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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ4269777 (SJO 0238464) ADJ1887256 (SJO 0247242)
Regular
Nov 13, 2008

DOLORES WALLACE-McLEAN vs. CUPERTINO UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed an arbitrator's award requiring Cupertino Unified School District (District) to reimburse CIGA for benefits paid to an applicant following the liquidation of the District's insurer, Reliance National. The District argued CIGA had no legal basis for reimbursement and its claim was untimely and procedurally flawed. The Board found CIGA was entitled to reimbursement for temporary disability and medical treatment paid post-liquidation, and 75% of benefits paid prior to liquidation, based on prior arbitration and settlement agreements.

CIGAReliance National Insurance Companyliquidationreimbursementspecific injurycumulative traumacompromise and releasepermanent disabilityfuture medical careself-insured
References
Case No. SFO 0444182 SFO 0470385
Regular
Nov 16, 2007

MARK CRUZ vs. WESTLAKE AUTO SERVICE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY, in liquidation, by INTERCARE INSURANCE SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and found the State Compensation Insurance Fund liable for 4% of pre-liquidation benefits paid by Reliance and 100% of post-liquidation benefits paid by CIGA. The Board clarified that "workers' compensation benefit payments" encompass temporary disability, permanent disability, and medical treatment but specifically exclude administrative costs such as medical management, copying, and bill review. Therefore, the State Fund is not obligated to reimburse CIGA for these administrative expenses.

CIGAReliance National Insurance CompanyState Compensation Insurance Fundcontributionpermanent disabilitymedical treatmentcumulative traumaspecific injurypre-liquidation paymentspost-liquidation payments
References
Case No. ADJ4430483 (SJO 0217023) ADJ3454827 (SJO 0226616)
Regular
Mar 10, 2011

JUAN L. ROMERO vs. ORLANDI TRAILER; CIGA by its servicing facility SEDGWICK CMS for LEGION INSURANCE in liquidation

The applicant, Juan L. Romero, sustained two industrial injuries. Defendant CIGA sought reconsideration of a prior order that allocated liability between these injuries and ordered reimbursement. CIGA later withdrew its petition for reconsideration after receiving clarification from the Workers' Compensation Arbitrator regarding its reimbursement entitlement. The Board vacated its previous order granting reconsideration and dismissed CIGA's petition.

CIGALegion Insurance in liquidationSedgwick CMSFindings and Orderreconsiderationliability allocationcumulative industrial injuryspecific industrial injuryreimbursementpre-liquidation benefits
References
Case No. ADJ1160933 (SAL 0073085) ADJ1668595 (SAL 0073084)
Regular
Mar 01, 2012

MARIA AYALA vs. MANN PACKING COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ZENITH INSURANCE COMPANY

This Workers' Compensation Appeals Board case involves a clerical error correction. CIGA, representing Industrial Indemnity, requested the correction of the liquidation date of Industrial Indemnity. The original order mistakenly stated the liquidation occurred in 2004, but CIGA correctly identified it as July 2, 2003. The Board agreed and ordered the amendment to reflect the accurate liquidation date, also adding Zenith Insurance to the caption, without altering the original decision's outcome.

CLERICAL ERROR CORRECTIONCIGAINDUSTRIAL INDEMNITY LIQUIDATIONFREMONT INDEMNITYSEDGWICK CMSZENITH INSURANCE COMPANYINSURANCE CODE SECTION 1063.1OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONDATE OF LIQUIDATION
References
Case No. ADJ3543960 (LAO 0789656) ADJ1691548 (LAO 0789657)
Regular
Mar 17, 2017

Patricia Soto vs. Mayfair Plastics, California Insurance Guarantee Association, INTERCARE INSURANCE SERVICES, Pacific National Insurance Company, Highlands Insurance Company

This case involves CIGA's petition for removal after a workers' compensation judge stayed CIGA's contribution claim against Highlands Insurance Company, which is in Texas receivership. The Appeals Board granted removal, rescinded the stay, and returned the matter for further proceedings. The Board found the judge lacked jurisdiction to stay the petition based solely on Texas law without determining if Texas is a "reciprocal state" under the Uniform Insurers Liquidation Act. The Board's review indicated Texas law meets some, but not all, UILA criteria for reciprocal status, leaving the issue unresolved.

CIGAHighlands Insurance CompanyUniform Insurers Liquidation ActUILAreciprocal statereceivershipliquidationPetition for ContributionPetition for Removalstay of proceedings
References
Case No. ADJ855806 (VNO 0433480) ADJ1859136 (VNO 0436396)
Regular
Aug 19, 2010

JOHN BATTISTA vs. GROUND BREAKING CONSTRUCTION COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SABLE INSURANCE COMPANY, In Liquidation

This case concerns a dispute over reimbursement between the California Insurance Guarantee Association (CIGA) and State Compensation Insurance Fund (SCIF). CIGA seeks reimbursement for over $52,000 paid on behalf of Sable Insurance Company, which is in liquidation. SCIF argues the Administrative Law Judge (ALJ) improperly awarded reimbursement without ruling on SCIF's evidentiary objections, its request for cross-examination, or its arbitration claim. The Appeals Board granted reconsideration, finding the ALJ's decision lacked sufficient explanation and analysis of SCIF's contentions. The case is remanded to the trial level for further proceedings and a properly reasoned decision addressing all issues.

CIGASCIFSable Insurance Companyliquidationreimbursementapportionmenttemporary disabilitymedical treatmentexpensesarbitration
References
Case No. ANA 352921
Regular
Oct 02, 2007

STEPHEN GRIFFIS vs. ORANGE COUNTY FIRE AUTHORITY, CIGA on behalf of RELIANCE NATIONAL INSURANCE COMPANY, in liquidation, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding an applicant's cumulative trauma injury to May 12, 1997. The WCAB found that AIG, as "other insurance," is liable for all benefits awarded after Reliance National Insurance Company (Reliance) became insolvent on October 3, 2001. Consequently, the California Insurance Guarantee Association (CIGA) is entitled to reimbursement from AIG for all benefits CIGA paid after Reliance's liquidation.

CIGAReliance National InsuranceAIG Claims Servicescumulative traumabilateral hearing lossstipulated awardliquidationreimbursementother insurancecovered claim
References
Case No. ADJ2161987 (FRE 0162457) ADJ253219 (FRE 0162458) ADJ1820437 (FRE 0173868)
Regular
Mar 07, 2014

RAMONA FARLEY vs. LINDSAY HOSPITAL C/O SIERRA VIEW LOCAL HEALTH CARE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FOR CAL COMP, in liquidation by INTERCARE

This Workers' Compensation Appeals Board (WCAB) case involves applicant Ramona Farley against Lindsay Hospital and its insurer, with the California Insurance Guarantee Association (CIGA) also involved due to liquidation. The WCAB issued an order dismissing a petition for reconsideration that had been filed by one of the parties. This dismissal is based solely on the petitioner's subsequent withdrawal of that very petition. No substantive issues regarding the original decision were addressed in this dismissal order.

Petition for ReconsiderationWithdrawnDismissedWorkers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationLiquidationIntercareADJ2161987ADJ253219ADJ1820437
References
Case No. ADJ2917674 (VNO 0407939)
Regular
Dec 13, 2010

HARRIET ZINGER, vs. JEFFER, MANGELS, BUTLER & MARMARO; SUPERIOR NATIONAL INSURANCE, In Liquidation; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION; STATE COMPENSATION INSURANCE FUND,

The WCAB granted the State Compensation Insurance Fund's (SCIF) petition for reconsideration. The SCIF sought to change the date of injury for applicant Harriet Zinger's orthopedic injury. While the WCJ initially set the date of injury as February 17, 2001, based on her first temporary disability, the SCIF argued for September 2, 2000. The WCAB affirmed the WCJ's decision on the date of injury and the period of liability. However, they amended the dismissal order to correctly identify Superior National Insurance, in liquidation, as a dismissed defendant.

WORKERS' COMPENSATION APPEALS BOARDState Compensation Insurance FundPetition for ReconsiderationFindings of FactOrder of DismissalLabor Code section 5412date of injurytemporary disabilityCalifornia Insurance Guarantee AssociationSuperior National Insurance
References
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