Schools Insurance Authority

What they litigate

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

• Apportionment3
• Medical treatment / UR / IMR1
• Permanent disability rating1
• Sanctions under Labor Code §58131
• SJDB voucher1
• Temporary disability1

Where they appear

• Sacramento 5
• Lodi 1
• Oakland 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.

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

Counted over 7 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.

• ADJ9712319 · 2025-06-20 · Sacramento District OfficeMedical treatment / UR / IMRdefendant prevailed

  Determinative passage · p.4Petitioner, Defendant-Elk Grove Unified School District, petitions for reconsideration of the Findings of Fact and Opinion on Decision issued March 28, 2025, arguing that the undersigned Workers' Compensation Judge (WCJ) misapplied the law in determining that utilization review (UR) was untimely. Specifically, the defendant contends that the Request for Authorization (RFA) was incomplete and returned in accordance with 8 CCR§ 9792.9.l(c)(2)(A) and that no further obligation existed absent a corrected RFA.

  The RFA was procedurally complete and triggered UR obligations. Defendant's failure to issue a timely denial with mandatory conditional language rendered the UR untimely and invalid.

  Official decision · page 4 →
• ADJ12140821 · 2024-04-12 · Sacramento District OfficeApportionmentapplicant prevailed

  Determinative passage · p.3August 9, 2023 supplemental report, do not constitute substantial evidence addressing the issue of apportionment. (Escobedo v. Marshalls, supra.)1

  Dr. Abelow's reports did not explain how and why non-industrial factors caused permanent disability or the assigned percentage, thus not substantial evidence; defendant failed to meet burden of proof on apportionment.

  Official decision · page 3 →
• ADJ12140821 · 2023-06-09 · Sacramento District OfficeApportionmentremanded

  Determinative passage · p.1Applicant and Defendant each seek reconsideration of the Findings of Fact (Findings) issued by the workers' compensation administrative law judge (WCJ) on March 23, 2023, wherein the WCJ found in pertinent part that applicant's disability should be rated using "dual occupational variants, 250 and 322" and that 75% of applicant's disability was caused by her industrial injury and 25% would be apportioned to prior non-industrial factors.1

  Dr. Abelow's apportionment reports lacked explanation for the change in opinion and failed to explain how and why pre-existing factors caused permanent disability at the time of evaluation, thus not constituting substantial evidence. The WCAB granted reconsideration and remanded for further proceedings to clarify apportionment and to use the single occupational variant with the higher disability rating.

  Official decision · page 1 →
• ADJ7054381 · 2022-08-30 · Sacramento District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.4The factors of permanent disability are based upon the reports of Dr. Isono. The basis for apportionment must be clear; the medical-legal report must "describe in detail the exact nature of the apportionable disability, and set forth the basis for the opinion." Escobedo v. Marshalls (2007) 70 Cal. Comp. Cases 604, 621 (en banc).

  Dr. Isono's detailed impairment ratings and apportionment findings were accepted, supporting a 51% permanent disability award.

  Official decision · page 4 →
• ADJ3359423 · 2021-04-27 · Oakland District OfficeApportionmentdefendant prevailed

  Determinative passage · p.8Here, applicant contends that there is no substantial evidence reflecting that he suffered a cumulative trauma through December 26, 2006 (ADJ7688594) and that Hikida precludes apportionment in this matter because his disability is a result of a failed laminectomy. However, at trial, the admitted facts in ADJ7688594 reflected that applicant had a cumulative injury through December 26, 2006. (Minutes of Hearing and Summary of Evidence (MOH/SOE), January 26, 2021, p. 3.) Applicant does not acknowledge that stipulation or provide good cause to set aside that stipulation. (County of Sacramento v. Workers Compensation Appeals Bd., (Weatherall) (2000) 65 Cal. Comp. Cases 1.) Moreover, applicant himself testified that after his 2002 injury he only performed half of his job duties, that his symptoms worsened as a result of working, and that "the work was wearing him down." (MOH/SOE, pp. 8-9, 12.) Similarly, Dr.

  The AME's apportionment determinations were found to constitute substantial evidence, supported by applicant's testimony, medical history, and the AME's reasoning. Vocational evidence and FCE did not rebut the scheduled rating as they did not properly account for apportionment or were not based on correct history.

  Official decision · page 8 →
• ADJ19129395 · 2025-06-03 · Lodi District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.1It has come to the attention of the Appeals Board that while this matter was pending on removal, the parties entered into a Compromise & Release. Therefore, the Petition for Removal in response to the decision issued on April 9, 2025 is moot, and it will be dismissed.

  The parties entered into a Compromise & Release while the Petition for Removal was pending, rendering the petition moot.

  Official decision · page 1 →
• ADJ10914052 · 2022-10-11 · Sacramento District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.5GOOD CAUSE TO REOPEN Generally good cause to rescind an Order Approving Compromise and Release r quires showing that the settlement was secured by fraud, mutual mistake, duress, undue influence, or substantial procedural irregularities. Applicant claims fraud and duress, of which there is no credible evidence.

  Applicant failed to establish good cause to reopen the Compromise and Release settlement; no credible evidence of fraud, duress, or procedural irregularities.

  Official decision · page 5 →

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.

• Schools Insurance Authority
• SCHOOLS INSURANCE AUTHORITY

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.