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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ7598160
Regular
Nov 19, 2014

MAURICE JOHNSON vs. PHILADELPHIA EAGLES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE INSURANCE COMPANY, in liquidation, FAIRMONT PREMIER INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a lower decision, finding California lacked jurisdiction over a professional football player's cumulative trauma claim against the Philadelphia Eagles. The Board held that playing only two games in California did not create a sufficient connection to the injury to warrant applying California law, citing *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*. The applicant's limited physical presence and routine pre/post-game treatment in California were deemed de minimis. Therefore, the applicant took nothing on his California WCAB claim.

CIGAPhiladelphia EaglesReliance Insurance Companycumulative traumaprofessional football playerjurisdictionFederal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)administrative law judgepermanent disabilityapportionment
References
Case No. ADJ4684775 (VEN 0117727) ADJ4381820 (VEN 0117723)
Regular
Dec 19, 2011

JOANNE LUTZ, JOANN LUTZ vs. RUSSELL WARNER dba ROTO ROOTER SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PAULA INSURANCE COMPANY, in liquidation, and for FREMONT INSURANCE COMPANY, in liquidation, LINDA McDONALD, STATE FARM INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling, allowing CIGA to pursue reimbursement from State Farm for benefits paid due to applicant's industrial injuries. The Board found that unlike a request to alter a prior award, CIGA's petition sought to enforce its statutory right to reimbursement from "available" insurance under Insurance Code section 1063.1(c)(9). Since State Farm, as a jointly and severally liable insurer, appears to be such "available" insurance, the case is remanded for further proceedings on CIGA's reimbursement claim.

California Insurance Guarantee AssociationCIGAPaula Insurance CompanyFremont Insurance CompanyState Farm Insurance Companystipulated awardreconsiderationreimbursementcontributionother insurance
References
Case No. VEN 0115536
Regular
Aug 04, 2008

ROBERT FROELICH vs. CONTRACTORS LABOR POOL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCATION, RELIANCE NATIONAL INSURANCE CO., GM NORTHROP CORP., NATIONAL FIRE INSURANCE COMPANY OF HARTFORD

This case concerns a dispute over workers' compensation liability following an industrial injury sustained by an employee who was a general employee of Contractors Labor Pool (insured by insolvent Reliance) and a special employee of GM Northrup Corp. The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding, determining that National Fire Insurance Company's policy for GM Northrup Corp. constituted "other insurance." Consequently, National Fire Insurance Company is now liable for the applicant's benefits, and the California Insurance Guarantee Association is not liable as the claim is not a "covered claim."

CIGAReliance National InsuranceNational Fire Insurance Companycovered claimsother insurancegeneral employerspecial employerjoint and several liabilitypolicy constructionInsurance Code section 1063.1
References
Case No. ADJ4415679 (OAK 0259031) ADJ2701101 (WCK0050594)
Regular
May 10, 2010

Stanley Sanders vs. REMEDY INTELLIGENT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY, OREGON STEEL MILLS, INC. dba NAPA PIPE

The Workers' Compensation Appeals Board reversed a judge's decision, ruling that Napa Pipe, a self-insured special employer, is liable for applicant Stanley Sanders' workers' compensation benefits. Despite an agreement between the general employer (Remedy Temp) and Napa Pipe attempting to limit liability to Remedy Temp's insurer (Reliance), Napa Pipe's joint and several liability as a special employer cannot be contractually eliminated. Because Napa Pipe's self-insurance was not excluded for special employees and constitutes "other insurance" under Insurance Code § 1063.1(c)(9), CIGA is relieved of its obligation to provide benefits following Reliance's insolvency. Therefore, Napa Pipe must now provide all workers' compensation benefits and administer the claim.

Workers' Compensation Appeals BoardStanley SandersRemedy Intelligent StaffingCalifornia Insurance Guarantee AssociationReliance National Insurance CompanyOregon Steel MillsNapa PipeADJ4415679ADJ2701101Opinion and Decision After Reconsideration
References
Case No. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
Case No. ADJ128210 (SAL 0093437) ADJ593542 (SAL 0093436)
Regular
Apr 12, 2010

JORGE RAMIREZ vs. LINO FINATTI, JR., CIGA on behalf of RELIANCE INSURANCE COMPANY, in liquidation, administered by INTERCARE SERVICES, CLARENDON INSURANCE COMPANY, adjusted by NORTH AMERICAN RISK SERVICES

This case involves a dispute over reimbursement for workers' compensation expenses between the California Insurance Guarantee Association (CIGA) and Clarendon Insurance Company. CIGA, covering for Reliance Insurance Company in liquidation, sought reimbursement for administrative expenses in addition to indemnity and medical costs. The arbitrator initially denied administrative expenses due to insufficient justification, but the Appeals Board granted reconsideration. The Board applied the *Ramos* decision, allowing CIGA to recover administrative costs like bill review and utilization review from Clarendon for the applicant's low back injuries.

CIGAReliance Insurance CompanyClarendon Insurance Companyadministrative expensesreimbursementbill reviewmedical managementutilization reviewsubpoenaing recordsjoint and several liability
References
Case No. ADJ2480026
Regular
Aug 26, 2011

CHAD IMES vs. SCENARIO DESIGNS, INC., EVEREST NATIONAL INSURANCE COMPANY, POWER PAYROLL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling and ordered Everest National Insurance Company to reimburse CIGA for benefits paid to the applicant. The Board found that Everest was "other insurance" available under Insurance Code section 1063.1(c)(9) because its insured, Scenario Designs, Inc., employed the applicant on the date of injury. This decision clarifies that reimbursement to CIGA does not alter the original award and aligns with statutory limitations on CIGA's liability. Everest is now obligated to reimburse CIGA and administer future benefits.

CIGAEverest National Insurance CompanyLegion Insurance CompanyScenario DesignsPower PayrollInc.other insurancereimbursementdate of injurygeneral-special employment
References
Case No. ADJ2398835 (LAO 0799123)
Regular
Mar 26, 2010

LETICIA FERNANDEZ vs. MOUNT ST. MARY'S COLLEGE, CONVERIUM INSURANCE COMPANY/SRS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK, INC., LEGION INSURANCE COMPANY, VILLANOVA INSURANCE COMPANY

Converium Insurance Company sought reconsideration of a decision denying its claim for reimbursement from the California Insurance Guarantee Association (CIGA). Converium had paid workers' compensation benefits to Leticia Fernandez, but later argued these payments were made in error due to applicant's denial of a specific injury. The Arbitrator recommended denying reconsideration, finding that CIGA statutes, particularly Insurance Code Sections 1063.1(c)(5) and (9), prohibit reimbursement to solvent insurance carriers for claims that are not "covered claims" or are made by assignees or subrogated parties. The Workers' Compensation Appeals Board adopted the Arbitrator's report, denying Converium's petition for reconsideration.

California Insurance Guarantee AssociationCIGAConverium Insurance CompanySRSLegion Insurance CompanyVillanova Insurance Companyliquidationreconsiderationarbitrator's reportspecific injury
References
Case No. ADJ4439745 (ANA 0351385)
Regular
Jul 24, 2012

ERNESTO AGRAMONT vs. ASSOCIATED CONCRETE PRODUCTS (NEW BASIS), AMERICAN PROTECTION INSURANCE COMPANY, GALLAGHER BASSETT INSURANCE SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, RELIANCE INSURANCE COMPANY

This case involves a denial of reconsideration for a workers' compensation claim. The Appeals Board adopted the Workers' Compensation Judge's (WCJ) findings, finding substantial support in the record for the determined dates of cumulative trauma injury, despite some conflicting evidence on missed work. The Board also noted a discrepancy in the defendant's insurer identification, stating defense counsel must properly identify their client. Consequently, the petition for reconsideration of the original findings of fact is denied.

WCABErnesto AgramontAssociated Concrete ProductsAmerican Protection Insurance CompanyGallagher BassettCalifornia Insurance Guarantee AssociationReliance Insurance CompanyWCJ ReportPetition for ReconsiderationCumulative Trauma Injury
References
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