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

Case No. ADJ6865421
Regular
Sep 08, 2017

DAVID BERRIOS-SEGOVIA vs. EJ DISTRIBUTION CORPORATION, SOUTHERN INSURANCE COMPANY, MARKEL dba FIRST COMP, STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case returns to the Appeals Board after the Court of Appeal determined that the rescission of an insurance policy is subject to mandatory arbitration. The Court annulled the arbitrator's prior findings, ordering further proceedings to determine the legal effectiveness of the insurer's rescission. The insurer must prove the employer's misrepresentations were material and that rescission is not being used to circumvent policy approval requirements. The matter is remanded to the arbitrator for further proceedings and a new decision.

Workers' Compensation Appeals BoardRemittiturMandatory ArbitrationLabor Code Section 5275Policy RescissionMaterial MisrepresentationUninsured Employers Benefits Trust FundDepartment of InsuranceInsurance CommissionerPrior Approval
References
0
Case No. MISSING
Regular Panel Decision
Sep 27, 2007

National Union Fire Insurance Co. of Pittsburgh v. St. Barnabas Community Enterprises, Inc.

This case concerns the arbitrability of disputes between an unnamed petitioner and its insured, St. Barnabas, over retrospective premiums and credits from workers' compensation policies covering 1995-1998 and 2000-2001. The Supreme Court's order, which compelled arbitration and denied St. Barnabas's cross-motion to dismiss, was modified. The appellate court affirmed arbitration for the 1995-1998 policies due to explicit arbitration clauses. However, arbitration for the 2000-2001 policies was stayed as they lacked such clauses and provided for litigation. Claims of fraudulent inducement related to the earlier policies were referred to arbitrators, as they did not specifically challenge the arbitration agreement itself.

ArbitrationWorkers' Compensation PoliciesRetrospective PremiumsInsurance DisputesPolicy InterpretationFraudulent InducementContract LawNew York CourtsAppellate DecisionJurisdiction
References
6
Case No. MISSING
Regular Panel Decision

Catania v. Hartford Accident & Indemnity Co.

This case involves a submitted controversy under sections 546 to 548 of the Civil Practice Act, concerning whether a liability policy issued to John Schiro extends coverage to the plaintiff for injuries sustained by Schiro's wife. Schiro's wife alleged negligence against her spouse in the operation of his vehicle during his employment with the plaintiff. The court analyzed Insurance Law section 167 (subd. 3), which states that policies do not cover liability for spousal injuries unless expressly provided. Citing Morgan v. Greater New York Taxpayers Mut. Ins. Assn., the court treated the policy as if issued to the plaintiff alone, determining that Schiro's wife is not the plaintiff's spouse, thus making section 167 (subd. 3) inapplicable. The decision, supported by Manhattan Cas. Co. v. Cholakis, concluded that the insurer is liable. Therefore, judgment was granted in favor of the plaintiff, requiring the defendant to defend the pending negligence action and pay any judgment up to the policy limits.

Liability PolicyInsurance CoverageSpousal LiabilityCivil Practice ActInsurance LawNegligenceDeclaratory JudgmentAutomobile AccidentEmployer LiabilityInterspousal Immunity
References
2
Case No. MISSING
Regular Panel Decision

Trojcak v. Valiant Millwrighting & Warehousing, Inc.

This case involves an appeal from a Workers' Compensation Board decision concerning the proper cancellation of an employer's workers' compensation policy. A claimant was injured in September 1995, leading to a dispute when the carrier claimed the policy was canceled in June 1995 due to nonpayment. Initially, a Workers' Compensation Law Judge ruled the policy was improperly canceled, citing Banking Law § 576 and estoppel. However, the Workers' Compensation Board reversed this, finding the cancellation adhered to Banking Law § 576's notice requirements. This appellate court affirmed the Board's decision, concluding that the statutory notice provisions were met and that the finance agency and carrier were not estopped from canceling the policy despite prior acceptance of late payments.

Workers' Compensation Policy CancellationBanking Law § 576Estoppel DoctrineNotice RequirementsLate PaymentsInsurance Coverage DisputePolicy DefaultAppellate ReviewStatutory CompliancePremium Finance Agreement
References
7
Case No. 6:09-CV-853
Regular Panel Decision

Utica Mutual Insurance Co. v. Fireman's Fund Insurance Co.

This case details a dispute between Utica Mutual Insurance Company (Utica) and Fireman’s Fund Insurance Company (FFIC) concerning reinsurance contracts, with Utica seeking substantial damages for alleged breach of contract and bad faith. FFIC counterclaimed for rescission of the reinsurance agreements. A central contention revolves around whether Utica's primary liability policies issued to Goulds from 1966-1972 contained aggregate limits for bodily injury, a condition critical to triggering FFIC's reinsurance obligations. The court dismissed Utica's bad faith claim (Count II) and its request for declaratory relief (Count III) but denied all other motions for summary judgment by both parties, including those regarding the 'follow the settlement' doctrine, FFIC's rescission counterclaim, and the timeliness of notice. Consequently, the core breach of contract claim (Count I) and FFIC's counterclaims for rescission are slated to proceed to trial.

Reinsurance DisputeBreach of ContractSummary JudgmentFollow the Settlement DoctrineAggregate LimitsBad Faith ClaimRescissionNotice of ClaimInsurance LawAsbestos Claims
References
56
Case No. MISSING
Regular Panel Decision

Fagnani v. American Home Assurance Co.

This case involves an appeal concerning an insurance policy's exclusionary clause. Plaintiffs' decedents, Stephen Fagnani and Brandon Young, were killed in a helicopter crash while working for ODECO. The defendant insurance carrier disclaimed liability, citing a policy exclusion for 'Flying in any Rotocraft being used for transportation of Oil Rig Crews to and from such rigs.' Special Term granted summary judgment for the plaintiffs, interpreting ambiguities against the insurer. Justice Titone, however, dissents, arguing that both sides presented extrinsic evidence, which creates a question of fact regarding the meaning of 'oil rig' that necessitates a trial. He recommends reversing the judgment, vacating the order, and remitting the matter for trial.

Insurance PolicyExclusionary ClauseSummary JudgmentContract InterpretationExtrinsic EvidenceAmbiguityHelicopter CrashAccidental DeathOil Rig CrewsAppellate Dissent
References
10
Case No. MISSING
Regular Panel Decision

Ramirez v. United States Fidelity & Guarantee Co.

Anthony Ramirez was killed in an accident while working for Leisure Pool Service, leading his estate and property owner Samuel Hillman to sue his employers for wrongful death. Hillman subsequently cross-claimed against the employers for indemnification and contribution. USF&G, the employers' insurer, disclaimed coverage for Hillman's cross-claim based on an employee bodily injury exclusion in their general liability policy. The Supreme Court granted summary judgment for USF&G, upholding the exclusion. On appeal, the court dismissed Ramirez's appeal, modified Hillman's appeal by explicitly declaring the exclusion applied, and affirmed the judgment, finding the policy's exclusionary language clear and unambiguous regarding employee injuries and related contribution claims.

Insurance policyDeclaratory judgmentSummary judgmentEmployee exclusionBodily injuryContributionIndemnificationAppellate reviewPolicy interpretationAmbiguity
References
10
Case No. MISSING
Regular Panel Decision

American Home Assurance Co. v. McDonald

This declaratory judgment action involves American Home Assurance Company seeking to limit its liability under professional liability policies issued to social workers Rory M. McDonald and Helene Ina Anisfeld, who are defendants in an underlying malpractice action brought by Randy Kamhi. Kamhi alleges sexual misconduct and professional negligence against McDonald, and vicarious liability and direct negligence against Anisfeld as McDonald's partner. American Home sought summary judgment to limit indemnification to $25,000 for sexual misconduct claims and punitive damages. The court granted summary judgment in part, affirming the $25,000 limit for McDonald's sexual misconduct and for punitive damages for both McDonald and Anisfeld. However, the court denied the request to terminate American Home's duty to defend McDonald upon exhausting the $25,000 limit and granted Kamhi's cross-motion to stay further summary judgment applications until discovery in the underlying action is complete. Crucially, the court found that extending the sexual misconduct coverage limit to non-sexual malpractice claims violates New York public policy.

Professional Liability InsuranceSexual MisconductInsurance Coverage DisputeDeclaratory JudgmentSummary Judgment MotionPublic Policy ArgumentTherapist MalpracticeDuty to DefendDuty to IndemnifyUnconscionability Claim
References
22
Case No. MISSING
Regular Panel Decision

Reliance Insurance v. Garsart Building Corp.

This case concerns an appeal from a judgment involving insurance coverage disputes. The Supreme Court of Rockland County declared that Reliance Insurance Company of New York properly disclaimed coverage under its general liability policy issued to Garsart Building Corp. and was not required to defend or indemnify Garsart in an underlying personal injury action. The court also ruled that Planet Insurance Company was not obligated to defend or indemnify Garsart under its workers' compensation policy. Appellants J and J Associates, Louis C. Pell, County of Rockland Industrial Development Authority, and Garsart Building Corp. appealed this judgment. The appellate court affirmed the judgment, finding the appellants failed to provide a valid excuse for not complying with notice requirements and that Horace Hall was an independent contractor, not an employee of Garsart.

Insurance CoverageDisclaimer of CoverageNotice RequirementsIndependent ContractorEmployers' LiabilityAppellate AffirmanceDeclaratory JudgmentPersonal Injury LitigationPolicy InterpretationInsurance Disputes
References
7
Case No. MISSING
Regular Panel Decision
Jun 15, 1984

Polito v. Polito

The plaintiff appealed a judgment dismissing her complaint seeking rescission of a release and reformation of a deed, alleging duress. The Supreme Court, Kings County, initially dismissed the complaint. The appellate court found ample evidence of the defendant's physical and emotional abuse, which compelled the plaintiff to sign the release, thus depriving her of free will. The court reversed the lower court's judgment, reinstated the complaint, and remitted the matter for entry of a judgment rescinding the release and reforming the deed to establish joint tenancy of the property.

DuressRescissionDeed ReformationDomestic ViolenceSpousal AbuseJoint TenancyEquitable ReliefAppellate ReviewFree WillRatification of Agreement
References
5
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