March 27, 2025 Vast changes are swiftly approaching regarding the efforts Workers’ Compensation practitioners must make in protecting Medicare’s interests in future medical settlements. The Centers for Medicare/Medicaid Services (CMS) has revised several sections of its Guidelines for Medicare Set-Asides (MSA’s). The first change is to section 4.2 of its guidelines for MSA’s, which took effect January 17, 2025. While many of the guidelines we have come to accept will go unchanged, there are two primary changes that must be […]
News & Knowledge
Category: Newsletters
March 27, 2025 The recent Barahona v. ABM Janitorial Services (2024) 53 CWCR 4, decision sheds light on a common but often misunderstood issue in California workers’ compensation: how liability is shared among multiple employers and insurers. When a worker has claims involving multiple coverage periods or employers, determining liability for indemnity and medical expenses is complex. However, understanding the distinction between contribution and reimbursement is key to ensuring fair cost allocation and avoiding unnecessary financial exposure. Contribution and Reimbursement: The Basics […]
January 31, 2025 In 2024, Californian workers faced a tempered legislative and judicial climate following an exciting election cycle from 2024. The California State Legislature and Governor Newsom have adjourned a legislative session that conflicted in a post-Covid landscape with ongoing attempts by the California Legislature to enact laws regarding utilization review and workplace safety, which failed as a result of vetoes by Governor Newsom. In addition, the WCAB issued several key decisions affecting combination of permanent impairments, and defense […]
January 31, 2025 The use of artificial intelligence (AI) technology in the workers’ compensation arena is on the horizon. Given the scale of AI applications and the speed at which the technology is developing and being applied, AI has the potential to optimize efficiency, increase accuracy, and enhance compliance. On the other hand, AI also presents unique challenges and ethical considerations, which if applied without care and consideration, could have disastrous consequences. Regardless of the oncoming challenges and ethical quandaries […]
October 8, 2024 California has one of the most diverse workforces in the country. Each distinct job industry has its own nuances within the Workers’ Compensation system. One often overlooked but invaluable part of California’s workforce is its seasonal workers. Whether working a harvest season for California’s bountiful produce, at a ski resort or summer destination, or working over the holidays for retailers like Amazon or Target, seasonal workers are an integral resource for employers in California. As with many […]
October 8, 2024 In 2020, California voters passed Proposition 22, otherwise known as the Protect App-Based Drivers Act (the Propositiont), exempting app-based drivers for companies like Uber, Lyft, and Instacart from a 2019 law known as AB5. AB5 narrowed the circumstances under which many workers can be considered “independent contractors,” thereby codifying the holding in Dynamex Operations West, Inc. v. Superior Court of Los Angeles (2018) 4 Cal.5th 903 (Dynamex). Proposition 22 if passed would allow app-based driver companies to continue classifying their drivers […]
June 25, 2024 The WCAB has issued a rare en banc decision providing guidance on the applicant’s burden of proof in rebutting the use of the “Combined Values Chart” (CVC) when combining impairments pursuant to the Kite decision. The WCAB found that the use of the phrase “synergistic effect” frequently used by QMEs when invoking the Kite decisions to justify addition of the impairments was insufficient to justify rebutting the use of the CVC without further analysis of whether the applicant’s impairments had overlapping […]
June 13, 2024 The Workers’ Compensation Appeals Board has designated its March 27, 2024, opinion in Sandra Ja’Chim Scheuing v. Livermore National Laboratory, permissibly self-insured, administered by Gallagher Bassett, as a significant panel decision. The decision tackles the issue of when a petition for reconsideration is timely filed, but is not received by the Appeals Board within the statutory time limit to act upon the petition by no fault of the parties. In Ja’Chim, Applicant sought a finding of permanent and total […]
June 13, 2024 It is well-established that the purpose of the workers’ compensation system is to provide benefits to employees who suffer on-the-job injuries or certain work-related illnesses. To adhere to the purpose of the workers’ compensation system, California Code of Regulations §10109(a) requires a claims administrator to “conduct a reasonable and timely investigation upon receiving notice or knowledge of an injury or claim for a workers’ compensation benefit.” This has been interpreted by courts as a “duty to investigate.” […]
February 14, 2024 For more than three years, virtually everyone in the California workers’ compensation community had become familiar with the Covid-19 presumptions. Labor Code sections 3212.86, 3212.87, and 3212.88 were passed as emergency legislation in response to the unprecedented pandemic that changed life as we knew it, beginning in the Spring of 2020. Understandably, the legislature sought to protect those who were still working on site and were unfortunate enough to contract Covid-19. All three Labor Code sections provided […]