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

Case No. 2024 NY Slip Op 03519
Regular Panel Decision
Jun 27, 2024

Matter of Reyes Bonilla v. XL Specialty Ins.

Claimants Jose Reyes Bonilla and Marvin Reyes Bonilla, carpenters, were involved in a motor vehicle accident while commuting to a job site in Greenpoint, Brooklyn, in an employer-provided van. They filed workers' compensation claims, which were established against XL Specialty Insurance by a Workers' Compensation Law Judge (WCLJ). XL Specialty appealed, arguing its policy did not cover commuting injuries and that it was not the proper carrier. The Workers' Compensation Board affirmed the WCLJ's decisions, finding XL Specialty failed to preserve its challenge to being the carrier and that the employer's responsibility for transportation made the injuries compensable. The Appellate Division, Third Department, affirmed, agreeing that the issue was unpreserved and that the injuries arose out of and in the course of employment due to the employer's control over the conveyance.

Workers' CompensationMotor Vehicle AccidentEmployment InjuriesCommuting AccidentEmployer Provided TransportationWrap-up PolicyInsurance Coverage DisputeCarrier LiabilityIssue PreservationAppellate Review
References
16
Case No. CV-22-2294, CV-22-2299
Regular Panel Decision
Jun 27, 2024

In the Matter of the Claim of Jose Reyes Bonilla

Jose Reyes Bonilla and Marvin Reyes Bonilla, carpenters, filed workers' compensation claims after being injured in a motor vehicle accident while traveling to a job site in an employer-provided van. The Workers' Compensation Board affirmed decisions that established their claims against XL Specialty Insurance, ruling that their injuries arose out of and in the course of their employment. XL Specialty appealed, arguing its policy did not cover commuting injuries and that it was not the proper carrier. The Appellate Division affirmed the Board's decisions, finding XL Specialty failed to preserve its challenge and that the injuries were compensable due to the employer's control over transportation. The court also concluded that XL Specialty's policy exclusion was inapplicable as the transportation was incidental to the project.

Workers' CompensationMotor Vehicle AccidentEmployment InjuriesCourse of EmploymentEmployer Provided TransportationInsurance Coverage DisputeWrap-up PolicyAppellate ReviewPreclusionPenalties
References
17
Case No. ADJ18434613
Regular
Jul 25, 2025

ANGELICA RAMIREZ DE ZARATE vs. RIVERSIDE HEALTHCARE AND WELLNESS CENTRE, LLC; XL SPECIALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board considered a Petition for Reconsideration filed by the Defendants, Riverside Healthcare and Wellness Centre, LLC, and XL Specialty Insurance Company. The petition challenged the Workers' Compensation Administrative Law Judge's (WCJ) findings regarding an injury sustained by the applicant, Angelica Ramirez de Zarate, to her left knee and the applicability of Labor Code Section 5400. The Appeals Board, adopting the WCJ's report and reasoning, found that the applicant credibly testified about her injury and that the defendants failed to prove prejudice due to late reporting under Labor Code Section 5403. Consequently, the Board denied the petition for reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Electronic Adjudication Management SystemAOE/COELabor Code Section 5400PrejudiceIndustrial CausationPanel Qualified Medical EvaluatorCredibility Determination
References
4
Case No. ADJ1351389 (SJO 0253295), ADJ7183596, ADJ7168611
Regular
Jun 17, 2019

DEBBIE CHADBURN vs. APPLIED MATERIALS, INC., XL SPECIALTY INSURANCE COMPANY, CORVEL, ARROWOOD INDEMNITY COMPANY

This case involves multiple industrial injuries sustained by the applicant, Debbie Chadburn, to her neck, upper extremities, and psyche. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the applicant's $100\%$ permanent disability award. The insurers, Arrowood and XL Specialty, contested the compensability of the psychiatric injury, arguing it stemmed from a consensual relationship with a treating physician unrelated to employment. The WCAB affirmed the permanent total disability award, finding the psychiatric injury caused by the physician's misconduct was a compensable consequence of the industrial injuries under *Hikida v. Workers' Comp. Appeals Bd.* The award was amended to reflect specific temporary disability rates and the calculation of attorney fees, with jurisdiction reserved for final adjustment.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityTemporary DisabilityPsychiatric InjuryCompensable ConsequenceSexual MisconductTreating PhysicianCumulative TraumaDate of Injury
References
1
Case No. 2017 NY Slip Op 06496
Regular Panel Decision
Sep 14, 2017

Matter of Cortes v. Eagle Sys., Inc.

Patricio Cortes, a truck driver, was injured in a motor vehicle accident and sought workers' compensation benefits from his employer, Eagle Systems, Inc. Although XL Specialty Insurance was the proper workers' compensation carrier, it failed to appear at hearings. Zurich American Insurance Company, despite not being the carrier and not on notice, participated, arguing Cortes was an independent contractor. The Workers' Compensation Law Judge (WCLJ) found Cortes to be an employee and his injuries compensable. Zurich appealed, asserting standing based on a contingency liability policy, but both the Workers' Compensation Board and the Appellate Division, Third Department, affirmed that Zurich lacked standing as it was not a direct party to the claim and its liability was a contractual issue beyond the Board's jurisdiction.

Workers' CompensationAppellate ReviewStandingInsurance LiabilityIndependent ContractorEmployer-Employee RelationshipJurisdictionMotor Vehicle AccidentContingency Policy
References
4
Case No. MISSING
Regular Panel Decision

Claim of Smith v. Specialty Services, Inc.

Claimant, a construction foreman for Specialty Services, Inc., was injured while performing work for a church in Pennsylvania. Although Specialty filed a work-related accident report and its carrier began paying benefits, the carrier filed a notice of controversy over seven months after the Workers' Compensation Board indexed the case, exceeding the 25-day limit. The carrier argued that the late filing was due to surprise, mistake, and newly discovered evidence regarding the church's involvement, which claimant and Specialty allegedly failed to disclose. The Workers' Compensation Board refused to excuse the late filing, finding the carrier failed to demonstrate good cause. The appellate court affirmed the Board's decision, noting that the carrier had ample time to investigate and that belatedly obtained evidence is not a sufficient ground to excuse a late filing.

Workers' CompensationLate Notice of ControversyTimely FilingEmployer-Employee RelationshipInsurance CarrierGood CausePleading BarAppellate ReviewBoard DecisionStatutory Interpretation
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. 2025 NYSlipOp 06801
Regular Panel Decision
Dec 09, 2025

AmTrust N. Am., Inc. v. Insurance Specialty Group LLC

The plaintiff, AmTrust North America, Inc., appealed an order dismissing parts of its breach of contract claim against Insurance Specialty Group LLC. The dispute stems from a 2010 Managing Producer Agreement where the defendant was to administer an asset protection program for the plaintiff, with fiduciary duties. Plaintiff alleged multiple breaches, including improper underwriting and concealment of issues, which came to light in 2022. The Supreme Court dismissed claims before May 19, 2017, but the Appellate Division modified this by applying equitable estoppel. The appellate court ruled that estoppel could allow most breach of contract claims, except those solely based on the fiduciary duty to disclose, which are not subject to estoppel for time-barred breaches.

Breach of ContractEquitable EstoppelFiduciary DutyStatute of LimitationsAsset Protection ProgramUnderwriting GuidelinesInsurance AdministrationConcealmentContinuing Wrong DoctrineAppellate Division
References
8
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. 2018 NY Slip Op 07194 [167 AD3d 142]
Regular Panel Decision
Oct 25, 2018

American Intl. Specialty Lines Ins. Co. v. Allied Capital Corp.

This appeal concerns an arbitration dispute between American International Specialty Lines Insurance Company (AISLIC) and Allied Capital Corporation regarding insurance coverage for a $10.1 million settlement. An arbitration panel initially issued a Partial Final Award (PFA) on liability but later reconsidered and reversed its decision, leading to a corrected PFA and a final award. AISLIC petitioned to vacate these subsequent awards and confirm the original PFA. The Appellate Division, First Department, ruled that the arbitration panel exceeded its authority under the functus officio doctrine by reconsidering its prior final determination on liability. Consequently, the corrected PFA and the final award were vacated, and the original PFA was reinstated.

ArbitrationFunctus OfficioPartial Final AwardVacaturInsurance CoverageAppellate ReviewJurisdictionArbitrator AuthorityLiabilityDamages
References
32
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