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

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 The Board rescinded the prior order and returned the matter to the trial level for a determination of who constitutes the applicant's employer(s) before insurance coverage issues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. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ4213301 (ANA 0398168)
Regular
Apr 01, 2015

REGGIE STEPHENS vs. NASHVILLE KATS, GREAT DIVIDE INSURANCE COMPANY, KANSAS CITY CHIEFS, TIG INSURANCE COMPANY

The Appeals Board affirmed the finding that the applicant was hired in California, establishing jurisdiction for workers' compensation claims under Labor Code sections 3600.5(a) and 5305. The Board found that accepting an employment offer by telephone in California constituted hiring, regardless of subsequent contract signing elsewhere. This hiring connection was deemed sufficient to support jurisdiction, overriding contractual choice-of-law provisions that conflicted with California's public policy protecting workers' compensation rights. The case was returned for further proceedings consistent with this decision.

Workers' Compensation Appeals BoardWCABcumulative industrial injuryoral contract of hirechoice of law provisionjurisdictioncontract of hireconditions subsequentforum selection clausepublic policy
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. ADJ8517777
Regular
Oct 07, 2019

DOUGLAS ARONSON vs. WORLD LEAGUE OF AMERICAN FOOTBALL, LIBERTY MUTUAL INSURANCE, STATE COMPENSATION INSURANCE FUND, PHILADELPHIA EGLES, FAIRMONT PREMIER INSURANCE COMPANY

In *Aronson v. World League of American Football*, the Workers' Compensation Appeals Board denied a petition for reconsideration, upholding an arbitrator's finding. The core issue was whether the State Compensation Insurance Fund's (SCIF) policy covered all employees of the League injured within California's jurisdiction, or only those affiliated with the Sacramento Surge. The Board affirmed that standard workers' compensation policies cover all employees unless explicitly limited, and any ambiguity is resolved in favor of the insured. Therefore, SCIF's policy was interpreted to provide coverage for all League employees injured in California during the relevant period.

Workers' Compensation Appeals BoardPetition for ReconsiderationInsurance Policy InterpretationSCIF PolicyCalifornia JurisdictionAmbiguity Resolved Against InsurerGreatest CoverageArbitrator's DecisionFindings and AwardState Compensation Insurance Fund
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. ADJ6865421
Regular
Sep 08, 2017

DAVID BERRIOS-SEGOVIA vs. EJ DISTRIBUTION CORPORATION, SOUTHERN INSURANCE COMPANY, MARKEL dba FIRST COMP, STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case returns to the Appeals Board after the Court of Appeal determined that the rescission of an insurance policy is subject to mandatory arbitration. The Court annulled the arbitrator's prior findings, ordering further proceedings to determine the legal effectiveness of the insurer's rescission. The insurer must prove the employer's misrepresentations were material and that rescission is not being used to circumvent policy approval requirements. The matter is remanded to the arbitrator for further proceedings and a new decision.

Workers' Compensation Appeals BoardRemittiturMandatory ArbitrationLabor Code Section 5275Policy RescissionMaterial MisrepresentationUninsured Employers Benefits Trust FundDepartment of InsuranceInsurance CommissionerPrior Approval
References
Case No. ADJ8501790
Regular
Jul 29, 2015

Kelly Chase vs. St. Louis Blues Hockey Club, Federal Insurance Company

The Workers' Compensation Appeals Board (WCAB) reversed a prior finding of industrial injury for a professional hockey player against the St. Louis Blues. The WCAB found insufficient connection to California for jurisdiction, citing the player's limited games in the state compared to his overall career. This decision followed the precedent set in *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*, which requires a legitimate and substantial connection to the state for jurisdiction. The WCAB concluded that 21 games out of 485 did not meet this standard for a cumulative injury claim.

WCABSt. Louis Blues Hockey ClubFederal Insurance CompanyADJ8501790Opinion and Decision After Reconsiderationcumulative industrial injuryprofessional hockey playersubject matter jurisdictionstatute of limitationssubstantial medical evidence
References
Case No. ADJ9641921, ADJ9640385
Regular
Mar 29, 2016

PAZ CORRALES vs. KIMPTON HOTEL AND RESTAURANT GROUP dba KHRG GOLETA, LLC, FEDERAL INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the Order Approving Compromise and Release (OACR) due to a problematic Addendum "A". Applicant contends Addendum "A" incorrectly settled their right to future attorney's fees and contains conflicting, unenforceable provisions regarding future claims and confidentiality. The Board found potential jurisdictional issues and inconsistencies with the law, returning the case for an evidentiary hearing to determine if the C&R should be set aside.

Petition for ReconsiderationCompromise and ReleaseAddendum ALabor Code section 5710attorney's feesrescinded OACRevidentiary hearingmistake inadvertence excusable neglectunenforceable provisionsconfidential provision
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
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