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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

Home Depot U.S.A., Inc. v. National Fire & Marine Insurance

Home Depot U.S.A., Inc., the general contractor, commenced an action against its subcontractor's insurer, National Fire & Marine Insurance Company, seeking a declaration of coverage. Home Depot, individually and as assignee of Westward Contracting, Inc., sought to compel National Fire to defend and indemnify it as an an additional insured in an underlying action, and to indemnify Westward. The Supreme Court denied Home Depot's discovery motion, granted National Fire summary judgment declaring Home Depot was not an additional insured, and denied National Fire's motion to dismiss Home Depot's claims as Westward's assignee for lack of standing and for summary judgment on the indemnification obligation to Westward. The appellate court affirmed the Supreme Court's order, finding Home Depot was not an additional insured and that the assignment to Home Depot was valid and did not relieve National Fire of its indemnification obligation to Westward.

Insurance CoverageAdditional InsuredIndemnificationSummary JudgmentStandingAssignment of ClaimsSubcontractor LiabilityGeneral ContractorCommercial General Liability PolicyAppellate Review
References
13
Case No. 2017 NY Slip Op 04774 [151 AD3d 504]
Regular Panel Decision
Jun 13, 2017

Nationwide Mutual Insurance Co. v. U.S. Underwriters Insurance Co.

This case concerns an insurance coverage dispute where Nationwide Mutual Insurance Company and Artimus Construction Corp., Inc., as subrogees, sought coverage from U.S. Underwriters Insurance Company. The Appellate Division, First Department, affirmed the lower court's decision to dismiss the complaint. The court found that the plaintiffs were collaterally estopped from relitigating insurance coverage issues because these matters had been decided in a prior declaratory judgment action. The majority concluded that Nationwide's subrogor, Artimus, and Artimus's subrogor, Armadillo, had a full and fair opportunity to litigate the coverage issues previously. Furthermore, the court held that the doctrine of res judicata also barred the claims, applying a transactional analysis which dictates that all claims arising from the same transaction that could have been raised in prior litigation are precluded.

Insurance CoverageSubrogationCollateral EstoppelRes JudicataAppellate ReviewDeclaratory JudgmentPersonal Injury ActionEmployer Liability ExclusionLate Notice of ClaimPrivity
References
12
Case No. 2 NY3d 787
Regular Panel Decision

U.S. Underwriters Insurance v. City Club Hotel, LLC

The New York Court of Appeals addressed two certified questions from the Second Circuit regarding an insured's right to recover attorneys' fees. U.S. Underwriters Insurance Company had sought a declaratory judgment against its insureds, City Club Hotel, LLC and Shelby Realty, LLC, to deny coverage for a personal injury claim. The insurer's disclaimer of coverage was found untimely. The Court held that an insured who prevails in an insurer-initiated declaratory judgment action to deny coverage may recover attorneys' fees, irrespective of whether the insurer initially provided a defense in the underlying suit. This decision underscores that the insurer's duty to defend extends to litigation arising from its attempts to avoid policy obligations. The Court answered the first certified question in the affirmative for Shelby.

Declaratory Judgment ActionAttorneys' FeesInsurer Duty to DefendInsurance CoverageUntimely DisclaimerPrevailing PartyCertified QuestionSecond CircuitNew York Court of AppealsPolicy Obligations
References
6
Case No. 13 Civ. 1580; 12 Civ. 6811
Regular Panel Decision
Jun 17, 2015

U.S. Bank National Ass'n v. PHL Variable Life Insurance

This decision and order by District Judge McMahon addresses numerous motions in limine filed by both U.S. Bank National Association (applicant) and PHL Variable Life Insurance Company (Phoenix, defendant). The court evaluates the admissibility of expert testimony, evidence relating to actuarial justifications for cost of insurance (COI) rate increases, and Phoenix's financial condition. Key rulings concern claims of breach of the covenant of good faith and fair dealing, the relevance of life settlement investments, and the application of hearsay and prejudice rules. The decision provides detailed findings on specific exhibits and types of testimony, balancing probative value against potential unfair prejudice.

Insurance LawContract LawCovenant of Good Faith and Fair DealingCost of Insurance RatesActuarial AnalysisExpert Witness AdmissibilityMotions in LimineHearsay EvidenceRule 403 Balancing TestLife Settlement Industry
References
48
Case No. MISSING
Regular Panel Decision

Insurance Corp. of New York v. United States Fire Insurance

This case concerns a dispute between a primary insurer, The Insurance Corporation of New York, and an excess insurer, United States Fire Insurance Company (US Fire), regarding the timeliness of claim notice and US Fire's subsequent disclaimer. The motion court initially denied US Fire's cross-motion for summary judgment, deeming its disclaimer untimely. However, the appellate court determined that US Fire received proper notice on April 20, 2006, not March 16, 2006, making its disclaimers, issued eight days later, timely as a matter of law. Consequently, the appellate court reversed the lower court's decision, granting US Fire's cross-motion for summary judgment and dismissing the complaint against it. Additionally, an appeal from a separate order regarding US Fire's request to rescind an insurance policy was dismissed as abandoned.

Insurance PolicyExcess InsurancePrimary InsuranceTimely NoticeDisclaimer of CoverageSummary JudgmentAppellate ReviewClaim NotificationInsurance ContractLiability Insurance
References
9
Case No. MISSING
Regular Panel Decision

National Union Fire Insurance Co. of Pittsburgh v. American Re-Insurance Co.

The case revolves around a dispute between National Union Fire Insurance Company and American Re-Insurance Company regarding a pollution exclusion clause in a reinsurance policy. National Union sought reimbursement from American Re after settling claims where employees were exposed to metalworking fluids. American Re denied coverage, arguing its pollution exclusion applied. The court, applying Ohio law, found American Re's pollution exclusion ambiguous due to its broad language and its intended purpose of covering environmental contamination. Consequently, American Re's motion for summary judgment was denied, and National Union's motion to strike American Re's defense was granted, requiring American Re to "follow the fortunes" of National Union.

ReinsurancePollution Exclusion ClauseContract InterpretationFollow the Fortunes DoctrineSummary JudgmentInsurance CoverageAmbiguity in ContractsOhio State LawDiversity JurisdictionIndustrial Contamination
References
31
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. ADJ4718986 (POM 0280167) ADJ2367642 (POM 0280166)
Regular
May 17, 2011

SEVERIANO GUZMAN vs. HANSON TRUSS, INC., ALLIANZ GLOBAL RISKS U.S. INSURANCE COMPANY, CENTRE INSURANCE COMPANY, VIRGINIA SURETY COMPANY, INC., LUMBERMAN'S UNDERWRITING ALLIANCE, TRAVELERS PROPERTY CASUALTY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES For REDWOOD FIRE AND CASUALTY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of an arbitrator's decision which denied Allianz Global Risks U.S. Insurance Company's petition for contribution and set the date of injury as January 21, 1997. The Board found the arbitrator failed to comply with procedural rules regarding record keeping and evidence admission. Therefore, the case was returned to the arbitrator for further proceedings to create a proper record and reanalyze the issues consistent with relevant case law. The reanalysis must specifically consider whether compensable disability existed prior to the employee missing work, per *Rodarte*.

Workers' Compensation Appeals BoardReconsiderationArbitrator's DecisionPetition for ContributionDate of InjuryLabor Code Section 5412Cumulative InjuryLiability PeriodLabor Code Section 5500.5Admitted Evidence
References
4
Case No. MISSING
Regular Panel Decision
Jan 13, 1995

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

Plaintiff National Union Fire Insurance Company of Pittsburgh, PA (National Union) initiated a declaratory judgment action against The State Insurance Fund (SIF) to recover defense and settlement costs. These costs were expended on behalf of Regional Scaffolding and Hoisting Co., Inc., a mutually insured party in an underlying personal injury action. The Supreme Court initially denied National Union's motion for summary judgment and ruled in favor of SIF. However, the appellate court reversed this decision, concluding that the antisubrogation rule did not apply in this context. Consequently, it determined that National Union and SIF were co-insurers for Regional Scaffolding's common-law liability. The court granted National Union's motion for summary judgment in part, declaring SIF's duty to reimburse National Union for one-half of the reasonable settlement and defense costs, and remanded for a trial to ascertain these amounts.

Antisubrogation RuleDeclaratory JudgmentSummary JudgmentInsurance Coverage DisputeCo-Insurer LiabilityDefense Costs ReimbursementSettlement CostsEmployer's LiabilityComprehensive General LiabilityThird-Party Action
References
8
Case No. 6:09-CV-853
Regular Panel Decision

Utica Mutual Insurance Co. v. Fireman's Fund Insurance Co.

This case details a dispute between Utica Mutual Insurance Company (Utica) and Fireman’s Fund Insurance Company (FFIC) concerning reinsurance contracts, with Utica seeking substantial damages for alleged breach of contract and bad faith. FFIC counterclaimed for rescission of the reinsurance agreements. A central contention revolves around whether Utica's primary liability policies issued to Goulds from 1966-1972 contained aggregate limits for bodily injury, a condition critical to triggering FFIC's reinsurance obligations. The court dismissed Utica's bad faith claim (Count II) and its request for declaratory relief (Count III) but denied all other motions for summary judgment by both parties, including those regarding the 'follow the settlement' doctrine, FFIC's rescission counterclaim, and the timeliness of notice. Consequently, the core breach of contract claim (Count I) and FFIC's counterclaims for rescission are slated to proceed to trial.

Reinsurance DisputeBreach of ContractSummary JudgmentFollow the Settlement DoctrineAggregate LimitsBad Faith ClaimRescissionNotice of ClaimInsurance LawAsbestos Claims
References
56
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