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

Case No. 03-15-00219-CV
Regular Panel Decision

Hallmark Specialty Underwriters, Inc. and Hallmark Specialty Insurance Company v. Texas Mutual Insurance Company

This case arises from a declaratory judgment action filed by Appellee Texas Mutual Insurance Company, seeking a determination regarding its duty to defend Absolute Oil Field Services, LLC. The trial court granted summary judgment in favor of Texas Mutual and denied Appellants Hallmark Specialty Underwriters, Inc. and Hallmark Specialty Insurance Company's cross-motion for summary judgment. Appellants contend that the trial court erred in its decision, arguing that the underlying petition contained sufficient factual allegations to trigger Appellee's duty of defense under the 'eight corners' rule, as the injured party, Jose Guzman, was an employee of Absolute and was potentially injured in the course of his employment. They argue that Texas law requires liberal interpretation of pleadings, resolving doubts in favor of coverage, and that Appellee's arguments misinterpret established legal principles regarding the duty to defend.

Insurance CoverageDuty to DefendWorkers' CompensationEight Corners RuleSummary JudgmentAppellate ReviewTexas LawEmployee InjuryCourse and Scope of EmploymentDeclaratory Judgment Action
References
38
Case No. 2024 NY Slip Op 03519
Regular Panel Decision
Jun 27, 2024

Matter of Reyes Bonilla v. XL Specialty Ins.

Claimants Jose Reyes Bonilla and Marvin Reyes Bonilla, carpenters, were involved in a motor vehicle accident while commuting to a job site in Greenpoint, Brooklyn, in an employer-provided van. They filed workers' compensation claims, which were established against XL Specialty Insurance by a Workers' Compensation Law Judge (WCLJ). XL Specialty appealed, arguing its policy did not cover commuting injuries and that it was not the proper carrier. The Workers' Compensation Board affirmed the WCLJ's decisions, finding XL Specialty failed to preserve its challenge to being the carrier and that the employer's responsibility for transportation made the injuries compensable. The Appellate Division, Third Department, affirmed, agreeing that the issue was unpreserved and that the injuries arose out of and in the course of employment due to the employer's control over the conveyance.

Workers' CompensationMotor Vehicle AccidentEmployment InjuriesCommuting AccidentEmployer Provided TransportationWrap-up PolicyInsurance Coverage DisputeCarrier LiabilityIssue PreservationAppellate Review
References
16
Case No. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
Case No. MISSING
Regular Panel Decision

Christi Bay Temple v. Guideone Specialty Mutual Insurance Co.

Christi Bay Temple, the appellant, appealed the trial court's order dismissing its suit against Guideone Specialty Mutual Insurance Company et al. for want of prosecution. The church had initially sued Guideone in 2004 over an insurance dispute. Guideone filed a plea in abatement, arguing that the church lacked the capacity to sue because its corporate charter had been forfeited in 1983 for failure to comply with franchise tax requirements, which the trial court granted. Despite being given an opportunity to cure this incapacity, the church failed to do so, leading to the dismissal of its case. On appeal, the court affirmed the dismissal but modified the trial court's judgment by deleting the allocation of costs and the 'Mother Hubbard clause,' clarifying that a dismissal for want of prosecution is not a judgment on the merits.

Dismissal for Want of ProsecutionPlea in AbatementCorporate Charter ForfeitureLack of Capacity to SueAbuse of DiscretionAppellate ReviewInsurance DisputeTrial Court Judgment ModificationTexas LawCivil Procedure
References
30
Case No. 13-19-00127-CV; 13-19-00128-CV
Regular Panel Decision
Oct 29, 2020

United Specialty Insurance Company v. Wasp Construction, LLC

This is a consolidated appeal concerning insurance coverage and breach of contract. Appellant, United Specialty Insurance Company (USIC), as the assignee of Alonzo Cantu Construction, Inc. (Cantu), contested summary judgments granted to Farmers Insurance Exchange (FIE) and Wasp Construction, LLC (Wasp). USIC argued that Cantu was an additional insured under FIE's policy and that Wasp breached its subcontract by not defending or indemnifying Cantu in an underlying personal injury suit. The appellate court affirmed the trial court's judgments, ruling that FIE's policy required a written additional insured agreement to exist prior to the loss, which was not the case, and that USIC's claims against Wasp were barred by res judicata due to a prior dismissal with prejudice in the underlying litigation.

Insurance CoverageSubcontract AgreementAdditional InsuredDuty to DefendDuty to IndemnifySummary JudgmentRes JudicataContract InterpretationPre-Loss Written AgreementAppellate Court Decision
References
38
Case No. 01-22-00031-CV
Regular Panel Decision
Nov 03, 2022

Turner Specialty Services, LLC v. Michaela Horn, Individually and as Next Friend of G.H. and M.M., Minors

Justin Horn died while working for Turner Specialty Services, LLC. His family, Michaela Horn and Atrelle Horn, sued Turner Specialty for gross negligence. Turner Specialty filed a special appearance, contesting personal jurisdiction in Texas. The trial court denied the special appearance, and Turner Specialty appealed. The Court of Appeals for the First District of Texas affirmed the trial court's decision, finding that Turner Specialty had sufficient minimum contacts with Texas through its recruitment, hiring, and initial safety training of Justin Horn and other employees in Texas, which was purposefully availed and related to the Horns' gross negligence claim.

personal jurisdictionspecial appearanceminimum contactspurposeful availmentgross negligencewrongful deathworkers' compensationappellate reviewforum stateinterstate federalism
References
24
Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. 01-08-00641-CV
Regular Panel Decision
Oct 01, 2009

Union Carbide & Hexion Specialty Chemicals, Inc.'s v. Oliver D. Smith and Peggy Ann Bowen Smith

Oliver D. Smith and Peggy Ann Bowen Smith sued Union Carbide Corporation and Hexion Specialty Chemicals, Inc. for Oliver's mesothelioma caused by asbestos exposure. A jury found Union Carbide and Hexion negligent. On appeal, the Court of Appeals for the First District of Texas reversed the trial court's judgment. The court found insufficient evidence that Union Carbide controlled the details of Oliver's work, which is required to establish premises owner liability under Chapter 95 of the Texas Civil Practice and Remedies Code. Additionally, the court held that the Smiths' claims against Hexion, as successor-in-interest to Smith-Douglas, were barred by the exclusive remedy provision of the Texas Workers' Compensation Act, declining to apply the 'dual-persona' doctrine.

Asbestos LitigationMesotheliomaPremises LiabilityIndependent ContractorWorkers' Compensation ActExclusive RemedyCorporate MergerSuccessor LiabilityDual-Persona DoctrineLegal Sufficiency
References
19
Case No. MISSING
Regular Panel Decision

Claim of Smith v. Specialty Services, Inc.

Claimant, a construction foreman for Specialty Services, Inc., was injured while performing work for a church in Pennsylvania. Although Specialty filed a work-related accident report and its carrier began paying benefits, the carrier filed a notice of controversy over seven months after the Workers' Compensation Board indexed the case, exceeding the 25-day limit. The carrier argued that the late filing was due to surprise, mistake, and newly discovered evidence regarding the church's involvement, which claimant and Specialty allegedly failed to disclose. The Workers' Compensation Board refused to excuse the late filing, finding the carrier failed to demonstrate good cause. The appellate court affirmed the Board's decision, noting that the carrier had ample time to investigate and that belatedly obtained evidence is not a sufficient ground to excuse a late filing.

Workers' CompensationLate Notice of ControversyTimely FilingEmployer-Employee RelationshipInsurance CarrierGood CausePleading BarAppellate ReviewBoard DecisionStatutory Interpretation
References
2
Case No. ADJ3308341
Regular
Jan 27, 2009

MICHAEL COLEMAN vs. RAITO, INC., TIG SPECIALTY INSURANCE CO., RISK ENTERPRISE MANAGEMENT, LTD.

The Workers' Compensation Appeals Board reconsidered a decision regarding Michael Coleman's entitlement to spinal surgery. The Board found that the defendant, TIG Specialty Insurance, failed to meet the strict procedural timelines required for objecting to a treating physician's surgical recommendation, specifically citing AD Rule 9792.6(o) and Labor Code section 4610(g)(1). Consequently, the Board rescinded the prior award and remanded the case, giving the defendant ten days to properly initiate the objection process for the spinal surgery. The Board also clarified that the Agreed Medical Evaluator was not qualified to perform the required second opinion surgery evaluation.

Workers' Compensation Appeals BoardReconsiderationFindings of Fact and AwardPetition for ReconsiderationAdjusting AgentUtilization ReviewSpinal SurgeryTreating PhysicianAdministrative Director RuleLabor Code Section
References
1
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