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

Case No. 2014 NYSlipOp 06892 [121 AD3d 481]
Regular Panel Decision
Oct 14, 2014

Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v. A. Cent. Ins. Co.

Petitioner, Emerald Claims Management for Ullico Casualty Insurance Company, as subrogee of Randolph Meyers, sought "loss transfer" reimbursement from A. Central Insurance Company, an adverse insurer, under Insurance Law § 5105. Petitioner had paid workers' compensation benefits to its insured after a motor vehicle accident and sought reimbursement for no-fault benefits. Respondent asserted a disclaimer of coverage due to noncooperation. The Supreme Court confirmed two arbitration awards in favor of the petitioner, and the Appellate Division unanimously affirmed this judgment. The arbitrators' decision was upheld as rational, construing Insurance Law § 5105 (a) to provide a direct right to reimbursement regardless of the respondent's disclaimer of coverage. The Appellate Division also found that the respondent waived any jurisdictional arguments by fully participating in the arbitration.

Insurance LawWorkers' CompensationSubrogationLoss TransferCompulsory ArbitrationDisclaimer of CoverageNoncooperationAppellate ReviewJudgment AffirmationInsurance Policy
References
6
Case No. ADJ9651491
Regular
Aug 22, 2016

JUDITH DIAZ vs. EXCELL SECURITY, INC., XL STAFFING, INC., XL CONSTRUCTION STAFFING; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for ULLICO CASUALTY COMPANY, in liquidation by its servicing facility, SEDGWICK CLAIMS MANAGEMENT SERVICES; SPARTA INSURANCE COMPANY by GALLAGHER BASSETT

The Workers' Compensation Appeals Board affirmed a prior finding that Sparta Insurance Company provided workers' compensation coverage for Judith Diaz. The Board found that Sparta's policy with Excell Security, Inc. did not exclude Diaz from coverage, despite Excell also having a policy with Ullico Casualty Company. Therefore, Sparta is considered "other insurance" and liable for applicant's benefits, upholding the Arbitrator's initial decision.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationFindings and OrderArbitratorother insuranceLabor Code section 1063California Insurance Guarantee AssociationCIGAULLICO CASUALTY COMPANYliquidation
References
2
Case No. ADJ7666292
Regular
Jan 08, 2013

KARL SWANIER vs. WESTERN STAR TRANSPORTATION, ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior award, specifically concerning the apportionment of permanent disability. The Board found that the Agreed Medical Evaluator's (AME) opinion regarding prior non-industrial injury to the applicant's left knee was substantial evidence. Therefore, the Board amended the award to defer the issue of permanent disability and returned the matter for further proceedings and a new decision on this specific issue. The Board otherwise affirmed the prior award, including the denial of a credit for overpayment.

Petition for ReconsiderationAmended Findings and AwardTemporary Total Disability IndemnityPermanent Disability IndemnityLabor Code 4664Labor Code 4663Agreed Medical EvaluatorApportionmentMaximum Medical ImprovementWhole Person Impairment
References
9
Case No. ADJ8816811
Regular
Sep 17, 2015

CANDELARIO ARREOLA vs. PICAR FARM LABOR, INC., ULLICO REPUBLIC

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal. This action rescinded two prior orders by the workers' compensation judge that denied the applicant's request for a new qualified medical evaluator panel and denied a trial setting. The Board returned the case to the judge to consider a recently filed compromise and release agreement. If the settlement is not approved, the judge may reissue the rescinded orders.

Petition for RemovalQualified Medical Evaluator (QME) panelMedical UnitMandatory Settlement ConferenceCompromise and ReleaseWorkers' Compensation Appeals Board (WCAB)Workers' Compensation Administrative Law Judge (WCJ)Decision After RemovalRescinded OrdersNew Specialty
References
0
Case No. ADJ8206042
Regular
Apr 02, 2013

ARTURO GUTIERREZ vs. VALLEY HARVESTING LABOR, ULLICO CASUALTY COMPANY

This case involves a petition for reconsideration filed by a lien claimant regarding a prior decision. The Workers' Compensation Appeals Board granted reconsideration, citing the need for further study of the factual and legal issues to ensure a just decision. All future communications in this matter are to be directed to the Office of the Commissioners in San Francisco, not the local office.

Lien claimantPetition for ReconsiderationWorkers' Compensation Appeals BoardStatutory time constraintsFactual and legal issuesDecision After ReconsiderationOffice of the CommissionersFrank M. BrassRonnie G. CaplaneMarguerite Sweeney
References
0
Case No. ADJ7554153
Regular
Mar 01, 2014

GABRIELA ADAME vs. AREOL STAFFING SERVICES, INC., ULLICO CASUALTY CO.

The Workers' Compensation Appeals Board rescinded its prior order granting reconsideration and dismissed the lien claimants' petition. The petition was untimely filed, as it was submitted significantly after the deadline for seeking reconsideration of the orders dismissing the liens. Furthermore, the lien claimants' arguments regarding lack of notice were refuted by proof of service, and they failed to properly update their representative information. The Board lacked jurisdiction to consider the petition due to its tardiness and other procedural defects.

Workers' Compensation Appeals BoardReconsiderationLien ClaimLien Activation FeePetition for ReconsiderationTimelinessJurisdictionService of ProcessRepresentative DesignationLabor Code Section 4903.06
References
2
Case No. ADJ7484505, ADJ7484506
Regular
Dec 18, 2019

FRANCISCO VILCHIS MONDRAGON vs. PACIFIC FLOOR COVERING, ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to award a lien claimant reimbursement for psychological treatment services. The Board found that the primary treating physician did refer the applicant to the lien claimant, received and reviewed the lien claimant's reports, and thus complied with reporting requirements. This reversed the trial judge's denial of the lien based on the primary physician's alleged failure to incorporate the secondary physician's reports. The matter was returned for determination of the amount owed.

Workers' Compensation Appeals BoardLien ClaimantPsychological Assessment ServicesPrimary Treating PhysicianSecondary Treating PhysicianRule 9785(e)(4)Reporting RequirementsMedical Treatment ExpensesIndustrial InjuryPsyche
References
3
Case No. ADJ8286745
Regular
Jul 30, 2018

ARNULFO LOPEZ ESPARZA vs. A1 COAST SANITATION RENTALS; CIGA, INTERCARE, ULLICO

This Workers' Compensation Appeals Board case concerns a Petition for Reconsideration filed by the lien claimant. The Board dismissed the petition as untimely because it was filed one day after the jurisdictional deadline. The applicant's claim of timely mailing was insufficient, as the petition must be *received* by the Board within the statutory period. Therefore, the Appeals Board lacked jurisdiction to consider the petition's merits.

Petition for ReconsiderationUntimely FilingWCABWorkers' Compensation Administrative Law JudgeJurisdictional LimitService by MailProof of MailingLabor CodeCalifornia Code of RegulationsOrder Dismissing Lien
References
4
Case No. ADJ7505198
Regular
Jan 16, 2015

OLGA ORDONEZ vs. NORWALK SKILLED NRS WELLNESS CENTER, ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board dismissed Olga Ordonez's Petition for Reconsideration because it was not verified as required by Labor Code section 5902. Even if it had been properly verified, the Board would have denied the petition on its merits, adopting the administrative law judge's reasoning. The dismissal was based on the procedural defect of a lack of verification.

Petition for ReconsiderationVerifiedLabor Code section 5902DismissedReport and RecommendationWorkers' Compensation Appeals BoardWCJDeny on the meritsADJ7505198Van Nuys District Office
References
2
Case No. ADJ8266758
Regular
Sep 24, 2015

CAROLINA HERNANDEZ vs. SUPER GROCERS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PATRIOT RISK/ULLICO

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's award to applicant Carolina Hernandez. Defendant CIGA contended the WCJ erred in finding an industrial injury, asserting applicant was the initial aggressor in an altercation and that the injury was not reported until after her termination notice. The Board determined that video evidence, Exhibit E, is crucial to resolving the initial aggressor issue and ordered defendant to provide it. Reconsideration was granted to review this evidence and ensure a just decision.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationUllicoSuperior GrocersPetition for ReconsiderationInitial Physical AggressorIndustrial InjuryTerminationExhibit EWCJ Report
References
0
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