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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ621008 (MON 0291717)
Regular
Sep 05, 2012

WILLIAM KEY vs. PRODUCTION PROCESSING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS, LEGION INSURANCE COMPANY, STONE STANLEY PRODUCTIONS, ST. PAUL TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves a workers' compensation claim where the California Insurance Guarantee Association (CIGA), covering Legion Insurance, seeks reconsideration of an arbitrator's award. The arbitrator found both CIGA and Travelers, insurer for the special employer, jointly liable for the applicant's injury and ordered Travelers to reimburse CIGA for all benefits paid since Legion's liquidation. CIGA contested being required to continue administering medical treatment and the denial of pre-judgment interest from Travelers. The Board granted reconsideration to amend the award, ordering Travelers to administer future medical treatment, but affirmed the denial of pre-judgment interest to CIGA.

CIGALegion InsuranceProduction ProcessingStone Stanley ProductionsSt. Paul TravelersWilliam Keyindustrial injurylow backliquidationother insurance
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. ADJ1717969 (VNO 0449705)
Regular
Mar 20, 2013

ERIKA ROLLINS vs. FILM PAYMENT SERVICES, KID BROTHERS PRODUCTION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION, in liquidation, ST. PAUL FIRE & MARINE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded an arbitrator's award because the arbitration proceedings lacked a proper record, violating Labor Code sections requiring findings on all facts and compliance with case record standards. The WCAB returned the matter for further proceedings to ensure a complete record is created, adhering to due process principles and established case law. If a compliant record cannot be created, the case will be remanded for a new arbitrator selection. The parties sought reconsideration of the original award, which found Travelers' insurance to be "other insurance" and held them liable for the applicant's injury, ordering CIGA's dismissal.

California Insurance Guarantee AssociationCIGASt. Paul Fire & Marine Insurance CompanyTravelersWorkers' Compensation Appeals BoardArbitrator's AwardReconsiderationOther InsuranceInsurance Code Section 1063.1(c)(9)Prejudgment Interest
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
Case No. GRO 27301, GRO 28637
Regular
Feb 11, 2008

HERMAN DENNLER vs. TIMEC CO., INC., ST. PAUL TRAVELERS, OPEN WAVES SYSTEMS, LUMBERMAN'S MUTUAL CASUALTY COMPANY

This Workers' Compensation Appeals Board opinion corrects a clerical error in a previous decision, specifically removing the incorrect statement that St. Paul Travelers was adjusted by Broadspire. The case involves two injuries sustained by Herman Dennler in 2002, with awards of permanent disability indemnity and future medical treatment granted against Timec Co., Inc. (insured by St. Paul Travelers) and Open Wave Systems (insured by Lumberman's Mutual Casualty Company). The correction clarifies that St. Paul Travelers was the insurance carrier for Timec Co., Inc. and was not adjusted by Broadspire.

Workers' Compensation Appeals Boardclerical errorreconsiderationaward correctionpermanent partial disabilitytemporary disability indemnitymedical treatmentattorney's feeslienTimec Co.
References
Case No. ADJ3523217 (OAK 0271650)
Regular
Apr 20, 2010

PAULINE ROACH ARREDONDO vs. MAJOR LEGAL SERVICES AND ST. PAUL TRAVELERS INSURANCE, American Protection/Broadspire

The Workers' Compensation Appeals Board granted applicant's petition for removal, rescinding the prior orders. The Board allowed the applicant's election against St. Paul Travelers Insurance, finding its prior liability res judicata. Discovery by newly-joined defendant American Protection/Broadspire was stayed pending resolution of the claim against St. Paul. This decision supports the applicant's right to elect against a carrier with established liability.

Petition for RemovalElection Against CarrierLabor Code 5500.5(c)Res JudicataInterim Findings Award and OrderSt. Paul Travelers InsuranceAmerican Protection/BroadspireWCJ Report and RecommendationDiscovery StayWorkers' Compensation Appeals Board
References
Case No. VNO 0423681, VNO 0469245
Regular
Jun 16, 2008

JANET ANN SAMBAR vs. SANTA CLARITA HEALTH CARE ASSOCIATES dba HENRY MAYO NEWHALL MEMORIAL HOSPITAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, BROADSPIRE CLAIM SERVICES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding its prior decision that Travelers Insurance Company is not liable for the applicant's cumulative trauma injury. The Board found that a prior stipulation by Travelers was not binding on CIGA in a separate arbitration proceeding. Furthermore, the evidence established that the applicant's date of injury was August 14, 2000, and Travelers was not the employer's insurer during the relevant one-year exposure period, thus limiting liability to Superior/CIGA.

CIGATravelers Insurance CompanySuperior National Insurance CompanyHenry Mayo Newhall Memorial Hospitalcumulative trauma injurylast year of injurious exposureLabor Code § 5500.5Petition for Contributionstipulation"other insurance"
References
Case No. ADJ475725 (MON 0270464) ADJ845300 (MON 0270462)
Regular
Oct 13, 2010

SHERRELL PARIS vs. T.P.I.R./MARK GOODSON PROD., PEARSON T.V.; ST. PAUL TRAVELERS, Formerly GULF INSURANCE COMPANY, and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision that barred CIGA's petition for reimbursement, finding the arbitrator erred in deeming it untimely under Labor Code section 5500.5. The dispute centers on enforcing a stipulated award regarding medical treatment responsibility between insurers for two injury dates. The WCAB remanded the case for a new decision on the merits of CIGA's reimbursement claim and a determination of respective liabilities for future medical treatment. Further proceedings are necessary to interpret the stipulated award and consider arguments about "other insurance."

CIGASt. Paul TravelersLegion Insurance CompanySherrell ParisExecutive AssistantIndustrial InjuryNeckBackRight ShoulderRight Hip
References
Case No. ADJ700106 (SAL 0075388) ADJ4293270 (SAL 0067937) ADJ3847224 (SAL 0067938) ADJ1646200 (SAL 0011386)
Regular
Sep 01, 2015

WILLIE PEARSON vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS, Chamberlain's Children Center, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SUPERIOR NATIONAL INSURANCE COMPANY

In this workers' compensation case, CIGA sought to be relieved of liability for applicant's medical treatment, arguing that the State of California Department of Corrections ("the State") constituted "other insurance." The Appeals Board affirmed the WCJ's decision that the State does not qualify as "other insurance" under Insurance Code section 1063.1(c)(9)(A). Unlike private self-insured employers, the State is not required to obtain workers' compensation insurance or a certificate of self-insurance, and thus does not fall within the statutory definition of an "insurer." The Board further clarified that the State Compensation Insurance Fund's role in claim adjustment services for the State does not make it "other insurance" when the State is not otherwise insured with SCIF.

CIGASupernational Insurance Companylegally uninsuredother insurancecovered claimsInsurance Code Section 1063.1State of California Department of Correctionsreimbursementstipulated awardjoint and several liability
References
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