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

Case No. ADJ8002816, ADJ8316468
Regular
Oct 05, 2016

LORENZO TOSCANO CORONA vs. KOOSHAREM, doing business as SELECT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA), ULLICO CASUALTY INSURANCE COMPANY, ACE AMERICAN INSURANCE COMPANY, RSI HOME PRODUCTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a dispute over workers' compensation coverage where applicant Lorenzo Toscano Corona was injured, allegedly while employed through a staff leasing arrangement between Koosharem (Select Staffing) and RSI Home Products. The Appeals Board granted reconsideration to address arguments by ACE American Insurance Company and Travelers Property Casualty Company that their policies excluded coverage for the applicant. The Board rescinded the prior decision due to the arbitrator's failure to adequately document the proceedings and admitted exhibits as required by law. The matter is returned to the arbitrator to create a proper record and evaluate whether ACE and Travelers' policies contained valid exclusions for the applicant's injuries, considering relevant insurance code provisions and endorsements.

Staff leasingGeneral employerSpecial employerJoint and several liabilityOther insuranceInsurance Code section 1063.1(c)(9)Hold harmless clauseWCAB Rule 10566Hamilton v. Lockheed Corp.Labor Code section 3602(d)
References
6
Case No. MISSING
Regular Panel Decision

Logan Bus Co. v. Discover Property & Casualty Insurance

The plaintiff, Logan Bus Company, Inc., initiated a declaratory judgment action against Discover Property & Casualty Insurance Company to establish Discover's obligation to defend and indemnify Logan in an underlying lawsuit. The underlying action involved a sexual assault perpetrated by a student on another student on a bus owned by Logan, allegedly due to inadequate supervision. Logan appealed two orders from the Supreme Court, Queens County: one denying its motion for summary judgment for coverage and another granting Discover's motion to declare no obligation and dismiss the complaint. The appellate court affirmed both lower court orders, concluding that the "abuse or molestation" endorsement in Logan's insurance policy with Discover explicitly limited coverage to acts committed by "employees" or "volunteer workers." Since the alleged incident was perpetrated by a student, Logan failed to demonstrate a prima facie entitlement to coverage, leading to the affirmation of Discover's non-obligation to defend or indemnify.

Declaratory JudgmentInsurance Policy InterpretationCoverage DisputeAbuse or Molestation EndorsementDuty to DefendDuty to IndemnifySummary JudgmentAppellate ReviewAutomobile InsuranceStudent Assault
References
11
Case No. MISSING
Regular Panel Decision

Atlantic Casualty Insurance v. Value Waterproofing, Inc.

Atlantic Casualty Insurance Company sought a declaratory judgment that it had no duty to defend or indemnify Value Waterproofing, Inc. in an underlying breach of contract and negligence lawsuit. Value counterclaimed, requesting a declaration that Atlantic Casualty was required to defend and indemnify. The court granted Atlantic Casualty's request, finding that Value failed to provide timely notice of the claim, thereby prejudicing Atlantic Casualty's investigation capabilities. Additionally, the court ruled that Value's work on a commercial property was not covered by its residential-only roofing insurance policy, further justifying the denial of coverage.

Insurance disputeBreach of contractNegligenceDeclaratory judgmentTimely noticeCoverage exclusionCommercial General LiabilityResidential roofingPolicy interpretationPrejudice
References
46
Case No. MISSING
Regular Panel Decision

Fulton Boiler Works, Inc. v. American Motorists Insurance

Fulton Boiler Works, Inc., filed an action against several insurance companies regarding defense and indemnification for thousands of asbestos claims. The court addressed multiple pending motions for summary judgment, focusing on the proper allocation of indemnity costs among the liable parties, Fulton's obligation for uninsured years, the applicability of equitable estoppel against insurers, and Travelers' specific obligations concerning notice of claims and disclaimers. The court ruled that a pro rata allocation of indemnity costs is appropriate, with Fulton liable for periods it was uninsured. Equitable estoppel was deemed inapplicable to bar insurers from seeking contribution, and Travelers was found to have received proper notice for many claims and is barred from disclaiming coverage due to untimely disclaimers. This order, along with a previous one, sets the 'ground rules' for resolving past, pending, and future asbestos claims.

Asbestos LiabilityInsurance Coverage DisputeIndemnity AllocationSummary JudgmentEquitable EstoppelNotice ProvisionsDisclaimer of CoveragePro Rata AllocationInjury-in-factComprehensive General Liability Policy
References
23
Case No. MISSING
Regular Panel Decision
May 12, 1995

Wausau Underwriters Insurance v. Continental Casualty Co.

This case addresses a dispute between Wausau Underwriters Insurance Company (Wausau) and Continental Casualty Company (Continental), along with The Hartford Insurance Group. Wausau, as the employer's liability carrier for H. Sand & Company, successfully argued that a third-party action by Slattery-Argrett, subrogor of Continental, against H. Sand & Company, constituted an impermissible subrogation claim by an insurer against its own insured. The underlying matter involved a personal injury sustained by an employee of H. Sand & Company. Continental had initially disclaimed coverage for Sand in the third-party action. The Supreme Court granted Wausau's motion for summary judgment, declaring the subrogation action a violation of public policy and awarding Wausau damages. The appellate court affirmed this judgment, distinguishing the present case from prior rulings like *North Star Reins. Corp. v Continental Ins. Co.*, and emphasizing the distinction between claims for indemnification and contribution within insurance policy exclusions.

Subrogation ClaimInsurance Coverage DisputeIndemnification vs. ContributionPublic Policy in InsuranceSummary JudgmentEmployer LiabilityGeneral Liability InsuranceExcess Liability InsuranceConstruction AccidentWorkers' Compensation Carrier
References
9
Case No. MISSING
Regular Panel Decision

State Farm Mutual Automobile Insurance v. Aetna Casualty & Surety Co.

This case concerns a dispute between insurance carriers following a workers' compensation claim. Douglas K. Ellsmore was injured while unloading a hospital bed when Shirley S. Miller, insured by State Farm Mutual Automobile Insurance Company, backed her car into him. Ellsmore's employer's workers' compensation carrier, Aetna Casualty and Surety Company, paid over $65,000 in benefits and then sought reimbursement from State Farm via a loss transfer claim and demanded arbitration under Insurance Law § 5105. State Farm initiated a special proceeding to permanently stay arbitration, arguing that Aetna's claim lacked legal basis. Special Term denied the stay, but the appellate court reversed this decision. The court clarified that the "for hire" provision in Insurance Law § 5105 modifies "vehicle," limiting its application to vehicles hired for transporting people (like taxis) or livery vehicles for property, and does not extend to commercial deliveries by an owner's vehicle. Consequently, Aetna was not entitled to recover compensation payments under this statute.

Insurance LawWorkers' CompensationAutomobile InsuranceLoss Transfer ClaimArbitration StayStatutory Interpretation"For Hire" ClauseCommercial DeliveryVehicle InsuranceFirst-Party Payments
References
1
Case No. MISSING
Regular Panel Decision

Romano v. Whitehall Properties

An employee of Sorbara Construction Company was injured at a construction site owned by Whitehall Properties, LLC. The employee received workers' compensation benefits from Travelers Indemnity Insurance Company of America, Sorbara's carrier. The employee also filed a negligence action against Whitehall and the general contractor, Kreisler Borg Florman General Construction Co., Inc. This negligence action was settled, with Travelers contributing under a general liability policy. Whitehall and Kreisler appealed a Supreme Court order denying their motion to extinguish Travelers' workers' compensation lien against the settlement. The appellate court affirmed, ruling that the anti-subrogation rule did not apply because Travelers' workers' compensation obligation arose from a separate policy issued to Sorbara, not the general liability policy covering Whitehall and Kreisler, thus allowing Travelers to assert its lien.

Workers' Compensation LienAnti-Subrogation RuleGeneral Liability PolicyPersonal Injury DamagesConstruction AccidentEmployer NegligenceInsurance CarrierSettlement AgreementAppellate DecisionThird-Party Action
References
6
Case No. MISSING
Regular Panel Decision

Levin v. Intercontinental Casualty Insurance

This case addresses whether a pre-answer motion to dismiss filed by an 'unauthorized foreign or alien' insurance carrier constitutes a 'pleading' under Insurance Law § 1213 (c), thereby requiring the carrier to post a bond. The New York State Superintendent of Insurance, as liquidator of Ideal Mutual Insurance Company, sued Intercontinental Casualty Insurance Company, a Cayman Islands carrier, for reinsurance proceeds. Intercontinental moved to dismiss on Statute of Limitations and documentary evidence grounds without posting a bond. The Supreme Court ordered a bond, which Intercontinental failed to provide, leading to a judgment against it. The Court of Appeals affirmed the lower courts' decisions, ruling that such motions, which address the merits of the case, fall within the definition of a 'pleading' for the purpose of ensuring funds are available to satisfy any potential judgment.

Insurance Law § 1213 (c)Unauthorized InsurerBond RequirementPleading DefinitionMotion to DismissStatute of LimitationsDocumentary EvidenceReinsurance AgreementLiquidation ProceedingForeign Carrier
References
2
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. 2014 NY Slip Op 06060
Regular Panel Decision
Sep 10, 2014

Key Fat Corp. v. Rutgers Casualty Insurance

This case involves an appeal concerning an insurer's obligation to reimburse attorney's fees. Key Fat Corp. and Seneca Insurance Company sued Rutgers Casualty Insurance Company after Rutgers disclaimed coverage to Key Fat's indemnitee, Bando Construction, Inc., in an underlying personal injury action. The Appellate Division affirmed the Supreme Court's decision, which found Rutgers Casualty estopped from disclaiming coverage because it failed to provide timely notice to Key Fat Corp. as required by Insurance Law § 3420 (d)(2). The court ruled that this provision applies to defense costs incurred in connection with an underlying personal injury action, thus obligating Rutgers Casualty to reimburse Key Fat Corp. for attorney's fees and litigation costs.

Insurance CoverageDisclaimer of CoverageAttorney's FeesLitigation CostsPersonal Injury ActionTimely NoticeEstoppelCommercial General Liability PolicyContractual IndemnificationCommon-Law Indemnification
References
7
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