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Case Law Database

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

Case No. WCK 066521
Regular
Dec 21, 2007

SALLY MERDIAN vs. AIG PRIMARY WC PROGRAM c/o GALLAGHER BASSETT SERVICES, INC., And Their Insured AIG CLAIM SERVICES

The Workers' Compensation Appeals Board granted reconsideration to allow further development of the record regarding which permanent disability rating schedule applies. The Board rescinded the previous decision and returned the case to the trial level to determine if the applicant missed enough time for medical treatment to trigger a notice requirement under Labor Code section 4061 before January 1, 2005. Proceedings are to be stayed pending a California Supreme Court decision on a related case, *Vera v. Workers' Comp. Appeals Bd.*

Workers' Compensation Appeals BoardSally MerdianAIG Primary WC ProgramGallagher Bassett Servicesindustrial injurybilateral upper extremitiesneckpermanent and stationary2005 Schedule1997 Schedule
References
4
Case No. MISSING
Regular Panel Decision
Jan 22, 2007

Liberty Mutual Insurance v. Insurance Co. of Pennsylvania

This case concerns an appeal regarding an insurance dispute between Liberty Mutual (excess insurer) and AIG (primary insurer) over a $1.5 million settlement payment in a personal injury action. The underlying action involved an employee of General Industrial Service Corporation, a subcontractor, suing the project's owner and construction manager under the Labor Law. AIG, General's primary insurer, had refused to participate in the defense or settlement. The Supreme Court's order, which limited plaintiff's recovery to $500,000, was modified on appeal. The appellate court increased AIG's potential liability limit to $1,000,000, pending a determination of whether the employee sustained a 'grave injury' under Workers' Compensation Law § 11. The court affirmed that AIG, as a primary insurer, must exhaust its coverage before Liberty's excess coverage is implicated and is not entitled to apportionment with the excess insurer.

Insurance Coverage DisputeExcess InsurancePrimary InsuranceIndemnificationSubrogationWorkers' Compensation LawGrave InjurySummary JudgmentPolicy LimitsApportionment of Liability
References
6
Case No. MISSING
Regular Panel Decision

Lugo v. AIG Life Insurance

Plaintiff Farecilpa Lugo sued AIG Life Insurance Company and Hobart Corporation, seeking accidental death benefits under ERISA after her husband's death in 1984. AIG denied claims, citing late notice and the cause of death. Lugo argued that notice to PMI (Hobart) was sufficient, AIG waived the late notice defense, and her claim was within ERISA's statute of limitations. The court found AIG did not waive its late notice defense due to a reservation of rights clause, Lugo failed to prove PMI was AIG's agent, and the Plans' three-year limitation period, not ERISA's six-year period, applied, barring the suit. Consequently, the court dismissed the action, rendering the request for a jury trial moot.

ERISAAccidental Death BenefitsInsurance PolicyLate Notice DefenseWaiverEstoppelStatute of LimitationsAgencySummary JudgmentFederal Common Law
References
37
Case No. 2018 NY Slip Op 07391
Regular Panel Decision
Nov 01, 2018

Matter of Community Hous. Improvement Program v. Commissioner of Labor

The Appellate Division, Third Department, dismissed an appeal filed by the Community Housing Improvement Program against the Commissioner of Labor. The appeal sought to challenge a decision by the Industrial Board of Appeals regarding a minimum wage order for the building service industry. The court determined it lacked subject matter jurisdiction because the petitioner failed to properly file a notice of appeal with the court of original instance, which was the Industrial Board of Appeals, not the Appellate Division. Additionally, the petitioner failed to timely and correctly serve the notice of appeal on the respondent's counsel at the designated address. Consequently, due to the complete failure to comply with CPLR 5515, the appeal was dismissed.

JurisdictionAppeal ProcedureService of ProcessAppellate DivisionIndustrial Board of AppealsMinimum WageLabor LawCPLRNew York CourtsStatutory Interpretation
References
12
Case No. 142 SSM 33
Regular Panel Decision
Nov 16, 2017

The Matter of the Claim of Lidia Burgos v. Citywide Central Insurance Program

The New York Court of Appeals affirmed the order of the Appellate Division. The decision concerned the claim of Lidia Burgos against Citywide Central Insurance Program and the Workers' Compensation Board. The Appellate Division had concluded that substantial evidence supported the Workers' Compensation Board's determinations regarding the claimant's degree of impairment and loss of wage-earning capacity. The Court of Appeals found no reason to overturn this conclusion.

Workers' CompensationImpairmentWage-earning CapacitySubstantial EvidenceAppellate DivisionClaimantInsurance ProgramBoard DeterminationJudicial ReviewAffirmed Order
References
1
Case No. MISSING
Regular Panel Decision

AIG Europe (Netherlands), N v. v. UPS Supply Chain Solutions, Inc.

Plaintiff AIG Europe (Netherlands), N.V. ("AIG") initiated a subrogation action against Defendant UPS Supply Chain Solutions, Inc. ("UPS") following damage to an x-ray machine during shipment. AIG, acting as the insurer for Philips Medical Systems Nederlands, B.V., asserted claims for breach of contract, bailment obligations, and tort. UPS sought summary judgment to limit its liability to $9,479.61, while AIG cross-moved for summary judgment, arguing against the enforceability of any liability limitation and its invalidity under the Carmack Amendment. The Court denied both motions for summary judgment on the contractual liability issues, citing genuine disputes of material fact regarding the existence and terms of a binding agreement between the parties. Furthermore, the applicability of the Carmack Amendment and the material deviation doctrine could not be determined as a matter of law. However, UPS's motion for summary judgment on AIG's tort claim was granted as it was unopposed.

SubrogationContract LawBailmentTort LawSummary JudgmentCarmack AmendmentInterstate CommerceLimitation of LiabilityShipping DamageX-ray Machine
References
50
Case No. 2017 NY Slip Op 04184 [150 AD3d 1589]
Regular Panel Decision
May 25, 2017

New York State Workers' Compensation Board v. Program Risk Management, Inc.

The New York State Workers' Compensation Board, acting as administrator and successor to the Community Residence Insurance Savings Plan, initiated legal action against various entities and individuals after the trust became severely underfunded. Defendants include Program Risk Management, Inc. (administrator), PRM Claims Services, Inc. (claims administrator), individual officers of PRM, the Board of Trustees, and Thomas Gosdeck (trust counsel). The plaintiff sought damages for claims such as breach of contract, breach of fiduciary duty, and legal malpractice. The Supreme Court's order partially dismissed some claims and denied others. On cross-appeal, the Appellate Division, Third Department, modified the Supreme Court's order, notably reversing the dismissal of several breach of fiduciary duty claims and common-law indemnification against PRMCS, while affirming denials of motions to dismiss breach of contract, legal malpractice, and unjust enrichment claims. The court's decision was influenced by recent rulings in State of N.Y. Workers' Compensation Bd. v Wang.

Workers' Compensation LawGroup Self-Insured TrustBreach of ContractBreach of Fiduciary DutyLegal MalpracticeUnjust EnrichmentStatute of LimitationsEquitable EstoppelAlter Ego LiabilityCommon-Law Indemnification
References
20
Case No. OAK 0278433 OAK 0295169 OAK 0307341 OAK 0307342 OAK 0307343 OAK 0321700
Regular
Jul 06, 2007

LATONIA PACE vs. COUNTY OF ALAMEDA/SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., and COUNTY OF ALAMEDA/AIG/ TRISTAR RISK MANAGEMENT

This case involves a petition for reconsideration filed by Defendant AIG concerning prior workers' compensation decisions. The Appeals Board dismissed AIG's petition because AIG was not newly aggrieved by the Board's prior order, which affirmed the original judge's decision without amendment. AIG failed to timely petition for reconsideration of the initial judge's decision, and therefore, cannot now seek review of it through this petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissedCumulative TraumaBilateral ShouldersUpper BackBilateral Upper ExtremitiesPermanent DisabilityWCJ Findings and AwardAggrieved Party
References
0
Case No. ADJ1630547 (MON 0209470)
Regular
Aug 10, 2009

Raymond Burrell vs. Boeing/McDonnell Douglas, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA), AIG

This case concerns AIG's petition for reconsideration of a supplemental workers' compensation award. The Appeals Board affirmed an administrative law judge's decision that relieved CIGA of liability and placed the full burden on AIG for an applicant's injury award. The Court found that because AIG was a solvent insurer with joint and several liability, CIGA was not responsible for benefits as it constituted a "non-covered claim" under statute. Therefore, AIG is liable for all benefits after the liquidation of CIGA's underlying insurer.

CIGAIndustrial IndemnityAIGSupplemental Findings and AwardStipulated Awardcontinuing jurisdictionLabor Code section 5803Labor Code section 5804Insurance Code section 1063.1(c)(9)covered claim
References
6
Case No. MISSING
Regular Panel Decision

Mangum v. National Union Fire Insurance

A claimant was injured in July 2000 and filed for workers' compensation after her disability claim was denied. The Workers' Compensation Board initially indexed the claim against Career Horizons, Inc., with AIG Claims Services, Inc. as its administrator. AIG failed to appear at multiple hearings, leading to the claim's establishment and penalties. After an initial appeal by AIG, the Board affirmed the establishment but remitted the case to identify the proper carrier. CNA Insurance Company was subsequently identified as the employer's true workers' compensation carrier. The WCLJ and the Board ruled that AIG was estopped by laches from denying coverage. This court, however, reversed the Board's finding of estoppel, concluding that the Board abused its discretion by not addressing evidence suggesting CNA had timely notice of the claim and basing its decision on incorrect employer/carrier identification. The matter was remitted for further proceedings.

Workers' CompensationEstoppelLachesInsurance CoverageCarrier LiabilityThird-Party AdministratorAppellate ReviewRemittalProcedural Due ProcessTimely Notice
References
9
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