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

Case No. ADJ8845585
Regular
Oct 09, 2025

WESLEY RENTFROW vs. COUNTY OF MERCED, PEGASUS RISK MANAGEMENT

Defendant, County of Merced, filed a petition for removal from an order taking the matter off calendar, contending further discovery was unnecessary. The Workers' Compensation Appeals Board (WCAB) considered the petition, the applicant's answer, and the WCJ's report, ultimately denying removal. The WCAB stated that removal is an extraordinary remedy and found no showing of substantial prejudice or irreparable harm. Furthermore, the Board noted the issue appeared moot as the defendant had not taken steps to place the matter back on calendar in the three years since filing the petition.

Petition for RemovalOff Calendar OrderWCJ ReportSubstantial PrejudiceIrreparable HarmReconsiderationMoot IssueDeclaration of Readiness to ProceedCOBRA PremiumsAdjudication Number
References
Case No. ADJ8015423
Regular
Nov 19, 2013

REMEDIOS LIRA vs. PREMIUM PACKING, INC., SEDGWICK CMS (Claims Administrator)

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration concerning an applicant's psychiatric injury claim. The WCJ had previously found the injury compensable and not barred by the post-termination defense. The defendant argued they had no notice of the psychiatric injury prior to termination, and the WCJ's report introduced the "sudden and extraordinary" event defense for the first time. The Board granted reconsideration to allow the defendant to respond to this new issue, pending further proceedings.

ADJ8015423Remedios LiraPremium PackingInc.Sedgwick CMSPetition for ReconsiderationFindings and Awardindustrial injurypsychepost-notice of termination
References
Case No. ADJ4668407 (RIV 0055963)
Regular
Feb 19, 2015

JOSE MARTINEZ vs. 2K FABRICATION, INCORPORATED, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior decision finding that State Compensation Insurance Fund (SCIF) did not provide coverage for 2K Fabrication, Inc. on July 8, 2003. The Board ruled that SCIF's cancellation of the employer's policy effective March 18, 2003, was valid. Arguments for coverage based on alleged lack of notice, estoppel due to premium acceptance, audits, and defense of the claim were rejected. The Board found no evidence of a written reinstatement of the canceled policy.

Workers' Compensation Appeals BoardReconsiderationPolicy CancellationCoverage DisputeEstoppelWaiverWritten NoticeInsurance ContractPremium PaymentPost-Cancellation Audit
References
Case No. ADJ2832796 (SAC 0362707) ADJ1414613 (SAC 0362718)
Regular
Mar 15, 2011

DANIEL WALTERS vs. HOLLAND CUSTOM IRON WORKS, INC., CALIFORNIA INSURANCE COMPANY

This case concerns whether an employer, Holland Custom Iron Works, Inc., had workers' compensation insurance coverage on August 16, 2006, following a notice of cancellation for non-payment. The Appeals Board affirmed an arbitrator's finding that coverage existed, relying on equitable estoppel and the ambiguity of the cancellation notice. The insurer's contention that coverage was contingent on a "gap premium" payment was rejected as exceeding the arbitrator's authority. The Board's decision clarifies that the payment made by the employer was sufficient to rescind the cancellation.

Gap premiumequitable estoppelworkers' compensation insurance coveragecancellation noticerescissionarbitration rulingpayment ambiguityrelianceambiguous languagemonetary default
References
Case No. ADJ8619480
Regular
Nov 22, 2019

MARCO MARTINEZ, vs. BRAM, LLC, aka VALLEY PROTEIN, LLC, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The WCAB rescinded an arbitrator's decision finding CIGA liable for benefits because the record lacked required findings, stipulations, and evidence, violating WCAB Rule 10566 and *Hamilton*. CIGA argued the policy was canceled due to the employer's failure to pay premiums, which the broker did not timely forward to the insolvent insurer. The Board noted that policy cancellation requires 10 days' written notice and that CIGA is not an insurer with the same responsibilities. The case is returned to the arbitrator to create an adequate record and issue a proper decision.

CIGAinsolvent insurerCastlepointpremium paymentpolicy cancellationauthorized agentWCAB Rule 10566Hamilton v. Lockheed Corp.arbitration recordfindings of fact
References
Case No. ADJ754138 (SDO 0358006)
Regular
Jul 13, 2012

IGNACIO GOMEZ vs. PREMIUM ROOF SERVICES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board reconsidered a decision regarding an applicant injured while employed as a roofer. The applicant was awarded home healthcare services, but the initial judge found no authority to order payment to the applicant's wife. The Board granted reconsideration, finding that the applicant has the right to choose his home healthcare provider, especially given the inadequate services previously provided by the defendant's agency. Therefore, the Board amended the award to ensure the applicant receives the stipulated attendant care/housekeeping services from his wife.

Workers' Compensation Appeals BoardPremium Roof ServicesInc.State Compensation Insurance FundIgnacio GomezFindings Award and Ordersrooferindustrial injurylow backstipulated award
References
Case No. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
Case No. GOL 0087934, GOL 0087935, GOL 0087936
En Banc
Feb 13, 2002

Alonso Navarro vs. A&A Farming, Western Growers Insurance Co.

The Board held that the applicant's claim of discrimination under Labor Code section 132a was preempted by the federal Employee Retirement Income Security Act (ERISA), as the claim was premised on the employer's termination of contributions to an ERISA-regulated health plan.

ERISA preemptionLabor Code section 132agroup health benefitsdiscrimination claimadverse actionemployee welfare benefit planworkers' compensationindustrial injuriesemployer contributionstemporary disability
References
Case No. ADJ8314191
Regular
Apr 27, 2015

JUAN MELO vs. THE SAN FRANCISCO GIANTS, ACE AMERICAN INSURANCE COMPANY, THE GOLDEN BASEBALL LEAGUE, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded a Workers' Compensation Judge's (WCJ) order for reimbursement of costs. The WCJ had ordered the State Compensation Insurance Fund (SCIF) to pay $1,350.00 to applicant's attorney for delays in clarifying insurance coverage. However, the Board clarified that Labor Code section 5811(a) does not permit the award of attorney's fees as costs, and any such award under Labor Code section 5813 would require proper notice and an opportunity to be heard, which was not provided. Therefore, the WCJ's order was improper.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder for Reimbursement of CostsLabor Code section 5811(a)State Compensation Insurance Fund (SCIF)Coverage issuesContinuous trauma claimInsurance policyRidersPolicy premium
References
Case No. ADJ7412203
Regular
Jul 15, 2011

RIGOBERTO GARCIA vs. COLE RANCH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that the applicant's industrial injury was caused by a "sudden and extraordinary" event, thereby exempting it from the six-month employment rule for psychiatric injuries under Labor Code section 3208.3(d). The Board corrected a clerical error in the citation of the relevant statute. While the defendant argued the event was an inherent risk of the job, the applicant's uncontradicted testimony provided the only evidence suggesting it was not routine. A dissenting opinion argued that a simple fall from a ladder, without more, should not qualify as extraordinary, especially given the short employment duration and lack of evidence for truly unusual circumstances.

Workers' Compensation Appeals BoardRigoberto GarciaCole RanchState Compensation Insurance FundADJ7412203Opinion and Order Denying Petition for ReconsiderationCorrecting Clerical ErrorFindings and Ordersavocado pickerhigh tree worker
References
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