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

Case No. SRO 0110490
Regular
Jan 14, 2008

DIANE INGRAM vs. DENNY'S RESTAURANTS, CIGA For HIH INSURANCE, In Liquidation, INTERCARE INSURANCE SERVICES, American Casualty Company

This case involves a dispute over reimbursement between the California Insurance Guarantee Association (CIGA) and American Casualty Company (American). CIGA, having paid benefits for an applicant's cumulative trauma injury, sought reimbursement from American, the solvent insurer during a portion of that injury period. The Workers' Compensation Appeals Board affirmed an award of $29,988.31 to CIGA, finding that American's delay in assuming responsibility and existing case law required American to cover CIGA's interim payments, despite American's res judicata arguments.

Workers Compensation Appeals BoardCIGAHIH InsuranceAmerican Casualty CompanyReconsiderationFindings and AwardArbitratorLien ClaimRes JudicataCumulative Trauma
References
Case No. ADJ10838822
Regular
Jan 03, 2020

ERNESTO NORIEGA vs. ROYAL CABINETS, TRAVELERS PROPERTY CASUALTY COMPANY, INSURANCE COMPANY OF THE WEST, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Ernesto Noriega's petition for reconsideration. The Board found that the medical opinions of Drs. Levine and Harris were not substantial evidence. These opinions failed to adequately support a finding of injury arising out of and occurring in the course of employment due to being based on incorrect facts, history, or legal theories. Therefore, the prior decision stands.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeSubstantial EvidenceMedical OpinionAOE/COEInjuryRoyal CabinetsTravelers Property Casualty CompanyInsurance Company of the West
References
Case No. SDO 0341777
Regular
Sep 21, 2007

ARMANDO GALLEGOS vs. A.O. REED & COMPANY, ST. PAUL TRAVELERS INSURANCE, UNIVERSAL MECHANICAL (EMCOR), AMERICAN CASUALTY COMPANY OF READING, PA., SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board affirmed an arbitration award against A.O. Reed & Company, finding that the arbitrator had jurisdiction despite Reed not being a signatory to the collective bargaining agreement. Reed waived its objections by participating in the arbitration and discovery without protest, thus effectively agreeing to the process. The Board also found that Reed could have discovered its signatory status with reasonable diligence prior to the arbitration.

Workers' Compensation Appeals BoardArmando GallegosA.O. Reed & CompanySt. Paul Travelers InsuranceUniversal MechanicalAmerican Casualty CompanySpecialty Risk ServicesSDO 0341777Opinion and Decision After ReconsiderationArbitrator jurisdiction
References
Case No. ADJ2239874 (STK 0170112) ADJ472994 (STK 0198041) ADJ3391005 (STK0208641)
Regular
Dec 15, 2008

MITCHELL PACHECO vs. INNOVATIVE STEEL SYSTEMS and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT COMPENSATION INSURANCE COMPANY, in liquidation, LENNAR CORPORATION and OLD REPUBLIC INSURANCE COMPANY, RICHMOND AMERICAN HOMES and AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to the trial level. The Board found that the WCJ erred by applying the wrong disability rating schedule and by issuing a combined award for three separate successive injuries. The matter is remanded for separate determinations of permanent disability for each injury, with the 2005 and 2006 injuries to be rated under the 2005 Schedule.

CIGAFremont Compensation Insurance CompanyliquidationInnovative Steel SystemsLennar CorporationOld Republic Insurance CompanyRichmond American HomesAmerican Home Assurance Companyindustrial injuriesneck
References
Case No. ADJ2321368 (AHM 0118316) ADJ4304697 (AHM 0118317) ADJ2426051 (AHM 0118318)
Regular
May 20, 2008

Douglas Dees vs. SOUTH COAST PLAZA SECURITY, EVEREST NATIONAL INSURANCE COMPANY, AMERICAN SAFETY CASUALTY COMPANY

This case concerns an applicant's industrial injury to his right foot. The Board granted reconsideration and amended the original order to reflect that Everest National Insurance Company is solely responsible for administering benefits, based on their prior stipulation that the injury occurred through January 13, 2004. The issue of the precise "date of injury" for liability allocation purposes was deferred, allowing Everest the opportunity to file for contribution. The Board otherwise affirmed the original findings.

Workers' Compensation Appeals BoardSouth Coast Plaza SecurityEverest National Insurance CompanyAmerican Safety Casualty CompanyDouglas DeesPetition for ReconsiderationJoint Findings and OrdersWorkers' Compensation Judge (WCJ)Industrial InjuryBack Injury
References
Case No. ADJ9685765
Regular
Feb 09, 2015

MARTIN VAN DOORN vs. WEST VALLEY CONSTRUCTION COMPANY, INC., ZURICH AMERICAN INSURANCE COMPANY, OLD REPUBLIC INSURANCE COMPANY

This case concerns a petition for reconsideration by West Valley Construction Company and Zurich American Insurance Company regarding a prior decision that reversed an arbitrator's finding. The arbitrator had barred the applicant's claim for specific injuries to his neck and back due to the statute of limitations. The defendants argued the applicant's petition was procedurally defective and that the Board did not properly weigh evidence. The Board denied reconsideration, finding the applicant's amended petition cured any initial defects and that the defendants were not prejudiced by the form of the original filing. The Board affirmed its previous decision based on its prior reasoning.

Workers' Compensation Appeals BoardPetition for ReconsiderationStatute of LimitationsSpecific InjuryCumulative InjuryProcedural DefectVerificationCase NumberArbitrator's FindingsDecision After Reconsideration
References
Case No. ADJ9651491
Regular
Aug 22, 2016

JUDITH DIAZ vs. EXCELL SECURITY, INC., XL STAFFING, INC., XL CONSTRUCTION STAFFING; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for ULLICO CASUALTY COMPANY, in liquidation by its servicing facility, SEDGWICK CLAIMS MANAGEMENT SERVICES; SPARTA INSURANCE COMPANY by GALLAGHER BASSETT

The Workers' Compensation Appeals Board affirmed a prior finding that Sparta Insurance Company provided workers' compensation coverage for Judith Diaz. The Board found that Sparta's policy with Excell Security, Inc. did not exclude Diaz from coverage, despite Excell also having a policy with Ullico Casualty Company. Therefore, Sparta is considered "other insurance" and liable for applicant's benefits, upholding the Arbitrator's initial decision.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationFindings and OrderArbitratorother insuranceLabor Code section 1063California Insurance Guarantee AssociationCIGAULLICO CASUALTY COMPANYliquidation
References
Case No. ADJ4484214, ADJ1095231, ADJ1532047, ADJ7900801
Regular
May 17, 2017

CANA SWARTOUT vs. ENTERTAINMENT PARTNERS, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES, CAST & CREW ENTERTAINMENT, ZURICH NORTH AMERICA, ENTERTAINMENT PARTNERS, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, CNA CLAIMS PLUS

This case involved multiple employers and insurance carriers for Dana Swartout's various work-related injuries sustained between 2002 and 2007. The Workers' Compensation Appeals Board (WCAB) initially issued findings but granted reconsideration to study the issues, including contentions about permanent total disability and statute of limitations. Following settlement conferences, the parties entered into a Compromise and Release agreement, which the WCAB has now approved. The WCAB rescinded its prior order and approved the settlement, finding it adequate and in the applicant's best interest.

Workers Compensation Appeals BoardDana SwartoutEntertainment PartnersAmerican Home AssuranceAIG Claims ServicesCast & Crew EntertainmentZurich North AmericaAmerican Casualty CompanyCNA Claims PlusPermanent Total Disability
References
Case No. ADJ613532 (VNO 0447332)
Regular
Dec 09, 2009

WILLIAM ROCCO vs. LANCASTER SCHOOL DISTRICT, TIG INSURANCE COMPANY, AMERICAN CASUALTY INSURANCE COMPANY

Reconsideration granted; rescinding the September 15, 2009 Joint Findings and Award. Matter returned to trial level for further proceedings on temporary disability and carrier liability.

Workers Compensation Appeals BoardLancaster School DistrictTIG Insurance CompanyAmerican Casualty Insurance CompanyJoint Findings and Awardindustrial injurieslow back injuryshoulders injurycustodiantemporary disability indemnity
References
Case No. ADJ1016953 (VNO 0447334) ADJ613532 (VNO 0447332)
Regular
May 23, 2011

WILLIAM ROCCO vs. LANCASTER UNIFIED SCHOOL DISTRICT, TIG INSURANCE CO., AMERICAN CASUALTY INSURANCE CO.

This case concerns a dispute over the scope of cross-examination of a medical evaluator regarding temporary disability. The defendant, American Casualty Insurance Company, sought removal after the WCJ limited cross-examination to new issues in a recent report. The Appeals Board granted removal to clarify the order, acknowledging the defendant's due process rights to fully develop the record on temporary disability and its causation by the claimed injuries. Ultimately, the Board amended the WCJ's order to permit cross-examination on the period(s) of temporary disability and their causal link to the injuries, in addition to new information in the latest medical report.

Petition for RemovalAppeals BoardAmerican Casualty Insurance CompanyWCJ OrderDue ProcessDevelop the RecordTemporary Total DisabilityMedical ReportQualified Medical EvaluatorCross-examination
References
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