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Case Law Database

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

Case No. ADJ9078233

Regular

Sep 21, 2022

DANIEL HUNTER vs. SHREVEPORT PIRATES, DENVER BRONCOS, SAN DIEGO CHARGERS, DALLAS COWBOYS, LOS ANGELES EXPRESS, LOUISIANA WORKERS COMPENSATION CORPORATION

The Workers' Compensation Appeals Board rescinded its prior decision and returned the case to the arbitrator. The Board found that the arbitrator erred in considering whether the defendant insurer's policy, issued in Louisiana, could cover an out-of-state injury under California jurisdiction. The Board clarified that workers' compensation coverage is distinct from employer's liability coverage and that policy endorsements limiting coverage require the Insurance Commissioner's approval. The matter was returned for further proceedings and a new decision based on recent clarifying case law.

Louisiana Workers' Compensation CorporationShreveport Piratesout-of-state insuranceCalifornia jurisdictionworkers' compensation arbitratorinsurance contractLouisiana lawemployer's liability insuranceNational Counsel on Compensation InsuranceLa Jolla Beach & Tennis Club

References

Case No. ADJ9854457

Regular

Jun 29, 2018

MARIO YBARRA vs. REED'S INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns CIGA's petition for reconsideration of an arbitrator's decision finding it liable for applicant Mario Ybarra's workers' compensation benefits. The core issue is whether an endorsement excluding coverage for leased employees on a Travelers policy issued to Reed's Inc. was valid. The Board granted reconsideration, rescinding the arbitrator's decision and finding the Travelers policy provided coverage. The Board determined the exclusion endorsement was invalid because it was not countersigned as required by the regulation in effect at the time the policy was issued, and the amendment to the regulation was not retroactive.

CIGAReed's Inc.Travelers Property Casualty Company of Americaleased employeescountersignatureRule 2259retroactiveLabor Code Section 3602(d)endorsement WC 04 03 17special employer

References

Case No. ADJ4629950

Regular

Dec 21, 2012

JOHNNY BETTENCOURT vs. DONALD WILLIAMS, SAFECO INSURANCE COMPANY, UNINSURED EMPLOYERS' BENEFIT TRUST FUND DEPARTMENT OF INDUSTRIAL RELATIONS

The Uninsured Employers' Benefit Trust Fund (UEBTF) sought reconsideration, arguing Safeco's policy covered the applicant's injury. The Arbitrator previously ruled Safeco had no liability as its policy with Donald Williams did not include "comprehensive personal liability" insurance as required by Insurance Code section 11590. The Appeals Board affirmed this decision, finding the Safeco policy explicitly limited coverage to premises liability and lacked the necessary language for comprehensive personal liability coverage. Therefore, Safeco was correctly found not liable for the applicant's injury.

Uninsured Employers' Benefit Trust Fundcomprehensive personal liability insuranceLabor Code section 3351(d)Labor Code section 3352(h)Insurance Code section 11590premises liability insuranceSafeco Insurance CompanyDonald WilliamsJohnny Bettencourtworker's compensation coverage

References

Case No. ADJ559526 (STK 0208625)

Regular

Jan 03, 2011

MICHAEL OZUNA vs. WEBCOR BUILDERS, ZURICH NORTH AMERICA, AMERICAN HOME ASSURANCE COMPANY

This case concerns whether Zurich North America or American Home Assurance Company provided workers' compensation coverage for an applicant's severe injury. An arbitrator initially ruled Zurich solely responsible, finding American Home's policy was limited and did not cover the claim. Zurich contends American Home's policy endorsement limiting coverage to a specific site was invalid due to non-compliance with Insurance Code requirements. The Appeals Board granted reconsideration to allow further proceedings, holding American Home bears the burden to prove its policy effectively excluded this claim.

Workers Compensation Appeals BoardReconsiderationArbitrationInsurance CoverageDefense and IndemnificationPolicy EndorsementInsurance Code Section 11657Insurance Code Section 11660Burden of ProofAffirmative of the Issue

References

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

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. ADJ10773162

Regular

May 21, 2018

JUAN CASTILLO vs. CORNERSTONE PROPERTIES FAMILY, LP, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over workers' compensation insurance coverage for Commercial Machineworx Company, LLC (CMC). The State Compensation Insurance Fund (SCIF) seeks to deny coverage, arguing CMC was not listed on the policy and its payroll was not properly reported. However, the Appeals Board found sufficient evidence that CMC was intended to be covered under the policy due to common ownership with other insured entities. The Board also found that payroll for CMC was indeed submitted, and SCIF failed to present contradictory evidence or adequately explain its position on combinability. Therefore, SCIF's petition for reconsideration was denied.

Workers' Compensation Appeals BoardCornerstone Properties Family LPState Compensation Insurance FundJuan CastilloADJ10773162Petition for ReconsiderationFindings and OrderCommercial Machineworx Company LLCcombinable entityexperience modification

References

Case No. ADJ7964733

Regular

May 29, 2018

JOSE LUIS MASTACHE vs. STAFFCHEX, INC., JESSIE LORD BAKERY; CALIFORNIA GUARANTEE ASSOCIATION for ULLICO CASUALTY COMPANY in Liquidation through its servicing facility SEDGWICK CMS; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves a workers' compensation claim where CIGA seeks reconsideration of a prior decision. The core dispute centers on whether a Travelers insurance policy issued to Jessie Lord Bakery excludes coverage for special employees leased from Staffchex. The Appeals Board granted reconsideration, rescinded the prior decision, and found that the Travelers policy provided coverage, reasoning that the exclusion endorsement was invalid as it lacked the required written affirmation by the policyholder. Furthermore, the Board clarified that general and special employers remain jointly and severally liable for workers' compensation benefits, irrespective of agreements between them.

CIGAStaffchexJessie Lord BakeryTravelers Property Casualty CompanyUllico Casualty CompanySpecial EmployeeGeneral EmployerJoint and Several LiabilityLabor Code Section 3602(d)Limiting Endorsement

References

Case No. ADJ2923882 (VNO 0550303)

Regular

Jan 29, 2014

MARCIAL MARTINEZ vs. MONARCH dba PES PAYROLL, AMERICAN HOME ASSURANCE, FOAMEX, GALLAGHER BASSETT

This case involves applicant Marcial Martinez, injured while working for Foamex, who was leased by HR Business Staffing and paid by Monarch/PES. The Appeals Board affirmed the arbitrator's decision, finding that Monarch's policy WC 573-39-25, due to its "alternate employer endorsement" and contract with Air Ground Manpower, provided workers' compensation coverage. The Board determined that Monarch's role in processing payroll, coupled with the written agreement specifying insurance provision, satisfied the endorsement's requirements. Despite Monarch's arguments regarding its limited payroll role and allegations of fraud, the policy provisions and parties' conduct established coverage.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderArbitrator's DecisionInsurance CoverageMonarch ConsultingPES PayrollAmerican Home AssuranceHR Business StaffingAir Ground Manpower

References

Case No. ADJ8002816, ADJ8316468

Regular

Oct 05, 2016

LORENZO TOSCANO CORONA vs. KOOSHAREM, doing business as SELECT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA), ULLICO CASUALTY INSURANCE COMPANY, ACE AMERICAN INSURANCE COMPANY, RSI HOME PRODUCTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a dispute over workers' compensation coverage where applicant Lorenzo Toscano Corona was injured, allegedly while employed through a staff leasing arrangement between Koosharem (Select Staffing) and RSI Home Products. The Appeals Board granted reconsideration to address arguments by ACE American Insurance Company and Travelers Property Casualty Company that their policies excluded coverage for the applicant. The Board rescinded the prior decision due to the arbitrator's failure to adequately document the proceedings and admitted exhibits as required by law. The matter is returned to the arbitrator to create a proper record and evaluate whether ACE and Travelers' policies contained valid exclusions for the applicant's injuries, considering relevant insurance code provisions and endorsements.

Staff leasingGeneral employerSpecial employerJoint and several liabilityOther insuranceInsurance Code section 1063.1(c)(9)Hold harmless clauseWCAB Rule 10566Hamilton v. Lockheed Corp.Labor Code section 3602(d)

References

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Updated Daily

Case Law Database

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

Case No. ADJ9078233

Regular

Sep 21, 2022

DANIEL HUNTER vs. SHREVEPORT PIRATES, DENVER BRONCOS, SAN DIEGO CHARGERS, DALLAS COWBOYS, LOS ANGELES EXPRESS, LOUISIANA WORKERS COMPENSATION CORPORATION

References

Case No. ADJ9854457

Regular

Jun 29, 2018

MARIO YBARRA vs. REED'S INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

CIGAReed's Inc.Travelers Property Casualty Company of Americaleased employeescountersignatureRule 2259retroactiveLabor Code Section 3602(d)endorsement WC 04 03 17special employer

References

Case No. ADJ4629950

Regular

Dec 21, 2012

JOHNNY BETTENCOURT vs. DONALD WILLIAMS, SAFECO INSURANCE COMPANY, UNINSURED EMPLOYERS' BENEFIT TRUST FUND DEPARTMENT OF INDUSTRIAL RELATIONS

References

Case No. ADJ559526 (STK 0208625)

Regular

Jan 03, 2011

MICHAEL OZUNA vs. WEBCOR BUILDERS, ZURICH NORTH AMERICA, AMERICAN HOME ASSURANCE COMPANY

References

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

References

Case No. ADJ4668407 (RIV 0055963)

Regular

Feb 19, 2015

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

Workers' Compensation Appeals BoardReconsiderationPolicy CancellationCoverage DisputeEstoppelWaiverWritten NoticeInsurance ContractPremium PaymentPost-Cancellation Audit

References

Case No. ADJ10773162

Regular

May 21, 2018

JUAN CASTILLO vs. CORNERSTONE PROPERTIES FAMILY, LP, STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ7964733

Regular

May 29, 2018

JOSE LUIS MASTACHE vs. STAFFCHEX, INC., JESSIE LORD BAKERY; CALIFORNIA GUARANTEE ASSOCIATION for ULLICO CASUALTY COMPANY in Liquidation through its servicing facility SEDGWICK CMS; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

CIGAStaffchexJessie Lord BakeryTravelers Property Casualty CompanyUllico Casualty CompanySpecial EmployeeGeneral EmployerJoint and Several LiabilityLabor Code Section 3602(d)Limiting Endorsement

References

Case No. ADJ2923882 (VNO 0550303)

Regular

Jan 29, 2014

MARCIAL MARTINEZ vs. MONARCH dba PES PAYROLL, AMERICAN HOME ASSURANCE, FOAMEX, GALLAGHER BASSETT

Workers' Compensation Appeals BoardReconsiderationFindings and OrderArbitrator's DecisionInsurance CoverageMonarch ConsultingPES PayrollAmerican Home AssuranceHR Business StaffingAir Ground Manpower

References

Case No. ADJ8002816, ADJ8316468

Regular

Oct 05, 2016

LORENZO TOSCANO CORONA vs. KOOSHAREM, doing business as SELECT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA), ULLICO CASUALTY INSURANCE COMPANY, ACE AMERICAN INSURANCE COMPANY, RSI HOME PRODUCTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, LIBERTY MUTUAL INSURANCE COMPANY

References

Showing 1-10 of 293 results

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