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

Case No. ANA 352921
Regular
Oct 02, 2007

STEPHEN GRIFFIS vs. ORANGE COUNTY FIRE AUTHORITY, CIGA on behalf of RELIANCE NATIONAL INSURANCE COMPANY, in liquidation, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding an applicant's cumulative trauma injury to May 12, 1997. The WCAB found that AIG, as "other insurance," is liable for all benefits awarded after Reliance National Insurance Company (Reliance) became insolvent on October 3, 2001. Consequently, the California Insurance Guarantee Association (CIGA) is entitled to reimbursement from AIG for all benefits CIGA paid after Reliance's liquidation.

CIGAReliance National InsuranceAIG Claims Servicescumulative traumabilateral hearing lossstipulated awardliquidationreimbursementother insurancecovered claim
References
7
Case No. SFO 0444182 SFO 0470385
Regular
Nov 16, 2007

MARK CRUZ vs. WESTLAKE AUTO SERVICE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY, in liquidation, by INTERCARE INSURANCE SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and found the State Compensation Insurance Fund liable for 4% of pre-liquidation benefits paid by Reliance and 100% of post-liquidation benefits paid by CIGA. The Board clarified that "workers' compensation benefit payments" encompass temporary disability, permanent disability, and medical treatment but specifically exclude administrative costs such as medical management, copying, and bill review. Therefore, the State Fund is not obligated to reimburse CIGA for these administrative expenses.

CIGAReliance National Insurance CompanyState Compensation Insurance Fundcontributionpermanent disabilitymedical treatmentcumulative traumaspecific injurypre-liquidation paymentspost-liquidation payments
References
6
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
2
Case No. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
Case No. STK 0142666
Regular
Jan 17, 2008

DAVID SOTO vs. ADVANCED PACKING & DISTRIBUTION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION On Behalf Of RELIANCE INSURANCE COMPANY, In Liquidation

This case involves a workers' compensation claim where the applicant sustained an injury while employed by both a general employer (Remedy) and a special employer (Advanced). Remedy's insurer, Reliance, became insolvent, leading CIGA to assume potential liability. The WCJ found that Advanced's insurer, SCIF, provided "other insurance" under Insurance Code § 1063.1(c)(9), thus relieving CIGA of responsibility. The Appeals Board denied SCIF's reconsideration, affirming that SCIF's policy constituted "other insurance" and that CIGA is a last resort insurer.

Workers Compensation Appeals BoardCIGAReliance Insurance Companyliquidationspecial employergeneral employerother insuranceInsurance Code section 1063.1(c)(9)covered claimsjoint and several liability
References
14
Case No. MISSING
Regular Panel Decision
Jan 03, 2000

Fireman's Fund Insurance v. Newark Insurance

This case concerns an appeal regarding an insurance coverage dispute. The Supreme Court, New York County, declared in favor of plaintiff insurer Fireman's, requiring defendant-appellant insurer Reliance to defend and indemnify Fireman's insured, Fisher, in an underlying personal injury action. The injury occurred at a construction site where Fisher was the general contractor and Reliance's insured, Consultants, was a subcontractor. The court affirmed the decision, finding that Fisher, as an additional insured on Reliance's policy, was entitled to the same coverage as Consultants, without a specific limitation for Consultants' negligence. The ruling also noted that General Obligations Law § 5-322.1 (1) does not affect the validity of insurance contracts, even while voiding agreements to indemnify negligent parties against their own negligence.

insurance coverageadditional insuredindemnificationduty to defendpersonal injuryconstruction liabilitysubcontractorgeneral contractorinsurance policy interpretationappellate review
References
3
Case No. MISSING
Regular Panel Decision

Serio v. Ardra Insurance

The Supreme Court, New York County, affirmed a judgment in favor of Gregory V. Serio, Superintendent of Insurance of the State of New York, as Liquidator of Nassau Insurance Company, against the DiLoreto defendants. The trial court's decision to pierce the corporate veil of Ardra Insurance Company, controlled from New York by Richard DiLoreto, was upheld based on New York law, despite Ardra's Bermuda incorporation. The court rejected the defendants' equitable estoppel claim, asserting that governmental agencies can alter positions in governmental functions. Furthermore, the evidence supported the jury's finding that transactions between Ardra and Nassau Insurance Company were unfair and inequitable, as the DiLoretos diverted funds, thereby denying Nassau coverage. The appellate court found the verdict consistent with the evidence and noted the defendants waived their claim regarding the jury's composition by consent.

Corporate Veil PiercingReinsuranceEquitable EstoppelGovernmental FunctionInsurance LawJury VerdictAppellate ReviewUnfair TransactionsCorporate DebtNew York Law
References
12
Case No. ADJ4618855 (VNO 0403261) ADJ181556 (VNO 0501021)
Regular
Jun 18, 2013

CYNTHIA WILLIAMS, vs. FORD MEEHAN INSURANCE; CIGA and its servicing facility, SEDGWICK CMS FOR RELIANCE INSURANCE COMPANY, in liquidation; MULLIN CONSULTING; FARMERS INSURANCE & EVEREST NATIONAL INSURANCE COMPANY,

The Workers' Compensation Appeals Board (WCAB) denied CIGA's petition for reconsideration, upholding the finding that CIGA, as administrator for Reliance Insurance, is solely liable for the applicant's injuries sustained between November 2, 1998, and July 19, 1999. The WCAB adopted the judge's report which found that the applicant's subsequent employment did not contribute to her disability. The decision was based on extensive medical evidence and the judge's determination of credibility regarding the applicant's testimony and the Agreed Medical Examiner's reports. CIGA's arguments regarding reliance on specific medical opinions and the admission of evidence were rejected by the WCAB.

CIGAReconsiderationWCJAgreed Medical ExaminerAMEContinuous TraumaReliance InsuranceSedgwick CMSDr. FriedmanDr. Mandel
References
0
Case No. AHM 90917 AHM 90918
Regular
Jul 11, 2007

ANGEL SOSA vs. D.W. FOODS, EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, VILLANOVA INSURANCE

This case concerns a dispute over reimbursement between an insurer, Everest, and the California Insurance Guarantee Association (CIGA), which is handling claims for a liquidated insurer, Villanova. The Board denied Everest's petition, upholding a prior award for reimbursement from Everest to CIGA. However, the Board granted CIGA's petition to amend the award to include Villanova Insurance as a party defendant.

CIGAEverest National Insurance CompanyVillanova Insuranceliquidationreconsiderationreimbursementbill review chargesjoint and several liabilitycumulative traumadenied due process
References
0
Case No. SRO 0088351
En Banc

Cheryl Coldiron vs. Compuware Corporation, California Insurance Guarantee Association, Reliance National Insurance Company (in liquidation), Intercare Insurance Services, Gallagher Bassett Services, Inc.

The Appeals Board held that a third-party administrator must disclose the identity of its client (employer or insurance carrier) and amended the award to be against the insurer, which had gone into liquidation and was succeeded by CIGA.

Workers' Compensation Appeals BoardThird-party administratorDisclosureSanctionsLabor Code Section 5813Insurance Code Sections 11650116571165911660Gallagher Bassett Services
References
7
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