September 17, 2024

What Makes a Workers’ Compensation Claim a High-Cost Claim? The Latest Word

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board Over the past several decades California has implemented broad legislative changes aimed at lowering the costs associated with workers’ compensation, especially medical expenditures. Such measures as fee schedules, treatment guidelines, medical provider networks, and utilization review...

September 12, 2024

California Compensation Cases September 2024

CALIFORNIA COMPENSATION CASES Vol. 89, No. 9 September 2024 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 2024 LexisNexis. All rights reserved. Lexis+ Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court...

September 09, 2024

Larson’s Workers’ Compensation Law Case Spotlights (Fall 2024)

By Thomas A. Robinson, co-author, Larson’s Workers’ Compensation Law Editorial Note: All section references below are to Larson’s Workers’ Compensation Law, unless otherwise indicated. Traveling Employee Injured in Fall Down Employer’s Unobstructed Stairs. Acknowledging that generally, traversing stairs is a neutral risk and injuries resulting therefrom are not compensable under the Illinois...

September 09, 2024

California: Define Causation of Disability % and Nail Apportionment

By Hon. Colleen Casey, Former Commissioner, California Workers’ Compensation Appeals Board One of the most common reasons evaluating physicians flunk the apportionment validity test is due to their tendency to conflate causation of injury with causation of disability. An easy way to avoid this problem is to adhere to a normal four-step progression of case development from AOE/COE (arising out of employment and...

August 28, 2024

Artificial Intelligence (AI) in Medicine and Law

Position paper presented at CSIMS 2024 by Hon. Robert G. Rassp, Chairman of the Board of Directors, Friends Research Institute (friendsresearch.org) Disclaimers: The opinions expressed in this article are those of the author and are not those of the State of California Department of Industrial Relations, Division of Workers’ Compensation, or the Workers’ Compensation Appeals Board. The opinions expressed...

August 22, 2024

California Compensation Cases August 2024

CALIFORNIA COMPENSATION CASES Vol. 89, No. 8 August 2024 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 2024 LexisNexis. All rights reserved. Lexis+ Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions...

August 15, 2024

California: A Clarification on the Requirements for Expedited Review under AD Rule 9792.9.1

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board The June 13, 2024 edition of the LexisNexis Workers’ Compensation eNewsletter included an article that discussed the requirements of an expedited request for medical treatment and the utilization review (UR) of that request (see https://www.lexisnexis.com/community/insights/legal...

August 05, 2024

California: Top 25 Noteworthy Panel Decisions (January through June 2024)

LexisNexis has selected some of the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period January through June 2024. The first part of this year yielded a number of cases addressing medical-legal procedure, including a decision discussing the requirements that must be met to obtain additional QME panels in different specialties, and another confirming...

July 30, 2024

California: The Binding Effect of Pre-liquidation Agreements on CIGA: The Latest Word

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board It is well understood that the California Insurance Guarantee Association (CIGA) is not an insurer that issues policies of insurance or assumes the contractual obligations under an insurance policy, nor does it collect premiums from insureds. Rather, it is a statutorily created association...

July 24, 2024

California Compensation Cases July 2024

CALIFORNIA COMPENSATION CASES Vol. 89, No. 7 July 2024 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 Lexis+ Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions, en banc decisions, writ denied summaries, panel decisions...

July 23, 2024

California: VR Experts Can Hit the Ball Out of the Park But Not Without Oversight from Doctors

Havanis v. Calif. Dept. of Transportation (Board Panel Decision) By Hon. Colleen Casey, Former Commissioner, California Workers’ Compensation Appeals Board I. Medical apportionment is not the same as VR apportionment Medical apportionment is a totally different concept from vocational apportionment. In sports terms, medical apportionment would be football, and vocational apportionment would be cricket. Football...

July 16, 2024

California: The Kite Case on Steroids: How to Rebut the Combined Values Chart

By Robert G. Rassp, author of The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation (LexisNexis) Disclaimer: The material and any opinions contained in this treatise are solely those of the author and are not the opinions of the Department of Industrial Relations, Division of Workers' Compensation, or the WCAB, or any other entity or individual. The materials are intended to be a...

July 09, 2024

Fewer Claims But Higher Losses for California Workers’ Comp Private Self-Insureds

Oakland, CA – Private self-insured claim volume in the California workers' compensation system fell 9.5% in 2023, producing the biggest year-to-year decline in private self-insured claim frequency in more than 15 years, but double-digit increases in the average amounts paid and incurred on these claims drove total paid and incurred losses for private self-insured employers sharply higher according to a California...

July 08, 2024

Excessive Heat’s Impact on Workers and Employers

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board No matter the source of your media consumption, it seems that the topic of heat is everywhere. Stories about excessive heat have become ubiquitous. For example, on December 5, 2023, US News & World Report released an article calling 2023 the hottest year on record. (Smith-Shoenwelder...

July 08, 2024

California: WCAB’s New Guidelines for Application of Labor Code § 4664(c)(1): Accuracy over Absurdity

By Hon. Colleen Casey, Former Commissioner, California Workers’ Compensation Appeals Board Who doesn’t agree with the fact that “[w]e should not interpret or apply statutory language in a manner that will lead to absurd results?” (See the recent Noteworthy Panel Decision (NPD) of Fraire v. Department of Corrections , 2020 Cal. Wrk. Comp. P.D. LEXIS 60 , 85 Cal Comp Cases 697 (Appeals Board noteworthy...

June 29, 2024

California: COVID-19 and the Fraudulent Concealment Exception

When do the exclusivity provisions of Labor Code section 3600 permit an action for law at damages? By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board Generally, an employee injured in the course and scope of their employment is limited to remedies under California’s Workers’ Compensation Act (act) (Lab. Code, § 3600(a...

June 29, 2024

California Workers’ Comp Med-Legal Costs Up Sharply Under New Fee Schedule

Oakland, CA -- Payments for medical-legal evaluations and reports used to resolve medical disputes in California work injury claims have increased more than expected since a new Med-Legal Fee Schedule (MLFS) took effect in April 2021 according to a new CWCI study, with the average payment for a comprehensive exam up 52%, primarily due to new per-page fees for record review that are paid on top of flat fees for med-legal...

June 20, 2024

California Compensation Cases June 2024

CALIFORNIA COMPENSATION CASES Vol. 89, No. 6 June 2024 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 Lexis+ Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions, en banc decisions, writ denied summaries, panel decisions...

June 19, 2024

California: Questioning the Vocational Expert; Criteria for Vocational Reports

By Hon. Robert G. Rassp and Hon. Clint Feddersen Questioning the Vocational Expert [a] Depositions Counsel will often need to take the deposition of the vocation expert. Live testimony of a vocational expert can occur only on a showing of good cause [ see [b], below ]. Vocational experts are now like medical physicians—their reports are admissible if in a proper form required by statute [ see Lab. Code, §...

June 17, 2024

CWCI Examines California’s Proposed Presumption for Agricultural Heat Injuries

Oakland, CA – A bill that would give a presumption of compensability to farmworker heat-related injury claims if the employer is found to be out of compliance with Cal/OSHA’s outdoor heat illness prevention standard would likely create more challenges than it would solve, entail significant administrative friction costs, and is unlikely to have an appreciable impact on agricultural worker safety according...

June 13, 2024

California: When Is an Expedited Review of a Treatment Request Required?

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board Utilization Review (UR) to determine the appropriateness and necessity of requested medical treatment in a timely manner based on accepted medical standards and guidelines has been a mandatory component of California’s workers’ compensation system for over two decades. In that...

May 29, 2024

California: Appeals Board Panel Clarifies Scope and Intent of Labor Code § 4663(d) Disclosure Requirement

Appeals Board panel revisits Hardesty By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board One of the first lessons learned by practitioners new to the field of workers’ compensation law is that proceedings before the Workers’ Compensation Appeals Board (WCAB) are governed by specific provisions of the Labor Code and the Rules...

May 29, 2024

California Compensation Cases May 2024

CALIFORNIA COMPENSATION CASES Vol. 89, No. 5 May 2024 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 Appellate Court Compensation Case Lexis+ Online Subscribers: You can link to your account on Lexis+ to read the complete headnotes and court decisions, en banc decisions...

May 17, 2024

California: A Look at the Distinct Roles of Evaluating Physicians

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board The medically related intricacies of a California workers’ compensation case are varied and often confusing. Acronyms abound. They include agreed medical evaluator (AME) and qualified medical evaluator (QME), medical provider network (MPN), primary treating physician (PTP) as well...

May 08, 2024

California: Noteworthy Independent Medical Review (IMR) Decisions (May 2024)

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+. The list discusses specific IMR opinions which explain...