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

Case No. ADJ6888100
Regular
Jul 03, 2012

MIGUEL AVALOS vs. SATICOY LEMON ASSOCIATION, Permissibly Self-Insured, Adjusted By YORK INSURANCE GROUP

In Miguel Avalos v. Saticoy Lemon Association, the Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration. This action was taken to allow the Board sufficient time to thoroughly review the factual and legal issues presented in the case. The WCAB requires this deeper examination to ensure a complete understanding of the record and to issue a just and reasoned decision. All future filings related to this matter must be submitted directly to the WCAB Commissioners in San Francisco.

WORKERS' COMPENSATION APPEALS BOARDMIGUEL AVALOSSATICOY LEMON ASSOCIATIONYORK INSURANCE GROUPPetition for ReconsiderationOPINION AND ORDER GRANTING RECONSIDERATIONstatutory time constraintsfactual and legal issuesjust and reasoned decisionfurther proceedings
References
Case No. ADJ3367486 (RIV 0016856) ADJ281670 (RIV 0008214) ADJ2292739 (RIV 0003259)
Regular
Feb 03, 2016

ROBERT O'NEAL vs. L.A. COUNTY FAIR ASSOCIATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA)

The Workers' Compensation Appeals Board (WCAB) has granted the applicant's petition for reconsideration in the case of Robert O'Neal v. L.A. County Fair Association and CIGA. This reconsideration is granted to allow for further study of the complex factual and legal issues presented. The WCAB needs a complete understanding of the record to issue a just decision. All future filings related to the petition must be submitted directly to the WCAB Commissioners' office, not to any district office.

Workers' Compensation Appeals BoardPetition for ReconsiderationGrant of ReconsiderationStatutory Time ConstraintsFactual and Legal IssuesJust and Reasoned DecisionOffice of the CommissionersElectronic Adjudication Management System (EAMS)Proposed SettlementWCJ
References
Case No. ADJ4399114 (POM 0281905) MF
Regular
Jun 27, 2013

RICARDO GARCIA vs. AMERICAN STAFF RESOURCES OF CALIFORNIA/TRIMCO, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CASCADE INSURANCE COMPANY, in liquidation, STATE COMPENSATION INSURANCE FUND

This case involves the State Compensation Insurance Fund (SCIF) seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB ordered SCIF to reimburse the California Insurance Guarantee Association (CIGA) $27,082.67 for costs incurred in a workers' compensation claim previously settled by SCIF. SCIF argued CIGA failed to prove reasonableness of costs and timely tendered the claim. The WCAB denied SCIF's petition, affirming the prior award, finding CIGA's expenditures were reasonable and necessary given SCIF's stipulation to the amounts spent and lack of evidence to the contrary. The Board clarified CIGA's legal status but upheld the reimbursement order based on statutory obligations and public policy.

Workers' Compensation Appeals BoardState Compensation Insurance FundCalifornia Insurance Guarantee AssociationCIGAreimbursementreasonable costsnecessary expenditurecompromise and releaseinvoluntary association of insurersstatutory duties
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
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
Case No. ADJ302560
Regular
Jan 10, 2012

DAVID COE vs. PROFESSIONAL ASSOCIATION OF DIVING INSTRUCTORS, MISSION INSURANCE COMPANY, IN LIQUIDATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Appeals Board granted reconsideration on its own motion to correct a clerical error in a prior decision regarding a Labor Code section 5710 attorney's fee. The original award of $1,903.75 was twice the applicant's attorney's requested fee of $1,093.75, which the WCJ and the Board's prior decision acknowledged. The Board corrected its decision to reflect the accurate attorney fee of $1,093.75, while reaffirming that CIGA has no liability for this fee due to a credit against the applicant's third-party recovery, which is reduced by the corrected fee amount.

Workers' Compensation Appeals BoardProfessional Association of Diving InstructorsMission Insurance CompanyCalifornia Insurance Guarantee Association (CIGA)Labor Code section 5710attorney's feeclerical errorpetition for reconsiderationthird-party recoverynet third party recovery
References
Case No. ADJ1868495 (VNO 0452398) ADJ4538828 (VNO 0468076)
Regular
Dec 14, 2012

JORGE HERNANDEZ vs. CRESCENT TRUCK LINES, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES, RELIANCE NATIONAL INSURANCE COMPANY

This case concerns the California Insurance Guarantee Association (CIGA) seeking reimbursement from the State Compensation Insurance Fund (SCIF) for costs incurred administering workers' compensation claims. The WCJ initially awarded CIGA reimbursement for benefits paid but not for associated administration expenses. The Appeals Board granted CIGA's reconsideration petition, ruling that CIGA is entitled to reimbursement for both benefits and specific claim administration expenses, including medical-legal costs. The Board amended the findings and award to reflect this, returning the matter to the trial level for further proceedings.

CIGAReliance National Insurance CompanySedgwick Claims Management ServicesState Compensation Insurance Fund (SCIF)Petition for ReconsiderationJoint Findings and Award (F&A)reimbursementassociated expensesmedical treatmentloss adjustment expense
References
Case No. ADJ2393611 (SBR 0306199)
Regular
Sep 18, 2012

LAZARA HERNANDEZ vs. CORONA COLLEGE HEIGHTS ORANGE & LEMON ASSOCIATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION BY ITS SERVICING FACILITY, INTERCARE HOLDINGS INSURANCE SERVICES FOR WESTERN GROWERS INSURANCE COMPANY, IN LIQUIDATION

Defendant CIGA sought reconsideration of the WCJ's Findings of Fact. After granting reconsideration, the Board was notified that the parties had resolved their dispute, rendering the petition moot. Consequently, the Board vacated its order granting reconsideration and dismissed CIGA's petition for reconsideration or removal. The original Findings of Fact remain unchanged.

Workers' Compensation Appeals BoardReconsiderationRemovalPetitionDismissedVacatedLiquidationServicing FacilityWCJFindings of Fact
References
Case No. ADJ3605789 (GOL 0101314), ADJ2387995 (GOL 0101316), ADJ460036 (GOL 0101315)
Regular
Jul 26, 2012

JORGE VIVANCO vs. NEVERLAND VALLEY RANCH, ESTATE OF MICHAEL JACKSON, MJJ PRODUCTIONS, TRAVELERS INDEMNITY, UNITED STAFFING ASSOCIATES, AMERICAN HOME ASSURANCE COMPANY, MONARCH CONSULTING dba PES PAYROLL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed the original findings regarding employment for both United Staffing Associates and Monarch Consulting. The Board found that United Staffing Associates was never the applicant's employer, rescinding findings that they were the employer on October 8, 2007, and for a cumulative trauma period. Regarding Monarch Consulting, the Board found they were not the employer on October 2, 2006, but were the general employer from March 2006 through August 30, 2007, with specific exclusions, reversing the prior ruling on the specific injury date. The case was returned for further proceedings consistent with these revised findings.

Workers Compensation Appeals BoardJorge VivancoNeverland Valley RanchEstate of Michael JacksonMJJ ProductionsTravelers IndemnityUnited Staffing AssociatesAmerican Home Assurance CompanyMonarch ConsultingPES Payroll
References
Case No. ADJ9621646
Regular
Jun 23, 2015

VIOLETA GOMEZ vs. FAIRVIEW ASSOCIATES, PROCENTURY INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the Petition for Removal filed in the case of Violeta Gomez v. Fairview Associates. The WCAB adopted and incorporated the reasoning of the workers' compensation administrative law judge's report. This order means the petition seeking removal from a lower decision was unsuccessful.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportdismissADJ9621646Salinas District Officeadministrative law judgeFairview AssociatesProCentury Insurance CompanyIllinois Midwest Insurance Agency
References
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