Justia Insurance Law Opinion Summaries

This suit was filed by a daughter against an organ donation charity when she discovered that the charity - contrary to an earlier representation to her - would allegedly profit from harvesting her deceased mother's tissues. The charity requested a defense from its insurer, and the insurer denied a defense. The insurer's subsequent suit against the charity resulted in two certified questions from the Fifth Circuit Court of Appeals. The Supreme Court held (1) the insurance policy provision for coverage of "personal injury" does not include coverage for mental anguish, unrelated to physical damage to or disease of the daughter's body; and (2) the insurance policy provision for coverage of "property damages," does not include coverage for the underlying plaintiff's loss of use of her deceased mother's tissues, organs, bones, and body parts. View "Evanston Ins. Co. v. Legacy of Life, Inc." on Justia Law

Employee suffered an injury during the course of his employment that was compensable under the Texas Workers' Compensation Act. Petitioner insurance company provided workers' compensation coverage to Employee's employer. Petitioner disputed the impairment rating of twenty percent assigned by the doctor in the administrative proceedings. A hearing officer issued a decision finding that Employee had an impairment rating of twenty percent. The Division of Workers' Compensation upheld the decision. Petitioner appealed. The trial court granted Employee's plea to the jurisdiction and dismissed the case. The court of appeals affirmed. At issue on appeal was whether a reviewing court lacks subject matter jurisdiction to resolve an impairment rating appeal if the only rating presented to the agency was invalid. The Supreme Court reversed, holding that the absence of a valid impairment rating does not deprive the court of jurisdiction. Remanded. View "Am. Zurich Ins. Co. v. Samudio" on Justia Law

The parties to the appeal disagreed about whether an employer who self funded a health-benefit plan for its employees was an "insurer" under the Texas Insurance Code, and therefore should be treated as a reinsurer when purchasing stop-loss insurance. The court of appeals concluded that an employer's self-funded plan was clearly an insurer under the Code and that a plan's purchase of stop-loss insurance was also clearly reinsurance beyond the regulatory scope of the Texas Department of Insurance. The court accordingly reversed the trial court's judgment, which held that the agency's regulation of the stop-loss policies at issue as direct insurance. Because the regulatory agency did not clearly err in its regulation of these stop-loss policies, however, the court reversed the court of appeals' judgment and rendered judgment for the agency.

This appeal stemmed from litigation between a homeowner, its insurer, and the company hired to restore the home after a series of storms caused damage to the home. A jury found in the restoration company's favor and the trial court rendered judgment against the homeowner and its insurer, jointly and severally. The court of appeals affirmed in part and reversed in part. The court affirmed the court of appeals' judgment with respect to the homeowner's state Deceptive Trade Practices Act (DTPA), Tex. Bus. & Com Code 17.50, claim because the homeowner was not a prevailing party and he was not a entitled to an order restoring all amounts paid under the contracts without deducting the value received under those agreements. The court also affirmed the restoration company's charge error complaint. The court reversed the court of appeals' judgment as to the insurer where the insurer received direct consideration for its promise to pay for the dehumidification and the court of appeals erred in concluding otherwise. The court remanded for that court to consider the insurer's remaining arguments, which included challenges to the factual sufficiency of the evidence supporting the jury findings.

Rafael Casados suffered a fatal, work-related injury while working for two employers that both had workers' compensation coverage. Casados' parents sued one of the employers. At issue was whether workers' compensation was the exclusive remedy to Casados' parents, which would bar their suit against Port Elevator. Because Port Elevator had a workers' compensation policy, Casados was an employee, he suffered a work-related injury, and the jury failed to find Port Elevator grossly negligent, the Texas Workers' Compensation Act (TWCA), Tex. Lab. Code 406, provided that the exclusive remedy was against the employer's insurer - not the employer. Accordingly, the claim at issue in this appeal was barred. The court reversed the judgment of the court of appeals and rendered judgment for Port Elevator.

This case concerned an arbitration provision that allowed each party to appoint one arbitrator to a panel, subject to certain requirements. At issue was whether Americo wavied its objection to the removal of the arbitrator it selected. The underlying dispute concerned the financing mechanism for Americo's purchase of several insurance companies from Robert Myer. Pursuant to the financing agreement, Americo and Myer submitted their dispute to arbitration under American Arbitration Association (AAA) rules. The arbitrators found in favor of Myer, and Americo filed a motion to vacate the award. The trial court granted the motion, holding that Americo was entitled to any arbitrator that met the requirements set forth in the financing agreement and that the arbitrator removed by the AAA met those requirements. The court of appeals reversed, holding that Americo had waived these arguments by not presenting them to the AAA. Because the record demonstrated otherwise, the court rejected the court of appeals' judgment and remanded the case to that court for further proceedings.

Respondent, on behalf of the estate of her deceased sister, filed suit against petitioner, a nursing home, alleging that while the sister was being cared for by petitioner, she was bitten by a brown recluse spider and died. At issue was whether the claims were healthcare liability claims that required an expert report to be served. The court held that the claims fell within the statutory definition of a health care liability claim and therefore, the statute required the suit to be dismissed unless respondent timely filed an expert report. Accordingly, the court granted the petition for review and reversed and remanded.

Petitioner sued respondent for injuries he sustained when the car he was driving collided with respondent's minivan as she was pulling out of a grocery store parking lot. At issue was whether section 41.0105 of the Texas Civil Practice and Remedies Code precluded evidence or recovery of expenses that neither the claimant nor anyone acting on is behalf would ultimately be liable for paying. The court held that only evidence of recoverable medical expenses was admissible at trial. The court also held that the collateral source rule continued to apply to such expenses and the jury should not be told that they would be covered in whole or in part by insurance. Nor should the jury be told that a health care provider adjusted its charges because of insurance. Accordingly, section 41.0105 limited recovery and consequently, the evidence at trial, to expenses that the provider had a legal right to be paid.

This case stemmed from a commercial bus driver's diagnosis of tuberculosis and subsequent transmission of the disease to passengers. At issue was whether the transmission of a communicable disease from the driver of a motor vehicle to a passenger was a covered loss under a business auto policy, which afforded coverage for accidental bodily injuries resulting from the vehicle's use. The court held that because communicable diseases were not an insured risk under the policy at issue, the court reversed the judgment and rendered judgment for the insurance carrier.

Appellant, an African-American resident of Texas, sued appellees alleging that their credit-scoring systems employed several undisclosed factors which resulted in disparate impacts for minorities and violated the federal Fair Housing Act ("FHA"), 42 U.S.C. 3601, 3619. At issue, in a certified question, was whether Texas law permitted an insurance company to price insurance by using a credit-score factor that had a racially disparate impact that, were it not for the McCarran-Ferguson Act, 15 U.S.C. 1012(b), would violate the FHA, absent a legally sufficient nondiscriminatory reason, or would using such a credit-score factor violate Texas Insurance Code ("Code") sections 544.002(a), 559.051, 559.052, or some other provision of Texas law. The court answered the certified question by holding that Texas law did not prohibit an insurer from using race-neutral factors in credit-scoring to price insurance, even if doing so created a racially disparate impact.