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

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. ADJ9761409, ADJ10946911
Regular
Sep 11, 2018

ANGELA COLE vs. MARCONI CONFERENCE CENTER, STATE COMPENSATION INSURANCE FUND, AMERICAN INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration, reversing a prior finding that SCIF was solely liable for applicant's cumulative injury. The Board determined the correct Labor Code section 5412 date of injury was December 10, 2014, based on the concurrence of disability and knowledge of its industrial nature. Consequently, the Labor Code section 5500.5(a) liability period is the year preceding that date, making American Insurance Company, the carrier during that period, solely liable for compensation. The Board rescinded the prior award and issued a new decision and award against American Insurance Company.

Labor Code section 5500.5Labor Code section 5412cumulative injurydate of injurydisabilityknowledgeliability periodconcurrent disability and knowledgetemporary disabilitypermanent disability
References
5
Case No. ADJ6671169
Regular
Oct 16, 2013

Christian Fauria vs. Carolina Panthers, Great Divide Insurance Co., Berkley Specialty Underwriting Managers, LLC, Washington Redskins, ESIS Insurance, New England Patriots, Liberty Mutual Insurance Co., Travelers Indemnity Co., Golf Insurance Co., Seattle Seahawks

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award finding California jurisdiction over Christian Fauria's claim due to lack of "regular employment" in California, as defined by Labor Code Section 3600.5(a). The case was remanded to the trial level to determine if jurisdiction exists based on injuries sustained within California or if the contract of hire was made in California, as per Labor Code Section 5305. The WCAB also instructed the judge to address all issues, including apportionment and liability periods under Labor Code Section 5500.5. The decision highlights the need for substantial evidence to establish jurisdiction and injury contribution within the state.

Workers' Compensation Appeals BoardChristian FauriaProfessional AthleteIndustrial InjuryPermanent DisabilityFurther Medical TreatmentLabor Code Section 3600.5(a)Statute of LimitationsLabor Code Section 5500.5Jurisdiction
References
29
Case No. ADJ2081826 (VNO 0525965)
Regular
Jun 09, 2011

JANET TANZMAN vs. WARNER PACIFIC INSURANCE, EMPLOYER'S COMPENSATION INSURANCE COMPANY, FREMONT COMPENSATION INSURANCE COMPANY

This case involves a cumulative trauma injury where the applicant disputes the workers' compensation judge's findings on the injury's ending date and the responsible insurance carrier. The Appeals Board granted reconsideration due to an incomplete record and unclear stipulations regarding the injury period and specific body parts affected. The Board rescinded the prior decision, returning the matter for further proceedings to clarify these crucial issues, including the date of injury under Labor Code section 5412 and potential carrier liability under section 5500.5. Issues of insurance coverage disputes are subject to mandatory arbitration.

Cumulative traumaDate of injuryInsurance coverage disputeCIGAFremont Compensation Insurance CompanyEmployers Compensation Insurance CompanyStipulationsLabor Code section 5412Labor Code section 5500.5Mandatory arbitration
References
6
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. Motions Nos. 5 and 7
Regular Panel Decision
Jul 27, 1978

Rachlin v. Lewis

This case consolidates two CPLR article 78 proceedings challenging the Insurance Department's regulations on attorneys' fees in no-fault automobile insurance disputes and the constitutionality of certain sections of the Insurance Law. The petitioners sought to rescind 11 NYCRR 65.16 and declare Insurance Law section 671 et seq. unconstitutional. The court ruled that sections 11 NYCRR 65.16 (c) (7) (ix), which prohibited attorneys from charging clients fees in excess of insurer-paid fees, and 11 NYCRR 65.16 (c) (7) (vii), concerning the regulation of disbursements, were invalid as they exceeded the scope of the enabling legislation. However, the court upheld the general fee schedule, finding a rational basis for its establishment by the Insurance Department.

Attorney's FeesNo-Fault InsuranceInsurance LawRegulatory ChallengeCPLR Article 78Administrative LawConstitutional LawDisbursementsArbitrationAutomobile Insurance
References
6
Case No. ADJ7539480
Regular
Sep 20, 2011

GARY KREFT vs. CELESTRON, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, COMPWEST INSURANCE COMPANY, HARTFORD INSURANCE COMPANY, AMERICAN CLAIMS MANAGEMENT, STATE COMPENSATION INSURANCE FUND, Everest National Insurance Co.

This case concerns a cumulative injury claim where the Workers' Compensation Appeals Board (WCAB) granted Everest National Insurance Co.'s Petition for Removal. The WCAB amended a prior order joining Everest and other carriers, clarifying that Labor Code section 5500.5(a) limits liability for cumulative injuries to employers/insurers covering the year immediately preceding the date of injury or last exposure. As the date of injury/exposure was not yet determined and appeared to be the last day of employment, only the carriers covering that final year (CompWest and Hartford) were ordered joined. Everest was removed as a party defendant pending further determination.

Petition for RemovalLabor Code section 5500.5(a)cumulative injurylast injurious exposurejoinder of partiesWorkers' Compensation Appeals Boarddate of injuryrepetitive job dutiesCalifornia Insurance Guarantee AssociationCIGA
References
1
Case No. GRO 017747 GRO 017748 GRO 019264
Regular
Jul 17, 2007

CRAIG ANTISTA vs. JORDANOS; CIGA By Its Servicing Facility INTERCARE INSURANCE SERVICES For CALIFORNIA COMPENSATION INSURANCE COMPANY, In Liquidation

The Workers' Compensation Appeals Board granted CIGA's petition for removal, rescinding a previous order compelling arbitration. The Board found that CIGA's reimbursement claim against TIG for successive injuries was not a mandatory arbitration matter under Labor Code Section 5500.5, but rather a matter governed by Insurance Code Section 1063.2. The case is returned to the trial level for further proceedings on CIGA's reimbursement petition.

CIGARemovalArbitrationContributionReimbursementInsurance Code Section 1063.2(b)Labor Code Section 5500.5WCJSuccessive InjuriesCumulative Injury
References
0
Case No. ADJ8967361
Regular
Nov 26, 2014

FELIPE GARCIA (DECEASED) GUILLERMINA GARCIA (WIDOW) vs. SALVADOR GAYTAN dba G\&P AG MANAGEMENT CONTRACTORS, INC.; STAR INSURANCE, Adjusted by MEADOWBROOK INSURANCE GROUP

This case involved a petition for reconsideration by the applicant in a workers' compensation matter where the deceased worker, Felipe Garcia, was initially found to be an employee but later deemed an independent contractor by the Appeals Board. The applicant argued the Board erred by disregarding the WCJ's credibility assessment and by not applying Labor Code section 2750.5 to unlicensed contractors. The Board denied the petition, finding no evidence the deceased worker was engaged in activities requiring a contractor's license under Business and Professions Code sections 7000 and 7026. Therefore, Labor Code section 2750.5 was inapplicable, and the prior decision finding the applicant an independent contractor was upheld.

Workers' Compensation Appeals BoardIndependent contractorEmployee statusReconsiderationLabor Code section 2750.5Contractors' State License LawBlew v. HornerGarza v. Worker's Comp. Appeals Bd.Rinaldi v. Workers' Comp. Appeals Bd.Unlicensed contractor
References
4
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
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