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

Case No. MISSING
Regular Panel Decision
Nov 02, 1981

Liberty Mutual Insurance v. Newman

Plaintiff insurer, Liberty Mutual Insurance Company, mistakenly paid $9,805.66 to defendant Ruth Newman, intended for an aggregate trust fund related to her deceased husband's workers' compensation benefits. After forwarding the correct payment to the fund, Liberty Mutual sought restitution from Newman, who refused. The Workers' Compensation Board declined to intervene, stating no recourse existed under the Workers' Compensation Law for the error. Special Term initially granted summary judgment to Liberty Mutual. On appeal, the judgment was modified, with the Appellate Division agreeing it was a mistake of fact, not an overpayment of benefits, thus affirming the denial of Newman's summary judgment motion. However, the case was remitted to Special Term for a hearing to determine if ordering full restitution would cause a detrimental change in Newman's position regarding her benefits, and clarified that interest and costs should not be awarded against her.

restitutionmistake of factworkers' compensationsummary judgmentunjust enrichmentdetrimental relianceequityinsurance carrieraggregate trust fundappellate review
References
19
Case No. ADJ11275154
Regular
Jul 09, 2018

CAROL JACKSON vs. TNG, ACE AMERICAN INSURANCE COMPANY, LIBERTY MUTUAL

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of an award. The defendant argued the award's indemnity rate and total value were based on a mutual mistake of fact. However, the applicant denied any mutual mistake regarding the rate. The Board found the defendant's mistake appeared unilateral and caused by neglect, thus upholding the original award.

Stipulations with Request for AwardPermanent disability indemnity rateMutual mistake of factPetition for ReconsiderationUnilateral mistakeGood causeLabor Code Section 5702Workers' Compensation Appeals BoardWCJApplicant
References
8
Case No. 04-12-00506-CV
Regular Panel Decision
Aug 30, 2013

Texas Mutual Insurance Company v. Clarence Dailey Electric, Inc

Texas Mutual Insurance Company appealed a trial court's summary judgment in favor of Clarence Dailey Electric, Inc. The case originated from a construction site accident where Cam E. Beasley, an employee of Tate Painting, was seriously injured while using a scissor-lift owned by Dailey Electric, driving it into an uncovered hole at a gymnasium remodeling project. Texas Mutual, Tate Painting's workers' compensation carrier, intervened to protect its subrogation interests, arguing that Dailey Electric was negligent. The appellate court affirmed the trial court's summary judgment, finding that Texas Mutual failed to raise a genuine issue of material fact regarding the cause in fact component of proximate cause for negligence, and also failed to produce proof on essential elements of premises liability.

Workers' CompensationSubrogationNegligencePremises LiabilitySummary JudgmentAppellate ReviewProximate CauseCause in FactDuty of CareConstruction Site Accident
References
30
Case No. 04-24-00386-CV
Regular Panel Decision
Feb 26, 2025

In Re Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance v. the State of Texas

Edward Santos filed a lawsuit against Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance, alleging liability for his injuries being compensated through workers' compensation benefits, thereby limiting liability under other coverages. Texas Mutual and Bond challenged the trial court's denial of their pleas to the jurisdiction, arguing that the Texas Department of Insurance, Division of Workers' Compensation (the Division) had exclusive jurisdiction over Santos's claims. The Fourth Court of Appeals found that Santos's claims against Texas Mutual and Bond, predicated on the improper investigation, handling, or settlement of his workers' compensation claim, fell within the Division's exclusive jurisdiction, and he failed to exhaust administrative remedies. Consequently, the Court conditionally granted the petition for a writ of mandamus for Texas Mutual and Bond, directing the trial court to dismiss claims against them. However, the Court denied Allstate's petition, as Santos's claims against Allstate involved a liability claim against a non-workers' compensation carrier, which did not abrogate the Division's exclusive jurisdiction by re-litigating the course and scope of employment question.

MandamusWorkers' CompensationExclusive JurisdictionAdministrative RemediesPlea to the JurisdictionInsurance CodeDeceptive Trade Practices ActFraudConspiracyEmployer Liability
References
25
Case No. MISSING
Regular Panel Decision

Graphic Arts Mutual Insurance v. Bakers Mutual Insurance

This case concerns a dispute between Graphic Arts Mutual, an automobile liability insurer, and Bakers Mutual, a workers' compensation carrier, over which policy covers an employer's derivative liability in a third-party personal injury action. An employee of Chimes Cake Co. was injured by a co-employee's negligence, leading to a third-party claim against the employer under the Dole-Dow doctrine. Graphic disclaimed responsibility, citing policy exclusions for employee bodily injury and workers' compensation obligations. The court affirmed that Graphic's automobile policy covered the employer's vicarious liability to a third-party tort-feasor, as this obligation did not fall within the stated exclusions. The decision emphasizes a functional analysis of separate insurance lines, concluding that automobile liability should cover obligations arising from vehicle operation.

Insurance disputeAutomobile liabilityWorkers' compensationThird-party actionDeclaratory judgmentEmployer's liabilityVicarious liabilityDole-Dow doctrinePolicy exclusionsCo-employee negligence
References
4
Case No. 03-01-00228-CV
Regular Panel Decision
May 23, 2002

Jessica Mychelle Woodard v. Michigan Mutual Insurance Company

This appeal arises from a suit where Michigan Mutual Insurance Company sued Jessica Mychelle Woodard for breach of a subrogation contract. Michigan Mutual alleged Woodard failed to reimburse them after settling a wrongful death lawsuit. Woodard contended that Michigan Mutual's claims were barred by the four-year statute of limitations. The district court initially granted summary judgment for Michigan Mutual. The appellate court reviewed the evidence, rejected Michigan Mutual's arguments regarding the tolling of limitations due to fraud or the minority of Woodard's children, and found that Woodard raised a fact issue on when the cause of action accrued. Consequently, the appellate court reversed the district court's judgment and remanded the case for further proceedings.

Statute of LimitationsBreach of ContractSubrogation RightsSummary JudgmentTolling of LimitationsFraudulent ConcealmentLegal DisabilityAppellate ReviewTexas Civil Practice and Remedies CodeWrongful Death
References
18
Case No. 10-10-00391-CV
Regular Panel Decision
Feb 02, 2011

in Re Texas Mutual Insurance Company

Texas Mutual Insurance Company sought a writ of mandamus from the Tenth Court of Appeals to compel Judge Robert G. Dohoney to dismiss a lawsuit filed by Leroy Bell. Texas Mutual argued that Bell failed to exhaust administrative remedies with the Division of Worker’s Compensation (DWC) regarding his Maximum Medical Improvement (MMI) date and impairment rating, which were crucial to his claims against Texas Mutual for aiding and abetting, conspiracy, and tortious interference with a contract. The Appeals Court denied the petition. It clarified that while Bell is barred from challenging the DWC's final determinations on MMI and impairment due to lack of administrative exhaustion, the trial court retains jurisdiction over Bell’s separate claims of wrongful termination and tortious interference, as these do not require a direct or indirect re-adjudication of the DWC's findings. The DWC's findings will serve as uncontrovertible facts in the trial court.

MandamusWorkers' Compensation ActAdministrative ExhaustionSubject Matter JurisdictionPlea to the JurisdictionJudicial ReviewMaximum Medical Improvement (MMI)Impairment RatingWrongful TerminationTortious Interference
References
10
Case No. MISSING
Regular Panel Decision

Blanks v. Liberty Mutual Fire Insurance Co.

Andre’ Cornell Blanks appealed the trial court’s summary judgment in favor of Liberty Mutual Fire Insurance Company, Elizabeth Pharr, and James Thayer. The underlying dispute stemmed from Blanks’ dissatisfaction with Liberty Mutual’s handling of his worker’s compensation claims. The 68th District Court had granted Liberty Mutual’s no-evidence motion for summary judgment. The appellate court affirmed the trial court’s judgment, finding that Blanks failed to adequately brief his complaints and did not produce summary judgment evidence to raise a genuine issue of material fact as required by Texas Rule of Civil Procedure 166a(i).

Summary JudgmentAppellate ReviewWorker's CompensationInsurance ClaimsInadequate BriefingWaiver of ErrorTexas Civil ProcedureNo-Evidence MotionTrial Court JudgmentAppellate Procedure
References
7
Case No. 03-03-00704-CV
Regular Panel Decision
Jan 21, 2005

Texas Mutual Insurance Company// Eckerd Corporation H.E. Butt Grocery Company Third-Party Solutions, Inc. Wal-Mart Stores, Inc. Apollo Enterprises, Inc. And Walgreen Company v. Eckerd Corporation H.E. Butt Grocery Company Third-Party Solutions, Inc. Wal-Mart Stores, Inc. Apollo Enterprises, Inc. And Walgreen Company//Cross-Appellee,Texas Mutual Insurance Company

This case involves cross-appeals concerning whether an insurance company must first exhaust administrative remedies under the Texas Workers' Compensation Act before filing a lawsuit for alleged overcharges by health care providers. Appellant Texas Mutual Insurance Company sued several pharmacies and billing companies for negligent misrepresentation and money had and received, claiming they over-billed for prescription drugs. The district court denied the defendants' motion to dismiss for lack of subject matter jurisdiction but granted partial summary judgment against Texas Mutual. The Court of Appeals, relying on prior precedent, determined that the Texas Workers' Compensation Commission holds exclusive jurisdiction over medical fee disputes within the Act's pervasive regulatory scheme. Consequently, the appellate court reversed the district court's judgment, concluding that the trial court lacked jurisdiction as Texas Mutual had not exhausted its administrative remedies.

Workers' Compensation ActAdministrative RemediesExclusive JurisdictionMedical Fee DisputesPharmaceutical Fee GuidelineOverbillingNegligent MisrepresentationMoney Had and ReceivedStatutory InterpretationAppellate Review
References
10
Case No. No. 11-12-00339-CV
Regular Panel Decision
Nov 26, 2014

Alfred Elwess v. Farm Bureau County Mutual Insurance Company of Texas and Texas Farm Bureau Mutual Insurance Company

Alfred Elwess, injured in an auto accident, sought to recover under his underinsured motorist (UIM) coverage from Farm Bureau County Mutual Insurance Company of Texas and Texas Farm Bureau Mutual Insurance Company (Appellees). The Appellees filed a motion for summary judgment, arguing Elwess failed to obtain permission to settle with the tortfeasor and that his damages were covered by workers' compensation. The trial court granted summary judgment for the Appellees. The Eleventh Court of Appeals reversed, finding insufficient evidence that Elwess's failure to obtain permission materially prejudiced the Appellees' subrogation rights and that his damages were payable under workers' compensation, especially since his employer did not have such coverage. The court remanded the case for further proceedings.

Summary JudgmentUnderinsured Motorist (UIM)Insurance Coverage DisputeSettlement Without Consent ExclusionSubrogation RightsWorkers' Compensation ExclusionMaterial BreachActual PrejudiceAppellate ReviewDe Novo Review
References
7
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