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

Case No. 2020 NY Slip Op 03444
Regular Panel Decision
Jun 18, 2020

Schoch v. Lake Champlain OB-GYN, P.C.

Kim E. Schoch, a certified nurse midwife, was employed by Lake Champlain OB-GYN, P.C. and covered by a professional liability insurance policy from Medical Liability Mutual Insurance Company (MLMIC), with the employer paying all premiums. Following MLMIC's conversion to a stock insurance company, a cash consideration was to be distributed to eligible policyholders. Schoch, as the named insured, was deemed the policyholder, but Lake Champlain OB-GYN objected, claiming entitlement due to its premium payments, a claim upheld by the Supreme Court based on unjust enrichment. The Appellate Division reversed, ruling that Schoch, as the policyholder, was legally entitled to the consideration per statute and MLMIC's conversion plan. The court found that the demutualization proceeds were an unexpected windfall not explicitly covered by the employment agreement, and that Lake Champlain OB-GYN's unjust enrichment claim failed because Schoch's entitlement was based on law, not mistake or fraudulent conduct. Consequently, Schoch was declared solely entitled to the $74,747.03 cash consideration.

DemutualizationInsurance PolicyPolicyholder RightsUnjust EnrichmentProfessional LiabilityEmployment BenefitsAppellate DivisionContractual InterpretationCash ConsiderationMutual to Stock Conversion
References
16
Case No. MISSING
Regular Panel Decision
Apr 11, 1991

Gold v. Local Union No. 888

Leonard Gold, an employee for 29 years, was terminated by John Hancock Mutual Life Insurance Company following accusations of theft from a policyholder. Gold denied the allegations, attributing them to the policyholder's senility. The United Food and Commercial Workers International Union and Local Union No. 888, UFCW-AFL-CIO, represented Gold through the grievance process but ultimately withdrew their intent to arbitrate after an allegedly inadequate investigation by union official Andre Henault. Gold filed an action alleging breach of collective bargaining agreement by the Company and breach of the duty of fair representation by the union. The court denied John Hancock's motion for summary judgment, finding sufficient facts for a jury to infer the union handled Gold's grievance arbitrarily. Additionally, the court granted the union's motion to dismiss John Hancock's cross-claim, which was filed after the union settled with Gold, ruling it was barred.

duty of fair representationsummary judgmentgrievance processarbitrationcollective bargaining agreementwrongful terminationlabor lawunion settlementcross-claimfederal civil procedure
References
16
Case No. MISSING
Regular Panel Decision

Mero v. Foster

The Supreme Court ruled that Farm Family Insurance Companies must defend and indemnify the Fosters under their primary liability policy. This decision was based on the interpretation of the optional farm employee coverage, which was deemed to cover the injuries of infant John Mero, Jr., resolving policy ambiguities in favor of the policyholder. Conversely, the court found Farm Family not obligated to indemnify the Fosters under their umbrella policy, as it specifically excluded workers' compensation-related injuries without optional coverage. This judgment, encompassing both the primary and umbrella policies, was unanimously affirmed on appeal.

Insurance LawPolicy InterpretationFarm Employee CoverageUmbrella PolicyDeclaratory JudgmentAppellate ReviewContract AmbiguityDuty to DefendIndemnificationWorkers' Compensation Exclusion
References
4
Case No. ADJ7964733
Regular
May 29, 2018

JOSE LUIS MASTACHE vs. STAFFCHEX, INC., JESSIE LORD BAKERY; CALIFORNIA GUARANTEE ASSOCIATION for ULLICO CASUALTY COMPANY in Liquidation through its servicing facility SEDGWICK CMS; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves a workers' compensation claim where CIGA seeks reconsideration of a prior decision. The core dispute centers on whether a Travelers insurance policy issued to Jessie Lord Bakery excludes coverage for special employees leased from Staffchex. The Appeals Board granted reconsideration, rescinded the prior decision, and found that the Travelers policy provided coverage, reasoning that the exclusion endorsement was invalid as it lacked the required written affirmation by the policyholder. Furthermore, the Board clarified that general and special employers remain jointly and severally liable for workers' compensation benefits, irrespective of agreements between them.

CIGAStaffchexJessie Lord BakeryTravelers Property Casualty CompanyUllico Casualty CompanySpecial EmployeeGeneral EmployerJoint and Several LiabilityLabor Code Section 3602(d)Limiting Endorsement
References
22
Case No. MISSING
Regular Panel Decision

Matter of People (Int'l Workers Order)

This Per Curiam decision affirmed the liquidation order against the International Workers Order (I.W.O.). The court found the I.W.O.'s continued operation to be financially "hazardous" and in violation of its charter and state laws due to its prolonged political activities, including financing the Communist Party and disseminating its literature. These unauthorized actions, spanning nearly two decades, were deemed sufficient grounds for liquidation under sections 511 (e) and (f), 463 (c) and (d) of the Insurance Law, and section 671 of the Penal Law. The decision also addressed concerns from policyholders, confirming that arrangements had been made for their reinsurance on substantially similar terms, thus mitigating potential undue hardship.

LiquidationInsurance LawPenal LawPolitical ActivitiesCommunist PartyCharter ViolationHazardous Financial OperationPolicyholder ProtectionReinsuranceAppellate Review
References
1
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

Methodist Hospital v. State Insurance Fund

This case concerns the constitutionality of a $190 million transfer from the State Insurance Fund (SIF) to New York State's general fund, as directed by chapter 55 of the Laws of 1982. Plaintiffs, employers insured by the SIF, challenged the transfer on multiple state and federal constitutional grounds, including impairment of contractual obligations, deprivation of property without due process, unlawful taking, and improper legislative intrusion. The defendants included the SIF, its officials, the State Comptroller, and the State. Special Term and the Appellate Division both ruled the transfer constitutional. The Court of Appeals affirmed, holding that the SIF is a State agency for which the State is responsible, not a mutual insurance pool, thereby negating any property or contractual interest of policyholders in its surplus. The Court also dismissed other constitutional challenges related to separation of powers, loan of state credit, creation of debt, and appropriation bills.

State Insurance FundConstitutional LawFund TransferState AgencyMutual InsuranceProperty RightsContract ImpairmentDue ProcessJust CompensationSeparation of Powers
References
17
Case No. MISSING
Regular Panel Decision
Apr 23, 2001

Safety Group No. 194—New York State Sheet Metal Roofing & Air Conditioning Contractors Ass'n v. State

Claimants, long-standing policyholders with the State Insurance Fund (Fund), discontinued their workers' compensation policies and subsequently sought payment of final dividends as per their safety group endorsement. However, the Fund refused, citing necessary reserves for past and anticipated future loss developments. In response, claimants initiated a breach of contract action against the Fund, but the Court of Claims dismissed the case, determining it lacked subject matter jurisdiction because the claim's essence was equitable, seeking review of the Fund's discretionary actions rather than purely monetary damages. On appeal, the higher court affirmed this dismissal, concluding that the Fund’s statutory and contractual discretion in declaring dividends was preserved by the policy endorsement. Thus, the court found the monetary relief sought was merely incidental to challenging the Fund's discretionary judgment, a matter outside the Court of Claims' jurisdiction.

Workers' Compensation InsuranceDividend DeclarationBreach of ContractSubject Matter JurisdictionCourt of ClaimsState Insurance FundStatutory DiscretionEquitable ReliefCPLR Article 78Loss Development
References
5
Case No. MISSING
Regular Panel Decision

Selective Insurance Company of America v. State of New York Workers' Compensation Board

Petitioners, a group of insurance carriers, challenged the Workers’ Compensation Board’s refusal to issue them a credit or refund for assessments paid in excess of surcharges collected from their policyholders between 2001 and 2009. This discrepancy arose due to different methodologies used to calculate assessments (by the Board based on "total written premiums") and surcharges (by carriers based on "standard premiums"), resulting in some carriers collecting more in surcharges (windfall carriers) and others paying more in assessments (shortfall carriers), like the petitioners. In 2009, the Legislature amended the Workers’ Compensation Law to align the assessment methodology with "standard premiums" and authorized the Board to collect excess funds from windfall carriers. The amendment also allowed the Board to issue credits or refunds for "overpayments made to the fund." Petitioners interpreted this as applicable to shortfall carriers, but the Board denied their request, contending "overpayments" referred only to those made by windfall carriers. The court affirmed the Board's determination, finding its interpretation rational and consistent with the legislative intent, which was focused on deficit reduction and did not provide for relief to shortfall carriers.

Workers' Compensation LawInsurance CarriersAssessments and SurchargesStatutory InterpretationCredit/RefundOverpaymentsShortfall CarriersWindfall CarriersAdministrative LawCPLR Article 78
References
17
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