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Case Law Database

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

Case No. Motions Nos. 5 and 7
Regular Panel Decision
Jul 27, 1978

Rachlin v. Lewis

This case consolidates two CPLR article 78 proceedings challenging the Insurance Department's regulations on attorneys' fees in no-fault automobile insurance disputes and the constitutionality of certain sections of the Insurance Law. The petitioners sought to rescind 11 NYCRR 65.16 and declare Insurance Law section 671 et seq. unconstitutional. The court ruled that sections 11 NYCRR 65.16 (c) (7) (ix), which prohibited attorneys from charging clients fees in excess of insurer-paid fees, and 11 NYCRR 65.16 (c) (7) (vii), concerning the regulation of disbursements, were invalid as they exceeded the scope of the enabling legislation. However, the court upheld the general fee schedule, finding a rational basis for its establishment by the Insurance Department.

Attorney's FeesNo-Fault InsuranceInsurance LawRegulatory ChallengeCPLR Article 78Administrative LawConstitutional LawDisbursementsArbitrationAutomobile Insurance
References
6
Case No. SRO 112972
Regular
Jun 12, 2008

STELLA JUAREZ vs. ARTERIAL VASCULAR ENGINEERING, NELSON STAFFING, CENTRE INSURANCE COMPANY by REM, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by BROADSPIRE for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation

The California Insurance Guarantee Association (CIGA) has the right to seek contribution from Centre Insurance Company for workers' compensation benefits paid to an applicant with a cumulative trauma injury. CIGA's claim is not barred by the one-year limitation period for employer contribution claims under Labor Code section 5500.5(e), as CIGA is not an employer and Centre is considered "other insurance" under Insurance Code section 1063.1(c)(9). Therefore, the Appeals Board granted CIGA's petition for reconsideration and reversed the arbitrator's decision, awarding CIGA contribution from Centre.

CIGAContributionReconsiderationFindings Award and OrderLabor Code section 5500.5Insurance Code section 1063.1(c)(9)Cumulative TraumaGeneral EmployerSpecial EmployerOther Insurance
References
8
Case No. MISSING
Regular Panel Decision
Sep 13, 2000

AIU Insurance v. American Motorists Insurance

This case concerns an appeal regarding primary liability coverage for HRH Construction Corp. and Hotel Grand Central in an underlying personal injury action. Plaintiffs, including their excess insurer AIU Insurance Co., sought to compel American Motorists Insurance Co. and St. Paul Fire & Marine Ins. Co. to provide primary defense and reimbursement. The court found American Motorists obligated to defend HRH and the Hotel, as their policy covered them as additional insureds for claims "arising out of" work performed by American Motorists' primary insured, Cord Contracting Co. However, St. Paul was not similarly obligated, as the injury did not "arise out of" work by its insured, Forest Electric Corp. Consequently, the court modified the prior declaration, vacating the plaintiffs' favor against St. Paul and dismissing Cord Contracting Co.'s cross-appeal.

Insurance DisputePrimary Liability CoverageExcess InsuranceAdditional InsuredPersonal InjuryConstruction SiteSubcontractorContractual ObligationDuty to DefendIndemnification
References
1
Case No. 2015 NY Slip Op 02049
Regular Panel Decision
Mar 17, 2015

Turner Construction Co. v. Harleysville Worcester Insurance

Plaintiffs, Turner Construction Company et al., appealed a judgment declaring that Harleysville Worcester Insurance Company was not obligated to defend or indemnify them in an underlying personal injury action. The Appellate Division, First Department, modified the judgment to explicitly declare Harleysville's non-obligation and otherwise affirmed the dismissal of the complaint against Harleysville. The court ruled that even if plaintiffs had additional insured status, they were not entitled to coverage due to their failure to provide timely notice of the occurrence to Harleysville, notifying the insurer nine months after the accident and over two months after the personal injury action commenced. The court found plaintiffs' belief that no claim would be asserted against them to be unreasonable, given their awareness of the injured worker's severe accident at the construction site.

Insurance CoverageNotice RequirementAdditional InsuredTimeliness of NoticePersonal InjuryConstruction AccidentDuty to DefendDuty to IndemnifyAppellate DecisionUnreasonable Delay
References
3
Case No. SRO 0107686
En Banc
Jul 27, 2004

Jose L. Martinez vs. Jack Neal & Son, Inc., Fremont Compensation Insurance Company, In Liquidation, California Insurance Guarantee Association, Cambridge Integrated Services, Inc.

The Appeals Board held that under Insurance Code section 1063.1(c)(8), as amended effective January 1, 2004, the California Insurance Guarantee Association (CIGA) is not liable for Labor Code section 5814 penalties awarded on or after that date for an insolvent insurer's unreasonable delay of benefits.

CIGAinsolvent insurercovered claimsLabor Code section 5814Insurance Code section 1063.1(c)(8)unreasonable delaymedical benefitsen banc decisionprospective applicationstatutory exclusion
References
20
Case No. 2016 NY Slip Op 03815 [139 AD3d 497]
Regular Panel Decision
May 12, 2016

Mt. Hawley Insurance v. American States Insurance

Mt. Hawley Insurance Company and other plaintiffs, Chatsworth Builders, LLC and 537 West 27th Street Owners, LLC, initiated a declaratory judgment action against J&R Glassworks, Inc. for breach of its obligation to procure insurance related to a construction project. J&R Glassworks, Inc. failed to respond to the complaint, leading to a default judgment. J&R's subsequent motion to vacate this default judgment was denied by the Supreme Court, New York County. The Appellate Division, First Department, affirmed the denial, clarifying that the default judgment was limited solely to the claim regarding the breach of the obligation to procure insurance, as agreements to indemnify are distinct from agreements to procure insurance.

Default JudgmentVacate DefaultInsurance ObligationBreach of ContractContractual IndemnificationProcure InsuranceAppellate ReviewConstruction ProjectSubcontractorDeclaratory Judgment
References
3
Case No. MISSING
Regular Panel Decision

Zappone v. Home Insurance

The dissenting opinion by Judge Gabrielli argues against the majority's interpretation of subdivision 8 of section 167 of the Insurance Law. The dissent contends that the statute, which requires insurers to provide prompt written notice of disclaimer or denial of coverage for death or bodily injuries, should apply irrespective of whether the denial stems from a policy exclusion or a complete lack of coverage for the person or vehicle involved. Judge Gabrielli emphasizes a literal reading of the statute, asserting that the Legislature intended for insurers to bear the responsibility of promptly notifying insureds about coverage, given their superior position to interpret complex policy documents. The dissent also refutes the majority's concern about 'unreasonable results' of expanding coverage without premium, highlighting that such outcomes are not unique to the broader interpretation.

Insurance LawStatutory InterpretationCoverage DenialDisclaimer of LiabilityLegislative IntentPolicy ExclusionsPrompt NoticeDissenting OpinionAppellate ReviewContract Law
References
15
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. 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. SRO 0107686
Significant
Jun 10, 2004

Jose L. Martinez, Applicant vs. Jack Neal & Son, Inc., Fremont Compensation Insurance Company, In Liquidation, California Insurance Guarantee Association, and Cambridge Integrated Services, Inc. (Servicing Facility), Defendants

The Appeals Board, in an en banc decision, granted CIGA's petition for reconsideration, holding that under the amended Insurance Code section 1063.1(c)(8), CIGA is not liable for Labor Code section 5814 penalties for an insolvent insurer's delays on awards issued after January 1, 2004.

CIGAFremont Compensation Insurance CompanyLabor Code section 5814Insurance Code section 1063.1(c)(8)covered claimsinsolvent insurerpenaltyunreasonable delaymedical benefitsen banc decision
References
18
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