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

Case No. 00-80050A
Regular Panel Decision
May 23, 2000

Victory Markets, Inc. v. NYS Unemployment Insurance (In Re Victory Markets Inc.)

Victory Markets, Inc. (VMI) and Victory Markets, LLC (LLC) initiated an adversary proceeding against the New York State Unemployment Insurance Division of the Department of Labor, challenging the Department's transfer of VMI's unemployment insurance tax experience rating to new owners following VMI's Chapter 11 reorganization. VMI argued this transfer violated its reorganization plan and negatively impacted funds available for creditors. The Department moved to dismiss for lack of subject matter jurisdiction, contending the dispute involved non-debtor parties and state law, and was furthermore precluded by the Tax Injunction Act. The Bankruptcy Court, presided over by Chief Judge STEPHEN D. GERLING, granted the Department's motion, finding it lacked jurisdiction under 'arising in,' 'arising under,' or 'related to' doctrines, as the matter concerned a state agency's application of state law against non-debtors with a remote connection to the bankruptcy estate. The court also emphasized the availability of a plain, speedy, and efficient remedy in state courts, which barred federal intervention.

BankruptcySubject Matter JurisdictionTax Injunction ActNew York Labor LawUnemployment Insurance TaxChapter 11 ReorganizationAdversary ProceedingState Tax DisputeNon-Debtor PartiesExperience Rating Transfer
References
20
Case No. ADJ7517959, ADJ7517960, ADJ10843671
Regular
Sep 22, 2017

Kobra Ghosemi vs. Sunrise Senior Living, Ace American Insurance Company

This case involves three separate workers' compensation claims filed by Kobra Ghosemi for injuries sustained as a caregiver. The Employment Development Department (EDD) sought reconsideration, arguing that the original decisions failed to award statutory interest on unemployment benefits paid. The Appeals Board granted reconsideration, rescinded the prior decisions, and issued a joint decision. This new decision clarifies the defendant's liability to both the applicant and EDD, crucially including the EDD's entitlement to Unemployment Insurance Code section 2629.1(e) interest.

Employment Development DepartmentEDD lienUnemployment Insurance Code section 2629.1(e)interestreconsiderationFindings of Facttemporary disabilitypermanent disabilityjoint decisioncaregiver
References
2
Case No. MISSING
Regular Panel Decision
Jan 29, 1974

In re Claim of Di Lella

This case is an appeal from a decision by the Unemployment Insurance Appeal Board, which denied unemployment insurance benefits to "outside" liquor and wine salesmen. The claimants, members of their respective salesmen's unions, lost their employment when other unions (Teamsters and Distillery Workers) went on strike against their common employers, wholesale liquor and wine distributors. The employers ceased operations, instructing the salesmen not to report to work. The Board determined that the claimants lost their jobs due to an industrial controversy in the same "establishment" as the striking employees, as per Labor Law § 592(1). The Appellate Division affirmed the Board's decision, finding substantial evidence that despite working remotely, the salesmen's operational ties to the employer's physical premises constituted employment within the same establishment.

Unemployment Insurance AppealIndustrial ControversyStrike Suspension of BenefitsSame Establishment TestLiquor SalesmenAppellate DivisionLabor Law § 592(1)Unemployment Benefits DenialPicket LinesSalesmen Employment
References
2
Case No. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
Case No. SRO 112972
Regular
Jun 12, 2008

STELLA JUAREZ vs. ARTERIAL VASCULAR ENGINEERING, NELSON STAFFING, CENTRE INSURANCE COMPANY by REM, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by BROADSPIRE for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation

The California Insurance Guarantee Association (CIGA) has the right to seek contribution from Centre Insurance Company for workers' compensation benefits paid to an applicant with a cumulative trauma injury. CIGA's claim is not barred by the one-year limitation period for employer contribution claims under Labor Code section 5500.5(e), as CIGA is not an employer and Centre is considered "other insurance" under Insurance Code section 1063.1(c)(9). Therefore, the Appeals Board granted CIGA's petition for reconsideration and reversed the arbitrator's decision, awarding CIGA contribution from Centre.

CIGAContributionReconsiderationFindings Award and OrderLabor Code section 5500.5Insurance Code section 1063.1(c)(9)Cumulative TraumaGeneral EmployerSpecial EmployerOther Insurance
References
8
Case No. MISSING
Regular Panel Decision

In re the Claim of Chmiel

The case involves an appeal by Magno Sound, Inc., a sound and video company, from a decision by the Unemployment Insurance Appeal Board. The Board had assessed Magno Sound for additional unemployment insurance contributions, determining that a film editor claimant, hired for a film production, was a statutory employee under Labor Law § 511 (1) (b) (1-a). Magno Sound contended the claimant was an independent contractor and that the statute was misconstrued. The appellate court affirmed the Board's decision, deferring to its rational interpretation of the Labor Law, which extends unemployment insurance benefits to those in the performing arts. The court found that claimant's services for a film production fit the criteria for statutory employment, upholding the assessment against Magno Sound.

Unemployment InsuranceStatutory EmployeeIndependent ContractorPerforming ArtsFilm ProductionLabor LawStatutory InterpretationAppellate ReviewEmployer ContributionsFilm Editor
References
3
Case No. MISSING
Regular Panel Decision

Bryam Hills Central School District No. 1 v. State Insurance Fund

This case involves an appeal concerning the obligations of the State Insurance Fund under insurance policies. The Bryam Hills Central School District No. 1 sought a declaratory judgment to compel the State Insurance Fund to defend actions initiated by Dorothy G. Caruolo. The initial Supreme Court judgment had granted summary judgment to the school district, mandating the State Insurance Fund to provide a defense. The appellate court modified this judgment, affirming the State Insurance Fund's duty to defend the first Caruolo action due to sufficient general negligence allegations, thereby invoking policy coverage. However, the court reversed the requirement to defend two other actions seeking salary and benefits, as these claims were rooted in contract and expressly excluded by the policy, negating any duty to defend in those specific instances.

Insurance Policy ObligationsDuty to DefendDeclaratory JudgmentSummary JudgmentAppellate ReviewContract ExclusionWorkers' Compensation ImplicationsNegligence ClaimsInsurance Coverage DisputeSupreme Court Appeal
References
4
Case No. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
Case No. MISSING
Regular Panel Decision
Jan 22, 2007

Liberty Mutual Insurance v. Insurance Co. of Pennsylvania

This case concerns an appeal regarding an insurance dispute between Liberty Mutual (excess insurer) and AIG (primary insurer) over a $1.5 million settlement payment in a personal injury action. The underlying action involved an employee of General Industrial Service Corporation, a subcontractor, suing the project's owner and construction manager under the Labor Law. AIG, General's primary insurer, had refused to participate in the defense or settlement. The Supreme Court's order, which limited plaintiff's recovery to $500,000, was modified on appeal. The appellate court increased AIG's potential liability limit to $1,000,000, pending a determination of whether the employee sustained a 'grave injury' under Workers' Compensation Law § 11. The court affirmed that AIG, as a primary insurer, must exhaust its coverage before Liberty's excess coverage is implicated and is not entitled to apportionment with the excess insurer.

Insurance Coverage DisputeExcess InsurancePrimary InsuranceIndemnificationSubrogationWorkers' Compensation LawGrave InjurySummary JudgmentPolicy LimitsApportionment of Liability
References
6
Case No. ADJ1025641 (OXN 0137996) ADJ3304480 (OXN 0136581)
Regular
Aug 24, 2011

PATRICK ESTRADA vs. AITKEN EQUIPMENT AND REPAIR, CLARENDON NATIONAL INSURANCE, AMERICAN ALL RISK LOSS ADMINISTRATORS

The Workers' Compensation Appeals Board denied reconsideration of a decision holding defendants liable for interest on an Employment Development Department (EDD) lien. The Board found defendants' arguments that stipulations absolved them of interest liability and that applicant should pay were meritless, as the EDD was not a party to the stipulations. Furthermore, Unemployment Insurance Code section 2629.1(e) clearly places interest liability on the employer. Consequently, the Board granted removal on its own motion to consider imposing sanctions against defendants' attorney for misrepresenting the law and record.

Workers' Compensation Appeals BoardAitken Equipment and RepairClarendon National InsuranceAmerican All Risk Loss AdministratorsJoint Findings and AwardEDD lienstipulated AwardLabor Code section 4904(c)Unemployment Insurance Code section 2629.1(e)removal
References
0
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