ADJ1022470 · December 23, 2025

The Board found that Desert Sands Unified School District, not CIGA, is liable to administer further medical treatment because Desert is the solvent insurer with joint and several liability, and CIGA is relieved of liability under Insurance Code section 1063.1(c)(9).

From the decision · page 7Here, as noted by the WCJ in his Report, given that Desert shares joint and several liability with CIGA in all three cases, we agree that CIGA is not liable for further medical treatment and amend the decisions accordingly.

The Board deferred the issue of new and further disability because the record was inadequate to determine whether the applicant sustained new and further disability and whether a petition to reopen was filed, and CIGA waived the issue by not raising it earlier.

From the decision · page 9Accordingly, as our Decision After Reconsideration, we rescind the decisions in ADJ3880940 and ADJ4230890, and substitute new decisions that find that CIGA and Desert have joint and several liability and order that Desert is to administer applicant's further medical treatment, and defer the issue of new and further disability in ADJ4230890. We make no other changes to any of the other decisions.

Desert Sands Unified School District is the solvent insurer with joint and several liability for the injuries.

Favours Defendant prevailed

This fact relieved CIGA of liability for further medical treatment under Insurance Code section 1063.1(c)(9).

From the decision · page 7Here, as noted by the WCJ in his Report, given that Desert shares joint and several liability with CIGA in all three cases, we agree that CIGA is not liable for further medical treatment and amend the decisions accordingly.

Applicant did not present evidence of a petition to reopen for new and further disability.

Favours Defendant prevailed

Lack of evidence and waiver by CIGA led the Board to defer the issue of new and further disability.

From the decision · page 7Here, CIGA never raised the issue of whether a petition to reopen was filed or whether the Appeals Board had jurisdiction to consider the January 12, 1998 injury at the time of trial in 2021. In the March 11, 2021 letter to the WCJ, where CIGA requested that the WCJ amend the MOH of March 3, 2021, they made no request for the WCJ to consider the issue of jurisdiction over permanent disability in the January 12, 1998 injury. CIGA stipulated at the September 27, 2021 trial that applicant had entered into Stipulations on December 2, 1998 to 13%, and they proceeded with submission on the matter, including on the issue of permanent disability, and despite affirmative knowledge of the Stipulations. Moreover, litigation on the case continued beyond the date of the end of the five year period in January 2003, and more than twenty years after the case was resolved. Yet, CIGA raises the issue for the first time on reconsideration. There is no explanation in their Petition as to why the issue was not raised previously, and thus, we conclude that CIGA waived the issue of whether a petition to reopen was filed.

Medical evidence was unclear whether prior disability was considered in current disability rating.

Favours Applicant prevailed

This uncertainty required the Board to further develop the record and defer the new and further disability issue.

From the decision · page 8Here, the parties stipulated that the parties entered into Stipulations in December 1998 that applicant had 13% permanent disability. Yet, in the decision, the WCJ found that applicant sustained 40% permanent disability without stating either way whether this was new and further disability or whether CIGA was entitled to a credit for the 13% benefits paid in 1998. Moreover, the medical evidence is unclear as to whether Dr. Woods took into account applicant's prior level of disability in opining on applicant's current level of disability. Therefore, the WCJ must develop

Attributed percentages of injury to cervical spine, right shoulder, and left knee to the injury period from 1970 to 2005; noted applicant's work duties and injury history.

The Board relied on Dr. Wood's report to understand the injury and apportionment but found the record inadequate for new and further disability determination.

From the decision · page 4On March 3, 2022, the WCJ vacated submission for further development of the record. Pursuant to the independent medical examination (IME) report of David Wood, M.D., dated December 19, 2018, applicant began working for Desert in 1970 and began to experience pain in his arms and shoulders beginning 1998 due to repetitively carrying a pool pump, water pump and other equipment all weighing 50 pounds each. (Def. Ex. J) He carried jugs and bags full of chemicals, moved a barrel weighing 400 pounds with a hand dolly. (Id. at p. 3.) He also began in 1970 to experience pain in his nose and eyes from repetitively breathing in chlorine and other chemicals. (Id. at p. 3.) He retired in 2005 due to pain. (Id. at p. 4.) Dr. Wood noted that on January 12, 1998 (ADJ4230890), applicant struck his right knee on a water heater sustaining an injury resulting in a partial medial meniscectomy in 1998. He returned to regular duty after reaching maximum medical improvement. (Id. at p. 23.) He also noted that applicant also claimed to have cumulative trauma during the period from March 22, 1998 to March 1999 (ADJ3880940), related to job related activities such as constant lifting, pushing and pulling, bending, reaching, squatting, kneeling, gripping, grasping and other

Insurance Code section 1063.1(c)(9)

CIGA liability limited to covered claims under Insurance Code section 1063.1(c)(9).

The Board applied this statute to determine that CIGA is not liable for further medical treatment because Desert Sands Unified School District is the solvent insurer with joint and several liability.

From the decision · page 6DISCUSSION With respect to CIGA's liability, it is specifically defined in Insurance Code section 1063.1 as extending only to "coveredclaims." "[C]overed claims" under section 1063.1 "are not coextensive with an insolvent insurer's obligations under its policies" (IndustrialIndemnity Co. v. Workers' Comp. Appeals Bd. (Garcia) (1997) 60 Cal.App.4th 548, 557 [62 Cal.Comp.Cases 1661]) and "does not include an obligation to insurers, insurance pools, or underwriting associations, nor their claims for contribution, indemnity, or subrogation, equitable or otherwise, except as otherwise provided in this chapter." (Ins. Code, § 1063.1(c)(5)(A).) As a result, if CIGA and a solvent insurer are jointly and severally liable for a benefit, the solvent insurer must pay the benefit and CIGA is relieved of liability. (CIGA v. Workers' Comp. Appeals Bd.

Labor Code section 5410

Appeal Board's continuing jurisdiction under Labor Code section 5410 requires filing a petition to reopen within five years of injury date.

The Board applied this standard to defer the issue of new and further disability due to lack of evidence of a timely petition to reopen and waiver by CIGA.

From the decision · page 7With respect to applicant's petition to reopen, pursuant to section 5410, an injured employee who has previously received workers' compensation benefits pursuant to an award is entitled to claim benefits for "new and further disability" within five years of the date of injury. (Sarabi v. Workers' Comp. Appeals Bd. (2007) 151 Cal.App.4th 920, 925 [72 Cal.Comp.Cases 778].)

Labor Code section 3202

Labor Code section 3202 requires liberal construction of limitation provisions in favor of injured employees.

The Board applied this standard to interpret the filing requirements liberally in favor of the applicant but found the record inadequate to decide the new and further disability issue.

From the decision · page 7However, invocation of the Appeal Board's continuing jurisdiction under section 5410 requires the filing of an appropriate pleading with the Board within five years from the date of injury. (Lab. Code, § 5410, 5804.) If timely filed within the five-year period, the power of the Board to reopen and decide a matter extends beyond the five-year period. (Bland v. Workmen's Comp. App. Bd. (1970) 3 Cal.3d 324, 329, fn. 3 [35 Cal.Comp.Cases 513].) In construing the pleading and its filing, the Board construes the limitation provisions in the Labor Code liberally in favor of the injured employee unless otherwise compelled by the language of the statute and that interpretation of such enactments should not be in a manner resulting in the loss of compensation. (Lab. Code, § 3202; Zurich Ins. Co. v. Workers' Comp. Appeals Bd. (1973) 9 Cal.3d 848, 852 [38 Cal.Comp.Cases 500]; Fruehauf Corp. v. Workmen's Comp. App. Bd. (1968) 68 Cal.2d 569, 577 [33 Cal.Comp.Cases 300].)

CIGA did not raise the issue of petition to reopen at trial and stipulated to prior disability award; litigation continued beyond five years; issue raised first on reconsideration.

From the decision · page 7Here, CIGA never raised the issue of whether a petition to reopen was filed or whether the Appeals Board had jurisdiction to consider the January 12, 1998 injury at the time of trial in 2021. In the March 11, 2021 letter to the WCJ, where CIGA requested that the WCJ amend the MOH of March 3, 2021, they made no request for the WCJ to consider the issue of jurisdiction over permanent disability in the January 12, 1998 injury. CIGA stipulated at the September 27, 2021 trial that applicant had entered into Stipulations on December 2, 1998 to 13%, and they proceeded with submission on the matter, including on the issue of permanent disability, and despite affirmative knowledge of the Stipulations. Moreover, litigation on the case continued beyond the date of the end of the five year period in January 2003, and more than twenty years after the case was resolved. Yet, CIGA raises the issue for the first time on reconsideration. There is no explanation in their Petition as to why the issue was not raised previously, and thus, we conclude that CIGA waived the issue of whether a petition to reopen was filed.

Medical evidence unclear if prior disability was considered in current disability rating; record incomplete for new and further disability adjudication.

From the decision · page 8Here, the parties stipulated that the parties entered into Stipulations in December 1998 that applicant had 13% permanent disability. Yet, in the decision, the WCJ found that applicant sustained 40% permanent disability without stating either way whether this was new and further disability or whether CIGA was entitled to a credit for the 13% benefits paid in 1998. Moreover, the medical evidence is unclear as to whether Dr. Woods took into account applicant's prior level of disability in opining on applicant's current level of disability. Therefore, the WCJ must develop