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

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

Serio v. Ardra Insurance

The Supreme Court, New York County, affirmed a judgment in favor of Gregory V. Serio, Superintendent of Insurance of the State of New York, as Liquidator of Nassau Insurance Company, against the DiLoreto defendants. The trial court's decision to pierce the corporate veil of Ardra Insurance Company, controlled from New York by Richard DiLoreto, was upheld based on New York law, despite Ardra's Bermuda incorporation. The court rejected the defendants' equitable estoppel claim, asserting that governmental agencies can alter positions in governmental functions. Furthermore, the evidence supported the jury's finding that transactions between Ardra and Nassau Insurance Company were unfair and inequitable, as the DiLoretos diverted funds, thereby denying Nassau coverage. The appellate court found the verdict consistent with the evidence and noted the defendants waived their claim regarding the jury's composition by consent.

Corporate Veil PiercingReinsuranceEquitable EstoppelGovernmental FunctionInsurance LawJury VerdictAppellate ReviewUnfair TransactionsCorporate DebtNew York Law
References
12
Case No. AHM 90917 AHM 90918
Regular
Jul 11, 2007

ANGEL SOSA vs. D.W. FOODS, EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, VILLANOVA INSURANCE

This case concerns a dispute over reimbursement between an insurer, Everest, and the California Insurance Guarantee Association (CIGA), which is handling claims for a liquidated insurer, Villanova. The Board denied Everest's petition, upholding a prior award for reimbursement from Everest to CIGA. However, the Board granted CIGA's petition to amend the award to include Villanova Insurance as a party defendant.

CIGAEverest National Insurance CompanyVillanova Insuranceliquidationreconsiderationreimbursementbill review chargesjoint and several liabilitycumulative traumadenied due process
References
0
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. 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
Case No. MISSING
Regular Panel Decision

Levin v. Intercontinental Casualty Insurance

This case addresses whether a pre-answer motion to dismiss filed by an 'unauthorized foreign or alien' insurance carrier constitutes a 'pleading' under Insurance Law § 1213 (c), thereby requiring the carrier to post a bond. The New York State Superintendent of Insurance, as liquidator of Ideal Mutual Insurance Company, sued Intercontinental Casualty Insurance Company, a Cayman Islands carrier, for reinsurance proceeds. Intercontinental moved to dismiss on Statute of Limitations and documentary evidence grounds without posting a bond. The Supreme Court ordered a bond, which Intercontinental failed to provide, leading to a judgment against it. The Court of Appeals affirmed the lower courts' decisions, ruling that such motions, which address the merits of the case, fall within the definition of a 'pleading' for the purpose of ensuring funds are available to satisfy any potential judgment.

Insurance Law § 1213 (c)Unauthorized InsurerBond RequirementPleading DefinitionMotion to DismissStatute of LimitationsDocumentary EvidenceReinsurance AgreementLiquidation ProceedingForeign Carrier
References
2
Case No. MISSING
Regular Panel Decision

In re the Liquidation of the Union Indemnity Insurance

The Superintendent of Insurance, as liquidator of Union Indemnity Insurance Company of New York, sought an order to compel Frank B. Hall and Co. of Connecticut, Inc. (Hall) to turn over funds held at First American Bank of New York. These funds originated from a workers' compensation insurance program between Union and the Public Employer Risk Management Association (PERMA), where Hall acted as Union's agent for premium collection and claims administration. Hall and PERMA opposed the application, arguing the program was self-insurance and Union was not entitled to the funds, with PERMA seeking a constructive trust. The court found that the segregated funds, representing unutilized premiums for claims, constituted general assets of Union and were not protected. It further determined that the PERMA-Union agreement was not a self-insurance plan, as Union bore the primary risk and the plan lacked Workers' Compensation Board approval. Consequently, the court granted the liquidator's application, directing Hall to remit the funds.

Insurance LiquidationAgency AgreementPremium FundsGeneral AssetsSelf-InsuranceConstructive TrustInsurance LawSuperintendent of InsuranceThird-Party AdministratorClaims Administration
References
2
Case No. MISSING
Regular Panel Decision
Feb 28, 1991

North River Insurance v. United National Insurance

This appellate decision addresses the apportionment of liability between North River Insurance Co. and United National Insurance Company arising from a settlement for an injured employee. The court clarified that North River, as the workers' compensation carrier, is solely responsible for its waived lien, reversing a lower court's finding. It further determined that both insurers' "other insurance" clauses called for pro rata contribution, not equal shares, for the $588,245 settlement payment and defense costs. The court calculated specific shares for each insurer and ruled that North River is entitled to interest from the original payment date in 1982. The Supreme Court's order was thus modified to reflect these findings.

Insurance disputePro rata contributionEquitable apportionmentWorkers' compensation lienDefense costsOther insurance clausesSettlement apportionmentInterest calculationAppellate decisionInsurer liability
References
10
Case No. SFO 0444182 SFO 0470385
Regular
Nov 16, 2007

MARK CRUZ vs. WESTLAKE AUTO SERVICE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY, in liquidation, by INTERCARE INSURANCE SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and found the State Compensation Insurance Fund liable for 4% of pre-liquidation benefits paid by Reliance and 100% of post-liquidation benefits paid by CIGA. The Board clarified that "workers' compensation benefit payments" encompass temporary disability, permanent disability, and medical treatment but specifically exclude administrative costs such as medical management, copying, and bill review. Therefore, the State Fund is not obligated to reimburse CIGA for these administrative expenses.

CIGAReliance National Insurance CompanyState Compensation Insurance Fundcontributionpermanent disabilitymedical treatmentcumulative traumaspecific injurypre-liquidation paymentspost-liquidation payments
References
6
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
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