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

Case No. 2025 NYSlipOp 06801
Regular Panel Decision
Dec 09, 2025

AmTrust N. Am., Inc. v. Insurance Specialty Group LLC

The plaintiff, AmTrust North America, Inc., appealed an order dismissing parts of its breach of contract claim against Insurance Specialty Group LLC. The dispute stems from a 2010 Managing Producer Agreement where the defendant was to administer an asset protection program for the plaintiff, with fiduciary duties. Plaintiff alleged multiple breaches, including improper underwriting and concealment of issues, which came to light in 2022. The Supreme Court dismissed claims before May 19, 2017, but the Appellate Division modified this by applying equitable estoppel. The appellate court ruled that estoppel could allow most breach of contract claims, except those solely based on the fiduciary duty to disclose, which are not subject to estoppel for time-barred breaches.

Breach of ContractEquitable EstoppelFiduciary DutyStatute of LimitationsAsset Protection ProgramUnderwriting GuidelinesInsurance AdministrationConcealmentContinuing Wrong DoctrineAppellate Division
References
8
Case No. 2025 NY Slip Op 00836 [235 AD3d 479]
Regular Panel Decision
Feb 13, 2025

TCS Constr. Corp. v. AmTrust N. Am., Inc.

The Appellate Division, First Department, reversed an order from the Supreme Court, Bronx County, which had denied summary judgment to defendants AmTrust North America, Inc., Wesco Insurance Company, and Morstan General Agency Inc. of New York. The lower court's denial meant that Wesco might have had a duty to defend or indemnify TCS Construction Corp. and Tsurishaddai Matsui. The Appellate Division found that Wesco, the insurer, had no duty to defend or indemnify based on employer's liability and independent contractor exclusions in the commercial general liability (CGL) policy. Furthermore, it ruled that Gabriel Pacheco's injuries were not

Summary judgmentInsurance coverageEmployer's liability exclusionIndependent contractors exclusionCommercial general liability policyEmployers' liability policyWorkers' Compensation Law § 11Grave injuryDuty to defendDuty to indemnify
References
6
Case No. 2024 NY Slip Op 00646
Regular Panel Decision
Feb 07, 2024

State Farm Mut. Auto. Ins. Co. v. Amtrust N. Am., Inc.

In this subrogation action, State Farm Mutual Automobile Insurance Company, as a no-fault insurer, sought to recover benefits paid to its subrogors who were also seeking workers' compensation benefits from Amtrust North America, Inc. The Supreme Court initially dismissed State Farm's unjust enrichment complaint, asserting the Workers' Compensation Board's primary jurisdiction over the coverage dispute. On appeal, the Appellate Division reversed the Supreme Court's order. The court held that the Workers' Compensation Board indeed has primary jurisdiction to determine the applicability of the Workers' Compensation Law and the causal relationship of medical expenses to the accident. Therefore, the matter was remitted to the Supreme Court for a new determination after a resolution by the Workers' Compensation Board.

SubrogationUnjust EnrichmentNo-Fault InsuranceWorkers' CompensationPrimary JurisdictionAppellate ReviewMedical ExpensesMotor Vehicle AccidentReimbursementRemittal
References
9
Case No. MISSING
Regular Panel Decision

Bernhardt v. Tradition North America

Donald Bernhardt sued his former employers, Tradition North America Inc. and Tradition Asiel Securities, Inc., alleging breach of an implied employment contract. Bernhardt claimed he was wrongfully terminated after exposing illegal securities schemes and reporting them to the SEC, violating an implied agreement that the firm would operate lawfully. Defendants moved to dismiss the amended complaint under Rule 12(b)(6) and sought Rule 11 sanctions against Bernhardt's attorney. The court granted the motion to dismiss, ruling that Bernhardt failed to state a plausible claim for breach of an implied contract under New York's at-will employment doctrine. However, the court denied the request for Rule 11 sanctions, finding the lawsuit, while unsuccessful, did not constitute sanctionable conduct.

Implied contractEmployment at willWrongful terminationWhistleblowerSecurities law violationsMotion to dismissRule 12(b)(6)Rule 11 sanctionsFederal Rules of Civil ProcedureNew York employment law
References
18
Case No. MISSING
Regular Panel Decision

Maida v. Life Insurance Co. of North America

Plaintiff Anthony Maida sued Life Insurance Company of North America (LINA) after his long-term disability benefits were terminated. Maida initially claimed physical disability due to a fall and later asserted mental disability from post-traumatic stress disorder. The court granted LINA's motion for summary judgment on the physical disability claim, finding LINA's denial was not arbitrary and capricious based on multiple medical reports. Additionally, LINA was awarded $10,155 on its counterclaim for overpaid benefits. However, the court vacated LINA's rejection of the mental disability claim, deeming it arbitrary and capricious due to the lack of proper medical review, and remanded the matter to LINA for reconsideration, while retaining jurisdiction.

Disability BenefitsERISA LitigationSummary JudgmentArbitrary and Capricious ReviewRemand to AdministratorPost-Traumatic Stress DisorderPhysical Injury ClaimMental Health ClaimInsurance Policy DisputeOverpayment Reimbursement
References
19
Case No. ADJ15951486, ADJ15951487
Regular
Aug 25, 2025

JEFF CRAIL vs. AMTRUST NORTH AMERICA, HARTFORD FIRE INSURANCE COMPANY

The defendant, Amtrust North America and Hartford Fire Insurance Company, filed a Petition for Reconsideration of a Joint Findings of Fact and Orders (F&O) issued on May 20, 2025. The F&O had ordered the replacement of Panel Qualified Medical Examiner (PQME) Dr. Wiseman due to his failure to properly serve his report. The defendant argued that the court improperly interpreted Administrative Director Rule 31.5(a)(12) and that a Declaration of Readiness (DOR) does not constitute both an objection and a request for a replacement panel. The Appeals Board denied the Petition for Reconsideration, affirming the WCJ's decision to replace Dr. Wiseman. The Board's decision cited its en banc ruling in Vazquez v. Inocensio Renteria, reinforcing that a QME's failure to timely issue and serve a report, and engaging in ex parte communication by serving only one party, grants a party the right to seek replacement. The Board also emphasized the informal nature of pleadings in workers' compensation proceedings, as established in Perez v. Chicago Dogs, when addressing the applicant's DOR.

PQMEPetition for ReconsiderationJoint Findings of Fact and OrdersAdministrative Director RuleDeclaration of ReadinessIrreparable HarmMandatory Settlement ConferenceOncology PanelQualified Medical ExaminerProof of Service
References
14
Case No. MISSING
Regular Panel Decision
Sep 28, 1979

Fiat Motors of North America, Inc. v. National Highway Traffic Safety Administration of the Department of Transportation

Plaintiff Fiat Motors of North America, Inc. sought a preliminary injunction to prevent the National Highway Traffic Safety Administration (NHTSA) from holding a hearing concerning alleged defects in Fiat vehicles and a repurchase campaign. Fiat contended it was deprived of adequate notice, an opportunity to present its views, and a hearing before an impartial tribunal. The court, presided over by District Judge Metzner, applied the exhaustion of remedies doctrine, emphasizing that judicial intervention is typically warranted only after a final agency determination. The court denied Fiat's motion, finding that Fiat received reasonable notice, its constitutional claims could be addressed at the hearing and were subject to de novo review, and there was insufficient evidence of agency bias. Consequently, the court ordered the hearing to proceed as scheduled on September 28, 1979.

Preliminary InjunctionAdministrative LawJudicial ReviewExhaustion of RemediesDue ProcessAdequate NoticeImpartial TribunalNational Highway Traffic Safety AdministrationVehicle SafetyProduct Recall
References
9
Case No. ADJ3393930 (AHM 0089017) ADJ2735537 (AHM 0094395)
Regular
May 06, 2013

DAVID CARMONA vs. BMW OF NORTH AMERICA, ZURICH NORTH AMERICA, FIREMAN'S FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration in *Carmona v. BMW of North America*, finding the Workers' Compensation Judge's (WCJ) report insufficient. The WCAB rescinded the WCJ's prior decision and returned the case for further proceedings and a new decision. While the WCJ intended to correct a clerical error regarding cumulative trauma dates, the WCAB felt further development of the record was needed on temporary total disability, but not apportionment related to Dr. Stewart. This is not a final decision on the merits.

DAVID CARMONABMW OF NORTH AMERICAZURICH NORTH AMERICAFIREMAN'S FUNDWORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONADMINISTRATIVE LAW JUDGECLERICAL ERRORCUMULATIVE TRAUMATEMPORARY TOTAL DISABILITY
References
0
Case No. MISSING
Regular Panel Decision

Town of North Hempstead v. Village of North Hills

Plaintiffs, including the Town of North Hempstead, homeowners, and residents, initiated an action against various Village defendants to enforce federal environmental laws, challenging land use and zoning decisions, specifically the downzoning of certain parcels in the Village of North Hills. Frank Martucci and Roslyn Pines, Inc., owners of a significantly affected 29.1-acre tract, sought to intervene as defendants, citing their direct interest in the property and the potential negative impact of the lawsuit on their development plans and economic interests. Plaintiffs opposed their intervention, primarily on technical grounds regarding the sufficiency of their application. The court ultimately granted the motion to intervene, finding that Martucci and Roslyn Pines, Inc. met all requirements of Rule 24(a), F.R.Civ.P., as their interests were not adequately represented by the existing governmental defendants and their active participation would ensure a more robust presentation of the economic arguments pertinent to the case.

Environmental LawLand UseZoningIntervention as of RightRule 24(a) F.R.Civ.P.Real EstateProperty RightsAdequate RepresentationEconomic InterestsMunicipal Law
References
7
Case No. ADJ10385904
Regular
Apr 21, 2017

DANIEL THOMAS vs. BIOLOGICAL TECHNOLOGY, AMTRUST NORTH AMERCA

This case concerns Daniel Thomas's workers' compensation claim against Biological Technology and Amtrust North America. The Workers' Compensation Appeals Board denied Thomas's petition for reconsideration, adopting the WCJ's report. The Board gave great weight to the WCJ's credibility determinations and found no substantial evidence to reject them. Crucially, the Board determined that Thomas failed to meet his burden under Labor Code Section 3600(a)(10) to demonstrate his claim was not barred by a layoff or termination notice.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationsLabor Code § 3600(a)(10)notice of termination or layoffpsychiatric injuriesevidence of injurymedical recordsdate of injurypreponderance of the evidence
References
1
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