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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

G.L.G. Contracting Corp. v. Aetna Casualty & Surety Co.

Plaintiff, a general contractor, failed to notify its liability insurer (defendant) about an employee's construction accident for nearly three years. After the injured employee initiated a personal injury lawsuit against plaintiff under the Labor Law, plaintiff notified its insurer, who then disclaimed coverage citing untimely notice. Plaintiff subsequently sued for a declaratory judgment, arguing it had a reasonable belief in nonliability. Defendant moved for summary judgment, contending plaintiff's owner, an experienced contractor and insurance broker, should have known of potential liability. The Supreme Court denied defendant's motion, ruling the reasonableness of belief in nonliability is a factual issue. The appellate court affirmed this decision, reserving credibility issues for the trier of fact.

Insurance Coverage DisputeTimely Notice RequirementCondition Precedent to CoverageReasonable Belief of NonliabilitySummary Judgment DenialDeclaratory Judgment ActionAppellate AffirmationLabor Law Sections 200Labor Law Sections 240Labor Law Sections 241(6)
References
8
Case No. MISSING
Regular Panel Decision

Hermany Farms, Inc. v. Seneca Ins.

This case concerns Hermany Farms Inc.'s declaratory judgment action against Seneca Insurance Company. Hermany sought a declaration that Seneca was obligated to defend and indemnify it in an underlying personal injury lawsuit. The Appellate Division reversed the lower court's grant of summary judgment to Hermany. The court found that Hermany failed to provide timely notice to Seneca 'as soon as practicable' after the occurrence. Despite Hermany's argument of a good faith belief in nonliability, evidence showed Hermany's employees and owners were aware of the accident and a workers' compensation report was filed shortly after the incident, negating a reasonable belief of nonliability. The court concluded that Hermany failed to establish the reasonableness of its proffered excuse for late notice.

Insurance coverage disputeDeclaratory judgmentLate notice of claimDuty to defendDuty to indemnifySummary judgment reversalPersonal injury claimGood faith beliefWorkers' compensation reportAppellate Division
References
4
Case No. MISSING
Regular Panel Decision

Seemann v. Sterling Insurance

Plaintiff Seemann, while at work in New Jersey, injured a co-worker with a paintball. Four months later, advised by the co-worker's attorney, Seemann notified Sterling Insurance, his homeowner's insurer in Schoharie County. Sterling Insurance disclaimed coverage due to delayed notice. The Supreme Court found Seemann's belief of no coverage justifiable and his delay reasonable, obligating Sterling Insurance to defend and pay. The Appellate Division affirmed, concluding that Seemann's good-faith belief that his homeowner's policy did not cover an off-premises incident was reasonable, and he acted diligently upon receiving the attorney's letter, thereby providing a reasonable excuse for the delay in notice.

Homeowner's InsuranceCoverage DisputeNotice RequirementsGood-Faith BeliefOff-Premises InjuryDeclaratory JudgmentAppellate ReviewReasonableness of DelayInsurance Policy InterpretationPaintball Incident
References
3
Case No. ADJ8334555
Regular
Apr 05, 2013

JOSE HERNANDEZ vs. BRYAN MIMAKI dba PACIFIC RIMS, PALMS; ZENITH INSURANCE COMPANY

This case concerns whether a knee injury sustained by an employee, Jose Hernandez, while playing basketball on company premises during lunch is compensable. The defendant argued the injury did not arise out of employment, as it stemmed from voluntary participation in an athletic activity not required by the employer. The Appeals Board denied reconsideration, affirming the finding that the injury was industrial. The majority found the employee's subjective belief of employer expectation was objectively reasonable, given the employer provided a court and balls and supervisors encouraged participation. Commissioner Lowe dissented, arguing the applicant failed to demonstrate an objectively reasonable belief of employer expectation, as he could opt out and faced no repercussions.

Workers' Compensation Appeals BoardIndustrial InjuryRight KneeField WorkerBasketball GameOff-Duty Recreational ActivityLabor Code Section 3600(a)(9)Reasonable Expectancy of EmploymentSubjective BeliefObjective Reasonableness
References
3
Case No. MISSING
Regular Panel Decision

25th Avenue v. Delos Insurance

Plaintiffs 25th Avenue, LLC and Colonial Construction and Development, LLC, appealed an order and judgment from the Supreme Court, Nassau County, which granted summary judgment to Delos Insurance Company. The Supreme Court had declared that Delos was not obligated to defend or indemnify the plaintiffs in an underlying Labor Law action, Jaramillo v Colonial Constr., LLC. The insurer had denied coverage due to late notice of the claim. The Appellate Court reversed the Supreme Court's judgment, denied the insurer's motion for summary judgment, and reinstated the plaintiffs' complaint. The court found that the plaintiffs had raised a triable issue of fact regarding their reasonable, good faith belief of nonliability, which could excuse their delay in providing notice to the insurer.

Insurance Coverage DisputeLate Notice of ClaimSummary Judgment AppealDuty to DefendDuty to IndemnifyReasonable Belief of NonliabilityCondition Precedent to CoverageAppellate ProcedureConstruction Site InjuryLabor Law Violations
References
15
Case No. MISSING
Regular Panel Decision
Oct 09, 2001

Generali-U.S. Branch v. Rothschild

This case concerns an insurance dispute between Generali, an insurer, and the Rothschild defendants, insureds, regarding commercial general liability coverage. The Rothschilds were notified in 1992 by tenants, the Eromosele family, and a social worker about lead poisoning in their children from peeling paint. In 1997, the Eromoseles sued the Rothschilds for negligence. Generali, notified in 1998, subsequently filed a declaratory judgment action to avoid defending or indemnifying the Rothschilds. The Supreme Court initially granted Generali's motion for summary judgment. On appeal, the court found Generali's two-month delay in disclaiming coverage reasonable as a matter of law. However, the court identified a factual issue regarding whether the Rothschilds were obligated to notify Generali in 1992, given Generali was not then their insurer and the Rothschilds' potential good faith belief of nonliability. Consequently, the appellate court modified the order, denying Generali's motion for summary judgment.

Insurance CoverageDisclaimer of LiabilitySummary JudgmentNegligence ActionLead Paint PoisoningGood Faith BeliefQuestion of FactAppellate ReviewProperty InsuranceTenant Claim
References
7
Case No. MISSING
Regular Panel Decision

St. James Mechanical, Inc. v. Royal & Sunalliance

St. James Mechanical, Inc., an insured party, initiated an action against its insurance carrier, Royal Insurance Company, and an affiliated carrier, seeking a judgment declaring their obligation to defend and indemnify St. James in an underlying personal injury lawsuit. This underlying action stemmed from an accident involving a worker hired by St. James for renovations at the Sheraton New York Hotel & Towers. Royal disclaimed coverage, citing St. James's two-year delay in providing notice of the accident, contending it failed to meet the 'as soon as practicable' clause in the commercial general liability policy. Initially, the Supreme Court granted the insurance carriers' cross-motion for summary judgment, dismissing St. James's complaint. However, the appellate court reversed this decision, ruling that St. James successfully raised a triable issue of fact regarding whether its delay in notice was reasonably based on a good faith belief in nonliability, thereby precluding summary judgment.

Insurance coverageTimely noticeDisclaimer of coverageSummary judgmentPersonal injuryDuty to defendDuty to indemnifyGood faith belief in nonliabilityCondition precedentAppellate review
References
15
Case No. ADJ6884625
Regular
Jun 19, 2012

JASON PETERSON, KIRSTIE MCCRAINE-PETERSON vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

This case concerns the death of Jason Peterson, a correctional officer, from a pulmonary embolism after injuring his calf in a kickboxing class. The applicant, his widow, claimed the injury and death were work-related, arguing the kickboxing class was a reasonable expectancy of employment due to a general fitness requirement and incentive program. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's decision, finding the claim barred by Labor Code Section 3600(a)(9) because the decedent's belief that kickboxing was required was not objectively reasonable, as mere general assertions of fitness expectations are insufficient. Commissioner Brass dissented, believing the decedent's participation was both subjectively and objectively reasonable given its likely benefit to his job performance as a correctional officer.

Labor Code Section 3600(a)(9)Pulmonary EmbolismCorrectional OfficerKickboxingOff-duty Recreational ActivityReasonable Expectancy of EmploymentSubjective BeliefObjective ReasonablenessEzzy testCity of Stockton v. Workers' Comp. Appeals Bd. (Jenneiahn)
References
2
Case No. MISSING
Regular Panel Decision
Feb 04, 1948

Hawkins v. Safety Casualty Co.

William M. Hawkins, the claimant, sustained an accidental injury on July 3, 1945, while in the course of his employment. He filed a workmen's compensation claim, but it was initially denied by the trial court and affirmed by the Court of Civil Appeals on the grounds that he failed to demonstrate "good cause" for not filing his claim within the six-month statutory period. Hawkins contended that his delay was due to a bona fide belief that his injuries were not serious, a belief reinforced by assurances from the company physician. The Supreme Court reversed the lower courts' judgments, ruling that the question of "good cause" is typically a matter for the jury to decide, and that a claimant's reasonable belief in the triviality of injuries, especially when based on a physician's advice, can constitute sufficient good cause for a delayed filing. The case was remanded to the district court for further proceedings consistent with this opinion.

Workmen's CompensationGood CauseLate FilingIndustrial Accident BoardAccidental InjuryCompany PhysicianMedical AdviceTrivial Injury BeliefOrdinary PrudenceQuestion of Fact
References
22
Case No. 2007 NY Slip Op 30531(U)
Regular Panel Decision
Apr 05, 2007

Schirmer v. Athena-Liberty Lofts, LP

This case is an appeal from an Order of the Supreme Court, New York County, regarding a personal injury action. The plaintiff, a worker at a construction site, sustained injuries, leading to the site owner, Lofts, settling the claim after being found liable under Labor Law § 240 (1). Lofts then pursued indemnity claims against lighting contractor HP and the plaintiff's employer, Burgess. The Appellate Court modified the lower court's decision, vacating the finding that Lofts' settlement amount was reasonable due to Lofts' failure to properly demonstrate reasonableness and its mischaracterization of waiver arguments by HP and Burgess. The Court also affirmed the denial of HP's motion for summary judgment, citing unresolved factual issues concerning inadequate lighting as a cause of the accident.

Personal InjuryConstruction Site AccidentSummary JudgmentIndemnity ClaimLabor Law § 240(1)Appellate DivisionThird-Party ActionSettlement ReasonablenessCross ClaimsInadequate Lighting
References
4
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