In a significant decision for California public employers and claims professionals, the California Supreme Court in Department of Corrections and Rehabilitation v. Workers’ Compensation Appeals Board (Ayala) has clarified that Industrial Disability Leave (IDL) benefits paid under the Government Code do not qualify as “compensation” under the Workers’ Compensation Act. This means that when an […]
Introduction In California’s workers’ compensation system, utilization review (UR) is the primary “gatekeeper” to determine whether requested medical treatment is medically necessary. If UR is performed timely and in compliance with statutory and regulatory requirements, a Workers’ Compensation Judge (WCJ) generally cannot second-guess or overturn the treatment determination. Instead, disputes go to Independent Medical Review […]
A recent panel decision, Moraido v. County of San Diego (2024) Cal. Wrk. Comp. P.D. LEXIS 375, provides valuable insight for claims adjusters and defense attorneys on the interplay between vocational evidence, medical apportionment, and permanent disability in California workers’ compensation cases. While this decision has not been designated a “significant panel decision,” it nonetheless […]
In Larson v. Moraga Orinda Fire Dist. (2024 Cal. Wrk. Comp. P.D. LEXIS 287, the Workers’ Compensation Appeals Board (WCAB) concluded that a firefighter’s off-duty trail running injury was compensable under Labor Code section 3600(a)(9). Despite the employer’s argument that the injury fell under the “voluntary participation” bar for off-duty recreational activities, the WCAB found […]
A recent Workers’ Compensation Appeals Board (WCAB) panel decision—D’Alessandro v. City of Menifee—addresses whether a police officer’s off-duty knee injury while taking a jiu-jitsu class qualified as industrial. In a split decision, the WCAB granted the officer’s Petition for Reconsideration and found that his activity was sufficiently tied to his employment and considered AOE/COE. D’Alessandro […]
It has been a decade since the California Supreme Court decided South Coast Framing, Inc. v. Workers’ Compensation Appeals Board (Clark) (2015) 61 Cal.4th 291. Despite the passage of time, this case remains a cornerstone for understanding causation in death claims—especially when multiple medications (both industrial and nonindustrial) are involved. Brief Recap Practical Takeaways for […]
If you are handling California workers’ compensation claims, keeping track of Workers’ Compensation Appeals Board (WCAB) and appellate deadlines is critical. Missing an appeal deadline can have serious consequences for your case. Here is what you need to know about the most important timeframes. Petition for Reconsideration – 20 Days (Labor Code §§ 5900, 5903) […]
In State Compensation Insurance Fund v. WCAB (2024 Cal. Wrk. Comp. P.D. LEXIS), the WCAB has provided much-needed clarity on interpreter fee disputes that significantly benefit claims administrators. The decision addresses two critical issues: the establishment of interpreter market rates and when disputing such rates constitutes bad faith under Labor Code Section 5813. Market Rate […]
In workers’ compensation cases, proving causation between an injury or condition and an employee’s workplace activities is a critical step. However, the burden of proof in these cases is unique to the workers’ compensation system, relying on the standard of “reasonable medical probability.” A recent decision by the Workers’ Compensation Appeals Board (WCAB) underscores the […]
Navigating the complexities of California’s workers’ compensation system can be overwhelming, especially when it comes to medical evaluations that can make or break a case. One regulation that plays a crucial role in ensuring fairness and efficiency is California Code of Regulations, Section 31.5, which governs the process of obtaining a replacement Qualified Medical Evaluator […]
