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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. 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. MISSING
Regular Panel Decision

Homestead Village Assoc., L.P. v. Diamond State Insurance

Plaintiff Homestead Village Associates, LP sued its insurers, Diamond State Insurance Company and Chubb Insurance Company of New Jersey, seeking a declaratory judgment regarding their duty to defend and indemnify Homestead in a personal injury action. Homestead also sued its insurance broker, Capacity Coverage Company of New Jersey, for breach of contract and negligence due to late notification of the accident. All parties cross-moved for summary judgment. The court granted Diamond's motion, finding Homestead's 16-month delay in notification unreasonable. Chubb's motion was granted in part and denied in part, as the court found late notice from Homestead, but a factual dispute remained regarding Chubb's timely disclaimer. The court also clarified that Chubb's excess policy would not 'drop down' to cover primary obligations and it had no duty to defend. Homestead's and Capacity's cross-motions for summary judgment were denied, with factual disputes remaining regarding a special relationship and Capacity's knowledge of the accident's seriousness.

Insurance Coverage DisputeDeclaratory JudgmentSummary Judgment MotionLate Notice DefenseExcess Insurance PolicyInsurance Broker LiabilityBreach of ContractNegligence ClaimChoice of LawNew York Insurance Law
References
41
Case No. MISSING
Regular Panel Decision

Northbrook Excess & Surplus Insurance v. Chubb Group of Insurance Companies

This declaratory judgment action addresses the hierarchy of excess insurance policies in a situation where one policy is primary for owned vehicles but excess for non-owned, and the second is an umbrella policy covering multiple risks. The case stems from an accident involving a rented van, which led to a $650,000 settlement. After the primary insurer paid $500,000, Chubb Group of Insurance Companies and Northbrook Excess and Surplus Insurance Co. each contributed $75,000, pending a determination of their respective excess coverage obligations. The Supreme Court initially ruled for ratable contribution. However, citing State Farm Fire & Cas. Co. v LiMauro, the appellate court reversed, holding that Northbrook's umbrella policy constitutes a final tier of coverage, not required to contribute ratably with Chubb's excess policy. Consequently, summary judgment was granted to Northbrook, entitling it to a $75,000 reimbursement from Chubb.

Excess InsuranceUmbrella InsuranceDeclaratory JudgmentInsurance Policy InterpretationInsurance Coverage DisputeAutomobile Liability InsuranceNon-Owned VehicleRatable ContributionFinal Tier CoverageSummary Judgment
References
2
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. 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. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
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. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
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
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