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

Case No. ADJ625812 (POM 0280514)
Regular
Aug 24, 2011

William McCarther vs. USS Cal Builders, Zurich North America, State Compensation Insurance Fund

Zurich North America sought removal after applicant's invalid election against SCIF, arguing it was precluded from discovery and entitled to its own medical evidence for a specific injury. The Board granted removal, finding the election void and the discovery delay unjustified. The case involves a specific industrial injury where both SCIF and Zurich may be liable, with Zurich having made its first appearance nearly twenty months after being joined. The Board redesignated the upcoming trial as a status conference to allow Zurich to present policy information and clarify its coverage stance.

Petition for RemovalZurich North AmericaSCIFElection Against SCIFLabor Code section 5500.5(c)Specific InjuryJoinder of Party DefendantCoverage DenialASCIPWorkers' Compensation Appeals Board
References
1
Case No. ADJ4072860 (AHM 0083472) ADJ2211265 (AHM 0083473)
Regular
Feb 28, 2012

DARLYN PIPER vs. DANKA OFFICE IMAGING, ZURICH NORTH AMERICA, LIBERTY MUTUAL INSURANCE COMPANY

This case involves cross-petitions for reconsideration of an award for applicant's industrial injuries. The Board denied the applicant's petition and granted the defendant's, clarifying that Zurich North America is solely liable. The Board affirmed the WCJ's decision, amending the award to reflect the applicant's election against Zurich and allowing Zurich to seek contribution from Liberty Mutual. A dissenting opinion argued that the apportionment of permanent disability was speculative and unsupported by substantial medical evidence.

Workers' Compensation Appeals BoardDarlyn PiperDanka Office ImagingZurich North AmericaLiberty Mutual Insurance CompanyADJ4072860ADJ2211265permanent disabilitycumulative traumacustomer service technician
References
0
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
1
Case No. ADJ3193455 (SJO 0234823)
Regular
Sep 28, 2009

STEPHEN HERRING vs. STANFORD UNIVERSITY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, RELIANCE INSURANCE COMPANY, ZURICH NORTH AMERICA

This case concerns Zurich North America's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that established the applicant's cumulative trauma injury date as June 13, 2003. The WCAB affirmed its prior ruling, finding that the applicant did not have the requisite knowledge of a distinct industrial injury beyond a prior specific injury until alerted by a medical report on that date. Zurich failed to present evidence demonstrating the applicant should have recognized a separate injurious process given the complexity of distinguishing between multiple potential injuries. Therefore, Zurich's petition for reconsideration was denied.

Labor Code § 5412Labor Code § 5500.5cumulative trauma injurydate of injuryCIGAZurich North AmericaReliance Insurance Companyspecific industrial injuryapportionmentmedical causation
References
13
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
8
Case No. ADJ10381208
Regular
Jun 27, 2017

ALEJANDRO RAMIREZ vs. TRI-STARR MANAGEMENT SERVICES, ZURICH NORTH AMERICA

The Appeals Board denied Zurich North America's Petition for Removal regarding a WCJ's Minute Order. The Board found that Zurich failed to demonstrate substantial prejudice or irreparable harm, and that reconsideration remains an adequate remedy. The WCJ's order allowing continued involvement in the claim was within their authority and did not deny due process. Although initially questioned, the petition was deemed timely filed.

Petition for RemovalDue Process RightsIrreparable HarmSubstantial PrejudiceWCJ Report and RecommendationTimeliness of PetitionDesignated ServicePersonal ServiceAdjudication of ClaimInterlocutory Orders
References
2
Case No. ADJ9065210
Regular
Mar 08, 2016

WILLIAM JOHNS vs. BEN F. SMITH, AIG, ZURICH NORTH AMERICA

Defendant Zurich North America sought reconsideration of a WCJ's decision awarding applicant benefits for injuries sustained as a carpenter. Zurich contested the date of injury, arguing it predated their coverage and denied due process by deferring this issue. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the case to the trial level. This action was taken because the WCJ failed to issue findings on all controverted issues, specifically the date of injury under Labor Code section 5412.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and AwardIndustrial InjuryLumbar SpineRight HipBilateral KneesLower ExtremitiesCarpenter
References
4
Case No. ADJ3393930 (AHM 0089017) ADJ2735537 (AHM 0094395)
Regular
May 06, 2013

DAVID CARMONA vs. BMW OF NORTH AMERICA, ZURICH NORTH AMERICA, FIREMAN'S FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration in *Carmona v. BMW of North America*, finding the Workers' Compensation Judge's (WCJ) report insufficient. The WCAB rescinded the WCJ's prior decision and returned the case for further proceedings and a new decision. While the WCJ intended to correct a clerical error regarding cumulative trauma dates, the WCAB felt further development of the record was needed on temporary total disability, but not apportionment related to Dr. Stewart. This is not a final decision on the merits.

DAVID CARMONABMW OF NORTH AMERICAZURICH NORTH AMERICAFIREMAN'S FUNDWORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONADMINISTRATIVE LAW JUDGECLERICAL ERRORCUMULATIVE TRAUMATEMPORARY TOTAL DISABILITY
References
0
Case No. MISSING
Regular Panel Decision

Bernhardt v. Tradition North America

Donald Bernhardt sued his former employers, Tradition North America Inc. and Tradition Asiel Securities, Inc., alleging breach of an implied employment contract. Bernhardt claimed he was wrongfully terminated after exposing illegal securities schemes and reporting them to the SEC, violating an implied agreement that the firm would operate lawfully. Defendants moved to dismiss the amended complaint under Rule 12(b)(6) and sought Rule 11 sanctions against Bernhardt's attorney. The court granted the motion to dismiss, ruling that Bernhardt failed to state a plausible claim for breach of an implied contract under New York's at-will employment doctrine. However, the court denied the request for Rule 11 sanctions, finding the lawsuit, while unsuccessful, did not constitute sanctionable conduct.

Implied contractEmployment at willWrongful terminationWhistleblowerSecurities law violationsMotion to dismissRule 12(b)(6)Rule 11 sanctionsFederal Rules of Civil ProcedureNew York employment law
References
18
Case No. MISSING
Regular Panel Decision

Maida v. Life Insurance Co. of North America

Plaintiff Anthony Maida sued Life Insurance Company of North America (LINA) after his long-term disability benefits were terminated. Maida initially claimed physical disability due to a fall and later asserted mental disability from post-traumatic stress disorder. The court granted LINA's motion for summary judgment on the physical disability claim, finding LINA's denial was not arbitrary and capricious based on multiple medical reports. Additionally, LINA was awarded $10,155 on its counterclaim for overpaid benefits. However, the court vacated LINA's rejection of the mental disability claim, deeming it arbitrary and capricious due to the lack of proper medical review, and remanded the matter to LINA for reconsideration, while retaining jurisdiction.

Disability BenefitsERISA LitigationSummary JudgmentArbitrary and Capricious ReviewRemand to AdministratorPost-Traumatic Stress DisorderPhysical Injury ClaimMental Health ClaimInsurance Policy DisputeOverpayment Reimbursement
References
19
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