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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. 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. 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. 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. ADJ2300229 (FRE 0183072) ADJ2635018 (FRE 0183073) ADJ3725774 (FRE 0183074)
Regular
Jul 19, 2016

ROBERT D. TULL vs. GENERAL LIGHTING SERVICE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION, In Liquidation

This case concerns Robert D. Tull's workers' compensation claims against General Lighting Service and the California Insurance Guarantee Association. The Workers' Compensation Appeals Board has issued an Opinion and Order Granting Petition for Reconsideration. Pending their Decision After Reconsideration, all future communications related to these cases must be directed to the Board's San Francisco office. This order reflects a procedural step in the ongoing appeals process for Tull's claims.

Workers' Compensation Appeals BoardPetition for ReconsiderationCalifornia Insurance Guarantee AssociationLiquidationDecision After ReconsiderationOffice of the CommissionersMullen & FilippiService by MailDouglas LowRobert D. Tull
References
0
Case No. OAK 234515, OAK 239085, OAK 240882
Significant

Victoria Gomez vs. Casa Sandoval, Golden Eagle Insurance Company, California Compensation (in liquidation), California Insurance Guarantee Association, Risk Enterprise Management

An en banc opinion clarifying that the California Insurance Guarantee Association (CIGA) is generally relieved of liability in cases with a solvent carrier, unless liability was already apportioned and finalized before the original carrier's insolvency.

California Insurance Guarantee AssociationCIGAcovered claimsother insuranceinsolvencyapportionment of liabilitysuccessive injuriescumulative traumamedical treatmentadministration of award
References
17
Case No. AHM 70712
En Banc
Jul 27, 2004

Jeannie Karaiskos vs. Metagenics, Inc., California Compensation Insurance Co., In Liquidation, California Insurance Guarantee Association, Risk Enterprise Management Ltd. (Servicing Facility)

The Appeals Board, following a remittitur from the Court of Appeal, rescinded a prior decision and affirmed that the California Insurance Guarantee Association (CIGA) is not obligated to pay a lien from the Employment Development Department (EDD) because it is not a 'covered claim'.

Workers' Compensation Appeals BoardRemittiturEmployment Development DepartmentEDD lienCalifornia Insurance Guarantee AssociationCIGAcovered claimInsurance CodeCourt of AppealWCJ
References
1
Case No. AHM 70712
Significant

Jeannie Karaiskos vs. Metagenics, Inc., California Compensation Insurance Co., In Liquidation, California Insurance Guarantee Association, and Risk Enterprise Management Ltd. (Servicing Facility)

The Appeals Board, following a remittitur from the Court of Appeal, rescinds its 2002 decision and reinstates its 2001 decision, affirming that the California Insurance Guarantee Association (CIGA) is not obligated to pay the lien claim of the Employment Development Department (EDD).

RemittiturEn BancEmployment Development DepartmentEDD lienCalifornia Insurance Guarantee AssociationCIGAcovered claimState of Californiarescindedreinstated
References
2
Case No. AHM 70712
Significant
Jul 15, 2002

Jeannie Karaiskos vs. Metagenics, Inc.; California Compensation Insurance Co., In Liquidation; California Insurance Guarantee Association; and Risk Enterprise Management Ltd. (Servicing Facility)

The Board held that liens for Unemployment Compensation Disability (UCD) benefits filed by the Employment Development Department (EDD) are 'covered claims' for which the California Insurance Guarantee Association (CIGA) is liable, as they constitute obligations to the injured worker rather than to the state.

California Compensation Insurance Co.California Insurance Guarantee AssociationCIGAEDD lienUnemployment Compensation Disability (UCD) benefitscovered claimsinsolvent insurerworkers' compensation lawlien trialreconsideration
References
13
Case No. PAS 0023953
En Banc
Jun 11, 2002

Lester Hershman vs. James Eisenberg Medical Group, California Compensation Insurance Company (In Liquidation), California Insurance Guarantee Association, Kemper Employers Claims Service (Servicing Facility)

The Board affirmed that the California Insurance Guarantee Association (CIGA) is liable for Labor Code section 5814 penalties for unreasonable payment delays by an insurer before insolvency, ruling they are 'covered claims' and not 'punitive damages'.

WORKERS' COMPENSATION APPEALS BOARDLester HershmanJames Eisenberg Medical GroupCalifornia Compensation Insurance CompanyCalifornia Insurance Guarantee AssociationKemper Employers Claims ServiceEN BANC DECISIONpre-liquidation delaysLabor Code section 5814 penaltiescovered claims
References
30
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