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

Case No. LBO 0319122
Regular
May 19, 2008

RICARDO MORAN-FLORES vs. ALEX STAVROPOULOS, dba THE GREEK MATTRESS WAREHOUSE, GOLDEN EAGLE INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed an Arbitrator's decision that the employer's workers' compensation policy was effectively cancelled on April 25, 2000, prior to the applicant's October 21, 2000 injury. The Board found that the insurer provided proper notice of cancellation for non-reporting of payroll, and the employer failed to present evidence rebutting receipt of this notice. Therefore, the policy was deemed terminated before the employee's injury.

Workers' Compensation Appeals BoardReconsiderationArbitrator DecisionInsurance CancellationPolicy TerminationNon Report of PayrollGolden Eagle Insurance CompanyRicardo Moran-FloresAlex StavropoulosThe Greek Mattress Warehouse
References
Case No. ADJ3732643 (OXN 0133370)
Regular
Aug 12, 2011

JAIME GONZALEZ vs. HAMLIN DEVELOPMENT CORPORATION: GRANITE STATE INSURANCE COMPANY, et al.

This case concerns Granite State Insurance Company (AIG) seeking reconsideration of a prior order finding their workers' compensation policy with Hamlin Development Corporation valid and in force at the time of applicant Jaime Gonzalez's injury. The Board denied reconsideration, upholding the arbitrator's finding that AIG failed to properly and timely cancel the policy. AIG's cancellation notice was deemed defective because it lacked statutory grounds, did not explain how to cure the alleged deficiency, and did not notify the insured's intermediaries. Therefore, AIG remains obligated to defend Hamlin and provide benefits to Gonzalez.

Workers' Compensation Appeals BoardGranite State Insurance CompanyHamlin Development CorporationJaime GonzalezInsurance Code section 676.8Notice of CancellationPremium Finance AgreementInsurexConcord InsuranceCananwill
References
Case No. ADJ4668407 (RIV 0055963)
Regular
Feb 19, 2015

JOSE MARTINEZ vs. 2K FABRICATION, INCORPORATED, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior decision finding that State Compensation Insurance Fund (SCIF) did not provide coverage for 2K Fabrication, Inc. on July 8, 2003. The Board ruled that SCIF's cancellation of the employer's policy effective March 18, 2003, was valid. Arguments for coverage based on alleged lack of notice, estoppel due to premium acceptance, audits, and defense of the claim were rejected. The Board found no evidence of a written reinstatement of the canceled policy.

Workers' Compensation Appeals BoardReconsiderationPolicy CancellationCoverage DisputeEstoppelWaiverWritten NoticeInsurance ContractPremium PaymentPost-Cancellation Audit
References
Case No. ADJ8619480
Regular
Nov 22, 2019

MARCO MARTINEZ, vs. BRAM, LLC, aka VALLEY PROTEIN, LLC, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The WCAB rescinded an arbitrator's decision finding CIGA liable for benefits because the record lacked required findings, stipulations, and evidence, violating WCAB Rule 10566 and *Hamilton*. CIGA argued the policy was canceled due to the employer's failure to pay premiums, which the broker did not timely forward to the insolvent insurer. The Board noted that policy cancellation requires 10 days' written notice and that CIGA is not an insurer with the same responsibilities. The case is returned to the arbitrator to create an adequate record and issue a proper decision.

CIGAinsolvent insurerCastlepointpremium paymentpolicy cancellationauthorized agentWCAB Rule 10566Hamilton v. Lockheed Corp.arbitration recordfindings of fact
References
Case No. ADJ11114421
Regular
Jun 05, 2025

FELIX CABRERA vs. OAA INVESTMENTS, INC.; CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

Defendant California Restaurant Mutual Benefit Corporation (CRMBC) sought reconsideration of a February 19, 2021 Findings and Order (F&O) which found CRMBC liable for coverage of applicant Felix Cabrera's injury, ruling that CRMBC's policy cancellation was premature. CRMBC contended it had no coverage obligations as the applicant was employed by OAA Investments, Inc., not insured by CRMBC, and argued against the applicability of Insurance Code section 676.8. The Appeals Board affirmed the WCA's F&O, treating the petition as one for reconsideration, and found that under Insurance Code section 676.8 and equitable principles, CRMBC was liable for coverage. The Board reasoned that due to a material change in ownership, CRMBC's cancellation notice required 30 days' notice, making January 27, 2018, the earliest effective cancellation date, which was after the November 22, 2017 injury date.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPolicy CancellationInsurance Code Section 676.8Material Change in OwnershipEquitable EstoppelAffiliate Certificate of Consent to Self-InsureGroup Self-InsurerAD Rule 15480
References
Case No. ADJ1389831
Regular
Sep 19, 2008

SHAWNDELL WILLIAMS vs. THRUSHWING HOME, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and reversed the Arbitrator's decision, finding that the worker's compensation policy was effectively cancelled before the injury date, thus SCIF had no liability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardNotice of CancellationInsurance Code section 676.8Code of Civil Procedure section 1013(a)Policy CancellationInsured StatusDate of InjuryArbitrator's Decision
References
Case No. ADJ10232182
Regular
Jul 07, 2017

JOSE SAENZ vs. WILLIAM STOESSER, CLAIRE WERNER, REBECCA B. PISCITELLI 2012 SPECIAL TRUST DATED 12/21/2012, ADAM W. BUCK 2012 SPECIAL TRUST Dated 12/21/2012, BENJAMIN C. BUCK 2012 SPECIAL TRUST Dated 12/21/2012, STATE FARM INSURANCE

This case involves a workers' compensation claim where the applicant, Jose Saenz, was injured on April 10, 2015. State Farm sought reconsideration of an arbitrator's finding that four of its insurance policies provided coverage. The Appeals Board granted reconsideration, finding the arbitrator's coverage determination premature. The Board rescinded the prior order and returned the matter to the trial level for a determination of who constitutes the applicant's employer(s) before insurance coverage issues can be addressed.

Workers Compensation Appeals BoardPetitions for ReconsiderationDecision After ReconsiderationWilliam StoesserClaire WernerRebecca B. Piscitelli 2012 Special TrustAdam W. Buck 2012 Special TrustBenjamin C. Buck 2012 Special TrustState Farm InsuranceHomeowner's Policy
References
Case No. ADJ775111 (AHM 0115194)
Regular
Jun 14, 2010

JUAN VARONA vs. SOFTEX, INC./GRANITE STATE INSURANCE COMPANY as administered by AIG DOMESTIC CLAIMS, INC.

This case involves Granite State Insurance Company's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB upheld the arbitrator's finding that Softex, Inc. was a co-employer responsible for applicant Juan Varona's workers' compensation coverage for a roofing injury. Granite State's arguments, including collateral estoppel based on a prior civil case and contentions about policy coverage and cancellation, were rejected. The WCAB found insufficient grounds to overturn the original decision, denying Granite State's petition.

Workers' Compensation Appeals BoardSoftexGranite State Insurance CompanyAIG Domestic ClaimsCo-employment agreementRoofing workCollateral estoppelRescission of policyMaterial misrepresentationCo-employee coverage
References
Case No. ADJ9136267
Regular
Aug 05, 2016

JERRY LEDGER III vs. STEVE DOVALI CONSTRUCTION, BARRY HALAJIAN DBA INDUSTRIAL ELECTRIC COMPANY, GRANITE STATE INSURANCE, BENCHMARK INSURANCE

In this workers' compensation case, the Appeals Board granted removal, rescinded a prior order staying Superior Court actions, and affirmed an order for mandatory arbitration. The Board found that coverage disputes arising from an insurer's claim of policy cancellation fall exclusively within the WCAB's jurisdiction, as resolution is necessary for applicant benefits. While the WCAB has exclusive jurisdiction over these disputes, it lacked the authority to stay the separate Superior Court actions, which is a power reserved for higher courts. Therefore, the parties must proceed to arbitration, and the Superior Court actions are not stayed by the WCAB.

Workers' Compensation Appeals BoardPetition for RemovalMandatory ArbitrationSuperior Court ActionPolicy CancellationDeclaratory ReliefConcurrent JurisdictionExclusive JurisdictionCoverage DisputeConstitutional Courts
References
Case No. ADJ2832796 (SAC 0362707) ADJ1414613 (SAC 0362718)
Regular
Mar 15, 2011

DANIEL WALTERS vs. HOLLAND CUSTOM IRON WORKS, INC., CALIFORNIA INSURANCE COMPANY

This case concerns whether an employer, Holland Custom Iron Works, Inc., had workers' compensation insurance coverage on August 16, 2006, following a notice of cancellation for non-payment. The Appeals Board affirmed an arbitrator's finding that coverage existed, relying on equitable estoppel and the ambiguity of the cancellation notice. The insurer's contention that coverage was contingent on a "gap premium" payment was rejected as exceeding the arbitrator's authority. The Board's decision clarifies that the payment made by the employer was sufficient to rescind the cancellation.

Gap premiumequitable estoppelworkers' compensation insurance coveragecancellation noticerescissionarbitration rulingpayment ambiguityrelianceambiguous languagemonetary default
References
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