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

Case No. ADJ2263363 (SAC 0291821) ADJ2654728 (SAC 0291246)
Regular
Dec 05, 2008

LEROY ARMSTRONG vs. ENVIRONMENTAL CONSTRUCTION, STATE COMPENSATION INSURANCE FUND, SLIPFORM CONCRETE, BROADSPIRE, California Insurance Guarantee Association (CIGA), Legion Insurance, State Compensation Insurance Fund (SCIF), Fireman's Fund

The Workers' Compensation Appeals Board dismissed CIGA's petition for reconsideration because the WCJ's deferral of CIGA's requested issues was not a final order, and CIGA was not aggrieved. The Board also denied CIGA's petition for removal, finding no extraordinary circumstances. Finally, the Board denied SCIF's petition for reconsideration, agreeing with the WCJ's determination that the applicant's claim against Environmental Construction was timely.

Workers Compensation Appeals BoardCIGASCIFReconsiderationRemovalPetitionFinal OrderStatute of LimitationsIndustrial InjuryDeferred Issue
References
7
Case No. ADJ1143803 (OXN 0128653) ADJ2709854 (OXN 0142376)
Regular
Nov 01, 2011

SALVADOR PAZ vs. MARTINEZ PAINTING & WALL COVERING, MB PAINTING, CIGA, for CREDIT GENERAL INSURANCE COMPANY, INTERCARE, CIGA for UNITED PACIFIC INSURANCE COMPANY, INTERCARE, STATE FARM INSURANCE COMPANY, ACE USA

This case involves a painter, Salvador Paz, who sustained cumulative and specific injuries to his back, shoulder, wrist, neck, and foot. The Workers' Compensation Appeals Board denied petitions for reconsideration from State Farm, CIGA, and the applicant. The Board upheld the original findings, which apportioned permanent disability at 72% to the specific injury (CIGA via Credit General) and 28% to the cumulative trauma (ACE USA and State Farm). Liability for temporary disability was also divided, and State Farm's arguments regarding an unequal division and due process were rejected.

CIGAState Farmcumulative injuryspecific injuryapportionmenttemporary disabilitypermanent disabilityvocational expertPetition for ReconsiderationCredit General Insurance
References
1
Case No. ADJ474396
Regular
Apr 26, 2013

VADIM KOVALENKO vs. PESP dba ACTION PRODUCTION, CIGA by SEDGWICK CMS for LEGION INSURANCE COMPANY, in liquidation, LUMINATIONS INC., ST PAUL FIRE & MARINE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order dismissing a lien claimant's lien with prejudice. The lien claimant failed to appear at a lien conference and provide proof of paying the required lien activation fee as mandated by Labor Code section 4903.06(a)(4). Despite the claimant's argument of not being aware of the conference date, the WCJ found this claim not credible based on the record. The Board adopted the WCJ's reasoning, affirming that no relief was available for the failure to pay the fee.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ OpinionReport and RecommendationDeniedApplicantDefendantsCIGALegion Insurance CompanyLiquidation
References
1
Case No. ADJ855136
Regular
Aug 14, 2017

ROSE SANTANA vs. STANFORD UNIVERSITY, ZURICH AMERICAN INSURANCE COMPANY, CIGA, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., RELIANCE INSURANCE COMPANY

In this workers' compensation case, CIGA sought reimbursement for benefits paid, arguing two cumulative trauma injuries were actually one and Zurich was liable. The Appeals Board affirmed the prior denial of CIGA's claim, finding CIGA was judicially estopped from disputing the existence of two distinct cumulative trauma injuries after previously stipulating to them. CIGA also failed to present sufficient medical evidence to prove that both injuries contributed to the need for temporary disability or medical treatment. Therefore, the arbitrator's original decision denying CIGA's petition for contribution/reimbursement was upheld.

Workers' Compensation Appeals BoardCIGAZurich American Insurance CompanyReliance Insurance Companyjudicial estoppelcumulative traumaapportionmentjoint and several liabilitycovered claimsinsolvent insurer
References
8
Case No. ADJ1124123 (BGN 0064929) ADJ3374432 (BGN 0061307)
Regular
Oct 22, 2018

MARY BAKER vs. SWEEETHEART CUPS; CIGA by SEDGWICK CMS for FREMONT INSURANCE in liquidation and PORTEOUS FASTENERS/PACIFIC INDEMNITY COMPANY, CHUBB INSURANCE

The Workers' Compensation Appeals Board granted CIGA's petition for reconsideration, reversing the finding that CIGA remained liable for permanent total disability indemnity and medical treatment for the applicant's industrial injuries. The Board found that because the applicant's injuries resulted in a joint and several award with a solvent insurer, Pacific Indemnity, CIGA has no obligation to pay as "other insurance" was available. The decision clarifies that CIGA is absolved of liability for medical treatment jointly caused by both injuries, but remains liable for treatment solely caused by the September 1979 injury. Pacific Indemnity is now solely responsible for all remaining permanent total disability indemnity and medical treatment costs, adjusting for payments already made by CIGA.

CIGASweetheart CupsPorteous FastenersFremont InsurancePacific IndemnityChubb InsuranceWilkinson doctrinejoint and several liabilitycovered claimsother insurance
References
10
Case No. ADJ10183604
Regular
Feb 13, 2019

TRACY HOVLAND vs. DISPENSING DYNAMICS INTERNATIONAL, STAFFING NETWORK LLC, AEROTEK, ALLEGIS GROUP, INC., EMPLOYCO USA, THE HARTFORD SYRACUSE, ESIS CHATSWORTH, LUMBERMEN'S UNDERWRITING BOA RATON, SEDGWICK CIGA GLENDALE, REPUBLIC INDEMNITY ENCINO, AMTRUST CONCORD, California Insurance Guarantee Association (CIGA)

The Workers' Compensation Appeals Board rescinded prior orders denying reimbursement for CIGA and dismissal for Hartford. The WCAB clarified that CIGA, unlike other insurers, is entitled to reimbursement rather than just contribution from solvent insurers when handling claims due to insurer insolvency. The Board also found Hartford's dismissal petition premature, as the underlying workers' compensation claim still requires adjudication. The case is returned to the trial level for further proceedings to resolve the underlying claim and related indemnity issues.

Workers' Compensation Appeals BoardReconsiderationPetition for ReimbursementPetition for ContributionCumulative Trauma PeriodJoint and Several LiabilityCalifornia Insurance Guarantee Association (CIGA)Third-Party AdministratorInsurer JoinderPetition for Dismissal
References
6
Case No. ADJ4430483 (SJO 0217023) ADJ3454827 (SJO 0226616)
Regular
Mar 10, 2011

JUAN L. ROMERO vs. ORLANDI TRAILER; CIGA by its servicing facility SEDGWICK CMS for LEGION INSURANCE in liquidation

The applicant, Juan L. Romero, sustained two industrial injuries. Defendant CIGA sought reconsideration of a prior order that allocated liability between these injuries and ordered reimbursement. CIGA later withdrew its petition for reconsideration after receiving clarification from the Workers' Compensation Arbitrator regarding its reimbursement entitlement. The Board vacated its previous order granting reconsideration and dismissed CIGA's petition.

CIGALegion Insurance in liquidationSedgwick CMSFindings and Orderreconsiderationliability allocationcumulative industrial injuryspecific industrial injuryreimbursementpre-liquidation benefits
References
0
Case No. ADJ1444335 (RIV 0017334), ADJ167619 (RIV 0017335), ADJ4158912 (RIV 0046324)
Regular
Sep 08, 2010

CHERYLE HUTCHINSON vs. COMMUNITY HOSPITAL OF SAN BERNARDINO, SEDGWICK CIGA GLENDALE, CHARTIS COSTA MESA, American Home Assurance Company (AHA)

The Appeals Board dismissed American Home Assurance Company's (AHA) Petition for Reconsideration regarding an order for AHA to administer three workers' compensation claims. The Board granted AHA's petition for removal, rescinded the order, and returned administration of the claims to CIGA. The Board found that the Workers' Compensation Judge prematurely ordered AHA to administer the claims, as no findings of liability or "other insurance" had been established, which are prerequisites for shifting administration away from CIGA. Therefore, CIGA will continue administering the claims until a determination of liability and coverage is made.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalClaims AdministrationCalifornia Insurance Guarantee AssociationCIGAOther InsuranceJoinder of DefendantDate of InjuryOverlap of Injuries
References
3
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. 13-08-00351-CV
Regular Panel Decision
Aug 31, 2009

Mitch Burkhart and Christine Burkhart v. Sedgwick Claim Management Services, Inc. and Concentra Integrated Services, and rgv/nueces Rehabilitation D/B/A Innovative Physical and Occupational Therapy

Mitch Burkhart sustained a foot and ankle injury while training for his employer, Verizon Communications. Verizon's workers' compensation claims were administered by Sedgwick Claim Management Services, Inc., who, along with Concentra Integrated Services, arranged a Functional Capacity Evaluation (FCE) for Burkhart with RGV/Nueces Rehabilitation d/b/a Innovative Physical and Occupational Therapy. The Burkharts alleged that the FCE aggravated Mitch's injury, causing permanent damage. They sued Sedgwick, Concentra, and Innovative, claiming negligence, civil conspiracy, assault, fraud, and breach of the duty of good faith and fair dealing. The trial court dismissed the case against Innovative for an inadequate expert report and granted summary judgment to Sedgwick and Concentra, citing the exclusive remedy provision of the Texas Workers' Compensation Act. The appellate court affirmed the trial court's judgment, concluding that Mitch's aggravation injury was an 'extension injury' covered by the exclusive remedy provision of the TWCA.

Workers' CompensationFunctional Capacity EvaluationExclusive RemedyAggravation InjurySummary JudgmentMedical Expert ReportHealth Care LiabilityCivil ConspiracyBreach of Duty of Good Faith and Fair DealingTexas Court of Appeals
References
23
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