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

Case No. ADJ265314 (LAO 0790236)
Regular
May 21, 2009

VICTORIA RODRIGUEZ vs. THIBIANT INTERNATIONAL, INC., FIREMAN'S FUND INSURANCE COMPANY, SELECT PERSONNEL SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCATION, LEGION INSURANCE CO.

This case involves a workers' compensation applicant injured while working for a special employer, Thibiant International, insured by Fireman's Fund. The applicant was hired by a general employer, Select Personnel, whose insurer, Legion Insurance, became insolvent. The California Insurance Guarantee Association (CIGA) paid benefits but argued its coverage was excluded by Fireman's Fund being "other insurance." The Appeals Board affirmed Fireman's Fund's liability as the special employer's insurer and reversed CIGA's dismissal, finding Fireman's Fund owed CIGA reimbursement for benefits paid. The Board also deemed Fireman's Fund's challenge to the reimbursement amount waived due to failure to raise it at trial.

Workers' Compensation Appeals BoardVictoria RodriguezThibiant InternationalInc.Fireman's Fund Insurance CompanySelect Personnel ServicesCalifornia Insurance Guarantee AssociationCIGALegion Insurance Companyliquidation
References
Case No. ADJ2425191 (LAO 0775944) ADJ3230477 (LAO 0775943) ADJ3919134 (LAO 0793799)
Regular
Apr 05, 2010

MARTHA ARIAS vs. CUSTOM FOODS PRODUCTS, INC., FIREMAN'S FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE SERVICES, INC., SUPERIOR NATIONAL INSURANCE COMPANY

This case concerns CIGA's petition for reconsideration of a denial of reimbursement from Fireman's Fund for workers' compensation benefits paid to Martha Arias. CIGA sought reimbursement, arguing Fireman's Fund's coverage for other injuries constituted "other insurance." However, the WCAB denied CIGA's petition, adopting the WCJ's reasoning that CIGA failed to prove applicant's injuries in the other cases contributed to the benefits CIGA paid. CIGA had the burden of establishing entitlement to reimbursement under the "other insurance" provision, which it did not meet.

CIGAreimbursementFireman's Fundindustrial injurymeat packerlow backleft handhipcumulative injuryspecific injury
References
Case No. ADJ2921203 (SAC 0309350)
Regular
May 10, 2010

LORI BIANCALANA vs. FRANKLIN RESOURCES, INC., CIGA, Through Its Servicing Facility, INTERCARE INSURANCE SERVICES for HIH INSURANCE, In Liquidation, and FIREMAN'S FUND INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration to clarify CIGA's reimbursement rights from a solvent insurer (Fireman's Fund) for benefits paid to an injured worker after the worker's primary insurer became insolvent. The Board reversed the arbitrator's decision, finding CIGA is entitled to full reimbursement for all good-faith payments made to the applicant. This decision emphasizes CIGA's role as an insurer of last resort and encourages prompt benefit payments even when subsequent claims adjustments may occur. Therefore, Fireman's Fund is now responsible for repaying CIGA the entirety of the benefits CIGA disbursed.

CIGAHIH InsuranceFireman's Fundinsolvencycovered claimsother insurancereimbursementcontributioncumulative traumatemporary disability
References
Case No. LAO 0784107
Regular

THELMA CUADRA vs. COMMUNITY HOME CARE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHRISTINE GATES, FIREMAN'S FUND INSURANCE COMPANY

This case involves a worker's compensation claim for an admitted industrial injury sustained in 2000. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior ruling that dismissed CIGA and found Fireman's Fund liable. The WCAB rescinded the prior decision and returned the matter to the trial level for further development of the record. This is necessary because neither party provided sufficient evidence, specifically insurance policies, to determine if Fireman's Fund coverage constitutes "other insurance" which would affect CIGA's liability.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGACredit General Insurance CompanyFireman's Fund Insurance CompanyCommunity Home CareChristine GatesGeneral EmployerSpecial EmployerIndustrial Injury
References
Case No. LBO 339165
Regular
Aug 28, 2007

ROBERT GILES vs. FILM PAYMENT SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, BROADSPIRE, KELLEY PRODUCTIONS, INC., FIREMAN'S FUND INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior finding, remanding the case to determine if the Fireman's Fund policy constitutes "other insurance" under Insurance Code section 1063.1(c)(9) for the applicant's injury. The Board rejected the application of collateral estoppel based on a prior appellate decision, finding that the specific facts and intent of the parties regarding coverage must be evaluated anew. This allows for a full development of the evidentiary record to address CIGA's liability and Fireman's Fund's coverage for the applicant's injuries.

CIGALegion Insurance CompanyFireman's Fund Insurance CompanyKelley ProductionsInc.Film Payment ServicesRobert Gilesother insurancecovered claimInsurance Code section 1063.1(c)(9)
References
Case No. ADJ2309063, 2603988
Regular
Jun 24, 2010

RAINIE JAEGER vs. APOTHE-CARE, INC., dba OWENS PHARMACY, FIREMAN'S FUND INSURANCE COMPANY, AMERICAN AUTO INSURANCE COMPANY, RISK ENTERPRISE MANAGEMENT, WALGREEN'S, AMERICAN MOTORISTS INSURANCE COMPANY, SEDGWICK CMS, Fairmont Premier Insurance Company, American Motorist Insurance Company adjusted by Sedgwick

This case involves a dispute over a worker's compensation claim for a low back injury determined to be a compensable consequence of a prior bilateral carpal tunnel injury. The Board granted reconsideration to correct the date of the compensable consequence injury to October 5, 2004. Furthermore, Fireman's Fund was ordered to reimburse Sedgwick CMS for benefits paid after that date, with the right to seek contribution from Fairmont Premier/REM. The Board rescinded prior findings and substituted new ones, clarifying liability for medical treatment and benefits.

compensable consequence injurybilateral carpal tunnellow back injuryspinal surgeryAgred Medical Evaluator (AME)Fireman's FundSedgwick CMSjoint and several liabilityreimbursementcontribution
References
Case No. ADJ6775950
Regular
Jun 22, 2017

MARTIN MENDOZA vs. W&M TEXTILE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted a petition for reconsideration filed by lien claimant Physician Funding Solutions, LLC. The Board rescinded the prior order dismissing the lien of Physician Funding Rancho Cucamonga and Rx Funding Solutions Rancho Cucamonga. The WCJ's report, which was adopted by the Board, provided the reasoning for this decision. This order reinstates the dismissed liens.

Physician Funding SolutionsLLCRx Funding SolutionsLLCPetition for ReconsiderationOrder Dismissing LienWorkers' Compensation Appeals BoardWCJ ReportGrant ReconsiderationRescind Order
References
Case No. ADJ3663514 (LAO 0820528) ADJ4004409 (LAO 0820529)
Regular
Dec 17, 2012

JOEL CORTEZ vs. WESTFIELD AMERICAN, FIREMAN'S FUND INSURANCE COMPANIES

The Workers' Compensation Appeals Board granted reconsideration and affirmed the original decision, with amendments. The applicant was found to have 68% permanent disability after apportionment. Fireman's Fund was awarded reimbursement of $31,732.84 as credit against the applicant's permanent disability award. Attorney's fees were set at $5,701.00.

JOEL CORTEZWESTFIELD AMERICANFIREMAN'S FUND INSURANCE COMPANIESWORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONAPPORTIONMENTPERMANENT DISABILITYREIMBURSEMENTCREDITARROWWOOD INSURANCE COMPANY
References
Case No. ADJ7541142
Regular
Jul 02, 2012

MIGUEL OSIO vs. EMBASSY SUITES, FIREMAN'S FUND INSURANCE COMPANY

This case involves a worker's compensation claim where the applicant, Miguel Osio, suffered an industrial injury to his right knee. The defendant insurer, Fireman's Fund, sought reconsideration of a finding that it was estopped from raising the statute of limitations. The Appeals Board denied reconsideration, agreeing that the insurer's February 3, 2004 notice was misleading. Specifically, the notice incorrectly stated the applicant had no permanent limitations and failed to inform him of any time limits to pursue further benefits, thus estopping the insurer from asserting the statute of limitations.

Workers' Compensation Appeals BoardFireman's Fund Insurance CompanyPetition for ReconsiderationFindings and AwardStatute of LimitationsEstoppelPermanent DisabilityRight Knee InjuryWaiterNotice Requirements
References
Case No. SRO 131835, SRO 132035
Regular
Jan 24, 2008

ABU POWELL vs. STELLAR SPA, FIREMAN'S FUND INSURANCE COMPANY, SPA DE NOVATO, CYMRU ELECTRIC, STATE COMPENSATION INSURANCE FUND

This case concerns a contribution claim for workers' compensation benefits. The Appeals Board reversed an arbitrator's award, ruling that Fireman's Fund's claim for contribution against SCIF as Cymru Electric's insurer was time-barred. Specifically, amending a petition to add a new co-defendant more than one year after the compensation award is considered a new cause of action, even if the original petition was timely filed against another party. Therefore, Fireman's Fund is only entitled to reimbursement from SCIF on behalf of Spa De Novato.

Workers' Compensation Appeals BoardReconsiderationContributionLabor Code section 5500.5Statute of LimitationsCumulative InjuryUpper ExtremitiesElectricianMasseurEmployer Liability
References
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