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

Case No. 03-01-00326-CV
Regular Panel Decision
Feb 22, 2002

Sunbeam Environmental Services, Inc. and Alphonso Solomon and Company, Inc. v. Texas Workers' Compensation Insurance Facility, Succeeded by the Facility Insurance Corporation

The appellants, Sunbeam Environmental Services, Inc. and Alphonso Solomon and Company, Inc., challenged a judgment favoring the Texas Workers' Compensation Insurance Facility. The district court found them jointly and severally liable for unpaid workers' compensation premiums, interest, and attorney's fees. The appellants raised issues concerning the statute of limitations, sufficiency of evidence, pre-suit notice for attorney's fees, and authorization of attorneys. The Court of Appeals affirmed the district court's judgment, finding the cause not barred by limitations, the evidence sufficient, and the attorney's fees and authorization issues resolved in favor of the judgment.

Workers' Compensation InsuranceUnpaid PremiumsStatute of LimitationsSufficiency of EvidenceAttorney's FeesJoint and Several LiabilityPayroll AuditInsurance Policy InterpretationAppellate ReviewTravis County
References
9
Case No. MISSING
Regular Panel Decision

Sunbeam Environmental Services, Inc. v. Texas Workers' Compensation Insurance Facility

The appellants, Sunbeam Environmental Services, Inc. and Alphonso Solomon and Company, Inc., challenged a district court judgment that found them jointly and severally liable to the Texas Workers’ Compensation Insurance Facility for unpaid insurance premiums, interest, and attorney’s fees. The appellants raised issues concerning the statute of limitations, sufficiency of evidence regarding contract terms, ASC's liability, and premium calculations, as well as the award of attorney’s fees and attorney authorization. The appellate court determined that the statute of limitations did not bar the claim, as the period commenced from the premium invoice date, not the policy expiration. Furthermore, the court found ample evidence to support the district court's findings on contract validity, ASC's shared financial responsibility, and accurate premium calculations. Ultimately, the judgment awarding unpaid premiums, interest, and attorney's fees to the Facility was affirmed.

Workers' CompensationInsurance PremiumsStatute of LimitationsSufficiency of EvidenceAttorney's FeesJoint and Several LiabilityPayroll AuditCorporate OwnershipAppellate ReviewContract Dispute
References
12
Case No. 2025 NY Slip Op 02248 [237 AD3d 1379]
Regular Panel Decision
Apr 17, 2025

Matter of Jehle v. DOCCS Coxsackie Corr. Facility

William Jehle, a correction officer, sustained a work-related injury, prompting his employer, DOCCS Coxsackie Correctional Facility, to continue paying his full wages. The employer sought reimbursement, and Jehle's attorney filed for counsel fees. The Workers' Compensation Law Judge (WCLJ) established the claim, found a temporary total disability, awarded a credit to the employer for wage reimbursement, and granted counsel fees of $4,300 as a lien against this reimbursement. The Workers' Compensation Board affirmed the WCLJ's decision, deeming the lien proper under Workers' Compensation Law § 24 (2) (b). The Appellate Division, Third Department, further affirmed the Board's decision, holding that an award for previously unawarded benefits constitutes an 'increase' under the law, and that counsel fees are appropriately a lien against the employer's reimbursement, dismissing arguments of the employer subsidizing fees.

Counsel FeesLien on AwardEmployer ReimbursementTemporary Total DisabilityWorkers' Compensation LawAppellate ReviewCorrection OfficerWage ReimbursementStatutory InterpretationClaimant Attorney Fees
References
3
Case No. 03-93-00541-CV
Regular Panel Decision
May 03, 1995

Aetna Casualty and Surety Company v. State

Aetna Casualty & Surety Company (Appellant) sought judicial review of an order by the State Board of Insurance and Texas Workers' Compensation Insurance Facility (Appellees) denying its claim for a servicing carrier fee. Aetna, as a servicing carrier, collected premiums for Tra-Jax, Inc., but a dispute arose over its entitlement to a 26.5% servicing fee on collected premiums totaling $863,000. The Facility denied the fee, arguing Aetna waived its right by declaring the account uncollectible and accepting reimbursement for legal and auditing expenses, which were ordinarily the servicing carrier's responsibility. The Board affirmed this decision, and the district court upheld the Board's order. The Court of Appeals affirmed the lower court's judgment, finding substantial evidence to support the Board's conclusion that Aetna waived its servicing fee.

Insurance DisputeServicing Carrier FeePremium CollectionWaiver of FeeSubstantial Evidence ReviewAdministrative Procedure ActTexas Workers' CompensationFraud InvestigationJudicial ReviewAgency Decision
References
10
Case No. MISSING
Regular Panel Decision
Aug 24, 1999

Town of Hempstead v. Inc. Village of Atlantic Beach

This case involves two related actions arising from inter-municipal agreements for waste disposal services. The defendants appealed from initial court orders concerning their obligations to pay minimum waste commitment tonnage fees and their entitlement to various credits, including those for private carters, recyclable materials, and yard waste. The plaintiffs cross-appealed regarding the methodology for calculating yard waste credits and the fees for using the Town's transfer facility. The Supreme Court, Nassau County, issued an initial order and a subsequent amended order upon reargument, clarifying several points. The Appellate Division affirmed the amended order, holding that the agreements unambiguously required villages to pay minimum tonnage fees regardless of actual waste delivered. The court also determined that the villages were only obligated to pay transfer facility fees based on actual waste delivered and that any ambiguities regarding yard waste credits should be interpreted against the Town as the drafter of the agreements.

Inter-municipal agreementsWaste disposalSummary judgmentContract interpretationMinimum commitment feesYard waste creditTransfer facility feesUnambiguous agreementsExtrinsic evidenceAmbiguity construction
References
10
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Facility v. Comptroller of Public Accounts and the Attorney General of the State of Texas

The case concerns an appeal by the Texas Workers’ Compensation Insurance Facility (the Facility) seeking a refund of approximately $24 million from the Comptroller for maintenance tax surcharges. The Facility argued it effectively paid the tax by reimbursing its member insurance companies and that the Department of Insurance exceeded its authority by adopting Rule 1.411, which mandated this reimbursement. The court rejected the Facility's arguments, holding that the member insurance companies, not the Facility, paid the tax, and affirmed the validity of Rule 1.411. Furthermore, the court found that the Facility failed to meet the statutory prerequisites for a tax refund, thereby affirming the trial court's judgment in favor of the Comptroller.

Tax RefundWorkers' Compensation InsuranceMaintenance Tax SurchargeInsurance LawAdministrative Rule ValidityAgency AuthorityStatutory InterpretationSummary JudgmentReimbursement ObligationInvoluntary Market
References
10
Case No. 03-17-00666-CV
Regular Panel Decision
Dec 05, 2018

Facility Insurance Corporation v. Patients Medical Center

This appeal arises from a medical fee dispute under the Texas Workers’ Compensation Act between Facility Insurance Corporation (Carrier) and Patients Medical Center (Provider). The Carrier challenged a trial court's judgment that affirmed a SOAH Decision and Order, mandating the Carrier to pay the Provider $20,495.78 for medical services. The primary issue was whether the administrative law judge (ALJ) incorrectly shifted the burden of proof from the Provider to the Carrier during the contested-case hearing. The Court of Appeals found that the Provider, as the party seeking affirmative relief, bore the burden of proof in the de novo hearing. Consequently, the court reversed the trial court's judgment and remanded the case to the Division for new proceedings consistent with its opinion.

Workers' Compensation ActMedical Fee DisputeBurden of ProofAdministrative Law Judge (ALJ)SOAH DecisionJudicial ReviewSubstantial Evidence RuleTexas Department of InsuranceSpinal Cord StimulatorReimbursement Claim
References
25
Case No. 19-0533
Regular Panel Decision
Jan 29, 2021

Patients Medical Center v. Facility Insurance Corporation

This case is an administrative appeal stemming from a medical fee dispute between Patients Medical Center, a healthcare provider, and Facility Insurance Corporation, a worker's compensation insurance carrier. The core issue revolves around the proper allocation of the burden of proof in a contested case hearing before the State Office of Administrative Hearings (SOAH) following an initial decision by the Texas Department of Insurance, Division of Workers’ Compensation. While the Division and the ALJ initially placed the burden on the carrier, the court of appeals reversed. The Texas Supreme Court, however, reversed the court of appeals, holding that the burden of proof lies with the party seeking relief from the Division's initial decision, which in this case was the carrier. The Supreme Court remanded the case for the court of appeals to address other unaddressed issues.

Worker's CompensationMedical Fee DisputeAdministrative LawBurden of ProofTexas Supreme CourtAppellate ReviewInsurance LawHealthcare ReimbursementSOAHALJ Decision
References
10
Case No. No. 91-16599-B
Regular Panel Decision

Texas Workers' Compensation Insurance Facility v. Personnel Services, Inc.

The Texas Workers’ Compensation Insurance Facility ("Facility") sued Personnel Services, Inc. ("PSI"), an employee leasing company, alleging that PSI misrepresented its employer status to procure lower workers’ compensation insurance rates for its client companies. The trial court found PSI misrepresented its status but issued a take-nothing judgment, citing the affirmative defenses of waiver, ratification, and estoppel. On appeal, the court examined whether the Facility had sufficient specific knowledge of PSI's fraud to bar recovery. The appellate court concluded that the Facility's general awareness of the staff leasing industry was insufficient to establish specific knowledge of PSI's misrepresentations. Consequently, the appellate court reversed the trial court's judgment and remanded the case for a determination of damages on the Facility’s fraud claim.

fraudworkers' compensation insuranceemployee leasingmisrepresentationexperience modifieraffirmative defenseswaiverratificationestoppelemployer status
References
13
Case No. 03-01-00371-CV
Regular Panel Decision
Jan 10, 2002

Texas Workers' Compensation Insurance Facility v. Comptroller of Public Accounts and the Attorney General of the State of Texas

The Texas Workers' Compensation Insurance Facility sought a refund of approximately $24,000,000 for maintenance tax surcharges it claimed it effectively paid by reimbursing its member insurance companies. The Facility argued it was not an insurance company itself and thus not subject to the tax, and that the Department of Insurance exceeded its authority by adopting Rule 1.411, which required the reimbursement. The court held that the member insurance companies, not the Facility, paid the tax. It also found Rule 1.411 to be valid and the Facility's reimbursement obligation a lawful component of the legislative scheme. Furthermore, the court determined that the Facility's role in reimbursing its servicing companies did not convert it into a taxpayer and that it failed to meet the statutory prerequisite for a tax refund by not first refunding its members. The trial court's judgment, denying the Facility's motion and granting the Comptroller's motion for summary judgment, was affirmed.

Tax Refund LitigationWorkers' Compensation Insurance FacilityMaintenance Tax SurchargeInsurance Company TaxationAdministrative Rule ValidityStatutory ConstructionSummary Judgment StandardInvoluntary Insurance MarketServicing Company ReimbursementTexas Tax Code Interpretation
References
9
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