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 72
• Sacramento 54
• Los Angeles 45
• Fresno 35
• Riverside 33
• San Diego 30
• Anaheim 27
• Marina del Rey 26
• Santa Ana 25
• Long Beach 24
• Oxnard 24
• Bakersfield 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.

• 268 for the defense
• 220 for the applicant
• 92 returned for more record

Counted over 555 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.

• ADJ9109258 · 2026-09-14 · Santa Rosa District OfficeJurisdiction / venuedefendant prevailed

  Determinative passage · p.8not only due, but overdue after payment in the amount of $71.20 was requested in a previous notice dated January 20, 2012. We also note that the notice of cancellation issued by State Fund was in compliance with Insurance Code section 676.8, which requires a minimum of 10 days’ written notice to the policyholder or insurer in the event of cancellation for failure to make premium payments when they are due. The February 21, 2012 notice of cancellation indicated that the policy would be cancelled for underpayment on March 8, 2012, which is 15 days’ notice. Accordingly, we will grant reconsideration, rescind the F&O, and substitute a new finding that State Fund effectively cancelled Dynamic’s policy due to Dynamic’s failure to timely pay a required premium payment that was due by March 8, 2012. For the foregoing reasons, IT IS ORDERED that State Fund’s Petition for Reconsideration of the Findings and Order issued by the WCA on February 2, 2026 is GRANTED. IT IS FURTHER ORDERED as the Decision After Reconsideration of the Workers’ Compensation Appeals Board that the February 2, 2026 Findings and Order is RESCINDED and the following is SUBSTITUTED therefor:

  The Appeals Board found that State Fund properly cancelled the policy due to Dynamic's failure to timely pay the required premium payment due March 8, 2012, in compliance with Insurance Code section 676.8 and proper notice requirements.

  Official decision · page 8 →
• ADJ6958667 · 2026-09-11 · Van Nuys District OfficeApportionmentapplicant prevailed

  Determinative passage · p.8Given the inconsistent histories provided by the applicant, the court appropriately found that the apportionment opinions provided by Dr. Bertoldi and Dr. Sones were speculative and unsupported. Thus, Defendant did not meet its apportionment burden since the medical evidence Defendant relies upon is based on inconsistent applicant history that remains unresolved. Apportionment cannot be based on possibilities – it must be based on reasonable medical probability. Per Kopping, that is defendant's burden. [Kopping v. Workers' Comp. Appeals Bd. (2006) 142 Cal. App. 4th 1099, 1101.] Notwithstanding the foregoing, even though the reports of Dr. Bertoldi and Dr. Sones were not substantial on the issue of apportionment, the court still found them substantial with respect to findings on causation and impairment. In Republic Indemnity Co. of America v. WCAB (Winner) (2007) 72 CCC 1175, the WCJ properly relied on the valid portions of the medical reports even though neither physician's apportionment analysis was entirely convincing, demonstrating that a report may be unreliable on apportionment yet still substantial on other issues. Defendant failed to meet their burden of proof and as such the award was issued without apportionment.

  Defendant failed to meet burden of proving apportionment due to inconsistent applicant history and speculative medical opinions, so no apportionment was applied.

  Official decision · page 8 →
• ADJ14292485 · 2026-09-04 · Santa Rosa District OfficePermanent total disabilityapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of the June 25, 2026 Amended Findings and Award (F&A), wherein the workers’ compensation administrative law judge (WCJ) found that applicant, while employed as a highway patrol officer on October 1, 2020, sustained injury arising out of and in the course of employment (AOE/COE) to his brain, psyche, neuropsychiatric system, cervical spine, and thoracic spine. The WCJ found that applicant’s injuries resulted in permanent and total disability. Defendant contends that the WCJ failed to adequately consider applicant’s residual functional capacity and post-injury activities. Defendant further asserts the WCJ erred in rejecting defendant’s vocational expert reporting and that the evidentiary record does not support a finding of permanent and total disability. We have received an Answer from applicant. The WCJ prepared a Report and Recommendation on Petition for Reconsideration (Report), recommending that the Petition be denied. We have considered the Petition for Reconsideration, the Answer, and the contents of the Report. Based on our review of the record, and for the reasons stated in the WCJ’s Report, which we adopt and incorporate, and for the reasons set forth below, we will deny reconsideration.

  The WCJ and WCAB found substantial medical and vocational evidence supporting applicant's permanent and total disability, including credible medical expert opinions and vocational expert reports showing applicant is not amenable to rehabilitation or employment.

  Official decision · page 1 →
• ADJ4162830 · 2026-08-14 · Marina del Rey District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.10749.) Among the methods described for challenging a rating obtained under the PDRS is establishing that “the injury to the employee impairs his or her rehabilitation, and for that reason, the employee’s diminished future earning capacity is greater than reflected in the employee’s scheduled rating.” (Ogilvie v. Workers’ Comp. Appeals Bd. (2011) 197 Cal.App.4th 1262, 1274 [76 Cal.Comp.Cases 624].) Our opinion in Nunes I made clear that “[t]he same considerations used to evaluate whether a medical expert’s opinion constitutes substantial evidence are equally applicable to vocational reporting … [i]n order to constitute substantial evidence, a vocational expert’s opinion must detail the history and evidence in support of its conclusions, as well as ‘how and why’ any specific condition or factor is causing permanent disability.” (Nunes I, supra, at p. 751.) Based upon our review of the evidentiary record, including the vocational reports in this matter, we believe that VE Wilson’s opinions are substantial evidence and that applicant has successfully rebutted the PDRS. Wilson completed a full assessment, took a detailed history, and provided evidence and reasoning in support of her conclusions.

  The WCJ found the vocational expert’s reports to be substantial evidence supporting the applicant’s inability to return to work and rebuttal of the PDRS, considering all medical records and apportionment.

  Official decision · page 10 →
• ADJ8706562 · 2026-08-10 · Marina del Rey District OfficeAOE/COEdefendant prevailed

  Determinative passage · p.9If applicant’s argument were followed, we would be compelled to exclude the evidence obtained by applicant after the close of the MSC, which included the January 2026 ratings report of Dr. Borsada, which provided applicant’s impairment for sleep disorder. In this case both parties continued to conduct discovery after the close of the MSC. B. Compensability of Orthopedic Body Parts 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).) “When the foundation of an expert’s testimony is determined to be inadequate as a matter of law, we are not bound by an apparent conflict in the evidence created by his bare conclusions.” (People v. Bassett (1968) 69 Cal.2d 122, 139.) Applicant argues that a finding of industrial injury should issue as to applicant’s orthopedic body parts. Applicant argues that the reporting of Dr. Greenfield should be followed in this regard, however, Dr. Greenfield issued no opinion as to whether applicant suffered an orthopedic injury

  No medical opinion addressed causation of orthopedic injury; therefore, no finding of industrial injury to orthopedic body parts could be made.

  Official decision · page 9 →
• ADJ11139524 · 2026-07-27 · Van Nuys District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of the April 20, 2026 Findings of Fact and Award (F&A), wherein the workers’ compensation administrative law judge (WCJ) found, in pertinent part, that while employed by defendant from August 1, 2016 through August 1, 2017 as an inmate laborer, applicant sustained injury arising out of and in the course of employment (AOE/COE) to his lower back, neck, knees, hips, ankles, wrists, upper gastrointestinal system, hypertension, coronary heart disease, and right elbow; that good cause has been shown to prove applicant has incurred new and further disability; that applicant’s impairments to his lower extremities and low back should be added under Vigil v. County of Kern (2024) 89 Cal. Comp.

  Official decision · page 1 →
• ADJ3375264 · 2026-07-21 · Long Beach District OfficeAOE/COEdefendant prevailed

  Determinative passage · p.9evidence to support a denial of benefits. (citation.)” (Kyle v. Workers’ Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.) Here, in her Opinion on Decision (OOD), the WCJ provided the following explanation regarding her finding that there was no substantial medical evidence of injury AOE/COE to the neck and bilateral shoulders during the periods from March 12, 2000 through March 12, 2001 (ADJ4499046) and from August 23, 2003 through August 23, 2004 (ADJ3207121): Dr. Feiwell, at the request of CIGA, evaluates Applicant, over four years after the Order issued dismissing the original Petition for Change of Administration. In his report of December 12, 2018, he states “At this juncture, I can state that very little if any of complaints or findings are likely due to cumulative trauma and are due to the sequalae of the specific injury, his prior car accident and most significantly his cerebral palsy.” 21 He further states, “I cannot state with medical certainly that any of his increasing complaints of pain are due to anything other than his underlying cerebral palsy and the prior specific injury in 2003.” 22 He does request the complete medical file and treating physicians records, as well as a formal job analysis.

  The WCJ found no substantial medical evidence of injury AOE/COE to the neck and bilateral shoulders during the periods from March 12, 2000 through March 12, 2001 and from August 23, 2003 through August 23, 2004, based on medical reports that lacked sufficient reasoning or relied on inaccurate job histories.

  Official decision · page 9 →
• ADJ4457963 · 2026-07-20 · Oxnard District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.92. The September 20, 2003 report of Julie Goalwin, Ph.D., was a legally obtained medical- legal report pursuant to section 4060 as it existed in 2003. 3. The ML-103 charges of Angoal Medical are subject to statutory increase and statutory interest under Labor Code sections 4622 and 5800, respectively. 4. Angoal Medical Collections is entitled to reimbursement of the filing fee, having demonstrated liability for the charges.

  The Appeals Board found the September 20, 2003 report of Dr. Goalwin was legally obtained under section 4060 as it existed in 2003, based on the report's statements that it was requested by applicant's counsel and addressed contested medical issues, making the lien reimbursable with statutory increase and interest.

  Official decision · page 9 →
• ADJ11214895 · 2026-07-17 · Lodi District OfficePermanent disability ratingremanded

  Determinative passage · p.1Applicant seeks reconsideration of the Findings of Fact, Orders and Award issued by the workers’ compensation administrative law judge (WCJ) on April 6, 2026. Therein, the WCJ found that:

  The WCJ found 73% and 13% permanent disability with apportionment supported by substantial evidence; applicant argued for a joint 100% award based on Vigil and Kite; the Appeals Board found the record incomplete on apportionment and granted reconsideration for further review.

  Official decision · page 1 →
• ADJ8450336 · 2026-07-15 · Salinas District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1We previously granted reconsideration to allow us time to further study the factual and legal issues in this case. This is our Opinion and Decision After Reconsideration. 1 Applicant seeks reconsideration of the Joint Findings & Award (F&A) issued on June 14, 2022, by the workers’ compensation administrative law judge (WCJ). The WCJ found in pertinent part that, in ADJ8450336, applicant sustained an industrial injury on July 20, 2010, while employed as a registered nurse, to her low back, both shoulders, both wrists, gastrointestinal system in the form of gastroesophageal reflux disease (GERD), and a sleep disorder, which resulted in 40% permanent disability, commencing February 25, 2014. The WCJ further found in pertinent part that, in ADJ8720647, applicant sustained an industrial injury during the period from March 5, 2007 to January 11, 2013, to her neck, low back, left wrist, left hip, left ankle, and gastrointestinal system in the form of GERD, which resulted in 26% permanent disability, commencing November 12, 2014. In both cases, the WCJ found that applicant did not sustain an industrial injury to her heart or cardiovascular system in the form of hypertensive cardiac disease, and that, while the presumption of compensability pursuant to Labor Code section 3212.2 2 applied, defendant successfully rebutted it.

  The Board found industrial injury to multiple body systems including heart and sleep disorder, and awarded permanent disability percentages of 43% and 100% in the two cases, with no apportionment to nonindustrial factors for certain injuries.

  Official decision · page 1 →
• ADJ8427517 · 2026-07-15 · Lodi District OfficeQME/AME processremanded

  Determinative passage · p.1We previously granted applicant’s Petition for Reconsideration of the “Findings of Fact, Orders, and Opinion on Decision” (F&O) issued on March 3, 2023, by the workers’ compensation administrative law judge (WCJ), in order to further study the factual and legal issues. This is our Opinion and Decision After Reconsideration. The WCJ found, in pertinent part, that applicant, in pro per, was not entitled to an additional and/or replacement panel qualified medical evaluator (QME) in the specialty of internal medicine. Applicant contends that the WCJ erred because the reporting of the agreed medical evaluator (AME) does not constitute substantial evidence and that further development of the record with the current AME is not warranted. We have received an answer from defendant. The WCJ filed a Report and Recommendation on Petition for Reconsideration (Report) recommending that we deny reconsideration. We have considered the allegations of the Petition for Reconsideration, the Answer, and the contents of the WCJ’s Report. Based on our review of the record and for the reasons discussed below, as our Decision After Reconsideration we will rescind the March 3, 2023 F&O and return this matter to the trial level for further proceedings.

  The WCJ found applicant was not entitled to an additional or replacement QME in internal medicine, but the Appeals Board rescinded that decision and returned the matter for further proceedings because the issue was not properly analyzed and further development of the record was warranted.

  Official decision · page 1 →
• ADJ11253479 · 2026-07-10 · Goleta District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of a workers’ compensation administrative law judge’s (WCJ) Findings and Award of April 3, 2026, wherein it was found that while employed as a Department of Motor Vehicles examiner, applicant sustained injury to his neck, psyche, head and in the form of headaches causing permanent disability of 72% and the need for further medical treatment.

  The WCAB found that the psychiatric permanent disability was valid under the violent act exception, apportionment under Labor Code section 4663 was appropriate with 40% attributed to pre-existing factors, and the pain add-on for headaches was disallowed as duplicative. The permanent disability rating was amended to 47%.

  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. These are the twelve commonest of 26.

• 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.