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Case Law Database

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

Case No. ADJ374246
Regular
Apr 23, 2015

CAROLINE PARAS vs. LOS ANGELES TIMES/TRIBUNE, ACE USA

Defendant ACE USA filed a Petition for Removal seeking to overturn an order changing the claims administrator from Gallagher Bassett to CIGA. The Board found ACE USA's contentions unintelligible. However, both ACE USA and the applicant subsequently filed a Compromise and Release, which was approved. Consequently, ACE USA's Petition for Removal is now moot and has been dismissed by the Board.

Petition for RemovalOrder to Change AdministratorsCalifornia Insurance Guarantee AssociationCIGACompromise and Releasemootalter egothird party administratorTPAWorkers' Compensation Appeals Board
References
Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
Case No. ADJ248306 (SAC 0298167) ADJ870873 (SAC 0298071)
Regular
Jul 28, 2017

Lonnie Roberts vs. Capital Plumbing, California Insurance Guarantee Association, Reliance National Indemnity Company, SEDGWICK CLAIMS MANAGEMENT SERVICES, ACE USA

The Workers' Compensation Appeals Board granted reconsideration to clarify ACE USA's liability for reimbursement to CIGA. ACE USA argued that CIGA's claim lacked sufficient proof and that the initial order failed to specify an amount. The Board affirmed the finding that ACE USA is liable for reimbursement to CIGA for temporary disability, medical treatment, bill review, and utilization review for services paid after January 26, 2001. However, the Board amended the order to clarify that the parties must adjust the reimbursement amount, with the trial judge retaining jurisdiction if an agreement is not reached.

Workers' Compensation Appeals BoardCIGAACE USAReimbursementLiquidationJointly and Severally LiableOther InsuranceBenefit PrintoutLabor Code Section 5815Unclean Hands Doctrine
References
Case No. SDO 0325797
Regular
Jan 25, 2008

Anthony Arinze vs. Labor Finders, ACE USA

This case involves an appeal by defendant ACE USA regarding an award for applicant Anthony Arinze's cumulative trauma injury. The Workers' Compensation Appeals Board granted reconsideration, rescinded the original award, and returned the case for further development of the medical record. The Board found insufficient medical evidence on apportionment of the applicant's back injury, particularly concerning pre-existing degenerative conditions. The matter will proceed to the trial level for a new Qualified Medical Evaluator to address these issues.

Labor FindersACE USAcumulative traumaright eye injuryhand injuryback injurypermanent disabilityapportionmentLabor Code section 5400Labor Code section 4663
References
Case No. ADJ4455621 (AHM 0086346)
Regular
May 14, 2014

ALVIN CAVALIER vs. BABCOCK & WILCOX; ACE USA, Administered By ESIS, INC.

This case involves Alvin Cavalier's workers' compensation claim against Babcock & Wilcox and its administrator, ACE USA. Cavalier petitioned for reconsideration of a prior decision by the Workers' Compensation Appeals Board (WCAB). The WCAB has denied Cavalier's petition, adopting the reasoning of the administrative law judge and incorporating it into their order.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportdeny reconsiderationAlvin CavalierBabcock & WilcoxACE USAESISInc.ADJ4455621
References
Case No. ADJ4022825 (AHM 0126552)
Regular
Aug 20, 2009

EMILIA MONROY vs. TEMPSTAR SERVICES, INC., CIGA By Its Servicing Facility BROADSPIRE For CALIFORNIA COMPENSATION INSURANCE COMPANY; In Liquidation, ITT CANNON INT'L, INC., ACE/USA

The Workers' Compensation Appeals Board granted CIGA's petition for reconsideration, overturning the dismissal of applicant Emilia Monroy's case. The prior dismissal, due to applicant's failure to prosecute, was modified to only dismiss the applicant's claim. This ensures CIGA, having paid benefits, can still pursue its statutory right to reimbursement from co-defendant ACE USA, regardless of the applicant's claim status.

CIGACalifornia Insurance Guarantee AssociationreimbursementIn liquidationACE USAPetition for ReconsiderationOrder Dismissing CaseApplicant's Application for Adjudication of Claimfailure to prosecutestatutory right
References
Case No. ADJ1143803 (OXN 0128653) ADJ2709854 (OXN 0142376)
Regular
Nov 01, 2011

SALVADOR PAZ vs. MARTINEZ PAINTING & WALL COVERING, MB PAINTING, CIGA, for CREDIT GENERAL INSURANCE COMPANY, INTERCARE, CIGA for UNITED PACIFIC INSURANCE COMPANY, INTERCARE, STATE FARM INSURANCE COMPANY, ACE USA

This case involves a painter, Salvador Paz, who sustained cumulative and specific injuries to his back, shoulder, wrist, neck, and foot. The Workers' Compensation Appeals Board denied petitions for reconsideration from State Farm, CIGA, and the applicant. The Board upheld the original findings, which apportioned permanent disability at 72% to the specific injury (CIGA via Credit General) and 28% to the cumulative trauma (ACE USA and State Farm). Liability for temporary disability was also divided, and State Farm's arguments regarding an unequal division and due process were rejected.

CIGAState Farmcumulative injuryspecific injuryapportionmenttemporary disabilitypermanent disabilityvocational expertPetition for ReconsiderationCredit General Insurance
References
Case No. ADJ7110663
Regular
May 09, 2016

WILLIAM BO MATTHEWS vs. SAN DIEGO CHARGERS, ZENITH INSURANCE COMPANY, NEW YORK GIANTS, INSURANCE COMPANY OF NORTH AMERICA/ACE USA, DENVER GOLD, THE NORTH RIVER INSURANCE COMPANY

This case involves a petition for reconsideration of an arbitrator's decision regarding workers' compensation liability for a professional football player's cumulative trauma injuries. The Workers' Compensation Appeals Board (WCAB) granted reconsideration and modified the arbitrator's award, finding the applicant sustained two separate cumulative trauma injuries due to distinct periods of employment exposure. Consequently, the WCAB ruled that the petitioner, Insurance Company of North America/ACE USA (ESIS), is not liable for contribution to another insurer, The North River Insurance Company (NRIC), which had mistakenly paid a portion of a settlement. The Board affirmed the finding of two injuries, citing a significant break in employment as creating separate compensable periods, but rescinded the award to NRIC, holding NRIC should recover nothing from ESIS.

WCABPetition for ReconsiderationArbitration DecisionContributionCumulative InjuryProfessional Football PlayerInsurance Company of North America/ACE USAZenith Insurance CompanyThe North River Insurance CompanyLabor Code Section 5500.5
References
Case No. ADJ9141320
Regular
Dec 03, 2014

, JOSE LUIS MUNOZ DAVILA, vs. , LOS ANGELES DODGERS; SEDGWICK, FIREMAN'S FUND, ESIS,

This case concerns a defendant, ACE USA, seeking removal to bifurcate the trial on the issue of jurisdiction for a professional athlete's workers' compensation claim. ACE argued it lacked due process because it wasn't adequately notified that all issues would proceed to trial. The Appeals Board denied the removal petition, finding ACE failed to demonstrate substantial prejudice or irreparable harm from the administrative law judge deferring the bifurcation decision. Commissioner Lowe dissented, believing ACE would be prejudiced by proceeding to trial on unprepared issues due to insufficient notice.

Petition for RemovalWorkers' Compensation Appeals BoardACE USAJurisdictionDue ProcessMandatory Settlement ConferencePretrial Conference StatementBifurcationLabor Code section 3600.5Prejudice
References
Case No. ADJ672705 (ANA0348598) MF ADJ786706 (ANA0334510) ADJ1359776 (AHM0072658)
Regular
Feb 15, 2013

HUMBERTO RIVAS vs. UNIVERSAL ALLOY CORPORATION; ACE USA; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INDEMNITY COMPANY and CALIFORNIA COMPENSATION INSURANCE, both in liquidation; REPUBLIC INDEMNITY COMPANY

This case involves an appeal by ACE USA regarding a Workers' Compensation Appeals Board decision that found applicant Humberto Rivas sustained cumulative injuries to both arms while employed by Universal Alloy Corporation. The Board granted reconsideration, primarily because ACE USA argued it was denied due process concerning reimbursement to CIGA. The Board affirmed the applicant's award but rescinded the findings on credit and reimbursement, returning these issues to the trial level for further proceedings. This ensures ACE USA and CIGA have a proper opportunity to address their respective liabilities and reimbursements.

Workers' Compensation Appeals BoardCumulative InjurySpecific InjuryPermanent DisabilityApportionmentFuture Medical TreatmentCalifornia Insurance Guarantee AssociationCIGAOther InsuranceReimbursement
References
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