Tokio Marine and Fire Insurance Company Ltd

What they litigate

Disputed issues across the decisions this insurance carrier is named in. Every row opens the decisions it counts.

Where they appear

• Los Angeles 4
• Santa Ana 4
• Van Nuys 3
• Long Beach 1
• Marina del Rey 1
• San Francisco 1
• San Jose 1

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 insurance carrier does its work. It describes how a set of appealed disputes came out.

• 8 for the applicant
• 4 for the defense
• 2 returned for more record

Counted over 13 appealed decisions. Not this insurance carrier’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 insurance carrier is named in, each with the passage the panel turned on and a link to the official PDF.

• ADJ17050134 · 2025-08-26 · Marina del Rey District OfficeDiscrimination under Labor Code §132aremanded

  Determinative passage · p.1Applicant timely petitioned for reconsideration of the Findings and Order issued by the workers' compensation administrative law judge (WCJ) on February 14, 2025. The WCJ found that applicant failed to prove that defendant violated Labor Code section 132a and that the issues of affirmative defenses and attorney fees are moot. Based on these findings, the WCJ ordered that applicant take nothing by way of his Petition for Increased Benefits for Discrimination under Labor Code section 132a. We granted reconsideration to study the factual and legal issues in this matter.

  The WCJ found that the applicant failed to prove the defendant violated Labor Code section 132a, but the parties later settled the issues by compromise and release, leading to remand for further proceedings.

  Official decision · page 1 →
• ADJ8750673 · 2024-11-19 · Santa Ana District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.1Applicant, though his attorneys Shehzad Ahmad and California Law Associates, seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Order issued on August 19, 2024, wherein it was found in pertinent part that applicant's attorney is not entitled to reimbursement for costs incurred for the services of an expert opinion regarding circuit board manufacturing and chemicals used in the construction of multilayer printed circuit boards because at the time it was incurred it was not reasonable and/or necessary.

  The Appeals Board found that the expert was qualified and the costs were reasonable and necessary due to the lack of sufficient MSDS from Polyclad Laminates, making the expert's report essential for the medical record development.

  Official decision · page 1 →
• ADJ14943245 · 2024-05-03 · Van Nuys District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.93. Patterson v. The Oaks Farm (2014) 79 Cal.Comp.Cases 910 (Appeals Board significant panel decision) is applicable to the issue of whether applicant is entitled to continued outpatient rehabilitation treatment at Centre for Neuro Skills (CNS).

  The WCAB found Patterson applicable and that defendant failed to prove a change in applicant's condition warranting discontinuation of treatment, entitling applicant to continued outpatient treatment at CNS.

  Official decision · page 9 →
• ADJ7810002 · 2023-11-21 · Los Angeles District OfficeApportionmentapplicant prevailed

  Determinative passage · p.5Here, Dr. Cohen issued a November 16, 2022 supplemental report addressing Benson apportionment. The supplemental report observed that the QME was unable to parcel out the respective percentages corresponding to applicant's specific and cumulative injuries, respectively. (Ex. V, Report of Gregory Cohen, M.D., November 16, 2022, p. 2.) Dr. Cohen observed that a "review of the medical records provided did not show that other treating or evaluating doctors documented any differences in psychiatric symptoms and dysfunction in relation to the cumulative and specific injuries." (Ibid.) Following a review of the entire record, including the submitted medical history, prior clinical examinations, and applicant's deposition testimony, Dr. Cohen concluded that "based upon reasonable medical probability, there is insufficient medical evidence

  The QMEs provided reasoned opinions explaining why apportionment could not be determined with reasonable medical probability, satisfying the requirements of Labor Code 4663(c) and the Benson decision, thus no further record development was needed.

  Official decision · page 5 →
• ADJ15567442 · 2023-05-09 · San Francisco District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.1We have considered the allegations of the Petition for Reconsideration and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, we will grant reconsideration, and as our Decision After Reconsideration, we will affirm the Findings, Award and Order, except that we will amend to find that applicant sustained injury to the abdomen in the form of umbilical and inguinal hernia and to defer the issue of injury to any other body parts and to correct the award. Based on the medical record, including applicant's emergency room records and the reports of the qualified medical evaluators (QME), at this time substantial evidence only supports a finding that applicant sustained industrial injury to the abdomen in the form of umbilical and inguinal hernia. (Exhibit A, QME Report of Dr. Michael Fujinaka, M.D., dated May 4, 2022, p. 65; Exhibit C, QME Report of Rommel Hindocha, D.C., dated July 22, 2021, page 11; Exhibit I, Emergency Room visit San Mateo Medical (excerpted record) dated May 4, 2019, pp. 128 & 129.) Thus, we will grant reconsideration, amend Finding of Fact #1, Award #1, and the Amended Order.

  Substantial evidence supports finding of industrial injury to abdomen in the form of umbilical and inguinal hernia; other body parts deferred

  Official decision · page 1 →
• ADJ8906863 · 2023-02-17 · San Jose District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.51. applicant, while employed during the period 7/17/2012 through 8/4/2012 in a capacity remaining in dispute in various locations beginning and ending in San Jose California by Hitachi Global Storage, insured for worker's compensation liability by Tokio Marine Insurance, sustained an injury arising out of and in the course of this employment to his lungs and body systems in the form of Legionella Pneumonia as described in the medical reports admitted into evidence herein.

  The injury was found to be compensable as it arose out of and in the course of employment, with exposure to Legionella Pneumonia occurring during travel for employer business, and no evidence of exposure in the employee's personal life or local community risk.

  Official decision · page 5 →
• ADJ10166893 · 2022-02-07 · Santa Ana District OfficeStatute of limitationsdefendant prevailed

  Determinative passage · p.5The applicant testified that she told a co-worker after the injury, "my brain is hurting." (report of Kenneth Geiger, M.D., January 31, 2020, pg. 3, 2nd paragraph [Board Exh. X].) On the whole, however, the testimony of the employer witnesses was more reliable and credible than that of the applicant. The WCJ determined the employer did not have notice of the injury before the notice of termination or layoff on October 10, 2014, and Labor Code § 3600(a)(10)(A) does not apply as an exception to the post-termination defense.

  The WCJ found the employer did not have notice of the injury before termination, and none of the exceptions to the post-termination bar applied, thus barring the specific injury claim.

  Official decision · page 5 →
• ADJ1690431 · 2021-09-13 · Los Angeles District OfficeQME/AME processmixed

  Determinative passage · p.1Defendant seeks reconsideration of the Findings of Fact (Findings) issued by the workers' compensation administrative law judge (WCJ) on April 27, 2021. By the Findings, the WCJ found that applicant is not entitled to a qualified medical evaluator (QME) replacement panel and should not be compelled to attend an examination with the current QME.

  Applicant did not meet the burden to show entitlement to a replacement QME panel due to lack of specific evidence of discriminatory conduct by the QME. However, the applicant was ordered to attend the QME examination with Dr. Watkin to allow completion of medical-legal discovery, with caution that refusal may result in suspension or barring of benefits.

  Official decision · page 1 →
• ADJ11102439 · 2025-03-10 · Van Nuys District OfficeOther disputed issuedefendant prevailed

  Determinative passage · p.6a 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).) Based on our review, we are not persuaded that the record is properly developed. Where the medical evidence or opinion on an issue is incomplete, stale, and no longer germane, or is based on an inaccurate history, or speculation, it does not constitute substantial evidence. (Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372 [35 Cal.Comp.Cases 525]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) Here, it is unclear from our preliminary review that there is substantial medical evidence to support the WCJ's decision without additional development of the record. The WCJ does not

  The Appeals Board found the record was not properly developed and the WCJ did not sufficiently explain the basis of the decision or the role of Dr. Pietruszka, warranting further review and reconsideration.

  Official decision · page 6 →
• ADJ8750673 · 2025-02-11 · Santa Ana District OfficeOther disputed issueapplicant prevailed

  Determinative passage · p.1Following their participation in a commissioners' settlement conference set at our request, the parties resolved applicant's attorney's claim for medical-legal costs against defendants, the sole issue raised in this reconsideration, by stipulation. The stipulation was filed on January 24, 2025.

  The parties resolved the sole issue of attorney's medical-legal costs by stipulation, which the Board approved, leading to rescission of the prior WCJ order.

  Official decision · page 1 →
• ADJ11588193 · 2024-08-20 · Long Beach District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.1Removal is an extraordinary remedy rarely exercised by the Appeals Board. (Cortez v. Workers' Comp. Appeals Bd. (2006) 136 Cal.App.4th 596, 599, fn. 5 [71 Cal.Comp.Cases 155]; Kleemann v. Workers' Comp. Appeals Bd. (2005) 127 Cal.App.4th 274, 280, fn. 2 [70 Cal.Comp.Cases 133].) The Appeals Board will grant removal only if the petitioner shows that substantial prejudice or irreparable harm will result if removal is not granted. (Cal. Code Regs., tit. 8, § 10955(a); see also Cortez, supra; Kleemann, supra.) Also, the petitioner must demonstrate that reconsideration will not be an adequate remedy if a final decision adverse to the petitioner ultimately issues. (Cal. Code Regs., tit. 8, § 10955(a).) Here, based upon the WCJ's analysis of the merits of petitioner's arguments, we are not persuaded that substantial prejudice or irreparable harm will result if removal is denied and/or that reconsideration will not be an adequate remedy if the matter ultimately proceeds to a final decision adverse to petitioner.

  The Appeals Board found that the petitioner did not demonstrate substantial prejudice or irreparable harm if removal was denied, nor that reconsideration would be inadequate, thus denying the petition.

  Official decision · page 1 →
• ADJ7810002 · 2022-08-30 · Los Angeles District OfficeReconsideration / removalapplicant prevailed

  Determinative passage · p.1We have considered the allegations of the Petition for Reconsideration and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, and for the reasons stated in the WCJ's report, which we adopt and incorporate, we will grant reconsideration, rescind the WCJ's decision, and return this matter to the WCJ for further proceedings and decision. This is not a final decision on the merits of any issues raised in the petition and any aggrieved person may timely seek reconsideration of the WCJ's new decision.

  The Board granted the petition for reconsideration and rescinded the prior WCJ decision, returning the matter for further proceedings.

  Official decision · page 1 →

Also recorded as

The same insurance carrier is printed several ways across the decisions, and all of them were counted as one. This is every spelling behind the figures above.

• TOKIO MARINE AMERICA
• TOKIO MARINE INSURANCE COMPANY
• TOKIO MARINE MANAGEMENT, INC.
• TOKIO MARINE MANAGEMENT
• TOKIO MARINE
• Tokio Marine and Fire Insurance Company Ltd
• Tokio Marine Management, Inc.
• Tokio Marine Management
• TOKIO MARINE INSURANCE
• TOKIO

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 insurance carrier is named in, and the decisions themselves are listed above with the passage each turned on.