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 […]
Valentine’s Day is nearly upon us, and while everyone else is playing Cupid, here at Yrulegui & Roberts we are focused on something a bit less romantic—managing (and hopefully avoiding) workers’ compensation claims. It might not be quite as swoon-worthy as a heart-shaped box of chocolates, but trust us, it is every bit as crucial […]
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 […]
In Henderson v. County of Butte Probation Department, a significant workers’ compensation decision, the WCAB has affirmed that a probation officer who performed peace officer duties during emergency response to California wildfires qualified for the cancer presumption under Labor Code § 3212.1. The case expands the application of the cancer presumption to probation officers when […]
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 […]
As another holiday season comes to a close here in California, our team at Yrulegui & Roberts has been reflecting on what truly matters – the invaluable gift of time with family and loved ones. In our line of work defending workers’ compensation cases across the Central San Joaquin Valley and beyond, we are constantly […]
