April 07, 2022

California: New and Further Disability and Filing a Timely Petition to Reopen

Pascacio v. Jacobo Farm Services, 2022 Cal. Wrk. Comp. P.D. LEXIS --, contains an excellent discussion about new and further disability and filing a timely petition to reopen. Here’s our headnote for the panel decision: Petition to Reopen—Five-Year Statute of Limitations—WCAB, granting reconsideration, rescinded WCJ’s decision that applicant laborer’s claim of new and further disability...

March 29, 2022

California Compensation Cases: March 2022

CALIFORNIA COMPENSATION CASES Vol. 87, No. 3 March 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...

March 29, 2022

California: Irregularities in Pleadings Before the WCAB: Are Defective Pleadings Always Fatal?

The Workers’ Compensation Appeals Board’s (WCAB) Rules of Practice and Procedure (see Cal. Code Reg., tit. 8, § 10300 et seq.) specify the process and manner for filing a claim asserting a work-related injury. WCAB rule 10450 states that the jurisdiction of the WCAB may be invoked by the filing of an Application for Adjudication of Claim (application), and rule 10455 requires the filing of an application...

March 27, 2022

California: Recent Board Panel Decision Applies Dubon II and Patterson

Castillo v. Midnight Impressions, 2022 Cal. Wrk. Comp. P.D. LEXIS – (Appeals Board noteworthy panel decision), should be read and kept handy by all workers’ compensation practitioners who represent or defend parties involving brain injury cases. The decision is replete with case law citations on the issue of continuing medical treatment in catastrophic cases. This case presents a line drawn between when a...

March 23, 2022

CWCI Study Finds Sharp Decline in California Workers’ Comp Independent Medical Reviews

Oakland, CA – A California Workers’ Compensation Institute (CWCI) study on the Independent Medical Review (IMR) process used to resolve workers’ comp medical disputes shows that the number of IMR decision letters hit an all-time low in 2021 as pharmaceutical disputes – especially those involving opioids – have continued to decline since the state adopted evidence-based chronic pain and opioid guidelines and a prescription...

March 14, 2022

Earnings Losses and Benefit Adequacy in California’s Workers’ Compensation System

A Review of RAND’s Final Report By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board Ask anyone generally familiar with workers’ compensation what the intended purpose of a workers’ compensation system is and you will be told that it is responsible for providing workers injured on the job with prompt no-cost medical care and indemnity benefits...

March 09, 2022

California: Noteworthy Independent Medical Review (IMR) Decisions (3/2022)

LexisNexis has selected some recently issued noteworthy IMR decisions that illustrate the criteria that must be met to obtain authorization for a variety of different medical treatment modalities. LexisNexis Commentary for each selected IMR is provided below. Many of these IMR decisions were reprinted in California Compensation Cases , which can be accessed on Lexis Advance. Lexis Advance subscribers can access those...

March 07, 2022

CWCI Examines Medical Access In California Workers' Compensation

Oakland, CA – A new California Workers’ Compensation Institute (CWCI) study finds that overall, injured workers’ access to medical care for their initial treatment remained relatively consistent between 2010 and 2020, though average and median wait times for the first doctor visit varied by type of care, and as in group health and other systems, rural residents have the farthest to travel and access to fewer providers...

March 02, 2022

California: CIGA: A Noteworthy Board Panel Decision

In what may be a case of first impression, a Board panel has held that CIGA cannot obtain reimbursement from an insurance carrier where CIGA and the carrier both were liable to an injured worker, but the carrier entered into a complete settlement with the worker. Here’s our headnote for the Suarez case: California Insurance Guarantee Association—Other Insurance—Reimbursement and Contribution—WCAB...

February 23, 2022

California Compensation Cases February 2022

IMPORTANT NOTICE: STARTING NEXT MONTH, WITH THE MARCH 2022 ISSUE OF CAL. COMP. CASES, ALL LEXIS CITES WILL DIRECT YOU TO LEXIS+. IF YOU DO NOT HAVE A LEXIS+ ACCOUNT YET, PLEASE CONTACT LEXISNEXIS CUSTOMER SERVICE.   CALIFORNIA COMPENSATION CASES Vol. 87, No. 2 February 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...

February 22, 2022

California: Information and Assistance Officers – The “Five” Ws: Who What When Why Where & How?

By Hon. Robert G. Rassp Also by: Rose Stephanian, I&A Officer, WCAB Los Angeles, Olivia Iniguez, I&A Officer, WCAB Los Angeles DISCLAIMER: The opinions expressed in this chapter are those of the authors and are not those of the California Department of Industrial Relations, the Division of Workers’ Compensation, or the Workers’ Compensation Appeals Board INTRODUCTION: Do you know what “Hopper-izing” the...

February 09, 2022

Should Losses Caused by COVID-19 Be Covered Through the Workers’ Compensation System?

RAND Examines the Pros and Cons By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board As we mark the second anniversary of the arrival of SARS-COV-2, which causes the disease known as COVID-19, there is growing recognition that this unpredictable and highly contagious virus will likely be with us for some time. COVID-19 has challenged our country...

February 04, 2022

California: Noteworthy Panel Decision on Sub Rosa Films

Juan Licea, Applicant v. Screwmatic, Insurance Company of the West, Defendants W.C.A.B. No. ADJ10568300—WCJ Roger A. Tolman, Jr. (LAO); WCAB Panel: Commissioner Razo, Chair Zalewski, Deputy Commissioner Schmitz Workers’ Compensation Appeals Board (Board Panel Decision) Opinion Filed January 28, 2022 Disposition: Reconsideration is granted , and the May 21, 2021 Findings and Orders are rescinded , and...

February 03, 2022

California Compensation Cases January 2022

CALIFORNIA COMPENSATION CASES Vol. 87, No. 1 January 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 Advance to read the complete headnotes and...

January 27, 2022

California: Occupational Infections and Workers' Compensation: Proving Industrial Exposure in Valley Fever Cases

With the novel COVID-19 pandemic still looming so large in our collective vision, it is sometimes easy to forget that infections have long been part of the landscape of our workers’ compensation system. An infection may be bacterial, like tuberculosis; viral, like some forms of pneumonia; or it may be fungal, like coccidiomycosis (aka valley fever). Of course, whether any infection is covered by workers’ compensation...

January 19, 2022

RAND Study Sheds Light on COVID-19’s Impact on California Workers’ Compensation System

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board As we enter the third year of the global pandemic, it is abundantly clear that COVID-19 has impacted nearly every aspect of life, not the least of which is our work lives. For nearly eighteen months, from March 19, 2020 to June 15, 2021, all California residents EXCEPT those workers necessary...

January 18, 2022

CWCI: California Workers’ Comp COVID Claims Spiked During the December Omicron Surge

Oakland – California workers’ comp COVID-19 claim volume continues to track with the state’s fluctuating COVID infection trends as the latest monthly count of COVID workers’ comp claims jumped 172% in December to the second highest level of the year as the Omicron variant spread rapidly across the state according to a California Workers’ Compensation Institute (CWCI) review of claims reported to the state Division of...

January 12, 2022

Mackie Board Panel Decision: The Anatomy of a Successful IMR Appeal

It’s been nearly a decade since the Legislature replaced Workers’ Compensation Judges (WCJ) and the Workers’ Compensation Appeals Board (WCAB) as the arbiters of medical treatment disputes involving industrially injured workers. We have become accustomed to the resolution of such disputes through utilization review (UR), with any appeal being conducted through independent medical review (IMR). We also know that the Legislature...

January 06, 2022

California: Top 25 Noteworthy Panel Decisions (July through December 2021)

LexisNexis has selected some of the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period July through December 2021. The latter part of this year yielded a number of cases addressing medical-legal issues, including one in which the WCAB Commissioners were split as to whether an employee was permitted to unilaterally withdraw from an agreement with his employer...

January 04, 2022

California Compensation Cases December 2021

CALIFORNIA COMPENSATION CASES Vol. 86, No. 12 December 2021 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 2021 LexisNexis. All rights reserved. LexisNexis Online Subscribers: You can link to your account on Lexis Advance to read the complete headnotes and...

January 01, 2022

Pennsylvania: “No-Holds-Barred” Meeting Leads to Compensable PTSD Claim

The evidence supported a WCJ’s finding that a “no-holds-barred” meeting, at which a former police officer was singled out for criticism, and which digressed into an abusive, vulgar, shouting match, was an extraordinary and unusual event, such that the officer’s mental injury claim for PTSD was compensable, held a Pennsylvania appellate court in an unreported decision. The court acknowledged that...

January 01, 2022

Oregon: Stress Claim Fails Under State’s “Major Contributing Cause” Standard

Construing Oregon’s “clear and convincing evidence” standard, along with the state’s requirement that work conditions constitute the “major contributing cause” of the worker’s claimed condition, a state appellate court affirmed a determination by the state’s Workers’ Compensation Board that denied benefits for a worker’s mental disorder claim. Acknowledging that the worker established that she had been under some level...

January 01, 2022

Missouri: Seasonal, Full-Time Work Shows Worker Was Not Permanently Totally Disabled

The Missouri Commission was justified in filing that an injured worker did not suffer from a permanent total disability where evidence indicated that following his injuries, the worker worked on a full-time, seasonable basis, held a state appellate court. Based upon that finding, the state’s Second Injury Fund was not liable to the employee for additional benefits. The appellate court said the evidence clearly showed...

January 01, 2022

Oregon: “Annex Parking Area” Considered Part of Employer’s Premises for Purposes of Going and Coming Rule

Where an employer determined that there was inadequate parking for its employees immediately adjacent to its offices and arranged through its landlord to secure additional parking spaces in a nearby parking lot, and encouraged its employees to utilize those spots, the “annex parking area” became a part of the employer’s premises, such that an employee’s injuries in a slip and fall on ice while walking from the annex area...

January 01, 2022

New York: 19-Month Delay in Seeking Treatment, Coupled with Inadequate Medical Evidence Supports Board’s Denial of Benefits

Substantial evidence supported a decision by New York’s Workers’ Compensation Board that denied benefits to a claims examiner who contended she suffered a shoulder injury in a work-related fall at her office where she waited 19 months before seeking medical treatment and acknowledged that she suffered from preexisting physical issues as well. Observing that the claimant had waited to file her claim and had...