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Case No. SRO 0088351

En Banc

Cheryl Coldiron vs. Compuware Corporation, California Insurance Guarantee Association, Reliance National Insurance Company (in liquidation), Intercare Insurance Services, Gallagher Bassett Services, Inc.

The Appeals Board held that a third-party administrator must disclose the identity of its client (employer or insurance carrier) and amended the award to be against the insurer, which had gone into liquidation and was succeeded by CIGA.

Workers' Compensation Appeals BoardThird-party administratorDisclosureSanctionsLabor Code Section 5813Insurance Code Sections 11650116571165911660Gallagher Bassett Services

References

Case No. ADJ559526 (STK 0208625)

Regular

Jan 03, 2011

MICHAEL OZUNA vs. WEBCOR BUILDERS, ZURICH NORTH AMERICA, AMERICAN HOME ASSURANCE COMPANY

This case concerns whether Zurich North America or American Home Assurance Company provided workers' compensation coverage for an applicant's severe injury. An arbitrator initially ruled Zurich solely responsible, finding American Home's policy was limited and did not cover the claim. Zurich contends American Home's policy endorsement limiting coverage to a specific site was invalid due to non-compliance with Insurance Code requirements. The Appeals Board granted reconsideration to allow further proceedings, holding American Home bears the burden to prove its policy effectively excluded this claim.

Workers Compensation Appeals BoardReconsiderationArbitrationInsurance CoverageDefense and IndemnificationPolicy EndorsementInsurance Code Section 11657Insurance Code Section 11660Burden of ProofAffirmative of the Issue

References

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Cheryl Coldiron vs. Compuware Corporation, California Insurance Guarantee Association, Reliance National Insurance Company (in liquidation), Intercare Insurance Services, Gallagher Bassett Services, Inc.

Workers' Compensation Appeals BoardThird-party administratorDisclosureSanctionsLabor Code Section 5813Insurance Code Sections 11650116571165911660Gallagher Bassett Services

MICHAEL OZUNA vs. WEBCOR BUILDERS, ZURICH NORTH AMERICA, AMERICAN HOME ASSURANCE COMPANY