CompFox AI Summary
This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the Gorgi case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from Gorgi due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the Carter case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.
Full Decision Text1 Pages
This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the Gorgi case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from Gorgi due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the Carter case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.
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