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

Case No. LBO 0319122
Regular
May 19, 2008

RICARDO MORAN-FLORES vs. ALEX STAVROPOULOS, dba THE GREEK MATTRESS WAREHOUSE, GOLDEN EAGLE INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed an Arbitrator's decision that the employer's workers' compensation policy was effectively cancelled on April 25, 2000, prior to the applicant's October 21, 2000 injury. The Board found that the insurer provided proper notice of cancellation for non-reporting of payroll, and the employer failed to present evidence rebutting receipt of this notice. Therefore, the policy was deemed terminated before the employee's injury.

Workers' Compensation Appeals BoardReconsiderationArbitrator DecisionInsurance CancellationPolicy TerminationNon Report of PayrollGolden Eagle Insurance CompanyRicardo Moran-FloresAlex StavropoulosThe Greek Mattress Warehouse
References
Case No. ADJ11114421
Regular
Jun 05, 2025

FELIX CABRERA vs. OAA INVESTMENTS, INC.; CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

Defendant California Restaurant Mutual Benefit Corporation (CRMBC) sought reconsideration of a February 19, 2021 Findings and Order (F&O) which found CRMBC liable for coverage of applicant Felix Cabrera's injury, ruling that CRMBC's policy cancellation was premature. CRMBC contended it had no coverage obligations as the applicant was employed by OAA Investments, Inc., not insured by CRMBC, and argued against the applicability of Insurance Code section 676.8. The Appeals Board affirmed the WCA's F&O, treating the petition as one for reconsideration, and found that under Insurance Code section 676.8 and equitable principles, CRMBC was liable for coverage. The Board reasoned that due to a material change in ownership, CRMBC's cancellation notice required 30 days' notice, making January 27, 2018, the earliest effective cancellation date, which was after the November 22, 2017 injury date.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPolicy CancellationInsurance Code Section 676.8Material Change in OwnershipEquitable EstoppelAffiliate Certificate of Consent to Self-InsureGroup Self-InsurerAD Rule 15480
References
Case No. ADJ3732643 (OXN 0133370)
Regular
Aug 12, 2011

JAIME GONZALEZ vs. HAMLIN DEVELOPMENT CORPORATION: GRANITE STATE INSURANCE COMPANY, et al.

This case concerns Granite State Insurance Company (AIG) seeking reconsideration of a prior order finding their workers' compensation policy with Hamlin Development Corporation valid and in force at the time of applicant Jaime Gonzalez's injury. The Board denied reconsideration, upholding the arbitrator's finding that AIG failed to properly and timely cancel the policy. AIG's cancellation notice was deemed defective because it lacked statutory grounds, did not explain how to cure the alleged deficiency, and did not notify the insured's intermediaries. Therefore, AIG remains obligated to defend Hamlin and provide benefits to Gonzalez.

Workers' Compensation Appeals BoardGranite State Insurance CompanyHamlin Development CorporationJaime GonzalezInsurance Code section 676.8Notice of CancellationPremium Finance AgreementInsurexConcord InsuranceCananwill
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. ADJ1389831
Regular
Sep 19, 2008

SHAWNDELL WILLIAMS vs. THRUSHWING HOME, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and reversed the Arbitrator's decision, finding that the worker's compensation policy was effectively cancelled before the injury date, thus SCIF had no liability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardNotice of CancellationInsurance Code section 676.8Code of Civil Procedure section 1013(a)Policy CancellationInsured StatusDate of InjuryArbitrator's Decision
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. ADJ7171783
Regular
Aug 14, 2012

William Mickens vs. New England Patriots

Dr. Einbund, the applicant's treating physician, petitioned for removal to prevent a deposition of his transcriber, Jamie Hill, alleging harassment. However, the defendant later informed the WCJ that the deposition was cancelled as Ms. Hill was not the correct transcriber in this case. Consequently, the Appeals Board dismissed Dr. Einbund's petition as moot.

Petition for RemovalUnverified PetitionWorkers' Compensation Appeals BoardAdministrative Law JudgeDepositionMootDismissedTreating PhysicianTranscriberHarassment
References
Case No. ADJ85664607
Regular
Nov 01, 2013

YANET DUARTE ORTUNI vs. LA PERLA MEXICANA A CORPORATION, INSURANCE COMPANY OF THE WEST

This case involves a defendant's petition to remove the matter due to the Presiding Workers' Compensation Judge's alleged denial of an expedited hearing on a PQME specialty dispute. The applicant countered that the PQME appointment had been canceled. The Appeals Board dismissed the petition as moot because the cancellation of the PQME appointment resolved the underlying dispute. Therefore, the Petition for Removal was dismissed.

Petition for RemovalPresiding Workers' Compensation JudgeExpedited HearingPanel Qualified Medical EvaluatorPQME specialtymootcancelled medical appointmentWorkers' Compensation Appeals Board
References
Case No. ADJ10068763, ADJ10567862, ADJ10694876, ADJ10758465
Regular
Jul 03, 2016

NAHIDEH SARRAFIEH vs. CITY OF EL SEGUNDO

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal due to a procedural error by the Workers' Compensation Judge (WCJ). The WCJ erroneously set the case for trial after issuing a confusing "Notice of Hearing Cancellation" which led applicant's counsel to believe the hearing was cancelled. Despite applicant's counsel appearing and objecting, the WCJ proceeded to set the trial, failing to provide adequate notice. The Appeals Board rescinded the trial setting order and remanded the case for a new Mandatory Settlement Conference to ensure proper notice and preparation.

Petition for RemovalNotice of Hearing CancellationMandatory Settlement ConferenceDue ProcessObjectionsTrial SettingRescind OrderReturn for MSCWCJ OpinionAppeals Board Decision
References
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