AmTrust North America

What they litigate

Disputed issues across the decisions this claims administrator is named in. Every row opens the decisions it counts.

Where they appear

• Van Nuys 17
• Los Angeles 12
• Santa Ana 6
• Anaheim 5
• Marina del Rey 5
• Riverside 4
• Sacramento 4
• San Diego 4
• San Francisco 4
• Fresno 3
• Long Beach 3
• Pomona 3

How the appealed decisions came out

These are decisions that were appealed and published — the tail of a system that mostly settles. Most claims end in a compromise and release or a stipulation and never reach a panel, so nothing below describes how this claims administrator does its work. It describes how a set of appealed disputes came out.

• 40 for the defense
• 26 for the applicant
• 11 returned for more record

Counted over 75 appealed decisions. Not this claims administrator’s book of work. A decision that went one way on one issue and the other way on another is counted in both columns, so the figures add up to more than the total.

Decisions

Newest decisions this claims administrator is named in, each with the passage the panel turned on and a link to the official PDF.

• ADJ20910758 · 2026-06-30 · Pomona District OfficeAOE/COEremanded

  Determinative passage · p.7In this matter, applicant attempted to amend the date of injury to conform to the testimony provided by applicant which, as all parties seem to agree, directly refuted a period of employment prior to April 20, 2025 as initially plead. It is not clear from the record whether defendant objected to the motion, but the WCJ denied the request. We agree that the request was made at a late point in litigation after both parties had effectively rested and the exhibits had been agreed to and discussed. However, the motion should have been granted and the matter deferred for further discovery and a hearing on the merits.

  The WCJ erred in denying amendment of the pleadings to conform to testimony regarding employment dates; the proper procedure was to develop the record further. The matter is remanded for further proceedings to determine employment during the correct period.

  Official decision · page 7 →
• ADJ9600339 · 2026-06-22 · Los Angeles District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.1Applicant seeks reconsideration of the Findings and Order (F&O) issued on December 6, 2022, by the workers' compensation administrative law judge (WCJ). The WCJ found that applicant, while employed by defendant, sustained injury arising out of and occurring in the course of employment (AOE/COE)1 to various body parts; and that defendant did not deny medical treatment to applicant.

  The Board found that defendant's refusal to authorize treatment with Dr. Patterson, a physician employed by Casa Colina listed in the MPN, constituted an unreasonable denial of medical treatment under Labor Code section 4600 and related regulations and precedent cases Rivas and Montiel.

  Official decision · page 1 →
• ADJ9195893 · 2026-04-01 · San Diego District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1Both applicant and defendant seek reconsideration of the Findings & Award (F&A) issued on October 21, 2022, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that applicant, while employed as a plumber on April 23, 2012, sustained industrial injury to his back, right foot and psyche resulting in 100% permanent disability.

  Official decision · page 1 →
• ADJ10684244 · 2026-04-01 · Santa Ana District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.8Accordingly, we rescind the F&O, and substitute a new Findings of Fact that finds that cost petitioner met its burden under Labor Code section 4620 to show a contested claim existed at the time it provided its medical-legal services beginning on January 23, 2017 and defer all other issues. We return this matter to the trial level for further proceedings consistent with this decision. For the foregoing reasons,

  The WCAB found that a contested claim existed at the time the cost petitioner provided medical-legal services beginning January 23, 2017, based on the filing of the Application, defendant's notices terminating benefits, and issuance of subpoenas, thus meeting the burden under Labor Code section 4620.

  Official decision · page 8 →
• ADJ14646082 · 2026-03-24 · Oakland District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.8It is well established that decisions by the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) To constitute substantial evidence "...a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)

  Dr. Welborn's medical opinions were found speculative and not substantial evidence to deny injury AOE/COE to the left shoulder and right upper extremity body parts; the Appeals Board granted reconsideration and remanded for further proceedings.

  Official decision · page 8 →
• ADJ14478546 · 2026-03-09 · San Francisco District OfficeJurisdiction / venueremanded

  Determinative passage · p.8Here, the WCJ's February 2, 2023 findings did not comply with the requirement in section 5313 that the WCJ "make and file findings upon all facts involved in the controversy." (Lab. Code, § 5313; Cal. Code Regs., tit. 8, § 10787(c)(5); Blackledge, supra, 75 Cal.Comp.Cases at p. 621.) In the 2023 proceeding, there were multiple body parts framed as issues for trial, including the left lower extremity, left leg, left ankle, and lumbar spine. The 2023 FA&O, however, only addressed injury to applicant's left lower extremity, left leg, and left ankle, and was silent as to injury to the lumbar spine. That is, the 2023 F&A included no finding regarding the additional body part of lumbar spine at issue here. Moreover, under Award in the F&A, it stated that "All other issues are deferred at this time." Thus, although the body part was listed as an issue in the minutes of hearing, and discussed in the Opinion on Decision, the issue was not actually "decided on the merits," as required. (Pacific Lumber, Co., supra, 37 Cal.4th 921, 943.)

  The WCJ's 2023 Findings and Award did not address lumbar spine injury, leaving that issue undecided and not final, so reconsideration was improper on that issue; continuing jurisdiction under Labor Code section 5410 and good cause under section 5803 allow reopening for new and further disability or compensable consequence injury.

  Official decision · page 8 →
• ADJ11448862 · 2026-01-26 · Riverside District OfficePenalties under Labor Code §5814defendant prevailed

  Determinative passage · p.5Here, the WCJ did not award costs, sanctions, or attorney's fees in the April 16, 2019 NOI.

  The WCJ did not award costs, sanctions, or attorney's fees in the Notice of Intention; no objections or petitions for reconsideration were filed within the statutory period; defendant paid the amount due promptly; therefore, claims for costs, attorney's fees, and sanctions were denied and no bad faith was found.

  Official decision · page 5 →
• ADJ11368321 · 2026-01-23 · Santa Ana District OfficeTemporary disabilityapplicant prevailed

  Determinative passage · p.93. We will amend the F&A as recommended by the WCJ in the Report to correct clerical error in a date so temporary disability runs from May 11, 2018, to May 10, 2020, less credit for days worked.

  The Board granted reconsideration to correct the temporary disability period to run from May 11, 2018, to May 10, 2020, less credit for days worked, based on the WCJ's Report and the Petition.

  Official decision · page 9 →
• ADJ9935791 · 2025-12-15 · Van Nuys District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.8Accordingly, we rescind the F&O, substitute a new Findings of Fact that finds that a contested claim existed at the time lien claimant provided its services and that it should be paid for its services, but we defer the amount and return this matter to the trial level for further proceedings consistent with this decision.

  The Board found that a contested claim existed at the time the lien claimant provided services, and that the services were reasonable and necessary, thus entitlement to payment was established. The amount owed was deferred for further proceedings.

  Official decision · page 8 →
• ADJ8371384 · 2025-11-14 · Los Angeles District OfficeMedical treatment / UR / IMRremanded

  Determinative passage · p.5On August 18, 2025, the WCJ issued a Joint Findings & Orders and Opinion on Decision. As relevant herein, the WCJ found that none of the lien claimants met their burden of proof to recover on their liens.

  The WCJ initially found lien claimants did not meet burden of proof for reasonable medical treatment, but the Appeals Board found the record insufficiently developed and granted reconsideration for further proceedings.

  Official decision · page 5 →
• ADJ11665067 · 2025-09-29 · Anaheim District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.4The March 25, 2019 report of orthopedic QME Dr. Mikhael diagnosed applicant as having sustained injury to the lumbar spine, bilateral shoulders, and right hand and wrist. (Ex. 25, Report of Mark Mikhael, M.D., dated March 25, 2019, at p. 9.) The QME concluded that "[i]t is within [a] reasonable degree of medical probability that the injury sustained by the examinee arose out of the course of employment due to cumulative trauma from the dates of October 24, 2013 to October 24, 2018." (Ibid.) Thus, the QME has identified injury AOE/COE.

  The medical evidence from QME Dr. Mikhael and treating physician Dr. Bazel uniformly supports injury AOE/COE, and defendants offered no rebuttal evidence; the WCJ's requirement for applicant testimony was not supported by law as substantial evidence supports injury AOE/COE.

  Official decision · page 4 →
• ADJ12202677 · 2025-06-18 · Anaheim District OfficeTemporary disabilityremanded

  Determinative passage · p.8However, defendant filed a DOR on November 7, 2024. At trial, the issue of permanent disability was submitted. Yet, there is no QME or agreed medical evaluator (AME) in psychology or psychiatry in violation of section 4061(i). Although the dissenting panelist appears to place responsibility for the failure to obtain such medical-legal reporting on applicant, it is defendant who filed the DOR without proceeding to a QME or AME and without a stipulation by applicant that she was not claiming permanent disability. Section 4061(i) clearly requires that the parties proceed to a medical-legal evaluation before a DOR is filed, and a defendant may not use an applicant's lack of diligence as an excuse to circumvent this statutory requirement.

  The Appeals Board found no psychiatric QME evaluation was obtained before trial as required by law, and deferred permanent disability, apportionment, and attorney fees for psychiatric injury for further development.

  Official decision · page 8 →

Also recorded as

The same claims administrator is printed several ways across the decisions, and all of them were counted as one. These are the twelve commonest of 19.

• AMTRUST NORTH AMERICA
• AMTRUST
• AmTrust North America
• Amtrust
• AmTrust North America, Inc.
• AmTrust
• AMTRUST NORTH AMERICA, INC.
• Amtrust North America
• AMTRUST CONCORD
• AMTRUST NORTH AMERICA STAR INSURANCE CO.
• AMTRUST NORTH AMERICA, INCORPORATED
• Amtrust Financial Services, Inc.

Is this your company and something here is wrong? Tell us and we will fix it. Every figure on this page is a count of released decisions this claims administrator is named in, and the decisions themselves are listed above with the passage each turned on.