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Case Law Database

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

Case No. ADJ1064616 (SAC 0296007)
Regular
Aug 11, 2009

LISA LaCROSS vs. 24 HOUR FITNESS, INSURANCE COMPANY OF THE STATE OF PENNYSLVANIA, ARROWOOD INDEMNITY COMPANY

The Appeals Board granted reconsideration of the WCJ's decision regarding applicant's right knee injury. The WCJ had relied on conflicting QME opinions, finding a one percent permanent disability for the right knee while denying a petition to reopen for new and further disability related to a prior left foot injury. The Board rescinded the May 29, 2009 decisions in both cases to allow the WCJ to incorporate a revised QME report and conduct further proceedings. The matter is returned to the trial level for a new decision.

Petition for ReconsiderationFindings Award and OrderWCJCertified ACE exercise instructorCumulative injurySpecific injuryPermanent disabilityPetition to ReopenQualified Medical EvaluatorAMA Guides
References
Case No. ADJ3051297 (SJO 0266175) ADJ2527197 (SJO 0231549)
Regular
Apr 28, 2010

VIRGINIA COCIO vs. MOUNTAIN VIEW SCHOOL DISTRICT, ACE, CIGA

This case involves an employee's permanent disability from two cumulative trauma injuries, one covered by CIGA and the other by a solvent carrier, ACE. The physician could not apportion the disability between the two injuries, creating an "unapportionable" award. The Board reconsidered its prior decision, now holding that ACE, as the solvent carrier for "other insurance," is solely liable for the entire indivisible permanent disability award. CIGA is relieved of any liability for this permanent disability.

CIGAACEBenson situationunapportionable permanent disabilitysolvent carrierapportionmentcumulative traumaindivisible award"other insurance"Insurance Code section 1063.1
References
Case No. ADJ374246
Regular
Apr 23, 2015

CAROLINE PARAS vs. LOS ANGELES TIMES/TRIBUNE, ACE USA

Defendant ACE USA filed a Petition for Removal seeking to overturn an order changing the claims administrator from Gallagher Bassett to CIGA. The Board found ACE USA's contentions unintelligible. However, both ACE USA and the applicant subsequently filed a Compromise and Release, which was approved. Consequently, ACE USA's Petition for Removal is now moot and has been dismissed by the Board.

Petition for RemovalOrder to Change AdministratorsCalifornia Insurance Guarantee AssociationCIGACompromise and Releasemootalter egothird party administratorTPAWorkers' Compensation Appeals Board
References
Case No. ADJ7658730
Regular
Mar 27, 2014

Maria Perez vs. TS STAFFING, LUMBERMEN'S UNDERWRITING ALLIANCE

This case concerns a lien claim for interpretation services provided by Santana, Lopez & Associates, LLC. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior order, finding that Santana failed to prove its interpreters were "qualified" for 14 medical appointments. The interpreters for these appointments were neither certified nor provisionally certified, nor were they documented as provisionally utilized by the treating physician, thus invalidating the lien for those services. Consequently, Santana is not entitled to further payment on its lien.

Santana Lopez & AssociatesLumbermen's Underwriting Alliancequalified interpretercertified interpreterprovisionally certifiedGovernment Code section 11435.55Labor Code section 4622Labor Code section 4603.2(b)Labor Code section 5813Administrative Director's Rule 9795.1
References
Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
Case No. ADJ248306 (SAC 0298167) ADJ870873 (SAC 0298071)
Regular
Jul 28, 2017

Lonnie Roberts vs. Capital Plumbing, California Insurance Guarantee Association, Reliance National Indemnity Company, SEDGWICK CLAIMS MANAGEMENT SERVICES, ACE USA

The Workers' Compensation Appeals Board granted reconsideration to clarify ACE USA's liability for reimbursement to CIGA. ACE USA argued that CIGA's claim lacked sufficient proof and that the initial order failed to specify an amount. The Board affirmed the finding that ACE USA is liable for reimbursement to CIGA for temporary disability, medical treatment, bill review, and utilization review for services paid after January 26, 2001. However, the Board amended the order to clarify that the parties must adjust the reimbursement amount, with the trial judge retaining jurisdiction if an agreement is not reached.

Workers' Compensation Appeals BoardCIGAACE USAReimbursementLiquidationJointly and Severally LiableOther InsuranceBenefit PrintoutLabor Code Section 5815Unclean Hands Doctrine
References
Case No. ADJ1335893 (SFO 0434184)
Regular
Aug 18, 2009

JEANETT BUTLER vs. CHARLES SCHWAB & COMPANY, ACE

The Workers' Compensation Appeals Board (WCAB) has dismissed Jeanette Butler's petition for reconsideration in her case against Charles Schwab & Company and ACE. The WCAB adopted and incorporated the reasons stated in the administrative law judge's report and recommendation. Therefore, the petition for reconsideration is officially dismissed.

Petition for ReconsiderationWorkers' Compensation Appeals BoardDismissalReport and RecommendationWCJAdministrative Law JudgeApplicantDefendantCharles Schwab & CompanyACE
References
Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
Case No. ADJ7949522
Regular
Jul 28, 2016

JORGE INZUNZA vs. CAAMACOSTA, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA; ACE INSURANCE COMPANY

Travelers sought reconsideration of a WCAB arbitrator's order denying its contribution claim against ACE. The arbitrator discovered a clerical error regarding ACE's coverage and issued an amended order correcting it. The WCAB dismissed Travelers' petition because the amended order resolved the issue, rendering Travelers not aggrieved. Therefore, Travelers' petition for reconsideration was dismissed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderContribution claimCumulative traumaClerical errorAmended Findings and OrderAggrieved partyLabor Code § 5900Dismissed Petition
References
Case No. ADJ3702833 (OXN 0149751) ADJ3963548 (OXN 0149750)
Regular
Dec 13, 2010

TANYA HIRZEL vs. 24 HOUR FITNESS, ACE, AMERICAN INSURANCE COMPANY C/O GALLAGHER BASSETT SERVICES, INC.

This case concerns an applicant who sustained two industrial injuries: to her left shoulder in 2007 and her right ankle in 2008. The defendant seeks reconsideration of awards for temporary disability indemnity for both injuries, arguing the 104-week limit was misapplied due to concurrent payments. The Board granted reconsideration to clarify the timeline of the defendant's denial and acceptance of the shoulder injury claim, and to further develop the record regarding the defendant's alleged offer of modified work. The Board rescinded the original awards and returned the matter for further proceedings to address these factual disputes.

Workers' Compensation Appeals BoardTanya Hirzel24 Hour FitnessAce American Insurance CompanyADJ3702833ADJ3963548Findings and AwardsIndustrial InjuryLeft Shoulder InjuryRight Ankle Injury
References
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