ACE American 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

• Santa Ana 43
• Van Nuys 43
• Oakland 27
• Los Angeles 23
• Anaheim 20
• Sacramento 14
• Marina del Rey 13
• San Diego 12
• Long Beach 11
• Riverside 8
• Fresno 6
• Oxnard 6

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.

• 114 for the applicant
• 109 for the defense
• 46 returned for more record

Counted over 255 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.

• ADJ13514341 · 2026-09-01 · San Francisco District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.3probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion … It must be reasonable in nature, credible, and of solid value.” (Braewood Convalescent Hosp. v. Workers’ Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.) 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).) Furthermore, the physician must explain the nature of the disease and how and why it is causing disability at the time of the evaluation. (Id.) For the reasons stated by the WCJ, we are persuaded that the opinion of panel qualified medical evaluator (PQME) Rommel Hindocha, D.C., is substantial medical evidence upon which the WCJ appropriately relied to determine applicant’s level of permanent disability by adding his impairments, consistent with the holding of Vigil v. County of Kern (Vigil) (2024) 89 Cal.Comp.Cases 686 [2024 Cal. Wrk. Comp.

  The WCJ and Appeals Board found the opinion of QME Dr. Hindocha to be substantial medical evidence supporting a 71% permanent disability rating by adding impairments due to synergistic effects on activities of daily living (ADLs), rebutting the use of the Combined Values Chart (CVC).

  Official decision · page 3 →
• ADJ18573103 · 2026-08-17 · Oakland District OfficeTemporary disabilityapplicant prevailed

  Determinative passage · p.8II. We will affirm the WCJ’s finding that applicant was totally temporarily disabled from January 9, 2026 going forward. Temporary disability indemnity is compensation for temporary impairment in earning ability caused by the industrial injury which is reasonably expected to be cured or materially improved with proper medical treatment or over time. (Lab. Code, §§ 4453 and 4653; see Chavira v. Workers’ Comp. Appeals Bd. (1991) 235 Cal.App.3d 463, 473 [56 Cal.Comp.Cases 631].) We adopt and incorporate the WCJ’s report on this issue as follows: THE FINDINGS OF FACT AND AWARD OF TTD FROM JANUARY 9, 2026 AND ONGOING WAS SUPPORTED BY THE RECORD AND NOT IN ERROR

  The WCAB found that the applicant was totally temporarily disabled from January 9, 2026, ongoing, based on the credible opinion of PTP Dr. Kamdar and applicant's testimony, rejecting the stale opinions of AMEs Dr. Levy and Dr. Woodcox regarding permanent and stationary status. The delay in payment was not unreasonable due to genuine medical doubt, so the 25% penalty under section 5814 was rescinded, but a 10% increase on delayed payments was awarded under section 4650(d). Attorney fees under section 5813 were rescinded and replaced with a 15% fee on delayed payments.

  Official decision · page 8 →
• ADJ18042476 · 2026-08-10 · Sacramento District OfficePermanent disability ratingremanded

  Determinative passage · p.12He estimates that he lifted consistently all day, especially while working in the warehouse.” (MOH, p. 5, lines 23-25.) Accordingly, we will grant applicant’s Petition, rescind the May 14, 2026 F&A and substitute a new F&A that defers the issues of permanent disability and occupational group number and return the matter for further proceedings consistent with this opinion. For the foregoing reasons, IT IS ORDERED that applicant’s Petition for Reconsideration of the Findings of Fact and Award issued by the WCJ on May 14, 2026 is GRANTED. IT IS FURTHER ORDERED as the Decision After Reconsideration of the Workers’ Compensation Appeals Board that the May 14, 2026 Findings of Fact and Award is RESCINDED and the following is SUBSTITUTED therefor:

  The WCJ's original permanent disability rating and occupational group number were rescinded due to insufficient explanation for the Almaraz/Guzman rating and incomplete evidence on occupational group; the matter was returned for further development of the record.

  Official decision · page 12 →
• ADJ13520237 · 2026-07-28 · Los Angeles District OfficePsyche AOE/COEremanded

  Determinative passage · p.1133, emphasis added.) The WCJ, by contrast, only discusses two skeletal medical leave of absence forms from 2019 before concluding “there is no medical evidence to establish applicant sustained a psych/stress claim.” (Opinion on Decision, pp. 1-2.) The WCJ does not discuss the 2020 and 2021 medical records which mention psychiatric/stress. A claimed cumulative psychiatric injury is the exemplar of “a scientific question, requiring a judgment based upon scientific knowledge and inaccessible to the unguided rudimentary capacities of lay arbiters.” (McLaughlin, supra, p. 839.) Here, there is medical evidence of a psychiatric injury in the form of limited reporting from chiropractor Torres and Dr. Green. What is missing is a substantial medical opinion addressing psychiatric injury. Until that opinion is obtained it is not possible to determine if there is an injury, the date of injury, nor what defenses, if any, may be applicable. The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue. (McClune v. Workers’ Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to

  There is medical evidence of psychiatric injury but no substantial medical opinion; issue deferred to WCJ for further development and obtaining psychiatric AME or PQME.

  Official decision · page 11 →
• ADJ13153374 · 2026-07-21 · Santa Ana District OfficeJurisdiction / venueapplicant prevailed

  Determinative passage · p.10We are therefore authorized to exercise jurisdiction over his claims by sections 3600.5, subdivision (a) and/or 5305. 3 Accordingly, we will rescind the Findings of Fact and substitute a new order finding that applicant was hired in California for purposes of California workers’ compensation law and is eligible to bring both his specific and cumulative injury claims in this forum. For the foregoing reasons, IT IS ORDERED, as the Decision After Reconsideration of the Workers’ Compensation Appeals Board, that the May 12, 2021 Joint Findings of Fact is RESCINDED, and the following order SUBSTITUTED therefore:

  The WCAB found that the applicant was hired in California for purposes of California workers’ compensation law based on binding precedent in Gandy, which holds that hire by a California-based team equates to hire in California, despite the contract being signed outside California. This established subject matter jurisdiction over the claims.

  Official decision · page 10 →
• ADJ19727180 · 2026-07-20 · San Luis Obispo District OfficeApportionmentapplicant prevailed

  Determinative passage · p.6Apportionment is the process utilized to segregate permanent disability or the residuals caused by an industrial injury from those attributable to other industrial injuries or to nonindustrial factors, to allocate legal responsibility fairly. (Brodie v. Workers’ Comp. Appeals Bd. (2007) Cal.4th 1313, 1321 [72 Cal.Comp.Cases 565]; Marsh v. Workers’ Comp. Appeals Bd. (2005) 130 Cal.App.4th 906, 911 [70 Cal.Comp.Cases 787].) The mere fact that a medical report assigns approximate percentages of industrial and nonindustrial causation does not make the report reliable medical evidence by itself. (E.L. Yeager Construction v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 927-928 [71 Cal.Comp.Cases 1687].) Instead, apportionment of permanent disability is “based on causation” and the “employer shall only be liable for the percentage of permanent disability directly caused by

  PQME Dr. Hyman provided substantial medical evidence that the applicant's permanent disability was entirely industrial, refusing to apportion any part to nonindustrial risk factors such as smoking, obesity, or genetic predisposition, which were only risk factors and not direct causes of the permanent disability. Defendant failed to meet the burden of proof to establish apportionment.

  Official decision · page 6 →
• ADJ18814242 · 2026-07-13 · Marina del Rey District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.10(1968) 69 Cal.2d 408, 419 [33 Cal.Comp.Cases 660].) “That burden manifestly does not require the applicant to prove causation by scientific certainty.” (Rosas v. Workers’ Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].) Here, PQME Dr. Tirmizi reviewed the extensive available data to arrive at his opinion on injury: Therefore, it is medically probable that [applicant] was exposed to silica or silicone like products at his workplace, which, in the process of manufacturing, resulted in respirable particles that he subsequently inhaled and resulted in him developing silicosis. It is therefore my opinion that based on [applicant]'s 23-year exposure to dust and fibers, which very likely contained silica, is a contributing and likely causative factor to his pneumoconiosis.

  The Appeals Board found substantial evidence supporting that applicant sustained injury to his respiratory system arising out of and in the course of employment, based on medical opinions and workplace exposure evidence, despite defendant's contention of no substantial evidence of silica exposure.

  Official decision · page 10 →
• ADJ12308686 · 2026-06-11 · Los Angeles District OfficeMedical treatment / UR / IMRdefendant prevailed

  Determinative passage · p.5In the present case, applicant designated Casa Colina rather than any individual physician as her primary treating physician. This designation violates AD Rule 9785(a)(1), which defines the primary treating physician as an actual physician and not a facility or other entity.

  Applicant designated a facility, not an individual physician, as primary treating physician, contrary to regulations; defendant provided access to three neurologists within the MPN, meeting statutory and regulatory requirements for access to care; applicant did not meet burden to show neglect or refusal to provide care.

  Official decision · page 5 →
• ADJ number not stated · 2026-06-10 · Santa Ana District OfficeStatute of limitationsapplicant prevailed

  Determinative passage · p.3On March 23, 2026, we issued our Decision determining in relevant part that the filing of a workers' compensation claim on applicant's behalf in 2004 did not impart the knowledge required to establish a date of injury under section 5412 and commence the running of the statute of limitations under section 5405. We observed that per applicant's testimony, he had not initiated the 2004 claim and had never spoken to the filing attorney. We also observed that none of the claim filing documents and supporting documentation were signed by applicant and that evidence established that applicant's only involvement with the claim had been to instruct that it be withdrawn after learning of the filing. (Decision, at pp. 9-10.) We noted the first evidence establishing compensable disability arising out of industrial exposures was the May 4, 2021 medical reporting of orthopedic physician Dr. Einbund. We thus identified May 4, 2021 as the section 5412 date of injury, and concluded that because the instant claim was not filed more than one year from the date of injury, compensation was not barred under section 5405. (Id. at p. 11.)

  The WCAB found that the applicant's date of injury was May 4, 2021, based on medical evidence, and that the 2004 claim filing did not establish knowledge of compensable disability to trigger the statute of limitations under section 5405.

• ADJ14305554 · 2026-06-09 · Santa Rosa District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.4II Section 4600(b) provides that "medical treatment that is reasonably required to cure or relieve the injured worker from the effects of the worker's injury means treatment that is based upon the guidelines adopted by the administrative director pursuant to Section 5307.27." (Lab. Code, § 4600(b).) Section 5307.27 specifies that these guidelines refer to the Medical Treatment Utilization Schedule (MTUS). (Lab. Code, § 5307.27(a).) The MTUS can be found in AD Rules 9792.20 through 9792.27.23 (Cal. Code Regs., tit. 8, § 9792.20-9792.27.23). The MTUS is presumptively correct on the extent and scope of treatment and is the primary source of guidance for physicians. (Lab. Code, § 4604.5(a); Cal. Code Regs., tit. 8, § 9792.21(c).) However, the MTUS may be rebutted, and treatment may be warranted based on recommendations outside the MTUS in limited situations. (Cal. Code Regs., tit. 8, § 9792.21(d); see also Lab. Code, § 4604.5(d).) If a UR decision is untimely, the determination of medical necessity must be made by the WCAB based on substantial medical evidence consistent with the MTUS. (Dubon II, supra, 79 Cal.Comp.Cases at 1300.)

  The Appeals Board found the December 3, 2024 UR determination was untimely under Labor Code section 4610 and former AD Rule 9792.9.1(f), requiring further development of the record with current medical evidence to determine medical necessity. The WCJ erred in dismissing the request as untimely without considering applicant's medical evidence.

  Official decision · page 4 →
• ADJ13797705 · 2026-06-09 · Santa Ana District OfficeJurisdiction / venuedeferred

  Determinative passage · p.1We granted reconsideration1 to further study the factual and legal issues in this case. Applicant sought reconsideration of the May 26, 2022 Findings and Order, wherein the workers' compensation administrative law judge (WCJ) found that the Workers' Compensation Appeals Board ("WCAB") cannot exercise subject matter jurisdiction over applicant's claim because he was not hired in California, did not regularly work here, and because California has no legitimate interest in his cumulative injury claim. Applicant contends that the WCJ erred because he was in fact hired in California and/or regularly employed here, thereby establishing subject matter jurisdiction pursuant to Labor Code section 3600.5, subdivisions (a). 2 We received an Answer. The WCJ prepared a Report and Recommendation on Petition for Reconsideration ("Report"), recommending that the Petition be denied. Subsequent to the grant of reconsideration, the Court of Appeal issued Atlanta Falcons v. Workers' Comp. Appeals Bd. (Gandy) (2025) 114 Cal.App.5th 1268 [90 Cal.Comp.Cases 997] ("Gandy"), a decision interpreting section 3600.5, subdivisions (c) and (d), and what constitutes "hire" in California for purposes of California workers' compensation proceedings more generally. Specifically, Gandy provided the following reasoning for rejecting the Appeals Board's interpretation of those subdivisions:

  The WCJ found no jurisdiction because applicant was not hired or regularly employed in California, but reconsideration was granted to consider the impact of the Court of Appeal decision Gandy (2025) which interprets 'hire' under section 3600.5 and favors a liberal construction to find California jurisdiction when a California-based team is involved.

  Official decision · page 1 →
• ADJ19384154 · 2026-06-04 · Santa Ana District OfficeJurisdiction / venueremanded

  Determinative passage · p.3(See Defendants' Trial Brief, at p. 1 ["It does appear there is personal jurisdiction over the Cardinals based on applicant's testimony that he worked in California briefly for the Cardinals in 2012."].) The matter went to trial on three issues: (1) subject matter jurisdiction over the case; (2) personal jurisdiction over each defendant; and (3) whether any defendant is exempt according to section 3600.5. (Minutes of Hearing / Summary of Evidence ("MOH/SOE"), 9/9/2025, at p. 2.) Applicant was the sole witness to testify. (MOH/SOE, 11/10/2025, at pp. 2§ 11.) The WCJ issued his F&O on March 2, 2026, finding as relevant to this Petition (1) personal jurisdiction over the Dodgers, and (2) that section 3600.5, subdivisions (c) and (d) do not bar applicant's claim. The appended Opinion on Decision makes clear that the WCJ based his finding on the rationale that the Dodgers, a California-based employer, employed applicant during the last year of his professional career. (Opinion on Decision, at pp. 6§ 8.) The F&O deferred the question of personal jurisdiction over the other defendants. (F&O, at p. 3.)

  The WCJ found personal jurisdiction over the Dodgers and that section 3600.5 subdivisions (c) and (d) do not bar the claim; however, the Appeals Board found concerns about substantial evidence on hire and work in California by the Dodgers, requiring further review.

  Official decision · page 3 →

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 36.

• ACE AMERICAN INSURANCE COMPANY
• ACE American Insurance Company
• ACE AMERICAN INSURANCE
• Ace American Insurance Company
• ACE American Insurance
• ACE AMERICAN
• ACE AMERICAN INSURANCE CO.
• Ace American Insurance
• ACE AMERICAN INSURANCE COMPANY/CHUBB
• ACE AMERICAN INSURANCE/CHUBB
• ACE USA
• ACE AMERICA 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.