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

Case No. 2014 NY Slip Op 08848 [123 AD3d 933]
Regular Panel Decision
Dec 17, 2014

Public Service Mutual Insurance v. Fiduciary Insurance Co. of America

This case involves an appeal by Fiduciary Insurance Company of America (appellant) from an order and judgment confirming an arbitration award in favor of Public Service Mutual Insurance Company (respondent), as subrogee of Peter Daversa. The Supreme Court, Queens County, granted the petition to confirm and denied Fiduciary's cross-petition to vacate the arbitration award. The Appellate Division, Second Department, dismissed the appeal from the intermediate order, finding it merged into the judgment, and affirmed the judgment. The court applied closer judicial scrutiny to the compulsory arbitration award, determining that the arbitrator's decision had ample evidentiary support and was not arbitrary or capricious. The appellant's contentions regarding proximate cause, burden of proof, and prejudgment interest were found to be without merit.

Arbitration Award ConfirmationInsurance SubrogationAppellate ReviewJudicial ScrutinyEvidentiary SupportArbitrator's DeterminationProximate CausationBurden of ProofPrejudgment InterestCPLR Article 75 Proceeding
References
8
Case No. MISSING
Regular Panel Decision

Stellar Mechanical Services of New York, Inc. v. Merchants Insurance of New Hampshire

This case involves an appeal concerning an insurance dispute over the duty to defend and indemnify. The plaintiff, Stellar Mechanical Services of New York, Inc., sought a declaratory judgment against Merchants Insurance of New Hampshire, claiming primary insurer obligations in an underlying personal injury action. Stellar, insured by American Empire Surplus Lines Insurance Company, had subcontracted duct work to Serge Duct Design, which was insured by Merchants. Serge was obligated to name Stellar as an additional insured. After a worker's injury and subsequent lawsuit, Merchants disclaimed coverage. The appellate court modified the lower court's order, ruling that Merchants is obligated as the primary insurer to defend Stellar from the time the second amended complaint was served, but not to indemnify Stellar. The case was remitted to the Supreme Court, Queens County, for an assessment of costs incurred by American Empire Surplus Lines Insurance Company.

Insurance CoverageAdditional Insured StatusDuty to DefendDuty to IndemnifyPrimary InsurerExcess InsurerSummary JudgmentContract LawSubcontract AgreementPersonal Injury Action
References
13
Case No. MISSING
Regular Panel Decision

Brentwood Pain & Rehabilitation Services, P.C. v. Allstate Insurance

This opinion addresses whether Magnetic Resonance Imaging (MRI) procedures are subject to the same fee limitations as X-rays under New York's no-fault auto insurance law. Plaintiffs, a group of MRI service providers ("Providers"), argued that applying x-ray fee schedules to MRIs is improper and violates insurance contracts. Defendants, numerous insurance companies ("Insurers"), along with the New York State Workers’ Compensation Board (WCB) and Department of Insurance (DOI), contended that the fee limitations for multiple diagnostic x-ray procedures (Ground Rule 3 of the WCB Fee Schedule) should also apply to MRIs. The court, deferring to the interpretations of the WCB and DOI, found their application of Ground Rule 3 to MRIs to be reasonable. Consequently, the court granted the Insurers' motion for summary judgment, denied the Providers' cross-motion for summary judgment, and denied the Providers' motion for class certification as moot.

MRIX-rayNo-Fault InsuranceFee ScheduleWorkers' Compensation BoardDepartment of InsuranceRegulatory InterpretationSummary JudgmentClass ActionDiagnostic Imaging
References
35
Case No. MISSING
Regular Panel Decision

Albany Truck Rental Service, Inc. v. New Hampshire Merchants Insurance

This case involves an appeal from a declaratory judgment action to determine insurance coverage obligations following a fatal tractor-trailer accident. The accident killed Michael L. Bennekin, a passenger and co-employee of the driver, David L. Sinnamon, both employed by the NYS Department of Correctional Services, which had leased the tractor from Albany Truck. Travelers insured Albany Truck, while Merchants insured the Department. Bennekin's estate initially sued Sinnamon, Albany Truck, and General Tire. Sinnamon was dismissed due to workers' compensation exclusivity, insulating Albany Truck from vicarious liability for Sinnamon's negligence but not its own independent negligence. The court affirmed the Special Term's ruling that Travelers is the primary insurer and Merchants is the secondary/excess insurer for Albany Truck's independent negligence. However, the court reversed the Special Term's decision to refer attorneys' fees for factual determination, concluding that no fees could be allowed as Sinnamon did not incur them to the Attorney-General.

Insurance coveragePrimary and excess insuranceDuty to defendWorkers' Compensation LawCo-employee defenseDeclaratory judgmentVicarious liabilityIndependent negligenceMotor vehicle accidentBreach of contract
References
10
Case No. 2018 NY Slip Op 08737
Regular Panel Decision
Dec 20, 2018

NYAHSA Servs., Inc., Self-Insurance Trust v. Recco Home Care Servs., Inc.

This case concerns an appeal from an order of the Supreme Court in Albany County. Plaintiff NYAHSA Services, Inc., Self-Insurance Trust, a self-insured trust providing workers' compensation coverage, sued defendant Recco Home Care Services, Inc. for unpaid adjustments after the defendant terminated its membership. Following an amendment to the complaint adding individual trustees as plaintiffs, the defendant asserted counterclaims for fraud, breach of fiduciary duty, and negligence against these trustees, which the Supreme Court dismissed as time-barred. The defendant also sought to amend its answer to include a counterclaim under General Business Law, which was denied. The Appellate Division, Third Department, found that the Supreme Court erred in dismissing the counterclaims for fraud and breach of fiduciary duty and in denying the cross-motion to amend for the General Business Law claim. Consequently, the Appellate Division modified the Supreme Court's order, reversing parts of the dismissal and denial, and affirmed the order as modified.

Workers' Compensation CoverageSelf-Insurance TrustFraud AllegationsBreach of Fiduciary DutyGeneral Business LawStatute of LimitationsAmended PleadingsCounterclaimsAppellate ReviewMotion to Dismiss
References
2
Case No. MISSING
Regular Panel Decision

Perfect Dental, PLLC v. Allstate Insurance

In this consolidated action, plaintiffs Perfect Dental Care, P.C., Zodiac Dental, PLLC, and Smooth Dental PLLC (Dental PCs) sought unpaid insurance claims from Allstate Insurance Company and State Farm Mutual Automobile Insurance Company (Insurers). The Insurers countersued alleging insurance fraud and unjust enrichment, and initiated a third-party action against various individuals and entities. The Insurers moved for partial summary judgment, seeking a declaratory judgment that Dental PCs could not recover for services provided by dentists and physical therapists, and for summary judgment on their fraud and unjust enrichment counterclaims. The court denied summary judgment concerning dentists' services, finding a triable issue of fact regarding their employment status. However, it granted summary judgment for the Insurers regarding physical therapy services, as Dental PCs conceded these services were provided by non-employees. Consequently, the court also denied summary judgment on the fraud and unjust enrichment claims, as their resolution depended on the unresolved employment status of the dentists.

Insurance ClaimsHealthcare ServicesContract LawSummary JudgmentProfessional CorporationsIndependent ContractorsEmployment LawFraud AllegationsUnjust EnrichmentDeclaratory Judgment
References
17
Case No. 06 Civ. 3994(DC)
Regular Panel Decision
Sep 14, 2007

BRENTWOOD PAIN & REHABILITATION SERV. v. Allstate Ins. Co.

The case examines whether Magnetic Resonance Imaging (MRI) charges fall under the same discounted fee schedule rules as x-rays for multiple body parts under New York's no-fault auto insurance law. Plaintiffs, MRI service providers, contested the application of Workers' Compensation Board (WCB) Radiology Ground Rule 3 to MRIs, arguing the rule specifically mentions only x-rays. Defendant insurance companies, supported by interpretations from the Department of Insurance (DOI) and WCB, asserted the rule's applicability to MRIs. The U.S. District Court for the Southern District of New York granted summary judgment to the insurers, deferring to the agencies' "rational" and "reasonable" interpretation. The court concluded that applying the discount rule to MRIs aligns with the No-Fault Law's objectives to control costs and prevent fraud, thus denying the providers' motions.

No-Fault InsuranceMRIX-rayFee ScheduleRadiologyWorkers' Compensation BoardDepartment of InsuranceAgency DeferenceStatutory InterpretationSummary Judgment
References
25
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. 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. MISSING
Regular Panel Decision

Integrated Construction Services, Inc. v. Scottsdale Insurance

Integrated Construction Services, Inc. (Integrated) purchased a commercial general liability policy from Scottsdale Insurance Company (Scottsdale). Integrated received delayed and initially incorrect notifications about a worker's injury. After clarifying details, Integrated notified Scottsdale, which denied coverage citing late notice. Integrated then filed a declaratory judgment action to compel Scottsdale to defend and indemnify it. Scottsdale's motion to dismiss the complaint was denied by the Supreme Court. On appeal, the order denying dismissal was affirmed, as Integrated adequately pleaded reasonable delay and Scottsdale's documentary evidence was insufficient to refute the claim.

Commercial General LiabilityInsurance PolicyDuty to DefendDuty to IndemnifyLate NoticeDeclaratory JudgmentMotion to DismissCPLR 3211(a)(1)CPLR 3211(a)(7)Documentary Evidence
References
10
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