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

Case No. ADJ7531724, ADJ7531690
Regular
Dec 01, 2017

AURORA LEMUS vs. FREEBIRDS WORLD BURRITO, GRANITE STATE INSURANCE COMPANY, MARK ORFALIA, REDWOOD FIRE AND CASUALTY COMPANY

This case involves a dispute between Granite State Insurance Company and Redwood Fire and Casualty Company regarding contribution for workers' compensation benefits paid to applicant Aurora Lemus. Granite, initially denied contribution by the WCJ, petitioned for reconsideration. The parties subsequently settled the contribution claim for $22,500.00 through mediation, which has been approved by the Board. This stipulation fully resolves Granite's claims against Redwood.

Workers' Compensation Appeals BoardReconsiderationContributionReimbursementJoint Findings of FactCompromise and ReleaseStipulationVoluntary MediationCommissioners' Settlement ConferenceInsurer
References
0
Case No. MISSING
Regular Panel Decision

Insurance Corp. of New York v. United States Fire Insurance

This case concerns a dispute between a primary insurer, The Insurance Corporation of New York, and an excess insurer, United States Fire Insurance Company (US Fire), regarding the timeliness of claim notice and US Fire's subsequent disclaimer. The motion court initially denied US Fire's cross-motion for summary judgment, deeming its disclaimer untimely. However, the appellate court determined that US Fire received proper notice on April 20, 2006, not March 16, 2006, making its disclaimers, issued eight days later, timely as a matter of law. Consequently, the appellate court reversed the lower court's decision, granting US Fire's cross-motion for summary judgment and dismissing the complaint against it. Additionally, an appeal from a separate order regarding US Fire's request to rescind an insurance policy was dismissed as abandoned.

Insurance PolicyExcess InsurancePrimary InsuranceTimely NoticeDisclaimer of CoverageSummary JudgmentAppellate ReviewClaim NotificationInsurance ContractLiability Insurance
References
9
Case No. ADJ391084 (GOL 0102020) ADJ1292455 (GOL 0100312)
Regular
May 26, 2015

MICHAEL LOPEZ vs. ED & TED'S EXCELLENT LIGHTING, FIREMAN'S FUND INSURANCE COMPANY, REDWOOD FIRE & CASUALTY COMPANIES

This case involves two workers' compensation claims for applicant Michael Lopez against Ed & Ted's Excellent Lighting, insured by Redwood Fire & Casualty and Fireman's Fund Insurance Company. The Arbitrator found industrial injuries to Lopez's back and extremities and allocated partial liability to both insurers for the second injury period. Both insurers sought reconsideration, alleging clerical errors and disputes over liability allocation. The Workers' Compensation Appeals Board granted reconsideration to correct these clerical errors. The Board rescinded the original decision and returned the case to the Arbitrator for further proceedings and a new decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderArbitratorIndustrial InjuryLumbar BackUpper ExtremitiesHerniaCumulative TraumaInsurance Company
References
0
Case No. MISSING
Regular Panel Decision
May 12, 1995

Wausau Underwriters Insurance v. Continental Casualty Co.

This case addresses a dispute between Wausau Underwriters Insurance Company (Wausau) and Continental Casualty Company (Continental), along with The Hartford Insurance Group. Wausau, as the employer's liability carrier for H. Sand & Company, successfully argued that a third-party action by Slattery-Argrett, subrogor of Continental, against H. Sand & Company, constituted an impermissible subrogation claim by an insurer against its own insured. The underlying matter involved a personal injury sustained by an employee of H. Sand & Company. Continental had initially disclaimed coverage for Sand in the third-party action. The Supreme Court granted Wausau's motion for summary judgment, declaring the subrogation action a violation of public policy and awarding Wausau damages. The appellate court affirmed this judgment, distinguishing the present case from prior rulings like *North Star Reins. Corp. v Continental Ins. Co.*, and emphasizing the distinction between claims for indemnification and contribution within insurance policy exclusions.

Subrogation ClaimInsurance Coverage DisputeIndemnification vs. ContributionPublic Policy in InsuranceSummary JudgmentEmployer LiabilityGeneral Liability InsuranceExcess Liability InsuranceConstruction AccidentWorkers' Compensation Carrier
References
9
Case No. MISSING
Regular Panel Decision
Sep 11, 1989

In re the Arbitration Between St. Paul Fire & Marine Insurance

St. Paul Fire & Marine Insurance Company petitioned for a stay of arbitration sought by James D. Brown, Jr. and for a declaration that Richard Faulkner's vehicle was covered by Aetna Casualty & Surety Company's policy issued to Empire Preferred Commercial Operations. Faulkner, an Empire employee, was involved in an accident with Brown while driving his own car for business purposes, despite making a stop to pick up his son en route to a job inspection site. Brown made a claim against the uninsured motorist provision of his policy with St. Paul. The lower court found Faulkner's vehicle was used "in connection with" Empire's business, and this finding was upheld on appeal. The court concluded that picking up his son was not a deviation from employment. Therefore, the judgment granting St. Paul's petition and affirming Aetna's coverage for Faulkner's vehicle was unanimously affirmed.

Insurance CoverageAutomobile AccidentScope of EmploymentNon-Owned AutomobilesArbitration StayDeclaratory JudgmentEmployer LiabilityEmployee TravelBusiness Use of VehicleDeviation from Employment
References
3
Case No. MISSING
Regular Panel Decision

National Union Fire Insurance Co. of Pittsburgh v. American Re-Insurance Co.

The case revolves around a dispute between National Union Fire Insurance Company and American Re-Insurance Company regarding a pollution exclusion clause in a reinsurance policy. National Union sought reimbursement from American Re after settling claims where employees were exposed to metalworking fluids. American Re denied coverage, arguing its pollution exclusion applied. The court, applying Ohio law, found American Re's pollution exclusion ambiguous due to its broad language and its intended purpose of covering environmental contamination. Consequently, American Re's motion for summary judgment was denied, and National Union's motion to strike American Re's defense was granted, requiring American Re to "follow the fortunes" of National Union.

ReinsurancePollution Exclusion ClauseContract InterpretationFollow the Fortunes DoctrineSummary JudgmentInsurance CoverageAmbiguity in ContractsOhio State LawDiversity JurisdictionIndustrial Contamination
References
31
Case No. MISSING
Regular Panel Decision

Atlantic Casualty Insurance v. Value Waterproofing, Inc.

Atlantic Casualty Insurance Company sought a declaratory judgment that it had no duty to defend or indemnify Value Waterproofing, Inc. in an underlying breach of contract and negligence lawsuit. Value counterclaimed, requesting a declaration that Atlantic Casualty was required to defend and indemnify. The court granted Atlantic Casualty's request, finding that Value failed to provide timely notice of the claim, thereby prejudicing Atlantic Casualty's investigation capabilities. Additionally, the court ruled that Value's work on a commercial property was not covered by its residential-only roofing insurance policy, further justifying the denial of coverage.

Insurance disputeBreach of contractNegligenceDeclaratory judgmentTimely noticeCoverage exclusionCommercial General LiabilityResidential roofingPolicy interpretationPrejudice
References
46
Case No. ADJ15763825
Regular
Sep 16, 2025

CLAUDIO CARDOZO vs. ROCK AND ROLL CAR WASH, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by Redwood Fire and Casualty Insurance Company dba Berkshire Hathaway Homestate Companies. The petition challenged a lien trial decision concerning a medical-legal evaluation performed by Dr. Michaels of Premier Psychological Services. The WCJ found that a medical dispute regarding psyche existed at the time of the evaluation, Dr. Michaels was validly designated as the Primary Treating Physician, and the evaluation was not barred by the 60-day rule for new claims as it was an amendment to an already accepted claim. The Appeals Board adopted the WCJ's reasoning and denied the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Adjudication NumberOpinion and Order Denying PetitionWCJ ReportEAMS TransmissionNotice of TransmissionProof of ServiceFindings and Order
References
4
Case No. MISSING
Regular Panel Decision

Levin v. Intercontinental Casualty Insurance

This case addresses whether a pre-answer motion to dismiss filed by an 'unauthorized foreign or alien' insurance carrier constitutes a 'pleading' under Insurance Law § 1213 (c), thereby requiring the carrier to post a bond. The New York State Superintendent of Insurance, as liquidator of Ideal Mutual Insurance Company, sued Intercontinental Casualty Insurance Company, a Cayman Islands carrier, for reinsurance proceeds. Intercontinental moved to dismiss on Statute of Limitations and documentary evidence grounds without posting a bond. The Supreme Court ordered a bond, which Intercontinental failed to provide, leading to a judgment against it. The Court of Appeals affirmed the lower courts' decisions, ruling that such motions, which address the merits of the case, fall within the definition of a 'pleading' for the purpose of ensuring funds are available to satisfy any potential judgment.

Insurance Law § 1213 (c)Unauthorized InsurerBond RequirementPleading DefinitionMotion to DismissStatute of LimitationsDocumentary EvidenceReinsurance AgreementLiquidation ProceedingForeign Carrier
References
2
Case No. ADJ6542364
Regular
Sep 21, 2009

Denise Patterson Crumrine vs. SISKIYOU HOSPITAL INC., BERSHIRE HATHAWAY PASADENA, State Compensation Insurance Fund, Redwood Fire and Casualty Insurance Company

The Workers' Compensation Appeals Board granted reconsideration to State Fund. While affirming the joinder of State Fund as a party defendant, the Board rescinded the prior order requiring State Fund to reimburse Redwood Fire and Casualty Insurance Company for 25.48% of applicant benefits. This rescission was based on State Fund's due process rights, which were violated by the lack of opportunity for discovery and defense. The case is returned to the trial level for further proceedings consistent with due process and relevant Labor Code sections.

State FundRedwood Fire and CasualtyPetition for ReconsiderationOrder Joining Party DefendantDue ProcessDiscoveryContributionReimbursementJoinderWCJ
References
1
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