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

Case No. 03-15-00314-CV
Regular Panel Decision
Aug 07, 2015

California Insurance Guarantee Association, Oklahoma Property and Casualty Insurance Guaranty Association, and Texas Property and Casualty Insurance Guaranty Association v. Hill Brothers Transportation, Inc.

The appellants, California Insurance Guarantee Association (CIGA), Oklahoma Property and Casualty Insurance Guaranty Association (OPCIGA), and Texas Property and Casualty Insurance Guaranty Association (TPCIGA), collectively "Guaranty Associations," are appealing a summary judgment granted in favor of the appellee, Hill Brothers Transportation, Inc. ("Hill Bros."). The suit was filed on March 31, 2009, alleging Hill Bros. failed to reimburse the Guaranty Associations for payments of workers' compensation benefits and claim handling expenses within the deductible limits of a policy issued by the insolvent Legion Insurance Company ("Legion"). The District Court granted summary judgment to Hill Bros. based on the statute of limitations, ruling that the cause of action accrued on April 1, 2002. The Guaranty Associations argue that the accrual date is incorrect, as their statutory obligations had not been triggered, payments had not been made, and demand for reimbursement had not occurred by that date. They also contend that their compliance with Pennsylvania law (the "Pennsylvania Act") in seeking reimbursement through Legion in Liquidation constitutes a mitigating circumstance for any delay, making reasonableness a fact question. Furthermore, they assert the policy was a continuing contract, and the statute of limitations should not have accrued until full performance on April 28, 2009. Alternatively, they argue that claims for deductible payments made within four years of filing suit (March 31, 2005) are not barred.

Workers' CompensationInsurance Guaranty AssociationStatute of LimitationsBreach of ContractDeductible ReimbursementInsolvencyInsurance PolicyContinuing ContractPennsylvania ActTravis County
References
21
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. 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

California Insurance Guarantee Ass'n v. Hill Bros. Transportation, Inc.

This appellate court opinion addresses a dispute between several state insurance guaranty associations (CIGA, OPCIGA, TPCIGA) and Hill Brothers Transportation, Inc., concerning the reimbursement of workers' compensation deductibles. Hill Brothers' insurer, Legion Insurance Company, became insolvent, leading the Guaranty Associations to pay claims on Legion's behalf. The associations then sought reimbursement from Hill Brothers for deductibles. The trial court granted summary judgment for Hill Brothers, citing the statute of limitations. On appeal, the court ruled that the California Insurance Guarantee Association (CIGA) lacked standing and dismissed its claims. However, the court found that the Oklahoma Property and Casualty Insurance Guaranty Association (OPCIGA) and Texas Property and Casualty Insurance Guaranty Association (TPCIGA) did have standing. Furthermore, the appellate court reversed the trial court's decision regarding limitations, holding that the cause of action for reimbursement accrued upon demand and refusal, not earlier. The case was remanded for further proceedings for OPCIGA and TPCIGA's claims.

Insurance Guaranty FundsInsurer InsolvencyWorkers' Compensation DeductiblesContract BreachLegal StandingStatute of Limitations DefenseAppellate ReversalJudicial RemandInsurance ReimbursementPolicy Obligations
References
30
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. 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. ADJ4699173 (FRE 204280) ADJ2234380 (FRE 204242) ADJ201252 (FRE 206405) ADJ3631426 (FRE 213090)
Regular
Nov 14, 2008

JOHNNY DURAN vs. DARRYL HITCHMAN, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, in liquidation, by BROADSPIRE, CENTREX HOMES, AMERICAN GUARANTEE AND LIABILITY INSURANCE/ZURICH NORTH AMERICAN OCIP

This case concerns applicant Johnny Duran's industrial injuries to his back and knees. The California Insurance Guarantee Association (CIGA) sought reconsideration of a finding that the cases should be returned to arbitration for insurance coverage issues. The Appeals Board rescinded the prior decision, finding no arbitration is necessary because Zurich already established coverage for cumulative trauma injuries. However, the cases are returned to the Workers' Compensation Judge to determine CIGA's liability for benefits solely attributable to specific injuries where Superior National was the sole available insurer.

CIGASuperior National Insurance CompanyliquidationreconsiderationWorkers' Compensation Appeals BoardArbitratorinsurance coverageLabor Code Section 5275(a)(1)compromise and releaseZurich North American
References
4
Case No. OAK 234515; OAK 239085; OAK 240882; SAC 289506; SAC 289507
En Banc
May 27, 2003

Victoria Gomez, Carol Nokes vs. Casa Sandoval, Golden Eagle Insurance Company, California Compensation (in liquidation), California Insurance Guarantee Association, Risk Enterprise Management, Placer Savings Bank, Fremont Compensation Insurance Company, Paula Insurance Company (in liquidation)

This en banc decision clarifies the liability of the California Insurance Guarantee Association (CIGA) in cumulative and successive injury cases, holding that CIGA is generally relieved of liability if a solvent insurance carrier exists, unless liability was previously apportioned and finalized before the other carrier's insolvency.

CIGACovered ClaimsInsurance Code section 1063.1(c)(9)GarciaIndustrial IndemnitySuccessive InjuryCumulative InjuryOccupational DiseaseApportionment of LiabilityWCJ
References
16
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