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

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. MISSING
Regular Panel Decision

Hartford Accident & Indemnity Co. v. Commercial Union Insurance

This case involves a dispute between two insurance companies, Hartford Accident and Indemnity Company (excess insurer) and Commercial Union Insurance Company (primary insurer), concerning liability for an injury claim. Michael Jutt, an employee of Minuteman Press International, Inc., was injured while on a Minuteman-owned boat. Commercial Union, the primary insurer, denied coverage and refused to defend Minuteman, leading Hartford, the excess insurer, to provide defense and settle Jutt's claim for $135,000. Hartford subsequently sued Commercial Union for breach of fiduciary duty. The District Court affirmed Hartford's standing to sue, recognizing a direct fiduciary duty owed by a primary insurer to an excess insurer, and found that the "paid employees" exclusion in Commercial Union's policy was ambiguous. Consequently, the Court ruled in favor of Hartford, ordering Commercial Union to pay $135,000 plus interest.

Insurance LawExcess InsurancePrimary InsuranceFiduciary DutyEquitable SubrogationPolicy ExclusionAmbiguous Contract TermDeclaratory Judgment ActionStanding to SueMarine Insurance
References
5
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. ADJ626438 (VNO 0450164) ADJ3665608 (VNO 0450166) ADJ3570389 (VNO 0521859) ADJ8592142
Regular
Jun 07, 2013

JOSEPH GIOIA vs. NEFTIN WESTLAKE CAR COMPANY, CALIFORNIA INDEMNITY INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC., FREMONT INSURANCE COMPANY, CIGA

This Workers' Compensation Appeals Board decision denies the petition for reconsideration filed by California Indemnity Insurance Company (CIIC). Conversely, it grants the petition filed by the California Insurance Guarantee Association (CIGA). The original decision of March 18, 2013, is affirmed but amended to reflect specific findings regarding the applicant's employment periods, injuries, and temporary total disability payments. The amendment clarifies insurance responsibilities, with CIIC responsible for 92% of the temporary total disability and Mid-Century/Farmers for 8%.

Workers' Compensation Appeals BoardCIICCIGAPetition for ReconsiderationWCJ ReportInsurance CodeTemporary Total DisabilityLC § 4661.5Joint Findings of FactNeftin Westlake Car Company
References
0
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. MISSING
Regular Panel Decision
Jun 30, 1992

National General Insurance v. Hartford Accident & Indemnity Co.

This case concerns a declaratory judgment action regarding insurance coverage following a fatal airplane crash. Warren Geddes, president of American Investor Services, Inc. (AIS), was piloting a plane carrying Gary Conway, an AIS employee, when it crashed, killing both. National General Insurance Company, insurer of the plane owner, sought for Hartford Accident and Indemnity Company, AIS's workers' compensation insurer, to defend and indemnify AIS and Geddes' Estate in a wrongful death action. Hartford denied coverage for Geddes' Estate, arguing he was not a named or additional insured under their policy. The court modified the initial judgment, declaring that Hartford has no duty to defend or indemnify the Estate of Geddes, while otherwise affirming the judgment.

Insurance CoverageDeclaratory JudgmentWrongful DeathDuty to DefendDuty to IndemnifyNamed InsuredAdditional InsuredWorkers' Compensation PolicyAirplane CrashEstate Liability
References
5
Case No. ADJ4258158 (OXN 0128983) ADJ4450153 (OXN 0136267)
Regular
Jun 01, 2010

BRENDA K. ROACH vs. BRIDAL TRADITIONS, CALIFORNIA INDEMNITY INSURANCE COMPANY, PREFERRED EMPLOYERS INSURANCE COMPANY

This case involves California Indemnity Insurance Company (CIIC) seeking reconsideration of a Workers' Compensation Arbitrator's decision. CIIC disputes the finding of a single cumulative trauma injury period and the assigned date of injury, arguing for a longer exposure period. The Appeals Board granted reconsideration and amended the prior findings to establish one cumulative trauma injury from March 5, 1999, through November 24, 2002. The original decision regarding CIIC's contribution claim against Preferred Employers Insurance Company was otherwise affirmed.

Cumulative traumaDate of injuryLabor Code section 5412Labor Code section 5500.5Petition for ContributionReconsiderationFindings and OrderCompromise and ReleaseAnti-merger statutesApportionment
References
2
Case No. MISSING
Regular Panel Decision

Fulton Boiler Works, Inc. v. American Motorists Insurance

Fulton Boiler Works, Inc., filed an action against several insurance companies regarding defense and indemnification for thousands of asbestos claims. The court addressed multiple pending motions for summary judgment, focusing on the proper allocation of indemnity costs among the liable parties, Fulton's obligation for uninsured years, the applicability of equitable estoppel against insurers, and Travelers' specific obligations concerning notice of claims and disclaimers. The court ruled that a pro rata allocation of indemnity costs is appropriate, with Fulton liable for periods it was uninsured. Equitable estoppel was deemed inapplicable to bar insurers from seeking contribution, and Travelers was found to have received proper notice for many claims and is barred from disclaiming coverage due to untimely disclaimers. This order, along with a previous one, sets the 'ground rules' for resolving past, pending, and future asbestos claims.

Asbestos LiabilityInsurance Coverage DisputeIndemnity AllocationSummary JudgmentEquitable EstoppelNotice ProvisionsDisclaimer of CoveragePro Rata AllocationInjury-in-factComprehensive General Liability Policy
References
23
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. ADJ857793
Regular
Oct 30, 2008

OLIVIA SOSA vs. NUPLA CORPORATION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INDEMNITY INSURANCE COMPANY

The Appeals Board rescinded the WCJ's decision because the finding of a specific date of injury was vague, unsupported by substantial evidence, and deprived California Indemnity Insurance Company (CIIC) of due process. The Board held that under Labor Code § 5500.5, the elected insurer (SCIF) should not have been dismissed at this stage, and any determination of liability among insurers should be deferred to a separate contribution proceeding. The case was returned to the trial level for further proceedings to determine if the applicant sustained an industrial injury and to address potential liability of all involved insurers.

Cumulative traumaDate of injuryLabor Code 5500.5Due processReconsiderationWCJ FindingsSubstantial evidenceJoinderPetition for DismissalContribution proceedings
References
17
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