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

Case No. 2018 NY Slip Op 07224 [165 AD3d 1558]
Regular Panel Decision
Oct 25, 2018

Healthcare Professionals Ins. Co. v. Parentis

This case involves an appeal regarding a declaratory judgment action initiated by Healthcare Professionals Insurance Company (HPI) against Michael A. Parentis and others. The dispute arises from a prior medical malpractice verdict against Parentis totaling $8.6 million, which exceeded his combined $2.3 million primary and excess insurance policies from Medical Liability Mutual Insurance Company (MLMIC) and HPI. Parentis alleged bad faith against both insurers for failing to settle the underlying action within policy limits. The Supreme Court initially granted summary judgment to HPI and MLMIC, dismissing Parentis' bad faith claim. The Appellate Division, Third Department, reversed this decision, finding that genuine issues of material fact exist concerning whether both HPI and MLMIC acted in bad faith during settlement negotiations, especially during jury deliberations.

Insurance LawBad Faith Insurance ClaimMedical MalpracticeSummary JudgmentAppellate ReviewSettlement NegotiationsExcess InsurancePrimary InsuranceJury DeliberationsDuty to Settle
References
16
Case No. MISSING
Regular Panel Decision
Jul 13, 2001

A.I. Transport v. New York State Insurance Fund

The Supreme Court, New York County, denied a liability insurer’s application to stay an arbitration initiated by a workers’ compensation insurer. The workers’ compensation insurer sought to recover benefits paid to a bus passenger injured in an accident, where the bus was insured by the liability insurer. The court interpreted Insurance Law § 5105 (a) to allow a workers’ compensation provider, paying benefits in lieu of first party benefits, to recover amounts paid from the insurer of a liable party, even if one of the vehicles involved is a bus. It was determined that an exception for losses arising from the use of a motor vehicle (Insurance Law § 5103 [a] [1]) did not apply, as the respondent was a workers’ compensation insurer and not an automobile insurer. Consequently, the arbitration was allowed to proceed, and the petition to stay it was dismissed and unanimously affirmed.

Arbitration DisputeInsurance Law InterpretationNo-Fault BenefitsWorkers' Compensation SubrogationBus AccidentLiability CoverageStatutory ConstructionAppellate ReviewInsurer Recovery
References
4
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
May 08, 2003

Allianz Underwriters Insurance v. Landmark Insurance

This case involves an appeal by Allianz Underwriters Insurance Company, an excess liability insurer, against the law firm Underberg & Kessler, LLP. Allianz alleged that Underberg, retained by the primary insurer General Star Indemnity Corporation to represent their mutual insured Dunlop Tire Corporation in an underlying wrongful death action, breached its fiduciary duty and committed professional negligence. Allianz claimed Underberg failed to initiate a third-party action against Nicholson & Hall, Dunlop's employer (also insured by General Star), to protect General Star's interests over Dunlop's and Allianz's. The Supreme Court initially dismissed Allianz's complaint against Underberg. However, the Appellate Division, First Department, reversed this decision, holding that Allianz could pursue its claim against Underberg based on principles of equitable subrogation and a "near privity" relationship, thereby reinstating the complaint.

Equitable SubrogationLegal MalpracticeProfessional NegligenceExcess InsurancePrimary InsuranceFiduciary DutyNear PrivityDismissal ReversalAppellate ReviewIndemnification Clause
References
15
Case No. MISSING
Regular Panel Decision

Adams v. Chicago Insurance

Eric R. Adams, an attorney, sued Chicago Insurance Company for breach of its professional liability insurance policy, seeking a declaration that Chicago had a duty to defend and indemnify him in an underlying professional malpractice lawsuit brought by Patricia E. Novak. Chicago disclaimed coverage, asserting Adams failed to provide timely notice of the potential malpractice claim as required by the policy's terms. The court initially found that Adams, despite his claims of a good faith belief in non-liability, unreasonably delayed notifying Chicago of the potential claim. However, the court ultimately concluded that Chicago was equitably estopped from denying coverage due to its own unreasonable eight-month delay in formally disclaiming coverage after receiving initial notice from Adams and for engaging in conduct that gave the appearance of defending Adams. Consequently, the court denied Chicago's motion for summary judgment and granted Adams' motion, compelling Chicago to defend and indemnify Adams in the malpractice action.

Professional LiabilityInsurance CoverageDuty to DefendDuty to IndemnifyLegal MalpracticeSummary JudgmentEquitable EstoppelTimeliness of NoticeDisclaimer of CoverageFederal Rules of Civil Procedure
References
22
Case No. 2012 NY Slip Op 30642(U)
Regular Panel Decision
Mar 08, 2012

Markel Insurance v. American Guarantee & Liability Insurance

Markel Insurance Company and New Empire Group, Ltd. (NEG) appealed an order dismissing their claims for legal malpractice and common-law indemnification against Rebore Thorpe & Pisarello, P.C. The claims originated from an underlying personal injury action where Rebore represented the American Gardens defendants, who faced an insurance coverage disclaimer by American Guarantee and Liability Insurance Company (AGLIC) due to alleged untimely notice. Markel, acting on behalf of NEG, contributed to the settlement of the underlying action following AGLIC's disclaimer. The Supreme Court dismissed the claims, reasoning that the American Gardens defendants suffered no ascertainable damages from the alleged malpractice and that Markel's payment for indemnification was voluntary. The appellate court affirmed this decision, concluding that the complaint failed to establish damages for legal malpractice or a non-voluntary payment necessary for common-law indemnification.

Legal MalpracticeCommon-Law IndemnificationMotion to DismissCPLR 3211 (a) (7)Ascertainable DamagesVoluntary Payment DoctrineSubrogationInsurance Coverage DisclaimerTimely NoticeAppellate Review
References
12
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. 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. MISSING
Regular Panel Decision

Continental Insurance v. State

Thomas Murray, an executive officer and co-owner of T & T Murray Company, Inc., sustained severe injuries while working, having previously elected to be excluded from Workers’ Compensation coverage under Workers’ Compensation Law § 54 (6). Following a successful lawsuit against the general contractor, Concept Construction Corp., and subsequent indemnification from T & T, Concept's liability carrier, Continental Insurance Company, sought coverage from T & T's insurer, State Insurance Fund. The State Fund denied the claim, asserting the exclusion applied to both Workers’ Compensation and Employers’ Liability coverage. The Court of Appeals affirmed the denial, ruling that the two types of coverage are inextricably linked, and the election to exclude executive officers from Workers’ Compensation coverage also eliminates Employers’ Liability coverage for injuries to those officers.

Workers' Compensation Law § 54(6)Employers' Liability CoverageExecutive Officer ExclusionCorporate OfficersStock OwnershipInsurance Policy InterpretationThird-Party IndemnificationSubrogation ClaimStatutory InterpretationNew York Court of Appeals
References
6
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
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