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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

Certified Multi-media Solutions, Ltd. v. Preferred Contractors Insurance Co. Risk Retention Group, LLC

This case involves a dispute over insurance coverage between Certified MultiMedia Solutions, LTD (Plaintiff) and Preferred Contractors Insurance Company Risk Retention Group, LLC (Defendant) regarding a commercial general liability policy. Plaintiff sought a declaratory judgment that the Defendant is obligated to defend and indemnify it in a third-party action related to a worker's injury by Anthony Balzano. The core dispute centered on the interpretation of Endorsement 23 of the policy, which the Defendant argued limited coverage to $10,000 for bodily injury claims. The Court, however, adopted the Plaintiff's interpretation, finding that the $10,000 limit only applied if the employee sustained a 'grave injury' under New York State Workers’ Compensation Law, which was not the case here. Consequently, the Defendant's motion to dismiss was denied, and the Plaintiff's motion for summary judgment was granted, entitling the Plaintiff to coverage up to the $1,000,000 policy limit.

Insurance Coverage DisputeDeclaratory JudgmentCommercial General Liability PolicyContractual IndemnificationWorkers' Compensation LawGrave Injury DefinitionPolicy InterpretationSummary JudgmentFederal Rules of Civil ProcedureThird-Party Action
References
38
Case No. ADJ3311649 (LAO 0871212)
Regular
Apr 20, 2009

MILTON JEOVANY LOPEZ vs. LAZAR TRUCK LINES, NOVAPRO RISK SOLUTIONS FOR CTSA

The Workers' Compensation Appeals Board granted reconsideration of a decision that awarded the applicant 2% permanent disability for a knee injury. The applicant argued the rating was inaccurate based on the AMA Guides and sought recalculation under *Almaraz/Guzman*. The Board found the permanent disability issue was properly raised and that the medical record needed further development. Therefore, the matter was returned to the trial level to re-evaluate permanent disability consistent with the *Almaraz/Guzman* ruling.

Workers' Compensation Appeals BoardMilton Jeovany LopezLazar Truck LinesNovapro Risk SolutionsADJ3311649LAO 0871212ReconsiderationFindings and AwardPermanent DisabilityAMA Guides
References
3
Case No. MISSING
Regular Panel Decision

Commercial Risk Reinsurance Co. v. Security Insurance

Petitioners Commercial Risk Reinsurance Company Limited and Commercial Risk Re-Insurance Company (collectively “Commercial Risk”) initiated an action to vacate an arbitration award obtained by respondent Security Insurance Company of Hartford (“Security”). Security subsequently cross-moved to confirm the Award. The District Court denied Commercial Risk’s motion to vacate and granted Security’s motion to confirm the Award, finding that Commercial Risk failed to establish sufficient grounds for misconduct by the arbitrators. Commercial Risk then sought reconsideration of this order, arguing improper exclusion of a witness and documents related to damages. The Court denied the motion for reconsideration, reaffirming its original decision and emphasizing the broad discretion granted to arbitrators in procedural matters, particularly given the "Honorable Engagement" clause in the parties' agreement.

ArbitrationReinsurance ContractsVacatur of Arbitration AwardConfirmation of Arbitration AwardMotion for ReconsiderationFederal Arbitration ActInternational ArbitrationEvidentiary RulingsJudicial ReviewArbitrator Discretion
References
27
Case No. MISSING
Regular Panel Decision

474431 Associates v. AXA Global Risks US Insurance

This case involves an appeal by Allcity Insurance Company in a consolidated action seeking a declaratory judgment regarding co-insurance liability between Allcity and AXA Global Risks US Insurance Company. The dispute arose from an underlying action where an injured worker obtained a judgment against a property owner, which was satisfied by the owner's insurer, AIG. AIG then sought reimbursement from the worker's employer's carriers, Allcity (worker's compensation) and AXA (general liability). The Supreme Court initially favored AXA, but the appellate court reversed, holding that AXA's disclaimer of coverage was untimely under Insurance Law § 3420 (d). The matter was remitted to declare AXA a co-insurer with Allcity.

Insurance Law § 3420 (d)Disclaimer of CoverageTimely Notice RequirementCo-Insurance DisputeGeneral Liability InsuranceWorker's Compensation InsuranceSummary Judgment MotionAppellate Court DecisionDeclaratory ReliefPolicy Exclusion
References
6
Case No. MISSING
Regular Panel Decision
May 17, 2011

Avrio Group Surveillance Solutions, Inc. v. Essex Insurance

Plaintiff Avrio Group Surveillance Solutions commenced a declaratory judgment action against Defendant Essex Insurance Company, seeking an order to defend and indemnify Avrio in a personal injury action. Essex filed a motion to dismiss, which was converted to a motion for summary judgment. The court addressed two main exclusions: the Completed Operations Exclusion and the Contractual Liability Exclusion. The court found a potentiality of coverage under the Completed Operations Exclusion due to ambiguities in the term "intended use" and unresolved factual issues regarding the completion of work, denying summary judgment on this ground. However, the court granted summary judgment in favor of Essex regarding the Contractual Liability Exclusion, as the subcontract did not qualify as an "insured contract" under the policy's specific definition in effect at the time of the incident, and Avrio was presumed to have agreed to these terms. The case will proceed to an evidentiary hearing on the Completed Operations Exclusion.

Insurance CoverageDeclaratory JudgmentSummary JudgmentContractual Liability ExclusionCompleted Operations ExclusionInsurance Policy InterpretationChoice of LawMaryland Contract LawFederal Civil ProcedureDuty to Defend
References
37
Case No. FRE 0238073
Regular
Jan 25, 2008

DANIEL MALTOS vs. ULTIMATE STAFFING SERVICES, ZURICH AMERICAN INSURANCE COMPANY, NOVAPRO RISK SOLUTIONS INC.

The Workers' Compensation Appeals Board granted reconsideration of an award finding the applicant's average weekly earnings at $390.00. The Board amended the award to find average weekly earnings of $320.00, resulting in a temporary disability indemnity rate of $213.33 per week. This adjustment was made because the original calculation of $390.00 was not adequately supported by the evidence, though the Board affirmed the applicability of Labor Code section 4453(c)(1) for determining earnings.

Petition for ReconsiderationFindings and Awardtemporary disability indemnityaverage weekly earningsLabor Code section 4453(c)(1)Labor Code section 4453(c)(4)wage lossearning capacityprobationary periodintermittent employment
References
8
Case No. ADJ3974600 (MON 0334960); ADJ4075150 (MON 0334961); ADJ277095 (MON 0358718)
Regular
Feb 17, 2009

GLADYS JIMENEZ vs. ROSS STAFFING, Dba ULTIMATE STAFFING; ZURICH AMERICA, Administered By NOVAPRO RISK SOLUTIONS

The Appeals Board granted reconsideration and amended the original award to correct clerical errors. Specifically, the temporary disability period was corrected to June 16, 2005, through June 20, 2005. The award was also clarified to reflect that the defendant is entitled to credit for attorney fees against permanent disability advances. Finally, the defendant was found not liable for medical-legal costs that did not comply with Labor Code sections 4061 and 4062.

Workers' Compensation Appeals BoardGladys JimenezRoss StaffingUltimate StaffingZurich AmericaNovapro Risk SolutionsADJ3974600ADJ4075150ADJ277095Opinion and Order Granting Reconsideration
References
5
Case No. ADJ6894399
Regular
Jun 16, 2010

URIEL DE AVILA vs. BRENT REDMOND TRANSPORTATION, NOVAPRO RISK SOLUTIONS, CALIFORNIA TRUCKERS SAFETY ASSOCIATIONS

In *De Avila v. Brent Redmond Transportation*, the applicant, Uriel De Avila, sought removal in a workers' compensation case. The Workers' Compensation Appeals Board reviewed the petition and the accompanying administrative law judge's report. Finding no grounds for removal, the Board denied the petition. This decision means the case will proceed without the requested removal.

Workers' Compensation Appeals BoardPetition for RemovalDeniedBrent Redmond TransportationNovapro Risk SolutionsCalifornia Truckers Safety AssociationsUriel de AvilaAdministrative Law JudgeRecord ReviewIncorporation by Reference
References
0
Case No. MISSING
Regular Panel Decision

Durant v. A.C.S. State & Local Solutions Inc.

Plaintiff Sharon Durant filed a lawsuit against A.C.S. State and Local Solutions, Inc. (ACS) alleging sexual harassment and a hostile work environment. Durant, a customer service representative, claimed she received two sexually explicit notes from a co-worker, Terri Simeon. Upon reporting the second note, ACS swiftly responded by moving Durant's workstation and disciplining Simeon, which ended the direct harassment. Despite these actions, Durant resigned, asserting constructive discharge because Simeon was not fired. The court granted summary judgment in favor of ACS, ruling that there was no quid pro quo harassment, the environment was not sufficiently hostile, no constructive discharge occurred, and her state law claims and intentional infliction of emotional distress claim also failed or were time-barred.

Sexual HarassmentHostile Work EnvironmentSummary JudgmentQuid Pro QuoConstructive DischargeEmployer LiabilityCorrective ActionCo-worker MisconductEmployment DiscriminationTitle VII
References
21
Case No. 2021 NY Slip Op 07321
Regular Panel Decision
Dec 23, 2021

Matter of Salinas v. Power Servs. Solutions LLC

The case involves a workers' compensation claim by Michel Salinas, which identified Power Services Solutions LLC as the employer and Everest National Insurance Company as the carrier. Everest's appeal to the Workers' Compensation Board was denied as untimely despite concerns about deficient notice and a potentially fraudulent certificate of insurance. The Appellate Division, Third Department, reversed the Board's decision, finding an abuse of discretion given the strong evidence of fraud and the flawed communication to Everest. The matter was remitted to the Board for further proceedings to investigate the fraud allegations. The court emphasized that the Board should not ignore legitimate evidence of fraud.

Workers' Compensation LawAppellate DivisionBoard DiscretionTimeliness of AppealFraudulent Insurance CertificateNotice RequirementsEmployer IdentificationCarrier LiabilityRemittalAbuse of Discretion
References
25
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