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

Case No. ADJ6699348
Regular
Mar 17, 2016

KANON MONKIEWICZ vs. RM STORE FIXTURES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) issued a Notice of Intention to find that Labor Code section 4903.8(a) does not preclude awards to lien claimants Rx Funding Solutions, LLC and PharmaFinance, LLC. This is because the 2014 amendments to section 4903.8(a)(2) specify that it does not apply to assignments completed prior to January 1, 2013. Both of the lien claimants' assignments were made before this date, thus exempting them from the preclusion. The WCAB is amending its previous order and returning the case to the trial level for further proceedings on the merits of the liens.

Labor Code 4903.8Lien claimantsAssignment of receivablesCessation of businessPharmacy lienMedical lienSB 863AB 2732Prospective vs. retrospective applicationWCAB rules
References
10
Case No. ADJ11114421
Regular
Jun 05, 2025

FELIX CABRERA vs. OAA INVESTMENTS, INC.; CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

Defendant California Restaurant Mutual Benefit Corporation (CRMBC) sought reconsideration of a February 19, 2021 Findings and Order (F&O) which found CRMBC liable for coverage of applicant Felix Cabrera's injury, ruling that CRMBC's policy cancellation was premature. CRMBC contended it had no coverage obligations as the applicant was employed by OAA Investments, Inc., not insured by CRMBC, and argued against the applicability of Insurance Code section 676.8. The Appeals Board affirmed the WCA's F&O, treating the petition as one for reconsideration, and found that under Insurance Code section 676.8 and equitable principles, CRMBC was liable for coverage. The Board reasoned that due to a material change in ownership, CRMBC's cancellation notice required 30 days' notice, making January 27, 2018, the earliest effective cancellation date, which was after the November 22, 2017 injury date.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPolicy CancellationInsurance Code Section 676.8Material Change in OwnershipEquitable EstoppelAffiliate Certificate of Consent to Self-InsureGroup Self-InsurerAD Rule 15480
References
15
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

Zappone v. Home Insurance

The dissenting opinion by Judge Gabrielli argues against the majority's interpretation of subdivision 8 of section 167 of the Insurance Law. The dissent contends that the statute, which requires insurers to provide prompt written notice of disclaimer or denial of coverage for death or bodily injuries, should apply irrespective of whether the denial stems from a policy exclusion or a complete lack of coverage for the person or vehicle involved. Judge Gabrielli emphasizes a literal reading of the statute, asserting that the Legislature intended for insurers to bear the responsibility of promptly notifying insureds about coverage, given their superior position to interpret complex policy documents. The dissent also refutes the majority's concern about 'unreasonable results' of expanding coverage without premium, highlighting that such outcomes are not unique to the broader interpretation.

Insurance LawStatutory InterpretationCoverage DenialDisclaimer of LiabilityLegislative IntentPolicy ExclusionsPrompt NoticeDissenting OpinionAppellate ReviewContract Law
References
15
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. 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. 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. 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. MISSING
Regular Panel Decision

Nationwide Insurance v. Empire Insurance Group

This case concerns a dispute over insurance coverage. Marcos Ramirez was injured while working for Fortuna Construction, Inc. at premises owned by 11194 Owners Corp. Fortuna had subcontracted work from Total Structural Concepts, Inc. and agreed to add Total Structural as an additional insured on its general liability policy with Empire Insurance Group and Allcity Insurance Company. Ramirez sued 11194 Owners Corp. and Total Structural. Total Structural then commenced a third-party action against Fortuna. Nationwide Insurance Company, as Total Structural's insurer and subrogee, initiated a declaratory judgment action against Empire and Allcity after discovering Total Structural was an additional insured on their policy, demanding coverage for the Ramirez action. The Supreme Court granted Nationwide's motion for summary judgment, but the appellate court reversed, finding that Total Structural failed to provide timely notice of the Ramirez action to Empire and Allcity as required by the policy. The court emphasized that timely notice is a condition precedent to recovery and that lack of diligent effort to ascertain coverage vitiates the policy. Consequently, the appellate court granted Empire and Allcity's cross-motion, declaring they are not obligated to defend or indemnify Nationwide/Total Structural.

Insurance CoverageTimely NoticeCondition PrecedentDeclaratory JudgmentAdditional InsuredSubrogationSummary JudgmentBreach of ContractPersonal InjuryGeneral Liability Policy
References
8
Case No. ADJ460672 (SFO 0499592), ADJ224818 (SFO 0499593)
Regular
Jul 11, 2012

HAMID KHAZAELI vs. SPEDIA.COM, INC., and SYSMASTER CORP., GREAT AMERICAN INSURANCE CO

Applicant Hamid Khazaeli has been declared a vexatious litigant under CCR Title 8, Section 10782, requiring pre-filing approval for any filings with the Workers' Compensation Appeals Board (WCAB) unless represented by an attorney. His "Petition for Reconsideration, Removal, Disqualification, and to Compel Testimony" filed on June 29, 2012, was reviewed. The WCAB did not accept this petition for filing, deeming it largely duplicative of prior dismissed and rejected filings. This decision reinforces the applicant's status as a vexatious litigant subject to strict pre-filing review protocols.

Vexatious LitigantPre-filing OrderCCR Title 8 Section 10782Petition for ReconsiderationRemovalDisqualificationCompel TestimonyJudicial OfficersQuasi-Judicial OfficersAppeals Board
References
2
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