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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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
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. ADJ3816448 (LAO 0789900) ADJ335314 (LAO 0818843) ADJ1177078 (LAO 0789901)
Regular
Sep 25, 2015

RAYMUNDO PITONES vs. MEL CAST LITHO, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves CIGA, the California Insurance Guarantee Association, seeking to be absolved of liability for workers' compensation benefits for an injured worker, Raymundo Pitones. CIGA argues that a settlement with another insurer for a subsequent, overlapping injury constitutes "other insurance" that should relieve CIGA of its obligations. The Workers' Compensation Appeals Board denied CIGA's petition, finding that the subsequent settlement did not fully cover all of Pitones' injuries, particularly those that did not overlap. Therefore, CIGA remains liable for the benefits not covered by the prior settlement to ensure the applicant can recover his full benefits.

CIGACalifornia Insurance Guarantee AssociationMel Cast LithoInc.California Compensation Insurance CompanyliquidationSEDGWICK CLAIMS MANAGEMENT SERVICESPetition for ReconsiderationJoint Findings of Fact and Orderworkers' compensation administrative law judge
References
Case No. ADJ4629950
Regular
Dec 21, 2012

JOHNNY BETTENCOURT vs. DONALD WILLIAMS, SAFECO INSURANCE COMPANY, UNINSURED EMPLOYERS' BENEFIT TRUST FUND DEPARTMENT OF INDUSTRIAL RELATIONS

The Uninsured Employers' Benefit Trust Fund (UEBTF) sought reconsideration, arguing Safeco's policy covered the applicant's injury. The Arbitrator previously ruled Safeco had no liability as its policy with Donald Williams did not include "comprehensive personal liability" insurance as required by Insurance Code section 11590. The Appeals Board affirmed this decision, finding the Safeco policy explicitly limited coverage to premises liability and lacked the necessary language for comprehensive personal liability coverage. Therefore, Safeco was correctly found not liable for the applicant's injury.

Uninsured Employers' Benefit Trust Fundcomprehensive personal liability insuranceLabor Code section 3351(d)Labor Code section 3352(h)Insurance Code section 11590premises liability insuranceSafeco Insurance CompanyDonald WilliamsJohnny Bettencourtworker's compensation coverage
References
Case No. ADJ4415679 (OAK 0259031) ADJ2701101 (WCK0050594)
Regular
May 10, 2010

Stanley Sanders vs. REMEDY INTELLIGENT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY, OREGON STEEL MILLS, INC. dba NAPA PIPE

The Workers' Compensation Appeals Board reversed a judge's decision, ruling that Napa Pipe, a self-insured special employer, is liable for applicant Stanley Sanders' workers' compensation benefits. Despite an agreement between the general employer (Remedy Temp) and Napa Pipe attempting to limit liability to Remedy Temp's insurer (Reliance), Napa Pipe's joint and several liability as a special employer cannot be contractually eliminated. Because Napa Pipe's self-insurance was not excluded for special employees and constitutes "other insurance" under Insurance Code § 1063.1(c)(9), CIGA is relieved of its obligation to provide benefits following Reliance's insolvency. Therefore, Napa Pipe must now provide all workers' compensation benefits and administer the claim.

Workers' Compensation Appeals BoardStanley SandersRemedy Intelligent StaffingCalifornia Insurance Guarantee AssociationReliance National Insurance CompanyOregon Steel MillsNapa PipeADJ4415679ADJ2701101Opinion and Decision After Reconsideration
References
Case No. GOL 86641, GOL 99800
Regular
Aug 07, 2008

MIGUEL TORRES vs. HENDRY TELEPHONE PRODUCTS, CONNECTICUT INDEMNITY/ROYAL & SUNALLIANCE INSURANCE, HR3 STAFFING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to correct errors in the original award, specifically the misidentification of employers and their insurers. The WCAB rescinded the prior award and returned the case for further proceedings to determine the existence of a cumulative injury and clarify employer liability. The Board also noted that Connecticut Indemnity's policy likely constitutes "other insurance," thus precluding CIGA's involvement.

Workers' Compensation Appeals BoardJoint Findings and AwardReconsiderationIndustrial InjuryNeckRight Upper ExtremityCarpal Tunnel SyndromeCubital Tunnel SyndromeHeadachesDizziness
References
Case No. ANA 0366568
Regular
Aug 21, 2007

STACY MACK vs. CAREER STRATEGIES TEMP., INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, BROADSPIRE, SUN AMERICA, STATE COMPENSATION INSURANCE FUND, TELEFLORA, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award, remanding the case to determine if the State Compensation Insurance Fund (SCIF) policy for Sun America constitutes "other insurance" under Insurance Code section 1063.1(c)(9). This determination is crucial for assessing the liability of the California Insurance Guarantee Association (CIGA), which seeks to avoid coverage by arguing the SCIF policy is available. The WCAB requires further proceedings to fully develop the record regarding the intent and applicability of the SCIF policy for special employees.

CIGAcovered claimother insurancegeneral employerspecial employerSuperior National Insurance CompanyState Compensation Insurance FundInsurance Code section 1063.1(c)(9)Insurance Code section 11663joint and several liability
References
Case No. SBR 309137
Regular
Aug 28, 2007

JOSE CARMONA vs. ARROW EMPLOYMENT SERVICES dba ARROW STAFFING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, in liquidation, by CAMBRIDGE INTEGRATED SERVICES, KELLY PRODUCTIONS, INC., FARMDALE CREAMERY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board is reconsidering a prior award due to CIGA's contention that the applicant's claim is not a "covered claim" because other insurance was available. The central issue is whether the special employer's (Farmdale Creamery) workers' compensation policy with SCIF constitutes "other insurance" under Insurance Code section 1063.1(c)(9), which would exclude the claim from CIGA's coverage. The case is remanded for further proceedings to definitively determine the availability of this "other insurance" and its impact on CIGA's liability.

CIGALegion Insurance CompanyArrow Employment ServicesFarmdale CreameryState Compensation Insurance Fundcovered claimother insuranceInsurance Code section 1063.1(c)(9)general employerspecial employer
References
Case No. ADJ3957329 (OAK 0162600) ADJ621097 (OAK 0183630)
Regular
Jan 27, 2017

JUDITH KRAFT vs. CORREY JAMESTOWN, HARTFORD INSURANCE COMPANY, FACILITY SYSTEMS, INC., BROADSPIRE CONCORD

Here's a summary for a lawyer in maximum four sentences: Hartford Insurance sought removal of an order requiring it to administer the applicant's future medical award for all body parts. Hartford argued this would cause irreparable harm by potentially barring reimbursement from CIGA for neck injury treatment, for which Hartford claims no current liability. The Workers' Compensation Appeals Board denied removal, adopting the judge's reasoning that potential prejudice to Hartford was outweighed by applicant's need for a single administrator and the judge's discretion to assign administration pending adjudication of neck injury liability. Commissioner Lowe dissented, arguing Hartford faces substantial prejudice and potential liability for an injury it did not insure.

Workers' Compensation Appeals BoardPetition for RemovalFindings of FactAdministrative Law JudgeIndustrial InjuryLow BackLeft AnkleNeckDistrict ManagerAccount Executive
References
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