State Compensation Insurance Fund

What they litigate

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

Where they appear

• Van Nuys 68
• Sacramento 53
• Los Angeles 43
• Fresno 34
• Riverside 32
• San Diego 30
• Anaheim 26
• Santa Ana 24
• Marina del Rey 23
• Oxnard 23
• Bakersfield 22
• Oakland 22

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.

• 257 for the defense
• 209 for the applicant
• 86 returned for more record

Counted over 528 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.

• ADJ8866704 · 2026-06-29 · Los Angeles District OfficeLiensapplicant prevailed

  Determinative passage · p.5Here, the WCJ did not find that a contested claim existed as of May 30, 2013 or May 31, 2013, when the subpoenas were issued because the claim associated with ADJ8866704 was accepted with benefits paid on May 22, 2013. (Report, at p. 2.) As is demonstrated by the C&R and the WCJ's OACR, defendant only accepted liability for injury to the left thumb, even though applicant's hand was identified as a claimed body part. Notably, no medical records have ever been submitted. Defendant disputed liability for temporary disability indemnity benefits throughout the pendency of ADJ8866704, and as evidenced by the Application, temporary disability indemnity was a contested issue in ADJ8866704, and it was not resolved until the settlement of the case-in-chief. Accordingly, we disagree with the WCJ's finding as to whether a contested claim existed because the WCJ appears to construe the meaning of "for the purpose of proving or disproving a contested claim" very narrowly.

  The WCAB found that the cost petitioner met its burden to prove a contested claim existed at the time the services were rendered, contrary to the WCJ's prior finding, based on the evidence of disputed liability and contested issues including temporary disability indemnity.

  Official decision · page 5 →
• ADJ11349173 · 2026-06-26 · Riverside District OfficeSanctions under Labor Code §5813remanded

  Determinative passage · p.8It is well established that the Appeals Board has exclusive jurisdiction over fees to be allowed or paid to applicants' attorneys. (Vierra v. Workers' Comp. Appeals Bd. (2007) 154 Cal.App.4th 1142, 1149 [72 Cal.Comp.Cases 1128]; Cal. Code Regs., tit. 8, § 10840.) In calculating attorney fees, our basic statutory command is that the fees awarded must be "reasonable." (Lab. Code, § 4903, 4906(a), (d).) Pursuant to section 4906, in determining what constitutes a "reasonable" attorney fee, the Appeals Board must consider four factors: 1) the responsibility assumed by the attorney; 2) the care exercised by the attorney; 3) the time expended by the attorney; and 4) the results obtained by the attorney. (Lab. Code, § 4906(d); see also Cal. Code Regs., tit. 8, § 10844.) In Vierra, the Court of Appeal held:

  The WCAB found insufficient evidence to support the 12% attorney fee awarded and deferred the issue for further proceedings, ordering defendant to withhold 15% in trust pending resolution.

  Official decision · page 8 →
• ADJ12672135 · 2026-06-18 · Sacramento District OfficeAOE/COEremanded

  Determinative passage · p.1Applicant seeks reconsideration of the Findings of Fact and Order (F&O) issued by a workers' compensation administrative law judge (WCJ) on March 19, 2026, wherein the WCJ found that applicant did not sustain injury arising out of and occurring in the course of his employment (AOE/COE), and ordered that applicant take nothing from his claim.

  The Appeals Board found that the WCJ erred in applying LaTourette to deny compensability because the injury was caused by the fall impact with the elevator rail and floor, not the non-industrial disease causing the fall, and thus the injury is compensable under established case law.

  Official decision · page 1 →
• ADJ15295325 · 2026-06-15 · Sacramento District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1Applicant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings of Fact and Award of March 12, 2026, wherein it was found that while employed as a correctional officer during a cumulative period ending on June 19, 2021, applicant sustained industrial injury to the neck causing permanent disability of 40% after apportionment. In finding permanent disability of 40%, it was determined that applicant did not prove that she was not amenable to vocational rehabilitation and did not prove that she was unable to compete in the open labor market. Additionally, it was found that, pursuant to the apportionment determination of qualified medical evaluator, physical medicine specialist Brian Karvelas, M.D., that 20 percent of applicant's permanent disability was caused by factors other than the industrial injury. Therefore, applicant's overall 48% permanent disability was apportioned, and it was found that applicant was entitled to an award of 40% compensable permanent disability.

  The Board found that the applicant did not rebut the scheduled rating but that the apportionment evidence by Dr. Karvelas was not substantial medical evidence, thus granting an unapportioned 48% permanent disability award.

  Official decision · page 1 →
• ADJ7376924 · 2026-05-28 · Riverside District OfficePermanent total disabilityremanded

  Determinative passage · p.5Accordingly, it is our decision after remand to affirm the 2024 Decision except that we amend the decision to amend Finding no. 9 and the Award to defer calculation of applicant's permanent total disability rate. It is our further decision after remand to return this matter to the WCJ for further proceedings consistent with this decision and Labor Code section 5313.

  The WCAB found error in the prior calculation of the permanent total disability rate, deferred the calculation, and remanded for further proceedings to properly consider evidence and apply the correct legal standards.

  Official decision · page 5 →
• ADJ767111 · 2026-05-26 · Los Angeles District OfficeLiensmixed

  Determinative passage · p.1Lien claimant Reliable Medical Supply seeks reconsideration of the June 26, 2025 Findings and Order issued by the workers' compensation administrative law judge (WCJ). Therein, the WCJ found that applicant sustained injury arising out of and in the course of employment (AOE/COE) to his chest, back, and leg, while employed as a laborer on February 17, 2002. The WCJ further found that lien claimant failed to meet its burden to prove that the medical treatment services provided were reasonably required to cure or relieve applicant from the effects of the industrial injury.

  The WCJ initially found the lien claimant failed to meet its burden to prove the medical treatment was reasonably required, disallowing the lien; the WCAB granted reconsideration and ordered settlement review, rescinding the WCJ's decision.

  Official decision · page 1 →
• ADJ15732786 · 2026-05-22 · Lodi District OfficeQME/AME processremanded

  Determinative passage · p.8Next, the F&O fails to list materials to be reviewed by the QME by their exhibit letter designation and instead lists them by a different letter which creates confusion. Even with respect to the exhibits that contained over a thousand pages, the WCJ made no attempt to cull the relevant materials and merely states that the records that were not admitted were "not relevant, duplicative, overly burdensome, or their prejudicial effect outweighed their probative value." The decision failed to explain the basis for admitting or excluding each potential exhibit into evidence, and just as significantly, the decision failed to provide a second analysis as to why each document would be provided to the QME, thereby depriving the parties of any meaningful review on the merits.

  The WCJ failed to adequately explain the basis for admitting or excluding each exhibit and which materials should be provided to the QME, depriving the parties of meaningful review. The F&O was rescinded and the matter remanded for further proceedings.

  Official decision · page 8 →
• ADJ13968756 · 2026-05-11 · Anaheim District OfficeAOE/COEmixed

  Determinative passage · p.1Defendant The Hoplon Group, LLC (Hoplon) seeks reconsideration of the Findings of Fact (Findings), issued by the workers' compensation administrative law judge (WCJ) on February 4, 2026, wherein the WCJ found in pertinent part that applicant was employed by the Hoplon Group on December 1, 2020, the date of the alleged work-related injury.

  The WCJ found Hoplon Group, LLC was the employer on the injury date based on testimony and evidence, but deferred the issue of Liebo Builders' employment status due to unclear control and subcontracting arrangements.

  Official decision · page 1 →
• ADJ12317646 · 2026-05-04 · Lodi District OfficeApportionmentapplicant prevailed

  Determinative passage · p.7nonindustrial apportionment of impairment for the lumbar spine, bilateral hips, heart, and hernia for the cumulative injury claim ending on May 10, 2019 and that the opinions of Drs. Amster and Schmitz on the issue of apportionment are not written in accordance with the requirements outlined in Escobedo and Gatten given their lack of specificity, lack of reasoning, and lack of supporting evidence.

  The Appeals Board found that defendant did not meet the burden of proving nonindustrial apportionment with substantial medical evidence, as the opinions of Drs. Amster and Schmitz lacked specificity, reasoning, and supporting evidence as required by Escobedo and Gatten.

  Official decision · page 7 →
• ADJ11850265 · 2026-04-28 · Salinas District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.3Defendant has filed a timely, verified Petition for Reconsideration from the Findings & Award of 11/09/2021, listing the usual statutory grounds. The issue is whether QME Dr. Stone's opinion, that the neck and upper extremity impairments should be combined with the lower extremity impairments by simple addition, qualifies as substantial medical evidence. I found that Dr. Stone's opinion in this regard did so qualify. The Petition for Reconsideration is without merit and should be denied.

  Dr. Stone's opinion that the neck and upper extremity impairments should be combined with the lower extremity impairments by simple addition rather than the Combined Values Chart (CVC) is supported as substantial evidence, leading to a 59% permanent disability rating rather than 51%.

  Official decision · page 3 →
• ADJ10128397 · 2026-04-24 · San Diego District OfficeApportionmentapplicant prevailed

  Determinative passage · p.13Thus, we concluded that both Dr. Pallia and Dr. McSweeney failed to provide substantial medical evidence that would support a finding of apportionment. We concluded that applicant is therefore entitled to an unapportioned award of 96 percent permanent disability (PD), based on rating strings set forth in the Decision, with impairment percentages and adjustments that do not appear to be contested by the Petition, apart from the absence of apportionment.

  The Appeals Board found that neither Dr. Pallia nor Dr. McSweeney provided substantial medical evidence to support apportionment, as their opinions lacked explanation of the mechanism of causation and reasoning for the apportionment percentages, leading to an unapportioned 96 percent permanent disability award.

  Official decision · page 13 →
• ADJ16889988 · 2026-04-21 · Oakland District OfficePenalties under Labor Code §5814applicant prevailed

  Determinative passage · p.10In its Answer to the Petition for Reconsideration, defendant SCIF asserts that its initial rejection of the interpreter's invoice was based on a good faith misunderstanding of the network billing rules where the adjuster mistakenly applied the medical provider network rule under section 4616 to an interpreter cost under section 5811. We agree with cost petitioner that even if the initial error by the adjuster was in good faith, the subsequent delay was simply unreasonable, and sanctions and attorney fees should be issued against defendant for its conduct and failure to promptly investigate, pay or dispute cost petitioner's invoice.

  Defendant SCIF delayed payment of a valid invoice for 15 months without reasonable excuse, constituting bad faith and tactics solely intended to cause unnecessary delay, warranting sanctions and attorney fees.

  Official decision · page 10 →

Also recorded as

The same insurance carrier is printed several ways across the decisions, and all of them were counted as one. These are the twelve commonest of 24.

• STATE COMPENSATION INSURANCE FUND
• State Compensation Insurance Fund
• STATE COMPENSATION INSURANCE FUND, LEGAL
• State Compensation Insurance Fund, Legal
• STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES
• STATE COMPENSATION INSURANCE FUND STATE EMPLOYEES
• State Compensation Insurance Fund-Legal Division
• STATE INSURANCE COMPENSATION FUND
• STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, ADJUSTING AGENCY
• STATE COMPENSATION INSURANCE FUND, STATE EMPLOYEES, ADJUSTING AGENCY
• STATE COMPENSATION INSURANCE FUND - STATE CONTRACTS SERVICES
• State Compensation Insurance Fund-State Employees San Diego

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.