Everest National Insurance Company

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 6
• Marina del Rey 5
• Oakland 5
• San Francisco 5
• Pomona 4
• Sacramento 4
• Los Angeles 3
• Oxnard 3
• San Diego 3
• Lodi 2
• San Jose 2
• Santa Rosa 2

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
• 16 for the applicant
• 8 returned for more record

Counted over 47 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.

• ADJ19191631 · 2026-03-19 · San Francisco District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.8Applicant's unrebutted credible testimony established that she worked for Avellino Labs USA. Avellino Labs USA was her employer at the time of injury. Defendants failed to rebut the Labor Code section 3357 presumption of employment. Defendants presented no evidence or witnesses on the issue. Whether or not applicant had a general and special employer at the time of injury is deferred. Applicant acknowledged being paid by Gava Talent Solutions.

  The WCJ found applicant was employed by Avellino based on credible testimony and evidence, and defendants failed to rebut the presumption of employment under Labor Code section 3357. The Appeals Board affirmed this finding and amended the F&A to clarify the injury arose out of and in the course of employment under Labor Code section 3600.

  Official decision · page 8 →
• ADJ10388154 · 2026-02-19 · Pomona District OfficeStatute of limitationsremanded

  Determinative passage · p.11Here, the WCJ determined applicant's claim was barred by the statute of limitations, ascribing a section 5412 date of injury of September 28, 2014, based upon an assumption that applicant gleaned the requisite disability and knowledge of his continuous trauma injury based upon the service of the AME Dr. Uppal's medical report of September 4, 2014 to his attorney, however, an applicant's knowledge cannot necessarily be presumed based solely upon written

  The WCJ's finding of a September 28, 2014 date of injury under section 5412 was rejected because applicant lacked knowledge of the injury on that date; medical treatment was last provided on June 29, 2015, tolling the statute of limitations; thus, the claim was not barred and the matter was remanded for further proceedings.

  Official decision · page 11 →
• ADJ6840627 · 2025-03-17 · Sacramento District OfficeMedical treatment / UR / IMRremanded

  Determinative passage · p.6Turning to defendant's argument that the WCJ erroneously found that applicant was entitled to reimbursement for self-procured chiropractic treatment because the treatment was not authorized under Utilization Review, we note that the parties raised the issue of "[l]iability for self-procured medical treatment" without reference to Utilization Review and without submitting Utilization Review documents for admission in evidence. It is thus unclear whether a Request for Authorization (RFA) was submitted and, if so, whether defendant reserved its right to retrospective Utilization Review by issuing a written decision complying with AD Rule 9792.9(b)(1). (Cal. Code Regs., tit. 8, § 9792.9(b)(1).) Hence, we will order that a final decision after reconsideration is deferred pending further review of the merits of this issue.

  The Appeals Board found unclear whether Utilization Review was properly followed and deferred final decision for further review.

  Official decision · page 6 →
• ADJ11686539 · 2025-02-21 · Oxnard District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.6Thus, and based on the reporting of PTP Dr. Shen, we are persuaded that lien claimant has sustained its burden of establishing injury AOE/COE to the right shoulder, arm, and wrist.

  The WCAB found the reporting of the QME was not substantial evidence due to lack of accurate history and analysis, but the PTP Dr. Shen's reports provided a reasonable medical and vocational history, competent examination, and analysis supporting industrial causation, thus establishing injury AOE/COE.

  Official decision · page 6 →
• ADJ10342642 · 2024-10-28 · Sacramento District OfficePermanent disability ratingremanded

  Determinative passage · p.1Applicant and defendant have filed separate petitions for reconsideration with regard to a workers' compensation administrative law judge's (WCJ) Findings and Award and Order of August 6, 2024, wherein it was found that while employed on May 13, 2015 as a foreman, applicant sustained industrial injury to the head, eyes, vision, face, jaw, chin and mouth causing permanent disability of 70%. It was also found that "the violent act exception [to not including psychiatric permanent disability as a compensable consequence to a physical injury] applies pursuant to Labor Code section 4660.1(c)(2)(A)." Although there was no finding of psychiatric injury, psychiatric permanent disability was included in the calculation of overall permanent disability.

  The WCJ included psychiatric permanent disability in the overall permanent disability calculation under the violent act exception, but the Appeals Board found the record needed further development and reanalysis in light of the en banc decision in Vigil v. County of Kern (2024).

  Official decision · page 1 →
• ADJ10519245 · 2024-10-23 · San Jose District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.1Applicant seeks reconsideration of the July 25, 2024 Findings and Award (F&A), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as an aide/substitute teacher on June 15, 2016, sustained industrial injury to her cervical spine, thoracic spine, lumbar spine, right shoulder, and in the form of headaches. The WCJ found in relevant part that applicant sustained permanent disability subject to nonindustrial apportionment, and that applicant was entitled to future medical care to the head/headaches, but not to the thoracic spine or bilateral knees.

  The Board concluded that the applicant's right to future medical care was not abrogated and granted entitlement to future medical care for the cervical spine, thoracic spine, lumbar spine, right shoulder, and head.

  Official decision · page 1 →
• ADJ11255137 · 2024-10-21 · Marina del Rey District OfficeCumulative traumadeferred

  Determinative passage · p.7While we agree that the WCJ properly found that applicant had sustained injury AOE/COE but based on the record before us, the issue of whether there is one or two cumulative trauma injuries requires further study. Moreover, the issue of the date of injury pursuant to section 5412 also requires further study because determination of the date requires that the issue of whether there was one or two periods of cumulative trauma be determined.

  The issue of whether there is one or two cumulative trauma injuries and the date of injury require further study, so final decision is deferred.

  Official decision · page 7 →
• ADJ10849328 · 2024-08-01 · Salinas District OfficeStatute of limitationsapplicant prevailed

  Determinative passage · p.1The WCJ found, in relevant part, that applicant's Petition to Reopen was timely filed; that based on the determination provided in a report written by PQME Dr. Stone (PQME) an MRI of applicant's right shoulder is necessary, as well as a determination regarding further disability to the knees; that applicant shall be allowed to assert a claim for psychological injury within her Petition to Reopen, based on psychological symptoms reported by the PQME in his first report; and, that based on the PQME's determinations and request for an additional PQME in psychology to evaluate applicant, the parties should proceed to agree on an Agreed Medical Evaluator, or to request an additional QME, to evaluate applicant's psychological complaints, and to assess the date of onset, causation, and need for treatment. The WCJ ordered that: "the parties proceed with obtaining the MRI of the right shoulder as requested by PQME Dr. Stone and that the parties proceed with selection of either an AME, or request for an additional QME panel in the specialty of psychology to address the Applicant's symptoms, need for treatment and determine causation and the date this condition arose, as requested by PQME Dr. Stone."

  The WCJ found the Petition to Reopen was timely filed, a threshold jurisdictional issue, making the decision final and subject to reconsideration rather than removal.

  Official decision · page 1 →
• ADJ10933797 · 2024-06-17 · Lodi District OfficeAOE/COEremanded

  Determinative passage · p.1Defendant Everest National Insurance Company has petitioned for reconsideration of the Findings of Fact, Orders, and Award issued and served by the workers' compensation administrative law judge (WCJ) in this matter on March 26, 2024. In that decision, the WCJ found that applicant sustained a cumulative trauma (CT) injury arising out of and in the course of employment (AOE/COE) to the lumbar spine, bilateral knees, bilateral shoulder and bilateral hips as well as to his respiratory system during the CT period ending on November 1, 2016. The WCJ further found that pursuant to the stipulation of the parties, and the fact that the respiratory system has been found to be an industrial injury, the permanent disability is 100%, based upon substantial evidence. Future medical care and attorney fees were awarded, and liens were deferred. The parties were ordered to adjust benefits according to the findings of fact, with jurisdiction reserved.

  The Appeals Board granted reconsideration to further review the date of injury and the period of exposure for the respiratory injury, deferring final decision pending further review of the entire record and applicable law.

  Official decision · page 1 →
• ADJ10116539 · 2024-04-29 · Los Angeles District OfficeMedical treatment / UR / IMRdefendant prevailed

  Determinative passage · p.4The designation of RMS as PTP was insufficient to wrest defendant's control of treatment within the MPN. The status of Chrislip Hervatin as applicant's attorney was in question without the statutorily required filing to take over applicant's representation. More importantly, no denial of care has been shown though it is alleged based on Lien Claimant's Exhibit 5, letter of 05/31/2016. This letter appears to only be addressed to applicant, and references a request for authorization dated 05/30/2016 without identifying the requesting party. There is no 05/30/2016 RFA in evidence. The letter refers to 8 Cal. Code of Reg. Sec. 9792.9.1 (b) (1) which relates to the UR deferral process. The letter contains an incomplete sentence stating "This treatment is disputed because" with no words following. Whatever the author of this letter might have intended, it does not demonstrate that defendant was denying care within the MPN. Rather, it appears to be the use of an incorrect template and possibly misdirected. The claim itself was never denied, and the treatment within the MPN was last documented by Defendant's Exhibit V, report of Dr. Aflatoon, 01/05/2016, who recommended further treatment.

  The designation of RMS as PTP was insufficient to wrest defendant's control of treatment within the MPN because no denial of care was shown and the treatment within the MPN was ongoing and authorized.

  Official decision · page 4 →
• ADJ9283221 · 2024-03-18 · Marina del Rey District OfficeAOE/COEremanded

  Determinative passage · p.1RECONSIDERATION We have considered the allegations of defendant's Petition for Reconsideration (petition) and the contents of the Report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, and for the reasons stated in the WCJ's Report, which we adopt and incorporate, we will grant reconsideration, rescind the WCJ's decision, and return this matter to the WCJ for further proceedings on the issues of: 1) causation of applicant's alleged psychiatric injury, and 2) whether the alleged psychiatric injury is "catastrophic" under Labor Code section 4660.1(c)(2)(B).1 This is not a final decision on the merits of these issues and any aggrieved person may timely seek reconsideration of the WCJ's new decision thereon. As noted in the Report, the WCJ agrees with defendant's additional argument that the WCJ erroneously awarded applicant an increase in his permanent disability rating for sexual dysfunction under section 4660.1(c)(2)(B). (Lab. Code, § 4660.1(c)(2)(B).) This issue and the other issues discussed in the Report should be considered at the trial level in the first instance.

  The WCJ found Dr. Wexler's causation opinion unclear and recommended further development of the record to clarify causation of psychiatric injury.

  Official decision · page 1 →
• ADJ15225348 · 2023-12-12 · Oakland District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1For the reasons stated in the WCJ's report, we agree that the opinions of panel qualified medical examiner (PQME) Rommel Hindocha is substantial medical evidence upon which the WCJ properly relied. To be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416§ 17, 419 [33 Cal.Comp.Cases 660].) A physician's report must also 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

  The WCJ properly relied on Dr. Hindocha's Almaraz/Guzman rating as substantial medical evidence because it was based on reasonable medical probability, supported by specific findings including significant limitations in 7/8 ADL categories, unsuccessful surgeries, and muscle atrophy, and was consistent with applicant's testimony and medical records.

  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. This is every spelling behind the figures above.

• EVEREST NATIONAL INSURANCE COMPANY
• Everest National Insurance Company
• Everest National Insurance
• EVEREST NATIONAL INSURANCE
• EVEREST PREMIER INSURANCE COMPANY
• EVEREST DENALI INSURANCE COMPANY
• EVEREST PREMIER INSURANCE CO.
• Everest Commercial Casualty
• EVEREST INSURANCE COMPANY

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.