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

Case No. 2017 NY Slip Op 04774 [151 AD3d 504]
Regular Panel Decision
Jun 13, 2017

Nationwide Mutual Insurance Co. v. U.S. Underwriters Insurance Co.

This case concerns an insurance coverage dispute where Nationwide Mutual Insurance Company and Artimus Construction Corp., Inc., as subrogees, sought coverage from U.S. Underwriters Insurance Company. The Appellate Division, First Department, affirmed the lower court's decision to dismiss the complaint. The court found that the plaintiffs were collaterally estopped from relitigating insurance coverage issues because these matters had been decided in a prior declaratory judgment action. The majority concluded that Nationwide's subrogor, Artimus, and Artimus's subrogor, Armadillo, had a full and fair opportunity to litigate the coverage issues previously. Furthermore, the court held that the doctrine of res judicata also barred the claims, applying a transactional analysis which dictates that all claims arising from the same transaction that could have been raised in prior litigation are precluded.

Insurance CoverageSubrogationCollateral EstoppelRes JudicataAppellate ReviewDeclaratory JudgmentPersonal Injury ActionEmployer Liability ExclusionLate Notice of ClaimPrivity
References
12
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
May 09, 2008

Continental Casualty Co. v. Employers Insurance Co. of Wausau

This class action for declaratory judgment addresses complex insurance coverage disputes arising from asbestos-related personal injury claims against Robert A. Keasbey Company. Plaintiffs, Continental Casualty Company and American Casualty Company, sought declarations on the interpretation of their general liability and excess insurance policies. The court made various rulings, including that asbestos exposures trigger coverage, that pollution exclusions do not bar coverage, and that class defendants are not subject to certain insurer defenses like laches or statute of limitations. The decision also clarified per-occurrence limits and the scope of coverage for specific excess policies, ultimately outlining the obligations of the insurers for the ongoing asbestos litigation.

Asbestos LitigationInsurance Coverage DisputeDeclaratory Judgment ActionProducts Hazard CoveragePremises Operations CoverageClass Action LawsuitInsurance Policy InterpretationPollution Exclusion ClauseNotice of OccurrenceStatute of Limitations Defense
References
65
Case No. MISSING
Regular Panel Decision
Mar 04, 2011

East 51st Street Crane Collapse Litigation v. Lincoln General Insurance

This Supreme Court order addresses an insurance coverage dispute stemming from a 2008 crane collapse in Manhattan, which led to multiple claims against the property owner, East 51st Street Development Company, LLC. The primary conflict involved insurance companies Lincoln General, AXIS Surplus, and Interstate Fire and Casualty regarding their duty to defend East 51st Street and reimburse Illinois Union Insurance Company for defense costs. Initially, the Supreme Court granted various motions for summary judgment, establishing duties to defend and determining policy priority. However, the appellate court modified the order, denying Lincoln General's assertions of excess coverage and declaring Lincoln General primarily obligated to provide coverage to East 51st Street. Other aspects, such as AXIS and Interstate's duty to share defense costs, and East 51st Street's status as an additional insured, were affirmed.

Insurance Coverage DisputeDuty to DefendDefense Costs ReimbursementPrimary CoverageExcess CoverageSummary Judgment MotionAdditional InsuredCrane Collapse LitigationPolicy InterpretationInsurance Policy Limits
References
9
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
Case No. LAO 0762226, LAO 0762227
Regular
Sep 05, 2007

SHIRLEE DYERLY vs. LAWRY'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, INTERCARE INSURANCE SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY

This case involves a dispute over insurance coverage for an applicant's neck and back injuries sustained across specific and cumulative trauma incidents. The Workers' Compensation Appeals Board (WCAB) is reconsidering an arbitrator's decision that ordered Zurich North America Insurance Company to reimburse the California Insurance Guarantee Association (CIGA) for all benefits paid by the liquidated California Compensation Insurance Company (Cal Comp). The WCAB rescinds the arbitrator's order, ruling that CIGA can only recover the amount Cal Comp would have been entitled to collect had it not been liquidated, not the full amount paid.

CIGACal CompZurichliquidationcontributionreimbursementspecific injurycumulative traumastatute of limitationsjoint findings
References
7
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. 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. MISSING
Regular Panel Decision

Logan Bus Co. v. Discover Property & Casualty Insurance

The plaintiff, Logan Bus Company, Inc., initiated a declaratory judgment action against Discover Property & Casualty Insurance Company to establish Discover's obligation to defend and indemnify Logan in an underlying lawsuit. The underlying action involved a sexual assault perpetrated by a student on another student on a bus owned by Logan, allegedly due to inadequate supervision. Logan appealed two orders from the Supreme Court, Queens County: one denying its motion for summary judgment for coverage and another granting Discover's motion to declare no obligation and dismiss the complaint. The appellate court affirmed both lower court orders, concluding that the "abuse or molestation" endorsement in Logan's insurance policy with Discover explicitly limited coverage to acts committed by "employees" or "volunteer workers." Since the alleged incident was perpetrated by a student, Logan failed to demonstrate a prima facie entitlement to coverage, leading to the affirmation of Discover's non-obligation to defend or indemnify.

Declaratory JudgmentInsurance Policy InterpretationCoverage DisputeAbuse or Molestation EndorsementDuty to DefendDuty to IndemnifySummary JudgmentAppellate ReviewAutomobile InsuranceStudent Assault
References
11
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
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