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

Case No. ADJ11114421
Regular
Jun 05, 2025

FELIX CABRERA vs. OAA INVESTMENTS, INC.; CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

Defendant California Restaurant Mutual Benefit Corporation (CRMBC) sought reconsideration of a February 19, 2021 Findings and Order (F&O) which found CRMBC liable for coverage of applicant Felix Cabrera's injury, ruling that CRMBC's policy cancellation was premature. CRMBC contended it had no coverage obligations as the applicant was employed by OAA Investments, Inc., not insured by CRMBC, and argued against the applicability of Insurance Code section 676.8. The Appeals Board affirmed the WCA's F&O, treating the petition as one for reconsideration, and found that under Insurance Code section 676.8 and equitable principles, CRMBC was liable for coverage. The Board reasoned that due to a material change in ownership, CRMBC's cancellation notice required 30 days' notice, making January 27, 2018, the earliest effective cancellation date, which was after the November 22, 2017 injury date.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPolicy CancellationInsurance Code Section 676.8Material Change in OwnershipEquitable EstoppelAffiliate Certificate of Consent to Self-InsureGroup Self-InsurerAD Rule 15480
References
Case No. LBO 0319122
Regular
May 19, 2008

RICARDO MORAN-FLORES vs. ALEX STAVROPOULOS, dba THE GREEK MATTRESS WAREHOUSE, GOLDEN EAGLE INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed an Arbitrator's decision that the employer's workers' compensation policy was effectively cancelled on April 25, 2000, prior to the applicant's October 21, 2000 injury. The Board found that the insurer provided proper notice of cancellation for non-reporting of payroll, and the employer failed to present evidence rebutting receipt of this notice. Therefore, the policy was deemed terminated before the employee's injury.

Workers' Compensation Appeals BoardReconsiderationArbitrator DecisionInsurance CancellationPolicy TerminationNon Report of PayrollGolden Eagle Insurance CompanyRicardo Moran-FloresAlex StavropoulosThe Greek Mattress Warehouse
References
Case No. ADJ3732643 (OXN 0133370)
Regular
Aug 12, 2011

JAIME GONZALEZ vs. HAMLIN DEVELOPMENT CORPORATION: GRANITE STATE INSURANCE COMPANY, et al.

This case concerns Granite State Insurance Company (AIG) seeking reconsideration of a prior order finding their workers' compensation policy with Hamlin Development Corporation valid and in force at the time of applicant Jaime Gonzalez's injury. The Board denied reconsideration, upholding the arbitrator's finding that AIG failed to properly and timely cancel the policy. AIG's cancellation notice was deemed defective because it lacked statutory grounds, did not explain how to cure the alleged deficiency, and did not notify the insured's intermediaries. Therefore, AIG remains obligated to defend Hamlin and provide benefits to Gonzalez.

Workers' Compensation Appeals BoardGranite State Insurance CompanyHamlin Development CorporationJaime GonzalezInsurance Code section 676.8Notice of CancellationPremium Finance AgreementInsurexConcord InsuranceCananwill
References
Case No. ADJ4668407 (RIV 0055963)
Regular
Feb 19, 2015

JOSE MARTINEZ vs. 2K FABRICATION, INCORPORATED, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior decision finding that State Compensation Insurance Fund (SCIF) did not provide coverage for 2K Fabrication, Inc. on July 8, 2003. The Board ruled that SCIF's cancellation of the employer's policy effective March 18, 2003, was valid. Arguments for coverage based on alleged lack of notice, estoppel due to premium acceptance, audits, and defense of the claim were rejected. The Board found no evidence of a written reinstatement of the canceled policy.

Workers' Compensation Appeals BoardReconsiderationPolicy CancellationCoverage DisputeEstoppelWaiverWritten NoticeInsurance ContractPremium PaymentPost-Cancellation Audit
References
Case No. ADJ1389831
Regular
Sep 19, 2008

SHAWNDELL WILLIAMS vs. THRUSHWING HOME, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and reversed the Arbitrator's decision, finding that the worker's compensation policy was effectively cancelled before the injury date, thus SCIF had no liability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardNotice of CancellationInsurance Code section 676.8Code of Civil Procedure section 1013(a)Policy CancellationInsured StatusDate of InjuryArbitrator's Decision
References
Case No. LAO 0797710
Regular
Apr 21, 2008

LEONARD DI PERI vs. INTERNET CONNECT, ST. PAUL TRAVELERS SPECIAL SERVICES

This case involves an applicant who sustained an admitted industrial back injury in 2000. The Workers' Compensation Appeals Board denied reconsideration of a prior award, affirming the applicant's entitlement to temporary disability indemnity. The Board found that the applicant was properly allowed an expedited hearing on retroactive TDI, and rejected the defendant's claims of due process denial and unjust enrichment due to delayed surgery.

Expedited hearingretroactive temporary disability indemnitydue processunjust enrichmentspinal surgery authorizationmedical evaluation cancellationadmitted industrial injuryLabor Code section 5502priority calendarvocational rehabilitation
References
Case No. ADJ8252128
Regular
Nov 30, 2015

HILARY RHONAN vs. COUNTY OF LOS ANGELES, INTERCARE INSURANCE SERVICES

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration to correct mathematical and clerical errors in an award approving stipulations. While the defendant sought to amend the award to include a credit, the Board affirmed the award with specific corrections to the retroactive temporary disability, self-imposed penalty, attorney's fees, and the permanent disability rate. The final award reflects these adjustments as agreed upon and recommended by the WCJ.

Petition for ReconsiderationAward Approving Stipulationsretroactive temporary disabilityself-imposed penaltyattorney's feepermanent disabilityLabor Code section 4658(d)mathematical errorsclerical errorWCJ
References
Case No. ADJ2832796 (SAC 0362707) ADJ1414613 (SAC 0362718)
Regular
Mar 15, 2011

DANIEL WALTERS vs. HOLLAND CUSTOM IRON WORKS, INC., CALIFORNIA INSURANCE COMPANY

This case concerns whether an employer, Holland Custom Iron Works, Inc., had workers' compensation insurance coverage on August 16, 2006, following a notice of cancellation for non-payment. The Appeals Board affirmed an arbitrator's finding that coverage existed, relying on equitable estoppel and the ambiguity of the cancellation notice. The insurer's contention that coverage was contingent on a "gap premium" payment was rejected as exceeding the arbitrator's authority. The Board's decision clarifies that the payment made by the employer was sufficient to rescind the cancellation.

Gap premiumequitable estoppelworkers' compensation insurance coveragecancellation noticerescissionarbitration rulingpayment ambiguityrelianceambiguous languagemonetary default
References
Case No. ADJ7054442
Regular
Jan 11, 2013

JARRAD JELSMA vs. WINE GROUP, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Board denied the defendant's petition for reconsideration of the WCJ's award of temporary disability indemnity. The defendant failed to demonstrate due diligence in producing a wage statement discovered after trial, which it claimed would lower the indemnity rate. While denying reconsideration of the retroactive award, the Board allowed the defendant to petition to reopen the award to prospectively adjust the temporary disability indemnity rate based on the disputed wage statement. The Board also denied credit to the defendant for any retroactive overpayment of temporary disability indemnity.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAverage Weekly EarningsTemporary Disability IndemnityWage StatementDue DiligenceNewly Discovered EvidenceReopen AwardRetroactive Overpayment
References
Case No. ADJ8619480
Regular
Nov 22, 2019

MARCO MARTINEZ, vs. BRAM, LLC, aka VALLEY PROTEIN, LLC, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The WCAB rescinded an arbitrator's decision finding CIGA liable for benefits because the record lacked required findings, stipulations, and evidence, violating WCAB Rule 10566 and *Hamilton*. CIGA argued the policy was canceled due to the employer's failure to pay premiums, which the broker did not timely forward to the insolvent insurer. The Board noted that policy cancellation requires 10 days' written notice and that CIGA is not an insurer with the same responsibilities. The case is returned to the arbitrator to create an adequate record and issue a proper decision.

CIGAinsolvent insurerCastlepointpremium paymentpolicy cancellationauthorized agentWCAB Rule 10566Hamilton v. Lockheed Corp.arbitration recordfindings of fact
References
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