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

Case No. 03 Civ. 0332(AKH)
Regular Panel Decision
Oct 29, 2004

In Re September 11th Liability Insurance Coverage Cases

This opinion and order addresses two Rule 12(c) motions regarding insurance coverage for the World Trade Center properties following the September 11, 2001, attacks. The Port Authority of New York and New Jersey sought a declaration that it is an "Additional Insured" under Zurich American Insurance Company's policies, while World Trade Center Properties LLC (WTCP) sought a declaration that Zurich is obligated to cover defense costs. The court, presided over by District Judge Hellerstein, denied both motions. It found ambiguity in the binder regarding the Port Authority's "Additional Insured" status, stating that the issue was premature without further discovery. Furthermore, the court held that New York Insurance Regulation 107 does not require rewriting Zurich's binder and policies to include defense costs, considering the unique circumstances, the sophistication of the insured, and the fact that Zurich explicitly excluded defense costs, which Silverstein (WTCP's affiliate) accepted after failing to secure conventional coverage. The court also affirmed supplemental jurisdiction over the insurance claims due to their close relation to the underlying September 11th liability cases.

Insurance CoverageSeptember 11 AttacksWorld Trade CenterRule 12(c) MotionDeclaratory ReliefAdditional Insured StatusDefense CostsInsurance BinderNew York Insurance LawRegulation 107
References
48
Case No. MISSING
Regular Panel Decision

Sexton v. Medicare

Plaintiff Kevin Sexton sued the Secretary of the United States Department of Health and Human Services (HHS) to prevent direct reimbursement for Medicare payments made after he was injured in an accident. Sexton argued that Medicare should pursue the primary insurer, American Transit Insurance Company, or the medical providers, rather than him. HHS moved to dismiss the case, asserting a lack of subject matter jurisdiction due to Sexton's failure to demonstrate an actual or imminent injury and to exhaust administrative remedies. The court granted HHS's motion, dismissing the complaint with prejudice. It ruled that Sexton lacked standing because Medicare had not yet formally demanded reimbursement from him, and its right to recover from a beneficiary only accrues after the beneficiary receives a primary payment, making his alleged injury purely speculative.

MedicareMedicare Secondary Payer ActMSP ActSubject Matter JurisdictionMotion to DismissStandingRipeness DoctrineConditional PaymentsReimbursement ClaimPrimary Payer
References
26
Case No. MISSING
Regular Panel Decision

McLaughlin v. Midrox Insurance

This case involves an appeal concerning an insurance coverage dispute. Plaintiffs sought to compel Midrox Insurance Company to indemnify the Blodgett Brothers Partnerships for a $1 million judgment in an underlying personal injury action. The accident involved a motorcycle operated by plaintiff Charles R. McLaughlin and a pickup truck driven by Ronald Blodgett. Midrox had disclaimed coverage, arguing the accident occurred off insured premises and involved a registered vehicle. The court affirmed the lower court's decision, ruling that the farmowner's policy did provide coverage. The court determined that public roadways used for transporting materials between farm parcels could be considered 'insured premises' and that the pickup truck's agricultural registration did not negate coverage given its exclusive use for farming purposes.

Personal InjuryFarmowner's InsuranceInsurance CoverageAgricultural TruckPolicy InterpretationOff-Premises AccidentPublic RoadwaysSummary JudgmentIndemnificationVehicle and Traffic Law
References
5
Case No. MISSING
Regular Panel Decision

In re the Liquidation of Midland Insurance

Policyholders New York Dock Railway (NYDR) and Brooklyn Eastern District Terminal (BEDT), joined by claimants Buividas and Romacho, moved to confirm a referee's report that found coverage for their claims by the Stock Workers' Compensation Security Fund. The Superintendent of Insurance, as liquidator of Midland Insurance Company, cross-moved to disaffirm the report, arguing against Security Fund coverage based on his interpretation of relevant statutes. The court reviewed the referee's decision, finding it erroneous due to a misinterpretation of legislative history and intent regarding security fund coverage limitations, particularly concerning Chapter 801 amendments. Upholding the Superintendent's rational interpretation, the court denied the motion to confirm and granted the cross-motion to disaffirm, affirming the denial of security fund coverage.

Workers' Compensation Security FundInsurance Coverage DisputeMidland Insurance Company LiquidationFederal Employers' Liability ActJones ActLongshoremen's and Harbor Workers' Compensation ActStatutory InterpretationLegislative HistoryThird-Party IndemnificationEmployer's Liability
References
6
Case No. MISSING
Regular Panel Decision

U. P. Iron Works v. Investors Insurance

Plaintiff insured brought a declaratory judgment action against their insurer, who issued both workers' compensation and general liability policies. The dispute arose after a partner was injured, leading to a third-party products liability action against the partnership. The insurer disclaimed coverage, citing lack of coverage for a direct suit by a partner and late notice of the accident. The court found that coverage existed for the third-party claim, extending it to a partner similar to an employee. Furthermore, the court determined that the notice provided by the insured, though three years after the accident, was not unreasonably late given the complexities involved. Consequently, the court declared the policy to be in full force and effect for the accident.

Declaratory JudgmentInsurance CoverageWorkers' Compensation PolicyGeneral Liability PolicyThird-Party ClaimPartner InjuryEmployee ExclusionLate Notice DisclaimerDuty to DefendSummary Judgment Motion
References
2
Case No. MISSING
Regular Panel Decision

LEFEVRE v. Niagara Mohawk Power Corp.

Plaintiffs, former employees of Niagara Mohawk Power Corporation, filed a putative class action alleging age discrimination under the Age Discrimination in Employment Act of 1967 (ADEA). They challenged amendments to the company's health benefit plans, arguing that Medicare-eligible retirees were required to pay greater dollar amounts and percentages of total premiums for the same coverage compared to non-Medicare eligible retirees. Defendants moved for summary judgment. The court found that the plans were exempt from ADEA prohibitions due to their coordination with Medicare and also fell within the ADEA's 'equal benefit' safe harbor, as the actual benefits received were the same regardless of Medicare eligibility. Consequently, the court granted summary judgment for the defendants and dismissed the complaint.

Age DiscriminationADEARetiree Health BenefitsMedicare CoordinationSummary JudgmentEmployee Benefit PlansDiscrimination LawStatutory ExemptionEqual Benefit PrincipleClass Action
References
4
Case No. MISSING
Regular Panel Decision

Hayden v. S & W Meat & Poultry

Claimant, a partner in S & W Meat & Poultry, sustained a serious injury. A workers' compensation claim was filed, but the carrier contested coverage, arguing that claimant, as a partner, had not formally elected coverage under Workers' Compensation Law § 54 (8). The Workers' Compensation Board applied estoppel, finding the carrier failed to advise the employer of the election requirement. On appeal, the court reversed this decision, holding that the employer's insurance broker, the Fear agency, was notified of the lack of coverage, and this knowledge is imputed to the employer. The court found insufficient evidence for estoppel and remitted the matter to the Board for further proceedings.

Workers' CompensationEstoppelInsurance CoveragePartnershipAgent LiabilityImputed KnowledgePremium RefundAppellate ReviewRemittalWorkers' Compensation Law § 54 (8)
References
5
Case No. MISSING
Regular Panel Decision

Claim of Cerbasi v. County Metal & Glass, Inc.

A claimant injured their left arm while working at a New York construction site for a New Jersey employer insured by New Jersey Manufacturers Insurance Company (NJMIC). A dispute arose regarding coverage, with the Workers’ Compensation Law Judge and Board determining the policy covered the accident because New York was not an explicitly excluded state and NJMIC’s attempt to amend the policy was ineffective. NJMIC appealed, arguing the Board erred in its coverage finding and that Workers’ Compensation Law § 54 (5) notice requirements did not apply to partial cancellations. The Appellate Division affirmed, finding the Board's determination on coverage implicit and that NJMIC failed to demonstrate an effective exclusion or proper cancellation under Workers' Compensation Law § 54 (5). The court also noted NJMIC's argument regarding partial cancellation was unpreserved.

Workers' CompensationInsurance CoveragePolicy ExclusionNew York LawNew Jersey BusinessStatutory ComplianceCancellation NoticeAppellate ReviewJurisdictionLeft Arm Injury
References
9
Case No. 2025 NY Slip Op 03690
Regular Panel Decision
Jun 18, 2025

Matter of Bentkowski v. City of New York

The City of New York implemented a new Medicare Advantage plan (Aetna MAP) for retirees, replacing their previous Medicare supplemental options, in an effort to reduce costs. Petitioners, a group of retirees and an organization, challenged this change, arguing that the City was bound by a promise to provide lifetime Medicare supplemental coverage under the doctrine of promissory estoppel and violated Administrative Code § 12-126 (b) (1). The Supreme Court and Appellate Division initially sided with the petitioners. However, the Court of Appeals reversed, concluding that the City's Summary Program Descriptions (SPDs) were descriptive, not a clear and unambiguous promise of specific lifetime health benefits, and found no violation of the Administrative Code or the Moratorium Law. The case was remitted to Supreme Court for further proceedings on remaining causes of action.

Promissory EstoppelHealth Insurance BenefitsRetiree BenefitsMedicare Advantage PlansMedigap PlansCollective BargainingAdministrative Code § 12-126Moratorium LawMunicipal EmployeesLifetime Coverage
References
10
Case No. MISSING
Regular Panel Decision
Apr 11, 2007

Macro Enterprises, Ltd. v. QBE Insurance

The Supreme Court, New York County, affirmed an order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment. The court declared that the plaintiff is not entitled to defense and indemnity coverage in an underlying third-party action. The decision was based on the plaintiff's failure to notify the defendant insurer for over two years about an employee's injury at a construction site, which constituted noncompliance with a condition precedent to coverage and vitiated the insurance contract. The plaintiff's claimed belief of nonliability, premised on the Workers' Compensation Law, was deemed unreasonable under the circumstances.

Summary JudgmentInsurance CoverageLate NoticeCondition PrecedentWorkers' Compensation LawConstruction AccidentIndemnity CoverageDefense CoverageAppellate AffirmationContract Vitiation
References
2
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