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

Case No. 03 Civ. 0332(AKH)
Regular Panel Decision
Oct 29, 2004

In Re September 11th Liability Insurance Coverage Cases

This opinion and order addresses two Rule 12(c) motions regarding insurance coverage for the World Trade Center properties following the September 11, 2001, attacks. The Port Authority of New York and New Jersey sought a declaration that it is an "Additional Insured" under Zurich American Insurance Company's policies, while World Trade Center Properties LLC (WTCP) sought a declaration that Zurich is obligated to cover defense costs. The court, presided over by District Judge Hellerstein, denied both motions. It found ambiguity in the binder regarding the Port Authority's "Additional Insured" status, stating that the issue was premature without further discovery. Furthermore, the court held that New York Insurance Regulation 107 does not require rewriting Zurich's binder and policies to include defense costs, considering the unique circumstances, the sophistication of the insured, and the fact that Zurich explicitly excluded defense costs, which Silverstein (WTCP's affiliate) accepted after failing to secure conventional coverage. The court also affirmed supplemental jurisdiction over the insurance claims due to their close relation to the underlying September 11th liability cases.

Insurance CoverageSeptember 11 AttacksWorld Trade CenterRule 12(c) MotionDeclaratory ReliefAdditional Insured StatusDefense CostsInsurance BinderNew York Insurance LawRegulation 107
References
48
Case No. MISSING
Regular Panel Decision

Certain Underwriters at Lloyd's v. KKM INC.

This appeal concerns an insurance claim for a building that collapsed due to corrosion. Appellee KKM, Inc. d/b/a Strand Surplus, the building owner, sought coverage from appellants, Certain Underwriters of Lloyd’s London, after its claim was denied. The trial court deemed the policy terms 'corrosion' and 'decay' ambiguous, submitting the coverage issue to a jury, which found for KKM, Inc. On appeal, the court upheld the trial court's finding of ambiguity and the interpretation that 'Additional Coverage' for hidden decay could override general exclusions. However, the judgment was reversed and remanded because the trial court erred in refusing to instruct the jury on the 'fortuity doctrine,' specifically regarding whether the insured knew or should have known of the ongoing corrosion before the policy was purchased.

Insurance claimBuilding collapsePolicy ambiguityContract interpretationCorrosionHidden decayFortuity doctrineKnown lossLoss in progressJury instructions
References
39
Case No. 07-14-00109-CV
Regular Panel Decision
Jul 06, 2015

Doe 1, Doe 2 and Doe 3 v. National Union Fire Insurance Company of Pittsburgh, PA.

This case involves an appeal from a trial court's summary judgment in favor of National Union Fire Insurance Company of Pittsburgh, PA, concerning a coverage dispute. The insureds, identified as Doe #1, Doe #2, and Doe #3, sought coverage under a commercial general liability (CGL) policy for claims of sexual misconduct. National Union argued that an endorsement (MS #2) replaced the policy's original exclusions with new ones, specifically excluding liability from conduct of a sexual nature. The insureds contended the endorsement's exclusions were ambiguous and only applied to clergy counseling professional liability coverage. The Court of Appeals found the language of the MS #2 endorsement ambiguous, thus reversing the trial court's judgment and remanding the case for further proceedings.

Insurance CoverageCommercial General LiabilityPolicy ExclusionsAmbiguitySummary JudgmentSexual MisconductClergy CounselingAppellate ReviewContract InterpretationTexas Law
References
7
Case No. MISSING
Regular Panel Decision

McLaughlin v. Midrox Insurance

This case involves an appeal concerning an insurance coverage dispute. Plaintiffs sought to compel Midrox Insurance Company to indemnify the Blodgett Brothers Partnerships for a $1 million judgment in an underlying personal injury action. The accident involved a motorcycle operated by plaintiff Charles R. McLaughlin and a pickup truck driven by Ronald Blodgett. Midrox had disclaimed coverage, arguing the accident occurred off insured premises and involved a registered vehicle. The court affirmed the lower court's decision, ruling that the farmowner's policy did provide coverage. The court determined that public roadways used for transporting materials between farm parcels could be considered 'insured premises' and that the pickup truck's agricultural registration did not negate coverage given its exclusive use for farming purposes.

Personal InjuryFarmowner's InsuranceInsurance CoverageAgricultural TruckPolicy InterpretationOff-Premises AccidentPublic RoadwaysSummary JudgmentIndemnificationVehicle and Traffic Law
References
5
Case No. MISSING
Regular Panel Decision

In re the Liquidation of Midland Insurance

Policyholders New York Dock Railway (NYDR) and Brooklyn Eastern District Terminal (BEDT), joined by claimants Buividas and Romacho, moved to confirm a referee's report that found coverage for their claims by the Stock Workers' Compensation Security Fund. The Superintendent of Insurance, as liquidator of Midland Insurance Company, cross-moved to disaffirm the report, arguing against Security Fund coverage based on his interpretation of relevant statutes. The court reviewed the referee's decision, finding it erroneous due to a misinterpretation of legislative history and intent regarding security fund coverage limitations, particularly concerning Chapter 801 amendments. Upholding the Superintendent's rational interpretation, the court denied the motion to confirm and granted the cross-motion to disaffirm, affirming the denial of security fund coverage.

Workers' Compensation Security FundInsurance Coverage DisputeMidland Insurance Company LiquidationFederal Employers' Liability ActJones ActLongshoremen's and Harbor Workers' Compensation ActStatutory InterpretationLegislative HistoryThird-Party IndemnificationEmployer's Liability
References
6
Case No. MISSING
Regular Panel Decision

U. P. Iron Works v. Investors Insurance

Plaintiff insured brought a declaratory judgment action against their insurer, who issued both workers' compensation and general liability policies. The dispute arose after a partner was injured, leading to a third-party products liability action against the partnership. The insurer disclaimed coverage, citing lack of coverage for a direct suit by a partner and late notice of the accident. The court found that coverage existed for the third-party claim, extending it to a partner similar to an employee. Furthermore, the court determined that the notice provided by the insured, though three years after the accident, was not unreasonably late given the complexities involved. Consequently, the court declared the policy to be in full force and effect for the accident.

Declaratory JudgmentInsurance CoverageWorkers' Compensation PolicyGeneral Liability PolicyThird-Party ClaimPartner InjuryEmployee ExclusionLate Notice DisclaimerDuty to DefendSummary Judgment Motion
References
2
Case No. MISSING
Regular Panel Decision

Hayden v. S & W Meat & Poultry

Claimant, a partner in S & W Meat & Poultry, sustained a serious injury. A workers' compensation claim was filed, but the carrier contested coverage, arguing that claimant, as a partner, had not formally elected coverage under Workers' Compensation Law § 54 (8). The Workers' Compensation Board applied estoppel, finding the carrier failed to advise the employer of the election requirement. On appeal, the court reversed this decision, holding that the employer's insurance broker, the Fear agency, was notified of the lack of coverage, and this knowledge is imputed to the employer. The court found insufficient evidence for estoppel and remitted the matter to the Board for further proceedings.

Workers' CompensationEstoppelInsurance CoveragePartnershipAgent LiabilityImputed KnowledgePremium RefundAppellate ReviewRemittalWorkers' Compensation Law § 54 (8)
References
5
Case No. MISSING
Regular Panel Decision

In re Arbitration between Exchange Insurance

This case addresses an underinsurance endorsement's 'Limit of Liability' clause, which permits the petitioner to reduce damages by amounts received from workers' compensation or disability benefits. The Supreme Court incorrectly found paragraph B ambiguous, and the appellate court determined that the petitioner is entitled to an offset for disability benefits. The court distinguished this case from prior rulings where ambiguity arose from the declarations page always reducing coverage. Here, the offset in paragraph B applies only in specific situations, thus avoiding ambiguity. While paragraph A, which creates ambiguity, is unenforceable, paragraph B, concerning disability benefit offsets, remains enforceable. The order is modified to grant the petition in part, allowing an offset for benefits received under General Municipal Law § 207-c, Retirement and Social Security Law § 363, and Federal Social Security disability benefit laws. However, the request for a stay of arbitration was properly denied, as the precise amount of disability benefits to be offset by the respondent remains an unresolved issue.

Underinsurance EndorsementLimit of LiabilityDisability Benefits OffsetWorkers' Compensation BenefitsInsurance Contract AmbiguityPolicy InterpretationGeneral Municipal LawRetirement and Social Security LawArbitration StayAppellate Court Decision
References
6
Case No. MISSING
Regular Panel Decision

Claim of Cerbasi v. County Metal & Glass, Inc.

A claimant injured their left arm while working at a New York construction site for a New Jersey employer insured by New Jersey Manufacturers Insurance Company (NJMIC). A dispute arose regarding coverage, with the Workers’ Compensation Law Judge and Board determining the policy covered the accident because New York was not an explicitly excluded state and NJMIC’s attempt to amend the policy was ineffective. NJMIC appealed, arguing the Board erred in its coverage finding and that Workers’ Compensation Law § 54 (5) notice requirements did not apply to partial cancellations. The Appellate Division affirmed, finding the Board's determination on coverage implicit and that NJMIC failed to demonstrate an effective exclusion or proper cancellation under Workers' Compensation Law § 54 (5). The court also noted NJMIC's argument regarding partial cancellation was unpreserved.

Workers' CompensationInsurance CoveragePolicy ExclusionNew York LawNew Jersey BusinessStatutory ComplianceCancellation NoticeAppellate ReviewJurisdictionLeft Arm Injury
References
9
Case No. ADJ2832796 (SAC 0362707) ADJ1414613 (SAC 0362718)
Regular
Mar 15, 2011

DANIEL WALTERS vs. HOLLAND CUSTOM IRON WORKS, INC., CALIFORNIA INSURANCE COMPANY

This case concerns whether an employer, Holland Custom Iron Works, Inc., had workers' compensation insurance coverage on August 16, 2006, following a notice of cancellation for non-payment. The Appeals Board affirmed an arbitrator's finding that coverage existed, relying on equitable estoppel and the ambiguity of the cancellation notice. The insurer's contention that coverage was contingent on a "gap premium" payment was rejected as exceeding the arbitrator's authority. The Board's decision clarifies that the payment made by the employer was sufficient to rescind the cancellation.

Gap premiumequitable estoppelworkers' compensation insurance coveragecancellation noticerescissionarbitration rulingpayment ambiguityrelianceambiguous languagemonetary default
References
5
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