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

Case No. 03 Civ. 0332(AKH)
Regular Panel Decision
Oct 29, 2004

In Re September 11th Liability Insurance Coverage Cases

This opinion and order addresses two Rule 12(c) motions regarding insurance coverage for the World Trade Center properties following the September 11, 2001, attacks. The Port Authority of New York and New Jersey sought a declaration that it is an "Additional Insured" under Zurich American Insurance Company's policies, while World Trade Center Properties LLC (WTCP) sought a declaration that Zurich is obligated to cover defense costs. The court, presided over by District Judge Hellerstein, denied both motions. It found ambiguity in the binder regarding the Port Authority's "Additional Insured" status, stating that the issue was premature without further discovery. Furthermore, the court held that New York Insurance Regulation 107 does not require rewriting Zurich's binder and policies to include defense costs, considering the unique circumstances, the sophistication of the insured, and the fact that Zurich explicitly excluded defense costs, which Silverstein (WTCP's affiliate) accepted after failing to secure conventional coverage. The court also affirmed supplemental jurisdiction over the insurance claims due to their close relation to the underlying September 11th liability cases.

Insurance CoverageSeptember 11 AttacksWorld Trade CenterRule 12(c) MotionDeclaratory ReliefAdditional Insured StatusDefense CostsInsurance BinderNew York Insurance LawRegulation 107
References
48
Case No. SFO 0472837
Regular
Jul 17, 2007

SHANE HUNTER vs. FRANCISCAN RESTAURANT, LLC, PIER 431 / 2 PARKING CORP., ALEA-NORTH AMERICA, CHUBB SERVICES GROUP

The Workers' Compensation Appeals Board denied a petition for removal but granted reconsideration regarding Alea North America's request to set aside a prior stipulation on insurance coverage. The Board determined that Labor Code section 5804 does not preclude reconsideration of Alea's stipulation to coverage and remanded the case for an evidentiary hearing on good cause to rescind that stipulation. The joinder of Republic Indemnity Insurance Company was reinstated, and Alea remains liable for benefits pending further proceedings.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and AwardLabor Code Section 5803Labor Code Section 5804Order of JoinderRepublic Indemnity Insurance CompanyAlea North America Insurance CompanyStipulation to Coverage
References
2
Case No. MISSING
Regular Panel Decision

National Union Fire Insurance Co. of Pittsburgh, Pa. v. State Insurance Fund

National Union Fire Insurance Company (National Union) initiated a declaratory judgment action against the State Insurance Fund (SIF) seeking reimbursement for funds spent to settle an underlying personal injury lawsuit, Daza v City of New York. National Union had issued general liability policies to EMD Construction Corp. (EMD), which also covered the City of New York as an additional insured. SIF, in turn, insured EMD for workers' compensation and employers' liability. The Daza action, involving an injured EMD employee, was settled for $175,000, with a stipulation that EMD was 99% actively negligent and the City 1%. National Union disclaimed coverage for the City due to untimely notice and paid the settlement on behalf of EMD. The Supreme Court granted summary judgment to National Union, finding SIF obligated to repay. The appellate court affirmed this decision, holding that National Union's disclaimer was valid, the antisubrogation rule was not violated, and the indemnification agreement between EMD and the City was unenforceable due to the City's active negligence, thus shifting the obligation to SIF for common-law indemnification.

Insurance CoverageDeclaratory JudgmentIndemnificationSubrogationUntimely NoticeActive NegligenceContractual LiabilityWorkers' CompensationEmployer's LiabilitySummary Judgment
References
16
Case No. ADJ744923 (ANA 0385182)
Regular
Jul 22, 2011

CHARLES BUFFINGTON III vs. FACTORY MUTUAL, INFRARED TESTING, INC., LIBERTY MUTUAL INSURANCE COMPANY, UNINSURED EMPLOYERS BENEFITS TRUST FUND

Factory Mutual seeks reconsideration of a workers' compensation decision finding Liberty Mutual provided coverage for Infrared Testing, Inc. during the applicant's injury period. Factory admits it sold its interest in Infrared before the cumulative injury period, arguing Liberty's coverage stipulation was a mistake. The Board dismissed Factory's petition, finding Factory lacks standing as it had no interest in the employer after August 2, 2000. The Board also indicated it would have denied the petition on the merits due to Liberty's stipulation and the elapsed premium collection period.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrdersStipulationCoverage disputeMistake in coverageSale of interestUninsured Employers Benefits Trust FundStandingAggrieved party
References
0
Case No. MISSING
Regular Panel Decision

McLaughlin v. Midrox Insurance

This case involves an appeal concerning an insurance coverage dispute. Plaintiffs sought to compel Midrox Insurance Company to indemnify the Blodgett Brothers Partnerships for a $1 million judgment in an underlying personal injury action. The accident involved a motorcycle operated by plaintiff Charles R. McLaughlin and a pickup truck driven by Ronald Blodgett. Midrox had disclaimed coverage, arguing the accident occurred off insured premises and involved a registered vehicle. The court affirmed the lower court's decision, ruling that the farmowner's policy did provide coverage. The court determined that public roadways used for transporting materials between farm parcels could be considered 'insured premises' and that the pickup truck's agricultural registration did not negate coverage given its exclusive use for farming purposes.

Personal InjuryFarmowner's InsuranceInsurance CoverageAgricultural TruckPolicy InterpretationOff-Premises AccidentPublic RoadwaysSummary JudgmentIndemnificationVehicle and Traffic Law
References
5
Case No. MISSING
Regular Panel Decision

In re the Liquidation of Midland Insurance

Policyholders New York Dock Railway (NYDR) and Brooklyn Eastern District Terminal (BEDT), joined by claimants Buividas and Romacho, moved to confirm a referee's report that found coverage for their claims by the Stock Workers' Compensation Security Fund. The Superintendent of Insurance, as liquidator of Midland Insurance Company, cross-moved to disaffirm the report, arguing against Security Fund coverage based on his interpretation of relevant statutes. The court reviewed the referee's decision, finding it erroneous due to a misinterpretation of legislative history and intent regarding security fund coverage limitations, particularly concerning Chapter 801 amendments. Upholding the Superintendent's rational interpretation, the court denied the motion to confirm and granted the cross-motion to disaffirm, affirming the denial of security fund coverage.

Workers' Compensation Security FundInsurance Coverage DisputeMidland Insurance Company LiquidationFederal Employers' Liability ActJones ActLongshoremen's and Harbor Workers' Compensation ActStatutory InterpretationLegislative HistoryThird-Party IndemnificationEmployer's Liability
References
6
Case No. ADJ3122863
Regular
Nov 14, 2008

LARRY LUCKETT vs. BSK & ASSOCIATES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Workers' Compensation Appeals Board denied a petition for reconsideration, upholding an award based on the parties' stipulations. The defendant sought to amend the stipulated date of injury, arguing it fell outside the insolvent carrier's coverage period, but the Board found no good cause to set aside the stipulation. The Board emphasized that stipulations are binding unless there is a mistake of fact, and the defendant's argument was deemed to stem from a lack of diligence rather than an actual error.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulations With Request for AwardDate of InjuryFremont Compensation Insurance CompanyIn LiquidationValley FeverAgreed Medical ExaminerPermanent DisabilityTemporary Disability
References
4
Case No. ADJ8973046
Regular
Dec 28, 2015

FERMIN CEJA vs. SAUSALITO MOVING & STORAGE, INC., ZURICH AMERICAN INSURANCE CO.

In this workers' compensation case, the defendant insurer, Zurich American Insurance Co., sought reconsideration of an order compelling them to comply with a stipulation agreement. Zurich argued they entered the stipulation by mistake, as they did not provide insurance coverage on the date of the applicant's specific injury. The Appeals Board granted reconsideration, rescinded the order to comply, and deferred Zurich's petition to set aside the stipulation. The Board emphasized that Zurich remains bound by the original stipulations until the petition to set aside is fully adjudicated.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition to Set Aside StipulationMistake of FactInsurance CoverageStipulation and OrdersTemporary Total DisabilityHernia InjuryMPNAppeal
References
0
Case No. MISSING
Regular Panel Decision

U. P. Iron Works v. Investors Insurance

Plaintiff insured brought a declaratory judgment action against their insurer, who issued both workers' compensation and general liability policies. The dispute arose after a partner was injured, leading to a third-party products liability action against the partnership. The insurer disclaimed coverage, citing lack of coverage for a direct suit by a partner and late notice of the accident. The court found that coverage existed for the third-party claim, extending it to a partner similar to an employee. Furthermore, the court determined that the notice provided by the insured, though three years after the accident, was not unreasonably late given the complexities involved. Consequently, the court declared the policy to be in full force and effect for the accident.

Declaratory JudgmentInsurance CoverageWorkers' Compensation PolicyGeneral Liability PolicyThird-Party ClaimPartner InjuryEmployee ExclusionLate Notice DisclaimerDuty to DefendSummary Judgment Motion
References
2
Case No. MISSING
Regular Panel Decision

Hayden v. S & W Meat & Poultry

Claimant, a partner in S & W Meat & Poultry, sustained a serious injury. A workers' compensation claim was filed, but the carrier contested coverage, arguing that claimant, as a partner, had not formally elected coverage under Workers' Compensation Law § 54 (8). The Workers' Compensation Board applied estoppel, finding the carrier failed to advise the employer of the election requirement. On appeal, the court reversed this decision, holding that the employer's insurance broker, the Fear agency, was notified of the lack of coverage, and this knowledge is imputed to the employer. The court found insufficient evidence for estoppel and remitted the matter to the Board for further proceedings.

Workers' CompensationEstoppelInsurance CoveragePartnershipAgent LiabilityImputed KnowledgePremium RefundAppellate ReviewRemittalWorkers' Compensation Law § 54 (8)
References
5
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