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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ937954 (POM 0254711)
Regular
Aug 18, 2010

ANGELITA (ANGIE) FERNANDEZ vs. OAK TREE RACING ASSOCIATION, LOS ANGELES TURF CLUB, CADDIE SERVICES, INCORPORATED, CIGA by its servicing agent CAMBRIDGE INTEGRATED SERVICES for LEGION INSURANCE, in liquidation, CRAWFORD & COMPANY on behalf of ZURICH INSURANCE

This case involved an applicant claiming industrial injury to her shoulders and upper extremities. A prior insurer, Legion Insurance, erroneously paid benefits through its administrator, REM, before its insolvency. The Workers' Compensation Appeals Board denied reconsideration of the arbitrator's decision, which held Zurich Insurance (adjusted by Crawford & Company) liable for reimbursement to CIGA. This is because Zurich provided "other insurance" for a portion of the cumulative trauma injury, making it solely responsible for benefits where both an insolvent and solvent insurer would be liable. The Board found CIGA could recover pre-insolvency and mistaken payments, and Zurich's due process claims were unpersuasive.

CIGAZurich InsuranceCrawford & CompanyOak Tree Racing AssociationLegion InsuranceFremont Indemnitycumulative traumainsolvent insurersolvent insurerreimbursement
References
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
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. ADJ4634668 (FRE 0169001)
Regular
Jan 31, 2012

SUE JORDAN vs. ANDERSON CLAYTON & CO. (COALINGA FEED YARD), STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE COMPANY, in liquidation

The California Insurance Guarantee Association (CIGA) sought reconsideration of an order approving a compromise and release agreement between the applicant and State Compensation Insurance Fund (SCIF). CIGA argued its due process rights were violated as it wasn't properly notified of the 2006 order. The Appeals Board found the 2006 order did not affect CIGA's right to seek reimbursement from SCIF, as CIGA's claim arises from insurance code provisions, not the prior agreement. The Board affirmed the 2006 order and returned the case to the trial level to determine CIGA's reimbursement claim against SCIF.

CIGASCIFFremont Insuranceliquidationcompromise and releasecumulative traumaindustrial injuryreimbursementother insuranceInsurance Code section 1063.1(c)(9)
References
Case No. ADJ3816448 (LAO 0789900) ADJ335314 (LAO 0818843) ADJ1177078 (LAO 0789901)
Regular
Sep 25, 2015

RAYMUNDO PITONES vs. MEL CAST LITHO, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves CIGA, the California Insurance Guarantee Association, seeking to be absolved of liability for workers' compensation benefits for an injured worker, Raymundo Pitones. CIGA argues that a settlement with another insurer for a subsequent, overlapping injury constitutes "other insurance" that should relieve CIGA of its obligations. The Workers' Compensation Appeals Board denied CIGA's petition, finding that the subsequent settlement did not fully cover all of Pitones' injuries, particularly those that did not overlap. Therefore, CIGA remains liable for the benefits not covered by the prior settlement to ensure the applicant can recover his full benefits.

CIGACalifornia Insurance Guarantee AssociationMel Cast LithoInc.California Compensation Insurance CompanyliquidationSEDGWICK CLAIMS MANAGEMENT SERVICESPetition for ReconsiderationJoint Findings of Fact and Orderworkers' compensation administrative law judge
References
Case No. FRE 0110112 and FRE 0114991
Regular
Feb 01, 2000

CENAIDA MEZA vs. SANDRINI BROTHERS, T & L HARVESTING, GOLDEN EAGLE INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE

The California Insurance Guarantee Association (CIGA) petitioned to be relieved as administrator of medical awards due to a solvent insurer's availability. The Appeals Board granted CIGA's petition, rescinding the prior decision and appointing Golden Eagle Insurance as the administrator. This decision aligns with precedent that CIGA is relieved of administrative duties when "other insurance" is available for successive injuries to the same body parts.

CIGAGolden Eagle InsuranceFremont InsuranceMedical Treatment AwardsSuccessive InjuriesApportionmentAdministratorSolvent InsurerInsolvencyCovered Claims
References
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
Case No. GOL 86641, GOL 99800
Regular
Aug 07, 2008

MIGUEL TORRES vs. HENDRY TELEPHONE PRODUCTS, CONNECTICUT INDEMNITY/ROYAL & SUNALLIANCE INSURANCE, HR3 STAFFING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to correct errors in the original award, specifically the misidentification of employers and their insurers. The WCAB rescinded the prior award and returned the case for further proceedings to determine the existence of a cumulative injury and clarify employer liability. The Board also noted that Connecticut Indemnity's policy likely constitutes "other insurance," thus precluding CIGA's involvement.

Workers' Compensation Appeals BoardJoint Findings and AwardReconsiderationIndustrial InjuryNeckRight Upper ExtremityCarpal Tunnel SyndromeCubital Tunnel SyndromeHeadachesDizziness
References
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