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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. 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
Dec 15, 1993

Nationwide Mutual Insurance v. Stokes

Mary Stokes was injured in a car accident caused by Russell Caldwell and Steven Schwartz. She settled with their insurer, Aetna Insurance Company, for the policy limit of $10,000. Stokes then sought underinsured motorist benefits from her own insurer, Nationwide Mutual Insurance Company, which provided $50,000 in coverage. Nationwide argued it was entitled to offset the $10,000 settlement and $2,100 in Workers’ Compensation benefits from Stokes's coverage. The Supreme Court initially allowed both offsets, limiting Stokes's recovery to $37,900. On appeal, the court ruled that the $10,000 tortfeasor settlement could not be offset against the underinsurance limits, but the Workers’ Compensation benefits could. Therefore, the order was modified to remove the $10,000 offset but affirmed regarding the Workers’ Compensation offset.

Underinsured motoristInsurance benefitsOffsetWorkers' Compensation benefitsAutomobile accidentArbitrationAppellate procedureStatutory interpretationInsurance LawCPLR
References
5
Case No. MISSING
Regular Panel Decision

Pellerin v. Nationwide Mutual Fire Insurance

Plaintiff Patrick Pellerin filed an action seeking a declaration that defendant Nationwide Mutual Fire Insurance Company is obligated to defend him and his son, Shawn Pellerin, in an underlying personal injury lawsuit. Nationwide moved for summary judgment, arguing the Pellerins failed to provide timely notice of the incident as required by their homeowner's insurance policy. The Pellerins cross-moved for summary judgment, asserting sufficient notice and the inapplicability of an intentional act exclusion. The court denied Nationwide's motion and granted the Pellerins' cross-motion, ruling that the notice given was reasonable as a matter of law and Nationwide failed to establish a genuine issue regarding the intentional act exclusion. Consequently, Nationwide was ordered to defend and indemnify the Pellerins in the underlying lawsuit.

Summary JudgmentInsurance CoverageNotice RequirementsIntentional Act ExclusionHomeowners PolicyDuty to DefendDuty to IndemnifyPersonal InjuryDeclaratory JudgmentNew York Law
References
7
Case No. ADJ9082632 ADJ9081645
Regular
Nov 09, 2020

ILMA OSORIO vs. EQUINOX INSURANCE COMPANY, INSURANCE COMPANY OF PENNSYLVANIA, NATIONWIDE AGRIBUSINESS INSURANCE/NATIONAL CASUALTY COMPANY

This case involved applicant Ilma Osorio's cumulative injury claim for left knee and left wrist injuries sustained as a laundry worker. The Workers' Compensation Appeals Board (WCAB) affirmed the Administrative Law Judge's (ALJ) decision finding Nationwide Agribusiness Insurance solely liable for medical treatment. This was based on Nationwide being the sole carrier during the final year preceding applicant's disability, as defined by Labor Code section 5412, which requires wage loss. The WCAB also upheld the exclusion of Nationwide's proffered medical evidence, deeming it not newly discovered and not contradicting existing findings.

Workers' Compensation Appeals BoardNationwide Agribusiness InsuranceInsurance Company of Pennsylvaniacumulative injurylaundry workerleft kneeleft wristorthopedic injuryagreed medical evaluatorpetition for joinder
References
6
Case No. MISSING
Regular Panel Decision
May 08, 1996

Nationwide Insurance v. Dean

This case involves an appeal by Nationwide Insurance Company from an order and judgment by the Supreme Court, Kings County. The initial order confirmed an arbitration award in favor of respondent Rosemary Dean and denied Nationwide's cross-motion to modify or vacate the award. Nationwide sought to reduce the award by the workers' compensation benefits Dean received, totaling $28,612.13, as per her automobile liability policy's terms. The appellate court modified the order, granting Nationwide's cross-motion to offset Dean's underinsured motorist benefits with her workers' compensation payments. As a result, Rosemary Dean's arbitration award was confirmed only for the principal amount of $21,387.87, plus prejudgment interest, a reduction from the original $40,000.

Uninsured MotoristUnderinsured MotoristArbitration AwardInsurance PolicyWorkers' Compensation OffsetPolicy LimitsAppellate ReviewModification of AwardPrejudgment InterestAutomobile Insurance
References
3
Case No. 2014 NYSlipOp 07168 [121 AD3d 1003]
Regular Panel Decision
Oct 22, 2014

Matter of Nationwide Mut. Ins. Co. v. Joseph-Sanders

Nationwide Mutual Insurance Company (Nationwide) initiated a proceeding to permanently stay arbitration of an uninsured motorist claim by Gloria Joseph-Sanders following a hit-and-run accident. Nationwide alleged that Melvin Hammer operated the offending vehicle, which was insured by AutoOne Insurance Company. The Supreme Court initially granted Nationwide's petition, prompting an appeal from AutoOne. The Appellate Division, Second Department, reviewed the evidence and concluded that the special referee's determination linking Hammer's vehicle to the accident lacked credible support. Discrepancies in witness descriptions, absence of immediate identification at the scene, and inconsistencies in evidence led to this conclusion. Consequently, the Appellate Division reversed the amended order, denied Nationwide's petition, and dismissed the proceeding.

Uninsured motoristarbitrationhit-and-runevidence credibilityAppellate Divisioninsurance claimmotor vehicle accidentjudicial reviewfactual determinationspecial referee
References
8
Case No. MISSING
Regular Panel Decision

Claim of Dick v. Nationwide Insurance

Decedent, a regional manager for Nationwide Insurance Company, met his death in a head-on collision while traveling from Canandaigua to his summer camp after a business meeting in September 1978. The Workers’ Compensation Board ruled that his death was an accidental injury in the course of his employment and awarded benefits, a decision subsequently affirmed on appeal. The court found that as an "outside worker," decedent was within the coverage of the Workers' Compensation Law from the time he left Syracuse until his return. His practice of staying overnight at his summer camp, known to his employer, was not considered a purely personal deviation. Instead, the entire arrangement was deemed to be for the ultimate benefit of the employer, supporting the Board's factual determination based on substantial evidence.

Workers' CompensationAccidental InjuryCourse of EmploymentOutside WorkerTravel ExpensesEmployer KnowledgePersonal DeviationAppellate ReviewBenefit AwardCar Accident
References
3
Case No. 94-CV-3954 (TCP)
Regular Panel Decision
Aug 09, 1995

Nationwide Mut. Ins. Co. v. Kaufman

The United States District Court, E.D. New York, affirmed a Magistrate Judge's Report and Recommendation regarding personal jurisdiction in a breach of contract action. Plaintiffs Nationwide Mutual Insurance Company sued Steven Kaufman, Myron Kaufman, The Estate of Harold Basser, and Basser-Kaufman, Inc., who sought dismissal for alleged improper service. The court found service on individual defendants proper by delivery to an adult co-worker at their business and subsequent mailing. Corporate service was valid based on the process server's reasonable belief that the recipient was authorized. The court also clarified that a partnership, Basser-Kaufman Co., was not initially a party but granted leave to amend the caption and serve it.

Personal JurisdictionService of ProcessFederal Rules of Civil ProcedureNew York Civil Practice Law and RulesManaging Agent DoctrineCorporate ServicePartnership LitigationMotion to DismissReport and RecommendationAffirmation of Order
References
19
Case No. MISSING
Regular Panel Decision
Jan 23, 2008

AIU Insurance v. Nationwide Mutual Insurance

The case involves a dispute between two insurers regarding their respective coverage obligations for a mutual insured in an underlying action following a fatal construction site accident. Plaintiff, who insured both the site owner and the subcontractor, sought reimbursement from defendant, who also insured the employer under a workers’ compensation policy, for half of a settlement paid in the underlying action. The Supreme Court initially granted summary judgment to plaintiff, obligating defendant to reimburse plaintiff. However, the appellate court reversed this decision, vacating the judgment and granting summary judgment to defendant. The appellate court ruled that the antisubrogation rule would have compelled the dismissal of any third-party action, thereby precluding plaintiff from obtaining reimbursement from a coinsurer.

Insurance CoverageSubrogationSummary JudgmentWorkers' CompensationConstruction AccidentFatal AccidentCoinsuranceAppellate ReversalUnderlying ActionThird-Party Action
References
1
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