CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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. 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. ADJ3299212
Regular
Oct 18, 2011

LISA WEILMANN vs. UNITED TEMPORARY SERVICE, TIG SPECIALTY INSURANCE COMPANY

This Workers' Compensation Appeals Board opinion awards supplemental attorney's fees of $2,100.00 to applicant's counsel. This award stems from the Court of Appeal's denial of the defendant's petition for writ of review and its subsequent granting of the applicant's request for fees under Labor Code § 5801. The applicant's attorney requested this fee for six hours of work at $350 per hour, which the Board found reasonable. The award is against TIG Specialty Insurance Company.

WORKERS' COMPENSATION APPEALS BOARDSUPPLEMENTAL ATTORNEY'S FEESLABOR CODE § 5801Court of Appealpetition for writ of reviewremittiturapplicant's attorney requestreasonable feeTIG Specialty Insurance CompanyRisk Enterprise Management
References
1
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. ADJ9178558 ADJ9178559
Regular
Feb 05, 2015

JAVIER RIVERA vs. JACO ENVIRONMENTAL, INC., ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a Petition for Removal filed by Zurich American Insurance Company concerning a dispute over Qualified Medical Evaluator (QME) panel selection. The administrative law judge had found both parties requested QME panels timely, but ruled the defendant's request invalid for seeking a different specialty without justification. The Board agreed that removal was not warranted and upheld the decision to assign a QME in pain management, the same specialty as the primary treating physician. The Board also clarified the interpretation of Rule 31.1(b), emphasizing the requirement for supporting documentation when requesting a QME in a different specialty.

Petition for RemovalQualified Medical Evaluator (QME) panelprimary treating physicianspecialtypain managementMedical Directortimely requestjustificationRule 31.1(b)extraordinary remedy
References
3
Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
1
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. MISSING
Regular Panel Decision

Weigl v. Quincy Specialties Co.

Plaintiff Susan Weigl, a laboratory technician at Yeshiva University, suffered severe burns when her lab coat ignited during an experiment on October 31, 1989. Her workers' compensation lawyers requested Yeshiva to preserve the lab coat, but Yeshiva later claimed it could not be located. Weigl sued Yeshiva and Quincy Specialties Company (the alleged manufacturer of the coat) for negligence, product liability, and spoliation of evidence. Yeshiva moved to dismiss the spoliation claims, arguing that New York jurisdiction does not recognize such a tort and that the claims were time-barred. The court, presided over by Judge Peter Tom, denied the motion to dismiss outright. While acknowledging that New York does not recognize spoliation as a standalone tort, the court allowed Weigl to amend her complaint to pursue claims against Yeshiva for negligently and/or intentionally impairing her right to sue a third-party tortfeasor, a recognized common-law cause of action. The court found that discovery was necessary to determine the circumstances of the lab coat's disappearance and whether Yeshiva intended to obstruct Weigl's legal remedies.

Spoliation of evidenceNegligenceIntentional tortWorkers' CompensationDiscoveryStatute of LimitationsMotion to dismissLeave to amendThird-party tortfeasorLaboratory accident
References
30
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
Showing 1-10 of 3,263 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational