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The Casaubon Firm v. Texas Mutual Insurance Company

December 21, 2021
The Eight Court of Appeals (El Paso) reversed the trial court’s judgment regarding attorney’s fees in Supplemental Income Benefit disputes. The case involved two separate worker’s compensation claims with the common issue: what constitutes a “dispute” for the purposes of triggering an employee’s right to seek attorney’s fees. In the first claim, the insurance carrier was presented with a claim for the third and fourth quarters of Supplemental Income Benefits that it neither agreed to pay, nor outright denied. Instead, the insurance carrier informed the worker that the applications for benefits were deficient and the insurance carrier would not act on them. The Court of Appeals concluded that the insurance carrier’s actions and inactions were sufficient to trigger a “dispute” as contemplated by the Texas Workers’ Compensation Act, thus ultimately making the insurance carrier liable for attorney’s fees necessary to resolve the matter. In the second claim, the insurance carrier initiated Supplemental Income Benefits, but it declined to stipulate to liability at a benefits review conference. For the second claim, the Court of Appeals found the issue was not ripe for decision because no claim for fees had yet been passed on by the administrative agency. As an adjunct to its rulings, the Court of Appeals also found that mandatory venue for a petition for judicial review that challenges only the issue of attorney’s fees is in Travis County.
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