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

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. ADJ2279830 (LBO 0290929) ADJ3851198 (LBO 0362934)
Regular
Sep 05, 2008

SUSAN ORTLOFF vs. ANAHEIM GENERAL HOSPITAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT COMPENSATION, ARGONAUT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted CIGA's reconsideration, affirming the denial of contribution for Fremont's pre-insolvency benefits due to untimeliness under Labor Code §5500.5(e). However, the Board reversed the denial of CIGA's reimbursement claim for post-insolvency benefits, finding that Argonaut provided "other insurance" and is therefore liable for reimbursement. The Board ordered Argonaut to reimburse CIGA for benefits paid after Fremont's insolvency.

CIGAFremont CompensationArgonaut Insurancecontributionreimbursementinsolvencycumulative traumastipulated awardstatute of limitationsLabor Code 5500.5(e)
References
Case No. ADJ244571 (VEN 0110022) ADJ3315572 (VEN 0110023) ADJ3817980 (OXN 0145232) ADJ2004405 (OXN 0145234) ADJ4239471 (OXN 0145235)
Regular
Jan 19, 2010

DIANA HARDMAN vs. COMMUNITY MEMORIAL HOSPITAL, AIG DOMESTIC CLAIMS, INC./CHARTIS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE, CALIFORNIA COMPENSATION INSURANCE COMPANY, FREMONT COMPENSATION INSURANCE COMPANY, American Home Assurance

This case involves five workers' compensation claims by applicant Diana Hardman against Community Memorial Hospital, with American Home Assurance (AIG) as a defendant insurer. AIG seeks reconsideration of the WCJ's findings, arguing it should only be liable for permanent disability directly arising from injuries covered by its policies, not those covered by insolvent insurers now handled by CIGA. The Appeals Board granted reconsideration, rescinded the WCJ's decisions, and returned the matter for further proceedings. Key issues include the admissibility of a deposition, the apportionment of permanent disability based on recent appellate decisions, and clarification of liability for injuries that occurred during periods covered by multiple insurers, including insolvent ones.

Workers' Compensation Appeals BoardDiana HardmanCommunity Memorial HospitalAIG Domestic ClaimsCalifornia Insurance Guarantee AssociationBroads PireCalifornia Compensation Insurance CompanyFremont Compensation Insurance CompanyOpinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ1034828
Regular
Jan 19, 2000

KELLY JOLLY vs. INPUT 1; CIGA administered by its servicing facility CAMBRIDGE INTEGRATED SERVICES GROUP, INC. for FREMONT COMPENSATION INSURANCE COMPANY; In liquidation; GRANITE STATE INSURANCE COMPANY, by AIG; STATE COMPENSATION INSURANCE FUND; AMERICAN SAFETY CASUALTY, by GALALGHER BASSETT

The Workers' Compensation Appeals Board denied reconsideration in this case. The Board adopted the arbitrator's report, which explained their prior holding. This holding established that CIGA is entitled to pre-litigation benefits from an insolvent carrier but must remit those proceeds to the insolvent carrier's trustee. Therefore, the petition for reconsideration was denied.

CIGAReconsideration DeniedInsolvent CarrierTrusteePre-litigation BenefitsLiquidated Insurance CompanyServicing FacilityWorkers' Compensation Appeals BoardArbitrator ReportAdjudication
References
Case No. OAK 234515, OAK 239085, OAK 240882
Significant

Victoria Gomez vs. Casa Sandoval, Golden Eagle Insurance Company, California Compensation (in liquidation), California Insurance Guarantee Association, Risk Enterprise Management

An en banc opinion clarifying that the California Insurance Guarantee Association (CIGA) is generally relieved of liability in cases with a solvent carrier, unless liability was already apportioned and finalized before the original carrier's insolvency.

California Insurance Guarantee AssociationCIGAcovered claimsother insuranceinsolvencyapportionment of liabilitysuccessive injuriescumulative traumamedical treatmentadministration of award
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. POM 248928
En Banc
Mar 28, 2003

Mark Miceli, et al. vs. Jacuzzi, Inc., Remedy Temp, Inc., American Home Assurance Co., Reliance National Indemnity Co. (In Liquidation), California Insurance Guarantee Association

The Appeals Board affirmed that where a temporary employee is injured and the general employer's insurance carrier is insolvent, the special employer's workers' compensation policy constitutes 'other insurance,' making that carrier liable for the claim instead of the California Insurance Guarantee Association (CIGA).

Workers' Compensation Appeals BoardEn Banc DecisionSpecial EmployerGeneral EmployerTemporary Staffing AgencyAlternate Employer EndorsementInsolvencyCalifornia Insurance Guarantee AssociationCovered ClaimsOther Insurance
References
Case No. OAK 234515; OAK 239085; OAK 240882; SAC 289506; SAC 289507
En Banc
May 27, 2003

Victoria Gomez, Carol Nokes vs. Casa Sandoval, Golden Eagle Insurance Company, California Compensation (in liquidation), California Insurance Guarantee Association, Risk Enterprise Management, Placer Savings Bank, Fremont Compensation Insurance Company, Paula Insurance Company (in liquidation)

This en banc decision clarifies the liability of the California Insurance Guarantee Association (CIGA) in cumulative and successive injury cases, holding that CIGA is generally relieved of liability if a solvent insurance carrier exists, unless liability was previously apportioned and finalized before the other carrier's insolvency.

CIGACovered ClaimsInsurance Code section 1063.1(c)(9)GarciaIndustrial IndemnitySuccessive InjuryCumulative InjuryOccupational DiseaseApportionment of LiabilityWCJ
References
Case No. POM 248928
Significant
Mar 28, 2003

Mark Miceli, et al. vs. Jacuzzi, Inc., Remedy Temp, Inc., American Home Assurance Co., Reliance National Indemnity Co. (In Liquidation), California Insurance Guarantee Association

The Appeals Board affirmed that when a temporary staffing agency's insurer becomes insolvent, the special employer's insurance policy constitutes 'other insurance,' making that insurer liable for the injured temporary employee's claim and relieving the California Insurance Guarantee Association (CIGA) of responsibility.

Workers Compensation Appeals BoardEn BancGeneral EmployerSpecial EmployerTemporary Staffing AgencyAlternate Employer EndorsementInsolvencyCalifornia Insurance Guarantee Association (CIGA)Covered ClaimOther Insurance
References
Case No. GRO 0022416
Regular
Mar 24, 2008

GERALD RICE vs. ALASCO RUBBER & PLASTICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CAMBRIDGE INTEGRATED SERVICES GROUP, FREMONT COMPENSATION INSURANCE COMPANY, NATIONAL SURETY/FIREMAN'S FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior decision. The Board found that the California Insurance Guarantee Association (CIGA) is solely liable for the applicant's industrial injury benefits. This is because the insolvent insurer, Fremont Compensation Insurance Company, was the only insurer on the risk during the one-year period preceding the applicant's cumulative trauma injury.

WORKERS' COMPENSATION APPEALS BOARDCIGAFREMONT COMPENSATION INSURANCE COMPANYINSOLVENCYLIQUIDATIONCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONNATIONAL SURETY/FIREMAN'S FUNDALASCO RUBBER & PLASTICSLABOR CODE SECTION 5500.5CUMULATIVE TRAUMA INJURY
References
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