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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. VNO 0413681, VNO 0469245
Regular
Mar 24, 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, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted Travelers Insurance Company's petition for reconsideration, reversing its prior decision that held Travelers liable for a portion of applicant's cumulative trauma injury. The Board determined that Travelers' prior stipulation was not binding in the contribution arbitration with CIGA, as CIGA was not a party to that stipulation. The Board reinstated the Arbitrator's finding that applicant's date of injury was August 14, 2000, during the coverage period of Superior National Insurance Company, and that no injurious exposure occurred while Travelers was the insurer.

Workers' Compensation Appeals BoardCumulative TraumaLabor Code $\S$ 5500.5Insurance Guarantee Association (CIGA)Superior National Insurance CompanyTravelers Insurance CompanyPetition for ContributionStipulationArbitrationDate of Injury
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. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
Case No. ADJ2480026
Regular
Aug 26, 2011

CHAD IMES vs. SCENARIO DESIGNS, INC., EVEREST NATIONAL INSURANCE COMPANY, POWER PAYROLL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling and ordered Everest National Insurance Company to reimburse CIGA for benefits paid to the applicant. The Board found that Everest was "other insurance" available under Insurance Code section 1063.1(c)(9) because its insured, Scenario Designs, Inc., employed the applicant on the date of injury. This decision clarifies that reimbursement to CIGA does not alter the original award and aligns with statutory limitations on CIGA's liability. Everest is now obligated to reimburse CIGA and administer future benefits.

CIGAEverest National Insurance CompanyLegion Insurance CompanyScenario DesignsPower PayrollInc.other insurancereimbursementdate of injurygeneral-special employment
References
Case No. VEN 0115536
Regular
Aug 04, 2008

ROBERT FROELICH vs. CONTRACTORS LABOR POOL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCATION, RELIANCE NATIONAL INSURANCE CO., GM NORTHROP CORP., NATIONAL FIRE INSURANCE COMPANY OF HARTFORD

This case concerns a dispute over workers' compensation liability following an industrial injury sustained by an employee who was a general employee of Contractors Labor Pool (insured by insolvent Reliance) and a special employee of GM Northrup Corp. The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding, determining that National Fire Insurance Company's policy for GM Northrup Corp. constituted "other insurance." Consequently, National Fire Insurance Company is now liable for the applicant's benefits, and the California Insurance Guarantee Association is not liable as the claim is not a "covered claim."

CIGAReliance National InsuranceNational Fire Insurance Companycovered claimsother insurancegeneral employerspecial employerjoint and several liabilitypolicy constructionInsurance Code section 1063.1
References
Case No. ADJ4458345 (AHM 0089036)
Regular
Mar 08, 2010

FRANCISCO VERDIN vs. HEADWAY CORPORATE STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of SUPERIOR NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a prior order finding the applicant sustained an industrial back injury in 2000, resulting in further medical treatment and 32.5% permanent disability. California Insurance Guarantee Association (CIGA) was liable for a prior stipulated award against the insolvent insurer. CIGA's petition to join Argonaut Insurance Company as a party, arguing Argonaut was liable as the insurer of a "special employer," was denied for failure to present evidence. The Board affirmed the denial, noting CIGA failed to meet its burden of proof regarding special employment and "other insurance."

Workers' Compensation Appeals BoardCIGASuperior National Insurance CompanyliquidationArgonaut Insurance Companyjoinderspecial employerDSL Transportation Servicesother insuranceInsurance Code section 1063.1
References
Case No. LAO 762161
Regular
Aug 13, 2007

MIGUEL CORTES vs. KWM CORP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, for SUPERIOR NATIONAL INSURANCE COMPANY, In Liquidation

The Workers' Compensation Appeals Board granted CIGA's petition for reconsideration, reversing a prior award of retroactive vocational rehabilitation maintenance allowance (VRMA). The Board found that CIGA is not liable because "other insurance" through Argonaut Insurance Company was available, negating CIGA's obligation under Insurance Code section 1063.1(c)(9)(i). Therefore, CIGA has no liability for the VRMA awarded.

CIGAvocational rehabilitation maintenance allowanceVRMAother insuranceArgonaut Insurance CompanySuperior National Insurance Companyliquidationcovered claimsInsurance Code section 1063.1(c)(9)joint and several liability
References
Case No. ANA 0366568
Regular
Aug 21, 2007

STACY MACK vs. CAREER STRATEGIES TEMP., INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, BROADSPIRE, SUN AMERICA, STATE COMPENSATION INSURANCE FUND, TELEFLORA, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award, remanding the case to determine if the State Compensation Insurance Fund (SCIF) policy for Sun America constitutes "other insurance" under Insurance Code section 1063.1(c)(9). This determination is crucial for assessing the liability of the California Insurance Guarantee Association (CIGA), which seeks to avoid coverage by arguing the SCIF policy is available. The WCAB requires further proceedings to fully develop the record regarding the intent and applicability of the SCIF policy for special employees.

CIGAcovered claimother insurancegeneral employerspecial employerSuperior National Insurance CompanyState Compensation Insurance FundInsurance Code section 1063.1(c)(9)Insurance Code section 11663joint and several liability
References
Case No. ADJ4684775 (VEN 0117727) ADJ4381820 (VEN 0117723)
Regular
Dec 19, 2011

JOANNE LUTZ, JOANN LUTZ vs. RUSSELL WARNER dba ROTO ROOTER SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PAULA INSURANCE COMPANY, in liquidation, and for FREMONT INSURANCE COMPANY, in liquidation, LINDA McDONALD, STATE FARM INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling, allowing CIGA to pursue reimbursement from State Farm for benefits paid due to applicant's industrial injuries. The Board found that unlike a request to alter a prior award, CIGA's petition sought to enforce its statutory right to reimbursement from "available" insurance under Insurance Code section 1063.1(c)(9). Since State Farm, as a jointly and severally liable insurer, appears to be such "available" insurance, the case is remanded for further proceedings on CIGA's reimbursement claim.

California Insurance Guarantee AssociationCIGAPaula Insurance CompanyFremont Insurance CompanyState Farm Insurance Companystipulated awardreconsiderationreimbursementcontributionother insurance
References
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