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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

Yklik Medical Supply, Inc. v. Allstate Insurance

Plaintiff Yklik Medical Supply, Inc., a medical supply provider, sued Allstate Insurance Company to recover $317 in unpaid medical bills for equipment supplied to its assignor, Tammy Agosto. Yklik moved for summary judgment, asserting proper bill submission and Allstate's failure to timely pay or deny the claim. Allstate argued that the charges exceeded the Workers' Compensation fee schedule and that a partial payment had been made. The court found that Yklik established a prima facie case. The central issue was whether Allstate's fee schedule defense was precluded due to its failure to issue a timely denial within 30 days as mandated by Insurance Law § 5106 (a) and 11 NYCRR 65-3.5. The court ruled that since Allstate waited 56 days to send its denial, it was precluded from raising the fee schedule defense, and therefore, summary judgment was granted to the plaintiff.

No-fault insurancesummary judgmenttimely denialfee schedulepreclusion ruleinsurance lawmedical supplybilling practicespersonal injury protectionassignor
References
19
Case No. ADJ1129507
Regular
May 23, 2013

CARLOS LEDESMA vs. CALIFORNIA FURNITURE SUPPLY COMPANY, ZENITH INSURANCE COMPANY

This case involves a petition for reconsideration filed by applicant Carlos Ledesma against California Furniture Supply Company and Zenith Insurance Company. The Workers' Compensation Appeals Board has reviewed the petition and the administrative law judge's report. The Board has adopted the judge's recommendation and ordered the dismissal of the petition for reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeReport and RecommendationDismissalCarlos LedesmaCalifornia Furniture Supply CompanyZenith Insurance CompanyADJ1129507LBO 0384640
References
0
Case No. 2018 NY Slip Op 02232 [159 AD3d 1321]
Regular Panel Decision
Mar 29, 2018

Matter of Larosa v. ABC Supply Co., Inc.

Claimant Stephen Larosa, a crane operator, sought workers' compensation benefits for a right knee injury in April 2015. The employer, ABC Supply Company, Inc., and its carrier controverted the claim, arguing it did not arise from employment. Both a Workers' Compensation Law Judge and the Workers' Compensation Board found the injury to be work-related. The employer appealed this decision to the Appellate Division, Third Department. The Appellate Division affirmed the Board's decision, concluding that substantial evidence supported the finding that Larosa's injury arose out of and in the course of his employment, despite arguments concerning inconsistent accounts, an idiopathic condition, and insufficient medical evidence.

Workers' Compensation ClaimRight Knee InjuryCausally Related InjuryArising Out of EmploymentCourse of EmploymentPresumption of CompensabilityIdiopathic ConditionPreexisting ConditionSubstantial EvidenceAppellate Review
References
10
Case No. ADJ4166687 (AHM 0046295) ADJ1681006 (AHM 0088073)
Regular
Jun 13, 2014

GINA NEVARES vs. McMASTER-CARR SUPPLY COMPANY, TIG/ZENITH INSURANCE COMPANY, ZURICH NORTH AMERICA

This case involves Gina Nevares as the applicant against McMaster-Carr Supply Company and its insurers. The Workers' Compensation Appeals Board (WCAB) considered a Petition for Removal filed in this matter. The WCAB adopted the report of the workers' compensation administrative law judge and ordered the Petition for Removal dismissed. The dismissal is based on the WCJ's report, which is incorporated by reference.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ ReportDismissalGina NevaresMcMaster-Carr Supply CompanyTIG/Zenith Insurance CompanyZurich North AmericaADJ4166687ADJ1681006
References
0
Case No. ADJ8002816, ADJ8316468
Regular
Oct 05, 2016

LORENZO TOSCANO CORONA vs. KOOSHAREM, doing business as SELECT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA), ULLICO CASUALTY INSURANCE COMPANY, ACE AMERICAN INSURANCE COMPANY, RSI HOME PRODUCTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a dispute over workers' compensation coverage where applicant Lorenzo Toscano Corona was injured, allegedly while employed through a staff leasing arrangement between Koosharem (Select Staffing) and RSI Home Products. The Appeals Board granted reconsideration to address arguments by ACE American Insurance Company and Travelers Property Casualty Company that their policies excluded coverage for the applicant. The Board rescinded the prior decision due to the arbitrator's failure to adequately document the proceedings and admitted exhibits as required by law. The matter is returned to the arbitrator to create a proper record and evaluate whether ACE and Travelers' policies contained valid exclusions for the applicant's injuries, considering relevant insurance code provisions and endorsements.

Staff leasingGeneral employerSpecial employerJoint and several liabilityOther insuranceInsurance Code section 1063.1(c)(9)Hold harmless clauseWCAB Rule 10566Hamilton v. Lockheed Corp.Labor Code section 3602(d)
References
6
Case No. 6:09-CV-853
Regular Panel Decision

Utica Mutual Insurance Co. v. Fireman's Fund Insurance Co.

This case details a dispute between Utica Mutual Insurance Company (Utica) and Fireman’s Fund Insurance Company (FFIC) concerning reinsurance contracts, with Utica seeking substantial damages for alleged breach of contract and bad faith. FFIC counterclaimed for rescission of the reinsurance agreements. A central contention revolves around whether Utica's primary liability policies issued to Goulds from 1966-1972 contained aggregate limits for bodily injury, a condition critical to triggering FFIC's reinsurance obligations. The court dismissed Utica's bad faith claim (Count II) and its request for declaratory relief (Count III) but denied all other motions for summary judgment by both parties, including those regarding the 'follow the settlement' doctrine, FFIC's rescission counterclaim, and the timeliness of notice. Consequently, the core breach of contract claim (Count I) and FFIC's counterclaims for rescission are slated to proceed to trial.

Reinsurance DisputeBreach of ContractSummary JudgmentFollow the Settlement DoctrineAggregate LimitsBad Faith ClaimRescissionNotice of ClaimInsurance LawAsbestos Claims
References
56
Case No. CA 10-00545
Regular Panel Decision
Feb 10, 2011

HAHN AUTOMOTIVE WAREHOUSE, INC. v. AMERICAN ZURICH INSURANCE COMPANY

Hahn Automotive Warehouse, Inc. (plaintiff) initiated a breach of contract action against American Zurich Insurance Company and Zurich American Insurance Company (defendants), contending that bills issued under insurance contracts were time-barred. Defendants counterclaimed for damages stemming from plaintiff's alleged breach of these contracts. The Supreme Court partially granted plaintiff's cross-motion, deeming counterclaims for debts arising over six years prior as time-barred. Concurrently, it permitted defendants to utilize a $400,000 letter of credit to satisfy any outstanding debt, including those deemed time-barred. On appeal, the Appellate Division affirmed the use of the letter of credit for time-barred debts, reasoning that the statute of limitations only bars the remedy, not the underlying obligation. The court also affirmed that defendants' counterclaims for debts over six years old were time-barred, as the right to demand payment accrued earlier. Finally, the court modified the order to dismiss plaintiff's second through fourth causes of action. A dissenting opinion argued that the counterclaims were not time-barred, asserting that the cause of action accrued upon demand and refusal of payment, not merely when the right to demand payment existed.

Breach of contractInsurance contractsStatute of limitationsLetter of creditSummary judgmentAppellate reviewContract interpretationTime-barred claimsAccrual of cause of actionRetrospective premiums
References
23
Case No. ADJ8521155
Regular
Sep 02, 2014

VICENTE AGUILAR vs. U-TURN SEVEN CORPORATION, EMPLOYERS COMPENSATION INSURANCE COMPANY, STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) vacated its prior order granting reconsideration and denied the petitions for reconsideration filed by Employers Compensation Insurance Company and Star Insurance Company. The WCAB adopted the WCJ's report, finding Star's petition contained inflammatory and intemperate language that impugned the integrity of the WCJ and the Board. Consequently, the WCAB granted removal on its own motion and issued a notice of intent to sanction Star and its attorney for approximately $1,500 due to these statements.

Workers' Compensation Appeals BoardVicente AguilarU-Turn Seven CorporationEmployers Compensation Insurance CompanyStar Insurance CompanyFindings and Awardcumulative injurybilateral handswristsarms
References
1
Case No. ADJ296202 (MON 0361418) ADJ4645901 (MON 0361419)
Regular
Apr 17, 2009

DERRICK ONYEMELUKWE vs. SYSTEMS SUPPLY STATIONERY, REPUBLIC INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) denied reconsideration in the case of Derrick Onyemulukwe v. Systems Supply Stationery; Republic Indemnity Company. The Board adopted and incorporated the findings of the workers' compensation administrative law judge (WCJ) in its decision. The WCAB gave great weight to the WCJ's credibility findings. Therefore, the petition for reconsideration was denied.

DERRICK ONYEMELUKWESYSTEMS SUPPLY STATIONERYREPUBLIC INDEMNITY COMPANYADJ296202ADJ4645901ORDER DENYING RECONSIDERATIONWORKERS' COMPENSATION APPEALS BOARDWCJ REPORTGARZA V. WORKERS' COMP. APPEALS BD.CREDIBILITY FINDING
References
1
Case No. 06 Civ. 0266; 06 Civ. 3461; 07 Civ. 3258
Regular Panel Decision
Sep 28, 2007

Abbatiello v. Monsanto Co.

This case involves consolidated actions brought by two groups of current and former employees and a group of landowners against General Electric Company (GE) and Monsanto Company (including Solutia, Inc., and Pharmacia Corporation). The plaintiffs allege various tort claims including negligence, breach of warranty, strict liability, fraud, emotional distress, abnormally dangerous activity, medical monitoring, fear of contracting illness, nuisance, and trespass, stemming from exposure to polychlorinated biphenyls (PCBs) from a GE manufacturing facility in Schenectady, New York, where Monsanto supplied PCBs. The defendants moved to dismiss certain claims under Federal Rules of Civil Procedure 12(b)(6) and 9(b). The court granted in part and denied in part the motions to dismiss, upholding claims such as abnormally dangerous activity, intentional infliction of emotional distress, nuisance, medical monitoring, fear of contracting illness, and, for GE, negligence, strict liability, and trespass, while dismissing claims like breach of warranty, fraud, and negligent infliction of emotional distress for various parties.

Toxic TortPCB ContaminationEnvironmental LitigationMotions to DismissStatute of LimitationsStrict LiabilityAbnormally Dangerous ActivityMedical MonitoringFear of IllnessNuisance
References
69
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