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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

Tower Insurance v. Classon Heights, LLC

This case is a declaratory judgment action regarding an insurance coverage disclaimer based on late notice of a personal injury claim. Plaintiff Tower Insurance issued a liability policy to Classon Heights and Renaissance Realty, who were notified of an accident involving Elizabeth Gonzalez on their premises in October 2006. Despite knowing about the incident where Gonzalez fell and was taken to a hospital, the insureds waited five months, until March 2007, to notify Tower Insurance. Tower Insurance subsequently disclaimed coverage due to the untimely notice and initiated this action to declare it had no duty to defend or indemnify the insureds. The Supreme Court granted summary judgment to Tower Insurance, concluding that a five-month delay was untimely as a matter of law and the insureds' belief in nonliability was unreasonable given their immediate knowledge of Gonzalez's fall and hospital transport.

Insurance CoverageDisclaimer of CoverageLate Notice of ClaimPersonal InjuryDeclaratory JudgmentSummary JudgmentDuty to NotifyPolicy ConditionsTimeliness of NoticeReasonable Belief
References
11
Case No. MISSING
Regular Panel Decision

Dean v. Tower Insurance

Plaintiffs Douglas and Joanna Dean purchased a home and obtained a homeowners' insurance policy from Tower Insurance Company of New York. Following the discovery of extensive termite damage, the plaintiffs undertook significant repairs, preventing them from immediately moving into the property. Before they could establish full residency, a fire completely destroyed the house. Tower Insurance Company disclaimed coverage, asserting the dwelling was unoccupied and thus did not qualify as a 'residence premises' under the policy's terms. The court found that the term 'residence premises,' defined only as 'where you reside' and with 'reside' undefined, was ambiguous in these circumstances, precluding summary judgment for the insurer. The decision highlighted factual issues regarding Douglas Dean's daily presence at the property and his intent to move in, citing other legal interpretations of occupancy in insurance contexts. The Appellate Division's order, which found the policy ambiguous, was affirmed.

Homeowners InsurancePolicy InterpretationContract AmbiguityResidency RequirementOccupancy ClauseFire DamageDisclaimer of CoverageSummary Judgment StandardsInsurance Contract BreachProperty Insurance
References
12
Case No. ADJ7432904
Regular
Sep 24, 2012

NEDA MOTAVAKEL vs. FANTASTIC SAM'S, TOWER SELECT INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, STAR INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, ENDURANCE WORKERS' COMPENSATION, SOUTHERN INSURANCE CO., FIRSTCOMP OMAHA

This case involves an appeal by Star and Tower Insurance Companies regarding a workers' compensation award. The primary issue is the applicant's average weekly earnings, specifically the inclusion of tip income, which was not adequately substantiated by documentary evidence. The Appeals Board found the initial decision lacked substantial evidence regarding earnings and rescinded the award. The matter is remanded for further proceedings to properly develop the evidentiary record on earnings and insurance coverage dates before a new decision is issued.

Workers' Compensation Appeals BoardNeda MotavakelFantastic Sam'sTower Select Insurance CompanyStar Insurance CompanyIllinois Midwest Insurance AgencyLLEndurance Workers' CompensationSouthern Insurance CompanyFirstComp Omaha
References
6
Case No. MISSING
Regular Panel Decision
Apr 04, 2006

In re Tower Automotive, Inc.

Federal Insurance Company objected to a Bankruptcy Court order that recommended granting summary judgment to Tower Automotive, Inc. on Federal's obligation to pay defense costs for ERISA actions. Tower commenced the action seeking a declaration of insurance coverage for lawsuits related to its employee benefit plans. Federal denied coverage, citing an exclusion in its Fiduciary Liability Policy after Securities Actions were filed. The District Court, applying Michigan law, found both parties' interpretations of the exclusion reasonable but, due to ambiguity, construed the clause against Federal. Consequently, the District Court overruled Federal's objections and granted summary judgment in favor of Tower, affirming Federal's duty to defend.

ERISAFiduciary Liability InsuranceInsurance Coverage DisputeDuty to DefendSummary JudgmentPolicy Exclusion InterpretationContract LawMichigan Insurance LawFederal Court ReviewBankruptcy Court Findings
References
9
Case No. ADJ7989476 ADJ9983597 ADJ9983898
Regular
Jun 18, 2018

MARIA MIRANDA vs. KOOSHAREM dba SELECT STAFFING dba SELECT FOCUS, EVANS MANUFACTURING, ACE AMERICAN INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE (CIGA) Adjusted by SEDGWICK for ULLICO CASUALTY, in liquidation, TRUCK INSURANCE EXCHANGE

This case involves a dispute over workers' compensation insurance liability for injuries sustained by applicant Maria Miranda in 2011 while employed by Select Staffing (general employer) and Evans Manufacturing (special employer). The Workers' Compensation Appeals Board (WCAB) rescinded the arbitrator's decision because the evidence, particularly insurance policy endorsements, was not adequately identified and admitted. The WCAB found the record insufficient to determine which insurer, ACE American Insurance Company or Truck Insurance Exchange, is primarily liable for benefits. The matter is returned to the arbitrator to establish a complete and proper record for a new decision, addressing the specific requirements for insurance endorsements limiting coverage.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderInsurance LiabilityGeneral EmployerSpecial EmployerACE American Insurance CompanyTruck Insurance ExchangeCalifornia Insurance Guarantee AssociationCIGA
References
10
Case No. MISSING
Regular Panel Decision

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
Case No. ADJ265314 (LAO 0790236)
Regular
May 21, 2009

VICTORIA RODRIGUEZ vs. THIBIANT INTERNATIONAL, INC., FIREMAN'S FUND INSURANCE COMPANY, SELECT PERSONNEL SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCATION, LEGION INSURANCE CO.

This case involves a workers' compensation applicant injured while working for a special employer, Thibiant International, insured by Fireman's Fund. The applicant was hired by a general employer, Select Personnel, whose insurer, Legion Insurance, became insolvent. The California Insurance Guarantee Association (CIGA) paid benefits but argued its coverage was excluded by Fireman's Fund being "other insurance." The Appeals Board affirmed Fireman's Fund's liability as the special employer's insurer and reversed CIGA's dismissal, finding Fireman's Fund owed CIGA reimbursement for benefits paid. The Board also deemed Fireman's Fund's challenge to the reimbursement amount waived due to failure to raise it at trial.

Workers' Compensation Appeals BoardVictoria RodriguezThibiant InternationalInc.Fireman's Fund Insurance CompanySelect Personnel ServicesCalifornia Insurance Guarantee AssociationCIGALegion Insurance Companyliquidation
References
7
Case No. ADJ8924427
Regular
Oct 10, 2014

JAVIER CHAVARRIA vs. JUAN RAMON VASQUEZ doing business as JRV CONSTRUCTION, INC., TOWER SELECT INSURANCE, CHRISTINE BAKER, DIRECTOR OF THE CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS, as administrator of the UNINSURED EMPLOYERS BENEFITS TRUST FUND

The Workers' Compensation Appeals Board (WCAB) dismissed Tower Select Insurance's petition for removal due to multiple procedural defects. The petition, styled as a request to reset trial dates and strike the record, was not properly verified as required by WCAB Rule 10450(e). Furthermore, the petition lacked specific references to the record and legal principles, violating WCAB Rule 10846. The WCAB also noted that reconsideration is only available for final orders, and this petition did not meet that criterion.

WORKERS' COMPENSATION APPEALS BOARDJAVIER CHAVARRIAJUAN RAMON VASQUEZJRV CONSTRUCTIONTOWER SELECT INSURANCECHRISTINE BAKERUNINSURED EMPLOYERS BENEFITS TRUST FUNDPetition for RemovalWCJReport and Recommendation
References
0
Case No. MISSING
Regular Panel Decision

Transcontinental Insurance v. State Insurance Fund

This case involves a dispute between two insurers, Transcontinental Insurance Company (plaintiff) and State Insurance Fund (defendant), regarding their contribution to the defense and settlement of an underlying personal injury action. Transcontinental, which insured the contractor Master, sought a declaration that State Insurance Fund, Master's workers' compensation insurer, should contribute as a co-insurer for expenses incurred defending and settling the action on behalf of NYPA. The Supreme Court dismissed the complaint, applying the antisubrogation rule. The Appellate Division modified the judgment, vacating the dismissal but affirming the application of the antisubrogation rule, declaring that State Insurance Fund is not obligated to reimburse Transcontinental for the expenses.

Insurance DisputeAntisubrogation RuleDeclaratory JudgmentCommercial General Liability PolicyWorkers' Compensation InsuranceIndemnificationCo-insurancePersonal Injury ActionAppellate ReviewContractual Obligation
References
5
Case No. MISSING
Regular Panel Decision
Feb 28, 1991

North River Insurance v. United National Insurance

This appellate decision addresses the apportionment of liability between North River Insurance Co. and United National Insurance Company arising from a settlement for an injured employee. The court clarified that North River, as the workers' compensation carrier, is solely responsible for its waived lien, reversing a lower court's finding. It further determined that both insurers' "other insurance" clauses called for pro rata contribution, not equal shares, for the $588,245 settlement payment and defense costs. The court calculated specific shares for each insurer and ruled that North River is entitled to interest from the original payment date in 1982. The Supreme Court's order was thus modified to reflect these findings.

Insurance disputePro rata contributionEquitable apportionmentWorkers' compensation lienDefense costsOther insurance clausesSettlement apportionmentInterest calculationAppellate decisionInsurer liability
References
10
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