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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. 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. ADJ4678688 (LBO 0318838) ADJ820791 (LBO 0319383)
Regular
Dec 11, 2008

DONALD ANSON vs. EDELMAN MENTAL HEALTH FACILITY, PDQ PERSONNEL SERVICES, INTERCARE for SUPERIOR NATIONAL INSURANCE COMPANY, California Insurance Guarantee Association (CIGA)

This case concerns a workers' compensation claim for an employee injured while working for a general employer (PDQ) and a special employer (County of Los Angeles). The California Insurance Guarantee Association (CIGA) sought reconsideration after an order found them solely liable. The Appeals Board reversed, finding the County of Los Angeles, as a self-insured entity, is solely liable for benefits because its self-insurance constitutes "other insurance" under relevant statutes, excluding CIGA's coverage.

CIGAPDQ Personnel ServicesSuperior National Insurance CompanyliquidationIntercaregeneral employerspecial employerCounty of Los AngelesLabor Code section 3602(d)Rule 15360
References
5
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. 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
6
Case No. ADJ4634668 (FRE 0169001)
Regular
Jan 31, 2012

SUE JORDAN vs. ANDERSON CLAYTON & CO. (COALINGA FEED YARD), STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE COMPANY, in liquidation

The California Insurance Guarantee Association (CIGA) sought reconsideration of an order approving a compromise and release agreement between the applicant and State Compensation Insurance Fund (SCIF). CIGA argued its due process rights were violated as it wasn't properly notified of the 2006 order. The Appeals Board found the 2006 order did not affect CIGA's right to seek reimbursement from SCIF, as CIGA's claim arises from insurance code provisions, not the prior agreement. The Board affirmed the 2006 order and returned the case to the trial level to determine CIGA's reimbursement claim against SCIF.

CIGASCIFFremont Insuranceliquidationcompromise and releasecumulative traumaindustrial injuryreimbursementother insuranceInsurance Code section 1063.1(c)(9)
References
17
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. ADJ4153143, ADJ1964837 and ADJ1933860
Regular
Nov 05, 2010

JACK L. MARCUM vs. OUTSOURCE MANAGEMENT, INC. dba THE MANAGEMENT CONNECTION, SUPERIOR NATIONAL INSURANCE CO., now liquidation, administered by CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, KLEEGE INDUSTRIES, INC. dba HANDS-ON EVENT LABOR SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant who sustained shoulder injuries in 1999 and 2000, with a compensation judge awarding 4% permanent disability. The California Insurance Guarantee Association (CIGA) is appealing a decision holding it liable, arguing the applicant was not employed by a company insured by Legion Insurance (now handled by CIGA) but rather by Kleege Industries, insured by SCIF. CIGA contended there was a general/special employment relationship and that SCIF's policy should cover the applicant. The Appeals Board granted reconsideration, affirmed the previous awards, and corrected a clerical error to accurately reflect Legion Insurance as the insurer for Outsource Management, Inc. during the relevant period.

California Insurance Guarantee AssociationLegion Insurance CompanyOutsource Management Inc.The Management ConnectionKleege Industries Inc.Hands-On Event Labor ServicesState Compensation Insurance Fundcumulative traumaright shoulder injurypermanent disability
References
1
Case No. ADJ3535372 (POM 0252700) ADJ4563878 (POM 0290856)
Regular
Sep 23, 2013

JANET BOWEN vs. MICHAEL J'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by INTERCARE INSURANCE SERVICES for PACIFIC NATIONAL INSURANCE, in liquidation, GLENDORA CONTINENTAL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior order finding the California Insurance Guarantee Association (CIGA) entitled to reimbursement from the State Compensation Insurance Fund (SCIF). SCIF argued CIGA's reimbursement claim was untimely and that CIGA knew of SCIF's joint liability. CIGA asserted SCIF never contested the reimbursement amount. The Board affirmed the WCJ's decision, clarifying CIGA's statutory role and distinguishing "coverage" from "covered claim," deeming SCIF's arguments regarding coverage misplaced.

California Workers CompensationCIGASCIFReimbursementPetition for ReconsiderationFindings and OrderStipulated AwardCovered ClaimsInsolvent InsurerInsurance Code Section 1063
References
3
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