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

245 Cal. App. 4th 1021, 200 Cal. Rptr. 3d 29, 81 Cal. Comp. Cases 317, 2016 Cal. App. LEXIS 213
CourtCalifornia Court of Appeal
DecidedMarch 22, 2016
DocketB263869
StatusPublished
Cited by1 cases

This text of 245 Cal. App. 4th 1021 (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, 245 Cal. App. 4th 1021, 200 Cal. Rptr. 3d 29, 81 Cal. Comp. Cases 317, 2016 Cal. App. LEXIS 213 (Cal. Ct. App. 2016).

Opinion

Opinion

CHANEY, J.

Two insurers, Care West Pegasus Modesto (Care West) and Ullico Casualty Company (Ullico), were jointly and severally liable for claims arising from an employee’s workplace injury. In a compromise and release agreement, they settled the employee’s claims and apportioned between themselves roughly 50/50 liability for any remaining third party charges. 1 When Ullico became insolvent and was liquidated, responsibility for third party claims against it was assumed by the California Insurance Guarantee Association (CIGA), which the Legislature established in 1969 to protect against loss to insureds “arising from the failure of an insolvent insurer to discharge its obligations under its insurance policies.” (Ins. Code, § 119.5; see id., § 1063 et seq.; Isaacson v. California Ins. Guarantee Assn. (1988) 44 Cal.3d 775, 784 [244 Cal.Rptr. 655, 750 P.2d 297].)

*1025 CIGA moved to be dismissed from the instant workers’ compensation cases on the ground that it was authorized to pay only “covered claims,” from which the Legislature expressly excluded any “claim to the extent it is covered by any other insurance.” (Ins. Code, § 1063.1, subd. (c)(9); see id., § 1063.2, subd. (a).) CIGA argued Care West’s policy constituted “other insurance” that covered third party claims. The Workers’ Compensation Appeals Board (the Appeals Board) denied CIGA’s motion on the ground that the Care West/Ullico agreement limited Care West’s liability to roughly half of any third party claims, thereby rendering Care West’s insurance unavailable as to the remaining half.

CIGA petitioned for a writ of review, contending the Care West/Ullico agreement did nothing to change the “several” nature of Care West’s obligation, under which Care West was liable for 100 percent of the lien claims, with contribution rights against Ullico’s estate, not CIGA. We summarily denied the petition, but the Supreme Court granted review and remanded the case to us with directions to hear the matter on the merits. We thereafter invited the Appeals Board to respond to CIGA’s petition, which it has done.

We now conclude the Care West/Ullico compromise and release agreement did not relieve Care West of its several Lability for third party claims. We therefore annul the Appeals Board’s decision.

BACKGROUND

Rosa Lopez filed an application for workers’ compensation benefits for a cumulative injury sustained while she was employed as a grocery clerk by Superior Center Concepts, which was insured during the period of injury under successive policies issued by Care West and Ullico. 2 Various medical providers filed lien claims in the action. On March 9, 2012, Lopez resolved her workers’ compensation claim by entering into a compromise and release agreement with Care West and Ullico for $15,000. No lien claimant participated in the settlement.

In the compromise and release agreement the insurers stipulated they would “pay, adjust, or litigate all liens of record,” would “share equally for liability for med-legal charges,” and would allocate 52 percent of liability for the treatment charges to Care West and 48 percent to Ullico, “according to proof and with rights to contribution and reimbursement between the two being reserved.” The settlement has been fully executed except as to third party lien claims.

*1026 On March 14, 2012, the workers’ compensation administrative law judge (WCI) approved the compromise and release, including the insurers’ stipulation apportioning liability, and issued an award in Lopez’s favor for $15,000.

Ullico became insolvent and was liquidated on May 30, 2013, after which CIGA assumed liability for its “covered claims” pursuant to Insurance Code section 1063.1.

On June 10, 2014, CIGA filed a petition for dismissal from the workers’ compensation cases, arguing all lien claims were excluded from CIGA’s mandate by Insurance Code section 1063.1, subdivision (c)(9), which prohibits CIGA from paying any “claim to the extent it is covered by any other insurance.” CIGA argued that because Care West was jointly and severally liable for claims arising from Lopez’s injury, its policy constituted “other insurance” that covered 100 percent of any outstanding claims notwithstanding the insurers’ compromise and release agreement apportioning liability.

Care West objected to CIGA’s petition, arguing the insurers’ apportionment of liability limited Care West’s liability to 50 percent of any remaining legal-medical charges and 52 percent of any remaining medical charges. Therefore, Care West argued, CIGA was liable for 50 percent of any outstanding legal-medical charges and 48 percent of any outstanding medical lien claims.

The WCJ denied CIGA’s petition, finding that its 2012 approval of the compromise and release agreement operated as a final judgment apportioning liability between the insurers and was now binding on CIGA as Ullico’s successor.

CIGA petitioned for reconsideration from the Appeals Board, contending even a final judgment against an insolvent insurer is subject to the Insurance Code’s exclusions from CIGA’s “covered claims.” The WCJ recommended denial of the petition.

The Appeals Board denied reconsideration, holding “insurers are not jointly and severally liable where they have entered into a stipulation as to apportionment of liability between them.” “In essence,” the Appeals Board held, “after the stipulation, liability [was] no longer joint and several, but [was] rather divided between the insurers in accordance with the stipulation,” and “where the [Appeals Board] has issued a final decision determining apportionment of liability between insurers, the decision is res judicata and may not be re-litigated.”

As noted, we summarily denied CIGA’s subsequent writ petition, but the Supreme Court granted review and remanded the case to us with directions to *1027 grant the petition. We did so, and directed the Appeals Board to answer the petition. In its answer, the Appeals Board contends the approved compromise and release was a final judgment that may not be relitigated, and after entry of that judgment Care West’s and Ullico’s liability was no longer joint and several.

DISCUSSION

The facts are undisputed, as is most of the law. The issue is whether the insurers’ agreement apportioning liability, and the WCJ’s approval of that agreement, rendered the insurers’ liability no longer joint and several. We conclude it did not.

Section 4 of article XIV of the California Constitution empowers the Legislature to “create . . . and enforce a complete system of workers’ compensation” by placing a liability on employers “to compensate . . . their workers for injury or disability . . . incurred or sustained ... in the course of their employment, irrespective of the fault of any party.” “A complete system of workers’ compensation includes . . .

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245 Cal. App. 4th 1021, 200 Cal. Rptr. 3d 29, 81 Cal. Comp. Cases 317, 2016 Cal. App. LEXIS 213, Counsel Stack Legal Research, https://law.counselstack.com/opinion/california-insurance-guarantee-assn-v-workers-compensation-appeals-board-calctapp-2016.