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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Dec 29, 2009

Admiral Insurance v. American Empire Surplus Lines Insurance

This case is an appeal from an order of the Supreme Court, New York County, concerning a dispute over insurance coverage and equitable contribution. Plaintiff Admiral Insurance Company sought reimbursement from defendants Scottsdale Insurance Company and American Empire Surplus Lines Insurance Company (AEI) for its share of a $2.3 million settlement in an underlying personal injury action. The underlying action involved an employee of B&R Rebar Consultants, Inc. (B&R) who was injured on a construction site, leading to a verdict against Cross Country Contracting, LLC (Cross Country), an additional insured under B&R's policies. The Appellate Division modified the lower court's decision, denying the defendants' motions and cross-motions. It granted Admiral summary judgment, ruling that Cross Country was entitled to coverage as an additional insured under policies issued by AEI and Scottsdale to B&R. Consequently, Admiral was awarded reimbursement of $566,667 from AEI and $150,000 from Scottsdale, plus interest, with costs to Admiral.

Insurance CoverageAdditional InsuredSummary JudgmentEquitable ContributionExcess InsurancePrimary InsuranceArising Out Of ClauseConstruction AccidentPersonal InjuryAppellate Review
References
5
Case No. MISSING
Regular Panel Decision

Claim of Surianello v. Consolidated Edison Co. of New York, Inc.

The claimant, an electrical construction mechanic, developed lung disease after working at the World Trade Center (WTC) site. He filed workers' compensation claims, and was eventually found permanently totally disabled. The self-insured employer sought reimbursement from the Special Disability Fund, arguing a preexisting lung condition contributed to the disability. The Workers’ Compensation Board denied reimbursement, concluding the disability was solely caused by WTC site exposure. However, the appellate court reversed, citing medical evidence from pulmonologists Carl Friedman and Neil Schacter, which indicated the claimant's overall disability was materially and substantially greater due to a preexisting restrictive lung disease, not just WTC exposure. The case was remitted to the Board for further proceedings.

WTC Site ExposureOccupational Lung DiseaseSpecial Disability FundReimbursement ClaimPreexisting Medical ConditionPermanent Total DisabilityCausationMedical Expert OpinionAppellate ReviewWorkers' Compensation Board
References
7
Case No. ADJ1019651 (ANA 0350140)
Regular
Mar 08, 2010

MARILYN FORKNER vs. APRIA HEALTHCARE/AIG CLAIMS SERVICES, COMMUNITY DIALYSIS (VIVRA)/ LIBERTY MUTUAL INSURANCE COMPANY

This case involves Apria Healthcare seeking reimbursement from Community Dialysis for workers' compensation benefits paid to an applicant who sustained two separate injuries with distinct employers. The arbitrator denied Apria's petition for contribution, and the Appeals Board affirmed this decision on reconsideration. The Board found that Apria failed to timely raise the issue of combined injuries or file a proper contribution/reimbursement claim before the respective settlements became final. Therefore, Apria's claim for reimbursement was deemed untimely and improper under the applicable Labor Code sections.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for ContributionLabor Code section 3208.2Labor Code section 5500.5(e)Compromise and Release AgreementsCumulative Trauma InjurySpecific InjuryApportionment of LiabilityAgreed Medical Evaluator
References
3
Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
3
Case No. ADJ581749 (VNO 0529719)
Regular
Jul 02, 2012

ARLENE HITE vs. TEPCO (STANDARD ABRASIVES, INC.), EVEREST NATIONAL INSURANCE COMPANY, CLARENDON NATIONAL INSURANCE COMPANY

This case concerns Clarendon National Insurance Company's petition for reconsideration of an arbitrator's contribution award. Clarendon argued it should not be liable for contribution because it was joined as a defendant over a year after the underlying cumulative trauma claim was settled. The Board denied reconsideration, finding that Clarendon received timely actual notice of Everest's contribution claim within one year of the settlement approval. Therefore, despite the delay in formal joinder, Clarendon cannot show prejudice and is liable for its share of the contribution award.

Workers' Compensation Appeals BoardPetition for ContributionLabor Code section 5500.5Cumulative traumaCompromise and releaseOrder of JoinderNunc pro tuncActual noticeTimely noticePrejudice
References
0
Case No. ADJ2022332 (ANA 0334821) ADJ947209 (ANA 0334822)
Regular
Feb 27, 2014

JOHN SHEA vs. PROPSERV, INC., CENTRE INSURANCE. COMPANY., CIGA For CALCOMP, In Liquidation

The California Workers' Compensation Appeals Board affirmed the Arbitrator's decision denying CIGA's requests for contribution and reimbursement from Centre Insurance Company. CIGA stipulated to liability for the injury date in 2000, and the Board found that CIGA's subsequent claims of mistake were untimely and lacked good cause to reopen a final award. The Board emphasized the importance of finality in awards and that CIGA failed to timely raise equitable arguments. Therefore, CIGA's appeal for contribution and reimbursement was unsuccessful.

CIGACalCompContributionReimbursementStipulated AwardGood CauseReopenEquitable ArgumentsPrejudgment InterestDate of Injury
References
4
Case No. MISSING
Regular Panel Decision
Oct 26, 2015

Matter of Newbill v. Town of Hempstead

Claimant, a sanitation crew chief, injured his right ankle and foot at work and was awarded disability benefits. His self-insured employer paid his full weekly wages during a period of disability and timely sought reimbursement for these advanced payments. A Workers’ Compensation Law Judge granted the employer's reimbursement request against a 20% schedule loss of use award for the right foot. The Board affirmed this decision, and the claimant appealed, arguing that reimbursement should not cover periods where no compensation awards were initially made. The court affirmed the Board's decision, reiterating that an employer is entitled to full reimbursement from a schedule loss of use award for advanced wages paid during disability, as schedule awards are not allocable to specific periods of lost work.

Schedule Loss of UseReimbursementAdvanced Wage PaymentsDisability BenefitsEmployer RightsAppellate ReviewWorkers’ Compensation BoardStatutory InterpretationPermanent Partial DisabilityTimely Claim
References
10
Case No. ADJ855136
Regular
Aug 14, 2017

ROSE SANTANA vs. STANFORD UNIVERSITY, ZURICH AMERICAN INSURANCE COMPANY, CIGA, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., RELIANCE INSURANCE COMPANY

In this workers' compensation case, CIGA sought reimbursement for benefits paid, arguing two cumulative trauma injuries were actually one and Zurich was liable. The Appeals Board affirmed the prior denial of CIGA's claim, finding CIGA was judicially estopped from disputing the existence of two distinct cumulative trauma injuries after previously stipulating to them. CIGA also failed to present sufficient medical evidence to prove that both injuries contributed to the need for temporary disability or medical treatment. Therefore, the arbitrator's original decision denying CIGA's petition for contribution/reimbursement was upheld.

Workers' Compensation Appeals BoardCIGAZurich American Insurance CompanyReliance Insurance Companyjudicial estoppelcumulative traumaapportionmentjoint and several liabilitycovered claimsinsolvent insurer
References
8
Case No. MISSING
Regular Panel Decision

Dachille v. Dachille

This matrimonial action addresses motions for temporary maintenance, counsel fees, and other financial relief. The plaintiff sought temporary maintenance, contribution to a Chapter 13 plan note, and counsel fees. The defendant cross-moved for exclusive use of the marital residence, reimbursement for medical insurance, and interim attorney's fees. The court denied the plaintiff's applications for temporary maintenance and contribution, citing income parity and lack of demonstrated need. Exclusive use and occupancy was also denied to the defendant. While both parties' requests for interim counsel fees were denied, the defendant's request for medical insurance reimbursement was granted, and the plaintiff was ordered to pay the marital residence mortgage.

Matrimonial LawTemporary MaintenanceSpousal SupportMarital ResidenceChapter 13 BankruptcyVeterans' Disability BenefitsIncome CalculationEquitable DistributionCounsel FeesExclusive Occupancy
References
20
Case No. MISSING
Regular Panel Decision

International Union of Electrical & Machine Workers v. General Electric Co.

This case involves a dispute between the International Union of Electrical Radio and Machine Workers (Union) and General Electric Company (Company), and Metropolitan Life Insurance Company, concerning a 1966 Pension and Insurance Agreement and its incorporated Insurance Plan. The Union alleged the Company wrongfully rejected sickness and accident claims filed during a strike and, alternatively, sought reimbursement for employee contributions for coverage not provided during the strike. The central issue was the interpretation of clauses governing sickness and accident benefits during voluntary strike absences. The Court found that the Company properly rejected claims for benefits arising more than 31 days into the strike, dismissing the Union's first claim. However, the Court ruled that employees are entitled to reimbursement for the portion of their contributions related to sickness and accident coverage not afforded during the strike, and ordered an assessment of damages if parties cannot agree on the amount.

labour lawcollective bargaining agreementinsurance plansickness and accident benefitsstrikeemployee contributionscontract interpretationunjust enrichmentdamagesfederal court
References
6
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