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

Case No. LAO 863258, LAO 863456
Regular
Oct 02, 2007

JULIE A. ALBRIGHT vs. SUN HEALTH CARE, AMERICAN HOME ASSURANCE COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board denied reconsideration of a finding that American Home Assurance, administered by Broadspire, was liable for administering an award for applicant Julie Albright's cumulative trauma injury. Despite covering only 39% of the period, the Board found it equitable for American Home Assurance to administer the award, given their responsibility for a specific injury and the potential confusion of dual administrators. The Board also upheld the determination of the cumulative trauma injury date and the administrator's responsibility for temporary disability payments.

WCABReconsiderationPetitionFindings and AwardAmerican Home AssuranceBroadspireCumulative TraumaDate of InjuryLabor Code § 5412Labor Code § 4656 (c) (1)
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The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to the trial level.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. POM 248928
Regular
May 12, 2006

MARK MICELI vs. JACUZZI, INC., REMEDYTEMP, INC., AMERICAN HOME ASSURANCE CO., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY CO., In Liquidation

The Court of Appeal reversed the Appeals Board's prior decision, finding that the special employer's insurance (American Home Assurance Co.) was not "other insurance" available to the applicant. This ruling invalidated the previous dismissal of CIGA and dictated that the case be returned for further proceedings. The Appeals Board, following this remittitur, rescinded the prior consolidation and stay order, denying RemedyTemp's request for dismissal and CIGA/RemedyTemp's request for a new consolidation. Assurance's petition for appeal costs was also dismissed as it was filed with the wrong entity.

CIGARemedyTempJacuzziAmerican Home Assurance Co.Reliance National Indemnity Co.special employergeneral employerother insuranceInsurance Code section 1063.1(c)(9)remittitur
References
Case No. ADJ7160968
Regular
Sep 20, 2013

KIM FICK vs. WAL MART ASSOCIATES, INC., AMERICAN HOME ASSURANCE

This case involves a Petition for Reconsideration filed by the applicant, Kim Fick, against Walmart Associates, Inc. and American Home Assurance. The Workers' Compensation Appeals Board (WCAB) dismissed the petition because it was not verified, violating Labor Code section 5902. Furthermore, the petition was deemed skeletal and insufficient under California Code of Regulations, title 8, section 10846. Consequently, the WCAB found the petition procedurally deficient and ordered its dismissal.

Petition for ReconsiderationVerifiedLabor Code section 5902Skeletal PetitionCalifornia Code of Regulations title 8 section 10846DismissedWorkers' Compensation Appeals BoardWCJApplicantDefendants
References
Case No. OAK 0337799; OAK 0337800
Regular
May 19, 2008

LI-PING LI vs. WAL-MART ASSOCIATES, INC., AMERICAN HOME ASSURANCE/AIG

The Workers' Compensation Appeals Board granted reconsideration to amend factual findings and the case caption. The Board affirmed the finding of temporary total disability for the applicant, Li-Ping Li, due to an industrial injury sustained while employed by Wal-Mart Associates, Inc., insured by American Home Assurance. The decision was amended to correct the employer's name, identify the correct insurance carrier, and exclude a specific period from the temporary total disability award.

Workers Compensation Appeals BoardLi-Ping LiWal-Mart AssociatesInc.American Home AssuranceFrank Gates Service CompanyOAK 0337799OAK 0337800Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ1755508 (SRO 0142328)
Regular
Dec 21, 2012

SOSTENES REYES vs. PROTRADES CONNECTIONS, AMERICAN HOME ASSURANCE, Adjusted By CHARTIS INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. While affirming most findings, the Board corrected a clerical error, changing the start date for applicant's home health care services to December 3, 2011. The Board upheld the finding that the defendant unreasonably delayed payment for these services, imposing a 25% penalty. The parties were ordered to adjust the payment amounts accordingly, with jurisdiction reserved for any disputes.

WCABProtrades ConnectionsAmerican Home AssuranceChartis InsuranceSosthenes Reyesindustrial injurycognitive impairmentmemory impairmentpost-traumatic stress disorderpermanent total disability
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. 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
Case No. LBO 0355505
Regular
Feb 26, 2008

REBECCA BETANCOURT vs. CHECKMATE STAFFING SERVICES, UNINSURED EMPLOYERS FUND, J.C. PENNEY, INC., AMERICAN HOME ASSURANCE c/o AIG CLAIM SERVICES

This case involves an applicant injured while working for Checkmate Staffing Services, a general employer, and J.C. Penney, Inc., a special employer. The Workers' Compensation Appeals Board (WCAB) reconsidered a prior decision, notably reversing the administrative law judge's (ALJ) assessment of penalties against Checkmate and remanding the issue of Checkmate's insurance coverage to the trial level. The WCAB affirmed joint and several liability for benefits against Checkmate, J.C. Penney, American Home Assurance, and the Uninsured Employers Fund (UEF), ordering American Home Assurance to administer benefits while reserving jurisdiction to determine ultimate liability.

Workers' Compensation Appeals BoardReconsiderationJoint and Several LiabilitySpecial EmployerGeneral EmployerUninsured Employers FundLabor Code Section 3722Certificate of Liability InsuranceDue ProcessDual Employment Relationship
References
Case No. ADJ951151 (MON 0340495)
Regular
Feb 16, 2010

Debra Faerber vs. CONTINENTAL AIRLINES, AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board (WCAB) reconsidered a prior decision that denied California jurisdiction over the applicant's hand injury. The WCAB found that the injury, occurring en route to California, should be considered an injury occurring within California due to the nature of flight attendant employment. This decision allows the case to proceed to the trial level for resolution of all remaining workers' compensation issues. The WCAB's decision aims to protect flight attendants from potential denial of claims by deeming in-flight injuries as occurring outside any jurisdiction.

Workers' Compensation Appeals BoardDebra FaerberContinental AirlinesAmerican Home AssuranceJurisdictionReconsiderationFindings of FactFlight AttendantContract of HireProvisional Employment
References
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