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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
Nov 18, 2004

Claim of Shanbaum v. Alliance Consulting Group

The claimant, a software solution architect for Alliance Consulting Group, sustained an injury on September 11, 2001, while evacuating her apartment located across from her employer's World Trade Center office after the terrorist attacks. Her employer provided and paid for the apartment, which also served as a remote workspace equipped with a company laptop for accessing the main server. On the morning of the incident, the claimant had logged onto her computer, checked work emails, and begun preparing for a meeting. The Workers’ Compensation Board determined that the apartment functioned as an extension of the employer’s office and that the injury arose within the scope of her employment. This decision was subsequently affirmed on appeal.

Workers' CompensationScope of EmploymentAccidental InjuryTelecommutingHome OfficeWorld Trade Center AttacksSeptember 11Employer LiabilityArising Out Of EmploymentCourse Of Employment
References
2
Case No. ADJ8139465
Regular
Apr 18, 2013

Robert Scharfe vs. VI-TEL, LUMBERMANS UNDERWRITING ALLIANCE

This case concerns applicant Robert Scharfe's petition for reconsideration of a workers' compensation award. Scharfe argued the administrative law judge erred in calculating his average weekly earnings, claiming the judge disregarded significant self-employment income. The Board denied reconsideration, affirming the judge's decision that Scharfe failed to provide substantial evidence of his self-employment earnings, as his tax returns showed a net loss. Additionally, the Board found no error in the admission of income declarations from Scharfe's child support cases, which contradicted his claimed earnings.

Robert ScharfeVi-TelLumbermans Underwriting AllianceADJ8139465Opinion and Order Denying Reconsiderationtemporary disability indemnityaverage weekly earningsself-employment incomechild support casesLos Angeles County Superior Court
References
1
Case No. ADJ7466813
Regular
Apr 10, 2013

ROBERTO MENA, COBERTON MENA vs. PRIORITY BUILDING SERVICES; LUMBERMAN'S UNDERWRITING, PRIORITY BUILDING SERVICES, LLC; LUMBERMAN'S UNDERWRITING

This case involves a lien claimant, Max MRI Imaging, whose lien was dismissed due to failure to pay the mandatory lien activation fee required by Labor Code section 4903.06(a)(4). The Workers' Compensation Appeals Board denied reconsideration, upholding the dismissal despite the claimant's argument of an oversight. The Board emphasized that the statute's language is mandatory and provides no exceptions for inadvertent non-payment. The ruling also clarified procedural arguments regarding notice, appearances, and the inapplicability of the *Hamilton v. Lockheed Corp.* case.

Workers' Compensation Appeals BoardRoberto MenaPriority Building ServicesLumberman's UnderwritingADJ7466813Petition for ReconsiderationLabor Code section 4903.06Lien Activation FeeDismissal of LienMandatory Requirement
References
1
Case No. MISSING
Regular Panel Decision
May 08, 2003

Allianz Underwriters Insurance v. Landmark Insurance

This case involves an appeal by Allianz Underwriters Insurance Company, an excess liability insurer, against the law firm Underberg & Kessler, LLP. Allianz alleged that Underberg, retained by the primary insurer General Star Indemnity Corporation to represent their mutual insured Dunlop Tire Corporation in an underlying wrongful death action, breached its fiduciary duty and committed professional negligence. Allianz claimed Underberg failed to initiate a third-party action against Nicholson & Hall, Dunlop's employer (also insured by General Star), to protect General Star's interests over Dunlop's and Allianz's. The Supreme Court initially dismissed Allianz's complaint against Underberg. However, the Appellate Division, First Department, reversed this decision, holding that Allianz could pursue its claim against Underberg based on principles of equitable subrogation and a "near privity" relationship, thereby reinstating the complaint.

Equitable SubrogationLegal MalpracticeProfessional NegligenceExcess InsurancePrimary InsuranceFiduciary DutyNear PrivityDismissal ReversalAppellate ReviewIndemnification Clause
References
15
Case No. ADJ8548139
Regular
Jul 11, 2014

HECTOR ALFARO vs. CONSOLIDATED PERSONNEL SERVICES, JR RESIDENTIAL, LUMBERMAN'S UNDERWRITING ALLIANCE

In this workers' compensation case, the Appeals Board granted removal and rescinded an administrative law judge's order vacating submission to develop the record. The defendant argued that the order prejudiced their due process rights by allowing the applicant to further develop evidence on apportionment when the threshold issue of injury AOE/COE had not yet been decided. The Board found that developing the record on apportionment was premature before a determination on causation. Consequently, the case was returned to the WCJ for a decision on the submitted issues.

Petition for RemovalVacating SubmissionDevelop the RecordApportionmentInjury AOE/COEPrimary Treating PhysicianSupplemental ReportIrreparable HarmDue ProcessRescind Order
References
0
Case No. 2023 NY Slip Op 04648 [219 AD3d 1393]
Regular Panel Decision
Sep 20, 2023

Alliance Natl. Ins. Co. v. Hagler

This case involves an action brought by Alliance National Insurance Company (plaintiff) against Daryl Hagler and other defendants for breach of contract and on an account stated, stemming from alleged unpaid Workers' Compensation and Employers' Liability policy payments. The Supreme Court, Nassau County, initially granted the plaintiff's motion for summary judgment and for a declaratory judgment regarding "Loss Funding obligations." However, the Appellate Division, Second Department, reversed this judgment. The appellate court found that the plaintiff failed to establish a prima facie case for summary judgment on the account stated cause of action due to insufficient proof of invoice mailing and receipt. Additionally, the plaintiff could not demonstrate prima facie entitlement to summary judgment on the breach of contract claims, failing to properly calculate premiums for some defendants and unable to prove a contractual obligation for administrative fees for others. The court also noted that the declaratory relief granted was not requested in the pleadings.

Breach of ContractAccount StatedSummary JudgmentDeclaratory JudgmentWorkers' Compensation PoliciesLoss Funding ObligationsAppellate ReviewPrima Facie CaseInvoice MailingContractual Obligation
References
8
Case No. MISSING
Regular Panel Decision
May 12, 1995

Wausau Underwriters Insurance v. Continental Casualty Co.

This case addresses a dispute between Wausau Underwriters Insurance Company (Wausau) and Continental Casualty Company (Continental), along with The Hartford Insurance Group. Wausau, as the employer's liability carrier for H. Sand & Company, successfully argued that a third-party action by Slattery-Argrett, subrogor of Continental, against H. Sand & Company, constituted an impermissible subrogation claim by an insurer against its own insured. The underlying matter involved a personal injury sustained by an employee of H. Sand & Company. Continental had initially disclaimed coverage for Sand in the third-party action. The Supreme Court granted Wausau's motion for summary judgment, declaring the subrogation action a violation of public policy and awarding Wausau damages. The appellate court affirmed this judgment, distinguishing the present case from prior rulings like *North Star Reins. Corp. v Continental Ins. Co.*, and emphasizing the distinction between claims for indemnification and contribution within insurance policy exclusions.

Subrogation ClaimInsurance Coverage DisputeIndemnification vs. ContributionPublic Policy in InsuranceSummary JudgmentEmployer LiabilityGeneral Liability InsuranceExcess Liability InsuranceConstruction AccidentWorkers' Compensation Carrier
References
9
Case No. 532120
Regular Panel Decision
Jun 24, 2021

Matter of Bugianishvili v. Alliance Refrig. Inc.

Archil Bugianishvili, a mechanic, filed for workers' compensation benefits after an April 2016 incident where he was exposed to toxic gas, leading to respiratory, neurological ailments, posttraumatic stress disorder, and major depression. A Workers' Compensation Law Judge determined he had a permanent total disability as of November 2019, which the Workers' Compensation Board affirmed. The employer, Alliance Refrigeration Inc., and its carrier appealed this decision. The Appellate Division, Third Department, affirmed the Board's determination, finding substantial medical evidence from an independent medical examination supported the permanent total disability ruling. The Court also upheld the Board's decision against apportionment for a separate burn incident and declined to allow further development of the record.

Workers' CompensationPermanent Total DisabilityToxic Gas ExposureRespiratory AilmentsNeurological AilmentsPosttraumatic Stress DisorderMajor DepressionIndependent Medical ExaminationMaximum Medical ImprovementApportionment
References
7
Case No. ADJ7640191
Regular
Nov 23, 2020

GLORIA MARIN vs. TRI-STATE EMPLOYMENT SERVICES, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, LUMBERMAN'S UNDERWRITING ALLIANCE

The Workers' Compensation Appeals Board (WCAB) granted CIGA's petition for reconsideration, overturning a prior ruling that denied joinder of another employer. The WCAB held that Labor Code section 5804 does not prevent the joinder of additional parties or employers after a settlement, and CIGA is not attempting to alter a prior award. The case is returned to the trial level for joinder of all appropriate parties and further proceedings. The WCAB also clarified that CIGA's liability is limited by Insurance Code section 1063.1 and subsequent case law, which prohibits apportionment of liability between CIGA and other insurers for certain benefits.

CIGALumberman's Underwriting AllianceliquidationLabor Code section 5804joinderCompromise and Releaselien claimsother insurancecovered claimsapportionment
References
9
Case No. 2 NY3d 787
Regular Panel Decision

U.S. Underwriters Insurance v. City Club Hotel, LLC

The New York Court of Appeals addressed two certified questions from the Second Circuit regarding an insured's right to recover attorneys' fees. U.S. Underwriters Insurance Company had sought a declaratory judgment against its insureds, City Club Hotel, LLC and Shelby Realty, LLC, to deny coverage for a personal injury claim. The insurer's disclaimer of coverage was found untimely. The Court held that an insured who prevails in an insurer-initiated declaratory judgment action to deny coverage may recover attorneys' fees, irrespective of whether the insurer initially provided a defense in the underlying suit. This decision underscores that the insurer's duty to defend extends to litigation arising from its attempts to avoid policy obligations. The Court answered the first certified question in the affirmative for Shelby.

Declaratory Judgment ActionAttorneys' FeesInsurer Duty to DefendInsurance CoverageUntimely DisclaimerPrevailing PartyCertified QuestionSecond CircuitNew York Court of AppealsPolicy Obligations
References
6
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