In California’s workers’ compensation system, medical evaluations are often the battleground where key disputes over treatment and disability ratings are resolved. As a defense attorney, protecting the interests of employers and insurance carriers requires a solid understanding of Labor Code 4062.3, which governs communication with medical evaluators, particularly Qualified Medical Evaluators (QMEs) and Agreed Medical […]
Navigating the intersection of workers’ compensation claims and Medicare can be complex, particularly when it comes to understanding the concept of conditional payments. These payments are an essential part of the Medicare Secondary Payer (MSP) rules and play a significant role in the administration of Workers’ Compensation Medicare Set-Asides (WCMSAs). In this blog post, we […]
When dealing with Workers’ Compensation Medicare Set-Asides (WCMSAs), one critical phase that often determines the outcome is the review process conducted by the Workers’ Compensation Review Contractor (WCRC). The WCRC plays a pivotal role in ensuring that Medicare’s interests are protected by thoroughly evaluating the adequacy of proposed WCMSA amounts. This blog post will explain […]
When it comes to settling workers’ compensation claims that involve Medicare beneficiaries, one crucial aspect that must be considered is the establishment of a Workers’ Compensation Medicare Set-Aside (WCMSA). A WCMSA allocates a portion of the settlement to cover future medical expenses that would otherwise be paid by Medicare. There are two primary ways to […]
When settling a workers’ compensation claim, particularly when the claimant is a Medicare beneficiary or may soon become one, it is crucial to consider Medicare’s interests regarding future medical expenses. This is where a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) comes into play. A WCMSA is designed to allocate a portion of the workers’ compensation […]
The Virgil v. State Compensation Insurance Fund decision has not only clarified aspects of combining impairments in workers’ compensation claims but also creates an interesting dialogue with earlier cases, notably the Kite case. Understanding the relationship between these two cases is critical for defense attorneys, as it provides a broader context for interpreting the WCAB’s […]
The recent en banc decision in Virgil v. County of Kern has set a new benchmark in the interpretation of workers’ compensation laws, particularly regarding the evaluation of permanent disabilities and the principles of apportionment. This case provides critical guidance for defense attorneys who navigate the complexities of workers’ compensation claims. Here, the attorneys at […]
In the recent case of Hever Rivera Flores v. L.A. Specialty Food Produce Company, Inc., the Workers’ Compensation Appeals Board (WCAB) made a pivotal ruling that underscores the complexity of calculating Average Weekly Earnings (AWE) during extraordinary times, such as the COVID-19 pandemic. Background The applicant, an employee of L.A. Specialty Food Produce Company, Inc., […]
In a recent decision, Hidalgo v. Ducoing Management, Inc., the Workers’ Compensation Appeals Board (WCAB) addressed whether lodging and food allowances should be included in the calculation of a worker’s wages for temporary disability benefits. The case involved an injured laborer who claimed weekly earnings of $1,658.46, while the employer argued that his earnings were […]
A worker who is injured on the job in California has the right to claim no-fault benefits. He or she is covered even if the employer did nothing wrong. With that being said, employers do have certain workers’ compensation defense options. An employer has the right to deny a workers’ compensation claim if the employee’s […]
