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

Case No. 2024 NY Slip Op 03519
Regular Panel Decision
Jun 27, 2024

Matter of Reyes Bonilla v. XL Specialty Ins.

Claimants Jose Reyes Bonilla and Marvin Reyes Bonilla, carpenters, were involved in a motor vehicle accident while commuting to a job site in Greenpoint, Brooklyn, in an employer-provided van. They filed workers' compensation claims, which were established against XL Specialty Insurance by a Workers' Compensation Law Judge (WCLJ). XL Specialty appealed, arguing its policy did not cover commuting injuries and that it was not the proper carrier. The Workers' Compensation Board affirmed the WCLJ's decisions, finding XL Specialty failed to preserve its challenge to being the carrier and that the employer's responsibility for transportation made the injuries compensable. The Appellate Division, Third Department, affirmed, agreeing that the issue was unpreserved and that the injuries arose out of and in the course of employment due to the employer's control over the conveyance.

Workers' CompensationMotor Vehicle AccidentEmployment InjuriesCommuting AccidentEmployer Provided TransportationWrap-up PolicyInsurance Coverage DisputeCarrier LiabilityIssue PreservationAppellate Review
References
16
Case No. ADJ752333
Regular
Jul 25, 2011

RICARDO RIVERA vs. COLOR SPOT NURSERIES, INC., CHARITIS, SPECIALTY RISK SERVICES

This case concerns applicant's petition for reconsideration and removal of an administrative law judge's (WCJ) order denying his objection to a replacement orthopedic QME panel. The WCJ allowed the orthopedic panel after finding the defendant had substantially complied with regulations for requesting a specialty change. The Workers' Compensation Appeals Board (WCAB) dismissed the reconsideration petition as the order was interlocutory and denied removal, finding no irreparable harm or prejudice to the applicant. The WCAB upheld the WCJ's decision, deeming the change in specialty appropriate and the defendant's compliance sufficient under the circumstances.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorOrthopedicsChiropracticLabor CodeIndustrial InjuryLeft Knee
References
12
Case No. MISSING
Regular Panel Decision

Claim of Smith v. Specialty Services, Inc.

Claimant, a construction foreman for Specialty Services, Inc., was injured while performing work for a church in Pennsylvania. Although Specialty filed a work-related accident report and its carrier began paying benefits, the carrier filed a notice of controversy over seven months after the Workers' Compensation Board indexed the case, exceeding the 25-day limit. The carrier argued that the late filing was due to surprise, mistake, and newly discovered evidence regarding the church's involvement, which claimant and Specialty allegedly failed to disclose. The Workers' Compensation Board refused to excuse the late filing, finding the carrier failed to demonstrate good cause. The appellate court affirmed the Board's decision, noting that the carrier had ample time to investigate and that belatedly obtained evidence is not a sufficient ground to excuse a late filing.

Workers' CompensationLate Notice of ControversyTimely FilingEmployer-Employee RelationshipInsurance CarrierGood CausePleading BarAppellate ReviewBoard DecisionStatutory Interpretation
References
2
Case No. ADJ18067229
Regular
Jul 10, 2025

RAY GUTIERREZ vs. CMAX COMMERCIAL MAINTENANCE, INC.; PALOMAR SPECIALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the Petition for Reconsideration filed by CMAX COMMERCIAL MAINTENANCE, INC. and PALOMAR SPECIALTY INSURANCE COMPANY (Defendants) regarding the continuation of home health care for applicant RAY GUTIERREZ. The WCAB affirmed the WCJ's finding that the defendants failed to meet their burden of proof to show a change in the applicant's medical condition or circumstances to justify terminating previously authorized ongoing home health care, citing the principles established in Patterson v. The Oaks Farm. The decision also clarified the applicability of Labor Code section 5909 regarding the timeline for acting on reconsideration petitions, which was met by the Board. Commissioner Razo dissented, arguing Patterson should not apply due to the initial limited authorization and that a change in circumstances was evident.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Utilization ReviewPatterson v. The Oaks FarmRequest for AuthorizationChange of CircumstancesHome Health CareMedical NecessityWCJ Report
References
15
Case No. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
Case No. 2025 NYSlipOp 06801
Regular Panel Decision
Dec 09, 2025

AmTrust N. Am., Inc. v. Insurance Specialty Group LLC

The plaintiff, AmTrust North America, Inc., appealed an order dismissing parts of its breach of contract claim against Insurance Specialty Group LLC. The dispute stems from a 2010 Managing Producer Agreement where the defendant was to administer an asset protection program for the plaintiff, with fiduciary duties. Plaintiff alleged multiple breaches, including improper underwriting and concealment of issues, which came to light in 2022. The Supreme Court dismissed claims before May 19, 2017, but the Appellate Division modified this by applying equitable estoppel. The appellate court ruled that estoppel could allow most breach of contract claims, except those solely based on the fiduciary duty to disclose, which are not subject to estoppel for time-barred breaches.

Breach of ContractEquitable EstoppelFiduciary DutyStatute of LimitationsAsset Protection ProgramUnderwriting GuidelinesInsurance AdministrationConcealmentContinuing Wrong DoctrineAppellate Division
References
8
Case No. 2019 NY Slip Op 00061 [168 AD3d 431]
Regular Panel Decision
Jan 08, 2019

U.S. Specialty Ins. Co. v. SMI Constr. Mgt., Inc.

The U.S. Specialty Insurance Company sought summary judgment to avoid defending or indemnifying SMI Construction Management, Inc. in a personal injury lawsuit and to recoup defense costs. The Supreme Court, New York County, denied this motion, and the Appellate Division, First Department, unanimously affirmed the decision. The appellate court found that material issues of fact existed regarding whether SMI Construction Management, Inc. performed as a construction manager for a fee, which could trigger an exclusion in the insurance policy. The determination hinges on the actual duties performed by SMI, rather than merely its label, with evidence suggesting roles consistent with both a construction manager and a general contractor, including providing workers, materials, and supervision. Furthermore, the court noted that the compensation structure, which included profit and overhead, raised further questions, distinguishing the case from precedents involving flat fees. The plaintiff's claim of prejudice due to delayed notice was also deemed insufficient, and any determination regarding the primacy of coverage was considered premature.

Insurance PolicyConstruction ManagementSummary JudgmentIndemnificationDefense CostsPolicy ExclusionGeneral ContractorDuty to DefendNotice of AccidentContract Interpretation
References
5
Case No. 2018 NY Slip Op 07194 [167 AD3d 142]
Regular Panel Decision
Oct 25, 2018

American Intl. Specialty Lines Ins. Co. v. Allied Capital Corp.

This appeal concerns an arbitration dispute between American International Specialty Lines Insurance Company (AISLIC) and Allied Capital Corporation regarding insurance coverage for a $10.1 million settlement. An arbitration panel initially issued a Partial Final Award (PFA) on liability but later reconsidered and reversed its decision, leading to a corrected PFA and a final award. AISLIC petitioned to vacate these subsequent awards and confirm the original PFA. The Appellate Division, First Department, ruled that the arbitration panel exceeded its authority under the functus officio doctrine by reconsidering its prior final determination on liability. Consequently, the corrected PFA and the final award were vacated, and the original PFA was reinstated.

ArbitrationFunctus OfficioPartial Final AwardVacaturInsurance CoverageAppellate ReviewJurisdictionArbitrator AuthorityLiabilityDamages
References
32
Case No. 23
Regular Panel Decision
Apr 30, 2020

American International Specialty Lines Insurance Company v. Allied Capital Corporation

This case addresses whether an arbitration panel exceeded its authority by reconsidering a "Partial Final Award" in an insurance dispute. The underlying dispute involved Ciena Capital LLC and Allied Capital Corporation seeking coverage from American International Specialty Lines Insurance Company (AISLIC) after settling a federal qui tam action. Initially, the arbitration panel issued a partial award, which was later reconsidered and corrected to grant both indemnification and defense costs. AISLIC challenged this reconsideration, arguing the panel was functus officio. The New York Court of Appeals reversed an Appellate Division ruling, holding that the initial "Partial Final Award" was not truly final because the parties had not mutually agreed to its finality. Consequently, the arbitration panel was deemed to have acted within its authority by reconsidering its initial determination, and the petition to vacate the corrected award was denied.

ArbitrationFunctus OfficioPartial Final AwardReconsiderationArbitrator AuthorityInsurance CoverageIndemnificationDefense CostsQui Tam ActionNew York Court of Appeals
References
18
Case No. MISSING
Regular Panel Decision

World Trading Corp. v. Kolchin

The plaintiff sought to permanently enjoin the defendant from arbitrating disputes, arguing that the defendant union's change in affiliation from the American Federation of Labor to the Committee for Industrial Organization, along with a name change, altered its legal entity and invalidated their contract. The court disagreed, holding that a union's identity, structure, operation, constitution, by-laws, officers, and membership remain the same despite changes in affiliation and name. The court affirmed that such changes do not affect the union's rights or responsibilities under existing contracts. Therefore, the court found no basis to support the plaintiff's contention.

union affiliationarbitration disputeinjunctioncontract validityorganizational identitylabor lawname changelegal entitytrade unionsAmerican Federation of Labor
References
2
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