California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board

153 Cal. App. 4th 524, 62 Cal. Rptr. 3d 855, 2007 Cal. App. LEXIS 1196, 1 Cal. WCC 483
CourtCalifornia Court of Appeal
DecidedJuly 18, 2007
DocketNo. B192962
StatusPublished
Cited by8 cases

This text of 153 Cal. App. 4th 524 (California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board, 153 Cal. App. 4th 524, 62 Cal. Rptr. 3d 855, 2007 Cal. App. LEXIS 1196, 1 Cal. WCC 483 (Cal. Ct. App. 2007).

Opinion

Opinion

PERREN, J.

In California Ins. Guarantee Assn. v. Workers’ Comp. Appeals Bd. (Weitzman),1 and California Ins. Guarantee Assn. v. Workers’ Comp. Appeals Bd. (Hooten),2 this court held that California Insurance Guarantee Association (CIGA) is not an insurer, and that contribution cannot be sought from CIGA by an “other insurer.” Here, CIGA paid an injured worker [528]*528temporary workers’ compensation benefits under similar circumstances. We conclude that, under the workers’ compensation law of California, an other insurer is jointly and severally liable to pay these benefits. (Lab. Code, § 3200 et seq.) It follows that CIGA is entitled to full reimbursement from that other insurer, State Compensation Insurance Fund (SCIF). This is so because SCIF is jointly and severally liable to pay such benefits.

In this case, a worker suffered a specific injury to his left knee. He subsequently sustained continuous trauma (CT) to the same knee. The workers’ compensation carrier insuring the first injury became insolvent while both claims were pending, and it was succeeded by CIGA. SCIF is admittedly responsible to insure the CT. Nonetheless, CIGA paid for all the nonpermanent disability indemnity benefits, for both injuries, in the sum of $43,505.53. CIGA seeks full reimbursement of that amount from SCIF. As we shall explain, SCIF is jointly and severally liable for all of these temporary claims,3 and must fully reimburse CIGA $43,505.53 for all of the temporary benefit payments made to the injured worker for which an “other insurer” is jointly and severally liable. (Ins. Code, §§ 1063.1, subds. (b), (c)(1), (9)(i), 1063.2, subd. (b); Lab. Code, § 4600; Weitzman, supra, 128 Cal.App.4th 307.)

After Alejandro Hernandez sustained a specific industrial injury to his left knee, his employer’s insurer, Superior National Insurance Company (SNIC), became insolvent and was liquidated. As required, CIGA began paying all of his nonpermanent workers’ compensation benefits. Hernandez then sustained industrial CT to the same knee. SCIF was on the risk during part of the period when the CT occurred, but CIGA continued to pay all of Hernandez’s temporary workers’ compensation benefits. These nonpermanent disability benefits included temporary disability, medical expenses, and vocational rehabilitation maintenance allowance for both injuries.

CIGA sought reimbursement from SCIF for the entire sum of the temporary workers’ compensation benefits it had paid. The arbitrator granted CIGA’s petition, but the Workers’ Compensation Appeals Board (Board) granted reconsideration to SCIF. Based on the medical evidence, Board determined that 75 percent of the worker’s disability was due to the first, specific injury, and 25 percent of his disability was due to CT, while SCIF was on the risk. The Board determined that SCIF should be responsible for contributing $10,876.38, which is 25 percent of the amount paid by CIGA for the nonpermanent disability benefits. CIGA petitioned this court for review.

[529]*529CIGA 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. SCIF contended it should only reimburse CIGA $10,876.38 because this amount represents its percentage share of the temporary disability caused by the CT while it was on the risk.

After we denied the petition, CIGA sought review from our Supreme Court. The Supreme Court granted the petition and transferred the matter back to this court with directions to vacate our summary denial and grant review. We have done so. 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 nonpermanent disability benefits paid by CIGA.

FACTS AND PROCEDURAL HISTORY

On August 30, 1999, Hernandez slipped, fell and twisted his left knee while on a tractor at work for Scarborough Farms, Inc. SNIC was on the risk for this specific industrial injury. On September 26, 2000, SNIC went into liquidation, and CIGA took responsibility for SNIC’s liability on that claim.

Between August 31, 1999, and November 19, 2001, Hernandez sustained further injury to his left knee while working for Scarborough Farms. Hernandez filed a separate claim for this CT. Since November 19, 2000, SCIF was the sole insurer for the CT claim.

Nonetheless, CIGA provided temporary workers’ compensation benefits to Hernandez, in the sum of $43,505.53, for all of his medical expenses, temporary disability (TD) and vocational rehabilitation maintenance allowance (VRMA) which resulted from both the specific injury and CT claims. Hernandez became permanent and stationary on October 27, 2003.

The agreed medical examiner (AME), Dr. Richard Scheinberg, opined that 75 percent of Hernandez’s disability was caused by the earlier, specific injury, and 25 percent of it resulted from CT. On July 20, 2004, Dr. Scheinberg stated that “[pjatient sustained a specific and a cumulative injury as a result of his industrial exposure. . . . [I]t appears as though in regard to causation, it is a specific injury which bears the majority of the burden . . . and a small [530]*530contribution for subsequent cumulative trauma.” In his supplemental report of September 22, 2004, Dr. Scheinberg refined the previous statement, saying that “75% of this patient’s level of disability should be attributable to the specific injury of 8/30/99 with 25% apportionable to the subsequent cumulative trauma.” Based on Dr. Scheinberg’s opinion, the parties entered into a compromise and release (C&R) to settle Hernandez’s claims. In the C&R, CIGA reserved the right to seek contribution from SCIF for $43,505.53, the sum it had paid for medical expenses, TD, and VRMA.

After the C&R was approved by Board, CIGA petitioned to obtain contribution from SCIF for the sum of $43,505.53 in nonpermanent disability benefits it had paid. Pursuant to Labor Code section 5275, subdivision (a)(2), the matter was referred to arbitration. In arbitration, CIGA asserted it is entitled to reimbursement from SCIF for the sum of $43,505.53, which it had paid for the nonpermanent disability benefits. (See Lab. Code, § 5500.5 [concerning apportionment]; Ins. Code, § 1063.1, subd. (c)(5), (9) [defining “covered claims”].) SCIF contended it is liable for no more than 25 percent of that sum because it was only on the risk when Hernandez sustained his CT, and the CT caused only 25 percent of his disability. SCIF argued that CIGA was responsible for the remaining 75 percent of the nonpermanent disability benefits because CIGA was responsible for the benefits attributable to the specific injury he sustained while SNIC, now insolvent, was on the risk.

In his findings, order and opinion (F&O), the arbitrator pointed out that under Insurance Code section 1063.1, subdivision (c)(5), (9)(ii), solvent insurers are barred from obtaining contribution from CIGA—that CIGA would not have been responsible for reimbursing SCIF for benefits it had paid if they were related to a specific injury, even if those injuries were sustained when an insolvent insurer was on the risk. (Citing Weitzman, supra, 128 Cal.App.4th at p. 313; California Ins. Guarantee Assn. v. Argonaut Ins. Co. (1991) 227 Cal.App.3d 624, 636 [278 Cal.Rptr. 23];

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Cite This Page — Counsel Stack

Bluebook (online)
153 Cal. App. 4th 524, 62 Cal. Rptr. 3d 855, 2007 Cal. App. LEXIS 1196, 1 Cal. WCC 483, Counsel Stack Legal Research, https://law.counselstack.com/opinion/california-insurance-guarantee-assn-v-workers-compensation-appeals-board-calctapp-2007.