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

Case No. M2003-02647-COA-R3-CV
Regular Panel Decision
Jun 10, 2005

Tennessee Insurance Guaranty Association v. Centre Insurance Company

The Tennessee Insurance Guaranty Association (TIGA) sued Centre Insurance Company, seeking to be exonerated from workers' compensation obligations it assumed after Commercial Compensation Insurance Company's insolvency. TIGA contended that Centre was liable due to its predecessor's name appearing on Form I-1 certificates of insurance, despite Commercial Compensation issuing the actual policies. The trial court granted summary judgment to Centre, a decision affirmed by the Court of Appeals. The appellate court distinguished the case from controlling precedent, holding that TIGA, as a statutory successor to an insolvent insurer, could not assert claims against Centre that the insolvent insurer itself did not possess. The court emphasized that TIGA inherits the rights and obligations of the insolvent insurer, and since Commercial Compensation Insurance Company had no claim against BICO/Centre, TIGA also had none.

Workers' Compensation InsuranceInsurance Company InsolvencyGuaranty AssociationsSummary Judgment AffirmationStatutory InterpretationAppellate Court DecisionInsurance Policy CertificationSuccessor Rights and ObligationsEmployer Insurance LiabilityTennessee Workers' Compensation Law
References
9
Case No. 03-15-00314-CV
Regular Panel Decision
Aug 07, 2015

California Insurance Guarantee Association, Oklahoma Property and Casualty Insurance Guaranty Association, and Texas Property and Casualty Insurance Guaranty Association v. Hill Brothers Transportation, Inc.

The appellants, California Insurance Guarantee Association (CIGA), Oklahoma Property and Casualty Insurance Guaranty Association (OPCIGA), and Texas Property and Casualty Insurance Guaranty Association (TPCIGA), collectively "Guaranty Associations," are appealing a summary judgment granted in favor of the appellee, Hill Brothers Transportation, Inc. ("Hill Bros."). The suit was filed on March 31, 2009, alleging Hill Bros. failed to reimburse the Guaranty Associations for payments of workers' compensation benefits and claim handling expenses within the deductible limits of a policy issued by the insolvent Legion Insurance Company ("Legion"). The District Court granted summary judgment to Hill Bros. based on the statute of limitations, ruling that the cause of action accrued on April 1, 2002. The Guaranty Associations argue that the accrual date is incorrect, as their statutory obligations had not been triggered, payments had not been made, and demand for reimbursement had not occurred by that date. They also contend that their compliance with Pennsylvania law (the "Pennsylvania Act") in seeking reimbursement through Legion in Liquidation constitutes a mitigating circumstance for any delay, making reasonableness a fact question. Furthermore, they assert the policy was a continuing contract, and the statute of limitations should not have accrued until full performance on April 28, 2009. Alternatively, they argue that claims for deductible payments made within four years of filing suit (March 31, 2005) are not barred.

Workers' CompensationInsurance Guaranty AssociationStatute of LimitationsBreach of ContractDeductible ReimbursementInsolvencyInsurance PolicyContinuing ContractPennsylvania ActTravis County
References
21
Case No. 03-11-00179-CV
Regular Panel Decision
Aug 29, 2013

the Attorney General of Texas and the Commissioner of Insurance v. Farmers Insurance Exchange, Fire Insurance Exchange, Mid-Century Insurance Company of Texas, Texas Farmers Insurance Company, and Farmers Texas County Mutual Insurance Company

This case involves an appeal concerning public-information requests made to the Texas Department of Insurance (TDI) for rate-filing information submitted by a group of appellee insurers. The central issue was whether this information, declared "open to public inspection" by the Insurance Code, was subject to exceptions under the Public Information Act (PIA). The district court initially ruled that the PIA's exceptions applied. However, the Court of Appeals reversed this decision, holding that the clear and unambiguous language of former section 2251.107 of the Insurance Code mandated public inspection without regard to the PIA's exceptions. The court emphasized plain-meaning statutory construction and dismissed arguments based on legislative history and constitutional challenges.

Statutory InterpretationPublic Information ActInsurance CodeOpen RecordsTrade SecretsRate FilingsTexas Department of InsuranceAppellate ReviewGovernment TransparencyTakings Clause
References
50
Case No. 04-25-00040-CV
Regular Panel Decision
Nov 26, 2025

Enrique Cantu and Bridgefield Casualty Insurance Company v. Javier A. Libson, Nosbil, Inc., Jose Luis Ramirez, Utica National Insurance Group, Utica National Insurance Company of Texas, Utica Mutual Insurance Company, and Republic Franklin Insurance Company

Appellants Enrique Cantu and Bridgefield Casualty Insurance Company appealed a no-evidence summary judgment. Cantu's claims of negligence per se, negligent hiring, training, retention, and negligent entrustment were affirmed. However, the summary judgment for Cantu's ordinary negligence claims was reversed and remanded. Additionally, the judgment favoring the insurance defendants (Utica National Insurance Group, Utica National Insurance Company of Texas, Utica Mutual Insurance Company, and Republic Franklin Insurance Company) was also reversed, as their motion for summary judgment was not properly heard. The case involved a collision between Cantu and Jose Luis Ramirez, an employee of Nosbil, Inc., in foggy conditions, leading to Cantu suing for negligence and insurance claims.

NegligenceAutomobile AccidentSummary JudgmentAppellate ReviewProximate CauseDuty of CareBreach of DutyCausationInsurance ClaimsVicarious Liability
References
36
Case No. 18-0216
Regular Panel Decision
Jun 26, 2020

Texas Mutual Insurance Company, Hartford Underwriters Insurance Company, Tasb Risk Management Fund, Transportation Insurance Company, Truck Insurance Exchange, Twin City Fire Insurance Company, Valley Forge Insurance Company v. Phi Air Medical, LLC

This concurring opinion addresses whether the Texas Workers' Compensation Act is shielded from federal preemption by the McCarran–Ferguson Act. The core issue is whether the Texas Act, which dictates how insurance carriers pay claimants like air-ambulance services, constitutes the 'business of insurance.' Justice Bland argues that the Act was indeed enacted for regulating the business of insurance, particularly given Texas's reliance on private insurers for workers' compensation. Therefore, its provisions should be protected from federal encroachment, leading to the reversal of the court of appeals' judgment.

McCarran-Ferguson ActFederal PreemptionState Insurance RegulationTexas Workers' Compensation ActBusiness of InsuranceAir-ambulance ServicesInsurance CarriersPolicyholder RiskThird-Party BeneficiaryAntitrust Exemption
References
19
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. 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
Case No. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
Case No. MISSING
Regular Panel Decision

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
Case No. 03-99-00293-CV
Regular Panel Decision
Feb 10, 2000

Texas Property and Casualty Insurance Guaranty Association v. Jack M. Webb, as Special Deputy Receiver of Employers Casualty Co. Jack M. Webb, as Special Deputy Receiver of Employers National Insurance Co.

This case involves an appeal from a summary judgment concerning the claims priority scheme within the Texas Insurance Code's liquidation statute. The appellant, Texas Property and Casualty Insurance Guaranty Association (TPCIGA), challenged the classification of its claims for defense costs incurred in defending liability and workers' compensation claims under policies of insolvent insurers. TPCIGA argued these costs should receive Class 1 priority as claims-handling expenses, while appellees contended they were Class 2 payments of policyholder claims. The court concluded that, prior to a 1995 amendment to the statute, such defense costs were properly classified as Class 2 claims. Therefore, the district court's judgment classifying them as Class 2 was affirmed.

Insurance LawClaims PriorityLiquidation StatuteTexas Insurance CodeGuaranty ActPolicyholder ClaimsDefense CostsStatutory InterpretationSummary JudgmentReceivership
References
22
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