CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. 2017 NY Slip Op 07909 [155 AD3d 1208]
Regular Panel Decision
Nov 09, 2017

NYAHSA Services, Inc., Self-Insurance Trust v. People Care Inc.

Plaintiff, a self-insured trust, commenced a collection action against defendant, a former member, for unpaid assessments related to workers' compensation claims. Defendant counterclaimed and filed a third-party action against Cool Insuring Agency, the trust's administrators, alleging mismanagement. During discovery, a dispute arose over a report commissioned by defendant's counsel from a consultant, which Cool and plaintiff sought to compel. Defendant asserted attorney-client privilege, attorney work product, and material prepared in anticipation of litigation. The Supreme Court partially granted the motions to compel, a decision largely affirmed by the Appellate Division, Third Department, with a modification regarding a specific email exchange found to be protected attorney work product.

Discovery DisputeAttorney-Client PrivilegeAttorney Work ProductMaterial Prepared for LitigationSelf-Insurance TrustWorkers' Compensation BenefitsBreach of ContractUnjust EnrichmentThird-Party ActionClaims Administration
References
20
Case No. 2018 NY Slip Op 08737
Regular Panel Decision
Dec 20, 2018

NYAHSA Servs., Inc., Self-Insurance Trust v. Recco Home Care Servs., Inc.

This case concerns an appeal from an order of the Supreme Court in Albany County. Plaintiff NYAHSA Services, Inc., Self-Insurance Trust, a self-insured trust providing workers' compensation coverage, sued defendant Recco Home Care Services, Inc. for unpaid adjustments after the defendant terminated its membership. Following an amendment to the complaint adding individual trustees as plaintiffs, the defendant asserted counterclaims for fraud, breach of fiduciary duty, and negligence against these trustees, which the Supreme Court dismissed as time-barred. The defendant also sought to amend its answer to include a counterclaim under General Business Law, which was denied. The Appellate Division, Third Department, found that the Supreme Court erred in dismissing the counterclaims for fraud and breach of fiduciary duty and in denying the cross-motion to amend for the General Business Law claim. Consequently, the Appellate Division modified the Supreme Court's order, reversing parts of the dismissal and denial, and affirmed the order as modified.

Workers' Compensation CoverageSelf-Insurance TrustFraud AllegationsBreach of Fiduciary DutyGeneral Business LawStatute of LimitationsAmended PleadingsCounterclaimsAppellate ReviewMotion to Dismiss
References
2
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

NYAHSA Servs., Inc., Self-Insurance Trust v. People Care Inc.

This case involves an appeal from an order of the Supreme Court, which granted the plaintiff's motions for leave to amend complaints. The plaintiff, a group self-insured trust, initiated collection actions against former member employers, People Care Incorporated and Recco Home Care Services, Inc., for unpaid workers' compensation adjustment bills. The plaintiff sought to add its trustees as party plaintiffs and to update allegations to include subsequently accrued unpaid bills. The appellate court affirmed the Supreme Court's decision, clarifying that an evidentiary showing of merit is not required for leave to amend pleadings under CPLR 3025 (b) unless there is prejudice, surprise, palpable insufficiency, or patent lack of merit. The court found no such grounds for denial and also rejected the defendants' statute of limitations arguments, affirming that for contracts requiring continuing performance, each breach can restart the limitations period.

Workers' Compensation CoverageSelf-Insured TrustBreach of ContractUnjust EnrichmentPleading AmendmentCPLR 3025 (b)Statute of LimitationsPrejudiceAppellate ReviewSupreme Court Order
References
18
Case No. MISSING
Regular Panel Decision
Mar 28, 2000

Oil Heat Institute of Long Island Insurance Trust v. Gerber Life Insurance

Plaintiff Oil Heat Institute of Long Island Insurance Trust (OHI) sued Gerber Life Insurance Company (Gerber), Island Group Administration, Inc. (IGA), and RMTS Associates, alleging Gerber refused to reimburse stop-loss claims and issue a letter of certification to a lender. OHI had established a self-insurance program, and Gerber issued an aggregate stop-loss (ASL) policy. OHI commenced the action on the day the ASL policy expired, before the attachment point for reimbursement could be calculated and before submitting proper documentation. The Supreme Court denied Gerber's motion for summary judgment. The Appellate Division reversed, finding that OHI failed to demonstrate compliance with the ASL policy's reimbursement terms, lacked material facts to support its claims, and initiated the action prematurely. Both causes of action were dismissed against Gerber.

Insurance LawSummary JudgmentAggregate Stop-Loss PolicyContract DisputeReimbursementPolicy TermsAppellate ReviewGood FaithDocumentation RequirementsAgency
References
3
Case No. ADJ6540543
Regular
Jun 07, 2013

Christopher Toms vs. Marvin Lee Weatherbee dba BEELINE TRANSPORTATION, illegally uninsured, KIEWIT PACIFIC COMPANY, permissibly self-insured

This case involves Christopher Toms, an applicant injured while employed as a truck driver by Beeline Transportation, an illegally uninsured entity. The Workers' Compensation Appeals Board granted reconsideration of a finding that Kiewit Pacific Company, permissibly self-insured, was a dual employer. The Board rescinded the prior award, finding that Kiewit was a contracting party who engaged Beeline as an independent contractor. No statutory basis existed to deem Toms an employee of Kiewit, therefore Kiewit is not liable for workers' compensation benefits.

Workers Compensation Appeals BoardChristopher TomsMarvin Lee WeatherbeeBeeline TransportationKiewit Pacific Companyillegally uninsuredpermissibly self-insureddual employersultimate hirerjoint and severally liable
References
2
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. ANA 0324555
Regular
Aug 19, 2007

CONNIE CERVANTES vs. TEMPEST SERVICES INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ITT CANON

This case concerns whether a self-insured special employer's coverage constitutes "other insurance" that would relieve the California Insurance Guarantee Association (CIGA) of liability for an injured worker's benefits. The Appeals Board denied reconsideration, affirming the administrative law judge's finding that ITT, a permissibly self-insured special employer, was liable for benefits. The Board relied on precedent establishing that self-insurance by an employer is considered "other insurance" under relevant statutes, thus excluding CIGA's coverage.

Workers Compensation Appeals BoardGeneral employerSpecial employerPermissibly self-insuredCalifornia Insurance Guarantee AssociationCIGALiquidationCovered claimsOther insuranceInsurance Code section 1063.1(c)(9)
References
3
Case No. MISSING
Regular Panel Decision

In re the Arbitration between Country-Wide Insurance & Manning

Daisy P. Manning, an employee of the Department of Transportation, was injured by an uninsured vehicle while driving a city-owned vehicle. She sought arbitration from her personal insurer, Country-Wide, which then moved to permanently stay arbitration. Country-Wide argued that the City of New York, a permissibly self-insured municipality, should provide primary uninsured motorist coverage. Judge Bloom dissents in part, agreeing with the necessity of reversal but advocating for a remand with specific directions to join the City of New York as a party. This would allow for a full determination of rights, particularly concerning the City's potential primary liability under uninsured motorist provisions and the exclusivity of the Workers' Compensation Law.

Uninsured Motorist CoverageWorkers' Compensation LawSelf-Insured MunicipalityStay of ArbitrationPrimary vs. Secondary LiabilityJoinder of PartiesVehicle and Traffic LawInsurance LawExclusive RemedyAppellate Dissent
References
1
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
Showing 1-10 of 12,769 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational