CIGA Builds Injured Worker Ramp for Wheelchair After Years-Long Legal Fight

Monday, May 16, 2016 | 0

After a years-long legal fight, the California Insurance Guarantee Association finally came through and paid $165,000 to modify an injured worker’s home to accommodate his wheelchair, Channel 4 KNBC I-team reported on Thursday.

KNBC news last November highlighted the plight of San Bernardino resident Nicolas Mercado, who was left a quadriplegic after an accident when he was driving a truck in 2011.

Since then he’s been living in hospitals and assisted living centers as he’s battled CIGA over a Workers’ Compensation Appeals Board ruling that it pay for home modifications.

CIGA inherited Mercado’s claim from Ullico Casualty Co. when the latter went insolvent in 2013. Mercado's doctor requested authorization for 66 modifications to his home in order to accommodate a wheelchair.

CIGA submitted the requests to UR, conducted by Dr. Phil Martin. The doctor certified 31 of the requests as reasonable and necessary, but he modified nine and denied 26.

When CIGA failed to have the modifications approved by Dr. Martin made, Mercado filed a case with Workers' Compensation Appeals Board, and the administrative law judge ruled in his favor. The WCAB later upheld his decision and CIGA petitioned for judicial review with the Second District California Court of Appeal. 

However, in February 2015 CIGA withdrew its petition, telling the court that that it was able to resolve the matter.

But KNBC reported last November that CIGA still hadn’t paid for the home modifications. During its coverage at the time, it interviewed Wayne Wilson, executive director of CIGA, who said, "We've looked into this and we think perhaps we could have taken a different path."

The TV station reported that CIGA spent $165,000 renovating Mercado’s home and he has moved back in with his family.