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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

Americredit Financial Services, Inc. v. Oxford Management Services

AmeriCredit Financial Services, Inc. (AmeriCredit) commenced an action to confirm an arbitration award against Oxford Management Services (OMS). OMS cross-moved to vacate the award, alleging the arbitrator exceeded his powers by dismissing a counterclaim and manifestly disregarded the law. The arbitrator had dismissed OMS's counterclaim for spoilation of evidence. The Court affirmed the arbitrator's decision, finding he did not exceed his authority under the RSA by dismissing the counterclaim or by interpreting the contract terms regarding account termination. The Court also found no manifest disregard for the law, concluding the arbitrator's decision was rationally supported by the record. Consequently, AmeriCredit's motion to confirm the award was granted, and OMS's motion to vacate was denied.

Arbitration Award ConfirmationArbitration Award VacaturFederal Arbitration ActManifest Disregard of LawArbitrator PowersSpoilation of EvidenceContract InterpretationCollection Agency DisputeSummary ProceedingJudicial Review of Arbitration
References
41
Case No. 2014 NY Slip Op 08848 [123 AD3d 933]
Regular Panel Decision
Dec 17, 2014

Public Service Mutual Insurance v. Fiduciary Insurance Co. of America

This case involves an appeal by Fiduciary Insurance Company of America (appellant) from an order and judgment confirming an arbitration award in favor of Public Service Mutual Insurance Company (respondent), as subrogee of Peter Daversa. The Supreme Court, Queens County, granted the petition to confirm and denied Fiduciary's cross-petition to vacate the arbitration award. The Appellate Division, Second Department, dismissed the appeal from the intermediate order, finding it merged into the judgment, and affirmed the judgment. The court applied closer judicial scrutiny to the compulsory arbitration award, determining that the arbitrator's decision had ample evidentiary support and was not arbitrary or capricious. The appellant's contentions regarding proximate cause, burden of proof, and prejudgment interest were found to be without merit.

Arbitration Award ConfirmationInsurance SubrogationAppellate ReviewJudicial ScrutinyEvidentiary SupportArbitrator's DeterminationProximate CausationBurden of ProofPrejudgment InterestCPLR Article 75 Proceeding
References
8
Case No. MISSING
Regular Panel Decision

Stellar Mechanical Services of New York, Inc. v. Merchants Insurance of New Hampshire

This case involves an appeal concerning an insurance dispute over the duty to defend and indemnify. The plaintiff, Stellar Mechanical Services of New York, Inc., sought a declaratory judgment against Merchants Insurance of New Hampshire, claiming primary insurer obligations in an underlying personal injury action. Stellar, insured by American Empire Surplus Lines Insurance Company, had subcontracted duct work to Serge Duct Design, which was insured by Merchants. Serge was obligated to name Stellar as an additional insured. After a worker's injury and subsequent lawsuit, Merchants disclaimed coverage. The appellate court modified the lower court's order, ruling that Merchants is obligated as the primary insurer to defend Stellar from the time the second amended complaint was served, but not to indemnify Stellar. The case was remitted to the Supreme Court, Queens County, for an assessment of costs incurred by American Empire Surplus Lines Insurance Company.

Insurance CoverageAdditional Insured StatusDuty to DefendDuty to IndemnifyPrimary InsurerExcess InsurerSummary JudgmentContract LawSubcontract AgreementPersonal Injury Action
References
13
Case No. MISSING
Regular Panel Decision

Brentwood Pain & Rehabilitation Services, P.C. v. Allstate Insurance

This opinion addresses whether Magnetic Resonance Imaging (MRI) procedures are subject to the same fee limitations as X-rays under New York's no-fault auto insurance law. Plaintiffs, a group of MRI service providers ("Providers"), argued that applying x-ray fee schedules to MRIs is improper and violates insurance contracts. Defendants, numerous insurance companies ("Insurers"), along with the New York State Workers’ Compensation Board (WCB) and Department of Insurance (DOI), contended that the fee limitations for multiple diagnostic x-ray procedures (Ground Rule 3 of the WCB Fee Schedule) should also apply to MRIs. The court, deferring to the interpretations of the WCB and DOI, found their application of Ground Rule 3 to MRIs to be reasonable. Consequently, the court granted the Insurers' motion for summary judgment, denied the Providers' cross-motion for summary judgment, and denied the Providers' motion for class certification as moot.

MRIX-rayNo-Fault InsuranceFee ScheduleWorkers' Compensation BoardDepartment of InsuranceRegulatory InterpretationSummary JudgmentClass ActionDiagnostic Imaging
References
35
Case No. MISSING
Regular Panel Decision

Government Employees Insurance v. Uptown Health Care Management, Inc.

Plaintiffs GEICO allege a scheme where defendants, including Uptown Health Care Management d/b/a East Tremont, Hisham Elzanaty, Alan Goldenberg, Dr. Hisham Ahmed, and Dr. Jadwiga Pawlowski, fraudulently billed GEICO for millions in services. GEICO contends East Tremont was ineligible for reimbursement under New York's no-fault insurance laws, operating without a legitimate medical director, violating its operating certificate, and paying kickbacks for referrals. The complaint raises six causes of action, including declaratory judgment, RICO violations (18 U.S.C. §§ 1962(c), 1962(d)), common law fraud, aiding and abetting fraud, and unjust enrichment. Defendants moved to dismiss under Rule 12(b)(1) for Burford abstention and Rule 12(b)(6) for failure to state a claim, arguing GEICO's claims would invalidate a DOH license and interfere with state oversight. Citing the similar Allstate Ins. v. Elzanaty action, the court denied defendants' motions, affirming that insurers can challenge fraudulent licensing and conduct under RICO and fraud claims, even if state authorities have approved the facility. The court concluded that such claims do not disrupt New York's regulatory scheme and need not be raised exclusively with the DOH or through an Article 78 proceeding.

Insurance FraudNo-Fault InsuranceRICO ActMedical LicensingHealthcare FraudAbstention DoctrineRule 12(b)(1) MotionRule 12(b)(6) MotionArticle 28 FacilitiesKickbacks
References
21
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. ADJ4153143, ADJ1964837 and ADJ1933860
Regular
Nov 05, 2010

JACK L. MARCUM vs. OUTSOURCE MANAGEMENT, INC. dba THE MANAGEMENT CONNECTION, SUPERIOR NATIONAL INSURANCE CO., now liquidation, administered by CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, KLEEGE INDUSTRIES, INC. dba HANDS-ON EVENT LABOR SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant who sustained shoulder injuries in 1999 and 2000, with a compensation judge awarding 4% permanent disability. The California Insurance Guarantee Association (CIGA) is appealing a decision holding it liable, arguing the applicant was not employed by a company insured by Legion Insurance (now handled by CIGA) but rather by Kleege Industries, insured by SCIF. CIGA contended there was a general/special employment relationship and that SCIF's policy should cover the applicant. The Appeals Board granted reconsideration, affirmed the previous awards, and corrected a clerical error to accurately reflect Legion Insurance as the insurer for Outsource Management, Inc. during the relevant period.

California Insurance Guarantee AssociationLegion Insurance CompanyOutsource Management Inc.The Management ConnectionKleege Industries Inc.Hands-On Event Labor ServicesState Compensation Insurance Fundcumulative traumaright shoulder injurypermanent disability
References
1
Case No. MISSING
Regular Panel Decision
Jul 26, 2000

AIU Insurance v. Unicover Managers, Inc.

This case involves plaintiff insurance companies, AIG, seeking a declaration that defendant ReliaStar Life Insurance Company was bound to reinsure AIG for certain workers' compensation risks based on reinsurance slips signed by Unicover Managers, Inc., ReliaStar's managing general underwriter. The Supreme Court, New York County, dismissed AIG's complaint against ReliaStar and Unicover, and ReliaStar's third-party complaint against E.W. Blanch Company. The appellate court affirmed the dismissal, finding that the parties' correspondence and conduct established that reinsurance would only be bound upon ReliaStar's own signature, negating any actual or apparent authority of Unicover or ratification by ReliaStar. Estoppel and misrepresentation claims against both defendants were also dismissed. The judgment was modified to explicitly dismiss all remaining cross claims and counterclaims, and the initial dismissal was otherwise affirmed.

Reinsurance AgreementSummary JudgmentContract InterpretationAgency AuthorityApparent AuthorityRatificationEstoppelMisrepresentationWorkers' Compensation RisksCross Claims
References
3
Case No. MISSING
Regular Panel Decision

Albany Truck Rental Service, Inc. v. New Hampshire Merchants Insurance

This case involves an appeal from a declaratory judgment action to determine insurance coverage obligations following a fatal tractor-trailer accident. The accident killed Michael L. Bennekin, a passenger and co-employee of the driver, David L. Sinnamon, both employed by the NYS Department of Correctional Services, which had leased the tractor from Albany Truck. Travelers insured Albany Truck, while Merchants insured the Department. Bennekin's estate initially sued Sinnamon, Albany Truck, and General Tire. Sinnamon was dismissed due to workers' compensation exclusivity, insulating Albany Truck from vicarious liability for Sinnamon's negligence but not its own independent negligence. The court affirmed the Special Term's ruling that Travelers is the primary insurer and Merchants is the secondary/excess insurer for Albany Truck's independent negligence. However, the court reversed the Special Term's decision to refer attorneys' fees for factual determination, concluding that no fees could be allowed as Sinnamon did not incur them to the Attorney-General.

Insurance coveragePrimary and excess insuranceDuty to defendWorkers' Compensation LawCo-employee defenseDeclaratory judgmentVicarious liabilityIndependent negligenceMotor vehicle accidentBreach of contract
References
10
Case No. MISSING
Regular Panel Decision

57th Street Management Corp. v. Zurich Insurance

The plaintiff, 57th Street Management Corp., sought a judgment declaring that Zurich Insurance Company, the defendant, had a duty to defend and indemnify it in an underlying negligence action initiated by an injured employee, Isaac Wilner, and a subsequent third-party action by Bade Cab Corp. Wilner was injured in 1984, received workers' compensation benefits from a policy issued by Zurich, and later sued 57th Street Management Corp. and Bade Cab Corp. The action against 57th Street Management Corp. was dismissed due to Workers' Compensation Law § 11. Bade Cab Corp. then served a third-party summons on the plaintiff. The Appellate Division reversed the Supreme Court's order, granting Zurich's cross motion for summary judgment. The court found that the plaintiff failed to provide timely notice to Zurich of the personal injury action, vitiating coverage, and that notice of the workers' compensation claim did not serve as notice for subsequent actions.

Insurance CoverageDuty to DefendDuty to IndemnifySummary Judgment AppealTimely Notice RequirementWorkers' Compensation ExclusivityThird-Party LiabilityNew York Appellate LawEmployer's Liability InsuranceVitiation of Coverage
References
5
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