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

Case No. ADJ11900759
Regular
Oct 20, 2025

Luis Hernandez vs. Cesar Chavez Foundation, Berkshire Hathaway Homestate Insurance Company

The Workers' Compensation Appeals Board denied defendant Berkshire Hathaway Homestate Insurance Company's petition for reconsideration. The defendant challenged an earlier decision that found a contested claim existed when cost petitioner DocCentral provided subpoena services. The Board affirmed its previous finding, clarifying that a claim becomes contested upon an employer's delay notice, thus allowing discovery. The Board rejected the defendant's argument that a denial was required for a contested claim, citing prior en banc decisions to support its position on discovery during delay periods.

Contested claimLabor Code § 4620(b)8 CCR § 9793(b)Petition for ReconsiderationOpinion and Order DenyingDocCentralsubpoena servicesdelay noticemedical-legal expenseAdjudication of Claim
References
6
Case No. ADJ7753735
Regular
Oct 23, 2015

JOSE VALENCIA vs. AL'S GARDEN ART, CYPRESS INSURANCE COMPANY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES, ARGONAUT INSURANCE COMPANY, US RISK MANAGEMENT CLAIMS-XL INSURANCE

This case involves Cypress Insurance Company's (BHHC) petition for contribution against Argonaut Insurance Company regarding applicant Jose Valencia's cumulative injury claim. The arbitrator initially denied BHHC's petition, finding insufficient evidence of cumulative injury AOE/COE. BHHC sought reconsideration, arguing issues regarding Argonaut's defense and the sufficiency of medical evidence. The Appeals Board granted reconsideration to amend the findings to include previously omitted BHHC exhibits, but otherwise affirmed the arbitrator's decision. The Board adopted the arbitrator's report which noted issues with the PQME reports and gaps in medical documentation, ultimately upholding the denial of contribution.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for ContributionCumulative InjuryAOE/COELabor Code 3208.1Labor Code 5500.5Labor Code 5412Qualified Medical ExaminerPQME
References
0
Case No. MISSING
Regular Panel Decision

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
Case No. ADJ14138672
Regular
Aug 05, 2025

MARIO HERNANDEZ vs. FRESH QUALITY PRODUCE, INC.; STATE COMPENSATION INSURANCE FUND; CYPRESS INSURANCE C/O BERKSHIRE HATHAWAY HOMESTATE COMPANY

Defendant State Compensation Insurance Fund (SCIF) sought reconsideration of an Arbitrator's Decision on Petition for Contribution, which found Cypress Insurance liable for a portion of contribution. SCIF contended that the WCA should have relied on Labor Code section 5500.5 to determine the last injurious exposure period and award a higher contribution. The Appeals Board received an answer and the Arbitrator's Report and Recommendation, which suggested denying reconsideration. After preliminary review, the Appeals Board granted SCIF's Petition for Reconsideration, but this is not a final order. The final decision after reconsideration is deferred pending further review of the merits and the entire record.

Petition for ReconsiderationState Compensation Insurance FundCypress InsuranceLabor Code section 5500.5contributionlast injurious exposurecumulative injurytimely actednotice of transmissionsubstantial evidence
References
21
Case No. ADJ3987000 (POM 0290737)
Regular
Feb 09, 2011

ROBERTO DOUMER vs. REYNOLDS BUICK GMC, EVEREST NATIONAL INSURANCE COMPANY, Administered By BERKSHIRE HATHAWAY HOMESTATE COMPANIES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by INTECARE for HIH AMERICA INSURANCE COMPANY, In Liquidation, STATE COMPENSATION INSURANCE FUND and SENTRY CLAIMS SERVICES

This case involves an applicant, Roberto Doumer, against multiple defendants, including Reynolds Buick GMC and various insurance entities. The Workers' Compensation Appeals Board has issued an order denying reconsideration of a prior decision. The Board adopted and incorporated the arbitrator's report in its reasoning for denial. Therefore, the applicant's petition for reconsideration has been formally rejected.

Workers' Compensation Appeals BoardPetition for ReconsiderationArbitrator's ReportDenial of ReconsiderationRoberto DoumerReynolds Buick GMCEverest National Insurance CompanyBerkshire Hathaway Homestate CompaniesCalifornia Insurance Guarantee AssociationHIH America Insurance Company
References
0
Case No. MISSING
Regular Panel Decision

Transcontinental Insurance v. State Insurance Fund

This case involves a dispute between two insurers, Transcontinental Insurance Company (plaintiff) and State Insurance Fund (defendant), regarding their contribution to the defense and settlement of an underlying personal injury action. Transcontinental, which insured the contractor Master, sought a declaration that State Insurance Fund, Master's workers' compensation insurer, should contribute as a co-insurer for expenses incurred defending and settling the action on behalf of NYPA. The Supreme Court dismissed the complaint, applying the antisubrogation rule. The Appellate Division modified the judgment, vacating the dismissal but affirming the application of the antisubrogation rule, declaring that State Insurance Fund is not obligated to reimburse Transcontinental for the expenses.

Insurance DisputeAntisubrogation RuleDeclaratory JudgmentCommercial General Liability PolicyWorkers' Compensation InsuranceIndemnificationCo-insurancePersonal Injury ActionAppellate ReviewContractual Obligation
References
5
Case No. ADJ16007451
Regular
Aug 25, 2025

MINA RADJABI vs. CENTURY COMMUNITIES, INC./INSPIRE HOME LOAN; BERKSHIRE HATHAWAY HOMESTATE INSURANCE COMPANY dba BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The applicant, Mina Radjabi, alleged a cumulative trauma injury to multiple body parts from July 2019 to February 2022 while employed by Century Communities, Inc./Inspire Home Loan. The case initially settled by Compromise and Release in March 2023, with the defendant maintaining a denial of injury AOE/COE. A lien claimant, Woodland Psyche Center, represented by PureMD Group Lomita, filed a petition for reconsideration after its lien for treatment was denied by a Workers' Compensation Administrative Law Judge (WCJ). The WCJ denied the lien because Woodland Psyche Center failed to prove injury arising out of and in the course of employment (AOE/COE) and its medical reports did not comply with regulatory requirements for proving a contested claim. The Appeals Board, after reviewing the petition and the WCJ's report, adopted the WCJ's findings and denied the petition for reconsideration, concluding that the lien claimant did not establish causation or due process violations, and that the treatment provided was outside the employer's Medical Provider Network.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5909TimelinessTransmission Date60-Day RuleNotice of TransmissionElectronic Adjudication Management System (EAMS)Report and RecommendationLien Claimant
References
10
Case No. ADJ10605700, ADJ9674568
Regular
Nov 02, 2018

JOSE VILLALOBOS vs. PIONEER THEATRES, INC., CYPRESS INSURANCE COMPANY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) denied a petition for reconsideration filed by State Compensation Insurance Fund. The petition challenged an order directing payment of $30.00 in interpreter costs to Tony Barriere Interpreting Service, Inc. The WCJ's report, adopted by the WCAB, found the defendant's claim of prior full payment unsupported by evidence and determined the requested costs were reasonable under the Labor Code. Therefore, reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenying PetitionWCJ ReportLabor Code § 5811Interpreter FeesCost PetitionerTony Barriere Interpreting ServiceInc.Industrial Injuries
References
1
Case No. MISSING
Regular Panel Decision
Feb 28, 1991

North River Insurance v. United National Insurance

This appellate decision addresses the apportionment of liability between North River Insurance Co. and United National Insurance Company arising from a settlement for an injured employee. The court clarified that North River, as the workers' compensation carrier, is solely responsible for its waived lien, reversing a lower court's finding. It further determined that both insurers' "other insurance" clauses called for pro rata contribution, not equal shares, for the $588,245 settlement payment and defense costs. The court calculated specific shares for each insurer and ruled that North River is entitled to interest from the original payment date in 1982. The Supreme Court's order was thus modified to reflect these findings.

Insurance disputePro rata contributionEquitable apportionmentWorkers' compensation lienDefense costsOther insurance clausesSettlement apportionmentInterest calculationAppellate decisionInsurer liability
References
10
Case No. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
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