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

Case No. ADJ4534513
Regular
Jul 26, 2016

JEFFREY FARMER vs. CITY OF FREMONT

The Workers' Compensation Appeals Board (WCAB) granted the City of Fremont's petition for reconsideration in the case of *Farmer v. City of Fremont*. This grants the WCAB more time to thoroughly review the factual and legal issues presented in the case. The WCAB will issue a Decision After Reconsideration following this further study. All communications related to the petition should be directed to the Appeals Board's San Francisco office, not district offices or e-filing.

Petition for ReconsiderationWorkers' Compensation Appeals BoardCity of FremontYORKStatutory Time ConstraintsFactual and Legal IssuesJust and Reasoned DecisionElectronic Adjudication Management System (EAMS)Trial Level DocumentsPetition for Penalties
References
0
Case No. ADJ2279830 (LBO 0290929) ADJ3851198 (LBO 0362934)
Regular
Sep 05, 2008

SUSAN ORTLOFF vs. ANAHEIM GENERAL HOSPITAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT COMPENSATION, ARGONAUT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted CIGA's reconsideration, affirming the denial of contribution for Fremont's pre-insolvency benefits due to untimeliness under Labor Code §5500.5(e). However, the Board reversed the denial of CIGA's reimbursement claim for post-insolvency benefits, finding that Argonaut provided "other insurance" and is therefore liable for reimbursement. The Board ordered Argonaut to reimburse CIGA for benefits paid after Fremont's insolvency.

CIGAFremont CompensationArgonaut Insurancecontributionreimbursementinsolvencycumulative traumastipulated awardstatute of limitationsLabor Code 5500.5(e)
References
11
Case No. ADJ2510198
Regular
Jul 28, 2011

ANGEL RIVERA vs. FREMONT FENCE, ENDURANCE INSURANCE COMPANY

The defendant, Fremont Fence and Endurance Insurance Company, filed an untimely petition for removal seeking to reopen discovery. The petition was filed one day after the deadline, which was June 8, 2011, because the order closing discovery was personally served on the defendant's counsel. The Workers' Compensation Appeals Board dismissed the petition due to its untimeliness.

Petition for RemovalUntimely PetitionWorkers' Compensation Appeals BoardAgreed Medical EvaluatorCross-examinationSupplemental ReportClose of DiscoveryMandatory Settlement ConferencePersonal ServiceCode of Civil Procedure 1013
References
2
Case No. ADJ2754339, ADJ2982695
Regular
Feb 22, 2023

VIRGINA VASQUEZ vs. KING MEAT, INC., FREMONT INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA)

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by CIGA. CIGA challenged a prior finding that allowed payment for medical treatment and a specific medical-legal report by Dr. Konstat. The Board adopted the Workers' Compensation Judge's report, which found that Dr. Konstat's treatment was reasonable and necessary, and that her 2007 medical-legal report was properly requested. The Board also determined that the prior judge's findings on reasonableness were binding in the subsequent lien trial.

CIGAPetition for ReconsiderationLien ClaimantPrimary Treating PhysicianMedical-Legal ReportsSelf-Procured TreatmentUtilization ReviewLabor Code section 4620Rules 9785(e)(3)Rules 9785(e)(4)
References
4
Case No. ADJ9085187
Regular
Feb 16, 2016

ESTES BANKS vs. CINCINNATI BENGALS, OAKLAND RAIDERS, FREMONT INDEMNITY

The Workers' Compensation Appeals Board granted reconsideration of a decision regarding applicant Estes Banks and defendants Cincinnati Bengals, Oakland Raiders, and Fremont Indemnity. The Board determined that reconsideration was necessary to allow further study of the factual and legal issues involved. This action is intended to ensure a complete understanding of the record and facilitate a just decision. All future filings related to this petition for reconsideration must be directed to the Office of the Commissioners.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationPermissibly SelfInsuredCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONliquidationstatutory time constraintsfactual and legal issuesjust and reasoned decisionfurther proceedingsElectronic Adjudication Management System
References
1
Case No. ADJ1256092 (VNO 0458544)
Regular
Oct 07, 2011

MARIA TOLEDO vs. WELLPOINT HEALTH NETWORK INC, CIGA for FREMONT in liquidation, administered by XCHANGING, ZURICH AMERICAN INSURANCE

This case involves Zurich American Insurance seeking reconsideration of a decision that extended applicant Maria Toledo's cumulative trauma injury period to November 1, 2001, placing liability on Zurich. Zurich argued the injury date should be December 2000, during Fremont/CIGA's coverage, as medical evidence, including the Agreed Medical Examiner (AME) Dr. Sohn's reports, allegedly only supported exposure until that earlier date. The Board denied reconsideration, affirming that the AME found the totality of applicant's employment duties, including those as a sales assistant after a job change, contributed to her cumulative trauma until November 1, 2001. Therefore, Zurich remains liable for the injury.

Cumulative traumaDate of injuryPeriod of injurious exposureLabor Code section 5412Section 5500.5Agreed Medical Examiner (AME)Dr. Roger SohnMedical evidenceZurich North AmericaFremont Compensation Insurance
References
1
Case No. ADJ1521373 (SFO 0475882)
Regular
Feb 03, 2012

JOHN KOCH vs. R.E. STATE ENGINEERING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE GROUP, in liquidation

In this workers' compensation case, the applicant's employer sought reimbursement from CIGA for benefits paid to the applicant following an industrial injury. The applicant was entitled to benefits under both California workers' compensation law and the federal Longshore and Harbor Workers' Compensation Act (LHWCA). CIGA argued it was not liable because the applicant claimed benefits under the LHWCA, which is excluded from CIGA's covered claims. The Appeals Board, however, affirmed the WCJ's decision, finding that the employer's claim for reimbursement of California statutory benefits was a "covered claim" and CIGA was liable due to the insolvency of the employer's insurer, Fremont. The Board reasoned that the employer's payment of LHWCA benefits did not make them "other insurance" and the claim was for benefits due under California law, not the LHWCA itself.

CIGAFremont Insurance GroupLongshore and Harbor Workers' Compensation ActLHWCAcollateral estoppelcovered claimInsurance Code Section 1063.1insolvencyreimbursementstate workers' compensation
References
16
Case No. ADJ1888124 (SAL 0111884) ADJ3322590 (SAL 0079903)
Regular
Oct 20, 2016

MARIA NUNEZ vs. MANN PACKING COMPANY, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For FREMONT COMPENSATION INSURANCE COMPANY, In Liquidation; STATE OF CALIFORNIA

This case concerns the California Insurance Guarantee Association's (CIGA) liability for an applicant's workers' compensation claims after Fremont Compensation Insurance Company became insolvent. CIGA argued it should be relieved of liability because the State of California, as the applicant's employer through IHSS, constituted "other insurance" under Insurance Code Section 1063.1. The Appeals Board affirmed the WCJ's decision, holding that the State of California does not qualify as "other insurance" under the relevant statutes. This distinction is based on the State not being required to obtain workers' compensation insurance or a certificate of self-insurance like private or other public employers.

CIGAFremont Compensation Insurance Companyliquidationlegally uninsuredother insuranceInsurance Code Section 1063.1covered claimsIn-Home Supportive Services (IHSS)statutory limitationsself-insurance
References
5
Case No. GRO 0022416
Regular
Mar 24, 2008

GERALD RICE vs. ALASCO RUBBER & PLASTICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CAMBRIDGE INTEGRATED SERVICES GROUP, FREMONT COMPENSATION INSURANCE COMPANY, NATIONAL SURETY/FIREMAN'S FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior decision. The Board found that the California Insurance Guarantee Association (CIGA) is solely liable for the applicant's industrial injury benefits. This is because the insolvent insurer, Fremont Compensation Insurance Company, was the only insurer on the risk during the one-year period preceding the applicant's cumulative trauma injury.

WORKERS' COMPENSATION APPEALS BOARDCIGAFREMONT COMPENSATION INSURANCE COMPANYINSOLVENCYLIQUIDATIONCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONNATIONAL SURETY/FIREMAN'S FUNDALASCO RUBBER & PLASTICSLABOR CODE SECTION 5500.5CUMULATIVE TRAUMA INJURY
References
1
Case No. LBO 272299
Regular
Apr 04, 2008

Margot Hamilton vs. McDONNELL DOUGLAS CORPORATION, CIGA By Its Servicing Facility, CAMBRIDGE INTEGRATED SYSTEMS, On Behalf Of FREMONT COMPENSATION, In Liquidation, Insurance Company for the State of Pennsylvania

The Workers' Compensation Appeals Board granted reconsideration to address the disputed earnings of applicant Margot Hamilton, deferring final determination of temporary and permanent disability indemnity. The Board affirmed the finding of cumulative trauma injury to the applicant's back and knees extending into the defendant's coverage period, and confirmed CIGA's entitlement to reimbursement for pre-insolvency benefits paid by Fremont Insurance. The Board also corrected the procedural heading of the original decision.

Cumulative TraumaDate of InjuryApportionmentPermanent DisabilityTemporary DisabilityReconsiderationCIGAFremont CompensationInsurance Company for the State of PennsylvaniaWCJ
References
0
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