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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ1234371 (LAO 0785447) ADJ2536321 (LAO 0863778)
Regular
Sep 17, 2012

JOSE AGUILAR vs. DAVALAN SALES, VIRGINIA SURETY COMPANY, CLARENDON NATIONAL INSURANCE COMPANY, GOLDEN EAGLE INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration due to a failure to properly serve Clarendon National Insurance Company. This procedural defect, specifically the lack of a required proof of service, is grounds for dismissal under California regulations. Had the petition not been dismissed, the Board would have denied it based on the administrative law judge's original findings. The applicant had sought reconsideration of findings regarding industrial injuries and disability assessments for multiple injury dates and insurers.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for Reconsiderationindustrial injurylow backlaborerwarehousemaninsurance coverageVirginia Surety CompanyClarendon National Insurance Company
References
Case No. ADJ1976073
Regular
Nov 09, 2009

JAMES GROVER vs. MVP HYDRATEC, INC., CLARENDON NATIONAL INSURANCE COMPANY, administered by F. A. RICHARDS and ASSOCIATES, REMEDYTEMP, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by INTERCARE INSURANCE SERVICES for RELIANCE NATIONAL INDEMNITY CO., in liquidation

The WCJ erred in making CIGA liable; Clarendon is "other insurance" available to applicant within the meaning of Insurance Code section 1063.1(c)(9) and liable for workers' compensation benefits.

California Insurance Guarantee AssociationCIGAgeneral employerspecial employerother insuranceReliance National Indemnity CompanyClarendon National Insurance CompanyInsurance Code section 1063.1(c)(9)covered claimsinsolvency
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. ADJ2480026
Regular
Aug 26, 2011

CHAD IMES vs. SCENARIO DESIGNS, INC., EVEREST NATIONAL INSURANCE COMPANY, POWER PAYROLL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling and ordered Everest National Insurance Company to reimburse CIGA for benefits paid to the applicant. The Board found that Everest was "other insurance" available under Insurance Code section 1063.1(c)(9) because its insured, Scenario Designs, Inc., employed the applicant on the date of injury. This decision clarifies that reimbursement to CIGA does not alter the original award and aligns with statutory limitations on CIGA's liability. Everest is now obligated to reimburse CIGA and administer future benefits.

CIGAEverest National Insurance CompanyLegion Insurance CompanyScenario DesignsPower PayrollInc.other insurancereimbursementdate of injurygeneral-special employment
References
Case No. VEN 0115536
Regular
Aug 04, 2008

ROBERT FROELICH vs. CONTRACTORS LABOR POOL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCATION, RELIANCE NATIONAL INSURANCE CO., GM NORTHROP CORP., NATIONAL FIRE INSURANCE COMPANY OF HARTFORD

This case concerns a dispute over workers' compensation liability following an industrial injury sustained by an employee who was a general employee of Contractors Labor Pool (insured by insolvent Reliance) and a special employee of GM Northrup Corp. The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding, determining that National Fire Insurance Company's policy for GM Northrup Corp. constituted "other insurance." Consequently, National Fire Insurance Company is now liable for the applicant's benefits, and the California Insurance Guarantee Association is not liable as the claim is not a "covered claim."

CIGAReliance National InsuranceNational Fire Insurance Companycovered claimsother insurancegeneral employerspecial employerjoint and several liabilitypolicy constructionInsurance Code section 1063.1
References
Case No. ADJ4684775 (VEN 0117727) ADJ4381820 (VEN 0117723)
Regular
Dec 19, 2011

JOANNE LUTZ, JOANN LUTZ vs. RUSSELL WARNER dba ROTO ROOTER SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PAULA INSURANCE COMPANY, in liquidation, and for FREMONT INSURANCE COMPANY, in liquidation, LINDA McDONALD, STATE FARM INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling, allowing CIGA to pursue reimbursement from State Farm for benefits paid due to applicant's industrial injuries. The Board found that unlike a request to alter a prior award, CIGA's petition sought to enforce its statutory right to reimbursement from "available" insurance under Insurance Code section 1063.1(c)(9). Since State Farm, as a jointly and severally liable insurer, appears to be such "available" insurance, the case is remanded for further proceedings on CIGA's reimbursement claim.

California Insurance Guarantee AssociationCIGAPaula Insurance CompanyFremont Insurance CompanyState Farm Insurance Companystipulated awardreconsiderationreimbursementcontributionother insurance
References
Case No. ADJ7539480
Regular
Sep 20, 2011

GARY KREFT vs. CELESTRON, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, COMPWEST INSURANCE COMPANY, HARTFORD INSURANCE COMPANY, AMERICAN CLAIMS MANAGEMENT, STATE COMPENSATION INSURANCE FUND, Everest National Insurance Co.

This case concerns a cumulative injury claim where the Workers' Compensation Appeals Board (WCAB) granted Everest National Insurance Co.'s Petition for Removal. The WCAB amended a prior order joining Everest and other carriers, clarifying that Labor Code section 5500.5(a) limits liability for cumulative injuries to employers/insurers covering the year immediately preceding the date of injury or last exposure. As the date of injury/exposure was not yet determined and appeared to be the last day of employment, only the carriers covering that final year (CompWest and Hartford) were ordered joined. Everest was removed as a party defendant pending further determination.

Petition for RemovalLabor Code section 5500.5(a)cumulative injurylast injurious exposurejoinder of partiesWorkers' Compensation Appeals Boarddate of injuryrepetitive job dutiesCalifornia Insurance Guarantee AssociationCIGA
References
Case No. FRE 193678
Regular
Apr 11, 2008

JAMES GROVER vs. MVP HYDRATEC, INC., CLARENDON NATIONAL INSURANCE COMPANY, REMEDYTEMP, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, RELIANCE NATIONAL INDEMNITY CO.

This case concerns whether Clarendon Insurance, covering the special employer, constitutes "other insurance" under Insurance Code section 1063.1(c)(9), relieving CIGA of liability for an injured worker whose general employer's insurer is insolvent. The Appeals Board granted reconsideration, rescinded the prior award due to incomplete findings and an unclear record regarding the "other insurance" issue, and returned the case to the trial level. The Workers' Compensation Administrative Law Judge must clarify the evidence and make specific findings on general and special employment and whether Clarendon's policy qualifies as "other insurance" before issuing a new decision and award.

Workers' Compensation Appeals BoardCIGAMVP HydratecClarendon National Insurance CompanyRemedyTempgeneral employerspecial employerpermanent disabilityfuture medical treatmentjudicial notice
References
Case No. ADJ128210 (SAL 0093437) ADJ593542 (SAL 0093436)
Regular
Apr 12, 2010

JORGE RAMIREZ vs. LINO FINATTI, JR., CIGA on behalf of RELIANCE INSURANCE COMPANY, in liquidation, administered by INTERCARE SERVICES, CLARENDON INSURANCE COMPANY, adjusted by NORTH AMERICAN RISK SERVICES

This case involves a dispute over reimbursement for workers' compensation expenses between the California Insurance Guarantee Association (CIGA) and Clarendon Insurance Company. CIGA, covering for Reliance Insurance Company in liquidation, sought reimbursement for administrative expenses in addition to indemnity and medical costs. The arbitrator initially denied administrative expenses due to insufficient justification, but the Appeals Board granted reconsideration. The Board applied the *Ramos* decision, allowing CIGA to recover administrative costs like bill review and utilization review from Clarendon for the applicant's low back injuries.

CIGAReliance Insurance CompanyClarendon Insurance Companyadministrative expensesreimbursementbill reviewmedical managementutilization reviewsubpoenaing recordsjoint and several liability
References
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