Legal Developments

Workers’ Compensation Appeals Board (WCAB) New Updated Final Rules In Effect Beginning January 1, 2022

Califonia’s Workers’ Compensation Appeals Board (WCAB) has formalized its Rules of Practice and Procedure regarding remote hearings, electronic filing and service which were developed during the COVID pandemic, resulting in some new and updated rules. The new rules are effective January 1, 2022 and signal a shift to a more paperless (electronic) process for documents being served by both the court and by the parties.

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Temporary Total Disability Rate Updates Announced, Effective January 1, 2022

The rate changes are pursuant to Labor Code Section 4453(a) (10), which requires that the maximum and minimum weekly earnings that determine TTD benefits be increased yearly, by a percentage equal to the increase in the State Average Weekly Wage (SAWW). Workers with injury dates on or after January 1, 2003 are entitled to have their weekly Life Pension (LP) or permanent total disability (PTD) benefits adjusted based on the updated data.

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California’s Division of Workers’ Compensation Emergency Regulations for Medical-Legal Evaluations and Reporting Extended Through January 11, 2022

On October 4, 2021, California’s Division of Workers’ Compensation (DWC) announced that emergency regulations §§ 36.7 and 46.2 have been extended through January 11, 2022. Below is a summary of what the emergency regulations provide.

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California Division of Workers’ Compensation Copy Service Price Schedule Amendment Gets Hearing Date

The California Department of Industrial Relations (DIR) Division of Workers’ Compensation (DWC) has set a public hearing for Monday, August 30th, 2021, at 10:00am, to amend the Copy Service Price Schedule. The proposed changes stand to significantly increase costs for medical-legal reports.

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California Legislature Compels Study On Workers’ Compensation Delays And Care Access Issues In Medical Provider Networks

The study, to be delivered no later than January 1, 2023, must compare data for injury claims in which workers were treated by a medical provider network (MPN) with the same data for those treated by doctors not part of an MPN.

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SB-335 Will Be Heard By CA State Senate Appropriations Committee on May 10th

The Califonia State Senate’s Labor, Public Employment and Retirement Committee passed SB-335 by a vote of 4-1, moving it on to a hearing by the Appropriations Committee on May 10th at 9am. The bill, proposed by Senator Dan Cortese (D-San Jose), would shorten the window for employers to reject workers’ compensation claims from 90 days to 45 days.

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Hearing Scheduled On Multiple Workers’ Compensation Bills, Including Medical Provider Network Creation

The California legislature’s Assembly Insurance Committee will hear testimony on Thursday regarding several pieces of workers’ compensation legislation, including a proposal for the creation of a state-wide network of medical providers for the treatment of injured workers. The deadline for DWC to establish the network could be June 30, 2022.

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New Medical-Legal Fee Schedule & Regulations Effective April 1, 2021, Including Fee Multipliers

The California Department of Industrial Relations, Division of Workers’ Compensation’s new Medical-Legal Fee Schedule (MLFS), which took effect on April 1st, 2021, will significantly increase the cost of medical-legal evaluations, and may have a wider impact on contested claims than initially indicated. The regulations apply to all evaluations taking place on or after April 1st, 2021, and include new multipliers that can further increase the cost of exams and evaluations.

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Summary of California’s Division of Workers’ Compensation Emergency Regulations for Medical-Legal Evaluations and Reporting

As announced yesterday, California’s Division of Workers’ Compensation (DWC) emergency regulations §§ 36.7 and 46.2 have been extended through October 12, 2021.  Below is a summary of what the emergency regulations provide. This extension is in accordance with California Governor Gavin Newsom’s Executive Orders N-40-20 and N-71-20, and is the first 210-day extension of these regulations.

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Employers: Stay Ahead of Additional Reporting and Posting Requirements for COVID-19

The global health crisis has spurred numerous pieces of legislation related to workers’ compensation, with a maze of requirements to navigate. Now, more than ever, it is important for employers to carefully take into consideration all applicable rules and regulations to ensure compliance and minimize risk.

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California WCAB Suspends Rule on Assignment of Walk-Through Cases

In an en banc decision Tuesday morning, California’s Workers’ Compensation Appeals Board (WCAB) suspended WCAB Rule 10789(c), which requires that each district office have a designee of the presiding judge available on court days to assign walk-through cases, citing the ongoing state of emergency and marking a shift from the current “e-file only” approach. This allows district offices to schedule their own timeframes based on staffing and safety.

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Worker Charged with 11 Felony Counts After Video Evidence Emerges in Workers Compensation Insurance Fraud Case

A worker who sustained injuries repairing a water line subsequently claimed additional injuries and a lack of improvement, and has been charged with multiple felony counts, including workers’ compensation fraud and presenting false documentation in order to receive compensation.

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Legislative Update: Amended COVID-19 Presumption Bills Remain Under Review as California Senate Closes Due to Coronavirus

The three bills under review to establish workers’ compensation presumptions for COVID-19 cases are still pending discussion, with more proposed amendments expected and negotiations anticipated to continue leading up to closure of the legislature’s 2020 session on Monday, August 30th. Discussion of the bills stalled when Wednesday’s floor session was canceled and the Senate closed temporarily due to a member testing positive for COVID-19.

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California Legislature Votes, Will Hold Appropriations Committee Hearing on Multiple Bills to Create COVID-19 Presumptions for “Essential” and Other Workers

As we have written previously, the California state legislature will begin to hear testimony on Senate Bill 1159, in a session beginning August 11th at 10am. In addition, testimony will be heard on two other bills, Assembly Bill 196 (AB 196) and Assembly Bill 664 (AB 664). These two bills create separate presumptions, one conclusive and one rebuttable, that cover essential employees. 

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California Legislature to Hear Testimony on Multiple Bills to Create COVID-19 Presumptions for “Essential” and Other Workers

As we have written previously, the California state legislature will begin to hear testimony on Senate Bill 1159, in a session beginning August 11th at 10am. In addition, testimony will be heard on two other bills, Assembly Bill 196 (AB 196) and Assembly Bill 664 (AB 664). These two bills create separate presumptions, one conclusive and one rebuttable, that cover essential employees. 

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Legislative Update: California Lawmakers To Evaluate Adding COVID-19 Presumption to Labor Code

The California Assembly Insurance Committee will hear testimony on Wednesday concerning SB1159, a bill that would codify Governor Newsom’s Executive Order establishing a rebuttable presumption that coronavirus (COVID-19) cases contracted at work between March 19th and July 5th are compensable.

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California Workers’ Compensation Anesthesiologist Charged With 88 Felony Counts in Insurance Fraud Scheme

A California workers’ compensation anesthesiologist has been charged with 88 felony counts in a healthcare insurance fraud scheme that prosecutors say cost insurance companies over $650 million in fraudulent billings.

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Workers’ Compensation Claims and Coronavirus Layoffs: Disability Liability For Workers on Modified Duty

If an employee was working modified duty under a workers’ compensation claim, and they are laid off, there is a substantial question of whether they are entitled to TTD under the workers’ compensation claim. 

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California Supreme Court Declines to Review or Depublish Ruling in Meadowbrook Insurance Co. v. WCAB (DFS Interpreting)

On Wednesday, the Supreme Court denied the petition for review and multiple depublication requests in the the case of Meadowbrook Insurance Co. v. WCAB (DFS Interpreting). The Court of Appeals’ November 2019 ruling will stand and be published and citable as a rule of law. 

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New and Amended Workers’ Compensation Rules of Practice and Procedure Effective January 1, 2020

New and amended Workers’ Compensation Rules of Practice and Procedure took effect on January 1, 2020. The updated Rules include renumbering and reorganization, as well as repeals and new regulations. Click here to read our Summary for a highlight of some of the relevant changes.

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3rd District Court of Appeal ruling in Meadowbrook Ins. Co. v. WCAB addresses timeliness of EOR and subsequent jurisdiction.

The 3rd District Court of Appeal issued a ruling in Meadowbrook Ins. Co. v. WCAB [link below] that an interpreter bill for med-legal services will be barred if the provider does not seek a second review following denial by the defendant’s EOR under the IBR/non-IBR process located in LC4603.2(e).

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Southern California Doctor Sentenced to Two Years Over Kickbacks

Dr. Timothy J. Hunt has been ordered to serve two years in federal prison and will forfeit $3 million after admitting to taking over $1.5 million in illegal kickbacks from Pacific Hospital of Long Beach over a five year period.

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Workers’ Comp Case in New Hampshire Involving Opioids Comes Down to Employee’s Intentional Ingestion of Drugs

In a workers’ comp case involving opioids in New Hampshire, the NH Disability Rights Center and its insurer faced an argument that “where a work-related injury leads to addiction or substance abuse, that death is compensable.” The New Hampshire Supreme Court affirmed the CAB ruling to deny benefits based on the employee’s actions.

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Appellate Court Confirms Change in Apportionment Law

The First Appellate District Court of Appeals has reversed the Workers’ Compensation Appeals Board (WCAB)’s decision on a high profile apportionment case, finding the WCAB was not applying the correct standard for apportionment under Labor Code Section 4663 to nonindustrial factors of impairment.

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Court of Appeals Limits Temporary Disability Award Length

The Court of Appeals issued a decision today in the case of Kyle Pike vs County of San Diego. The decision found that, for dates of injury after January 1st, 2008, there can be no temporary disability awarded more than 5 years after the injury.

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Criminal Medical Providers and Their Liens

In 2012, the Legislature enacted SB 863 in order to thwart the longstanding lien crisis and achieve the Constitutional goals of the workers’ compensation system. Although the quest to eradicate ancient liens by establishing time limits and the requirements for payment of activation and filing fees, the beneficial results were short-lived.

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Supreme Court Won’t Decide Whether MPN Doctors’ Opinions Are Subject to UR/IMR

The California Supreme Court has declined a request for review of the Workers’ Compensation Appeals Board’s (WCAB) decision in Parrent v. SBC-Pacific Bell Telephone Company.

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Defending a Second Panel Obtained By Filing a Cumulative Trauma Claim

The Workers’ Compensation Appeals Board recently issued its decision in Feige v State of California 2017 Cal. Wrk. Comp. P.D. LEXIS 10.

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Recent Noteworthy Panel Decisions

Recent Noteworthy Panel Decisions (NPDs) involving the determination of an applicant’s official date of injury and the statute of limitations as well as who is liable for the applicant’s injury.

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Addressing Fraud with New Legislation – SB 1160 and AB 1244

Numerous efforts were undertaken in years past to eliminate fraud from the workers’ compensation system.

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Claims & Lost Wages – LC §132a

In the case of Victoria Lacheta v. Olympic Security Services (2014 Cal. Wrk. Comp. P.D. LEXIS 324), applicant prevailed in her wrongful termination claim against her employer; however, she failed to sustain her burden of entitlement to lost wages six years after the initial Findings and Award. This case poses two questions: (1) Does the … Continued

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