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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. 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. 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. 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. 23
Regular Panel Decision
Apr 30, 2020

American International Specialty Lines Insurance Company v. Allied Capital Corporation

This case addresses whether an arbitration panel exceeded its authority by reconsidering a "Partial Final Award" in an insurance dispute. The underlying dispute involved Ciena Capital LLC and Allied Capital Corporation seeking coverage from American International Specialty Lines Insurance Company (AISLIC) after settling a federal qui tam action. Initially, the arbitration panel issued a partial award, which was later reconsidered and corrected to grant both indemnification and defense costs. AISLIC challenged this reconsideration, arguing the panel was functus officio. The New York Court of Appeals reversed an Appellate Division ruling, holding that the initial "Partial Final Award" was not truly final because the parties had not mutually agreed to its finality. Consequently, the arbitration panel was deemed to have acted within its authority by reconsidering its initial determination, and the petition to vacate the corrected award was denied.

ArbitrationFunctus OfficioPartial Final AwardReconsiderationArbitrator AuthorityInsurance CoverageIndemnificationDefense CostsQui Tam ActionNew York Court of Appeals
References
18
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. MISSING
Regular Panel Decision

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
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. MISSING
Regular Panel Decision

Transcontinental Insurance v. State Insurance Fund

This case involves a dispute between two insurers, Transcontinental Insurance Company (plaintiff) and State Insurance Fund (defendant), regarding their contribution to the defense and settlement of an underlying personal injury action. Transcontinental, which insured the contractor Master, sought a declaration that State Insurance Fund, Master's workers' compensation insurer, should contribute as a co-insurer for expenses incurred defending and settling the action on behalf of NYPA. The Supreme Court dismissed the complaint, applying the antisubrogation rule. The Appellate Division modified the judgment, vacating the dismissal but affirming the application of the antisubrogation rule, declaring that State Insurance Fund is not obligated to reimburse Transcontinental for the expenses.

Insurance DisputeAntisubrogation RuleDeclaratory JudgmentCommercial General Liability PolicyWorkers' Compensation InsuranceIndemnificationCo-insurancePersonal Injury ActionAppellate ReviewContractual Obligation
References
5
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