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

Case No. ADJ1543435
Regular
Feb 04, 2013

Sergio Cordero vs. Michael Bernier dba Pacific Services, Stellrecht Company, State Compensation Insurance Fund, Uninsured Employers Benefit Trust Fund

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that the applicant was injured in the course and scope of employment with an unlicensed contractor, Michael Bernier. The Board gave great weight to the Workers' Compensation Judge's credibility determination regarding the employer's testimony. The applicant's injury occurred while he was directed by Bernier to remove solar panels from a property owned by Stellrecht Company. The Board clarified the distinction between "course of employment" and "scope of employment" in workers' compensation law to affirm the decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibilitycourse and scope of employmentunlicensed contractoruninsured contractorgeneral-special relationshipLabor Code §2750.5B&P §7125.2Blew v. Horner
References
5
Case No. ADJ4517414 (EUR 0036075)
Regular
Sep 13, 2010

, C. AND J. RANDY LINGARD vs. EUREKA CITY SCHOOL DISTRICT, PACIFIC EMPLOYERS INSURANCE, by ESIS CHATSWORTH

The defendant, Pacific Employers Insurance, sought reconsideration of a compromise and release order, arguing the payment was erroneously ordered against ACE USA instead of "Pacific Employers Insurance Group." The Appeals Board granted reconsideration because a fully executed amended compromise and release agreement was subsequently submitted. The original order is rescinded and the matter is returned to the trial level for review of the amended agreement.

Workers' Compensation Appeals BoardReconsiderationCompromise and ReleaseWCJPacific Employers Insurance GroupACE USAESISAmended Compromise and Release AgreementRescinded OrderTrial Level
References
0
Case No. MISSING
Regular Panel Decision

Employers Insurance v. General Accident, Fire & Life Assurance Corp.

Employers Insurance of Wausau (Wausau) sought summary judgment for 50% reimbursement of a $500,000 settlement and defense costs. The settlement stemmed from an underlying personal injury action where Frank Rayno, an employee of Sage Garage, was injured on a construction site in 1976. Wausau provided workers' compensation and employer's liability insurance to Sage Garage, while General Accident provided general liability coverage. Wausau paid the full settlement and then pursued General Accident for contribution. General Accident argued for a pro rata contribution based on policy limits. The court granted Wausau's motion for summary judgment, ruling that both insurers should contribute equally up to the limit of the smaller policy, which was General Accident's $500,000 policy, meaning General Accident owed $250,000. The defendants' cross-motion was denied.

Insurance disputeSummary judgmentDeclaratory judgmentContribution among insurersReimbursementPolicy limitsEmployer's liability insuranceGeneral liability insuranceWorkers' compensationPro rata contribution
References
0
Case No. ADJ10454739
Regular
Jan 07, 2020

Antonio Santelices vs. Baron HR, LLC, Bison Workforce Solutions, Inc., State Compensation Insurance Fund, Public Investment Corp., Insurance Company of the West

This case concerns a workers' compensation claim where the applicant alleged injury while employed by Baron HR, LLC, who sent him to work for Pacific Coast Warehouse. The arbitrator found Baron HR to be the general employer and Pacific Coast Warehouse the special employer, and importantly, that Bison Workforce Solutions (BWS) was the employer for insurance purposes, making its insurer, SCIF, liable. SCIF petitions for reconsideration, arguing BWS and Bison Data Systems are distinct and BWS was insured by Hartford, not SCIF, and challenging the arbitrator's evidentiary findings. The Board rescinded the arbitrator's decision, remanding for further proceedings to clarify the employment and insurance coverage relationships, especially concerning BWS's role as a Professional Employer Organization and compliance with PEO insurance regulations.

Workers' Compensation Appeals BoardAntonio SantelicesBaron HR LLCBison Workforce SolutionsState Compensation Insurance Fundgeneral employerspecial employeremployee leasingProfessional Employer OrganizationPEO
References
0
Case No. MISSING
Regular Panel Decision
Feb 18, 1972

Claim of McGee v. Allstate Insurance

The claimant's husband, a District Sales Manager for Allstate Insurance Company, died in a car accident on September 30, 1970, after attending a sales meeting and continuing business discussions at bars. Although his home was in Utica, the accident occurred en route from Rome. The Workmen’s Compensation Board found the decedent was an outside worker and in the course of his employment at the time of death, awarding death benefits to the claimant. The employer and its insurance carrier appealed this decision. The appellate court affirmed the board's decision, ruling that social activities connected with and incidental to an employer’s business are considered part of employment and that the decedent had not deviated from his employment.

Death BenefitsCourse of EmploymentOutside WorkerSales MeetingBusiness DiscussionCar AccidentDeviation from EmploymentAppellate ReviewAffirmation
References
3
Case No. ADJ347577 (SAC 0220919)
Regular
Jul 09, 2009

STEPHEN FLANNERY vs. G & O SERVICES, RELIANCE INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, PACIFC BELL

In this workers' compensation case, the Appeals Board affirmed an award for applicant Stephen Flannery's back and psyche injury. Pacific Bell, the special employer, was found jointly and severally liable with the general employer's insurer, Reliance (now CIGA), for ongoing benefits, as Pacific Bell's self-insurance constitutes "other insurance." The Board reversed the WCJ's award of temporary total disability beyond the five-year jurisdictional limit unless the disability straddled the anniversary date. The doctrine of laches was found inapplicable against CIGA, and CIGA was not liable for EDD's lien as Pacific Bell was the primary source of benefits.

Workers' Compensation Appeals BoardCIGAReliance Insurance liquidationCalifornia Insurance Guarantee AssociationPacific Bellspecial employerjoint and several liabilitylachesnew and further disabilityfive-year jurisdictional period
References
13
Case No. MISSING
Regular Panel Decision

Continental Insurance v. State

Thomas Murray, an executive officer and co-owner of T & T Murray Company, Inc., sustained severe injuries while working, having previously elected to be excluded from Workers’ Compensation coverage under Workers’ Compensation Law § 54 (6). Following a successful lawsuit against the general contractor, Concept Construction Corp., and subsequent indemnification from T & T, Concept's liability carrier, Continental Insurance Company, sought coverage from T & T's insurer, State Insurance Fund. The State Fund denied the claim, asserting the exclusion applied to both Workers’ Compensation and Employers’ Liability coverage. The Court of Appeals affirmed the denial, ruling that the two types of coverage are inextricably linked, and the election to exclude executive officers from Workers’ Compensation coverage also eliminates Employers’ Liability coverage for injuries to those officers.

Workers' Compensation Law § 54(6)Employers' Liability CoverageExecutive Officer ExclusionCorporate OfficersStock OwnershipInsurance Policy InterpretationThird-Party IndemnificationSubrogation ClaimStatutory InterpretationNew York Court of Appeals
References
6
Case No. MISSING
Regular Panel Decision

Perfect Dental, PLLC v. Allstate Insurance

In this consolidated action, plaintiffs Perfect Dental Care, P.C., Zodiac Dental, PLLC, and Smooth Dental PLLC (Dental PCs) sought unpaid insurance claims from Allstate Insurance Company and State Farm Mutual Automobile Insurance Company (Insurers). The Insurers countersued alleging insurance fraud and unjust enrichment, and initiated a third-party action against various individuals and entities. The Insurers moved for partial summary judgment, seeking a declaratory judgment that Dental PCs could not recover for services provided by dentists and physical therapists, and for summary judgment on their fraud and unjust enrichment counterclaims. The court denied summary judgment concerning dentists' services, finding a triable issue of fact regarding their employment status. However, it granted summary judgment for the Insurers regarding physical therapy services, as Dental PCs conceded these services were provided by non-employees. Consequently, the court also denied summary judgment on the fraud and unjust enrichment claims, as their resolution depended on the unresolved employment status of the dentists.

Insurance ClaimsHealthcare ServicesContract LawSummary JudgmentProfessional CorporationsIndependent ContractorsEmployment LawFraud AllegationsUnjust EnrichmentDeclaratory Judgment
References
17
Case No. ADJ6697300
Regular
Aug 31, 2015

Lorenzo Yanez vs. Universal Label Printers, Sparta Insurance Company, Employers Compensation Insurance Company

This case involves an insurance dispute over contribution liability for a workers' compensation claim. The applicant, Lorenzo Yanez, sustained an injury while employed by Universal Label Printers, with coverage from Sparta Insurance Company and Employers Compensation Insurance Company. A Compromise and Release (C&R) agreement was approved, which included an addendum purportedly allocating liability between Sparta (17%) and Employers (87%). Sparta sought to enforce this addendum for reimbursement, but the trial judge denied their petition, finding a lack of jurisdiction due to no separate petition for contribution being filed within the statutory one-year period. The Appeals Board granted reconsideration, finding continuing jurisdiction to enforce the C&R and its addendum under Labor Code section 5803, and returned the matter to the trial judge to determine the enforceability and terms of the addendum.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderCompromise and ReleaseOrder Approving Compromise and ReleasePetition for ContributionLabor Code Section 5500.5Continuing JurisdictionLabor Code Section 5803Apportionment of Liability
References
10
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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