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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. 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. SAC 0297421
Regular
Mar 11, 2008

MICHAEL THAO vs. COCA COLA BOTTLING COMPANY, SELECT PERSONNEL SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, On Behalf Of LEGION INSURANCE COMPANY, Adjusted By CAMBRIDGE INTEGRATED GROUP

The Workers' Compensation Appeals Board granted reconsideration to address whether Zurich's insurance policy constituted "other insurance" under Insurance Code § 1063.1(c)(9), which would absolve CIGA of liability and entitle it to reimbursement from Zurich. The Board returned the case for further proceedings to allow the WCJ to make an explicit finding on this issue, as it was not fully developed or addressed in the original decision. The special employment finding concerning Coca Cola Bottling Company was not reached pending the "other insurance" determination.

Special employmentCIGAother insurancereimbursementliquidationindustrial injurywarehousemanreconsiderationFindings and OrderWCJ
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. ADJ9685765
Regular
Feb 09, 2015

MARTIN VAN DOORN vs. WEST VALLEY CONSTRUCTION COMPANY, INC., ZURICH AMERICAN INSURANCE COMPANY, OLD REPUBLIC INSURANCE COMPANY

This case concerns a petition for reconsideration by West Valley Construction Company and Zurich American Insurance Company regarding a prior decision that reversed an arbitrator's finding. The arbitrator had barred the applicant's claim for specific injuries to his neck and back due to the statute of limitations. The defendants argued the applicant's petition was procedurally defective and that the Board did not properly weigh evidence. The Board denied reconsideration, finding the applicant's amended petition cured any initial defects and that the defendants were not prejudiced by the form of the original filing. The Board affirmed its previous decision based on its prior reasoning.

Workers' Compensation Appeals BoardPetition for ReconsiderationStatute of LimitationsSpecific InjuryCumulative InjuryProcedural DefectVerificationCase NumberArbitrator's FindingsDecision After Reconsideration
References
Case No. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
Case No. ADJ153728 (MON 253391) ADJ171701 (MON 256163)
Regular
Jan 23, 2009

Ana Sandoval vs. UNION BANK OF CALIFORNIA, ZURICH AMERICAN INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE COMPANY

The Appeals Board granted petitions for reconsideration and rescinded the WCJ's November 10, 2008 decision. CIGA's liability was clarified, and the temporary disability issue was returned to the trial level for further decision.

Workers Compensation Appeals BoardCIGAZurich American Insurance CompanyFremont Insurance CompanyLiquidationCovered ClaimsOther InsuranceTail CarrierCumulative TraumaSpecific Injury
References
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