August 18, 2022

California: Continuation of Treatment Previously Certified by Utilization Review

Who has the burden of proof and what must be shown before a unilateral termination of treatment? It’s been nearly a decade since the California Legislature adopted utilization review (UR) and independent medical review (IMR) as the new paradigm for resolving workers’ compensation medical treatment disputes. Ten years should be ample time to resolve all of the intricacies of UR. Nonetheless, many aspects of the UR-IMR...

August 08, 2022

Reflections on the National Commission on State Workmen’s Compensation Programs: An Interview with John F. Burton, Jr.

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board The Commission’s findings are as relevant today as they were 50 years ago. The Occupational Health and Safety Act of 1970 (Act) was signed into law on December 29, 1970, by President Richard M. Nixon. The Act, a truly bipartisan measure, was intended to ensure that all workers in the nation...

August 05, 2022

California: WCAB Jurisdiction Over Claim for Out-of-State Injury to Non-California Resident

Here’s an interesting Board Panel Decision on California jurisdiction over a claim for an out-of-state injury to a non-California resident. CA - NOTEWORTHY PANEL DECISIONS Copyright 2022 by Matthew Bender & Company, Inc. Brian Burk , Applicant v. Sarens international, Arch Insurance administered by Charles Taylor, Inc., Defendants W.C.A.B. No. ADJ13623575—WCJ Norma L. Acosta (SJO); WCAB Panel:...

August 03, 2022

California Compensation Cases July 2022

CALIFORNIA COMPENSATION CASES Vol. 87, No. 7 July 2022 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2022 LexisNexis. All rights reserved. LexisNexis Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions...

July 29, 2022

California: Labor Code 3600(a)(8) Explained: The Crime Exception to Employer Liability

What exactly is a crime that is punishable as specified in Section 17 of the Penal Code? It goes without saying that the exceptions to employer liability for compensation for an injury sustained by their employee that arises out of and occurs in the course of employment are quite limited. Those exceptions are listed in Labor Code section 3600 (a)(4) to (10). Among the most familiar include where the employee’s...

July 27, 2022

California Private Self-Insured Claim Frequency Hit a 14-Year High in 2021

Oakland, CA – Workers' compensation claim frequency among California's private self-insured employers hit the highest level since 2007 last year as both medical-only and indemnity claim volume rose according to a California Workers' Compensation Institute (CWCI) review of initial data from the state Office of Self-Insurance Plans (OSIP). OSIP's annual summary of private self-insured data, issued July...

July 22, 2022

Gig Drivers in the Era of COVID: How Safe Does it Feel Behind the Wheel?

By Roger Rabb, J.D. A new qualitative study examines the safety hurdles faced by digital platform drivers navigating the COVID landscape A common complaint by worker advocates against the rise of the “gig economy” is that gig workers are often provided little or no health and safety protection. In a recent study, “Perceived COVID-19 health and job risks faced by digital platform drivers and measures in place to protect...

July 22, 2022

CWCI Examines Issues in Reducing California’s Workers’ Comp Investigation Timeline

Oakland, CA – Proposals to cut the amount of time California workers’ compensation claims administrators have to investigate work-related injuries and determine employer liability may be easier said than done given existing statutory and regulatory time frames for the various steps within the process, many of which claims organizations do not control, according to a new analysis by the California Workers’ Compensation...

July 21, 2022

California: Top 25 Noteworthy Panel Decisions (January through June 2022)

LexisNexis has selected some of the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period January through June 2022. The first part of this year yielded a number of cases involving claims by professional athletes, including several clarifying the exemptions from California jurisdiction set forth in Labor Code § 3600.5(c) and (d). The list also includes decisions...

July 13, 2022

The Million Dollar Question on COVID-19 Presumptions: RAND’s Latest Study Expected to Guide the California Legislature

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board The Commission on Health, Safety and Worker’s Compensation (CHSWC) is responsible for on-going monitoring of California’s workers compensation system. As part of its oversight responsibilities, CHSWC asked The RAND Corporation (RAND) to evaluate how COVID-19 has affected the system. In particular...

July 13, 2022

California Compensation Cases June 2022

CALIFORNIA COMPENSATION CASES Vol. 87, No. 6 June 2022 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2022 LexisNexis. All rights reserved. LexisNexis Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions...

July 13, 2022

CWCI Finds Sharp Increase in California Workers’ Comp Med-Legal Costs Under New Fee Schedule

Oakland, CA -- Payments for medical-legal services used to resolve medical disputes over compensability issues in California work injury claims have risen sharply under the new Medical-Legal Fee Schedule (MLFS) that took effect last year according to a new CWCI study, with the increase in aggregate med-legal fees in the first seven months after the schedule took effect far exceeding the 25% increase anticipated by the...

June 24, 2022

California: Psychiatric/Sleep Injury; Violent Act Not Found

An interesting Board Panel Decision recently held that applicant’s injury, which occurred when he tried to stop an ice machine from falling, was not caused by a “violent act” so as to fall within the Labor Code § 4660.1(c)(2)(A) exception. As such, he was precluded under Labor Code § 4660.1(c)(1) from receiving a separate permanent disability rating for his psychiatric/sleep injury. The LexisNexis...

June 14, 2022

Study on COVID-19’s Impact on Drug Overdose Deaths by Occupational Is a Cause for Alarm

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board Take a look at the headlines in any newspaper or listen to the highlights of your favorite daily news broadcast and you are almost certain to receive an update on COVID-19. Perhaps you will be informed that Shanghai is expected to end its COVID-19 lockdown by the end of June 2022, or that Alameda...

June 10, 2022

New California WC Medical Mileage Rate For Travel On or After July 1, 2022

The mileage rate that California workers' comp claims administrators pay injured workers for travel related to medical treatment or evaluation of their injuries will increase from 58.5¢ per mile to 62.5¢ per mile for travel on or after July 1, 2022, regardless of the date of injury.  The old rate of 58.5¢ per mile still applies for travel from January 1 through June 30, 2022. California Labor Code §4600(e)(2), in...

June 09, 2022

CWCI Notes Changes in the Mix of California Workers’ Comp Prescription Drugs and Payments

Oakland, CA – New data from the California Workers’ Compensation Institute (CWCI) shows the types of drugs used to treat injured workers in California, and the distribution of payments for those medications, has shifted dramatically over the past decade, with opioids becoming far less prevalent and anti-inflammatory drugs (NSAIDs) accounting for an increasing share of the prescriptions and the total drug spend within...

June 06, 2022

California: Setting Aside the Dismissal of a Claim

A WCAB panel set aside an order dismissing an applicant’s death claim for inactivity. This decision is interesting for its discussion of when the Code of Civil Procedure applies, and the interplay of WCAB rules and the Code of Civil Procedure, among other things. Read our headnote here. Fredy Lara Portillo (Dec’d), Lorena Lara, Applicant v. Norman Etchison, Zenith Insurance Company, Defendants W.C.A.B...

June 01, 2022

California: Insurance Coverage; Site-Specific Workers' Compensation Insurance Policies

Recently a panel of the California WCAB issued an opinion regarding the validity of so-called site-specific workers’ compensation insurance policies. Read more about the Gharakhanian decision below in our headnote: CA - NOTEWORTHY PANEL DECISIONS Copyright 2022 by Matthew Bender & Company, Inc. Minas Gharakhanian , Applicant v. Cool Air Supply, California Insurance Guarantee Association for Ulico Casualty...

June 01, 2022

California Compensation Cases May 2022

CALIFORNIA COMPENSATION CASES Vol. 87, No. 5 May 2022 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2022 LexisNexis. All rights reserved. LexisNexis Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions...

May 19, 2022

California: Election by Employee in Cumulative Injury Case

A recent noteworthy Board panel decision discusses elections by the employee in cumulative injury cases. Reminder: Board panel decisions are not binding precedent. Our headnote reads: Lorenzo Arevalo , Applicant v. Limoneira Company, Inc., Main Limoneira Co., Zurich American Insurance Company administered by Gallagher Bassett Services, Inc., Defendants W.C.A.B. Nos. ADJ14549823, ADJ14549350—WCJ Sandra Rosenfeld...

May 11, 2022

Dealing with Long COVID in the Workplace: A Work in Progress?

A recent webinar addressed the issue of Long COVID and some current impacts on employment in the U.S. By Roger Rabb, J.D. While most of the media attention associated with the effects of COVID-19 infection has focused on test results, hospitalizations, and deaths, over two years into the pandemic more attention is now being given to the lingering long-term effects of the virus suffered by some patients, so-called...

May 05, 2022

California: Employer’s Serious and Willful Misconduct; Calculation of Increased Compensation Due; Industrial Disability Leave

In a noteworthy panel decision, a panel of the California Workers’ Compensation Appeals Board noted that while it does not have jurisdiction to order payments of IDL, it does have jurisdiction to award a 50 percent increase in compensation payments pursuant to Labor Code section 4553, calculated by including IDL payments made to Applicant during his TD period. The Board panel’s detailed explanation as to why...

April 28, 2022

California Compensation Cases April 2022

CALIFORNIA COMPENSATION CASES Vol. 87, No. 4 April 2022 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2022 LexisNexis. All rights reserved. LexisNexis Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions...

April 15, 2022

New Study Confirms Age as Strongest Risk Factor Associated with Increased Workers’ Comp Costs Related to COVID-19 Claims

By Thomas A. Robinson, J.D., co-author, Larson’s Workers’ Compensation Law A recent study—the report of which has been accepted for publication in the Journal of Occupational and Environmental Medicine (JOEM)—appears to confirm anecdotal evidence that an employee’s age at the time of COVID-19 infection is the major factor associated with prolonged impairment and high costs of COVID-19 workers’ compensation claims [see...

April 11, 2022

California: Board Panel Reverses Rebolledo 1, Clarifies Term “Lien Owner” under Labor Code Section 4903.8

On October 29, 2021, an Appeals Board panel issued a decision in which it held that a medical provider’s billing/collection service could pursue a lien for medical services as a non-attorney representative on the provider’s behalf but could not be the owner of the lien under Labor Code section 4903.8 for purposes of payment because it was not the assignee of the lien, nor did the circumstances permit it to...