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

Case No. ADJ10264533
Regular
Oct 07, 2017

KENNETH GOSLING vs. CALIFORNIA SECURITY AND INVESTIGATIONS ACADEMY, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision. The Board found that while the applicant was correctly identified as an employee, the issue of whether he was excluded from workers' compensation coverage is a matter for mandatory arbitration. Therefore, the case is remanded to the trial level to proceed with arbitration on the coverage issue. The WCJ's prior finding that the applicant was not excluded from coverage is superseded by this order.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactCumulative TraumaCorporate Officer ExclusionLabor Code Sections 3351(c)Labor Code Section 4151Mandatory ArbitrationInsurance CoverageEmployee Definition
References
Case No. ADJ9136267
Regular
Aug 05, 2016

JERRY LEDGER III vs. STEVE DOVALI CONSTRUCTION, BARRY HALAJIAN DBA INDUSTRIAL ELECTRIC COMPANY, GRANITE STATE INSURANCE, BENCHMARK INSURANCE

In this workers' compensation case, the Appeals Board granted removal, rescinded a prior order staying Superior Court actions, and affirmed an order for mandatory arbitration. The Board found that coverage disputes arising from an insurer's claim of policy cancellation fall exclusively within the WCAB's jurisdiction, as resolution is necessary for applicant benefits. While the WCAB has exclusive jurisdiction over these disputes, it lacked the authority to stay the separate Superior Court actions, which is a power reserved for higher courts. Therefore, the parties must proceed to arbitration, and the Superior Court actions are not stayed by the WCAB.

Workers' Compensation Appeals BoardPetition for RemovalMandatory ArbitrationSuperior Court ActionPolicy CancellationDeclaratory ReliefConcurrent JurisdictionExclusive JurisdictionCoverage DisputeConstitutional Courts
References
Case No. ADJ18217235; ADJ18217236
Regular
Apr 29, 2025

Crispin Bermudez vs. Elkhorn Packing Company, LLC; Zenith Insurance Company

The Workers' Compensation Appeals Board addressed a petition for reconsideration filed by Zenith Insurance Company challenging an arbitrator's finding that applicant Crispin Bermudez was covered by a workers' compensation policy despite signing a waiver. The Board granted the petition, rescinded the arbitrator's decision, and issued a new decision. It found that as a managing member of a limited liability company, Bermudez had executed a valid written waiver of his workers' compensation rights under Labor Code sections 3351(f) and 3352(a)(17). Consequently, the applicant was deemed excluded from the definition of an employee and thus not entitled to workers' compensation coverage.

Workers' CompensationManaging MemberWaiver of CoverageLabor Code Section 3352(a)(17)Conclusive PresumptionIndustrial InjuryPetition for ReconsiderationArbitrator's DecisionRescinded DecisionLimited Liability Company
References
Case No. ADJ7793905, ADJ7793938
Regular
Feb 25, 2014

SHEDERICK FOWLKS vs. LUBE PIT STOP, INC., ADVANTAGE WORKERS' COMPENSATION INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision finding the applicant, Shderick Fowlks, not covered by workers' compensation. Fowlks, an officer and sole shareholder of Lube Pit Stop, Inc., was deemed an employee under Labor Code section 3351(c) but excluded from compensation coverage by section 4151(a) because the corporation lacked specific election through a compensation policy. The WCAB clarified that while officers are generally employees, sole shareholder-officers require election to be covered, which was not demonstrated here due to policy exclusions. Therefore, Fowlks' claims for injuries sustained while working for the corporation were dismissed.

Labor Code section 3351(c)corporate officersole shareholderworkers' compensation coverageelectioninsurance policyexclusionshamadministrative law judgePetition for Reconsideration
References
Case No. ADJ6710001 (ANA) MF ADJ7803228 (ANA) ADJ8017966 (ANA) ADJ8064588 (ANA) ADJ8262934 (ANA) ADJ9093396 (ANA) ADJ9076943 (ANA) ADJ9083545 (SDO) ADJ6925792 (ANA) ADJ8907815 (ANA) ADJ8819925 (ANA) ADJ9087879 (ANA) ADJ9093460 (ANA) ADJ8443963 (ANA) ADJ6829099 (ANA) ADJ6843222 (ANA)
Regular
May 07, 2015

LARRY WATKINS, GORDON BELL, DANIEL BUGGS, JAMES STIENKE, WILLIAM BRYANT, RONALD JOHNSON, ROBERT HYLAND, WALKER GILLETTE, REGGIE RUCKER, ANDREW SELFRIDGE, DOUG VAN HORN, ANANIAS CARSON, JACK GREGORY, THOMAS MULLEN, WILLIE YOUNG, JOHN HICKS vs. NEW YORK GIANTS, NEW YORK STATE INSURANCE FUND

This case concerns the New York State Insurance Fund's (NYSIF) liability for workers' compensation claims filed by former New York Giants employees. NYSIF argued it was not liable due to sovereign immunity and limitations in its New York-centric insurance policies. The Workers' Compensation Appeals Board affirmed the Arbitrator's decision, finding that Coverage B of the policy broadly indemnified the Giants for employee injuries sustained "wherever such injuries may be sustained," without clear exclusionary language. This coverage extended despite NYSIF's arguments about its New York origin and lack of authorization to write insurance in California. The Board also deferred the jurisdictional question for individual claims to the Workers' Compensation Judge.

Workers' Compensation Appeals BoardNew York State Insurance FundNew York Giantssovereign immunitycomitycoverageextraterritorial injuriesinsurance policy interpretationCoverage Bbusiness operations
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. ADJ744923 (ANA 0385182)
Regular
Jul 22, 2011

CHARLES BUFFINGTON III vs. FACTORY MUTUAL, INFRARED TESTING, INC., LIBERTY MUTUAL INSURANCE COMPANY, UNINSURED EMPLOYERS BENEFITS TRUST FUND

Factory Mutual seeks reconsideration of a workers' compensation decision finding Liberty Mutual provided coverage for Infrared Testing, Inc. during the applicant's injury period. Factory admits it sold its interest in Infrared before the cumulative injury period, arguing Liberty's coverage stipulation was a mistake. The Board dismissed Factory's petition, finding Factory lacks standing as it had no interest in the employer after August 2, 2000. The Board also indicated it would have denied the petition on the merits due to Liberty's stipulation and the elapsed premium collection period.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrdersStipulationCoverage disputeMistake in coverageSale of interestUninsured Employers Benefits Trust FundStandingAggrieved party
References
Case No. ADJ559526 (STK 0208625)
Regular
Jan 03, 2011

MICHAEL OZUNA vs. WEBCOR BUILDERS, ZURICH NORTH AMERICA, AMERICAN HOME ASSURANCE COMPANY

This case concerns whether Zurich North America or American Home Assurance Company provided workers' compensation coverage for an applicant's severe injury. An arbitrator initially ruled Zurich solely responsible, finding American Home's policy was limited and did not cover the claim. Zurich contends American Home's policy endorsement limiting coverage to a specific site was invalid due to non-compliance with Insurance Code requirements. The Appeals Board granted reconsideration to allow further proceedings, holding American Home bears the burden to prove its policy effectively excluded this claim.

Workers Compensation Appeals BoardReconsiderationArbitrationInsurance CoverageDefense and IndemnificationPolicy EndorsementInsurance Code Section 11657Insurance Code Section 11660Burden of ProofAffirmative of the Issue
References
Case No. ADJ6710001 (ANA) MF ADJ7803228 (ANA) ADJ8017966 (ANA) ADJ8064588 (ANA) ADJ8262934 (ANA) ADJ9093396 (ANA) ADJ9076943 (ANA) ADJ9083545 (SDO) ADJ6925792 (ANA) ADJ8907815 (ANA) ADJ8819925 (ANA) ADJ9087879 (ANA) ADJ9093460 (ANA) ADJ8443963 (ANA) ADJ6829099 (ANA) ADJ6843222 (ANA)
Regular
May 07, 2015

LARRY WATKINS, GORDON BELL, DANIEL BUGGS, JAMES STIENKE, WILLIAM BRYANT, RONALD JOHNSON, ROBERT HYLAND, WALKER GILLETTE, REGGIE RUCKER, ANDREW SELFRIDGE, DOUG VAN HORN, ANANIAS CARSON, JACK GREGORY, THOMAS MULLEN, WILLIE YOUNG, JOHN HICKS vs. NEW YORK GIANTS, NEW YORK STATE INSURANCE FUND, et al.

The Workers' Compensation Appeals Board affirmed an Arbitrator's decision finding the New York State Insurance Fund (NYSIF) liable for workers' compensation claims against the New York Giants. Despite NYSIF's claims of sovereign immunity and limitations to New York coverage, the Board found that the policy's Coverage B provided indemnity for injuries sustained by employees "wherever such injuries may be sustained." The Board emphasized that insurance policy exclusions must be clear, and NYSIF failed to demonstrate any such limitations for injuries occurring outside New York, especially given the team's extensive operations outside the state. The Board also noted that NYSIF's contentions regarding California jurisdiction would be determined on a claim-by-claim basis.

Workers' Compensation Appeals BoardNew York State Insurance FundNew York GiantsSovereign ImmunityComityCalifornia JurisdictionCoverage BOut-of-State InjuriesInsurance Policy LimitationsIndemnify
References
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
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