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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. 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. ADJ700106 (SAL 0075388) ADJ4293270 (SAL 0067937) ADJ3847224 (SAL 0067938) ADJ1646200 (SAL 0011386)
Regular
Sep 01, 2015

WILLIE PEARSON vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS, Chamberlain's Children Center, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SUPERIOR NATIONAL INSURANCE COMPANY

In this workers' compensation case, CIGA sought to be relieved of liability for applicant's medical treatment, arguing that the State of California Department of Corrections ("the State") constituted "other insurance." The Appeals Board affirmed the WCJ's decision that the State does not qualify as "other insurance" under Insurance Code section 1063.1(c)(9)(A). Unlike private self-insured employers, the State is not required to obtain workers' compensation insurance or a certificate of self-insurance, and thus does not fall within the statutory definition of an "insurer." The Board further clarified that the State Compensation Insurance Fund's role in claim adjustment services for the State does not make it "other insurance" when the State is not otherwise insured with SCIF.

CIGASupernational Insurance Companylegally uninsuredother insurancecovered claimsInsurance Code Section 1063.1State of California Department of Correctionsreimbursementstipulated awardjoint and several liability
References
Case No. ANA 0366568
Regular
Aug 21, 2007

STACY MACK vs. CAREER STRATEGIES TEMP., INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, BROADSPIRE, SUN AMERICA, STATE COMPENSATION INSURANCE FUND, TELEFLORA, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award, remanding the case to determine if the State Compensation Insurance Fund (SCIF) policy for Sun America constitutes "other insurance" under Insurance Code section 1063.1(c)(9). This determination is crucial for assessing the liability of the California Insurance Guarantee Association (CIGA), which seeks to avoid coverage by arguing the SCIF policy is available. The WCAB requires further proceedings to fully develop the record regarding the intent and applicability of the SCIF policy for special employees.

CIGAcovered claimother insurancegeneral employerspecial employerSuperior National Insurance CompanyState Compensation Insurance FundInsurance Code section 1063.1(c)(9)Insurance Code section 11663joint and several liability
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. 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
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