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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. VEN 0115536
Regular
Aug 04, 2008

ROBERT FROELICH vs. CONTRACTORS LABOR POOL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCATION, RELIANCE NATIONAL INSURANCE CO., GM NORTHROP CORP., NATIONAL FIRE INSURANCE COMPANY OF HARTFORD

This case concerns a dispute over workers' compensation liability following an industrial injury sustained by an employee who was a general employee of Contractors Labor Pool (insured by insolvent Reliance) and a special employee of GM Northrup Corp. The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding, determining that National Fire Insurance Company's policy for GM Northrup Corp. constituted "other insurance." Consequently, National Fire Insurance Company is now liable for the applicant's benefits, and the California Insurance Guarantee Association is not liable as the claim is not a "covered claim."

CIGAReliance National InsuranceNational Fire Insurance Companycovered claimsother insurancegeneral employerspecial employerjoint and several liabilitypolicy constructionInsurance Code section 1063.1
References
Case No. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
Case No. ADJ2480026
Regular
Aug 26, 2011

CHAD IMES vs. SCENARIO DESIGNS, INC., EVEREST NATIONAL INSURANCE COMPANY, POWER PAYROLL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling and ordered Everest National Insurance Company to reimburse CIGA for benefits paid to the applicant. The Board found that Everest was "other insurance" available under Insurance Code section 1063.1(c)(9) because its insured, Scenario Designs, Inc., employed the applicant on the date of injury. This decision clarifies that reimbursement to CIGA does not alter the original award and aligns with statutory limitations on CIGA's liability. Everest is now obligated to reimburse CIGA and administer future benefits.

CIGAEverest National Insurance CompanyLegion Insurance CompanyScenario DesignsPower PayrollInc.other insurancereimbursementdate of injurygeneral-special employment
References
Case No. ADJ1526910 (LAO 0881311) ADJ1183697 (LAO 0881312)
Regular
Apr 14, 2017

MARGARITA GIUSTRA vs. PRIMARY PROVIDER MANAGEMENT, NATIONAL LIABILITY AND FIRE INSURANCE COMPANY, DELOS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Delos Insurance Company's petition for reconsideration. The Board adopted the arbitrator's report, which found that a prior Compromise and Release agreement between the applicant and Delos Insurance Company only settled a specific injury, not the continuous trauma claim. This decision allowed National Liability and Fire Insurance Company's petition for contribution against Delos Insurance Company for a portion of benefits paid for the continuous trauma injury. The arbitrator also determined that prior conflicting judicial decisions did not bar Delos Insurance Company from being joined in the contribution proceedings.

Workers Compensation Appeals BoardMargarita GiustraPrimary Provider ManagementNational Liability and Fire Insurance CompanyDelos Insurance CompanyADJ1526910ADJ1183697Petition for ReconsiderationArbitrator's ReportCompromise and Release
References
Case No. ADJ3773540 ADJ4461811 ADJ4227366
Regular
Sep 17, 2008

, Applicant, Richard Rodriguez, vs. Peninsula Floors, Inc.; National Union Fire Insurance Company, AIG Claims Services, Inc., Legion Insurance, In Liquidation, CIGA, As Administered by Broadspire

The WCJ's decision was amended to add Finding of Fact No. 13, stating that National Fire Insurance Company is liable for all joint and several benefits.

Workers' Compensation Appeals BoardCIGALegion InsuranceNational Union Fire Insurance CompanyAIG Claims ServicesBroadspireBenson v. Permanente Medical GroupWilkinson v. Workers' Comp. Appeals Boardjoint and several liabilitypermanent disability apportionment
References
Case No. ADJ4684775 (VEN 0117727) ADJ4381820 (VEN 0117723)
Regular
Dec 19, 2011

JOANNE LUTZ, JOANN LUTZ vs. RUSSELL WARNER dba ROTO ROOTER SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PAULA INSURANCE COMPANY, in liquidation, and for FREMONT INSURANCE COMPANY, in liquidation, LINDA McDONALD, STATE FARM INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling, allowing CIGA to pursue reimbursement from State Farm for benefits paid due to applicant's industrial injuries. The Board found that unlike a request to alter a prior award, CIGA's petition sought to enforce its statutory right to reimbursement from "available" insurance under Insurance Code section 1063.1(c)(9). Since State Farm, as a jointly and severally liable insurer, appears to be such "available" insurance, the case is remanded for further proceedings on CIGA's reimbursement claim.

California Insurance Guarantee AssociationCIGAPaula Insurance CompanyFremont Insurance CompanyState Farm Insurance Companystipulated awardreconsiderationreimbursementcontributionother insurance
References
Case No. ADJ3388315 (SBR 0294441) ADJ683842 (SBR 0340933)
Regular
Jul 22, 2014

Marvin Camacho vs. Western Metal Lathe, Sompo Japan Insurance Company, Broadspire, Remedy Temp, Reliance National, California Insurance Guarantee Association, Williams Furnace Company, St. Paul Fire & Marine, Kimco Staffing, Liberty Mutual Insurance

The Workers' Compensation Appeals Board denied Williams Furnace Company's petition for reconsideration and granted Sompo Japan Insurance Company's petition. The Board affirmed the original award for Marvin Camacho's neck and back injuries sustained while employed by Remedy Temp and Western Metal Lathe, as well as prior injuries to his cervical and lumbar spine from Williams Furnace Company. Issues of temporary total disability, additional attorney's fees, and other matters were deferred for further development at the trial level. Liberty Mutual Insurance, carrier for Kimco Staffing, was dismissed from the case.

WORKERS' COMPENSATION APPEALS BOARDWESTERN METAL LATHESOMPO JAPAN INSURANCE COMPANYBROADSPIREREMEDY TEMPRELIANCE NATIONALCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONWILLIAMS FURNACE COMPANYST. PAUL FIRE & MARINEKIMCO STAFFING
References
Case No. ADJ7539480
Regular
Sep 20, 2011

GARY KREFT vs. CELESTRON, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, COMPWEST INSURANCE COMPANY, HARTFORD INSURANCE COMPANY, AMERICAN CLAIMS MANAGEMENT, STATE COMPENSATION INSURANCE FUND, Everest National Insurance Co.

This case concerns a cumulative injury claim where the Workers' Compensation Appeals Board (WCAB) granted Everest National Insurance Co.'s Petition for Removal. The WCAB amended a prior order joining Everest and other carriers, clarifying that Labor Code section 5500.5(a) limits liability for cumulative injuries to employers/insurers covering the year immediately preceding the date of injury or last exposure. As the date of injury/exposure was not yet determined and appeared to be the last day of employment, only the carriers covering that final year (CompWest and Hartford) were ordered joined. Everest was removed as a party defendant pending further determination.

Petition for RemovalLabor Code section 5500.5(a)cumulative injurylast injurious exposurejoinder of partiesWorkers' Compensation Appeals Boarddate of injuryrepetitive job dutiesCalifornia Insurance Guarantee AssociationCIGA
References
Case No. ADJ2042153 (SRO 0120961), ADJ1591784 (SRO 0120962), ADJ4036022 (SRO 0136498)
Regular
Sep 14, 2012

CHELA PACHECO vs. BERINGER WINE ESTATES COMPANY, NATIONAL UNION FIRE INSURANCE COMPANY, Adjusted By CHARTIS/AIG, CHATEAU SOUVERAIN, SAFECO INSURANCE COMPANY

This case involves Chela Pacheco's workers' compensation claim against Beringer Wine Estates and their insurers. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision. The WCAB affirmed the original decision but amended a finding of fact regarding the Employment Development Department (EDD) lien. The EDD lien was deemed reasonable only for a specific period and capped at $400 per week.

Workers' Compensation Appeals BoardBeringer Wine Estates CompanyNational Union Fire Insurance CompanyChartis/AIGChateau SouverainSafeco Insurance CompanyADJ2042153ADJ1591784ADJ4036022Reconsideration
References
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