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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Van Deusen v. United States Fidelity & Guaranty Co.

Petitioners Duane and Barbara Van Deusen appealed the denial of their request for apportionment of attorney's fees against United States Fidelity and Guaranty Company (USF&G). USF&G was the workers' compensation and liability insurer for Duane's employer, Goettle, and its lien was satisfied from the Van Deusens' third-party award for personal injuries. Special Term had denied the apportionment based on the precedent set in *France v Abstract Tit. Div. of Tit. Guar. Co.*, which held that when the lienor is also the employer's liability insurer, the attorney's efforts are considered adverse, extinguishing the contribution obligation. This court reconsidered the *France* ruling, deeming it unfair to injured plaintiffs and contrary to the legislative intent behind the Workers' Compensation Law amendment regarding lienor contribution to litigation costs. The court found no legal or logical reason to differentiate an injured employee's recovery based on whether the employer's compensation and liability insurance were with one or two carriers. Consequently, the court reversed the Special Term's order and remitted the matter for further proceedings, instructing that litigation costs be calculated based on the direct benefit the lienor received from the recovery through lien recoupment, with an additional consideration for any wrongfully withheld compensation benefits.

Workers' Compensation LawAttorney's Fees ApportionmentInsurance LienThird-Party ActionEmployer LiabilityIndemnificationContributionDole-Dow DoctrineAppellate ReviewLegal Precedent Reconsideration
References
8
Case No. ADJ1414313 (LAO 0781721)
Regular
Jul 21, 2010

Robert Lesh vs. Drake Office Overload, CIGA for RELIANCE, USF DISTRIBUTION, GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board (WCAB) rescinded the original award and returned the case to the trial level for further proceedings due to insufficient evidence. Specifically, the WCAB found a lack of conclusive evidence supporting the general/special employment relationship between Drake Office Overload and USF Distribution. Additionally, the WCAB determined that the awarded reimbursement amount to CIGA from Pennsylvania was based on unreliable evidence and required further proceedings to ensure accuracy. The WCAB also noted that Pennsylvania's petition improperly relied on evidence not in the record.

Workers' Compensation Appeals BoardGeneral-Special EmploymentInsurance Code Section 1063.1Insurance Code Section 11663California Insurance Guarantee Association (CIGA)Reliance National Insurance CompanyInsurance Company of the State of PennsylvaniaOther InsuranceJoint and Several LiabilityIndustrial Injury
References
1
Case No. ADJ1179569 (AHM 0099178)
Regular
Jun 10, 2011

JERRY CHASTAIN vs. COUNTY OF ORANGE, ORANGE COUNTY FIRE AUTHORITY, STATE COMPENSATION INSURANCE FUND, AMERICAN HOME ASSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, USF&G

In this workers' compensation case, the Appeals Board granted reconsideration to address USF&G's challenge to liability for an applicant's prostate cancer, who died after a prolonged period following exposure. The Board rescinded the prior decision, finding the WCJ erred by not fully addressing liability under Labor Code section 5500.5, specifically regarding the latency period and last date of injurious exposure. The matter was returned to the trial level for further proceedings and a new decision on liability, while affirming the presumption under Labor Code section 3212.1.

Workers' Compensation Appeals BoardFire Apparatus EngineerProstate CancerContinuous Trauma InjuryLabor Code Section 5412Labor Code Section 5500.5Labor Code Section 3212.1 PresumptionLatency PeriodInjurious ExposureCumulative Injury
References
3
Case No. MISSING
Regular Panel Decision

Sabre v. Rutland Plywood Corp.

This case concerns an appeal from a Special Term order in Albany County regarding a fourth-party action. The action involved Tupper Lake Veneer Corp., an employer, and its general liability carrier, United States Fidelity and Guaranty Company (USF&G), concerning insurance coverage. USF&G had disclaimed liability for a third-party action against Tupper Lake, citing policy exclusions and untimely notice. Special Term granted summary judgment to Tupper Lake, ordering USF&G to provide coverage and defend. The appellate court affirmed, ruling that USF&G's reliance on policy exclusions was erroneous and Tupper Lake's notice was timely, given the circumstances and recent legal precedents regarding workers' compensation exclusivity.

Summary JudgmentFourth-Party ActionInsurance Coverage DisputeTimely NoticeDisclaimer of LiabilityWorkers' Compensation ExclusivityGeneral Liability PolicyIndemnificationContributionAppellate Review
References
8
Case No. MISSING
Regular Panel Decision

Huffman v. Lake City Contracting Corp.

Claimant Huffman sought workers' compensation benefits from Lake City Contracting Corporation. A referee found a 66% schedule loss of a left arm and dual insurance coverage by State Insurance Fund and USF&G. Both insurers contested coverage and the award's excessiveness. The Workers' Compensation Board affirmed the schedule award but found State Insurance Fund had no coverage and required further development on USF&G's liability, remanding the case. The employer and USF&G appealed this non-final Board decision. The Workers' Compensation Board then moved to dismiss these appeals on the grounds that its decision was interlocutory and non-appealable. The court granted the motion, dismissing the appeals, noting that non-final decisions are not appealable and protective notices of appeal are unnecessary in such instances.

Appeal DismissalInterlocutory DecisionNon-final OrderCoverage DisputeSchedule Loss AwardProtective Notice of AppealAppellate ProcedureInsurance CoverageMotion PracticeJudicial Review
References
1
Case No. MISSING
Regular Panel Decision

Ramirez v. United States Fidelity & Guarantee Co.

Anthony Ramirez was killed in an accident while working for Leisure Pool Service, leading his estate and property owner Samuel Hillman to sue his employers for wrongful death. Hillman subsequently cross-claimed against the employers for indemnification and contribution. USF&G, the employers' insurer, disclaimed coverage for Hillman's cross-claim based on an employee bodily injury exclusion in their general liability policy. The Supreme Court granted summary judgment for USF&G, upholding the exclusion. On appeal, the court dismissed Ramirez's appeal, modified Hillman's appeal by explicitly declaring the exclusion applied, and affirmed the judgment, finding the policy's exclusionary language clear and unambiguous regarding employee injuries and related contribution claims.

Insurance policyDeclaratory judgmentSummary judgmentEmployee exclusionBodily injuryContributionIndemnificationAppellate reviewPolicy interpretationAmbiguity
References
10
Case No. 2010 NY Slip Op 32441[U]
Regular Panel Decision
Oct 25, 2010

United States Fidelity & Guaranty Co. v. American Re-Insurance

This dissenting opinion addresses the affirmation of a judgment that granted plaintiffs' motion for summary judgment. The dissent argues that a genuine triable issue of fact exists regarding whether a portion of a substantial settlement between United States Fidelity & Guaranty Company (USF&G) and Western MacArthur was attributable to bad faith claims, which are purportedly not covered by the defendants' reinsurance treaty. The dissenting judge contends that the treaty's plain language excludes such extra-contractual liabilities and that the majority incorrectly applied the 'follow the fortunes' clause. Furthermore, the dissent cites findings from bankruptcy court and evidence from the underlying Western MacArthur v USF&G coverage litigation, both suggesting that bad faith damages were indeed part of the settlement. Therefore, the dissenting justice advocates for denying the plaintiffs' motion for summary judgment and vacating the judgment.

ReinsuranceBad Faith ClaimsSettlement AgreementSummary JudgmentContract InterpretationDissenting OpinionExtra-Contractual LiabilityFollow the Fortunes ClauseBankruptcy Court FindingsCoverage Litigation
References
7
Case No. ADJ8015424; ADJ8102669
Regular
Jul 01, 2025

ESPERANZA SANCHEZ vs. MCDONALD'S, USF&G

Applicant Esperanza Sanchez sought reconsideration of an April 7, 2025 Findings and Award (F&A) which determined her permanent total disability was subject to apportionment. The Workers' Compensation Appeals Board (WCAB) granted the petition, concluding that the medical apportionment analyses provided by Dr. Jeffrey Hirsch and Dr. Ezekiel Fink were incomplete as they lacked a detailed explanation for how the apportionment percentages were derived. Consequently, the WCAB amended the F&A to find that the applicant sustained 100 percent permanent and total disability, without a legal basis for apportionment. The matter was returned to the trial level for further proceedings regarding attorney's fees.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardindustrial injuryheartcirculatory systembrain/strokediabetespermanent total disabilityapportionment
References
7
Case No. MISSING
Regular Panel Decision
Mar 20, 2000

Claim of Hamm v. USF Red Star

A truck driver, referred to as 'claimant', was injured while crossing a street to get a meal before starting a new assignment. The Workers’ Compensation Board found the injury compensable, categorizing the claimant as an 'outside employee' entitled to expanded coverage. The employer and its insurance carrier appealed, arguing the accident occurred during a deviation from employment. The court affirmed the Board's decision, ruling that the activity was reasonable and within the course of employment. The court also dismissed an appeal concerning the calculation of benefits due to abandonment by the claimant.

Traveling EmployeePortal-to-Portal CoverageCourse of EmploymentDeviation from EmploymentCompensable InjuryAccidentTruck DriverMeal BreakOff-Duty InjuryBoard Resolution
References
7
Case No. LAO 0841263, LAO 0840495
Regular
Feb 01, 2008

LORENZA FERNANDEZ vs. MOTEL 6, USF\& G

This case involves a worker's compensation applicant seeking reconsideration of a prior award that denied her claim for psychiatric injury. The applicant argues the judge improperly relied on a medical report obtained in violation of agreed-upon procedures and excluded a crucial rebuttal report. The Appeals Board granted reconsideration, agreeing that the defendant's medical report should have been excluded, and returned the matter for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryPsyche InjuryAgreed Medical Evaluator (AME)Labor Code sections 4061 and 4062Substantial EvidenceDue ProcessDiscovery
References
1
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