American International Insurance Group

What they litigate

Disputed issues across the decisions this claims administrator is named in. Every row opens the decisions it counts.

• AOE/COE1
• Apportionment1
• Serious and willful misconduct1

Where they appear

• Long Beach 2
• Oakland 1
• Redding 1
• Sacramento 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 claims administrator does its work. It describes how a set of appealed disputes came out.

• 2 returned for more record
• 1 for the applicant
• 1 for the defense

Counted over 4 appealed decisions. Not this claims administrator’s book of work.

Decisions

Newest decisions this claims administrator is named in, each with the passage the panel turned on and a link to the official PDF.

• ADJ9626208 · 2023-10-23 · Redding District OfficeApportionmentremanded

  Determinative passage · p.4Here, as the WCJ stated in the Opinion on Decision, Dr. Sommer "...does not address the requirements set out in Escobedo, in that his opinions generally leave out,... the necessary explanation of why and how the pathology and prior injury result in the current disability, and why and how these conditions lead him to choose the percentages that he does." (F&A, pp. 7 § 8, Opinion on Decision.) In his Report, the WCJ explained, "Considering that the missing analysis here is required by Escobedo to find that the opinion is substantial evidence, these faults are fatal to the substantiality of his opinion on apportionment of disability in the back." (Report, p. 3.)

  The WCJ and WCAB found that the AME Dr. Sommer's opinions on apportionment lacked the necessary explanation required by Escobedo to be substantial evidence, leading to rescission and remand for further proceedings.

  Official decision · page 4 →
• ADJ10058585 · 2021-07-30 · Oakland District OfficeSerious and willful misconductdefendant prevailed

  Determinative passage · p.7What is essential to the legal analyses cited above is that it is the employer that is the party to whom a claim for serious and willful misconduct is brought. As this is applied to the facts in the current case, it is apparent that this requirement is lacking.

  Official decision · page 7 →
• ADJ12202655 · 2021-04-05 · Long Beach District OfficeAOE/COEremanded

  Determinative passage · p.1Applicant seeks reconsideration of the Findings of Fact and Orders (F&O) issued by the workers' compensation administrative law judge (WCJ) on January 12, 2021, wherein the WCJ found in pertinent part that applicant did not sustain injury arising out of and occurring in the course of employment (AOE/COE) to his bilateral knees.

  The medical reports from both Dr. Secor and Dr. Hwang were found not to constitute substantial evidence due to inaccuracies and lack of adequate reasoning, leading to the conclusion that the record lacked substantial evidence on injury AOE/COE to the knees.

  Official decision · page 1 →
• ADJ12202655 · 2021-06-21 · Long Beach District OfficeReconsideration / removalnot_reached

  Determinative passage · p.2In our prior Decision we explained that the reports from the reporting physicians do not constitute substantial evidence and it is necessary that the record be further developed to clarify the issue of injury arising out of and occurring in the course of employment (AOE/COE). We again note that the trial record did not contain substantial evidence regarding the issue of whether applicant sustained a cumulative injury AOE/COE. Our prior Decision does not determine the substantive rights or liabilities of either party and as such it is not a final order. Thus, the Petition is dismissed.

  The prior WCAB decision remanding for further proceedings did not determine substantive rights or liabilities and was not a final order; thus, reconsideration does not lie.

  Official decision · page 2 →

Also recorded as

The same claims administrator is printed several ways across the decisions, and all of them were counted as one. This is every spelling behind the figures above.

• AMERICAN INTERNATIONAL GROUP, INC.
• American International Insurance Group

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 claims administrator is named in, and the decisions themselves are listed above with the passage each turned on.