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

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. 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. 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. 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. 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. 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
Case No. ADJ7379899
Regular
Nov 12, 2012

DARRIN LANNING vs. BAYWOOD INTERIORS, INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address the defendant's contention that the WCJ erred by deeming the post-termination defense moot. The Board clarified that Labor Code section 3600(a)(10) provides a defense against claims filed after termination or layoff, and this issue is not moot if an industrial injury is found. Consequently, the Board rescinded the prior findings and returned the case for further proceedings to determine if the post-termination defense applies and, if so, whether applicant meets any exceptions. The merits of the original finding of industrial injury were not decided and are subject to a new ruling after the post-termination defense is resolved.

AOE/COEpost-termination defenseLabor Code section 3600(a)(10)industrial injurycabinetmakerlower backleft groinright kneemootfindings of fact
References
Case No. ADJ10288379
Regular
Sep 13, 2017

XOCHITL CARRERA-MORALES vs. PRIORITY WORKFORCE, INC., ZURICH INSURANCE

This case involves a workers' compensation claim where the administrative law judge (WCJ) initially denied benefits based on the post-termination defense. The applicant argued that her date of injury, defined by significant disability and awareness of its industrial causation, occurred after her termination, thus triggering an exception to the defense. The Appeals Board found that the WCJ's decision lacked clarity regarding the basis for the injury determination and that the analysis of the post-termination defense was insufficient. Therefore, the Board rescinded the original decision and returned the case to the trial level for further proceedings to clarify the findings and address the post-termination defense.

Post-termination defenseSection 3600(a)(10)Date of injurySection 5412Continuous trauma injuryTemporary partial disabilityMedical evidenceSubstantial evidenceReconsiderationFindings and Orders
References
Case No. ADJ10924076
Regular
Aug 28, 2018

PATRICIA VERA vs. BUMBLE BEE FOODS, ACE AMERICAN INSURANCE COMPANY, ESIS

The Workers' Compensation Appeals Board (WCAB) rescinded the Administrative Law Judge's (ALJ) decision denying applicant Patricia Vera's claim. The ALJ had found that Vera did not sustain an injury arising out of and in the course of employment and that her claim was barred by the post-termination defense. The WCAB found that the ALJ failed to fully address the exceptions to the post-termination defense under Labor Code Section 3600(a)(10), specifically subsection (D) concerning the date of injury. Therefore, the case was returned to the trial level for further proceedings to determine if the post-termination defense applies and, if not, to address the issue of industrial causation.

Workers Compensation Appeals BoardBumble Bee FoodsACE American Insurance CompanyESISPatricia VeraOpinion and Decision After ReconsiderationFindings and OrderWCJpost-termination defenseindustrial causation
References
Case No. ADJ10312473
Regular
Sep 01, 2017

CLARA LUNA vs. FISCHER MOLD, INC., PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded the prior decision and returned the case to the trial level for further proceedings. The WCAB found that the administrative law judge's (WCJ) decision, which barred the applicant's claim based on the post-termination defense under Labor Code section 3600(a)(10), was procedurally flawed and lacked sufficient analysis. Specifically, the WCAB determined that the applicant may qualify for an exception to the post-termination defense if her date of injury, defined by disability and knowledge of its work-related cause, occurred after her termination. This determination hinges on whether the applicant suffered disability and had the requisite knowledge post-termination, which requires further exploration.

Workers Compensation Appeals BoardClara LunaFischer Mold Inc.Pacific Compensation Insurance CompanyOpinion and Decision After ReconsiderationFindings and Orderspost-termination defenseLabor Code Section 3600(a)(10)Labor Code Section 5412continuous trauma injury
References
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