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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. ADJ3732235 (STK 0198780)
Regular
Sep 13, 2010

CURTIS J. MORGAN vs. CONSOLIDATED PERSONNEL CORP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, in liquidation, BRIDGESTONE/FIRESTONE, INC, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board denied reconsideration, affirming the finding of dual employers: Consolidated Personnel Corp. (CPC) as the general employer and Bridgestone/Firestone (B/F) as the special employer. Despite CPC's insurer (Legion) being insolvent and CIGA being involved, B/F's insurer (ICSP) was found liable as "other insurance" because its policy covered B/F's joint and several liability to the applicant. The Board upheld that CIGA is relieved of obligation when other insurance is available, as per statute. Therefore, ICSP is responsible for the applicant's industrial injury benefits.

Dual employmentGeneral employerSpecial employerJoint and several liabilityInsurance Code section 1063.1(c)(9)Covered claimsOther insuranceInsurer insolvencyCIGACollateral estoppel
References
13
Case No. ADJ621008 (MON 0291717)
Regular
Sep 05, 2012

WILLIAM KEY vs. PRODUCTION PROCESSING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS, LEGION INSURANCE COMPANY, STONE STANLEY PRODUCTIONS, ST. PAUL TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves a workers' compensation claim where the California Insurance Guarantee Association (CIGA), covering Legion Insurance, seeks reconsideration of an arbitrator's award. The arbitrator found both CIGA and Travelers, insurer for the special employer, jointly liable for the applicant's injury and ordered Travelers to reimburse CIGA for all benefits paid since Legion's liquidation. CIGA contested being required to continue administering medical treatment and the denial of pre-judgment interest from Travelers. The Board granted reconsideration to amend the award, ordering Travelers to administer future medical treatment, but affirmed the denial of pre-judgment interest to CIGA.

CIGALegion InsuranceProduction ProcessingStone Stanley ProductionsSt. Paul TravelersWilliam Keyindustrial injurylow backliquidationother insurance
References
1
Case No. MISSING
Regular Panel Decision

Serio v. Ardra Insurance

The Supreme Court, New York County, affirmed a judgment in favor of Gregory V. Serio, Superintendent of Insurance of the State of New York, as Liquidator of Nassau Insurance Company, against the DiLoreto defendants. The trial court's decision to pierce the corporate veil of Ardra Insurance Company, controlled from New York by Richard DiLoreto, was upheld based on New York law, despite Ardra's Bermuda incorporation. The court rejected the defendants' equitable estoppel claim, asserting that governmental agencies can alter positions in governmental functions. Furthermore, the evidence supported the jury's finding that transactions between Ardra and Nassau Insurance Company were unfair and inequitable, as the DiLoretos diverted funds, thereby denying Nassau coverage. The appellate court found the verdict consistent with the evidence and noted the defendants waived their claim regarding the jury's composition by consent.

Corporate Veil PiercingReinsuranceEquitable EstoppelGovernmental FunctionInsurance LawJury VerdictAppellate ReviewUnfair TransactionsCorporate DebtNew York Law
References
12
Case No. ADJ474396
Regular
Apr 26, 2013

VADIM KOVALENKO vs. PESP dba ACTION PRODUCTION, CIGA by SEDGWICK CMS for LEGION INSURANCE COMPANY, in liquidation, LUMINATIONS INC., ST PAUL FIRE & MARINE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order dismissing a lien claimant's lien with prejudice. The lien claimant failed to appear at a lien conference and provide proof of paying the required lien activation fee as mandated by Labor Code section 4903.06(a)(4). Despite the claimant's argument of not being aware of the conference date, the WCJ found this claim not credible based on the record. The Board adopted the WCJ's reasoning, affirming that no relief was available for the failure to pay the fee.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ OpinionReport and RecommendationDeniedApplicantDefendantsCIGALegion Insurance CompanyLiquidation
References
1
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. ADJ937954 (POM 0254711)
Regular
Aug 18, 2010

ANGELITA (ANGIE) FERNANDEZ vs. OAK TREE RACING ASSOCIATION, LOS ANGELES TURF CLUB, CADDIE SERVICES, INCORPORATED, CIGA by its servicing agent CAMBRIDGE INTEGRATED SERVICES for LEGION INSURANCE, in liquidation, CRAWFORD & COMPANY on behalf of ZURICH INSURANCE

This case involved an applicant claiming industrial injury to her shoulders and upper extremities. A prior insurer, Legion Insurance, erroneously paid benefits through its administrator, REM, before its insolvency. The Workers' Compensation Appeals Board denied reconsideration of the arbitrator's decision, which held Zurich Insurance (adjusted by Crawford & Company) liable for reimbursement to CIGA. This is because Zurich provided "other insurance" for a portion of the cumulative trauma injury, making it solely responsible for benefits where both an insolvent and solvent insurer would be liable. The Board found CIGA could recover pre-insolvency and mistaken payments, and Zurich's due process claims were unpersuasive.

CIGAZurich InsuranceCrawford & CompanyOak Tree Racing AssociationLegion InsuranceFremont Indemnitycumulative traumainsolvent insurersolvent insurerreimbursement
References
8
Case No. ADJ974365 (SAL 0098936)
Regular
Nov 23, 2011

SALVADOR ARANDA vs. EARLY CHILDHOOD.COM, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Administered By SEDGWICK CLAIMS MANAGEMENT SERVICES, LEGION INSURANCE COMPANY

This case involves Salvador Aranda's workers' compensation claim against Early Childhood.com and its insurer, Legion Insurance Company, which is in liquidation and administered by the California Insurance Guarantee Association (CIGA). The Workers' Compensation Appeals Board (WCAB) is dismissing Aranda's Petition for Reconsideration. The dismissal is primarily due to the petition being untimely, unverified, and lacking proper service on the defendant.

Petition for ReconsiderationWorkers' Compensation Appeals BoardUntimely petitionUnverified petitionFailure to serve defendantDismissalLegion Insurance CompanyLiquidationCalifornia Insurance Guarantee AssociationSedgwick Claims Management Services
References
0
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. 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
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