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

Case No. 03-03-00176-CV
Regular Panel Decision
Dec 04, 2003

Texas Workers' Compensation Insurance Fund/Texas Workers' Compensation Commission and Leonard D. Watts v. Texas Workers' Compensation Commission and Leonard D. Watts/Texas Workers' Compensation Insurance Fund

This case involves a cross-appeal stemming from a workers' compensation claim by Leonard D. Watts, who sought lifetime income benefits for injuries sustained as a truck driver. The Texas Workers' Compensation Commission (appeals panel) initially reversed a hearing officer's decision and awarded Watts benefits, but this decision was later set aside by a Travis County district court. In this appeal, the Texas Workers' Compensation Insurance Fund (Texas Mutual) and the Commission challenged the district court's ruling. The Court of Appeals addressed arguments regarding the appeals panel's statutory authority for factual-sufficiency review and the interpretation of "issue" under the labor code, including legal doctrines of res judicata and collateral estoppel. The court ultimately reversed the judgment of the district court, thereby affirming the decision of the Commission's appeals panel which granted Watts lifetime income benefits.

Workers' CompensationLifetime Income BenefitsAppeals Panel ReviewFactual SufficiencyStatutory AuthorityCross-AppealRes JudicataCollateral EstoppelCausationMaximum Medical Improvement
References
17
Case No. 07-02-0169-CV
Regular Panel Decision
Jan 14, 2003

Texas Workers' Compensation Commission v. Texas Workers' Compensation Insurance Fund

The Texas Workers' Compensation Commission (Commission) appealed a summary judgment that relieved the Texas Worker's Compensation Insurance Fund (Insurance Fund) of liability for workers' compensation benefits to Glenn Everett, the real party of interest. The Commission contended that the Texas Workers' Compensation Act abrogates the common law defense of election of remedies and that Everett did not make an election. Everett had previously settled a personal injury suit for $37,500 and later pursued a worker's compensation claim. The Court of Appeals affirmed the trial court's decision, finding that the Act does not abrogate the election of remedies defense and that Everett made an informed choice to elect remedies by settling his claim after consulting with attorneys, thus barring his right to workers' compensation benefits.

Workers' CompensationElection of RemediesSummary JudgmentTexas Appellate CourtStatutory InterpretationCommon Law DefenseIndemnificationSettlement AgreementEmployee StatusInsurance Fund Liability
References
18
Case No. 03-11-00009-CV
Regular Panel Decision
May 26, 2011

Rod Bordelon, Commissioner of the Texas Department of Insurance, Division of Workers' Compensation And the Texas Department of Insurance, Division of Workers' Compensation v. Brian Fanette

The appellants, Rod Bordelon, Commissioner of the Texas Department of Insurance, Division of Workers' Compensation, and the Texas Department of Insurance, Division of Workers' Compensation, filed a motion requesting the dismissal of their appeal. The Texas Court of Appeals, Third District, at Austin, granted this motion and consequently dismissed the appeal. This decision was made in the case against Appellee Brian Fanette.

Texas Court of AppealsWorkers' Compensation DivisionAppeal DismissalAppellant MotionJudicial DistrictTravis CountyMemorandum OpinionAdministrative AgencyState GovernmentAppellate Procedure
References
0
Case No. 01-07-00310-CV
Regular Panel Decision
Jan 29, 2009

Sembera Security Systems, Inc. A/K/A Sembera Security, Inc. v. El Dorado Insurance Agency, Inc., and Texas Mutual Insurance Company, F/N/A Texas Workers' Compensation Fund and Texas Workers' Compensation Fund, Texas Workers' Compensation Fund

The case involves a dispute between Sembera Security Systems Inc. (Sembera) and Texas Mutual Insurance Company (TMI) regarding the cancellation of Sembera’s workers’ compensation insurance coverage. Sembera sued TMI for breach of contract, alleging that TMI improperly cancelled its policy for non-payment of an "additional premium" during the policy term, leading to the termination of an agreement with En-Touch Systems, Inc. and causing Sembera lost profits. Both parties filed cross-motions for summary judgment, with the trial court initially ruling in favor of Sembera. On appeal, the Court of Appeals for the First District of Texas reversed the trial court's decision, concluding that TMI's cancellation of the policy was justified due to Sembera's failure to repay a $490 portion of the estimated initial premium after the policy's retroactive reinstatement. The appellate court held that TMI had the contractual right to cancel for non-payment of premium.

Breach of ContractWorkers' Compensation InsuranceSummary JudgmentInsurance Policy CancellationNon-payment of PremiumContract InterpretationLost Profits DamagesAppellate ReviewRetroactive ReinstatementInsurance Agent Liability
References
11
Case No. 14-07-00103-CV
Regular Panel Decision
Aug 27, 2008

Sonic Systems International, Inc. v. Randy Croix, Eddie Croix Insurance Agency, Inc., and Texas Mutual Insurance Company F/K/A Texas Worker's Compensation Insurance Fund

Appellant, Sonic Systems International, Inc. (Sonic), sued appellee, Texas Mutual Insurance Company f/k/a Texas Worker=s Compensation Insurance Fund (TMI), based on TMI=s denial of insurance coverage relative to a work-related injury sustained by a Sonic employee. Sonic also sued appellees, Randy Croix and Eddie Croix Insurance Agency, Inc. (collectively the Croix Parties), based on their alleged failure to properly procure insurance to cover the employee=s claims. The trial court granted separate motions for summary judgment filed by TMI and the Croix Parties. The trial court rendered a final judgment that Sonic take nothing from all appellees. Sonic presents four appellate issues, challenging both summary judgments. The appellate court reverses the portions of the judgment ordering that Sonic take nothing on all its contractual and extra-contractual causes of action against TMI to the extent they are based on TMI=s denial of the claim for Texas workers= compensation benefits at issue in this suit. It affirms the portions of the judgment ordering that Sonic take nothing on all its contractual and extra-contractual causes of action to the extent they are not based on TMI=s denial of the Texas workers= compensation claim. It also affirms the summary judgment on Sonic=s request for declaratory relief and the judgment in favor of the Croix Parties.

Workers' Compensation InsuranceInsurance Coverage DisputeEmployer ClaimsInsurance Agent NegligenceSummary Judgment AppealTexas Labor LawDeceptive Trade Practices ActBad Faith ClaimsOut-of-State Workers' InjuryElection of Remedies
References
21
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. 03-95-00298-CV
Regular Panel Decision
Dec 13, 1995

Turner Brothers Trucking Company, Inc. v. Commissioner of Insurance of the State of Texas and Texas Workers' Compensation Insurance Facility

Turner Brothers Trucking Company, Inc. appealed a district court judgment affirming an order by the Commissioner of Insurance. The appeal concerned a retroactive premium increase in its workers' compensation insurance policy by the Texas Workers' Compensation Insurance Facility and the Facility's authority to offset this balance against a refund owed to Turner Brothers. Turner Brothers argued that the retroactive increase was impermissible under the applicable Manual rules and policy terms, and that the Facility lacked the authority to offset the outstanding balance. The court affirmed the judgment of the district court, finding the Commissioner's interpretation of the Manual to be reasonable and consistent with the policy terms regarding the retroactive change in the experience modifier. Furthermore, the court concluded that the Facility had the authority to offset the debt and credit as they arose from sufficiently related transactions concerning workers' compensation insurance coverage.

Workers' Compensation InsuranceRetroactive PremiumExperience ModifierInsurance Policy OffsetAgency InterpretationJudicial ReviewTexas Insurance CodeWorkers' Compensation FacilityPremium AdjustmentInterstate Operations
References
8
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. B167017
Significant
Nov 18, 2004

General Casualty Insurance and Regent Insurance, Joseph A. Lane, American Home Assurance Company vs. Workers' Compensation Appeals Board and California Insurance Guarantee Association

The court has requested responses from the Workers' Compensation Insurance Rating Bureau (WCIRB) and the California Insurance Commissioner regarding the exclusion of special employees from a special employer's workers' compensation policy, specifically questioning the use and requirements of Form No. 11 for this purpose.

WCIRBForm No. 11limiting endorsementsrestricting endorsementsspecial employeesgeneral employerstemporary employeesleased employeesInsurance CommissionerCalifornia Code of Regulations
References
1
Case No. 03-05-00776-CV
Regular Panel Decision
Dec 15, 2006

Texas Mutual Insurance Company v. Texas Department of Insurance, Division of Workers' Compensation

This interlocutory appeal addresses whether the Texas Department of Insurance, Division of Workers' Compensation, holds exclusive jurisdiction over disputes concerning employers' liability insurance coverage periods and if a challenge to a Division rule was ripe for adjudication. The case originated from a wrongful death claim against AJ Commercial, whose insurance carrier, Texas Mutual, sought a declaratory judgment that the employers' liability policy had expired. The district court had granted the Division's plea to the jurisdiction, finding exclusive jurisdiction and lack of ripeness for the rule challenge. The appellate court reversed, ruling that the Division does not have exclusive jurisdiction over employers' liability coverage disputes when no worker's compensation benefits claim is pending and that the rule challenge was indeed ripe, remanding the case for further proceedings.

Workers' Compensation LawEmployer Liability InsuranceExclusive JurisdictionRipeness DoctrineDeclaratory JudgmentAdministrative LawInsurance Coverage DisputeStatutory InterpretationAppellate ReviewTexas Court of Appeals
References
25
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