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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. 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
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. 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
Case No. ADJ8069196 ADJ7219457
Regular
Jan 19, 2017

MICHELLE RIDDLE vs. LAS FLORES CONVALESCENT HOSPITAL, CIGA by its servicing facility INTERCARE INSURANCE SERVICES, ULLICO CASUALTY CO.

This case involves CIGA's petition for reconsideration regarding reimbursement for nonpermanent disability benefits paid to an applicant. CIGA sought reimbursement from Travelers Insurance Company, arguing Travelers' earlier policy constituted "other insurance." The Appeals Board denied CIGA's petition, adopting the WCJ's reasoning. The Board found that Travelers had no further liability for the applicant's benefits due to a prior approved Compromise and Release agreement, thus Travelers' policy was not "other insurance" for the purpose of reimbursement.

California Insurance Guarantee AssociationCIGAreimbursementTravelers Insurance Companyjoint and several liabilitynonpermanent disability benefitsother insurancecompromise and releasecovered claimscumulative injury
References
Case No. ADJ3292672
Regular
Nov 08, 2012

SUSAN VIRDIER vs. CONCENTRA MANAGED CARE, ATLANTIC MUTUAL INSURANCE COMPANY (in liquidation), CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRAVELERS INDEMNITY INSURANCE COMPANY

This case concerns Travelers Indemnity Insurance Company's petition for reconsideration regarding its liability for applicant Susan Verdier's medical treatment. Travelers argued it should not be responsible for medical care in ADJ4661775, as it did not insure the employer at the time of the specific left wrist injury in ADJ3701452, and the cumulative trauma injury in ADJ4661775 involved different body parts. The Board denied the petition, holding that medical treatment expenses are not apportionable and that Travelers' coverage for the cumulative trauma period constitutes "other insurance" when the primary insurer is insolvent. The Board found no medical evidence distinguishing the need for treatment between the upper extremities and the wrist, thus upholding the finding that Travelers is available coverage for the award.

Workers Compensation Appeals BoardConcentra Managed CareAtlantic Mutual Insurance CompanyCalifornia Insurance Guarantee AssociationTravelers Indemnity Insurance CompanyreconsiderationFindings and Ordersother coveragemedical treatmentcumulative trauma
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. 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
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