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Case Law Database

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3525697 (LAO 0534774) ADJ2342373 (LAO 0512482) ADJ1310306 (LAO 0568035) ADJ2645702 (LAO 0519888) ADJ1384751 (LAO 0568036) ADJ2871875 (ANA 0235799)
Regular
Feb 03, 2017

ALICE BRYANT vs. REGENTS OF THE UNIVERITY OF CALIFORNIA, permissibly self-insured, UCLA MEDICAL CENTER; SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves applicant Alice Bryant's petition for reconsideration of prior dismissed workers' compensation claims and a Labor Code section 132a retaliation claim. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, upholding the administrative law judge's findings. The WCAB concluded that Bryant's claims were previously dismissed, with some dismissed by her own request and others for failure to prosecute. Furthermore, the WCAB found that Bryant failed to demonstrate extrinsic fraud and lacked the required diligence to reopen these final dismissals, even with newly discovered evidence.

Workers' Compensation Appeals BoardRegents of the University of CaliforniaSedgwick Claims Management ServicesPetition for ReconsiderationFindings and OrdersWorkers' Compensation Administrative Law JudgeLabor Code section 132aRetaliation claimExtrinsic fraudDismissed claims
References
Case No. ADJ1282419 (LAO 0846452) ADJ915214 (LAO 0854736)
Regular
Feb 01, 2010

VALERIE VANCE DILLON vs. TJ MAXX, CNA CLAIMS PLUS

This case involves a Compromise and Release agreement between the applicant and defendants. The Board granted reconsideration, rescinded the prior decision, and returned the matter to the trial level. This action is contingent on the workers' compensation administrative law judge approving the settlement. If not approved, the original decision could be reinstated, with the right to seek reconsideration.

Compromise and ReleasePetition for ReconsiderationGrant ReconsiderationRescind DecisionTrial LevelWorkers' Compensation Appeals BoardAdministrative Law JudgeSalvage and ClaimsSalvage and ClaimsSalvage and Claims
References
Case No. ADJ4593512 (AHM077352)
Regular
Jul 12, 2010

FRANCISCO ENRIQUEZ vs. DOUGLAS FURNITURE OF CALIFORNIA, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE

The WCAB granted CIGA's petition for reconsideration to address its contention that the administrative law judge (WCJ) erred in finding a medical lien constituted a "covered claim" under Insurance Code § 1063.1(c). Although the WCJ ultimately disallowed the lien because its reasonable value had been paid, CIGA argued that the "covered claim" finding created potential collateral estoppel issues. Finding these findings irrelevant to the ultimate resolution, the WCAB amended the original order to delete the specific findings regarding the "covered claim" status. The WCAB affirmed the disallowance of the remaining lien balance.

CIGACalifornia Insurance Guarantee AssociationReconsiderationLien ClaimCovered ClaimInsurance Code § 1063.1(c)Findings and OrderWCJTorrance Memorial Medical CenterAssignment for Collection
References
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
Case No. ADJ3257025 (LAO 0731675) ADJ127700 (LAO 0744086)
Regular
Jul 09, 2012

JOSE LUIS ARELLANO vs. R.B.R. MEAT COMPANY, CIGA by BROADSPIRE for SUPERIOR NATIONAL INC. CO.

The Workers' Compensation Appeals Board affirmed a judge's order finding applicant sustained industrial spinal and psychiatric injuries. The Board ruled that CIGA failed to prove Coast Plaza Doctors Hospital's lien claim was not a "covered claim," rejecting CIGA's argument that an assignment to Innovative Medical Management invalidated the claim. This decision aligns with established appellate precedent. Therefore, the original findings and order requiring CIGA and the hospital to adjust the lien remain in effect.

CIGAInsurance Code section 1063.1(c)(9)covered claimlien claimIndustrial InjurySpinePsycheReconsiderationJoint Findings and OrderWCJ
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ9030735
Regular
Jul 08, 2014

HECTOR CASILLAS vs. XERXES CORPORATION, BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board denied Xerxes Corporation's Petition for Removal. The Board found that while the defendant raised legitimate concerns about potential fraud, these issues were not relevant to the applicant's current claim. The Board adopted the administrative law judge's report, concluding that the evidence presented did not support a fraudulent claim and the forum was not appropriate for addressing concerns about running, capping, and steering. Therefore, the petition was denied.

Petition for RemovalWorkers' Compensation Appeals Boardrunningcappingsteeringfraudulent claimadministrative law judge reportADJ9030735Xerxes CorporationBroadspire Claims Services
References
Case No. SAU2262762
Regular
Sep 17, 2019

KEVIN TUCKER vs. E.L. YEAGER CONSTRUCTION CO., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRISTAR RISK MANAGEMENT

This case concerns whether the California Insurance Guarantee Association (CIGA) must pay a medical lien assigned to EDS Financial Services. The Workers' Compensation Appeals Board denied EDS's petition for reconsideration, upholding a prior ruling that issue preclusion bars EDS from relitigating the lien's status as a "covered claim." The Board found that the identical issues of whether the assigned lien constituted a covered claim under Insurance Code section 1063.1 were actually litigated and decided in a previous case, *Wanda Fullylove*. EDS's arguments regarding separate statutory provisions and the nature of assignments were rejected, as prior litigation fully addressed the claim's covered status under CIGA's statutory framework, including the exclusion for assignee claims.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGACovered ClaimIssue PreclusionCollateral EstoppelInsurance Code Section 1063.1(c)(1)(F)Insurance Code Section 1063.1(c)(9)(B)AssigneeLien Claimant
References
Case No. ADJ2812382 (SRO 0062290) ADJ4059498 (SAC 0137621)
Regular
Mar 12, 2009

ROSE M. TIDWELL MARTINEZ vs. TACO BELL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, PRIVATE ADJUSTING CLAIMS SERVICES, HOME INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the WCJ's order, dismissing CIGA as a defendant. CIGA is an insurer of last resort and only covers claims where no other insurance is available. In this case, CNA provided "other insurance" covering future medical treatment, thus precluding CIGA's liability. Therefore, CIGA has no obligation to provide medical treatment to the applicant.

CIGAHome Insurance CompanyTaco BellCompromise and Releasefuture medical treatmentTransportation Insurance CompanyCNAjoint and several liabilityinsurer of last resortcovered claims
References
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