicle owner, and Tennessee Risk Management Trust (TRMT) for uninsured/underinsured motorist coverage. TRMT, a governmental self-insurance pool, denied coverage, citing an exclusion for employees receiving workers' compensation. The Trial Court granted summary judgment to TRMT, finding Anderson County was self-insured through TRMT, rendering uninsured/underinsured motorist statutes inapplicable. The appellate court affirmed, upholding that TRMT is not an insurance company, and the Coverage Document's employee exclusion is valid. The court concluded that it is a policy decision for the legislative body of Anderson County, not the court, to decide on providing uninsured/underinsured motorist coverage to its employees.

Workers' Compensation BenefitsUninsured Motorist CoverageUnderinsured Motorist CoverageGovernmental Self-Insurance PoolEmployee ExclusionContract InterpretationSummary Judgment AppealTennessee Court of AppealsRisk Management TrustTort Liability Act
References
18
Case No. MISSING
Regular Panel Decision

Erwin v. Rose

This case addresses the liability of a municipality and its agents under the Governmental Tort Liability Act, as well as the liability of an underinsured motorist carrier. Ms. Erwin's parents filed a wrongful death action after their daughter was killed in a high-speed chase involving Deputy Mike Rose of Maury County. The court apportioned fault between Deputy Rose and Tracy Joe Lovell, limiting Maury County's liability to $130,000 and dismissing claims against Deputy Rose. The court affirmed the dismissal of the claim against the underinsured motorist carrier, Tennessee Farmers Mutual Insurance Co., finding that payments from other tort-feasors reduce the carrier's coverage. The appellate court affirmed the lower court's decisions on municipal and agent liability and the dismissal of the underinsured motorist claim, but reversed the award of prejudgment interest as it exceeded the statutory liability limit for the municipality. A petition to rehear was subsequently overruled.

Governmental Tort Liability ActUnderinsured Motorist CoverageWrongful DeathHigh-Speed ChasePolice MisconductMunicipal LiabilityDeputy Sheriff LiabilityPrejudgment InterestInsurance Policy LimitsCivil Rights Violations
References
21
Case No. MISSING
Regular Panel Decision

Federal Insurance v. Watnick

Jay and Marianna Watnick, New York residents, were severely injured in a car accident in Quebec with Jay Anderson. They were insured by Federal Insurance Company under a policy with uninsured and underinsured motorist endorsements. After seeking limited compensation from Quebec's Régie, Federal denied their claims, arguing Anderson's vehicle was neither uninsured nor underinsured, and sought to stay arbitration. The Supreme Court granted Federal's application to stay both claims, but the Appellate Division reversed the stay for the underinsured claim. The Court of Appeals agreed that Anderson's vehicle was not uninsured. However, it disagreed with the Appellate Division on the underinsured claim, ruling that the Watnicks had not exhausted by payment the limits of all applicable bodily insurance policies as required by statute and their policy. Consequently, the Court modified the Appellate Division's order, granting Federal's application to permanently stay arbitration of the underinsured motorist claim, thereby reinstating the Supreme Court's original decision to stay both claims.

Underinsured Motorist CoverageUninsured Motorist EndorsementCar AccidentQuebec Automobile Insurance ActExhaustion of Policy LimitsInsurance LawVehicle and Traffic LawArbitration StayNew York Insurance PolicyInter-jurisdictional Accident
References
3
Case No. MISSING
Regular Panel Decision

American Motorists Insurance Co. v. Sells

James Sells was initially awarded workers' compensation benefits for temporary total incapacity. Following Sells' motion, the district court granted a new trial based on allegations of jury misconduct and other errors. The subsequent second trial found Sells suffered both temporary total and permanent partial incapacity. American Motorists appealed, challenging the district court's decision to grant a new trial and an alleged error during voir dire where Sells' counsel mentioned the duration of compensation. The appellate court affirmed the trial court's judgment, concluding there was no reversible error in either the new trial grant or the voir dire statement, and denied Sells' cross-point for frivolous appeal damages.

Workers' CompensationNew TrialAppellate ReviewJury MisconductVoir DireAbuse of DiscretionHarmless ErrorPlenary PowerAppellate ProcedureTrial Errors
References
18
Case No. MISSING
Regular Panel Decision

Kelley v. Progressive County Mutual Insurance Co.

Regan Kelley sued Progressive County Mutual Insurance Company for breach of contract and Insurance Code violations after Progressive refused to pay for underinsured benefits under a second policy, claiming only one policy existed and stacking was prohibited. Kelley was injured while riding her horse after being struck by a motorist, receiving $100,000 from the motorist's insurer and $500,025 from Progressive. Progressive sought a declaratory judgment that stacking was prohibited. The trial court granted Progressive's summary judgment motion. The appellate court reversed and rendered in part, and reversed and remanded in part, finding that Progressive issued two separate policies and that its 'Two or More Auto Policies' provision, which prohibited stacking, violated public policy under Texas uninsured/underinsured motorist statutes. Kelley is entitled to recover under the second policy.

Insurance LawUnderinsured MotoristUninsured MotoristPolicy StackingSummary JudgmentBreach of ContractPublic PolicyTexas LawAppellate ReviewInsurance Policies
References
20
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