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

Case No. 05-16-00875-CV
Regular Panel Decision
Jul 20, 2018

Peerless Indemnity Insurance Company, America First Insurance Company, the Netherlands Insurance Company, and America First Lloyds Insurance Company A.K.A. America First Insurance Company v. GLS Masonry, Inc.

The case involves an appeal by several insurance companies (Appellants) against GLS Masonry, Inc. (Appellee) after a take-nothing judgment in their suit to collect unpaid insurance premiums. The dispute centered on whether GLS's masonry workers were independent contractors or employees for premium calculation purposes, particularly for workers' compensation and general liability policies. The Appellants argued that GLS owed additional premiums due to audits reclassifying workers as employees and based on a lack of liability insurance for subcontractors. The trial court sided with GLS, finding that the insurance companies failed to establish the applicability of certain labor code provisions and did not sufficiently prove that GLS owed additional premiums, especially considering evidence that the workers were independent contractors and payments were made on policies. The Court of Appeals affirmed the trial court's judgment.

Insurance DisputeUnpaid PremiumsCommercial General LiabilityPremium AuditIndependent Contractor StatusEmployee ClassificationBreach of ContractTexas Appellate LawFactual Sufficiency ReviewSworn Account Claim
References
12
Case No. 02-20-00225-CV
Regular Panel Decision
Feb 11, 2021

Steven Hernandez, Francisco Azuero, and Family Heritage Life Insurance Company of America v. Combined Insurance Company of America

Individual Appellants Steven Hernandez and Francisco Azuero, along with Family Heritage Life Insurance Company of America, appealed a temporary injunction order granted to Combined Insurance Company of America. Combined alleged that Hernandez and Azuero, former district sales managers, violated non-solicitation and confidentiality covenants in their employment agreements by soliciting Combined's employees and policyholders after joining Family Heritage. The Court of Appeals affirmed the trial court's findings that the covenants were reasonable, that Individual Appellants probably solicited Combined's policyholders and agents, and that Combined would suffer imminent and irreparable injury. However, the court reversed and remanded the injunction's form for lacking reasonable detail regarding identified parties and geographic scope. Crucially, the court sustained Family Heritage's appeal, vacating and dissolving the injunction against it, finding no evidence of tortious interference or an agency relationship to support vicarious liability for Individual Appellants' acts.

Temporary InjunctionNoncompete CovenantNonsolicitation AgreementConfidential InformationTortious InterferenceIndependent ContractorVicarious LiabilityAbuse of DiscretionAppellate ReviewContract Breach
References
77
Case No. 03-07-00429-CV
Regular Panel Decision
Dec 12, 2008

Texas Health Insurance Risk Pool v. Southwest Service Life Insurance Company and Regal Life of America Insurance Company

Southwest Service Life Insurance Company and Regal Life of America Insurance Company (Appellees) brought a declaratory-judgment action against the Texas Health Insurance Risk Pool (Appellant) to challenge assessments levied against them, arguing their policies qualified as 'other limited benefit coverage' under the Texas Insurance Code. The trial court granted summary judgment in favor of the Appellees and awarded attorney's fees. The Pool appealed, contending the summary judgment was erroneous and the attorney's fee award should be reversed. The appellate court affirmed the trial court's judgment, holding that the policies issued by Southwest and Regal were indeed covered by the 'limited benefit coverage' exception, and thus the summary judgment and attorney's fee award were proper.

Insurance LawHealth InsuranceStatutory ConstructionDeclaratory JudgmentSummary JudgmentAttorney's FeesTexas Insurance CodeLimited Benefit CoverageHIPAAAdministrative Law
References
15
Case No. 01-05-00988-CV
Regular Panel Decision
Jul 26, 2007

Gilbane Building Company and Zurich American Insurance Company v. Keystone Structural Concrete, Ltd. and Royal Insurance Company of America

Gilbane Building Company and Zurich American Insurance Company appealed a trial court's summary judgment in favor of Keystone Structural Concrete, LTD. The core issues involved a contractual indemnity claim and several breach of contract claims stemming from an injury to a Keystone employee on a construction project. Gilbane sought to recover a $1 million settlement it paid. The Court of Appeals affirmed the lower court's decision, ruling that the indemnity agreement was unenforceable due to its failure to satisfy the express negligence test. Furthermore, the court found no breach regarding insurance priorities, safety obligations, or a duty to inform Gilbane about an additional insurance policy, thereby denying Gilbane's attempts to reform the contract or recover damages.

Contractual IndemnityBreach of ContractSummary Judgment ReviewExpress Negligence RuleInsurance Coverage DisputeSubrogationContract ReformationMutual MistakeTexas Labor CodeConstruction Subcontract
References
29
Case No. 06-1030
Regular Panel Decision
Aug 29, 2008

Zurich American Insurance Company, Federal Insurance Company, and National Union Fire Insurance Company v. Nokia, Incorporated

This is a dissenting opinion from Justice Hecht of the Supreme Court of Texas, joined by Justice Brister, concerning a petition for review by various insurance companies (Zurich American, Federal, National Union Fire) against Nokia, Inc. The central issue is whether the insurers have a duty to defend Nokia in class action lawsuits. These lawsuits allege "biological injury" from cellphone radiation but meticulously avoid claiming "bodily injury," instead seeking damages for the lack of provided headsets. Justice Hecht argues that despite a liberal interpretation rule for pleadings, these class action complaints do not trigger the insurers' duty to defend, as the damages claimed are not for personal injury and class counsel explicitly denied seeking personal injury compensation. He concludes that the majority's decision, which implies a duty to defend, rewards ambiguous pleading.

Insurance LawDuty to DefendClass ActionBodily InjuryBiological InjuryPleading InterpretationCellphone RadiationAppellate ReviewDissenting OpinionTexas Supreme Court
References
11
Case No. LAO 0762226, LAO 0762227
Regular
Sep 05, 2007

SHIRLEE DYERLY vs. LAWRY'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, INTERCARE INSURANCE SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY

This case involves a dispute over insurance coverage for an applicant's neck and back injuries sustained across specific and cumulative trauma incidents. The Workers' Compensation Appeals Board (WCAB) is reconsidering an arbitrator's decision that ordered Zurich North America Insurance Company to reimburse the California Insurance Guarantee Association (CIGA) for all benefits paid by the liquidated California Compensation Insurance Company (Cal Comp). The WCAB rescinds the arbitrator's order, ruling that CIGA can only recover the amount Cal Comp would have been entitled to collect had it not been liquidated, not the full amount paid.

CIGACal CompZurichliquidationcontributionreimbursementspecific injurycumulative traumastatute of limitationsjoint findings
References
7
Case No. CA 10-00545
Regular Panel Decision
Feb 10, 2011

HAHN AUTOMOTIVE WAREHOUSE, INC. v. AMERICAN ZURICH INSURANCE COMPANY

Hahn Automotive Warehouse, Inc. (plaintiff) initiated a breach of contract action against American Zurich Insurance Company and Zurich American Insurance Company (defendants), contending that bills issued under insurance contracts were time-barred. Defendants counterclaimed for damages stemming from plaintiff's alleged breach of these contracts. The Supreme Court partially granted plaintiff's cross-motion, deeming counterclaims for debts arising over six years prior as time-barred. Concurrently, it permitted defendants to utilize a $400,000 letter of credit to satisfy any outstanding debt, including those deemed time-barred. On appeal, the Appellate Division affirmed the use of the letter of credit for time-barred debts, reasoning that the statute of limitations only bars the remedy, not the underlying obligation. The court also affirmed that defendants' counterclaims for debts over six years old were time-barred, as the right to demand payment accrued earlier. Finally, the court modified the order to dismiss plaintiff's second through fourth causes of action. A dissenting opinion argued that the counterclaims were not time-barred, asserting that the cause of action accrued upon demand and refusal of payment, not merely when the right to demand payment existed.

Breach of contractInsurance contractsStatute of limitationsLetter of creditSummary judgmentAppellate reviewContract interpretationTime-barred claimsAccrual of cause of actionRetrospective premiums
References
23
Case No. 03-04-00755-CV
Regular Panel Decision
Feb 16, 2006

Indemnity Insurance Company of North America v. Martin Bowie

Indemnity Insurance Company of North America appealed a district court judgment that awarded disability benefits to Martin Bowie under the Texas Worker's Compensation Act. The appellant contended the judgment was void due to Bowie's alleged failure to notify the Texas Worker's Compensation Commission of the proposed judgment thirty days prior to its signing, as mandated by the Texas Labor Code. However, the appellate court found no evidence in the record to substantiate this claim, noting Bowie's assertion of timely notice. The court affirmed the district court's November 2, 2004 judgment. Additionally, Bowie's request for remand to consider attorney's fees was denied because he had not filed a notice of appeal.

Workers' CompensationDisability BenefitsJudicial ReviewStatutory ComplianceNotice RequirementProposed JudgmentVoid JudgmentAppellate ProcedureAttorney's FeesTexas Court of Appeals
References
8
Case No. 03S01-9712-CH-00150
Regular Panel Decision
Nov 02, 1998

Gary Charles Hill v. Insurance Company of North America

Gary Charles Hill, an employee, was awarded 10% permanent partial disability to the body as a whole by the trial court due to a work-related incident on February 16, 1995, while industrial painting. The defendant, Insurance Company of North America, appealed this finding, contending insufficient evidence of permanent disability. Medical testimony presented conflicting opinions regarding the plaintiff's condition, with Dr. Larry Gibson diagnosing nerve damage and a 15% impairment, while other physicians found no impairment. The trial court accepted Dr. Gibson's opinion over the others, noting less careful documentation by a different physician. The Workers' Compensation Appeals Panel reviewed the case de novo and affirmed the trial court's judgment, finding no preponderance of evidence against its findings.

Workers' Compensation AppealPermanent Partial DisabilityNerve DamageMedical ImpairmentConflicting Medical TestimonyAppellate ReviewTrial Court AffirmationCervical Nerve PainWork RestrictionsIndustrial Painting Injury
References
1
Case No. 14-02-00860-CV
Regular Panel Decision
Feb 23, 2006

Lennar Corporation, Lennar Homes of Texas Land and Construction, Limited, and Lennar Homes of Texas Sales and Marketing, Limited, D/B/A Village Builders v. Great American Insurance Company, American Dynasty Surplus Lines Insurance Company, Markel American Insurance Company Gerling America Insurance Company, RLI Insurance Company, Insurance Company of the State of Pennsylvania and Westchester Fire Ins Company

This case concerns an insurance coverage dispute between homebuilder Lennar Corporation and its CGL insurance carriers over damages caused by defective stucco (EIFS) applied to homes. The court analyzed whether negligently defective construction constitutes an "occurrence" and distinguished between covered costs (repairing actual water damage) and non-covered costs (preventative EIFS replacement, overhead). While affirming summary judgment for several insurers due to unmet self-insured retentions based on individual homes as separate occurrences, the court reversed for American Dynasty and Markel, citing unresolved factual issues regarding "known loss" and policy conditions. Lennar's extra-contractual claims against American Dynasty were ultimately denied for lack of proven damages or statutory violations.

Insurance Policy InterpretationConstruction DefectsCommercial Liability InsuranceProperty Damage ClaimsStucco DefectsDuty to IndemnifySelf-Insured RetentionsKnown Loss PrincipleSubcontractor LiabilityTexas Law
References
96
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