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

Case No. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
Case No. AHM 90917 AHM 90918
Regular
Jul 11, 2007

ANGEL SOSA vs. D.W. FOODS, EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, VILLANOVA INSURANCE

This case concerns a dispute over reimbursement between an insurer, Everest, and the California Insurance Guarantee Association (CIGA), which is handling claims for a liquidated insurer, Villanova. The Board denied Everest's petition, upholding a prior award for reimbursement from Everest to CIGA. However, the Board granted CIGA's petition to amend the award to include Villanova Insurance as a party defendant.

CIGAEverest National Insurance CompanyVillanova Insuranceliquidationreconsiderationreimbursementbill review chargesjoint and several liabilitycumulative traumadenied due process
References
0
Case No. ADJ4699173 (FRE 204280) ADJ2234380 (FRE 204242) ADJ201252 (FRE 206405) ADJ3631426 (FRE 213090)
Regular
Nov 14, 2008

JOHNNY DURAN vs. DARRYL HITCHMAN, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, in liquidation, by BROADSPIRE, CENTREX HOMES, AMERICAN GUARANTEE AND LIABILITY INSURANCE/ZURICH NORTH AMERICAN OCIP

This case concerns applicant Johnny Duran's industrial injuries to his back and knees. The California Insurance Guarantee Association (CIGA) sought reconsideration of a finding that the cases should be returned to arbitration for insurance coverage issues. The Appeals Board rescinded the prior decision, finding no arbitration is necessary because Zurich already established coverage for cumulative trauma injuries. However, the cases are returned to the Workers' Compensation Judge to determine CIGA's liability for benefits solely attributable to specific injuries where Superior National was the sole available insurer.

CIGASuperior National Insurance CompanyliquidationreconsiderationWorkers' Compensation Appeals BoardArbitratorinsurance coverageLabor Code Section 5275(a)(1)compromise and releaseZurich North American
References
4
Case No. ADJ6865467
Regular
Nov 14, 2012

TIRADO vs. OAKMOUNT COUNTRY CLUB, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION BY ITS SERVICING FACILITY, XCHANGING FOR FREMONT INSURANCE COMPANY, IN LIQUIDATION

This case concerns whether a collection agreement constituted an assignment, thereby excluding the California Insurance Guarantee Association (CIGA) from liability for a workers' compensation lien. The Workers' Compensation Appeals Board (WCAB) rescinded a prior finding that an assignment occurred. The WCAB found that the agreement with WSG & Associates, despite granting broad authority for collection and settlement, did not transfer ownership of the lien. Key factors included the lien claimant retaining the right to terminate the agreement and the ultimate payment being made to the lien claimant, aligning with precedent that such arrangements are not assignments.

Workers' Compensation Appeals BoardCIGAInsurance Code section 1063.1assignment of lienlien claimantnon-attorney representativecovered claiminsolvent insurercompromise and releaseFindings and Order
References
2
Case No. ADJ1868495 (VNO 0452398) ADJ4538828 (VNO 0468076)
Regular
Dec 14, 2012

JORGE HERNANDEZ vs. CRESCENT TRUCK LINES, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES, RELIANCE NATIONAL INSURANCE COMPANY

This case concerns the California Insurance Guarantee Association (CIGA) seeking reimbursement from the State Compensation Insurance Fund (SCIF) for costs incurred administering workers' compensation claims. The WCJ initially awarded CIGA reimbursement for benefits paid but not for associated administration expenses. The Appeals Board granted CIGA's reconsideration petition, ruling that CIGA is entitled to reimbursement for both benefits and specific claim administration expenses, including medical-legal costs. The Board amended the findings and award to reflect this, returning the matter to the trial level for further proceedings.

CIGAReliance National Insurance CompanySedgwick Claims Management ServicesState Compensation Insurance Fund (SCIF)Petition for ReconsiderationJoint Findings and Award (F&A)reimbursementassociated expensesmedical treatmentloss adjustment expense
References
10
Case No. MISSING
Regular Panel Decision
May 20, 1994

Twyford v. Production Associates, Inc.

Production Associates, Inc. appealed an order from the Supreme Court, Richmond County, which granted McDonald’s Corporation’s motion to dismiss a third-party complaint. The primary action involved Thomas E. Twyford, a McDonald's employee, who sued Production Associates for injuries suffered at a convention. Production Associates then sought contribution from McDonald's. The Supreme Court initially applied Pennsylvania law, leading to the dismissal of the third-party complaint. However, the appellate court reversed this decision, concluding that Illinois law should apply based on an 'interests analysis' approach, as both Production Associates and McDonald's have significant ties to Illinois. Illinois workers' compensation law, unlike Pennsylvania's or New Jersey's, does not preclude third-party contribution claims against an employer.

Personal InjuryThird-Party ActionWorkers' CompensationChoice of LawConflict of LawsContribution ClaimsSummary JudgmentAppellate ReviewIllinois LawPennsylvania Law
References
4
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. ADJ2747954 (LAO 0820830) ADJ1942372 (LAO 0822123) ADJ2627431 (LAO 0820831)
Regular
Aug 15, 2016

ROSARIO GUTIERREZ vs. ADVANCE PAPER BOX, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Workers' Compensation Appeals Board (WCAB) has dismissed a petition for reconsideration in the case of Rosario Gutierrez versus Advance Paper Box and its insurer, the California Insurance Guarantee Association. The dismissal is due to the petitioner voluntarily withdrawing their request for reconsideration of the June 3, 2016 decision. This administrative order formally closes the reconsideration process as requested.

Petition for ReconsiderationDismissedWithdrawnWorkers' Compensation Appeals BoardAdvance Paper BoxCalifornia Insurance Guarantee AssociationSedgwickUS Fidelity & GuaranteeLiquidationCase Numbers
References
0
Case No. LAO 0830286, LAO 0830287
Regular
Aug 27, 2007

GUADALUPE MORERA vs. ANNA'S LINENS, SAFETY NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted CIGA's petition, finding that the applicant sustained cumulative trauma orthopedic injury based on substantial medical evidence. The Board rescinded the award for temporary total disability from September 4 to October 16, 2002, as evidence showed the applicant took vacation during that period. The case is returned to the trial level for further proceedings regarding apportionment of permanent disability.

Workers' Compensation Appeals BoardGUADALUPE MORERAANNA'S LINENSSAFETY NATIONAL INSURANCE COMPANYCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONLEGION INSURANCE COMPANYBROADSPIREPetition for ReconsiderationFindings and AwardsWCJ
References
4
Case No. ADJ1153742
Regular
Aug 27, 2009

PAUL MANVELYAN vs. BROADSPIRE CLAIM SERVICE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

This case concerns a lien claimant seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB affirmed the judge's finding that the California Insurance Guarantee Association (CIGA) is not liable for interest on a medical lien, despite the claimant being an assignee. The Board adopted the judge's report, incorporating its reasoning, and denied the petition for reconsideration. The Board also admonished the lien claimant for using disrespectful language towards the judge in her petition.

Workers' Compensation Appeals BoardPaul ManvelyanBroadspire Claim ServiceCalifornia Insurance Guarantee AssociationTina DyckDr. Jeannette Martellolien claimantPetition for ReconsiderationFindings and Awardadministrative law judge
References
0
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