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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. FRE 186612
Regular
Mar 26, 2008

, Jose Maravilla, vs. , JOSE AND FLORENCIA ALVERNAZ and CIGA, by CAMBRIDGE INTERGRATE SERVICES for FREMONT INSURANCE COMPANY, in liquidation; LIBERTY MUTUAL INSURANCE COMPANY; CALIFORNIA INDEMNITY INSURANCE COMPANY, adjusted by GAB ROBINS

This case involves Liberty Mutual/Golden Eagle Insurance Company's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision finding applicant sustained a cumulative trauma injury to both knees. The WCAB denied reconsideration, finding the Statute of Limitations defense was waived and that the *Benson* case regarding allocation of disability cause was not applicable as there was only one industrial injury. The WCAB adopted the WCJ's report in its entirety for its denial.

Workers' Compensation Appeals BoardJose MaravillaJose and Florencia AlvernaCIGAFremont Insurance CompanyLiberty Mutual Insurance CompanyCalifornia Indemnity Insurance CompanyGAB RobinsFRE 186612Opinion and Order Denying Petition for Reconsideration
References
Case No. ADJ7598160
Regular
Nov 19, 2014

MAURICE JOHNSON vs. PHILADELPHIA EAGLES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE INSURANCE COMPANY, in liquidation, FAIRMONT PREMIER INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a lower decision, finding California lacked jurisdiction over a professional football player's cumulative trauma claim against the Philadelphia Eagles. The Board held that playing only two games in California did not create a sufficient connection to the injury to warrant applying California law, citing *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*. The applicant's limited physical presence and routine pre/post-game treatment in California were deemed de minimis. Therefore, the applicant took nothing on his California WCAB claim.

CIGAPhiladelphia EaglesReliance Insurance Companycumulative traumaprofessional football playerjurisdictionFederal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)administrative law judgepermanent disabilityapportionment
References
Case No. ADJ7529761
Regular
Sep 02, 2018

MARIA GARCIA vs. GREEN CUISINE, INC., GOLDEN EAGLE INSURANCE COMPANY, SOUTHERN INSURANCE COMPANY

This case involves Southern Insurance Company seeking reconsideration of an arbitrator's award of contribution to Golden Eagle Insurance Company. Southern argued a contribution petition filed before a Compromise and Release (C&R) approval was void, and Golden Eagle missed the subsequent one-year limitations period. The Board denied reconsideration, adopting the arbitrator's report and finding the initial petition timely filed under Labor Code Section 5500.5(e). The Board clarified that filing before award approval does not void a contribution petition, especially when the C&R doesn't require a refiling.

Petition for ReconsiderationCompromise and ReleasePetition for ContributionLabor Code section 5500.5(e)ContributionArbitratorFindings and AwardGolden Eagle Insurance CompanySouthern Insurance CompanyIndustrial Injury
References
Case No. ADJ1234371 (LAO 0785447) ADJ2536321 (LAO 0863778)
Regular
Sep 17, 2012

JOSE AGUILAR vs. DAVALAN SALES, VIRGINIA SURETY COMPANY, CLARENDON NATIONAL INSURANCE COMPANY, GOLDEN EAGLE INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration due to a failure to properly serve Clarendon National Insurance Company. This procedural defect, specifically the lack of a required proof of service, is grounds for dismissal under California regulations. Had the petition not been dismissed, the Board would have denied it based on the administrative law judge's original findings. The applicant had sought reconsideration of findings regarding industrial injuries and disability assessments for multiple injury dates and insurers.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for Reconsiderationindustrial injurylow backlaborerwarehousemaninsurance coverageVirginia Surety CompanyClarendon National Insurance Company
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. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
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. ADJ2480026
Regular
Aug 26, 2011

CHAD IMES vs. SCENARIO DESIGNS, INC., EVEREST NATIONAL INSURANCE COMPANY, POWER PAYROLL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling and ordered Everest National Insurance Company to reimburse CIGA for benefits paid to the applicant. The Board found that Everest was "other insurance" available under Insurance Code section 1063.1(c)(9) because its insured, Scenario Designs, Inc., employed the applicant on the date of injury. This decision clarifies that reimbursement to CIGA does not alter the original award and aligns with statutory limitations on CIGA's liability. Everest is now obligated to reimburse CIGA and administer future benefits.

CIGAEverest National Insurance CompanyLegion Insurance CompanyScenario DesignsPower PayrollInc.other insurancereimbursementdate of injurygeneral-special employment
References
Case No. ADJ2398835 (LAO 0799123)
Regular
Mar 26, 2010

LETICIA FERNANDEZ vs. MOUNT ST. MARY'S COLLEGE, CONVERIUM INSURANCE COMPANY/SRS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK, INC., LEGION INSURANCE COMPANY, VILLANOVA INSURANCE COMPANY

Converium Insurance Company sought reconsideration of a decision denying its claim for reimbursement from the California Insurance Guarantee Association (CIGA). Converium had paid workers' compensation benefits to Leticia Fernandez, but later argued these payments were made in error due to applicant's denial of a specific injury. The Arbitrator recommended denying reconsideration, finding that CIGA statutes, particularly Insurance Code Sections 1063.1(c)(5) and (9), prohibit reimbursement to solvent insurance carriers for claims that are not "covered claims" or are made by assignees or subrogated parties. The Workers' Compensation Appeals Board adopted the Arbitrator's report, denying Converium's petition for reconsideration.

California Insurance Guarantee AssociationCIGAConverium Insurance CompanySRSLegion Insurance CompanyVillanova Insurance Companyliquidationreconsiderationarbitrator's reportspecific injury
References
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