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

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. 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. 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. 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
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. FRE 0110112 and FRE 0114991
Regular
Feb 01, 2000

CENAIDA MEZA vs. SANDRINI BROTHERS, T & L HARVESTING, GOLDEN EAGLE INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE

The California Insurance Guarantee Association (CIGA) petitioned to be relieved as administrator of medical awards due to a solvent insurer's availability. The Appeals Board granted CIGA's petition, rescinding the prior decision and appointing Golden Eagle Insurance as the administrator. This decision aligns with precedent that CIGA is relieved of administrative duties when "other insurance" is available for successive injuries to the same body parts.

CIGAGolden Eagle InsuranceFremont InsuranceMedical Treatment AwardsSuccessive InjuriesApportionmentAdministratorSolvent InsurerInsolvencyCovered Claims
References
6
Case No. ADJ4399114 (POM 0281905) MF
Regular
Jun 27, 2013

RICARDO GARCIA vs. AMERICAN STAFF RESOURCES OF CALIFORNIA/TRIMCO, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CASCADE INSURANCE COMPANY, in liquidation, STATE COMPENSATION INSURANCE FUND

This case involves the State Compensation Insurance Fund (SCIF) seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB ordered SCIF to reimburse the California Insurance Guarantee Association (CIGA) $27,082.67 for costs incurred in a workers' compensation claim previously settled by SCIF. SCIF argued CIGA failed to prove reasonableness of costs and timely tendered the claim. The WCAB denied SCIF's petition, affirming the prior award, finding CIGA's expenditures were reasonable and necessary given SCIF's stipulation to the amounts spent and lack of evidence to the contrary. The Board clarified CIGA's legal status but upheld the reimbursement order based on statutory obligations and public policy.

Workers' Compensation Appeals BoardState Compensation Insurance FundCalifornia Insurance Guarantee AssociationCIGAreimbursementreasonable costsnecessary expenditurecompromise and releaseinvoluntary association of insurersstatutory duties
References
2
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