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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

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
Case No. STK 0142666
Regular
Jan 17, 2008

DAVID SOTO vs. ADVANCED PACKING & DISTRIBUTION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION On Behalf Of RELIANCE INSURANCE COMPANY, In Liquidation

This case involves a workers' compensation claim where the applicant sustained an injury while employed by both a general employer (Remedy) and a special employer (Advanced). Remedy's insurer, Reliance, became insolvent, leading CIGA to assume potential liability. The WCJ found that Advanced's insurer, SCIF, provided "other insurance" under Insurance Code § 1063.1(c)(9), thus relieving CIGA of responsibility. The Appeals Board denied SCIF's reconsideration, affirming that SCIF's policy constituted "other insurance" and that CIGA is a last resort insurer.

Workers Compensation Appeals BoardCIGAReliance Insurance Companyliquidationspecial employergeneral employerother insuranceInsurance Code section 1063.1(c)(9)covered claimsjoint and several liability
References
14
Case No. MISSING
Regular Panel Decision

Transcontinental Insurance v. State Insurance Fund

This case involves a dispute between two insurers, Transcontinental Insurance Company (plaintiff) and State Insurance Fund (defendant), regarding their contribution to the defense and settlement of an underlying personal injury action. Transcontinental, which insured the contractor Master, sought a declaration that State Insurance Fund, Master's workers' compensation insurer, should contribute as a co-insurer for expenses incurred defending and settling the action on behalf of NYPA. The Supreme Court dismissed the complaint, applying the antisubrogation rule. The Appellate Division modified the judgment, vacating the dismissal but affirming the application of the antisubrogation rule, declaring that State Insurance Fund is not obligated to reimburse Transcontinental for the expenses.

Insurance DisputeAntisubrogation RuleDeclaratory JudgmentCommercial General Liability PolicyWorkers' Compensation InsuranceIndemnificationCo-insurancePersonal Injury ActionAppellate ReviewContractual Obligation
References
5
Case No. ADJ11391724, ADJ11391757
Regular
Oct 03, 2019

PABLO LOPEZ DURAN vs. SOUTH HILLS ACADEMY, CHURCH MUTUAL INSURANCE COMPANY, SECURITY NATIONAL INSURANCE COMPANY, AMTRUST NORTH AMERICA, CRESCENT HOTELS & RESORTS, LLC, CHUBB INSURANCE GROUP, GALLAGHER BASSETT SERVICES, INC.

This Workers' Compensation Appeals Board case involves applicant Pablo Lopez Duran and multiple defendants including South Hills Academy, Church Mutual Insurance Company, Security National Insurance Company, Crescent Hotels & Resorts, LLC, and Chubb Insurance Group. The Board granted a petition for reconsideration and affirmed a prior order regarding sanctions and costs. Specifically, Chubb Insurance Group, administered by Gallagher Bassett Services, Inc., was ordered to pay an additional $395 for attorneys' fees related to a petition for fees, less any credit for prior payments.

WORKERS' COMPENSATION APPEALS BOARDSOUTH HILLS ACADEMYCHURCH MUTUAL INSURANCE COMPANYSECURITY NATIONAL INSURANCE COMPANYAMTRUST NORTH AMERICACRESCENT HOTELS & RESORTSLLCCHUBB INSURANCE GROUPGALLAGHER BASSETT SERVICESINC.
References
0
Case No. ADJ2921203 (SAC 0309350)
Regular
May 10, 2010

LORI BIANCALANA vs. FRANKLIN RESOURCES, INC., CIGA, Through Its Servicing Facility, INTERCARE INSURANCE SERVICES for HIH INSURANCE, In Liquidation, and FIREMAN'S FUND INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration to clarify CIGA's reimbursement rights from a solvent insurer (Fireman's Fund) for benefits paid to an injured worker after the worker's primary insurer became insolvent. The Board reversed the arbitrator's decision, finding CIGA is entitled to full reimbursement for all good-faith payments made to the applicant. This decision emphasizes CIGA's role as an insurer of last resort and encourages prompt benefit payments even when subsequent claims adjustments may occur. Therefore, Fireman's Fund is now responsible for repaying CIGA the entirety of the benefits CIGA disbursed.

CIGAHIH InsuranceFireman's Fundinsolvencycovered claimsother insurancereimbursementcontributioncumulative traumatemporary disability
References
8
Case No. MISSING
Regular Panel Decision
Feb 28, 1991

North River Insurance v. United National Insurance

This appellate decision addresses the apportionment of liability between North River Insurance Co. and United National Insurance Company arising from a settlement for an injured employee. The court clarified that North River, as the workers' compensation carrier, is solely responsible for its waived lien, reversing a lower court's finding. It further determined that both insurers' "other insurance" clauses called for pro rata contribution, not equal shares, for the $588,245 settlement payment and defense costs. The court calculated specific shares for each insurer and ruled that North River is entitled to interest from the original payment date in 1982. The Supreme Court's order was thus modified to reflect these findings.

Insurance disputePro rata contributionEquitable apportionmentWorkers' compensation lienDefense costsOther insurance clausesSettlement apportionmentInterest calculationAppellate decisionInsurer liability
References
10
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. AHM 90917 AHM 90918
Regular
Jul 11, 2007

ANGEL SOSA vs. D.W. FOODS, EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, VILLANOVA INSURANCE

This case concerns a dispute over reimbursement between an insurer, Everest, and the California Insurance Guarantee Association (CIGA), which is handling claims for a liquidated insurer, Villanova. The Board denied Everest's petition, upholding a prior award for reimbursement from Everest to CIGA. However, the Board granted CIGA's petition to amend the award to include Villanova Insurance as a party defendant.

CIGAEverest National Insurance CompanyVillanova Insuranceliquidationreconsiderationreimbursementbill review chargesjoint and several liabilitycumulative traumadenied due process
References
0
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

Insurance Corp. of New York v. United States Fire Insurance

This case concerns a dispute between a primary insurer, The Insurance Corporation of New York, and an excess insurer, United States Fire Insurance Company (US Fire), regarding the timeliness of claim notice and US Fire's subsequent disclaimer. The motion court initially denied US Fire's cross-motion for summary judgment, deeming its disclaimer untimely. However, the appellate court determined that US Fire received proper notice on April 20, 2006, not March 16, 2006, making its disclaimers, issued eight days later, timely as a matter of law. Consequently, the appellate court reversed the lower court's decision, granting US Fire's cross-motion for summary judgment and dismissing the complaint against it. Additionally, an appeal from a separate order regarding US Fire's request to rescind an insurance policy was dismissed as abandoned.

Insurance PolicyExcess InsurancePrimary InsuranceTimely NoticeDisclaimer of CoverageSummary JudgmentAppellate ReviewClaim NotificationInsurance ContractLiability Insurance
References
9
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