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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Vigilant Insurance Co. v. Travelers Property Casualty Co. of America

The case concerns a coverage lawsuit for equitable subrogation between Vigilant Insurance Co. (Plaintiff) and Travelers Property Casualty Company of America (Defendant). Vigilant sought to recover $650,000 it contributed to a $5.3 million settlement in an underlying personal injury case, arguing Travelers improperly refused to acknowledge priority of coverage. Travelers countered that Vigilant's payment was voluntary and the settlement unreasonable. The Court granted Vigilant's motion in part, finding its payment was not voluntary and was an obligation for which Vigilant was not primarily liable. However, the Court denied summary judgment on the reasonableness of the settlement, citing a genuine dispute of material fact and scheduling a trial for this issue.

Equitable SubrogationInsurance CoverageVoluntary Payment DoctrineSummary JudgmentPersonal Injury SettlementNew York Labor LawIndemnificationExcess InsurancePrimary InsuranceDeclaratory Judgment
References
51
Case No. MISSING
Regular Panel Decision
Jul 22, 2005

National Football League v. Vigilant Insurance

This appeal addresses whether a former college football player's antitrust lawsuit against the NFL, regarding its draft eligibility rule, falls under the employment practices exclusion of an insurance policy issued by Vigilant. The court determined that the exclusion was open to a reasonable interpretation that would make it inapplicable to the antitrust claim. As a result, the trial court's dismissal of the complaint was reversed. The court emphasized that the exclusion, primarily focused on employment law claims and workplace torts, did not clearly and unambiguously extend to the NFL's liability when not acting as an employer in an antitrust context. Consequently, any ambiguity in the policy's scope was resolved in favor of the insured, the NFL.

Insurance Coverage LitigationEmployment Practices ExclusionAntitrust Law ChallengeNFL Draft RulesPolicy AmbiguityContract InterpretationDeclaratory ReliefWrongful Deprivation of Career OpportunityStatutory ConstructionEjusdem Generis Principle
References
8
Case No. ADJ11201607 (MF); ADJ11201608
Significant
Jun 10, 2024

Sammy Vigil vs. County of Kern

The Appeals Board holds that the Combined Values Chart (CVC) in the Permanent Disability Ratings Schedule (PDRS) may be rebutted by adding impairments when an applicant demonstrates through substantial evidence that there is no overlap in the impact on Activities of Daily Living (ADLs), or that any overlap creates a synergistic effect that amplifies the disability.

Workers' Compensation Appeals BoardEn Banc DecisionReconsiderationPermanent Disability Ratings ScheduleCombined Values ChartRebuttalActivities of Daily LivingSynergistic EffectApportionmentHikida
References
18
Case No. ADJ11201607, ADJ11201608
Regular
Jun 10, 2024

SAMMY VIGIL vs. COUNTY OF KERN

The Appeals Board held that the Combined Values Chart (CVC) may be rebutted and impairments added where an applicant establishes the impact of each impairment on the activities of daily living (ADLs) and shows either that there is no overlap between the effects on ADLs or that the overlap increases or amplifies the impact on the overlapping ADLs.

WCABEn BancReconsiderationFindings of FactAwards and OrdersPermanent Partial DisabilityHip Replacement SurgeryApportionmentCombined Values ChartPermanent Disability Ratings Schedule
References
19
Case No. ADJ3639705
Regular
Oct 01, 2009

THEMAS VIGIL vs. SAN DIEGO UNIFIED SCHOOL DISTRICT

The WCAB rescinds the WCJ's decision and returns the matter for further proceedings to develop the record on apportionment and for a new decision by the WCJ.

ApportionmentLabor Code Section 4664Labor Code Section 4663Permanent DisabilityPrior Industrial InjuriesConclusive PresumptionOverlapMedical EvidenceAgreed Medical EvaluatorCumulative Trauma
References
10
Case No. ADJ10438517, ADJ10590208
Regular
May 23, 2017

MARIA VIGIL (aka MARIA MORGAN) vs. COUNTY OF MERCED PROBATION DEPARTMENT

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal, which sought to overturn a judge's denial of her venue change request. The applicant argued for a venue change to Stockton, citing her new residence, her adjuster's location, and potential future litigation in Stockton. However, the Board found no good cause for the requested change, concluding that the applicant's attorney's convenience, not the applicant's hardship, was the primary motivation. Granting the petition would undermine the statutory provisions for venue changes when the initial venue is based solely on attorney convenience and the employer objects.

Workers' Compensation Appeals BoardPetition for RemovalPetition for Change of VenueWCJVenueLabor Code Section 5501.5Labor Code Section 5501.6Good CauseConvenience of CounselCumulative Trauma
References
2
Case No. ADJ971954 (OAK 0113623)
Regular
Dec 19, 2014

LEO VIGIL vs. MILAN'S SMOKED MEATS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and affirmed the finding that the defendant's utilization review (UR) denials were untimely served, rendering them invalid. As a result, the Board found the requested medications, Norco and Pennsaid, to be reasonably necessary based on substantial medical evidence from the applicant's physician. However, the Board limited Norco refills to five, acknowledging that ongoing opioid use requires periodic review, unlike the nurse case manager services in a prior case. The case was returned to the trial level for further proceedings.

Utilization ReviewRequest for AuthorizationNorcoPennsaidTimelinessServiceInvalid URMedical NecessityDubon IDubon II
References
6
Case No. ADJ6866226
Regular
Sep 08, 2014

Patrick Vigil vs. Clars Estate Auction Gallery, First Comp Insurance

The Appeals Board granted reconsideration to correct a clerical error, rescinding the WCJ's finding of no industrial injury. While the parties had stipulated to injury AOE/COE and settled the claim, the WCJ erroneously found otherwise. However, the Board upheld the WCJ's finding that the applicant failed to establish a violation of Labor Code section 132a. Ultimately, the applicant takes nothing on his section 132a claim, but the industrial injury finding is reinstated based on the prior stipulation.

Workers' Compensation Appeals BoardADJ6866226Patrick VigilCLARS Estate Auction GalleryFIRST COMP INSURANCEPetition for ReconsiderationFindings and OrderInjury AOE/COELabor Code Section 132aViolation of 132a
References
8
Case No. ADJ8800095
Regular
Oct 28, 2016

MARIE HINGADA vs. AXIS SPECIALTY U.S. SERVICES, INC., VIGILANT INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Marie Hingada's petition for reconsideration in Case No. ADJ8800095. The Board adopted and incorporated the findings of the workers' compensation administrative law judge (WCJ). The decision emphasized giving great weight to the WCJ's credibility determinations due to their observation of witnesses. No substantial evidence warranted rejecting the WCJ's credibility findings.

Workers' Compensation Appeals BoardPetition for Reconsideration DeniedWCJ credibility determinationGarza v. Workmen's Comp. Appeals Bd.substantial evidenceADJ8800095Van Nuys District Officeadministrative law judgeapplicantdefendants
References
0
Case No. SDO 0360376
Regular
Jul 29, 2008

RAUL VIGIL PERALTA vs. NEW VISION PRESTIGE REAL ESTATE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the administrative law judge's decision that the defendant provided adequate notice of its Medical Provider Network (MPN). The applicant argued that insufficient notice should have resulted in a permanent waiver from the MPN, but the Board found that the applicant and his attorney received sufficient notice, including a guidebook and awareness of the option to select MPN physicians. Therefore, the applicant is required to treat within the defendant's MPN as of the date adequate notice was provided.

Medical Provider NetworkMPN noticepermanent waiveradequate noticepre-designate physiciancompensable consequenceindustrial injurypetition for reconsiderationAmended Findings and AwardWCJ
References
0
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