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

Case No. 14-17-00528-CV
Regular Panel Decision
Aug 21, 2018

Liberty Mutual Insurance Company v. Buddy J. Trahan

Liberty Mutual Insurance Company appealed a summary judgment from the 240th District Court, Fort Bend County, Texas, which affirmed a decision by the Texas Department of Insurance, Division of Workers’ Compensation (TDI). The TDI had ruled that Liberty Mutual contractually waived its right to reimbursement and/or subrogation under sections 417.001 and 417.002 of the Texas Labor Code. This waiver pertained to workers’ compensation benefits paid to Buddy J. Trahan, preventing Liberty Mutual from recovering these funds from Trahan's settlement with a third party. The court referenced the Supreme Court of Texas's decision in Wausau Underwriters Insurance Company v. Wedel, which involved a substantively identical waiver endorsement. Applying the precedent set by Wedel, which held that such a waiver precludes a carrier from seeking reimbursement indirectly from an injured employee out of third-party settlement funds, the appellate court affirmed the trial court's judgment.

Reimbursement WaiverSubrogation RightsSummary JudgmentAppellate ReviewThird-Party SettlementContractual WaiverInsurance LawJudicial PrecedentInterpretation of EndorsementInjury Claim
References
5
Case No. 03-04-00105-CV
Regular Panel Decision
Mar 03, 2006

Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company, and Liberty Insurance Corporation v. Texas Department of Insurance and Jose Montemayor, as Commissioner of Insurance Amber, Inc., Champagne-Webber, Inc. Churchill Truck Lines, Inc. And Royal Seating Corp.

Liberty Mutual Insurance Company and its affiliates appealed a district court judgment requiring them to issue rebates to workers' compensation policyholders for 1991 and 1992 surpluses. The appellants argued that a rule from the Texas Department of Insurance, which mandated these pass-throughs, unconstitutionally impaired their contractual rights, deprived them of property without due process, and constituted an impermissible retroactive law. The appeals court affirmed the district court's decision, finding that the Department's rule was a valid exercise of legislative power, served a legitimate public purpose by preventing insurers from retaining unforeseen windfalls, and did not violate constitutional prohibitions regarding retroactive legislation, contract impairment, or due process rights.

Insurance LawWorkers' Compensation InsuranceRetrospective Rating PlanInsurance RegulationConstitutional ChallengesContractual ObligationsDue ProcessRetroactive LegislationAppellate Court DecisionTexas Department of Insurance
References
35
Case No. ADJ9053637
Regular
Jan 10, 2015

ZINAIDA GOFNUNG vs. THIBIANT INTERNATIONAL, CYPRESS INSURANCE/BERKSHIRE HATHAWAY, LIBERTY MUTUAL INSURANCE/WAUSAU

The Workers' Compensation Appeals Board granted reconsideration to amend a prior decision. The original award incorrectly excluded Wausau/Liberty Mutual as a liable party. The Board clarified that Wausau/Liberty Mutual, having been properly joined to the cumulative trauma claim, had standing to petition for reconsideration. The decision was amended to specify that the award is against Cypress Insurance, with a right of contribution against Wausau/Liberty Mutual.

Petition for ReconsiderationWorkers' Compensation Appeals BoardJoinderCumulative TraumaSpecific InjuryMedical Legal EvaluatorsLabor Code §5500.5ArbitrationStandingContribution
References
0
Case No. MISSING
Regular Panel Decision

Long v. Liberty Mutual Insurance

A claimant, a member of the Buffalo Destroyers football team, was injured and filed a workers' compensation claim with Liberty Mutual Insurance Company. Liberty Mutual denied coverage, arguing the claimant was not an employee of its insured, Source One Group, and that the policy could not cover a New York entity. The Workers' Compensation Board initially found the claimant a dual employee, then a special employee of the Destroyers and a general employee of Source One, entitling him to coverage. The court determined that while the claimant was not a de facto employee of Source One, Liberty Mutual was estopped from denying coverage due to its conduct, including issuing a certificate of insurance and accepting premiums. Therefore, the court affirmed the Board's decision, holding Liberty Mutual responsible for the claimant's workers' compensation benefits.

Insurance Coverage DisputeEmployer LiabilityProfessional Employee OrganizationSpecial Employment DoctrineEstoppel in InsuranceAssigned-Risk Insurance PolicySports Athlete InjuryAppellate DecisionPayroll Audit DisputeCertificate of Insurance Validity
References
11
Case No. 2-08-444-CV
Regular Panel Decision
Aug 31, 2009

Liberty Mutual Insurance Company v. Roy Burk

Roy Burk sustained a work-related back injury in 1998, which necessitated multiple surgeries, including one for cauda equina syndrome. Liberty Mutual Insurance Company, who accepted the initial injury, later contested the extent of Burk's injury, specifically arguing that his work injury did not cause his polyneuropathy and foot ulceration. Following a Contested Case Hearing and an affirmation by an appeals panel in Burk's favor, Liberty Mutual initiated judicial review. The trial court subsequently ruled that Burk's work-related injury did indeed extend to his polyneuropathy and foot ulcerations. Liberty Mutual appealed this decision, citing legal and factual insufficiency of the evidence. The Court of Appeals, Second District of Texas, affirmed the trial court's judgment, finding legally and factually sufficient evidence to support the trial court's findings, highlighting inconsistencies in the expert testimony presented by Liberty Mutual.

Workers' CompensationJudicial ReviewSufficiency of EvidenceCausationPolyneuropathyFoot UlcerationBack InjuryCauda Equina SyndromeMedical Expert TestimonyTexas Law
References
28
Case No. 08-0742
Regular Panel Decision
Aug 28, 2009

in Re Liberty Mutual Fire Insurance Company

Raymond Nickelson sought bad-faith damages against Liberty Mutual Fire Insurance Company for denying preauthorization of medical treatment related to neck and back injuries sustained in 2003. Liberty Mutual, Nickelson's workers’ compensation carrier, stopped paying temporary income benefits after a designated doctor found maximum medical improvement. Nickelson pursued administrative remedies for income benefits but failed to exhaust them for medical care preauthorization, which was the basis of his bad-faith claim. The Supreme Court of Texas conditionally granted Liberty Mutual's petition for writ of mandamus. The court directed the trial court to grant Liberty Mutual's plea to the jurisdiction and dismiss the case, ruling that Nickelson had not exhausted the required administrative remedies for medical benefits.

Workers' CompensationBad Faith ClaimAdministrative RemediesPreauthorizationMedical BenefitsExhaustion of RemediesWrit of MandamusPlea to JurisdictionTexas LawInsurance Carrier
References
4
Case No. MISSING
Regular Panel Decision

Turner v. Liberty Mutual Insurance Co.

Mrs. Turner sustained a back injury in 1974 while employed by Day & Zimmermann, Inc. She filed a worker's compensation claim with the Industrial Accident Board in October 1975, which was beyond the six-month statutory period. Liberty Mutual, the insurance carrier, moved for summary judgment, arguing the claim was untimely and Mrs. Turner lacked good cause for late filing. The trial court granted summary judgment. On appeal, Mrs. Turner argued that Liberty Mutual failed to file a sworn denial of her timely filing or good cause, as required by Tex.R.Civ.P. 93(n). The appellate court reversed the summary judgment, finding that under Rule 93(n), Mrs. Turner's allegations were conclusively presumed true due to Liberty Mutual's lack of a verified denial, and remanded the case for trial.

worker's compensationsummary judgmenttimely filinggood causeTexas Rules of Civil ProcedureRule 93(n)Rule 90verified pleadingswaiverappellate review
References
2
Case No. 01-09-00178-CV
Regular Panel Decision
Jan 14, 2010

Donna Adams v. Liberty Mutual Insurance Company

Donna Adams appeals a judgment in favor of Liberty Mutual Insurance Company in a worker's compensation judicial review proceeding involving two separate injury claims. Adams contested the trial court's jurisdiction over both claims and its failure to submit a period of disability question to the jury. The Court of Appeals found that the trial court lacked jurisdiction over the second claim because administrative remedies were not exhausted. However, it affirmed the trial court's jurisdiction over the first claim, finding Liberty Mutual adequately pleaded its challenge. The court also addressed the jury charge, noting Adams waived her complaint by not providing a reporter's record. Finally, the court remanded the case for a determination of attorney's fees for Liberty Mutual, as they were the prevailing party on the first claim.

Worker's CompensationJudicial ReviewSubject Matter JurisdictionAdministrative RemediesAppeals Panel DecisionContested Case Hearing (CCH)Period of DisabilityAttorney's FeesJury ChargeAppellate Procedure
References
14
Case No. 07-02-0376-CV
Regular Panel Decision
Aug 09, 2004

Floyd Weatherton v. Liberty Mutual Insurance Company

Appellant Floyd Weatherton appealed a summary judgment entered against him in his suit against Liberty Mutual Insurance Company. Weatherton, injured in a work accident in 1994, received supplemental income benefits which were later terminated by a Texas Workers' Compensation Commission (TWCC) hearing officer in 1999; Weatherton did not appeal this decision. He subsequently sued Liberty Mutual, alleging breach of contract, bad faith, and violations of various Texas codes due to the termination of benefits and denial of medical treatments. The trial court granted summary judgment for Liberty Mutual. The appellate court affirmed the dismissal of claims related to supplemental income benefits, citing Weatherton's failure to exhaust administrative remedies. However, it reversed the summary judgment regarding claims for denial of medical benefits, remanding that portion of the case for further proceedings, as those claims were not fully addressed and evidence was lacking.

Workers' CompensationSummary JudgmentAdministrative RemediesSupplemental Income BenefitsMedical BenefitsBad FaithInsurance LawJurisdictionTexas LawAppellate Review
References
7
Case No. 2024 NY Slip Op 04245
Regular Panel Decision
Aug 21, 2024

Diluglio v. Liberty Mut. Group, Inc.

The plaintiff, Louis A. Diluglio, Jr., an auto damage appraiser, brought an action against his employer, Liberty Mutual Group, Inc., and manager, John Austin, alleging retaliation under New York State Human Rights Law and Labor Law § 215, assault by Austin, and vicarious liability against Liberty Mutual. The Supreme Court denied the defendants' motion for summary judgment on these claims. On appeal, the Appellate Division, Second Department, modified the Supreme Court's order. The appellate court granted summary judgment to the defendants on the retaliation claims against Liberty Mutual, finding that the plaintiff did not engage in protected activity under the NYSHRL or identify a violated Labor Law provision. It also granted summary judgment on the vicarious liability claim, concluding that Austin's alleged tortious conduct was not within the scope of his employment. However, the Appellate Division affirmed the denial of summary judgment on the assault claim, as the defendants failed to establish, prima facie, that Austin's physical conduct did not place the plaintiff in imminent apprehension of harmful contact.

RetaliationEmployment LawNew York State Human Rights LawLabor Law § 215AssaultVicarious LiabilitySummary JudgmentAppellate ReviewDiscriminatory PracticesProtected Activity
References
19
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