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Case Law Database

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

Case No. ADJ18217235; ADJ18217236
Regular
Apr 29, 2025

Crispin Bermudez vs. Elkhorn Packing Company, LLC; Zenith Insurance Company

The Workers' Compensation Appeals Board addressed a petition for reconsideration filed by Zenith Insurance Company challenging an arbitrator's finding that applicant Crispin Bermudez was covered by a workers' compensation policy despite signing a waiver. The Board granted the petition, rescinded the arbitrator's decision, and issued a new decision. It found that as a managing member of a limited liability company, Bermudez had executed a valid written waiver of his workers' compensation rights under Labor Code sections 3351(f) and 3352(a)(17). Consequently, the applicant was deemed excluded from the definition of an employee and thus not entitled to workers' compensation coverage.

Workers' CompensationManaging MemberWaiver of CoverageLabor Code Section 3352(a)(17)Conclusive PresumptionIndustrial InjuryPetition for ReconsiderationArbitrator's DecisionRescinded DecisionLimited Liability Company
References
Case No. ADJ4668407 (RIV 0055963)
Regular
Feb 19, 2015

JOSE MARTINEZ vs. 2K FABRICATION, INCORPORATED, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior decision finding that State Compensation Insurance Fund (SCIF) did not provide coverage for 2K Fabrication, Inc. on July 8, 2003. The Board ruled that SCIF's cancellation of the employer's policy effective March 18, 2003, was valid. Arguments for coverage based on alleged lack of notice, estoppel due to premium acceptance, audits, and defense of the claim were rejected. The Board found no evidence of a written reinstatement of the canceled policy.

Workers' Compensation Appeals BoardReconsiderationPolicy CancellationCoverage DisputeEstoppelWaiverWritten NoticeInsurance ContractPremium PaymentPost-Cancellation Audit
References
Case No. ADJ6940334
Regular
Jan 28, 2011

AURELIO RAMOS LOPEZ vs. JESUS AGUILAR dba C&A FRAMING et al.

The Workers' Compensation Appeals Board granted reconsideration, rescinded a deficient arbitrator's judgment, and returned the matter for further proceedings. The original "Judgment" failed to comply with statutory requirements for a decision, lacking an opinion and a signature. Defendant Granite argued denial of due process due to insufficient time for discovery after being joined as a party. Defendant C&A contended substantial evidence supported coverage by AIG on the date of injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationJudgmentArbitrationCoverageDate of InjuryDue ProcessDiscoverySubstantial EvidenceWaiver
References
Case No. ADJ6710001 (ANA) MF ADJ7803228 (ANA) ADJ8017966 (ANA) ADJ8064588 (ANA) ADJ8262934 (ANA) ADJ9093396 (ANA) ADJ9076943 (ANA) ADJ9083545 (SDO) ADJ6925792 (ANA) ADJ8907815 (ANA) ADJ8819925 (ANA) ADJ9087879 (ANA) ADJ9093460 (ANA) ADJ8443963 (ANA) ADJ6829099 (ANA) ADJ6843222 (ANA)
Regular
May 07, 2015

LARRY WATKINS, GORDON BELL, DANIEL BUGGS, JAMES STIENKE, WILLIAM BRYANT, RONALD JOHNSON, ROBERT HYLAND, WALKER GILLETTE, REGGIE RUCKER, ANDREW SELFRIDGE, DOUG VAN HORN, ANANIAS CARSON, JACK GREGORY, THOMAS MULLEN, WILLIE YOUNG, JOHN HICKS vs. NEW YORK GIANTS, NEW YORK STATE INSURANCE FUND

This case concerns the New York State Insurance Fund's (NYSIF) liability for workers' compensation claims filed by former New York Giants employees. NYSIF argued it was not liable due to sovereign immunity and limitations in its New York-centric insurance policies. The Workers' Compensation Appeals Board affirmed the Arbitrator's decision, finding that Coverage B of the policy broadly indemnified the Giants for employee injuries sustained "wherever such injuries may be sustained," without clear exclusionary language. This coverage extended despite NYSIF's arguments about its New York origin and lack of authorization to write insurance in California. The Board also deferred the jurisdictional question for individual claims to the Workers' Compensation Judge.

Workers' Compensation Appeals BoardNew York State Insurance FundNew York Giantssovereign immunitycomitycoverageextraterritorial injuriesinsurance policy interpretationCoverage Bbusiness operations
References
Case No. ADJ8627409
Regular
Feb 18, 2025

PAUL PIUROWSKI vs. DALLAS COWBOYS, ACE AMERICAN INSURANCE COMPANY, MIAMI DOLPHINS, MULTI-LINE CLAIMS SERVICES, INC., TAMPA BAY BANDITS, ZENITH INSURANCE COMPANY, SUMMIT CONSULTING LLC

The Workers' Compensation Appeals Board granted reconsideration regarding a cumulative trauma injury claim filed by Paul Piuroswki. The Board affirmed the WCJ's finding that defendants Tampa Bay Bandits and Associated Industries of Florida Self-Insurers Fund (AIFSIF) waived their personal jurisdiction defense by failing to timely litigate the issue over nearly two years while participating in the trial on the merits. However, the Board deferred the entry of an award. Further proceedings are required to determine the proper liable entity or entities and resolve issues related to insurance coverage under Labor Code section 5500.5.

Workers CompensationPersonal JurisdictionWaiverGeneral AppearanceSpecial AppearanceNotice of AppearancePetition for ReconsiderationFindings and AwardLabor Code Section 5500.5Insurance Coverage
References
Case No. ADJ744923 (ANA 0385182)
Regular
Jul 22, 2011

CHARLES BUFFINGTON III vs. FACTORY MUTUAL, INFRARED TESTING, INC., LIBERTY MUTUAL INSURANCE COMPANY, UNINSURED EMPLOYERS BENEFITS TRUST FUND

Factory Mutual seeks reconsideration of a workers' compensation decision finding Liberty Mutual provided coverage for Infrared Testing, Inc. during the applicant's injury period. Factory admits it sold its interest in Infrared before the cumulative injury period, arguing Liberty's coverage stipulation was a mistake. The Board dismissed Factory's petition, finding Factory lacks standing as it had no interest in the employer after August 2, 2000. The Board also indicated it would have denied the petition on the merits due to Liberty's stipulation and the elapsed premium collection period.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrdersStipulationCoverage disputeMistake in coverageSale of interestUninsured Employers Benefits Trust FundStandingAggrieved party
References
Case No. ADJ559526 (STK 0208625)
Regular
Jan 03, 2011

MICHAEL OZUNA vs. WEBCOR BUILDERS, ZURICH NORTH AMERICA, AMERICAN HOME ASSURANCE COMPANY

This case concerns whether Zurich North America or American Home Assurance Company provided workers' compensation coverage for an applicant's severe injury. An arbitrator initially ruled Zurich solely responsible, finding American Home's policy was limited and did not cover the claim. Zurich contends American Home's policy endorsement limiting coverage to a specific site was invalid due to non-compliance with Insurance Code requirements. The Appeals Board granted reconsideration to allow further proceedings, holding American Home bears the burden to prove its policy effectively excluded this claim.

Workers Compensation Appeals BoardReconsiderationArbitrationInsurance CoverageDefense and IndemnificationPolicy EndorsementInsurance Code Section 11657Insurance Code Section 11660Burden of ProofAffirmative of the Issue
References
Case No. ADJ1389831 (SRO 0137920)
Regular
Dec 10, 2008

SHAWNDELL WILLIAMS vs. THRUSHWING HOME/HAZEL HOME, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address the defendants' due process concerns regarding the denial of workers' compensation coverage. While affirming the cancellation of the State Compensation Insurance Fund policy, the Board acknowledges that the issues of waiver and estoppel were raised but not fully litigated. Therefore, the case is remanded to the trial level for the arbitrator to consider these remaining defenses.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardState Compensation Insurance FundCancellation NoticeDue ProcessArbitration HearingWaiverEstoppelLabor Code
References
Case No. ADJ9016568
Regular
Feb 23, 2016

JAVIER SOTO CONTRERAS, AMANDA ARANA vs. A.C. CUSTOM CATERING, INC., STATE COMPENSATION INSURANCE FUND, JAVIER SOTO CONTRERAS, ALLMERICA FINANCIAL BENEFIT INSURANCE, THE HANOVER INSURANCE GROUP

This case concerns a petition by SCIF (on behalf of A.C. Custom Catering) seeking removal and disqualification of both the applicant's attorney and the Workers' Compensation Judge (WCJ). The petition argued the applicant's attorney had a conflict of interest representing two claimants and that the WCJ was biased. The Appeals Board dismissed the petition regarding the attorney's disqualification as untimely. Regarding the WCJ, the Board denied disqualification because the petition lacked specific factual allegations of bias and was also untimely.

Petition for RemovalPetition for DisqualificationWCJSCIFA.C. Custom Cateringjoint representationconflict of interestwaiveruntimelyjudicial bias
References
Case No. ADJ13120564
Regular
Sep 15, 2022

Hector Barragan vs. Stanford Healthcare, Safety National Casualty, Tristar Insurance Group

This Workers' Compensation Appeals Board case involved an applicant seeking reconsideration of a prior order that deemed an EAMS document discoverable. The Board admitted the document into evidence as Exhibit XX but reversed the prior ruling on discoverability. The Board found the document not relevant to the applicant's alleged foot and ankle injuries, nor was there a waiver of privacy. Consequently, the defendant is prohibited from producing the document without WCAB authorization.

EAMSdiscoverablerelevantprivacy waiverQualified Medical EvaluatorPetition for Removalin camera reviewinadmissibilitycumulative injurydeposition transcript
References
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