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Case Law Database

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

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. ADJ9268751
Regular
Jul 03, 2017

THITIKORN GALBRAITH vs. JAMES E. FITZGERALD, D.D.S., INC., EMPLOYERS COMPENSATION INSURANCE COMPANY, PREFERRED EMPLOYERS INSURANCE COMPANY

Defendant Preferred Employers Insurance Company (PEIC) sought reconsideration of an administrative law judge's (ALJ) order denying reformation of a Compromise and Release and finding another defendant joined in error. PEIC argued the ALJ should not have ruled on the matter, as a different judge initially approved the settlement. The Workers' Compensation Appeals Board denied PEIC's petition, finding it procedurally defective and untimely filed as a disqualification request. Therefore, PEIC's attempt to challenge the ALJ's authority after the decision was unsuccessful.

Compromise and ReleasePetition for ReconsiderationFindings of Fact and OrdersWCJJudge AssignmentDisqualificationWCAB Rule 10452Labor Code section 5311TimelinessRemoval
References
0
Case No. ADJ4258158 (OXN 0128983) ADJ4450153 (OXN 0136267)
Regular
Jun 01, 2010

BRENDA K. ROACH vs. BRIDAL TRADITIONS, CALIFORNIA INDEMNITY INSURANCE COMPANY, PREFERRED EMPLOYERS INSURANCE COMPANY

This case involves California Indemnity Insurance Company (CIIC) seeking reconsideration of a Workers' Compensation Arbitrator's decision. CIIC disputes the finding of a single cumulative trauma injury period and the assigned date of injury, arguing for a longer exposure period. The Appeals Board granted reconsideration and amended the prior findings to establish one cumulative trauma injury from March 5, 1999, through November 24, 2002. The original decision regarding CIIC's contribution claim against Preferred Employers Insurance Company was otherwise affirmed.

Cumulative traumaDate of injuryLabor Code section 5412Labor Code section 5500.5Petition for ContributionReconsiderationFindings and OrderCompromise and ReleaseAnti-merger statutesApportionment
References
2
Case No. ADJ4276340 RDG 0095395 ADJ7960157
Regular
Aug 15, 2013

David Sandrock vs. Independent Business Forms, Inc., Preferred Employers Insurance Company

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and amended a prior decision regarding David Sandrock's cumulative trauma claim. The WCAB found that Sandrock's cumulative trauma injury ending July 28, 2006, is not presumptively compensable because no claim form was filed with the employer, as required by Labor Code sections 5401 and 5402. The Board determined that the insurer, Preferred Employers, did not violate due process by submitting the case on briefs at a conference. The WCAB deferred the issue of injury arising out of and occurring in the course of employment (AOE/COE) and returned the matter to the trial level for further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderCumulative TraumaPresumptive CompensabilityClaim Form90-Day Investigation PeriodDue ProcessIndustrial InjuryAOE/COE
References
1
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. ADJ16913929
Regular
Oct 24, 2025

NIDYA GONZALEZ vs. SIZZLER USA ACQUISITION, INC., PREFERED EMPLOYERS INSURANCE COMPANY

Applicant Nidya Gonzalez and defendant Sizzler USA Acquisition, Inc., insured by Preferred Employers Insurance Company, both sought reconsideration of a WCJ's Findings of Fact and Award (F&A) from February 27, 2025, which found applicant sustained a cumulative injury with 95% permanent disability. Defendant contended the claim was barred by the statute of limitations and post-termination defense, and that Dr. Rubanenko's reports lacked substantial medical evidence, while applicant contended a miscalculation in permanent disability. The Appeals Board denied the defendant's petition, finding the claim was not barred and Dr. Rubanenko's reports constituted substantial medical evidence. The Board granted the applicant's petition, amending the F&A to set applicant's earnings at $1,272.03 per week, resulting in a temporary and permanent total disability rate of $848.20 per week, and increasing the permanent disability to 100% based on an age adjustment correction and the application of the Vigil decision regarding overlapping impairments.

Statute of LimitationsCumulative TraumaDate of InjuryPost-Termination DefenseSubstantial Medical EvidenceAMA GuidesPermanent Disability RatingPetition for ReconsiderationEarningsVocational Injury
References
23
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. ADJ8386118
Regular
Jan 04, 2013

RALPH GONZALES vs. PURELY CLEAN POOLS, PREFERRED EMPLOYERS INSURANCE

This Workers' Compensation Appeals Board case involves an applicant, Ralph Gonzales, and defendants Purely Clean Pools and Preferred Employers Insurance. A petition for removal was filed by a party in this matter. However, the petitioner subsequently withdrew the petition for removal. Consequently, the Board has issued an order dismissing the petition, and no further action will be taken.

Petition for RemovalWithdrawn PetitionDismissed PetitionWorkers' Compensation Appeals BoardPurely Clean PoolsPreferred Employers InsuranceADJ8386118Oakland District OfficeAlfonso J. MoresiRonnie G. Caplane
References
0
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