CompFox AI Summary
This case involved an applicant claiming industrial injury to her shoulders and upper extremities. A prior insurer, Legion Insurance, erroneously paid benefits through its administrator, REM, before its insolvency. The Workers' Compensation Appeals Board denied reconsideration of the arbitrator's decision, which held Zurich Insurance (adjusted by Crawford & Company) liable for reimbursement to CIGA. This is because Zurich provided "other insurance" for a portion of the cumulative trauma injury, making it solely responsible for benefits where both an insolvent and solvent insurer would be liable. The Board found CIGA could recover pre-insolvency and mistaken payments, and Zurich's due process claims were unpersuasive.
Full Decision Text1 Pages
This case involved an applicant claiming industrial injury to her shoulders and upper extremities. A prior insurer, Legion Insurance, erroneously paid benefits through its administrator, REM, before its insolvency. The Workers' Compensation Appeals Board denied reconsideration of the arbitrator's decision, which held Zurich Insurance (adjusted by Crawford & Company) liable for reimbursement to CIGA. This is because Zurich provided "other insurance" for a portion of the cumulative trauma injury, making it solely responsible for benefits where both an insolvent and solvent insurer would be liable. The Board found CIGA could recover pre-insolvency and mistaken payments, and Zurich's due process claims were unpersuasive.
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