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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ1817205 (RIV 0076837) ADJ2824273 (RIV 0076838)
Regular
Jul 02, 2014

SONNY LOVELESS vs. NEWPORT FARMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ZURICH AMERICAN INSURANCE CO., VIRGINIA SURETY INSURANCE COMPANY

This case involves a dispute over reimbursement for workers' compensation benefits paid by CIGA. The Appeals Board affirmed an arbitrator's decision granting CIGA full reimbursement from Virginia Surety and Zurich for benefits paid to the applicant. Virginia Surety's arguments that the cumulative trauma periods should be reevaluated and that CIGA was liable for the first period were rejected. The Board found Virginia Surety is bound by prior stipulations establishing two cumulative trauma periods, making its coverage "other insurance" under Insurance Code § 1063.1(c)(9) and thus excluding CIGA's liability for those benefits.

Workers' Compensation Appeals BoardSonny LovelessNewport FarmsCalifornia Insurance Guarantee Association (CIGA)Superior NationalZurich American Insurance Co.Virginia Surety Insurance Companycumulative traumastipulated awardreimbursement
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. ADJ 4359672 (VNO 0478019)
Regular
Apr 08, 2016

JORGE OROZCO vs. MARRIOTT DOWNTOWN LOS ANGELES/INTERSTATE HOTELS AND RESORTS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for AMERICAN PROTECTION INSURANCE COMPANY, ZURICH NORTH AMERICA, CENTURY PLAZA HOTEL

This case concerns the California Insurance Guarantee Association's (CIGA) liability for an insolvent insurer's obligations under a workers' compensation settlement. The applicant settled a cumulative trauma injury claim, and the settlement agreement apportioned liability for remaining lien claims among insurers, including American Protection Company. After American Protection Company became insolvent, CIGA stepped in, but sought dismissal, arguing its liability was not joint and several and no "other insurance" existed. The Board affirmed the dismissal of CIGA, holding that the original joint and several nature of the insurers' liability, as established by case law and the settlement, means Zurich North America's remaining liability constitutes "other insurance" relieving CIGA.

CIGAAmerican Protection Insurance CompanyMarriott Downtown Los AngelesInterstate Hotels and ResortsZurich North AmericaCentury Plaza HotelBroadspireSedgwick Claims Management ServicesCompromise and Release Agreementcumulative trauma
References
Case No. ADJ8973046
Regular
Dec 28, 2015

FERMIN CEJA vs. SAUSALITO MOVING & STORAGE, INC., ZURICH AMERICAN INSURANCE CO.

In this workers' compensation case, the defendant insurer, Zurich American Insurance Co., sought reconsideration of an order compelling them to comply with a stipulation agreement. Zurich argued they entered the stipulation by mistake, as they did not provide insurance coverage on the date of the applicant's specific injury. The Appeals Board granted reconsideration, rescinded the order to comply, and deferred Zurich's petition to set aside the stipulation. The Board emphasized that Zurich remains bound by the original stipulations until the petition to set aside is fully adjudicated.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition to Set Aside StipulationMistake of FactInsurance CoverageStipulation and OrdersTemporary Total DisabilityHernia InjuryMPNAppeal
References
Case No. ADJ7989476 ADJ9983597 ADJ9983898
Regular
Jun 18, 2018

MARIA MIRANDA vs. KOOSHAREM dba SELECT STAFFING dba SELECT FOCUS, EVANS MANUFACTURING, ACE AMERICAN INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE (CIGA) Adjusted by SEDGWICK for ULLICO CASUALTY, in liquidation, TRUCK INSURANCE EXCHANGE

This case involves a dispute over workers' compensation insurance liability for injuries sustained by applicant Maria Miranda in 2011 while employed by Select Staffing (general employer) and Evans Manufacturing (special employer). The Workers' Compensation Appeals Board (WCAB) rescinded the arbitrator's decision because the evidence, particularly insurance policy endorsements, was not adequately identified and admitted. The WCAB found the record insufficient to determine which insurer, ACE American Insurance Company or Truck Insurance Exchange, is primarily liable for benefits. The matter is returned to the arbitrator to establish a complete and proper record for a new decision, addressing the specific requirements for insurance endorsements limiting coverage.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderInsurance LiabilityGeneral EmployerSpecial EmployerACE American Insurance CompanyTruck Insurance ExchangeCalifornia Insurance Guarantee AssociationCIGA
References
Case No. ADJ8517777
Regular
Oct 07, 2019

DOUGLAS ARONSON vs. WORLD LEAGUE OF AMERICAN FOOTBALL, LIBERTY MUTUAL INSURANCE, STATE COMPENSATION INSURANCE FUND, PHILADELPHIA EGLES, FAIRMONT PREMIER INSURANCE COMPANY

In *Aronson v. World League of American Football*, the Workers' Compensation Appeals Board denied a petition for reconsideration, upholding an arbitrator's finding. The core issue was whether the State Compensation Insurance Fund's (SCIF) policy covered all employees of the League injured within California's jurisdiction, or only those affiliated with the Sacramento Surge. The Board affirmed that standard workers' compensation policies cover all employees unless explicitly limited, and any ambiguity is resolved in favor of the insured. Therefore, SCIF's policy was interpreted to provide coverage for all League employees injured in California during the relevant period.

Workers' Compensation Appeals BoardPetition for ReconsiderationInsurance Policy InterpretationSCIF PolicyCalifornia JurisdictionAmbiguity Resolved Against InsurerGreatest CoverageArbitrator's DecisionFindings and AwardState Compensation Insurance Fund
References
Case No. VEN 0120092
Regular
Apr 11, 2008

JOSE AVILA vs. SEMINIS VEGETABLE SEEDS, INC., REMEDYTEMP, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by INTERCARE for RELIANCE INSURANCE COMPANY in liquidation, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board denied Zurich North America's petition for reconsideration, affirming the arbitrator's decision that Zurich's policy with Seminis Vegetable Seeds constituted "other insurance." This finding relieved the California Insurance Guarantee Association (CIGA) of liability, as the applicant's claim was not a "covered claim" under CIGA's statutory authority. The Board found that despite Seminis being a special employer, its policy with Zurich covered special employees, making it primary to CIGA's involvement following the insolvency of the general employer's insurer.

Workers' Compensation Appeals BoardSeminis Vegetable SeedsRemedyTempCalifornia Insurance Guarantee AssociationCIGAZurich North AmericaReliance Insurance Companyliquidationspecial employergeneral employer
References
Case No. ADJ4699173 (FRE 204280) ADJ2234380 (FRE 204242) ADJ201252 (FRE 206405) ADJ3631426 (FRE 213090)
Regular
Nov 14, 2008

JOHNNY DURAN vs. DARRYL HITCHMAN, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, in liquidation, by BROADSPIRE, CENTREX HOMES, AMERICAN GUARANTEE AND LIABILITY INSURANCE/ZURICH NORTH AMERICAN OCIP

This case concerns applicant Johnny Duran's industrial injuries to his back and knees. The California Insurance Guarantee Association (CIGA) sought reconsideration of a finding that the cases should be returned to arbitration for insurance coverage issues. The Appeals Board rescinded the prior decision, finding no arbitration is necessary because Zurich already established coverage for cumulative trauma injuries. However, the cases are returned to the Workers' Compensation Judge to determine CIGA's liability for benefits solely attributable to specific injuries where Superior National was the sole available insurer.

CIGASuperior National Insurance CompanyliquidationreconsiderationWorkers' Compensation Appeals BoardArbitratorinsurance coverageLabor Code Section 5275(a)(1)compromise and releaseZurich North American
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
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