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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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, et al.

The Workers' Compensation Appeals Board affirmed an Arbitrator's decision finding the New York State Insurance Fund (NYSIF) liable for workers' compensation claims against the New York Giants. Despite NYSIF's claims of sovereign immunity and limitations to New York coverage, the Board found that the policy's Coverage B provided indemnity for injuries sustained by employees "wherever such injuries may be sustained." The Board emphasized that insurance policy exclusions must be clear, and NYSIF failed to demonstrate any such limitations for injuries occurring outside New York, especially given the team's extensive operations outside the state. The Board also noted that NYSIF's contentions regarding California jurisdiction would be determined on a claim-by-claim basis.

Workers' Compensation Appeals BoardNew York State Insurance FundNew York GiantsSovereign ImmunityComityCalifornia JurisdictionCoverage BOut-of-State InjuriesInsurance Policy LimitationsIndemnify
References
Case No. GOL 86641, GOL 99800
Regular
Aug 07, 2008

MIGUEL TORRES vs. HENDRY TELEPHONE PRODUCTS, CONNECTICUT INDEMNITY/ROYAL & SUNALLIANCE INSURANCE, HR3 STAFFING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to correct errors in the original award, specifically the misidentification of employers and their insurers. The WCAB rescinded the prior award and returned the case for further proceedings to determine the existence of a cumulative injury and clarify employer liability. The Board also noted that Connecticut Indemnity's policy likely constitutes "other insurance," thus precluding CIGA's involvement.

Workers' Compensation Appeals BoardJoint Findings and AwardReconsiderationIndustrial InjuryNeckRight Upper ExtremityCarpal Tunnel SyndromeCubital Tunnel SyndromeHeadachesDizziness
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. 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. ADJ937954 (POM 0254711)
Regular
Aug 18, 2010

ANGELITA (ANGIE) FERNANDEZ vs. OAK TREE RACING ASSOCIATION, LOS ANGELES TURF CLUB, CADDIE SERVICES, INCORPORATED, CIGA by its servicing agent CAMBRIDGE INTEGRATED SERVICES for LEGION INSURANCE, in liquidation, CRAWFORD & COMPANY on behalf of ZURICH INSURANCE

This case involved an applicant claiming industrial injury to her shoulders and upper extremities. A prior insurer, Legion Insurance, erroneously paid benefits through its administrator, REM, before its insolvency. The Workers' Compensation Appeals Board denied reconsideration of the arbitrator's decision, which held Zurich Insurance (adjusted by Crawford & Company) liable for reimbursement to CIGA. This is because Zurich provided "other insurance" for a portion of the cumulative trauma injury, making it solely responsible for benefits where both an insolvent and solvent insurer would be liable. The Board found CIGA could recover pre-insolvency and mistaken payments, and Zurich's due process claims were unpersuasive.

CIGAZurich InsuranceCrawford & CompanyOak Tree Racing AssociationLegion InsuranceFremont Indemnitycumulative traumainsolvent insurersolvent insurerreimbursement
References
Case No. ADJ11391724, ADJ11391757
Regular
Oct 03, 2019

PABLO LOPEZ DURAN vs. SOUTH HILLS ACADEMY, CHURCH MUTUAL INSURANCE COMPANY, SECURITY NATIONAL INSURANCE COMPANY, AMTRUST NORTH AMERICA, CRESCENT HOTELS & RESORTS, LLC, CHUBB INSURANCE GROUP, GALLAGHER BASSETT SERVICES, INC.

This Workers' Compensation Appeals Board case involves applicant Pablo Lopez Duran and multiple defendants including South Hills Academy, Church Mutual Insurance Company, Security National Insurance Company, Crescent Hotels & Resorts, LLC, and Chubb Insurance Group. The Board granted a petition for reconsideration and affirmed a prior order regarding sanctions and costs. Specifically, Chubb Insurance Group, administered by Gallagher Bassett Services, Inc., was ordered to pay an additional $395 for attorneys' fees related to a petition for fees, less any credit for prior payments.

WORKERS' COMPENSATION APPEALS BOARDSOUTH HILLS ACADEMYCHURCH MUTUAL INSURANCE COMPANYSECURITY NATIONAL INSURANCE COMPANYAMTRUST NORTH AMERICACRESCENT HOTELS & RESORTSLLCCHUBB INSURANCE GROUPGALLAGHER BASSETT SERVICESINC.
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. GRO 0023124
Regular
Dec 31, 2007

CAROLINA CAMACHO vs. TEAMWORK, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, DEN-MAT, ZENITH INSURANCE COMPANY

Zenith Insurance sought reconsideration of a WCAB decision that found CIGA not liable because other insurance was available, ordering Zenith to reimburse CIGA for benefits paid. Zenith argued the WCAB lacked jurisdiction, claiming the contribution issue was subject to mandatory arbitration under Labor Code § 5275. The WCAB denied reconsideration, ruling that § 5275 did not apply as this was a general/special employment situation, not a cumulative trauma case, and Zenith's insurance constituted "other insurance" relieving CIGA of liability.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAZenith Insurance CompanyContributionMandatory ArbitrationLabor Code Section 5275Labor Code Section 5500.5General EmploymentSpecial Employment
References
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