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Case Name: CIGA v. WCAB (Argonaut Ins. Co.) 04/18/2005
Summary: We conclude that this distinction is of no legal significance and that the WCAB erred when it directed CIGA to reimburse real party in interest Argonaut Insurance Company (Argonaut), a solvent insurance carrier. CIGA petitioned this court for a writ of review on the ground that the reimbursement ordered by the WCAB is precluded by section 1063. 1, subdivisions (c)(5) and (c)(9)(ii). We remand with instructions to respondent WCAB to vacate its order and issue a new order denying Argonaut's reimbursement claim. CIGA also argued that the WCAB had no jurisdiction to issue an award against it because it was not properly joined as a party defendant and that the statute of limitations barred the claim. CIGA's petition for review to this court included an argument that the WCAB lacked jurisdiction over disputes involving reimbursement claims against it by other insurers.
Note: There is no legal distinction between a claim for 'contribution, indemnity, or subrogation' and claims that are characterized as 'joint and several' for purposes of CIGA liability under Insurance Code section 1063.1.
Citation: 128 Cal. App. 4th 569
WCC Citation: WCC 30962005 CA
 
 
Case Name: CIGA v. WCAB (Carls) 06/04/2008
Summary: CIGA also challenges the Board's finding that CIGA was estopped to assert the statute of limitations due to its delay in determining that the 1997 injury was a covered claim. As a defense to the claim, CIGA raised the one-year statute of limitations set forth in section 5405, subdivision (a). The WCAB adopted the WCJ's report and recommendation, and incorporated them into its order denying reconsideration. On January 25, 2007, the WCJ entered a compensation award for the 1997 injury, and after the WCAB denied CIGA's petition for reconsideration of that order, CIGA timely filed its petition for review by this court. To carry its burden, CIGA was required to overcome a rebuttable presumption that Carls was ignorant of his compensation rights.
Note: Claimant's awareness of his right to compensation for a past injury did not necessarily inform him of his potential right to compensation for the subsequent injury.
Citation: B199404
WCC Citation: WCC 33792008 CA
 
 
Case Name: CIGA v. WCAB (Oracle) 02/06/2012
Summary: We affirm the ruling that Pinnacle is not excluded from pursuing the claims against CIGA for two reasons. CIGA sought reconsideration, again contending that a claim asserted by an assignee is not a covered claim. The WCAB opined that CIGA had failed to prove that legal title to the medical providers' claims had been transferred to Pinnacle, and therefore there was no assignment but only a delegation of the task of collection to Pinnacle. Though "liability claim" is not defined by the CIGA statutes, "covered claim" is defined as an obligation of an insolvent insurer. One issue was whether the employee could have made a third party claim against CIGA if the insurer had been a CIGA member.
Note: A collections service agency acting as a lien representative for three medical service providers can pursue claims against the California Insurance Guarantee Association (CIGA) under Insurance Code Sec. 1063.1(c)(9).
Citation: B231491
WCC Citation: WCC 38542012 CA
 
 
Case Name: CIGA v. WCAB (White) 02/27/2006
Summary: CIGA was created by legislation to establish a fund from which insureds could obtain financial and legal assistance in the event their insurers became insolvent. CIGA's role in guaranteeing workers' compensation claims is therefore limited: [¶] " ' " 'CIGA is not, and was not created to act as, an ordinary insurance company. EDD also contends that CIGA should be estopped from now arguing that Viveros was effectively overruled by Karaiskos because essentially CIGA took a contrary position in its petition for review in Karaiskos. Second, the precise arguments CIGA made in Karaiskos are not germane here as CIGA did not argue that Karaiskos should be decided in its favor because it was different than Viveros. CIGA claimed there was "other insurance," covering the injury, that is, federal Social Security disability insurance and state unemployment compensation insurance.
Note: State Employment Development Department lien is not a 'covered claim' that CIGA is required to pay.
Citation: 136 Cal. App. 4th 1528
WCC Citation: WCC 31442006 CA
 
 
Case Name: CIGA v. WCAB; SCIF 07/18/2007
Summary: Nonetheless, CIGA paid for all the non-permanent disability indemnity benefits, for both injuries, in the sum of $43,505. 53. CIGA seeks full reimbursement of that amount from SCIF. CIGA sought reimbursement from SCIF for the entire sum of the temporary workers' compensation benefits it had paid. CIGA contended that SCIF, a solvent insurer, should reimburse it for the entire $43,505. 53 paid by CIGA because SCIF bears joint and several liability for all of the temporary workers' compensation expenses CIGA incurred. As we shall explain, we annul Board's decision with directions to enter a new and different decision requiring SCIF to reimburse CIGA $43,505. 53 - the entire sum of the temporary benefits paid by CIGA. SCIF argued that CIGA was responsible for the remaining 75 percent of the temporary benefits because CIGA was responsible for the benefits attributable to the specific injury he sustained while SNIC, now insolvent, was on the risk.
Note: 'Cases interpreting [Ins. Code, Section 1063.1, subd. (c)(9)(i)] have established that where an insured has overlapping insurance policies and one insurer becomes insolvent, the other insurer, even if only a secondary or excess insurer, is responsible for paying the claim. In other words, CIGA is an insurer of last resort and does not assume responsibility for claims where there is any other insurance available.'
Citation: 72 CCC 910
WCC Citation: WCC 32372007 CA
 
 
Case Name: CIGA vs. WCAB; EDD 03/30/2004
Summary: The Workers' Compensation Appeals Board (the Board) ruled against CIGA, reasoning that reimbursement of the EDD's lien is a payment to the particular disabled worker's account, not to the EDD. After the hearing, the Board ruled the EDD was entitled to reimbursement from CIGA. The logical, inescapable conclusion is that the EDD lien is an obligation to the State and is not a covered claim that CIGA is obligated to pay. Based on these internal procedures, the EDD argued and the Board agreed that "CIGA's duty to reimburse EDD liens . As written, Insurance Code section 1063. 1 does not authorize CIGA to reimburse the EDD for UCD benefits the EDD paid to Karaiskos.
Note: EDD lien is not a 'covered claim' for purposes of CIGA liability.
Citation: 117 Cal.App.4th 350
WCC Citation: WCC 29792004 CA
 
 
Case Name: Cisneros v. WCAB 12/19/1995
Summary: JOSE CISNEROS, Petitioner, v. WORKERS' COMPENSATION APPEALS BOARD, DANCING STAR RANCH et al. , Respondents. Facts On February 15, 1993, applicant Jose Cisneros injured his spine and back while working as a farm laborer for defendant Dancing Star Ranch, insured by the State Compensation Insurance Fund. The Rehabilitation Unit will determine if vocational rehabilitation services were sufficient or if you are entitled to further services. 'He argued that 'WCAB Rule 10017 only requires that the applicant have a 'change of mind' regarding participating in vocational rehabilitation. 'The administrative director shall prescribe by rule and regulation the form and manner by which an employee may decline participation.
Note: Where applicant was required to decline rehab. to get benefits of C&R, rehab. may be reopened.
Citation: 41 Cal.App.4th 759, 60 CCC 1144
WCC Citation: WCC 27421995 CA
 
 
Case Name: Cisneros v. WCAB 12/19/1995
Summary: JOSE CISNEROS, Petitioner, v. WORKERS' COMPENSATION APPEALS BOARD, DANCING STAR RANCH et al. , Respondents. Facts On February 15, 1993, applicant Jose Cisneros injured his spine and back while working as a farm laborer for defendant Dancing Star Ranch, insured by the State Compensation Insurance Fund. The Rehabilitation Unit will determine if vocational rehabilitation services were sufficient or if you are entitled to further services. 'He argued that 'WCAB Rule 10017 only requires that the applicant have a 'change of mind' regarding participating in vocational rehabilitation. 'The administrative director shall prescribe by rule and regulation the form and manner by which an employee may decline participation.
Note: No 'Thomas Finding' required when C&R does not release claims for rehab. benefits.
Citation: 41 Cal.App.4th 759
WCC Citation: WCC 25281995 CA
 
 
Case Name: Citizens of Humanity v. Applied Underwriters 12/31/1969
Summary: Filed 11/22/17  CERTIFIED FOR PUBLICATION IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA SECOND APPELLATE DISTRICT DIVISION TWO .             CITIZENS OF HUMANITY et al. , Plaintiffs and Respondents, .             v. .             APPLIED UNDERWRITERS, INC. , et al. , Defendants and Appellants. .             B276601 .             (Los Angeles County Super. .             Defendants and appellants Applied Underwriters, Inc. (Applied Underwriters), California Insurance Company (CIC), Continental Indemnity Company (CNI), Applied Risk Services, Inc. , Joan Sheppard, Westin Fredrick Penfield, and Michael Scott Wichman (collectively, defendants) appeal from an order denying their petition to compel arbitration of a dispute with plaintiffs and respondents Citizens of Humanity, LLC and CM Laundry, LLC (collectively, plaintiffs). .           The RPA also contains a choice of law provision that states: .           “16. )4 .           Defendants next contend the RPA falls outside the scope of section 25-2602. 01(f) and cite South Jersey Sanitation Co. v. Applied Underwriters Captive Risk Assur.
Note: The 2nd District Court of Appeal ruled that Applied Underwriters was not entitled to compel arbitration with two disgruntled customers who had purchased its EquityComp insurance program.
Citation: B276601
WCC Citation: Los Angeles County Super. Ct. No. BC571913
 
 
Case Name: City and County of San Francisco v. WCAB (Medrano) 12/28/1973
Summary: CITY AND COUNTY OF SAN FRANCISCO, Petitioner, v. WORKMEN'S COMPENSATION APPEALS BOARD, MERIEL L. MEDRANO et al. , Respondents (Opinion by Molinari, P. J. , with Sims and Elkington, JJ. , concurring. )[36 Cal. App. 3d 413] COUNSEL Thomas M. O'Connor, City Attorney, Raymond E. Agosti and Donald J. Garibaldi, Deputy City Attorneys, for Petitioner. An award in the sum of $1,000 was made by respondent board in favor of Mrs. Cyr for such expenses. The board should have properly awarded the burial expenses to the widow subject to a lien in favor of Mrs. Cyr. (See Lyons v. Hoover, supra, 41 Cal. 2d 145, 149; City etc. of S. F. v. Workmen's Comp.
Note: Non-heir payment of burial costs only entitled to a lien against heir's death benefit.
Citation: 36 Cal.App.3d 412, 39 CCC 52
WCC Citation: WCC 24711973 CA
 
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