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

Case No. ADJ10132416
Regular
Sep 04, 2019

ARMANDO SALAZAR vs. DOTY BROS. EQUIPMENT COMPANY, AIG CLAIMS for NATIONAL UNION FIRE INSURANCE COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case concerns the determination of the cumulative trauma injury date and the corresponding liability period for a workers' compensation claim. The Appeals Board clarified that the date of injury under Labor Code section 5412 is July 30, 2005, through September 30, 2015, based on when the applicant should have reasonably recognized his disability as work-related, evidenced by his attorney filing a claim. Crucially, the Board distinguished this from the liability period under Labor Code section 5500.5, which was established as July 30, 2014, through July 30, 2015, the applicant's last day of work. This revised liability period confirmed that Starr Indemnity & Liability Company was within coverage for the claim.

Labor Code Section 5412Labor Code Section 5500.5cumulative trauma perioddate of injuryinjurious exposureknowledge of disabilityApplication for Adjudication of Claimpetition to dismisscoverageamended findings
References
3
Case No. ADJ4606826 (SJO 0265682)
Regular
Jul 01, 2009

WILBERT LEE vs. COCA-COLA BOTTLING CO., Permissibly Self-Insured, Adjusted By SEDGWICK CMS

In this workers' compensation case, the Board rescinded its prior decision and found the applicant entitled to temporary total disability indemnity. This indemnity is awarded for the period between November 21, 2007, and January 28, 2008, when the applicant was medically deemed unable to work. However, the applicant is estopped from receiving temporary disability indemnity for periods of temporary partial disability due to refusing modified work without good cause. The Board affirmed its finding that the applicant is not entitled to temporary disability for periods of partial disability for the reasons stated in its earlier opinion.

Workers' Compensation Appeals BoardReconsiderationTemporary Disability IndemnityModified WorkEstoppelAgreed Medical EvaluatorPrimary Treating PhysicianTemporary Total DisabilityTemporary Partial DisabilityOdd Lot Doctrine
References
4
Case No. ADJ4258158 (OXN 0128983) ADJ4450153 (OXN 0136267)
Regular
Jun 01, 2010

BRENDA K. ROACH vs. BRIDAL TRADITIONS, CALIFORNIA INDEMNITY INSURANCE COMPANY, PREFERRED EMPLOYERS INSURANCE COMPANY

This case involves California Indemnity Insurance Company (CIIC) seeking reconsideration of a Workers' Compensation Arbitrator's decision. CIIC disputes the finding of a single cumulative trauma injury period and the assigned date of injury, arguing for a longer exposure period. The Appeals Board granted reconsideration and amended the prior findings to establish one cumulative trauma injury from March 5, 1999, through November 24, 2002. The original decision regarding CIIC's contribution claim against Preferred Employers Insurance Company was otherwise affirmed.

Cumulative traumaDate of injuryLabor Code section 5412Labor Code section 5500.5Petition for ContributionReconsiderationFindings and OrderCompromise and ReleaseAnti-merger statutesApportionment
References
2
Case No. 15 Civ. 3975 (NRB)
Regular Panel Decision

National Indemnity Co. v. IRB Brasil Resseguros S.A.

This case involves a dispute between National Indemnity Company (NICO) and IRB Brasil Resseguros S.A. (IRB) over reinsurance obligations. Following contentious arbitrations, a tribunal issued three awards favoring NICO. NICO petitioned the U.S. District Court to confirm these awards, while IRB cross-petitioned for vacatur, citing alleged 'evident partiality' of the neutral umpire, Daniel Schmidt, due to his concurrent service in an unrelated arbitration involving a NICO affiliate (Equitas) and challenging the tribunal's jurisdiction. The court found Schmidt's disclosures reasonable and his concurrent assignments insufficient to demonstrate partiality. It also affirmed the arbitration panel's jurisdiction over the disputed 2008 premium and associated fees. Consequently, the court granted NICO's petition to confirm the awards and denied IRB's cross-petition to vacate them.

ArbitrationReinsurance DisputeEvident PartialityUmpire DisclosureVacatur of Arbitration AwardConfirmation of Arbitration AwardFederal Arbitration ActNew York ConventionArbitration ClauseContract Interpretation
References
42
Case No. MISSING
Regular Panel Decision
Jun 30, 1992

National General Insurance v. Hartford Accident & Indemnity Co.

This case concerns a declaratory judgment action regarding insurance coverage following a fatal airplane crash. Warren Geddes, president of American Investor Services, Inc. (AIS), was piloting a plane carrying Gary Conway, an AIS employee, when it crashed, killing both. National General Insurance Company, insurer of the plane owner, sought for Hartford Accident and Indemnity Company, AIS's workers' compensation insurer, to defend and indemnify AIS and Geddes' Estate in a wrongful death action. Hartford denied coverage for Geddes' Estate, arguing he was not a named or additional insured under their policy. The court modified the initial judgment, declaring that Hartford has no duty to defend or indemnify the Estate of Geddes, while otherwise affirming the judgment.

Insurance CoverageDeclaratory JudgmentWrongful DeathDuty to DefendDuty to IndemnifyNamed InsuredAdditional InsuredWorkers' Compensation PolicyAirplane CrashEstate Liability
References
5
Case No. MISSING
Regular Panel Decision

Hartford Accident & Indemnity Co. v. Commercial Union Insurance

This case involves a dispute between two insurance companies, Hartford Accident and Indemnity Company (excess insurer) and Commercial Union Insurance Company (primary insurer), concerning liability for an injury claim. Michael Jutt, an employee of Minuteman Press International, Inc., was injured while on a Minuteman-owned boat. Commercial Union, the primary insurer, denied coverage and refused to defend Minuteman, leading Hartford, the excess insurer, to provide defense and settle Jutt's claim for $135,000. Hartford subsequently sued Commercial Union for breach of fiduciary duty. The District Court affirmed Hartford's standing to sue, recognizing a direct fiduciary duty owed by a primary insurer to an excess insurer, and found that the "paid employees" exclusion in Commercial Union's policy was ambiguous. Consequently, the Court ruled in favor of Hartford, ordering Commercial Union to pay $135,000 plus interest.

Insurance LawExcess InsurancePrimary InsuranceFiduciary DutyEquitable SubrogationPolicy ExclusionAmbiguous Contract TermDeclaratory Judgment ActionStanding to SueMarine Insurance
References
5
Case No. MISSING
Regular Panel Decision

Hartford Accident & Indemnity Co. v. Coastal Dry Dock & Repair Corp.

This case concerns an appeal by Hartford Accident and Indemnity Co. (insurer) against Coastal Dry Dock and Repair Corp. (insured) regarding unpaid retrospective premiums on a workers' compensation policy. The insurer sought to recover additional premiums calculated based on the insured's loss record, as stipulated by a 'Retrospective Premium Endorsement.' The defendant raised multiple defenses and counterclaims, alleging improper calculations, misrepresentation, and mishandling of claims. The Supreme Court initially denied the plaintiff's motion for summary judgment. However, the Appellate Division reversed this decision, ruling that the defendant's opposition, primarily an attorney's affidavit lacking personal knowledge, was insufficient to raise a genuine issue of material fact. The court found the defendant's defenses and counterclaims legally insufficient, affirming the insurer's contractual right to negotiate and settle claims.

Workers' Compensation PolicyRetrospective PremiumSummary JudgmentContract DisputeInsurance LawAppellate ReviewAffidavit SufficiencyEvidentiary FactsClaims SettlementPolicy Interpretation
References
6
Case No. MISSING
Regular Panel Decision
May 18, 2017

TransAtlantic Lines LLC v. American Steamship Owners Mutual Protection & Indemnity Ass'n

TransAtlantic Lines LLC sought to overturn an adverse insurance coverage decision by the Board of Directors of American Steamship Owners Mutual Protection and Indemnity Association, following a shipping accident. TransAtlantic argued for a de novo review, asserting the alternative dispute resolution (ADR) process was fundamentally unfair due to the Board's inherent financial bias and violated public policy. The district court, however, applied the contractually agreed-upon "arbitrary and capricious" standard of review. The court rejected TransAtlantic's claims of bias and public policy violations, finding that TransAtlantic had voluntarily consented to the ADR framework. Consequently, the court upheld the Board's decision to deny coverage for attorney's fees, U.S. Government cargo losses, and perishable cargo expenses, concluding that these denials were not arbitrary or capricious.

Alternative Dispute Resolution (ADR)Insurance Coverage DisputeSummary JudgmentArbitrary and Capricious StandardContract LawMarine InsuranceJudicial Review of ArbitrationWaiver of RightsPublic Policy ExceptionAttorney Ethics
References
24
Case No. 2017 NY Slip Op 04775
Regular Panel Decision
Jun 13, 2017

Ironshore Indemnity, Inc. v. W&W Glass, LLC

Ironshore Indemnity, Inc., as subrogee of The Related Companies, L.P., appealed a judgment that dismissed their action. The Supreme Court initially granted the Related Companies' motion to intervene, quash subpoenas, and dismiss the complaint. The Appellate Division, First Department, affirmed this judgment, finding that the Related Companies had a strong interest in the litigation. The court concluded that Ironshore had no subrogation rights because it had not made any payments or covered defense costs on behalf of the Related Companies in the underlying personal injury action. Additionally, Ironshore's subrogation claims were barred by Workers' Compensation Law § 11, as no 'grave injury' was alleged or proven.

subrogation rightsinterventionworkers' compensation lawgrave injuryadditional insuredindemnificationcontributiondefense costsappellate divisionjudgment dismissal
References
6
Case No. ADJ8024286, ADJ2761399
Regular
Apr 18, 2023

KENNETH CASE vs. UNION DODGE, INC., EVEREST NATIONAL INSURANCE COMPANY, ARROWOOD INDEMNITY COMPANY

The Workers' Compensation Appeals Board granted Arrowood Indemnity Company's petition for reconsideration, amending an arbitrator's decision. While the Board agreed with Arrowood that only one cumulative injury occurred, it found the liability period for this injury to be the year preceding February 4, 2004, based on the applicant's date of knowledge of disability. The Board affirmed the arbitrator's decision not to recuse himself, despite improper settlement disclosures by Everest. Arrowood may still argue apportionment to subsequent injuries in further proceedings.

ADJ8024286ADJ2761399Union DodgeInc.Arrowood Indemnity CompanyEverest National Insurance CompanyPetition for ReconsiderationCumulative InjuryLabor Code section 5500.5Labor Code section 5412
References
4
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