American Home Assurance

What they litigate

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

Where they appear

• San Francisco 7
• Van Nuys 7
• Anaheim 4
• Los Angeles 4
• Oakland 4
• Marina del Rey 3
• Oxnard 3
• Riverside 3
• Santa Barbara 3
• Pomona 2
• Fresno 1
• Long Beach 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.

• 24 for the defense
• 12 for the applicant
• 10 returned for more record

Counted over 45 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.

• ADJ292246 · 2026-07-01 · San Francisco District OfficeJurisdiction / venuedefendant prevailed

  Determinative passage · p.4Under California's workers' compensation system, questions relating to the medical necessity of a treatment requested by a physician are decided through a compulsory UR process. Section 4610 requires that employers establish a UR process and once a treating physician submits an RFA to an employer, the employer must either approve the treatment request or dispute the treatment request and submit the matter for review by a UR physician who then must determine, based on "medical necessity," whether to approve, modify, or deny the requested treatment. (§ 4610; State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230, 241.)

  The WCAB concluded that the request for a motorized wheelchair is a new and different treatment subject to utilization review, so the WCAB lacks jurisdiction to decide its medical necessity at this time.

  Official decision · page 4 →
• ADJ19403295 · 2026-06-08 · San Francisco District OfficeStatute of limitationsremanded

  Determinative passage · p.10Accordingly, the record is not fully developed and the WCJ's decision was not based on substantial evidence. We grant KForce's Petition as one seeking reconsideration, rescind the March 2, 2026 Findings of Fact, and return this matter to the trial level for further proceedings consistent with this decision.

  The WCJ's March 2, 2026 Findings of Fact on date of injury and statute of limitations were rescinded due to insufficient substantial evidence and incomplete record development.

  Official decision · page 10 →
• ADJ13039423 · 2026-06-01 · Anaheim District OfficeAOE/COEdefendant prevailed

  Determinative passage · p.13vehicle's air-conditioning in December 2020 and January 2021. (See MOH/SOE (12-17-2025) supra at 5:11-14; 8:10-11; 8:25-9:3.) The timeline of events as relayed by the applicant is inconsistent. Based on the totality of the evidence before the Court, and without any evidence offered in support of applicant's suspicion, it is found that applicant did not sustain his burden of proving by a preponderance of the evidence that he sustained an injury arising out of and in the course of hi[s] employment with Northup Grumman. (Opinion on Decision, March 5, 2026, at pp. 1-10, EAMS Doc ID numbers omitted.) Accordingly, we deny the Petition for Reconsideration.

  Applicant failed to prove industrial causation by a preponderance of the evidence; the evidence was speculative and inconsistent.

  Official decision · page 13 →
• ADJ14784661 · 2025-08-01 · Van Nuys District OfficeQME/AME processapplicant prevailed

  Determinative passage · p.4evaluate his claimed injury. Orthopedic QME Andrew Rah, M.D. has documented applicant's complaints of depression and anxiety in reporting dated August 30, 2021 and March 7, 2022. (Ex. X2, Report of Andrew Rah, M.D., dated August 30, 2021, at p. 7; Ex. X2, Report of Andrew Rah, M.D., dated March 7, 2022, at p. 7.) Applicant's August 9, 2024 Declaration of Readiness to Proceed indicated the disputed issues included a request for a panel of QMEs in psychiatry. (Declaration of Readiness to Proceed, dated August 9, 2024, at p. 7.) The parties proceeded to trial on February 27, 2025, and the corresponding minutes reflect applicant's claimed body parts as included psyche. (Minutes of Hearing and Summary of Evidence (Minutes), dated February 27, 2025, at p. 2:8.) Applicant testified to continued emotional difficulties related to his injury, including difficulties with focus and concentration, vertigo, and anxiety. (Id. at p. 5:12.)

  The WCAB found good cause for issuance of additional QME panels in both neurology and psychiatry based on the record, including applicant's testimony, prior QME reports documenting psychiatric complaints, and procedural history.

  Official decision · page 4 →
• ADJ12953785 · 2024-08-22 · Sacramento District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1The WCJ found, in pertinent part, that applicant sustained a cumulative industrial injury to her bilateral wrists and hands, which resulted in 26% permanent partial disability after apportionment.

  The WCAB found that the applicant failed to rebut the PDRS for permanent total disability based on the AME's credible opinion and vocational evidence; however, the defendant failed to meet its burden of proof on apportionment because the AME's opinion was based on generalizations and not specific facts of the case. The applicant's permanent disability was found to be 35%.

  Official decision · page 1 →
• ADJ11380104 · 2024-07-23 · Oakland District OfficeAOE/COEremanded

  Determinative passage · p.2Based on our review of the record, and for the reasons stated in the WCJ's Report, which we adopt and incorporate to the extent set forth in the attachment to this opinion, we will affirm the WCJ's finding in ADJ111380104 that on June 27, 2018, applicant sustained industrial injury by way of intercostal muscle strain, and to his left shoulder and back; the WCJ's finding in ADJ11997925 that the injury claimed by applicant, allegedly involving his back and lower extremities on June 29, 2018, is not compensable; and the WCJ's finding in ADJ11997956 that the injury claimed by applicant during the period of employment ending June 29, 2018, allegedly involving his back and lower extremities, is not compensable. In ADJ111380104, however, we are persuaded that furth

  The WCJ found industrial injury to the left shoulder and back despite the QME's contrary opinion, creating an irreconcilable conflict requiring further development on disability and medical treatment.

  Official decision · page 2 →
• ADJ16497715 · 2024-07-08 · Los Angeles District OfficeLiensdefendant prevailed

  Determinative passage · p.6We will not disturb the WCJ's finding that lien claimant is not entitled to reimbursement for medical treatment services because lien claimant did not prove that applicant sustained compensable industrial injury. We note that lien claimant did not challenge or address the finding as to AOE/COE in the Petition. (Lab. Code, § 5904 [Petitioner is deemed to have waived an issue that is not raised in the petition for reconsideration].)

  Lien claimant did not prove that applicant sustained compensable industrial injury; no challenge to AOE/COE finding in the Petition.

  Official decision · page 6 →
• ADJ11584131 · 2024-06-28 · Marina Del Rey District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.1Preliminarily, we note that defendant does not challenge the WCJ's finding that the utilization review (UR) denial letter dated October 2, 2023 of the September 19, 2023 Request for Authorization (RFA) was untimely. In Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298, 1299 (Appeals Board en banc) (Dubon II), the Appeals Board held that if a UR decision is untimely, the UR decision is invalid and not subject to independent medical review (IMR). If a UR decision is untimely, the determination of medical necessity for the treatment requested may be made by the Appeals Board based on substantial evidence. (Id. at pp. 1300; 1312.) In this case, the WCJ correctly determined that the September 19, 2023 Request for Authorization is reasonable and necessary.

  The WCJ and Appeals Board found the opinions of Dr. Bradley Thomas and Dr. Peter Gleiberman to be substantial medical evidence supporting the reasonableness and necessity of the lumbar surgery, while rejecting the untimely UR denial and IMR denial as not substantial evidence. Applicant's credible testimony and consistent medical records supported the surgery request.

  Official decision · page 1 →
• ADJ2419734 · 2024-06-06 · San Francisco District OfficeMedical treatment / UR / IMRdeferred

  Determinative passage · p.13Accordingly, as our Decision After Reconsideration, we will rescind the Joint Findings of Fact and substitute findings that (1) applicant sustained injury arising out of and occurring in the course of her employment to her upper extremities while employed by defendant during the periods ending July 19, 2005 (ADJ2419734), July 1, 2004 (ADJ2647713), and April 30, 2008 (ADJ292246); (2) applicant is entitled to reasonable and necessary medical care to cure or relieve from the effects of these injuries; and (3) defer the issues of (a) whether defendant met its burden of establishing a change of circumstances or condition warranting review of the issue of whether the TENS treatment was no longer medically necessary after the February 13, 2017 TENS treatment authorization; (b) whether any discontinuation of the TENS treatment by defendant was based upon substantial medical evidence showing that the treatment was no longer necessary to cure or relieve applicant from her injury; and, as appropriate (c) whether the WCAB holds jurisdiction to determine the issue of what medical treatment is reasonably required to cure or relieve applicant from the effects of her injury; and (d) whether applicant met her burden of proof

  The board rescinded prior findings and deferred the issue of medical necessity and authorization of TENS supplies for further development and trial level proceedings due to insufficient evidence on change of condition and medical necessity after 2017 authorization.

  Official decision · page 13 →
• ADJ12382020 · 2023-12-22 · Pomona District OfficeStatute of limitationsapplicant prevailed

  Determinative passage · p.10The subsequent CT injury must have been filed within the time deadlines in Labor Code Section 5405. The court was persuaded by Applicant's argument in their trial brief, consistent with the Plotnick case, that when treatment is provided for an injury that settled via stipulated award and Applicant has another unfiled date of injury for the same body part, when he gets treatment under the stipulated award he is also getting treatment on the unfiled case for purposes of Labor Code Section 5405(c). Applicant was still getting treatment for the neck under his stipulated award in ADJ6967095 less than a year before the Application for Adjudication was filed in the case as bar for the same body part. Thus, the claim is not barred under Labor Code Section 5405.

  The court found that the claim was timely filed within one year after the last provision of treatment pursuant to Labor Code Section 5405(c), and that ongoing medical treatment tolled the statute of limitations.

  Official decision · page 10 →
• ADJ12431390 · 2023-12-21 · Oxnard District OfficeJurisdiction / venueremanded

  Determinative passage · p.4Pursuant to Section 5412: The date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment. (Lab. Code, § 5412.) As noted above, at the trial the parties stipulated that applicant's period of employment for Atkore International was during the period from November 2013, through January 2019. In order to determine the section 5412 date of injury, the date that applicant first suffered disability and knew that the disability was caused by his employment, must be established. Our review of the record indicates these dates have not been adequately established.

  The WCJ did not adequately establish the Section 5412 date of injury or the Section 5500.5 date of injury, so the matter is remanded for further development and determination of these dates and liability.

  Official decision · page 4 →
• ADJ14201376 · 2023-12-18 · Oxnard District OfficeTemporary disabilitydeferred

  Determinative passage · p.2We are not persuaded that the record supports the allowance of a credit for overpayment of TD. The WCJ relies on the December 15, 2020 pain management panel qualified medical examination report of Lawrence Miller, M.D., to allow the credit. Dr. Miller found applicant to have reached maximum medical improvement. (Dr. Miller's 12/15/20 report, at p. 13, defendant's Exhibit D.) However, the signature page of Dr. Miller's December 15, 2020 report is undated, the attached proof of service is undated and unsigned, and what appears to be a facsimile stamp at the bottom of each page of the report states "12/31/2020 12:00:00 AM." Thus, there does not appear to be evidence that the report was transmitted prior to December 31, 2020. In addition, EDD began to pay benefits on January 8, 2021 (Minutes of Hearing and Summary of Evidence (MOH/SOE) 8/16/23, at p 3:9-11), presumably based on the certification of her treating physician.

  The issue of credit for overpayment of temporary disability was deferred for further development of the record due to questions about the timeliness of the Panel QME report and communications with EDD.

  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.

• AMERICAN HOME ASSURANCE
• AMERICAN HOME ASSURANCE COMPANY
• American Home Assurance
• American Home Assurance Company
• AMERICAN HOME ASSURANCE CO.
• AMERICAN HOME ASSURANCE COMPANY BY HELMSMAN MANAGEMENT SERVICES, LLC
• American Home Assurance, Inc.
• HOME ASSURANCE

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.