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Case Law Database

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

Case No. ADJ9282902
Regular
Oct 10, 2017

JUAN CARRILLO vs. ASKEW INDUSTRIAL CORPORATION, TWIN CITY FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the Employment Development Department's (EDD) petition for reconsideration. The EDD sought interest on reimbursement awarded for disability benefits, but the original Findings and Award did not specify the reimbursement amount or rule on interest. The Board found the EDD was not aggrieved by the initial award, as the parties were instructed to adjust the amount themselves. Therefore, the EDD must first seek a final order on the reimbursement amount before pursuing reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardtemporary disability indemnityreimbursementEmployment Development Department (EDD)lienUnemployment Insurance Code section 2629.1interestadministrative law judge (WCJ)
References
Case No. ADJ2834079 (SDO 0293027) ADJ2839895 (SDO 0358837)
Regular
Jun 25, 2009

THUAN CRIM-ROLFE vs. LA COSTA RESORT AND SPA, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, BROADSPIRE, SAFETY NATIONAL CASUALTY INSURANCE COMPANY

This case involves a clerical error in a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB previously ordered Safety National Casualty Insurance Company (SNCC) to reimburse the California Insurance Guarantee Association (CIGA) a specific amount for bill review charges. CIGA requested clarification, noting the amount ordered was incorrect. The WCAB affirmed its earlier decision that CIGA is entitled to reimbursement for bill review costs but amended the order nunc pro tunc. The corrected order now states SNCC must reimburse CIGA for bill review charges, with the exact amount to be determined by the parties or the arbitrator.

California Insurance Guarantee AssociationLegion Insurance CompanySafety National Casualty Insurance Companynunc pro tuncclerical errorbill review chargesliquidationcovered claimsreimbursementpetition for reconsideration
References
Case No. ADJ8296879
Regular
Oct 26, 2016

JUANA SANTILLAN vs. D'ARIGGO BROTHERS COMPANY OF CALIFORNIA, NATIONAL UNION FIRE INSURANCE

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, rescinding a prior ruling that awarded a lien claimant additional payment. While the lien claim was not barred by statute of limitations and the defendant was not entitled to reimbursement for prior payments, the Appeals Board found the lien claimant failed to present sufficient evidence. Specifically, the claimant did not establish that services were billed to the defendant or that the billed amounts were reasonable. Therefore, the lien claimant was awarded nothing further on its lien.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and OrderLien ClaimStatute of LimitationsLabor Code section 4604.524 visit capLabor Code section 4903.5Self-authenticating documentWCJ Report and Recommendation
References
Case No. ADJ4137919 (LAO 0855341) ADJ3018408 (LAO 0855344)
Regular
Dec 15, 2009

Enrique Madrigal vs. KAVLICO CORP, NOVA PRO RISK SOLUTIONS

Lien claimants' Petition for Reconsideration is granted; the Orders of Reimbursement are affirmed, but amended to delete the award of interest.

Petition for ReconsiderationOrder of ReimbursementLien ClaimantsPetition for ReimbursementAmounts Paid in ErrorInterest AwardWCJ's OrderStatutory BasisAppeals BoardDecision After Reconsideration
References
Case No. ADJ248306 (SAC 0298167) ADJ870873 (SAC 0298071)
Regular
Jul 28, 2017

Lonnie Roberts vs. Capital Plumbing, California Insurance Guarantee Association, Reliance National Indemnity Company, SEDGWICK CLAIMS MANAGEMENT SERVICES, ACE USA

The Workers' Compensation Appeals Board granted reconsideration to clarify ACE USA's liability for reimbursement to CIGA. ACE USA argued that CIGA's claim lacked sufficient proof and that the initial order failed to specify an amount. The Board affirmed the finding that ACE USA is liable for reimbursement to CIGA for temporary disability, medical treatment, bill review, and utilization review for services paid after January 26, 2001. However, the Board amended the order to clarify that the parties must adjust the reimbursement amount, with the trial judge retaining jurisdiction if an agreement is not reached.

Workers' Compensation Appeals BoardCIGAACE USAReimbursementLiquidationJointly and Severally LiableOther InsuranceBenefit PrintoutLabor Code Section 5815Unclean Hands Doctrine
References
Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
Case No. ADJ3535372 (POM 0252700) ADJ4563878 (POM 0290856)
Regular
Sep 23, 2013

JANET BOWEN vs. MICHAEL J'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by INTERCARE INSURANCE SERVICES for PACIFIC NATIONAL INSURANCE, in liquidation, GLENDORA CONTINENTAL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior order finding the California Insurance Guarantee Association (CIGA) entitled to reimbursement from the State Compensation Insurance Fund (SCIF). SCIF argued CIGA's reimbursement claim was untimely and that CIGA knew of SCIF's joint liability. CIGA asserted SCIF never contested the reimbursement amount. The Board affirmed the WCJ's decision, clarifying CIGA's statutory role and distinguishing "coverage" from "covered claim," deeming SCIF's arguments regarding coverage misplaced.

California Workers CompensationCIGASCIFReimbursementPetition for ReconsiderationFindings and OrderStipulated AwardCovered ClaimsInsolvent InsurerInsurance Code Section 1063
References
Case No. ADJ3685689 (ANA 0335527) ADJ1125665 (ANA 0345901) ADJ1288486 (ANA 0345902) ADJ3581550 (ANA 0345904) ADJ2369046 (ANA 0335528) MF ADJ2208312 (ANA 0349503)
Regular
Nov 16, 2012

MARIA WENCES vs. JC RESORTS, INC., dba SAND & SURF HOTEL, et. al.; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION; by BROADSPIRE, for CALIFORNIA COMPENSATION and HIH, in liquidation, EBIC, administered by ARROWWOOD INDEMNITY COMPANY

The Appeals Board granted reconsideration of a WCJ's decision, amending the date of cumulative injury to the applicant's lower extremities to September 21, 1998, through February 18, 2000. The Board affirmed the finding that EBIC, as a solvent carrier, must administer the claim and reimburse CIGA for payments made. This reimbursement amount is to be adjusted by the parties. The Board found the Agreed Medical Examiner's opinions constituted substantial evidence supporting the cumulative trauma finding.

Workers' Compensation Appeals BoardMaria WencesJC ResortsSand and Surf HotelCalifornia Insurance Guarantee AssociationCIGABroadspireHIHEBICArrowpoint Capital
References
Case No. ADJ3133627 (SAL 0114355) ADJ1802214 (SAL 0110847) ADJ3324036 (SAL 0111146)
Regular
Oct 16, 2012

DAVID TANNAHILL vs. SKIP'S AUTO PARTS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, in liquidation, SENTRY INSURANCE COMPANY

This case concerns Sentry Insurance's petition for reconsideration of a previous Appeals Board decision. The Board denied Sentry's petition, upholding its prior ruling that the California Insurance Guarantee Association (CIGA) is entitled to reimbursement for reasonable bill review costs, not the specific $35,152.88 initially claimed. The amount of reimbursement remains to be determined by the workers' compensation judge if the parties cannot resolve it themselves. This decision allows for further development of the evidentiary record to ensure substantial justice.

CIGASkip's Auto PartsSuperior National Insurance CompanySentry Insurance CompanyPetition for ReconsiderationBill Review CostsReimbursementAdministrative Law JudgeOpinion and OrderWorkers' Compensation Appeals Board
References
Case No. ADJ8860181
Regular
Jul 16, 2015

GARY GATSON vs. BIMBO BAKERIES USA, INC., ACE AMERICAN INSURANCE COMPANY

This case involves a dispute over the Employment Development Department's (EDD) lien for temporary disability benefits paid to the applicant. The original award found the applicant sustained a cumulative trauma injury and awarded temporary disability benefits, but only allowed partial reimbursement to EDD. Both EDD and the employer sought reconsideration, with EDD arguing for full reimbursement and the employer challenging the EDD lien finding. The Appeals Board granted EDD's petition, denied the employer's, and will allow further proceedings to determine the correct amount of EDD's lien and temporary disability award.

WCABcumulative traumaAchilles tendonpermanent disabilitytemporary disabilityEDD lienreconsiderationsubstantial evidencestandingLabor Code section 4904
References
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