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

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
3
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
0
Case No. ADJ620686
Regular
Jul 06, 2015

YOLANDA ALVAREZ vs. BURNS INTERNATIONAL SECURITY SERVICES, ACE USA/ESIS

This case concerns a Petition for Removal filed by Burns International Security Services and ACE USA/ESIS. The Workers' Compensation Appeals Board denied the petition because removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm, which the defendants failed to demonstrate. The Board found that reconsideration would be an adequate remedy should an adverse final decision issue. The Board also noted a slight discrepancy regarding the closure of discovery, but ultimately adopted the WCJ's reasoning in denying removal.

Petition for RemovalWorkers' Compensation Appeals BoardMandatory Settlement ConferenceDiscoveryCompensable Consequence InjuryIncontinencyLumbar Spine InjuryUtilization ReviewAuthorizationPrejudice
References
2
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
1
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
7
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
9
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
0
Case No. ADJ9527444
Regular
May 23, 2018

, REYES P. HERNANDEZ, vs. , QUALI RUN RANCH; STATE COMPENSATION INSURANCE FUND; OMA OJAI PACIFIC; ZENITH INSURANCE COMPANY; ACE USA INSURANCE COMPANY, Administered By ESIS; MICHAEL AND JODY CROMER, Homeowners; STATE FARM INSURANCE,

The Workers' Compensation Appeals Board granted ESIS's Petition for Removal because the WCJ's order denying ESIS a panel Qualified Medical Evaluator (PQME) evaluation was found to cause significant prejudice and irreparable harm. ESIS was not a party to the original Agreed Medical Examiner (AME) agreement between the applicant and SCIF, and the WCJ's decision unfairly bound ESIS to the AME's findings and effectively closed ESIS's discovery rights. The Board rescinded the WCJ's decision and ordered a PQME evaluation for ESIS, recognizing the denial violated ESIS's due process rights.

Petition for RemovalQualified Medical EvaluatorAgreed Medical ExaminerDue ProcessSignificant PrejudiceIrreparable HarmDiscoveryFindings and OrderWorkers' Compensation Appeals BoardCumulative Trauma
References
6
Case No. ADJ2624099 (AHM 0134865)
Regular
Nov 06, 2013

JACALYN HALE (Deceased) vs. MESA MEDICAL GROUP, ACE USA c/o ESIS, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Appeals Board dismissed ECIC's Petition for Reconsideration because the WCJ's order regarding contribution proceedings was not a final determination of substantive rights. The Board also denied ECIC's Petition for Removal, finding no evidence of substantial prejudice or irreparable harm from the WCJ's statement that the contribution issue might eventually be subject to mandatory arbitration. The WCJ had merely overruled ECIC's objection to ACE/ESIS's contribution petition and allowed discovery, not ordered arbitration itself. Therefore, any arguments about mandatory arbitration were premature.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWCJ OrderContribution ProceedingsMandatory ArbitrationLabor Code Section 5500.5ACE/ESISECICIndustrial Injury
References
0
Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
2
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