CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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. SRO 0107686
En Banc
Jul 27, 2004

Jose L. Martinez vs. Jack Neal & Son, Inc., Fremont Compensation Insurance Company, In Liquidation, California Insurance Guarantee Association, Cambridge Integrated Services, Inc.

The Appeals Board held that under Insurance Code section 1063.1(c)(8), as amended effective January 1, 2004, the California Insurance Guarantee Association (CIGA) is not liable for Labor Code section 5814 penalties awarded on or after that date for an insolvent insurer's unreasonable delay of benefits.

CIGAinsolvent insurercovered claimsLabor Code section 5814Insurance Code section 1063.1(c)(8)unreasonable delaymedical benefitsen banc decisionprospective applicationstatutory exclusion
References
20
Case No. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
Case No. SRO 112972
Regular
Jun 12, 2008

STELLA JUAREZ vs. ARTERIAL VASCULAR ENGINEERING, NELSON STAFFING, CENTRE INSURANCE COMPANY by REM, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by BROADSPIRE for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation

The California Insurance Guarantee Association (CIGA) has the right to seek contribution from Centre Insurance Company for workers' compensation benefits paid to an applicant with a cumulative trauma injury. CIGA's claim is not barred by the one-year limitation period for employer contribution claims under Labor Code section 5500.5(e), as CIGA is not an employer and Centre is considered "other insurance" under Insurance Code section 1063.1(c)(9). Therefore, the Appeals Board granted CIGA's petition for reconsideration and reversed the arbitrator's decision, awarding CIGA contribution from Centre.

CIGAContributionReconsiderationFindings Award and OrderLabor Code section 5500.5Insurance Code section 1063.1(c)(9)Cumulative TraumaGeneral EmployerSpecial EmployerOther Insurance
References
8
Case No. MISSING
Regular Panel Decision

Bryam Hills Central School District No. 1 v. State Insurance Fund

This case involves an appeal concerning the obligations of the State Insurance Fund under insurance policies. The Bryam Hills Central School District No. 1 sought a declaratory judgment to compel the State Insurance Fund to defend actions initiated by Dorothy G. Caruolo. The initial Supreme Court judgment had granted summary judgment to the school district, mandating the State Insurance Fund to provide a defense. The appellate court modified this judgment, affirming the State Insurance Fund's duty to defend the first Caruolo action due to sufficient general negligence allegations, thereby invoking policy coverage. However, the court reversed the requirement to defend two other actions seeking salary and benefits, as these claims were rooted in contract and expressly excluded by the policy, negating any duty to defend in those specific instances.

Insurance Policy ObligationsDuty to DefendDeclaratory JudgmentSummary JudgmentAppellate ReviewContract ExclusionWorkers' Compensation ImplicationsNegligence ClaimsInsurance Coverage DisputeSupreme Court Appeal
References
4
Case No. SRO 0107686
Significant
Jun 10, 2004

Jose L. Martinez, Applicant vs. Jack Neal & Son, Inc., Fremont Compensation Insurance Company, In Liquidation, California Insurance Guarantee Association, and Cambridge Integrated Services, Inc. (Servicing Facility), Defendants

The Appeals Board, in an en banc decision, granted CIGA's petition for reconsideration, holding that under the amended Insurance Code section 1063.1(c)(8), CIGA is not liable for Labor Code section 5814 penalties for an insolvent insurer's delays on awards issued after January 1, 2004.

CIGAFremont Compensation Insurance CompanyLabor Code section 5814Insurance Code section 1063.1(c)(8)covered claimsinsolvent insurerpenaltyunreasonable delaymedical benefitsen banc decision
References
18
Case No. MISSING
Regular Panel Decision
Jan 22, 2007

Liberty Mutual Insurance v. Insurance Co. of Pennsylvania

This case concerns an appeal regarding an insurance dispute between Liberty Mutual (excess insurer) and AIG (primary insurer) over a $1.5 million settlement payment in a personal injury action. The underlying action involved an employee of General Industrial Service Corporation, a subcontractor, suing the project's owner and construction manager under the Labor Law. AIG, General's primary insurer, had refused to participate in the defense or settlement. The Supreme Court's order, which limited plaintiff's recovery to $500,000, was modified on appeal. The appellate court increased AIG's potential liability limit to $1,000,000, pending a determination of whether the employee sustained a 'grave injury' under Workers' Compensation Law § 11. The court affirmed that AIG, as a primary insurer, must exhaust its coverage before Liberty's excess coverage is implicated and is not entitled to apportionment with the excess insurer.

Insurance Coverage DisputeExcess InsurancePrimary InsuranceIndemnificationSubrogationWorkers' Compensation LawGrave InjurySummary JudgmentPolicy LimitsApportionment of Liability
References
6
Case No. STK 0142666
Regular
Jan 17, 2008

DAVID SOTO vs. ADVANCED PACKING & DISTRIBUTION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION On Behalf Of RELIANCE INSURANCE COMPANY, In Liquidation

This case involves a workers' compensation claim where the applicant sustained an injury while employed by both a general employer (Remedy) and a special employer (Advanced). Remedy's insurer, Reliance, became insolvent, leading CIGA to assume potential liability. The WCJ found that Advanced's insurer, SCIF, provided "other insurance" under Insurance Code § 1063.1(c)(9), thus relieving CIGA of responsibility. The Appeals Board denied SCIF's reconsideration, affirming that SCIF's policy constituted "other insurance" and that CIGA is a last resort insurer.

Workers Compensation Appeals BoardCIGAReliance Insurance Companyliquidationspecial employergeneral employerother insuranceInsurance Code section 1063.1(c)(9)covered claimsjoint and several liability
References
14
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
9
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
13
Showing 1-10 of 17,055 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational