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

Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
Case No. MON 0278744
Regular
Nov 26, 2007

JULIANA LAMBETH vs. RN NETWORK, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FOR PHICO INSURANCE, KAISER PERMANENTE

In this workers' compensation case, the applicant sustained an injury in 1999 while employed by both RN Network (general employer) and Kaiser Permanente (special employer). The Workers' Compensation Appeals Board denied Kaiser's petition for reconsideration, affirming the dismissal of CIGA and holding Kaiser solely liable. The Board found that Kaiser's self-insured status constituted "other insurance" under Insurance Code section 1063.1(c)(9), thereby precluding CIGA's liability, regardless of contractual agreements between the employers attempting to shift liability.

SPECIAL EMPLOYERGENERAL EMPLOYERCIGAOTHER INSURANCESELF-INSURED STATUSWORKERS' COMPENSATION COVERAGEJOINT AND SEVERAL LIABILITYCONTRACTUAL EXCLUSIONINDUSTRIAL INJURYLIQUIDATED INSURER
References
Case No. ADJ7735518 ADJ7735519 ADJ7735513 ADJ7735501 ADJ7735502 ADJ7736429 ADJ7736449 ADJ7735498 ADJ7098593 ADJ7735514
Regular
Jul 29, 2014

Marialaine Tabak vs. SAN DIEGO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration regarding a dispute over medical treatment authorization. The core issue was whether a Medical Provider Network (MPN) could restrict treatment to specific office locations of a listed physician. The Board affirmed the WCJ's finding that the defendant school district properly denied authorization for treatment at an unauthorized location of an MPN physician. The MPN's explicit listing stated providers were in-network only at designated locations, and this contractual limitation was upheld. Therefore, treatment outside the approved location was at the applicant's own expense.

Medical Provider NetworkMPNPhysician locationAuthorizationSelf-procureGeographic limitExclusive rightContractual limitationsEmployer's obligationAdministrative Director's Rule
References
Case No. ADJ9136267
Regular
Aug 05, 2016

JERRY LEDGER III vs. STEVE DOVALI CONSTRUCTION, BARRY HALAJIAN DBA INDUSTRIAL ELECTRIC COMPANY, GRANITE STATE INSURANCE, BENCHMARK INSURANCE

In this workers' compensation case, the Appeals Board granted removal, rescinded a prior order staying Superior Court actions, and affirmed an order for mandatory arbitration. The Board found that coverage disputes arising from an insurer's claim of policy cancellation fall exclusively within the WCAB's jurisdiction, as resolution is necessary for applicant benefits. While the WCAB has exclusive jurisdiction over these disputes, it lacked the authority to stay the separate Superior Court actions, which is a power reserved for higher courts. Therefore, the parties must proceed to arbitration, and the Superior Court actions are not stayed by the WCAB.

Workers' Compensation Appeals BoardPetition for RemovalMandatory ArbitrationSuperior Court ActionPolicy CancellationDeclaratory ReliefConcurrent JurisdictionExclusive JurisdictionCoverage DisputeConstitutional Courts
References
Case No. ADJ7793905, ADJ7793938
Regular
Feb 25, 2014

SHEDERICK FOWLKS vs. LUBE PIT STOP, INC., ADVANTAGE WORKERS' COMPENSATION INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision finding the applicant, Shderick Fowlks, not covered by workers' compensation. Fowlks, an officer and sole shareholder of Lube Pit Stop, Inc., was deemed an employee under Labor Code section 3351(c) but excluded from compensation coverage by section 4151(a) because the corporation lacked specific election through a compensation policy. The WCAB clarified that while officers are generally employees, sole shareholder-officers require election to be covered, which was not demonstrated here due to policy exclusions. Therefore, Fowlks' claims for injuries sustained while working for the corporation were dismissed.

Labor Code section 3351(c)corporate officersole shareholderworkers' compensation coverageelectioninsurance policyexclusionshamadministrative law judgePetition for Reconsideration
References
Case No. SDO 0249452
Regular
May 12, 2008

GAIL GODFREY vs. COUNTY OF SAN DIEGO, PROFESSIONAL RESOURCE ENTERPRISE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by BROADSPIRE for SUPERIOR PACIFIC CASUALTY COMPANY

The California Workers' Compensation Appeals Board found that the County of San Diego was the applicant's special employer, making them jointly and severally liable for her injury. This determination was made despite a contract stating the applicant was not a County employee, as the Board found sufficient evidence of San Diego's control over her work. Consequently, the County is considered "other insurance available" to the applicant, meaning CIGA is not liable for her benefits.

CIGAcovered claimspecial employergeneral employerlabor brokerageindustrial injuryinsolvent insurerother insurancejoint and several liabilitycontractual exclusion
References
Case No. ADJ10298988
Regular
Jan 31, 2018

BRIAN BERRY vs. HOSPICE OF THE FOOTHILLS, ALPHA FUND

The Appeals Board rescinded the prior decision and returned the case to the trial level for further proceedings. The Board found that the record was insufficient to determine if the applicant voluntarily retired or was constructively terminated from his employment. Further development of evidence is needed to establish whether the applicant intended to permanently leave the labor force or if his industrial injury prevented him from continuing to work. This determination is crucial for assessing his entitlement to additional temporary disability benefits and potentially permanent disability benefits.

Workers' Compensation Appeals Boardindustrial injuryright shouldertemporary disability indemnityvoluntarily retiredlabor forcedue processself-representedadmission of evidenceexclusion of evidence
References
Case No. ADJ10264533
Regular
Oct 07, 2017

KENNETH GOSLING vs. CALIFORNIA SECURITY AND INVESTIGATIONS ACADEMY, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision. The Board found that while the applicant was correctly identified as an employee, the issue of whether he was excluded from workers' compensation coverage is a matter for mandatory arbitration. Therefore, the case is remanded to the trial level to proceed with arbitration on the coverage issue. The WCJ's prior finding that the applicant was not excluded from coverage is superseded by this order.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactCumulative TraumaCorporate Officer ExclusionLabor Code Sections 3351(c)Labor Code Section 4151Mandatory ArbitrationInsurance CoverageEmployee Definition
References
Case No. ADJ262420 (ANA 0302091)
Regular
Nov 23, 2009

ROBERT ORNELAS vs. SANTA ANA UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured

The WCAB granted reconsideration, rescinded the August 24, 2009 Findings and Order, and returned the matter to the trial level for further proceedings. The defendant had a contractual obligation to pay the lien claimant.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderAdministrative Law JudgeLabor Code sections 4903 and 4903.1(a)(3)Compromise and ReleaseLiving ExpensesContractual ObligationBad Faith
References
Case No. B167017
Significant
Nov 18, 2004

General Casualty Insurance and Regent Insurance, Joseph A. Lane, American Home Assurance Company vs. Workers' Compensation Appeals Board and California Insurance Guarantee Association

The court has requested responses from the Workers' Compensation Insurance Rating Bureau (WCIRB) and the California Insurance Commissioner regarding the exclusion of special employees from a special employer's workers' compensation policy, specifically questioning the use and requirements of Form No. 11 for this purpose.

WCIRBForm No. 11limiting endorsementsrestricting endorsementsspecial employeesgeneral employerstemporary employeesleased employeesInsurance CommissionerCalifornia Code of Regulations
References
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