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

Case No. B167017
Significant
Nov 18, 2004

General Casualty Insurance and Regent Insurance, Joseph A. Lane, American Home Assurance Company vs. Workers' Compensation Appeals Board and California Insurance Guarantee Association

The court has requested responses from the Workers' Compensation Insurance Rating Bureau (WCIRB) and the California Insurance Commissioner regarding the exclusion of special employees from a special employer's workers' compensation policy, specifically questioning the use and requirements of Form No. 11 for this purpose.

WCIRBForm No. 11limiting endorsementsrestricting endorsementsspecial employeesgeneral employerstemporary employeesleased employeesInsurance CommissionerCalifornia Code of Regulations
References
1
Case No. ADJ1888124 (SAL 0111884) ADJ3322590 (SAL 0079903)
Regular
Oct 20, 2016

MARIA NUNEZ vs. MANN PACKING COMPANY, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For FREMONT COMPENSATION INSURANCE COMPANY, In Liquidation; STATE OF CALIFORNIA

This case concerns the California Insurance Guarantee Association's (CIGA) liability for an applicant's workers' compensation claims after Fremont Compensation Insurance Company became insolvent. CIGA argued it should be relieved of liability because the State of California, as the applicant's employer through IHSS, constituted "other insurance" under Insurance Code Section 1063.1. The Appeals Board affirmed the WCJ's decision, holding that the State of California does not qualify as "other insurance" under the relevant statutes. This distinction is based on the State not being required to obtain workers' compensation insurance or a certificate of self-insurance like private or other public employers.

CIGAFremont Compensation Insurance Companyliquidationlegally uninsuredother insuranceInsurance Code Section 1063.1covered claimsIn-Home Supportive Services (IHSS)statutory limitationsself-insurance
References
5
Case No. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
Case No. LAO 0762226, LAO 0762227
Regular
Sep 05, 2007

SHIRLEE DYERLY vs. LAWRY'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, INTERCARE INSURANCE SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY

This case involves a dispute over insurance coverage for an applicant's neck and back injuries sustained across specific and cumulative trauma incidents. The Workers' Compensation Appeals Board (WCAB) is reconsidering an arbitrator's decision that ordered Zurich North America Insurance Company to reimburse the California Insurance Guarantee Association (CIGA) for all benefits paid by the liquidated California Compensation Insurance Company (Cal Comp). The WCAB rescinds the arbitrator's order, ruling that CIGA can only recover the amount Cal Comp would have been entitled to collect had it not been liquidated, not the full amount paid.

CIGACal CompZurichliquidationcontributionreimbursementspecific injurycumulative traumastatute of limitationsjoint findings
References
7
Case No. SRO 112972
Regular
Jun 12, 2008

STELLA JUAREZ vs. ARTERIAL VASCULAR ENGINEERING, NELSON STAFFING, CENTRE INSURANCE COMPANY by REM, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by BROADSPIRE for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation

The California Insurance Guarantee Association (CIGA) has the right to seek contribution from Centre Insurance Company for workers' compensation benefits paid to an applicant with a cumulative trauma injury. CIGA's claim is not barred by the one-year limitation period for employer contribution claims under Labor Code section 5500.5(e), as CIGA is not an employer and Centre is considered "other insurance" under Insurance Code section 1063.1(c)(9). Therefore, the Appeals Board granted CIGA's petition for reconsideration and reversed the arbitrator's decision, awarding CIGA contribution from Centre.

CIGAContributionReconsiderationFindings Award and OrderLabor Code section 5500.5Insurance Code section 1063.1(c)(9)Cumulative TraumaGeneral EmployerSpecial EmployerOther Insurance
References
8
Case No. AHM 90917 AHM 90918
Regular
Jul 11, 2007

ANGEL SOSA vs. D.W. FOODS, EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, VILLANOVA INSURANCE

This case concerns a dispute over reimbursement between an insurer, Everest, and the California Insurance Guarantee Association (CIGA), which is handling claims for a liquidated insurer, Villanova. The Board denied Everest's petition, upholding a prior award for reimbursement from Everest to CIGA. However, the Board granted CIGA's petition to amend the award to include Villanova Insurance as a party defendant.

CIGAEverest National Insurance CompanyVillanova Insuranceliquidationreconsiderationreimbursementbill review chargesjoint and several liabilitycumulative traumadenied due process
References
0
Case No. ADJ2398835 (LAO 0799123)
Regular
Mar 26, 2010

LETICIA FERNANDEZ vs. MOUNT ST. MARY'S COLLEGE, CONVERIUM INSURANCE COMPANY/SRS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK, INC., LEGION INSURANCE COMPANY, VILLANOVA INSURANCE COMPANY

Converium Insurance Company sought reconsideration of a decision denying its claim for reimbursement from the California Insurance Guarantee Association (CIGA). Converium had paid workers' compensation benefits to Leticia Fernandez, but later argued these payments were made in error due to applicant's denial of a specific injury. The Arbitrator recommended denying reconsideration, finding that CIGA statutes, particularly Insurance Code Sections 1063.1(c)(5) and (9), prohibit reimbursement to solvent insurance carriers for claims that are not "covered claims" or are made by assignees or subrogated parties. The Workers' Compensation Appeals Board adopted the Arbitrator's report, denying Converium's petition for reconsideration.

California Insurance Guarantee AssociationCIGAConverium Insurance CompanySRSLegion Insurance CompanyVillanova Insurance Companyliquidationreconsiderationarbitrator's reportspecific injury
References
9
Case No. ADJ2599827 (LAO 0802863) ADJ3258052 (LAO 0802864) ADJ4519810 (LAO 0802865)
Regular

GONZALO SIS vs. MGM CONVERTERS, INC., EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INDEMNITY INSURANCE COMPANY

This case involves a dispute over contribution between two insurance companies, Everest National Insurance Company and California Indemnity Insurance Company (CIIC), regarding applicant Gonzalo Sis's workers' compensation claim. The Workers' Compensation Appeals Board (WCAB) rescinded the arbitrator's decision ordering CIIC to reimburse Everest. The WCAB found the record incomplete and lacking substantial evidence, particularly regarding proof of service and the arbitrator's reliance on conflicting medical reports. The matter was returned to the trial level for selection of a new arbitrator and the preparation of a proper record, including clear findings of fact and evidence.

Workers' Compensation Appeals BoardArbitrationContributionCumulative TraumaCompromise and ReleaseSubstantial EvidenceTimelinessProof of ServiceRecord CompletenessMinutes of Hearing
References
7
Case No. ADJ1463963 (POM 0273971 ADJ3120431 (POM 0268474)
Regular
Jan 09, 2012

RUBEN ORTIZ vs. LINKS-NILSON CORPORATION, CALIFORNIA COMPENSATION INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, DAART ENGINEERING, XL FIRE PROTECTION, STATE COMPENSATION INSURANCE FUND

This case involves Ruben Ortiz seeking workers' compensation benefits. The primary issue is whether the applicant's injuries from a specific incident are compensable under workers' compensation law. The litigation involves multiple defendants, including the applicant's employer, its insurer (in liquidation), and the California Insurance Guarantee Association, alongside other entities. The core dispute centers on the causal link between the employment and the claimed injuries. The outcome will determine the extent of benefits Ortiz is entitled to and the responsibility of the named defendants.

Workers' Compensation Appeals BoardApplicantDefendantLinks-Nilsen CorporationCalifornia Compensation Insurance CompanyliquidationCalifornia Insurance Guarantee AssociationDaart EngineeringXL Fire ProtectionState Compensation Insurance Fund
References
15
Case No. GRO 0022416
Regular
Mar 24, 2008

GERALD RICE vs. ALASCO RUBBER & PLASTICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CAMBRIDGE INTEGRATED SERVICES GROUP, FREMONT COMPENSATION INSURANCE COMPANY, NATIONAL SURETY/FIREMAN'S FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior decision. The Board found that the California Insurance Guarantee Association (CIGA) is solely liable for the applicant's industrial injury benefits. This is because the insolvent insurer, Fremont Compensation Insurance Company, was the only insurer on the risk during the one-year period preceding the applicant's cumulative trauma injury.

WORKERS' COMPENSATION APPEALS BOARDCIGAFREMONT COMPENSATION INSURANCE COMPANYINSOLVENCYLIQUIDATIONCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONNATIONAL SURETY/FIREMAN'S FUNDALASCO RUBBER & PLASTICSLABOR CODE SECTION 5500.5CUMULATIVE TRAUMA INJURY
References
1
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