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

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. 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. 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
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. 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

In re the Claim of Morales

The case concerns an appeal from a decision by the Unemployment Insurance Appeal Board, which ruled that a claimant and others working for Ronmar Specialties, Inc., a manufacturer of steel security products, were employees rather than independent contractors, thus making them eligible for benefits. The Board's findings were based on factors such as Ronmar determining work assignments and costs, guarantees to customers, and a non-compete clause for installers, alongside equipment leasing. The appellate court affirmed the decision, underscoring that the determination of an employment relationship is a factual matter, and the Board's conclusions are conclusive if supported by substantial evidence, even in the presence of conflicting information.

Employment RelationshipIndependent ContractorUnemployment BenefitsSubstantial EvidenceAppellate ReviewFactual DeterminationNon-Compete ClauseEquipment LeaseWork AssignmentsGuarantees
References
5
Case No. MISSING
Regular Panel Decision

Hobbs v. Lavine

Petitioner's home relief assistance was discontinued by the New York City Department of Social Services based on a finding that she was fully employed. This determination was affirmed by the respondent after a hearing. The court found that the respondent's determination was not supported by substantial evidence, as the city agency's evidence consisted only of two vague case-record entries. Consequently, the application was granted, and the determination was annulled, with petitioner's assistance directed to be reinstated retroactively.

Home ReliefPublic AssistanceSocial ServicesEmployment StatusSubstantial EvidenceArticle 78 CPLRAdministrative ReviewRetroactive BenefitsDiscontinuation of Benefits
References
2
Case No. MISSING
Regular Panel Decision

Howard v. New York Times

This case concerns a motion seeking leave to appeal from an Appellate Division order, which had affirmed a Workers' Compensation Board determination. The Board's determination denied an application for reconsideration and/or full Board review. The motion for leave to appeal, insofar as it pertained to the Board's denial of reconsideration, was dismissed on the grounds that this portion of the order did not constitute a final determination within the meaning of the Constitution. The remaining aspects of the motion for leave to appeal were denied.

Motion PracticeLeave to AppealAppellate ReviewWorkers' CompensationBoard ReviewReconsiderationJurisdictionFinality of OrderConstitutional LawDismissal
References
3
Case No. MISSING
Regular Panel Decision
Jan 26, 1982

Hodge v. D'Elia

This case involves a proceeding under CPLR article 78 to review a determination by the State Commissioner of Social Services. The determination affirmed a local agency's decision to reduce the petitioner's public assistance grant. This reduction was for the recoupment of income tax refunds and workers' compensation benefits received by the petitioner. Although the court agreed that the petitioner willfully withheld information, it found that the respondents failed to evaluate if the recoupment rate would cause undue hardship. Consequently, the court annulled the determination and remitted the matter for further proceedings to assess undue hardship.

Public AssistanceRecoupmentIncome Tax RefundsWorkers' Compensation BenefitsUndue HardshipCPLR Article 78Administrative ReviewFair HearingAnnulmentRemittal
References
1
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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