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

Case No. MISSING
Regular Panel Decision

DBL Liquidating Trust v. Clarkson Construction Co. (In Re Drexel Burnham Lambert Group, Inc.)

DBL Liquidating Trust (Drexel) appealed the Bankruptcy Court's denial of summary judgment in a claim filed by Clarkson Construction Company (Clarkson). The core issue was whether Clarkson ratified approximately 3,000 unauthorized trading transactions by failing to object in writing, despite explicit contractual requirements. Clarkson argued that oral assurances from their broker, Thomas Carpenter, stating 'nothing much was going on,' constituted an oral modification or grounds for equitable estoppel. However, the court found no legal basis for these arguments, emphasizing that the Account Agreement mandated written modifications and timely written objections. The court also highlighted that Clarkson's comptroller, authorized to review account statements, never raised any objections to the trades. Consequently, the District Court reversed the Bankruptcy Court's decision, ruling that Clarkson failed to present a triable issue of fact and dismissing Clarkson's claim.

Securities TradingBrokerage ContractSummary JudgmentEquitable EstoppelOral ModificationRatificationCommodity Customer Account AgreementUnauthorized TradingWritten ObjectionCustomer-Broker Relations
References
20
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. ADJ128210 (SAL 0093437) ADJ593542 (SAL 0093436)
Regular
Apr 12, 2010

JORGE RAMIREZ vs. LINO FINATTI, JR., CIGA on behalf of RELIANCE INSURANCE COMPANY, in liquidation, administered by INTERCARE SERVICES, CLARENDON INSURANCE COMPANY, adjusted by NORTH AMERICAN RISK SERVICES

This case involves a dispute over reimbursement for workers' compensation expenses between the California Insurance Guarantee Association (CIGA) and Clarendon Insurance Company. CIGA, covering for Reliance Insurance Company in liquidation, sought reimbursement for administrative expenses in addition to indemnity and medical costs. The arbitrator initially denied administrative expenses due to insufficient justification, but the Appeals Board granted reconsideration. The Board applied the *Ramos* decision, allowing CIGA to recover administrative costs like bill review and utilization review from Clarendon for the applicant's low back injuries.

CIGAReliance Insurance CompanyClarendon Insurance Companyadministrative expensesreimbursementbill reviewmedical managementutilization reviewsubpoenaing recordsjoint and several liability
References
2
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. ADJ855806 (VNO 0433480) ADJ1859136 (VNO 0436396)
Regular
Aug 19, 2010

JOHN BATTISTA vs. GROUND BREAKING CONSTRUCTION COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SABLE INSURANCE COMPANY, In Liquidation

This case concerns a dispute over reimbursement between the California Insurance Guarantee Association (CIGA) and State Compensation Insurance Fund (SCIF). CIGA seeks reimbursement for over $52,000 paid on behalf of Sable Insurance Company, which is in liquidation. SCIF argues the Administrative Law Judge (ALJ) improperly awarded reimbursement without ruling on SCIF's evidentiary objections, its request for cross-examination, or its arbitration claim. The Appeals Board granted reconsideration, finding the ALJ's decision lacked sufficient explanation and analysis of SCIF's contentions. The case is remanded to the trial level for further proceedings and a properly reasoned decision addressing all issues.

CIGASCIFSable Insurance Companyliquidationreimbursementapportionmenttemporary disabilitymedical treatmentexpensesarbitration
References
4
Case No. LAO 0762226, LAO 0762227
Regular
Sep 05, 2007

SHIRLEE DYERLY vs. LAWRY'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, INTERCARE INSURANCE SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY

This case involves a dispute over insurance coverage for an applicant's neck and back injuries sustained across specific and cumulative trauma incidents. The Workers' Compensation Appeals Board (WCAB) is reconsidering an arbitrator's decision that ordered Zurich North America Insurance Company to reimburse the California Insurance Guarantee Association (CIGA) for all benefits paid by the liquidated California Compensation Insurance Company (Cal Comp). The WCAB rescinds the arbitrator's order, ruling that CIGA can only recover the amount Cal Comp would have been entitled to collect had it not been liquidated, not the full amount paid.

CIGACal CompZurichliquidationcontributionreimbursementspecific injurycumulative traumastatute of limitationsjoint findings
References
7
Case No. CA 10-00545
Regular Panel Decision
Feb 10, 2011

HAHN AUTOMOTIVE WAREHOUSE, INC. v. AMERICAN ZURICH INSURANCE COMPANY

Hahn Automotive Warehouse, Inc. (plaintiff) initiated a breach of contract action against American Zurich Insurance Company and Zurich American Insurance Company (defendants), contending that bills issued under insurance contracts were time-barred. Defendants counterclaimed for damages stemming from plaintiff's alleged breach of these contracts. The Supreme Court partially granted plaintiff's cross-motion, deeming counterclaims for debts arising over six years prior as time-barred. Concurrently, it permitted defendants to utilize a $400,000 letter of credit to satisfy any outstanding debt, including those deemed time-barred. On appeal, the Appellate Division affirmed the use of the letter of credit for time-barred debts, reasoning that the statute of limitations only bars the remedy, not the underlying obligation. The court also affirmed that defendants' counterclaims for debts over six years old were time-barred, as the right to demand payment accrued earlier. Finally, the court modified the order to dismiss plaintiff's second through fourth causes of action. A dissenting opinion argued that the counterclaims were not time-barred, asserting that the cause of action accrued upon demand and refusal of payment, not merely when the right to demand payment existed.

Breach of contractInsurance contractsStatute of limitationsLetter of creditSummary judgmentAppellate reviewContract interpretationTime-barred claimsAccrual of cause of actionRetrospective premiums
References
23
Case No. ADJ9651491
Regular
Aug 22, 2016

JUDITH DIAZ vs. EXCELL SECURITY, INC., XL STAFFING, INC., XL CONSTRUCTION STAFFING; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for ULLICO CASUALTY COMPANY, in liquidation by its servicing facility, SEDGWICK CLAIMS MANAGEMENT SERVICES; SPARTA INSURANCE COMPANY by GALLAGHER BASSETT

The Workers' Compensation Appeals Board affirmed a prior finding that Sparta Insurance Company provided workers' compensation coverage for Judith Diaz. The Board found that Sparta's policy with Excell Security, Inc. did not exclude Diaz from coverage, despite Excell also having a policy with Ullico Casualty Company. Therefore, Sparta is considered "other insurance" and liable for applicant's benefits, upholding the Arbitrator's initial decision.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationFindings and OrderArbitratorother insuranceLabor Code section 1063California Insurance Guarantee AssociationCIGAULLICO CASUALTY COMPANYliquidation
References
2
Case No. ANA 352921
Regular
Oct 02, 2007

STEPHEN GRIFFIS vs. ORANGE COUNTY FIRE AUTHORITY, CIGA on behalf of RELIANCE NATIONAL INSURANCE COMPANY, in liquidation, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding an applicant's cumulative trauma injury to May 12, 1997. The WCAB found that AIG, as "other insurance," is liable for all benefits awarded after Reliance National Insurance Company (Reliance) became insolvent on October 3, 2001. Consequently, the California Insurance Guarantee Association (CIGA) is entitled to reimbursement from AIG for all benefits CIGA paid after Reliance's liquidation.

CIGAReliance National InsuranceAIG Claims Servicescumulative traumabilateral hearing lossstipulated awardliquidationreimbursementother insurancecovered claim
References
7
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