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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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
Case No. ADJ4269777 (SJO 0238464) ADJ1887256 (SJO 0247242)
Regular
Nov 13, 2008

DOLORES WALLACE-McLEAN vs. CUPERTINO UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed an arbitrator's award requiring Cupertino Unified School District (District) to reimburse CIGA for benefits paid to an applicant following the liquidation of the District's insurer, Reliance National. The District argued CIGA had no legal basis for reimbursement and its claim was untimely and procedurally flawed. The Board found CIGA was entitled to reimbursement for temporary disability and medical treatment paid post-liquidation, and 75% of benefits paid prior to liquidation, based on prior arbitration and settlement agreements.

CIGAReliance National Insurance Companyliquidationreimbursementspecific injurycumulative traumacompromise and releasepermanent disabilityfuture medical careself-insured
References
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
Case No. LAO 779193
Regular
Dec 04, 2007

ZACHARY THOMAS vs. CONTRACTORS LABOR POOL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a prior award finding an applicant sustained industrial injuries while employed as a laborer. CIGA argued the claim was not a "covered claim" under Insurance Code section 1063.1(c)(9) due to alleged "other insurance" availability, but the Board found no substantial evidence that special employers' insurers provided coverage to the applicant. The Board also found no evidence of subsequent injury to the same body parts under a solvent insurer, thus affirming the applicant's entitlement to benefits.

California Insurance Guarantee AssociationCIGAReliance National Insuranceliquidationcovered claimspecial employerjoint and several liabilityother insuranceState Compensation Insurance FundSCIF
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. VEN 0120092
Regular
Apr 11, 2008

JOSE AVILA vs. SEMINIS VEGETABLE SEEDS, INC., REMEDYTEMP, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by INTERCARE for RELIANCE INSURANCE COMPANY in liquidation, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board denied Zurich North America's petition for reconsideration, affirming the arbitrator's decision that Zurich's policy with Seminis Vegetable Seeds constituted "other insurance." This finding relieved the California Insurance Guarantee Association (CIGA) of liability, as the applicant's claim was not a "covered claim" under CIGA's statutory authority. The Board found that despite Seminis being a special employer, its policy with Zurich covered special employees, making it primary to CIGA's involvement following the insolvency of the general employer's insurer.

Workers' Compensation Appeals BoardSeminis Vegetable SeedsRemedyTempCalifornia Insurance Guarantee AssociationCIGAZurich North AmericaReliance Insurance Companyliquidationspecial employergeneral employer
References
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
Case No. ADJ3672958 (ANA 0348289)
Regular
Aug 08, 2011

JUAN FLORES vs. KENDALL MCGAW LABORATORIES, REMEDY TEMP, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE, For RELIANCE INSURANCE COMPANY, In Liquidation

The WCAB rescinded the dismissal of Braun Medical and St. Paul, returning the case for further proceedings. CIGA, responsible for benefits from the insolvent Reliance, sought reimbursement from St. Paul, Braun Medical's insurer, alleging St. Paul's coverage constituted "other insurance." The WCAB found the previous dismissal lacked a clear basis and adequate record, necessitating a new decision by the WCJ after proper stipulation and evidentiary presentation. The decision emphasizes the importance of a complete record for review.

CIGAReliance Insurance CompanyIntercare InsuranceBraun MedicalSt. Pauljoinderreimbursementother insuranceinsolvent insurerspecial employer
References
Case No. ADJ3816448 (LAO 0789900) ADJ335314 (LAO 0818843) ADJ1177078 (LAO 0789901)
Regular
Sep 25, 2015

RAYMUNDO PITONES vs. MEL CAST LITHO, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves CIGA, the California Insurance Guarantee Association, seeking to be absolved of liability for workers' compensation benefits for an injured worker, Raymundo Pitones. CIGA argues that a settlement with another insurer for a subsequent, overlapping injury constitutes "other insurance" that should relieve CIGA of its obligations. The Workers' Compensation Appeals Board denied CIGA's petition, finding that the subsequent settlement did not fully cover all of Pitones' injuries, particularly those that did not overlap. Therefore, CIGA remains liable for the benefits not covered by the prior settlement to ensure the applicant can recover his full benefits.

CIGACalifornia Insurance Guarantee AssociationMel Cast LithoInc.California Compensation Insurance CompanyliquidationSEDGWICK CLAIMS MANAGEMENT SERVICESPetition for ReconsiderationJoint Findings of Fact and Orderworkers' compensation administrative law judge
References
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