State Farm General Insurance v. Workers' Compensation Appeals Board

218 Cal. App. 4th 258, 159 Cal. Rptr. 3d 779, 78 Cal. Comp. Cases 758, 2013 Cal. App. LEXIS 592
CourtCalifornia Court of Appeal
DecidedJuly 1, 2013
DocketB240742
StatusUnpublished
Cited by13 cases

This text of 218 Cal. App. 4th 258 (State Farm General Insurance 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
State Farm General Insurance v. Workers' Compensation Appeals Board, 218 Cal. App. 4th 258, 159 Cal. Rptr. 3d 779, 78 Cal. Comp. Cases 758, 2013 Cal. App. LEXIS 592 (Cal. Ct. App. 2013).

Opinion

Opinion

PERREN, J.

Labor Code section 5950 provides that any person aggrieved by a final order, decision, or award of the Workers’ Compensation Appeals Board (WCAB) may, within the prescribed time limit, apply to the Court of Appeal for a writ of review. Appellate review is limited to final orders that affect a substantial right or liability of a party. (Duncan v. Workers’ Comp. *261 Appeals Bd. (2008) 166 Cal.App.4th 294, 299 [82 Cal.Rptr.3d 664].) The failure of an aggrieved party to seek judicial review of a final order of the WCAB bars later challenge to the propriety of the order or decision before either the WCAB or the court. (Maranian v. Workers’ Comp. Appeals Bd. (2000) 81 Cal.App.4th 1068, 1075-1076 [97 Cal.Rptr.2d 418] (Maranian); see Safeway Stores, Inc. v. Workers’ Comp. Appeals Bd. (1980) 104 Cal.App.3d 528, 532-535 [163 Cal.Rptr. 750].)

This petition for writ of review challenges the WCAB’s decision allowing California Insurance Guarantee Association (CIGA) to pursue a claim for reimbursement against State Farm General Insurance Company (State Farm), after the WCAB had previously rejected the claim and CIGA had failed to timely seek judicial review. We conclude that CIGA’s claim is barred by principles of res judicata. We annul the WCAB’s decision and remand for further proceedings.

FACTUAL AND PROCEDURAL BACKGROUND

On June 8, 1999, and January 20, 2000, Joanne Lutz (applicant) was injured while working as a personal assistant to Linda McDonald, president of Roto Rooter (aka Russell Warner, Inc.). The applicant was on Roto Rooter’s payroll at the time. During 1999 and 2000, Roto Rooter was insured for workers’ compensation by Fremont Compensation Insurance Company and Paula Insurance Company, respectively. Linda McDonald and her homeowner’s insurance carrier, State Farm, were joined as additional parties to the applicant’s claim.

In February of 2002, at a mandatory settlement conference, the parties disputed the issues of employment and which insurance carrier should be responsible for coverage of the applicant’s claim, i.e., whether the applicant was working as a domestic employee of Linda McDonald at the time of her injuries such that State Farm should provide coverage for her claim, or whether she was employed by Roto Rooter.

On March 15, 2002, in lieu of trial, the parties entered into “Joint Stipulations With Request for Award.” The parties stipulated that the applicant was employed by Roto Rooter and Linda McDonald, and “sustained injury arising out of and in the course of employment.” Paula Insurance Company agreed to administer all benefits under the award, and under any future award. State Farm agreed to “indemnify and/or contribute 25% of all incurred benefits paid to or on behalf of applicant (including, but not limited to TD [(temporary disability)], PD [(permanent disability)], medical treatment, and vocational rehabilitation), as to injuries of 6/8/99 and 1/20/00. [f] Paula Ins. reserves its right to seek contribution from Fremont Compensation *262 Ins. Co.” That same day, Workers’ Compensation Judge (WCJ) William Carero approved the award allocating liability between the parties. No party sought reconsideration of the award and, consequently, it became final between these parties.

In June of 2002 and July of 2003, Paula Insurance Company and Fremont Insurance Company, respectively, were liquidated. CIGA assumed administration of the claim. Since then, State Farm has been reimbursing CIGA for 25 percent of all benefits paid to the applicant.

In September of 2003, CIGA filed a petition for dismissal, arguing it should be dismissed because Paula Insurance Company had not provided workers’ compensation coverage for residential or domestic employees. State Farm opposed the petition, contending the evidence supported a finding of employment by Roto Rooter and coverage, and that the March 15, 2002, stipulated award was final and binding on CIGA. The record before us discloses no action on this petition.

In February of 2008, five years later, CIGA sought to be relieved as administrator of the applicant’s claim. CIGA filed a declaration of readiness with the WCAB, stating that the parties were unable to “resolve the dispute concerning employment as a domestic employee versus employment with Roto Rooter.” CIGA requested resolution of the questions (1) “whether State Farm homeowner’s insurance qualifies as ‘other insurance’ to make the claim against CIGA a non-covered claim per Insurance Code section 1063.1” and (2) whether the applicant qualifies as a domestic employee under Labor Code section 3351, subdivision (d).

On April 4, 2008, the WCJ ruled that the WCAB was without jurisdiction to rescind or alter the March 15, 2002, stipulated award, and that CIGA was bound by the stipulation. The WCJ reasoned: “Labor Code section 5804 confers limited power upon the Board to rescind, alter or amend its Awards. That power is limited by the statutory language as to time and as to content. Specifically, that Section states ‘that after an award has been made finding that there was employment and the time to petition for a rehearing or reconsideration or review has expired . . . , the appeals board upon a petition to reopen shall not have the power to find that there was no employment.’ This includes determination of the identity of the employer previously determined by the Award. [j[] Neither does the subsequent liquidation of the Paula Insurance Company and Fremont Indemnity . . . permit CIGA to upset the final legal determination as to employment. . . . [][] In essence, CIGA avers that it is not bound by the Award entered against the then-solvent carriers for which CIGA is now responsible to the extent the Insurance Code requires. [][] No determination is made as to the extent of CIGA’s ultimate *263 liability under the March 15, 2002 Award. It is found nevertheless that the Award binds CIGA.” CIGA did not seek reconsideration of the WCJ’s order before the WCAB. (Lab. Code, § 5900.)

Two months later, on June 9, 2008, CIGA filed a petition for reimbursement and for a change of administrator, renewing its claim that it should be relieved of responsibility to pay benefits because of the presence of other insurance. (Ins. Code, § 1063.1, subd. (c)(9).) 1 CIGA argued that State Farm was jointly and severally liable for the benefits paid by CIGA, and as solvent “other insurance” must reimburse CIGA in full for all temporary disability benefits, medical treatment, and medical-related expenses. CIGA requested that State Farm reimburse it $382,833, less credit for payments made by State Farm.

State Farm opposed the petition, arguing that (1) CIGA’s failure to seek reconsideration of the WCJ’s decision on April 4, 2008, precluded it from relitigating its reimbursement claim (Lab. Code, § 5804); (2) State Farm’s homeowner’s insurance policy does not constitute “other insurance” as defined by the Insurance Code because its policy was not “available to the claimant or insured” (Ins. Code, § 1063.1, subd. (c)(9)); and (3) CIGA’s claims were barred by the equitable doctrine of laches.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Hartnett v. San Diego County Office of Education
California Court of Appeal, 2017
Hartnett v. San Diego Cnty. Office of Educ.
227 Cal. Rptr. 3d 81 (California Court of Appeals, 5th District, 2017)
Hikida v. Workers' Comp. Appeals Bd.
California Court of Appeal, 2017
Hikida v. Workers' Comp. Appeals Bd.
219 Cal. Rptr. 3d 654 (California Court of Appeals, 5th District, 2017)
Corman v. Corman CA2/7
California Court of Appeal, 2016
Truck Insurance Exchange v. Workers' Compensation Appeals Board
2 Cal. App. 5th 394 (California Court of Appeal, 2016)
California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board
245 Cal. App. 4th 1021 (California Court of Appeal, 2016)
Allen v. WCAB CA3
California Court of Appeal, 2014
Crosby v. HLC Properties, Ltd.
223 Cal. App. 4th 597 (California Court of Appeal, 2014)
Edwards v. Broadwater Casitas Care Center, LLC
221 Cal. App. 4th 1300 (California Court of Appeal, 2013)
Keller v. Keller CA2/7
California Court of Appeal, 2013

Cite This Page — Counsel Stack

Bluebook (online)
218 Cal. App. 4th 258, 159 Cal. Rptr. 3d 779, 78 Cal. Comp. Cases 758, 2013 Cal. App. LEXIS 592, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-general-insurance-v-workers-compensation-appeals-board-calctapp-2013.