CIGA by Tristar Risk Management

What they litigate

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

Where they appear

• Santa Ana 8
• Los Angeles 7
• Anaheim 6
• Sacramento 4
• Van Nuys 4
• San Diego 2
• Stockton 2
• Fresno 1
• Long Beach 1
• Marina del Rey 1
• Oxnard 1
• Pomona 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.

• 21 for the defense
• 13 for the applicant
• 6 returned for more record

Counted over 39 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.

• ADJ1058134 · 2025-09-04 · Los Angeles District OfficeStatute of limitationsapplicant prevailed

  Determinative passage · p.9Accordingly, we grant applicant's Petition for Reconsideration and as our Decision After Reconsideration, we rescind the June 10, 2025 F&O and substitute a new Finding of Fact that defendant failed to meet its burden of proving the statute of limitations and return this matter to the trial level for further proceedings.

  Defendant failed to meet its burden of proving the statute of limitations because there was no evidence of notice of benefits to applicant, and the employer did not provide statutory notice, triggering the claims administrator's duty to notify.

  Official decision · page 9 →
• ADJ3246274 · 2025-09-04 · Van Nuys District OfficeAOE/COEmixed

  Determinative passage · p.72. Pursuant to Labor Code section 5412, applicant's date of injury is May 14, 2002.

  The date of injury under Labor Code section 5412 is May 14, 2002, based on the concurrence of knowledge and disability when applicant was taken off work and paid temporary disability. The period of liability under Labor Code section 5500.5 is May 14, 2001 through May 14, 2002, as the date of injury controls liability determination. CIGA's petition to dismiss was denied because Quest and Travelers did not have coverage during the period of liability, so CIGA remains properly joined. The issue of Travelers' dismissal was deferred.

  Official decision · page 7 →
• ADJ13556390 · 2025-08-13 · Santa Ana District OfficeJurisdiction / venueremanded

  Determinative passage · p.10IV. Accordingly, we grant defendants' Petition for Reconsideration, and order that a final decision after reconsideration is deferred pending further review of the merits of the Petition for Reconsideration and further consideration of the entire record in light of the applicable statutory and decisional law.

  The Appeals Board granted reconsideration to further study whether defendants are exempt from California jurisdiction under Labor Code § 3600.5(b) and related exemptions, deferring final decision pending further review.

  Official decision · page 10 →
• ADJ7763838 · 2025-05-19 · Van Nuys District OfficeStatute of limitationsdefendant prevailed

  Determinative passage · p.4In the instant matter, defendant Zenith is taking the position that the December 15, 2009 report of Dr. Nelson (Exhibit X1) sufficiently put CIGA on notice of the existence of a cumulative trauma claim so as to establish that same date as the § 5412 date of injury. Zenith argues that CIGA is a sophisticated party, and that therefore, the language in Dr. Nelson's report was sufficient to place it on notice of the potential existence of applicant's cumulative trauma injury.

  The court found that the December 15, 2009 report of Dr. Nelson did not provide sufficient knowledge to fix the date of injury for cumulative trauma. The first report that clearly defined the cumulative trauma injury was the November 17, 2010 report, establishing the §5412 date of injury. The application filed on April 27, 2011 was timely under the statute of limitations.

  Official decision · page 4 →
• ADJ285288 · 2025-01-03 · Anaheim District OfficeAOE/COEdefendant prevailed

  Determinative passage · p.11JOINT FINDINGS OF FACT 1. the applicant, age 49, while employed on 2/29/2000, and during the period 4/15/1995 to 2/29/2000, sustained injury arising out of and in the course of his employment as a soil technician in California with his general employer being GTG, Inc. dba Leighton & Associates, whose workers' compensation insurance carrier was American Motorists Insurance, now identified as California Insurance Guarantee Association by its servicing facility, Tristar Risk Management, for Lumbermens Mutual Casualty Company in liquidation. 2. The applicant did not have dual or special employment with Koll Construction Company on February 29, 2000 nor during the period October 1999 to February 29, 2000.

  The evidence showed Koll did not exercise control over applicant's work, applicant was paid and supervised by GTG, Inc., and Koll's role was limited to scheduling and oversight without direct control, thus no dual or special employment existed.

  Official decision · page 11 →
• ADJ10143466 · 2024-08-08 · San Bernardino District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.1In the Findings of Fact issued on July 15, 2021, the Workers' Compensation Administrative Law Judge ("WCJ") found that on May 27, 2014, applicant, while employed by Insured Solutions/Fontana Logistics Center, insured by Lumbermans [sic] Underwriting Alliance, now in liquidation and administered by defendant California Insurance Guarantee Association ("CIGA"), sustained industrial injury to his lumbar spine and right leg. The WCJ also found that applicant needs further medical treatment for this injury, including but not limited to the Utilization Review ("UR") determination that back surgery is medically necessary, and that there is no factual or legal basis for CIGA to deny authorization for surgery.

  The WCAB found substantial evidence including medical opinions of Dr. Osborne, Dr. Paquette, and Dr. Feiwell, as well as the Utilization Review certification, supporting that the applicant's need for back surgery is related to the May 27, 2014 injury and that the surgery is medically necessary.

  Official decision · page 1 →
• ADJ8923383 · 2024-05-23 · Los Angeles District OfficeAOE/COEremanded

  Determinative passage · p.5The Applicant was a credible witness who testified he physically did not work for any employer as a production assistant, electrician, or grip after the specific injury of November 22, 1998 (Minutes of Hearing February 2, 2024, page 5, lines 3-6). Although the Applicant was compensated for work until approximately June 1999, the Applicant did not perform any physical work for the employer, but clocked in as he was owed "favors" from work he preformed [sic]on other jobs (Minutes of Hearing February 2, 2024, page 4, lines 13-17).

  The WCJ found no compensable cumulative trauma injury because the applicant did not perform physical work after the specific injury date, which is necessary to support a cumulative trauma claim. The WCAB granted reconsideration to further review the merits and record.

  Official decision · page 5 →
• ADJ10160818 · 2023-12-04 · Santa Ana District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of the Findings and Award (F&A), issued by the workers' compensation administrative law judge (WCJ) on September 8, 2023, wherein the WCJ found in pertinent part that applicant sustained a cumulative trauma to his thoracic spine, with a cumulative trauma period ending on October 19, 2001 (finding no. 5, finding no. 7) and that there is 10% legal apportionment to non-industrial causes (finding no. 11).

  The WCJ found that applicant sustained a cumulative trauma to his thoracic spine with a cumulative trauma period ending on October 19, 2001, supported by substantial medical evidence including Dr. Newton's well-reasoned reports and history.

  Official decision · page 1 →
• ADJ10504110 · 2023-09-25 · Santa Ana District OfficeJurisdiction / venuenot_reached

  Determinative passage · p.3Here, the WCJ issued the order2 joining the Mets 15 days after the filing of the petition for joinder, without providing the parties with notice of intention under rule 10832 or setting the matter for further hearing, and accordingly, there is an insufficient basis upon which to evaluate the issues raised in the Mets' Petition. (Cal. Code Regs., tit. 8, § 10832.)

  There was no evidentiary record or notice of intention before the order joining the Mets as party defendant, so the Petition for Reconsideration is dismissed as premature and the matter is returned for further proceedings to create a record.

  Official decision · page 3 →
• ADJ3937323 · 2023-09-22 · Van Nuys District OfficeCumulative traumaapplicant prevailed

  Determinative passage · p.4portion of the findings and award that required CIGA to pay the Employment Development Department (EDD) for reimbursement of benefits and interest.... Based on the stipulations of the parties at trial, it was found that applicant was employed during the period of October 19, 1979 to June 18, 1991 as a Machine Operator, at Sun Valley, California, by Roy J. Maier Products, whose workers' compensation insurance carrier was Fremont Indemnity Company, which is now in liquidation. Based on the Schedule for Rating Permanent Disabilities issued in July 1988, which is the applicable schedule for this injury, it was found that applicant's Occupational Group Number is 11, which corresponds to a machine or hand cutter of various materials. Based on the findings of Agreed Medical Evaluators (AMEs) Mark Mandel, M.D., Gerald Markovitz, M.D., Brian Jacks, M.D., and Mitchell Silverman, M.D., all of whose opinions are entitled to great weight for their presumed expertise and neutrality as medical experts jointly selected by the parties, it was found that applicant sustained a cumulative injury arising out of and occurring in the course of employment to her bilateral upper extremities, gastritis (GERD), irritable bowel syndrome (IBS), and psyche, arising out of and occurring in the course of her employment by Roy J. Maier Products.

  The WCJ found the applicant sustained a cumulative injury to the specified body parts during employment, supported by unrebutted AME opinions.

  Official decision · page 4 →
• ADJ7882792 · 2023-03-09 · Marina del Rey District OfficeDiscrimination under Labor Code §132aapplicant prevailed

  Determinative passage · p.3The focus of Defendant's argument is challenging the judge's decision to rely on the findings of Applicant's vocational expert Laura Wilson rather than the findings of Defendant's vocational expert Amy Koellner.

  The judge found Applicant's vocational expert Laura Wilson more persuasive and better reasoned than Defendant's expert Amy Koellner, supporting the 100% permanent disability finding.

  Official decision · page 3 →
• ADJ2466188 · 2023-02-14 · San Diego District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.2We now turn to the merits of the case. In addition to the reasons stated by the WCJ in the Report, we note that the issue of cumulative trauma to the bilateral knees did not arise until agreed medical examiner (AME) John Lane, M.D., opined about it in his March 2, 2008 report. (Exhibit 9, at p. 2.) Therefore, the requisite knowledge necessary for determination of the date of injury under Labor Code section 5412 did not exist until that time. While defendant cites to a 1999 report by William Bowman, M.D., as evidence of cumulative trauma, that report is not in evidence and is only briefly summarized by Dr. Lane in his July 19, 2007 report. (Exhibit 8 at p. 7.) Defendant appears to be arguing that applicant suffered a cumulative trauma to her knees during her employment with Basic American and a separate cumulative trauma to her hips during her employment with ConAgra. However, the medical evidence in the record, as summarized by the WCJ in the Report, supports a single cumulative trauma through 2005.

  The medical evidence, including opinions from Dr. John Lane and Dr. Hall, supports that the applicant sustained a cumulative trauma injury to her bilateral knees through her employment with Basic American and ConAgra, with liability shared by ConAgra due to continuing employment through 2005.

  Official decision · page 2 →

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.

• CIGA
• CIGA FOR LUMBERMENS UNDERWRITING ALLIANCE
• CIGA FOR INDUSTRIAL INDEMNITY/FREMONT
• CIGA FOR INDUSTRIAL INDEMITY/FREMONT
• CIGA by TRISTAR RISK MANAGEMENT
• CIGA FOR AMERICAN MANUFACTURING
• CIGA FOR HIH AMERICA INSURANCE
• CIGA FOR HOMELAND INSURANCE
• CIGA FOR ATLANTIC MUTUAL
• CIGA/INTERCARE

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.