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

I concur with the outcome. I write separately because I disagree with the majority’s conclusion that the medical providers qualify as “original claimants” making “covered” liability claims. In my opinion, Insurance Code section 1063.1, subdivision (c)(9) addresses only claims made by an insured and has no application to a third party claim asserted by a lien claimant under Labor Code section 4903. In other words, lien claims are different than liability claims asserted under an insurance policy.

*1342 I. The Statutory Lien Scheme

The Insurance Code recognizes there is an entire body of law governing workers’ compensation. The threshold provisions of Insurance Code section 1063.1, subdivision (c)(1) defining “covered claims” includes in paragraph (F) “In the case of a policy of workers’ compensation insurance, to provide workers’ compensation benefits under the workers’ compensation law of this state.” (Ins. Code, § 1063.1, subd. (c)(1)(F).)

It is undisputed by the California Insurance Guarantee Association (CIGA) that the medical providers have statutory medical lien claims arising from medical services provided to the injured worker. Medical liens in the workers’ compensation…

Petitioner California Insurance Guarantee Association (CIGA) seeks review of a ruling by the Workers’ Compensation Appeals Board (WCAB) that recognized claims asserted by real parties in interest Oracle Imaging, N-Care and Nations Surgery Center (collectively medical providers) as “covered” claims under Insurance Code section 1063.1. 1 The claims were asserted by real party in interest Pinnacle Lien Services (Pinnacle) on behalf of the medical providers. CIGA contends that it has no obligation to pay because Pinnacle was an assignee of the claims and assigned claims are excluded under section 1063.1, subdivision (c)(9).

We granted CIGA’s petition for writ of review. We affirm the ruling that Pinnacle is not excluded from pursuing the claims against CIGA for two reasons. First, the facts do not establish that the medical providers assigned their claims to Pinnacle. Second, section 1063.1, subdivision (c)(9) does not exclude the claims from being “covered” because the medical providers are original claimants and Pinnacle is their administrator or personal representative.

BACKGROUND

Anastasia Jenkins filed a workers’ compensation claim against her employer, whose workers’…