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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

National Union Fire Insurance Co. of Pittsburgh v. American Re-Insurance Co.

The case revolves around a dispute between National Union Fire Insurance Company and American Re-Insurance Company regarding a pollution exclusion clause in a reinsurance policy. National Union sought reimbursement from American Re after settling claims where employees were exposed to metalworking fluids. American Re denied coverage, arguing its pollution exclusion applied. The court, applying Ohio law, found American Re's pollution exclusion ambiguous due to its broad language and its intended purpose of covering environmental contamination. Consequently, American Re's motion for summary judgment was denied, and National Union's motion to strike American Re's defense was granted, requiring American Re to "follow the fortunes" of National Union.

ReinsurancePollution Exclusion ClauseContract InterpretationFollow the Fortunes DoctrineSummary JudgmentInsurance CoverageAmbiguity in ContractsOhio State LawDiversity JurisdictionIndustrial Contamination
References
31
Case No. MISSING
Regular Panel Decision
Sep 13, 2000

AIU Insurance v. American Motorists Insurance

This case concerns an appeal regarding primary liability coverage for HRH Construction Corp. and Hotel Grand Central in an underlying personal injury action. Plaintiffs, including their excess insurer AIU Insurance Co., sought to compel American Motorists Insurance Co. and St. Paul Fire & Marine Ins. Co. to provide primary defense and reimbursement. The court found American Motorists obligated to defend HRH and the Hotel, as their policy covered them as additional insureds for claims "arising out of" work performed by American Motorists' primary insured, Cord Contracting Co. However, St. Paul was not similarly obligated, as the injury did not "arise out of" work by its insured, Forest Electric Corp. Consequently, the court modified the prior declaration, vacating the plaintiffs' favor against St. Paul and dismissing Cord Contracting Co.'s cross-appeal.

Insurance DisputePrimary Liability CoverageExcess InsuranceAdditional InsuredPersonal InjuryConstruction SiteSubcontractorContractual ObligationDuty to DefendIndemnification
References
1
Case No. CA 10-00545
Regular Panel Decision
Feb 10, 2011

HAHN AUTOMOTIVE WAREHOUSE, INC. v. AMERICAN ZURICH INSURANCE COMPANY

Hahn Automotive Warehouse, Inc. (plaintiff) initiated a breach of contract action against American Zurich Insurance Company and Zurich American Insurance Company (defendants), contending that bills issued under insurance contracts were time-barred. Defendants counterclaimed for damages stemming from plaintiff's alleged breach of these contracts. The Supreme Court partially granted plaintiff's cross-motion, deeming counterclaims for debts arising over six years prior as time-barred. Concurrently, it permitted defendants to utilize a $400,000 letter of credit to satisfy any outstanding debt, including those deemed time-barred. On appeal, the Appellate Division affirmed the use of the letter of credit for time-barred debts, reasoning that the statute of limitations only bars the remedy, not the underlying obligation. The court also affirmed that defendants' counterclaims for debts over six years old were time-barred, as the right to demand payment accrued earlier. Finally, the court modified the order to dismiss plaintiff's second through fourth causes of action. A dissenting opinion argued that the counterclaims were not time-barred, asserting that the cause of action accrued upon demand and refusal of payment, not merely when the right to demand payment existed.

Breach of contractInsurance contractsStatute of limitationsLetter of creditSummary judgmentAppellate reviewContract interpretationTime-barred claimsAccrual of cause of actionRetrospective premiums
References
23
Case No. 532194
Regular Panel Decision
Nov 10, 2022

In the Matter of the Claim of Marc Trombino

Claimant Marc Trombino, an iron worker, filed a workers' compensation claim in September 2016 for work-related lung conditions, including silicosis and chronic obstructive pulmonary disease, naming FMB Inc. as his employer. The claim was initially indexed against Phoenix Insurance Co., then corrected to Liberty Insurance Corporation after an investigation. Liberty disputed coverage, but a Workers' Compensation Law Judge (WCLJ) found prima facie evidence and established the claim, finding an occupational disease and permanent total disability. Liberty appealed, belatedly raising a lack of policy coverage for the work location. The Board remitted the matter for a hearing on coverage, during which Ace American Insurance Company was put on notice. The WCLJ and subsequently the Board invoked the doctrine of laches, barring Liberty from denying coverage due to its inexcusable delay in raising the defense and the resultant prejudice to Ace American. The Supreme Court, Appellate Division, Third Judicial Department, affirmed the Board's decision.

Workers' CompensationOccupational DiseaseSilicosisChronic Obstructive Pulmonary DiseaseLaches DoctrineInsurance Coverage DisputeAppellate ReviewPrima Facie EvidencePermanent Total DisabilityMedical Expert Testimony
References
7
Case No. ADJ1630366 (SFO 0450955) ADJ4338389 (SFO 0431370)
Regular
Apr 05, 2019

PATRICIA MARSH vs. US AIRWAYS GROUP, INC., ACE AMERICAN INSURANCE COMPANY, SEDGWICK CMS, CALIFORNIA ISURANCE GUARANTEE ASSOCIATION, RELIANCE INSURANCE COMPANY

This case involves CIGA's petition for reimbursement from ACE American Insurance Company for workers' compensation benefits paid due to the insolvency of Reliance Insurance Company. The WCAB rescinded the prior denial, finding CIGA has standing and its claim is not barred by laches. However, CIGA must still prove ACE's joint and several liability for medical treatment and that ACE's policy constitutes "other insurance." The matter is returned to the trial level for a complete record and further determination on these issues.

CIGALachesStandingReimbursementJoint and Several LiabilityOther InsuranceCompromise and ReleaseInsured InsolvencyWCABWCJ
References
12
Case No. ADJ8002816, ADJ8316468
Regular
Oct 05, 2016

LORENZO TOSCANO CORONA vs. KOOSHAREM, doing business as SELECT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA), ULLICO CASUALTY INSURANCE COMPANY, ACE AMERICAN INSURANCE COMPANY, RSI HOME PRODUCTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a dispute over workers' compensation coverage where applicant Lorenzo Toscano Corona was injured, allegedly while employed through a staff leasing arrangement between Koosharem (Select Staffing) and RSI Home Products. The Appeals Board granted reconsideration to address arguments by ACE American Insurance Company and Travelers Property Casualty Company that their policies excluded coverage for the applicant. The Board rescinded the prior decision due to the arbitrator's failure to adequately document the proceedings and admitted exhibits as required by law. The matter is returned to the arbitrator to create a proper record and evaluate whether ACE and Travelers' policies contained valid exclusions for the applicant's injuries, considering relevant insurance code provisions and endorsements.

Staff leasingGeneral employerSpecial employerJoint and several liabilityOther insuranceInsurance Code section 1063.1(c)(9)Hold harmless clauseWCAB Rule 10566Hamilton v. Lockheed Corp.Labor Code section 3602(d)
References
6
Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
3
Case No. MISSING
Regular Panel Decision

National Union Fire Insurance v. Great American E&S Insurance

Plaintiff Ethical Culture Fieldston School (ECF) and Tishman, the project manager, were named additional insureds on Solar's general liability policy with Great American. Solar employee, Lisa Best, was injured on site. While Solar filed workers' compensation, notice to Great American about Best's personal injury lawsuit against Tishman and ECF, and Solar's subsequent impleading, was delayed. Tishman and ECF sought a declaratory judgment that Great American was obligated to defend and indemnify them, and Solar cross-claimed. Great American moved for summary judgment, asserting untimely notice. The court found Solar's delay of over a year in notifying Great American was untimely and that Solar's belief of nonliability was unreasonable, especially given its contractual indemnification obligations. Consequently, Great American was not obligated to provide coverage to Solar in the underlying action.

Insurance Coverage DisputeTimely Notice RequirementCondition PrecedentDuty to DefendDuty to IndemnifySummary JudgmentWorkers' Compensation ExclusivityContractual IndemnificationAdditional Insured StatusConstruction Site Injury
References
5
Case No. ADJ7989476 ADJ9983597 ADJ9983898
Regular
Jun 18, 2018

MARIA MIRANDA vs. KOOSHAREM dba SELECT STAFFING dba SELECT FOCUS, EVANS MANUFACTURING, ACE AMERICAN INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE (CIGA) Adjusted by SEDGWICK for ULLICO CASUALTY, in liquidation, TRUCK INSURANCE EXCHANGE

This case involves a dispute over workers' compensation insurance liability for injuries sustained by applicant Maria Miranda in 2011 while employed by Select Staffing (general employer) and Evans Manufacturing (special employer). The Workers' Compensation Appeals Board (WCAB) rescinded the arbitrator's decision because the evidence, particularly insurance policy endorsements, was not adequately identified and admitted. The WCAB found the record insufficient to determine which insurer, ACE American Insurance Company or Truck Insurance Exchange, is primarily liable for benefits. The matter is returned to the arbitrator to establish a complete and proper record for a new decision, addressing the specific requirements for insurance endorsements limiting coverage.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderInsurance LiabilityGeneral EmployerSpecial EmployerACE American Insurance CompanyTruck Insurance ExchangeCalifornia Insurance Guarantee AssociationCIGA
References
10
Case No. MISSING
Regular Panel Decision
Apr 15, 1983

American White Cross Laboratories, Inc. v. North River Insurance

Vincent Yeager, an employee of American White Cross Laboratories, Inc. (American), was injured during employment, leading to a lawsuit against a machine manufacturer, who then brought a third-party action against American for indemnification. American was covered by both a workers’ compensation policy from the State Insurance Fund and a general liability policy from North River Insurance Co. North River disclaimed liability, citing exclusions for workers’ compensation obligations and bodily injury to employees. American then initiated a fourth-party action against North River for contribution. The Supreme Court initially denied American's summary judgment motion and granted North River's cross-motion to dismiss, with leave to replead for indemnification. This court reversed, holding that North River's exclusions do not insulate it from American’s claims because the employer's liability to a third-party tort-feasor for an employee's injury arises from equitable apportionment, not directly from workers' compensation law, thus granting American's motion for summary judgment and denying North River's cross-motion.

Insurance coverage disputeGeneral liability policyWorkers' compensation exclusionContribution between tort-feasorsIndemnificationSummary judgmentFourth-party actionDole-Dow doctrineEquitable apportionmentEmployer liability
References
2
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