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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

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
Case No. MISSING
Regular Panel Decision

Deluca v. Arch Insurance Group

This case involves an appeal from an order and judgment concerning an arbitration award. The Supreme Court, Suffolk County, confirmed an arbitration award dated December 12, 2011, in favor of the petitioner, and denied a cross-petition by Arch Insurance Group and Gallagher Bassett Services to vacate the award. Arch Insurance Group and Gallagher Bassett Services appealed this decision. The appellate court dismissed the appeal from the intermediate order dated June 5, 2012, as the right of direct appeal terminated with the entry of judgment. The court affirmed the judgment, finding the petitioner's service of the demand for arbitration proper and noting that insufficiencies did not warrant vacatur. The arbitrator's award was found to have evidentiary support and a rational basis, and was not duplicative of any worker’s compensation benefits. One bill of costs was awarded to the petitioner.

Arbitration ConfirmationArbitration Award VacaturCPLR Article 75Appellate ReviewInsurance ArbitrationUninsured MotoristUnderinsured MotoristEvidentiary SupportArbitrary and Capricious StandardSufficiency of Arbitration Demand
References
9
Case No. 25 NY3d 907
Regular Panel Decision
2015-XX-XX

Government Employees Insurance v. Avanguard Medical Group, PLLC

This case addresses whether no-fault insurance carriers are obligated to pay facility fees to New York State-accredited office-based surgery (OBS) centers for the use of their premises and support services. The court concluded that neither existing statutes nor regulations mandate such payments. Plaintiffs, a group of GEICO insurers, successfully sought a declaratory judgment that they are not legally required to reimburse Avanguard Medical Group, PLLC, for OBS facility fees, totaling over $1.3 million. The decision affirmed the Appellate Division's ruling, emphasizing that OBS facility fees are not explicitly covered by statute or fee schedules, nor do they fall under reimbursable "professional health services" as per 11 NYCRR 68.5. The court highlighted the distinct regulatory frameworks for OBS centers compared to hospitals and ambulatory surgery centers, declining to mandate policy changes best left to the legislature.

No-Fault InsuranceOffice-Based Surgery (OBS)Facility FeesInsurance LawBasic Economic LossFee SchedulesWorkers' Compensation BoardDepartment of Financial ServicesStatutory InterpretationRegulatory Framework
References
16
Case No. MISSING
Regular Panel Decision
May 12, 1995

Wausau Underwriters Insurance v. Continental Casualty Co.

This case addresses a dispute between Wausau Underwriters Insurance Company (Wausau) and Continental Casualty Company (Continental), along with The Hartford Insurance Group. Wausau, as the employer's liability carrier for H. Sand & Company, successfully argued that a third-party action by Slattery-Argrett, subrogor of Continental, against H. Sand & Company, constituted an impermissible subrogation claim by an insurer against its own insured. The underlying matter involved a personal injury sustained by an employee of H. Sand & Company. Continental had initially disclaimed coverage for Sand in the third-party action. The Supreme Court granted Wausau's motion for summary judgment, declaring the subrogation action a violation of public policy and awarding Wausau damages. The appellate court affirmed this judgment, distinguishing the present case from prior rulings like *North Star Reins. Corp. v Continental Ins. Co.*, and emphasizing the distinction between claims for indemnification and contribution within insurance policy exclusions.

Subrogation ClaimInsurance Coverage DisputeIndemnification vs. ContributionPublic Policy in InsuranceSummary JudgmentEmployer LiabilityGeneral Liability InsuranceExcess Liability InsuranceConstruction AccidentWorkers' Compensation Carrier
References
9
Case No. MISSING
Regular Panel Decision
May 17, 2011

Avrio Group Surveillance Solutions, Inc. v. Essex Insurance

Plaintiff Avrio Group Surveillance Solutions commenced a declaratory judgment action against Defendant Essex Insurance Company, seeking an order to defend and indemnify Avrio in a personal injury action. Essex filed a motion to dismiss, which was converted to a motion for summary judgment. The court addressed two main exclusions: the Completed Operations Exclusion and the Contractual Liability Exclusion. The court found a potentiality of coverage under the Completed Operations Exclusion due to ambiguities in the term "intended use" and unresolved factual issues regarding the completion of work, denying summary judgment on this ground. However, the court granted summary judgment in favor of Essex regarding the Contractual Liability Exclusion, as the subcontract did not qualify as an "insured contract" under the policy's specific definition in effect at the time of the incident, and Avrio was presumed to have agreed to these terms. The case will proceed to an evidentiary hearing on the Completed Operations Exclusion.

Insurance CoverageDeclaratory JudgmentSummary JudgmentContractual Liability ExclusionCompleted Operations ExclusionInsurance Policy InterpretationChoice of LawMaryland Contract LawFederal Civil ProcedureDuty to Defend
References
37
Case No. 2012 NY Slip Op 30642(U)
Regular Panel Decision
Mar 08, 2012

Markel Insurance v. American Guarantee & Liability Insurance

Markel Insurance Company and New Empire Group, Ltd. (NEG) appealed an order dismissing their claims for legal malpractice and common-law indemnification against Rebore Thorpe & Pisarello, P.C. The claims originated from an underlying personal injury action where Rebore represented the American Gardens defendants, who faced an insurance coverage disclaimer by American Guarantee and Liability Insurance Company (AGLIC) due to alleged untimely notice. Markel, acting on behalf of NEG, contributed to the settlement of the underlying action following AGLIC's disclaimer. The Supreme Court dismissed the claims, reasoning that the American Gardens defendants suffered no ascertainable damages from the alleged malpractice and that Markel's payment for indemnification was voluntary. The appellate court affirmed this decision, concluding that the complaint failed to establish damages for legal malpractice or a non-voluntary payment necessary for common-law indemnification.

Legal MalpracticeCommon-Law IndemnificationMotion to DismissCPLR 3211 (a) (7)Ascertainable DamagesVoluntary Payment DoctrineSubrogationInsurance Coverage DisclaimerTimely NoticeAppellate Review
References
12
Case No. CA 13-00513
Regular Panel Decision
May 09, 2014

DRYDEN MUTUAL INSURANCE COMPANY v. GOESSL, STANLEY

Plaintiff Dryden Mutual Insurance Company initiated an action seeking a declaration that it was not obligated to defend or indemnify Stanley Goessl in an underlying tort action, which arose from a fire during plumbing work. Defendants AP Daino & Plumbing, Inc. and its insurer, The Main Street America Group, also denied coverage for Goessl. The Supreme Court initially ruled in favor of Dryden Mutual and against Main Street America Group. However, the Appellate Division reversed this judgment, declaring that Dryden Mutual is obligated to defend and indemnify Goessl and reimburse his attorney's fees, based on his status as a sole proprietor insured by them. Conversely, The Main Street America Group was found to have no duty to defend or indemnify Goessl, as he was deemed an independent contractor, not an employee of AP Daino, according to their policy's plain meaning and their business arrangement. Sconiers, J., dissented, arguing that the trial court's finding of Goessl as an employee should have been upheld.

Insurance coverage disputeBusiness liabilityIndependent contractor classificationEmployee statusDuty to indemnifyDuty to defendSubcontracting agreementDeclaratory judgment actionAppellate review of judgmentContract interpretation
References
22
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. ADJ11391724, ADJ11391757
Regular
Oct 03, 2019

PABLO LOPEZ DURAN vs. SOUTH HILLS ACADEMY, CHURCH MUTUAL INSURANCE COMPANY, SECURITY NATIONAL INSURANCE COMPANY, AMTRUST NORTH AMERICA, CRESCENT HOTELS & RESORTS, LLC, CHUBB INSURANCE GROUP, GALLAGHER BASSETT SERVICES, INC.

This Workers' Compensation Appeals Board case involves applicant Pablo Lopez Duran and multiple defendants including South Hills Academy, Church Mutual Insurance Company, Security National Insurance Company, Crescent Hotels & Resorts, LLC, and Chubb Insurance Group. The Board granted a petition for reconsideration and affirmed a prior order regarding sanctions and costs. Specifically, Chubb Insurance Group, administered by Gallagher Bassett Services, Inc., was ordered to pay an additional $395 for attorneys' fees related to a petition for fees, less any credit for prior payments.

WORKERS' COMPENSATION APPEALS BOARDSOUTH HILLS ACADEMYCHURCH MUTUAL INSURANCE COMPANYSECURITY NATIONAL INSURANCE COMPANYAMTRUST NORTH AMERICACRESCENT HOTELS & RESORTSLLCCHUBB INSURANCE GROUPGALLAGHER BASSETT SERVICESINC.
References
0
Case No. LAO 0834414
Regular
Mar 03, 2008

NATASHA FANE vs. PRIME CLINICAL SYSTEMS, INC., EVEREST NATIONAL INSURANCE, ARGONAUT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted Everest's petition for reconsideration, rescinded a prior order, and remanded the case for further proceedings to determine contribution liability between Everest and Argonaut. Argonaut's petition for reconsideration was dismissed as it was not a final order, but its petition for removal was granted, rescinding an improperly issued joinder order and issuing a new order joining Argonaut as a party defendant. The Board clarified that contribution proceedings under Labor Code section 5500.5(e) can be initiated after a settlement and that Argonaut, having been notified, may not be bound by prior evidentiary records.

Workers' Compensation Appeals BoardNatasha FanePrime Clinical SystemsInc.Everest National InsuranceArgonaut Insurance CompanyContributionLabor Code section 5500.5(b)Labor Code section 5500.5(e)Compromise and Release
References
0
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