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

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. ADJ2263363 (SAC 0291821) ADJ2654728 (SAC 0291246)
Regular
Dec 05, 2008

LEROY ARMSTRONG vs. ENVIRONMENTAL CONSTRUCTION, STATE COMPENSATION INSURANCE FUND, SLIPFORM CONCRETE, BROADSPIRE, California Insurance Guarantee Association (CIGA), Legion Insurance, State Compensation Insurance Fund (SCIF), Fireman's Fund

The Workers' Compensation Appeals Board dismissed CIGA's petition for reconsideration because the WCJ's deferral of CIGA's requested issues was not a final order, and CIGA was not aggrieved. The Board also denied CIGA's petition for removal, finding no extraordinary circumstances. Finally, the Board denied SCIF's petition for reconsideration, agreeing with the WCJ's determination that the applicant's claim against Environmental Construction was timely.

Workers Compensation Appeals BoardCIGASCIFReconsiderationRemovalPetitionFinal OrderStatute of LimitationsIndustrial InjuryDeferred Issue
References
7
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. 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. 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
Case No. ADJ2022332 (ANA 0334821) ADJ947209 (ANA 0334822)
Regular
Feb 27, 2014

JOHN SHEA vs. PROPSERV, INC., CENTRE INSURANCE. COMPANY., CIGA For CALCOMP, In Liquidation

The California Workers' Compensation Appeals Board affirmed the Arbitrator's decision denying CIGA's requests for contribution and reimbursement from Centre Insurance Company. CIGA stipulated to liability for the injury date in 2000, and the Board found that CIGA's subsequent claims of mistake were untimely and lacked good cause to reopen a final award. The Board emphasized the importance of finality in awards and that CIGA failed to timely raise equitable arguments. Therefore, CIGA's appeal for contribution and reimbursement was unsuccessful.

CIGACalCompContributionReimbursementStipulated AwardGood CauseReopenEquitable ArgumentsPrejudgment InterestDate of Injury
References
4
Case No. ADJ6656180
Regular
Aug 24, 2009

LEONARD REASON vs. MCNEAR BRICK & BLOCK, CIGA for CALIFORNIA COMPENSATION, in liquidation

The Workers' Compensation Appeals Board granted CIGA's petition for removal, reversing a prior WCJ order that denied CIGA's objection to the applicant's Declaration of Readiness to Proceed. The Board found that the WCJ erred by preventing CIGA from conducting discovery and obtaining a Qualified Medical Evaluator (QME) exam, despite the applicant filing his claim nearly eleven years after the alleged injury. The Board emphasized that CIGA has a right to discovery, even after denying a claim, and that any potential violation of administrative rules does not automatically waive these discovery rights. The case was returned to the trial level for further proceedings, allowing CIGA the opportunity to complete its discovery.

CIGAPetition for RemovalQualified Medical EvaluatorDeclaration of Readiness to ProceedObjection to Declaration of ReadinessDue ProcessDiscovery RightsRescinded OrderWorkers' Compensation Appeals BoardIndustrial Injury
References
0
Case No. ADJ3885934 (ANA 0349373)
Regular
Mar 01, 2010

SAUL GONZALEZ vs. REMEDY TEMP/CIGA FOR RELIANCE IN LIQUIDATION, MARRIOTT CORPORATION/MARRIOTT CLAIMS SERVICES

The Workers' Compensation Appeals Board (WCAB) granted CIGA's petition for reconsideration, reversing a prior decision that found no jurisdiction to hear CIGA's claim for reimbursement. The WCAB determined it retains supplemental jurisdiction over disputes between defendants, like CIGA and Marriott, even after the injured worker's case was dismissed for lack of prosecution. This decision recognizes that the dismissal was intended to address the applicant's failure to prosecute, not to extinguish CIGA's independent right to seek reimbursement from Marriott. The case is returned to the trial level for further proceedings on CIGA's reimbursement claim.

CIGAReimbursementJurisdictionDismissalReconsiderationSupplemental JurisdictionContributionSpecial EmploymentLack of ProsecutionStipulation
References
11
Case No. ADJ7167333; ADJ7167413
Regular
Mar 24, 2015

ROSA LOPEZ vs. SUPERIOR CENTER CONCEPTS, INC., CARE WEST and PEGASUS RISK MANAGEMENT, PATRIOT RISK SERVICES for CIGA

In this workers' compensation case, CIGA sought reconsideration of a decision finding it liable for a portion of medical treatment and legal expenses. CIGA argued that because Care West provided "other insurance," it should not be liable. However, the Board denied CIGA's petition, upholding the original findings. This decision was based on a prior stipulation between Ullico (whose claims CIGA now administers) and Care West, which contractually apportioned liability. The Board found that CIGA is bound by this pre-liquidation stipulation, which supersedes CIGA's statutory exclusion for claims covered by other insurance.

CIGAUllicoCare WestPatriot Risk ServicesPegasus Risk ManagementSuperior Center Concepts Inc.Rosa LopezPetition for ReconsiderationFindings and OrderCompromise and Release
References
6
Case No. ADJ1143803 (OXN 0128653) ADJ2709854 (OXN 0142376)
Regular
Nov 01, 2011

SALVADOR PAZ vs. MARTINEZ PAINTING & WALL COVERING, MB PAINTING, CIGA, for CREDIT GENERAL INSURANCE COMPANY, INTERCARE, CIGA for UNITED PACIFIC INSURANCE COMPANY, INTERCARE, STATE FARM INSURANCE COMPANY, ACE USA

This case involves a painter, Salvador Paz, who sustained cumulative and specific injuries to his back, shoulder, wrist, neck, and foot. The Workers' Compensation Appeals Board denied petitions for reconsideration from State Farm, CIGA, and the applicant. The Board upheld the original findings, which apportioned permanent disability at 72% to the specific injury (CIGA via Credit General) and 28% to the cumulative trauma (ACE USA and State Farm). Liability for temporary disability was also divided, and State Farm's arguments regarding an unequal division and due process were rejected.

CIGAState Farmcumulative injuryspecific injuryapportionmenttemporary disabilitypermanent disabilityvocational expertPetition for ReconsiderationCredit General Insurance
References
1
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