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

Case No. 03-08-00532-CV
Regular Panel Decision
Jan 27, 2010

Severiano DeLeon v. Royal Indemnity Company

This is a workers’ compensation case where the insurance carrier, Royal Indemnity Company, contested the impairment rating assigned to the claimant, Severiano DeLeon, by the Texas Department of Insurance, Division of Workers’ Compensation. The impairment rating was based on advisories issued by the Division, which were subsequently determined by the Court of Appeals to be invalid. The district court held that the assigned impairment rating was invalid, and the Court of Appeals affirmed this judgment. The court concluded that the 20% impairment rating assigned to DeLeon was invalid because it was improperly based on the invalid and withdrawn Division Advisories.

Workers' CompensationImpairment RatingSpinal FusionAMA GuidesMaximum Medical ImprovementAdministrative LawJudicial ReviewUltra Vires ActMedical EvaluationTexas Labor Code
References
9
Case No. MISSING
Regular Panel Decision

Associated Indemnity Co. v. Hartford Accident & Indemnity Co.

Hartford Accident & Indemnity Company, a workmen's compensation insurer for a temporary labor contractor (Greene's Temporaries, Inc.), sued Associated Indemnity Company, the insurer for a customer (Frito-Lay Company), seeking subrogation for a compensation claim paid to an injured temporary employee. Hartford contended the loss was covered by Associated's policy as the employee was under Frito-Lay's control. The court reversed the trial court's decision in favor of Hartford, denying equitable subrogation. The appellate court found that Hartford had collected premiums for the temporary employees and was charged with knowledge of the contractual arrangement, thus preventing unjust enrichment if subrogation were granted.

Workmen's CompensationTemporary EmploymentSubrogationInsurance LawBorrowed Servant DoctrineRight of ControlEquitable RemediesUnjust EnrichmentInsurance PremiumsContractual Agreements
References
17
Case No. CIV.A.H-98-1484
Regular Panel Decision
Aug 28, 2000

Sandwich Chef of Texas v. Reliance Nat. Indemnity Ins. Co.

Sandwich Chef of Texas, Inc. (d/b/a Wall Street Deli), as plaintiff, filed a class action against numerous insurance carriers, including Reliance National Indemnity Insurance Company, alleging that they defrauded employers by charging excessive workers' compensation premiums between May 1988 and January 1990. The plaintiff claims that the defendants utilized the National Council on Compensation Insurance, Inc. (NCCI) as a racketeering enterprise to commit mail and wire fraud. This was allegedly done by improperly factoring 'residual market charges' (RMLs) into premiums, which were purportedly unfiled and unapproved. The defendants moved for a Supplemental Motion for Summary Judgment, arguing that the plaintiff's claims failed to allege indictable acts of racketeering, lacked a basis for proving injury 'by reason of' alleged misrepresentations due to a 'presumption of knowledge' of filed rates, and were precluded by the McCarran-Ferguson Act. The United States District Court, S.D. Texas, Houston Division, denied the defendants' motion for summary judgment, finding that overbilling can constitute RICO mail fraud, that claims to enforce filed rates are not barred by the 'presumption of knowledge,' and that the McCarran-Ferguson Act did not preclude RICO's application as it complemented state regulations. The court also allowed the plaintiff's 'fraud-on-the-regulator' theory and conspiracy claims to proceed.

RICO ActWorkers' Compensation InsuranceMail FraudWire FraudClass ActionSummary JudgmentFiled Rate DoctrineInsurance FraudRetrospectively Rated InsuranceResidual Market Charges
References
15
Case No. MISSING
Regular Panel Decision

Home Indemnity Co. v. Pate

Home Indemnity, a worker's compensation carrier, made payments to employee Charles Riddle, who subsequently sued Allied Chemical Corporation in federal court. Home Indemnity's attempt to intervene in the federal suit to assert its subrogation lien was denied as untimely. Riddle and Allied Chemical settled without addressing Home Indemnity's claim. Consequently, Home Indemnity filed a state court suit against Riddle, Allied Chemical, attorney Gordon Pate, and his law firm, alleging conversion for disbursing funds without acknowledging the lien. Pate's motion for summary judgment, citing res judicata/collateral estoppel and good faith reliance on the federal judgment, was granted by the trial court. The appellate court reversed and remanded, ruling that Home Indemnity was not barred by res judicata or collateral estoppel since it was not a party to the federal judgment on the merits of its claim, and that good faith is not a defense to conversion.

Subrogation LienSummary Judgment AppealRes JudicataCollateral EstoppelConversionInsurance Carrier RightsThird-Party LiabilityTexas Civil PracticeFederal Judgment ImpactAttorney Liability
References
16
Case No. MISSING
Regular Panel Decision

Benavidez v. Travelers Indemnity Co. of Connecticut

Dora Benavidez initiated a workers' compensation claim, which was administratively ruled final regarding an impairment rating. After the appeals panel affirmed this ruling on October 25, 1996, Benavidez sought judicial review, filing a district court petition against Travelers Indemnity Company of Connecticut on December 4, 1996. The trial court dismissed her petition for lack of jurisdiction because she failed to file a copy with the Texas Workers' Compensation Commission within the statutory forty-day period. This court affirmed the dismissal, holding that Texas Labor Code sections 410.252 and 410.253 impose a mandatory and jurisdictional requirement for simultaneously filing the petition with both the court and the Commission within forty days of the appeals panel's decision.

Workers' CompensationJudicial ReviewAdministrative LawJurisdictionStatutory InterpretationTimelinessFiling RequirementsTexas Labor CodeAppellate ReviewDismissal
References
9
Case No. MISSING
Regular Panel Decision

Royal Indemnity Co. v. Futtrell

The case concerns a coal miner's claim for increased workers' compensation benefits due to worsening pneumoconiosis. The plaintiff's disability was initially adjudicated at 75% permanent partial disability, which the Chancellor later increased to 100% permanent total disability. The defendant insurer appealed, challenging both the increase in disability and the application of the current compensation rate. The Supreme Court upheld the finding of increased disability based on new evidence but reversed the Chancellor's decision on the compensation rate, ruling that the rate in effect at the time of the original injury (incapacity) should be applied, rather than the rate current at the second hearing. The case was remanded to the trial court for recalculation of benefits.

Workers' Compensation AppealCoal Worker's PneumoconiosisDisability ReassessmentBenefit Rate DisputeStatutory Interpretation of Compensation LawsTennessee Supreme CourtOccupational Lung DiseaseMedical Evidence ReviewRemand for RecalculationFederal vs. State Law
References
6
Case No. MISSING
Regular Panel Decision
Sep 03, 1979

Texas General Indemnity Co. v. McKay

This case involves an appeal by the defendant, Indemnity Company, after the trial court denied its motion for a new trial. A default judgment was entered against Indemnity Company in a workers' compensation case filed by plaintiff McKay, awarding total permanent disability and medical expenses. The defendant failed to appear for trial, leading to the default judgment on June 21, 1979. Indemnity Company's subsequent motions for a new trial were overruled by operation of law on September 3, 1979. The appellate court affirmed the trial court's decision, concluding that the defendant did not satisfy the legal requirements for setting aside a default judgment, specifically regarding the reasons for non-appearance, presenting a meritorious defense, and ensuring no prejudice to the plaintiff.

Default JudgmentMotion for New TrialWorkers' CompensationTotal Permanent DisabilityAppellate ProcedureMeritorious DefenseFailure to AppearJudicial DiscretionBurden of ProofAffidavit Evidence
References
11
Case No. 04-08-00070-CV
Regular Panel Decision
Nov 26, 2008

the Connecticut Indemnity Company v. Latietta J. Cay

Latietta Cay, injured on the job at Normandy Terrace Nursing Home, filed a workers' compensation claim which her employer's insurer, Connecticut Indemnity Company, contested. After an adverse decision by the Texas Workers’ Compensation Commission Appeals Panel, Cay sought judicial review. The trial court granted Cay’s motions for summary judgment, determining Connecticut Indemnity waived its right to dispute compensability and that Cay had a disability. Connecticut Indemnity appealed, arguing the trial court should have stayed proceedings pending a Texas Supreme Court decision in another case (*Mitchell*) and erred in granting summary judgment. The appellate court affirmed, stating the trial court was not obligated to await the *Mitchell* decision and that Connecticut Indemnity failed to challenge all grounds for summary judgment.

Workers' CompensationWaiverCompensabilitySummary JudgmentAppellate ReviewTexas Labor CodeInsurance ClaimDisabilityEmployer LiabilityJudicial Precedent
References
6
Case No. MISSING
Regular Panel Decision

Fulton v. Associated Indemnity Corp.

Donald Fulton sustained a back injury and was initially assessed at maximum medical improvement (MMI) with a seven percent impairment rating. His condition later deteriorated, leading his doctors to request an amendment to his MMI date and impairment rating. The Workers’ Compensation Commission deemed the initial rating final due to Fulton's failure to dispute it within 90 days, as per Commission Rule 130.5(e). Fulton challenged this rule's validity, arguing it contravenes the Workers’ Compensation Act by prematurely finalizing MMI certification. The district court affirmed the Commission’s decision. This appellate court ruled the 90-day Rule invalid for impermissibly shortening the statutory 104-week period for a worker to achieve MMI, thereby reversing the lower court's judgment and granting summary judgment to Fulton.

Maximum Medical Improvement (MMI)Impairment Rating90-day Rule InvalidityStatutory AuthorityAdministrative Rule ChallengeJudicial Review of Agency DecisionSummary Judgment GrantTexas Labor Code § 401.011(30)Claimant RightsMedical Condition Deterioration
References
19
Case No. 3-91-003-CV
Regular Panel Decision
May 19, 1993

Texas Commissioner of Insurance Georgia D. Flint, Permanent Receiver of Standard Financial Indemnity Corporation v. Aetna Casualty & Surety Company, Employers Insurance of Wausau, a Mutual Company, the Hartford Accident and Indemnity Company, Houston General Insurance Company, CIGNA Insurance Company of Texas, Liberty Mutual Fire Insurance Company

Standard Financial Indemnity Corporation (SFIC) appealed the Travis County district court's judgment dismissing its suit for lack of subject matter jurisdiction. SFIC alleged antitrust and tortious interference claims, arguing that the Workers' Compensation Assigned Risk Pool and its members conspired to monopolize the market and unfairly treated its servicing company application. The Hidalgo County district court transferred venue to Travis County, a decision SFIC contested. The Court of Appeals found that SFIC had pleaded valid common law causes of action not solely governed by statutory procedures and that the venue transfer based on forum non conveniens was unauthorized under Texas law. Consequently, the court reversed the judgment and remanded the case with instructions to return it to Hidalgo County for further proceedings.

AntitrustTortious InterferenceSubject Matter JurisdictionVenue TransferForum Non ConveniensWorkers' Compensation Assigned Risk PoolTexas Free Enterprise and Antitrust ActStatutory InterpretationAppellate ReviewDistrict Court
References
19
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