California Court of Appeal, Third District — filed May 16 , 2025, certified for publication June 11, 2025 Why This Decision Matters The published opinion in DPR Construction is a sharp reminder that Labor Code section 5502’s discovery cut‑off is jurisdictional. When either side—most frequently an applicant’s attorney (AA)—tries to slip non‑disclosed evidence into the record after the Pre‑Trial Conference […]
A recent Court of Appeal decision, Travelers Indemnity Co. v. Workers’ Compensation Appeals Board (Zeber) (2025), offers a timely reminder of how crucial it is to nail down the correct “date of injury” for cumulative trauma claims under Labor Code Section 5412. While the opinion also addresses whether insurance coverage disputes must proceed to mandatory […]
May 19, 2025 Introduction In a significant en banc decision, Vazquez v. Renteria (Zenith Insurance Co.) (May 19, 2025) ADJ11017003 (Salinas District Office), the Workers’ Compensation Appeals Board (WCAB) clarified when a Qualified Medical Evaluator (QME) in a represented case may be replaced due to unavailability. The decision emphasizes that while Administrative Director (AD) rules […]
Seasonal workers are indispensable to many of California’s industries—particularly agriculture, tourism, and hospitality. When these workers are injured on the job, determining how to calculate Temporary Total Disability (TTD) and Permanent Disability (PD) benefits can be challenging, especially if there is an “off-season” when the worker does not perform services for the employer. Below is […]
Overview In the recent Workers’ Compensation Appeals Board (WCAB) panel decision, Lira v. Cottage Health System, the Board clarified how to analyze cumulative trauma (“CT”) claims when an applicant alleges separate injury periods at different employers but maintains similar job duties with no real break in treatment or recovery. Below is a concise guide for […]
Introduction A recent panel decision of the Workers’ Compensation Appeals Board (WCAB) — Evans v. San Mateo County Transit District (2025 Cal. Wrk. Comp. P.D. LEXIS 27) — offers critical insights into two hot-button issues for claims adjusters: (1) establishing valid apportionment of permanent disability and (2) seeking a credit against overpaid temporary disability (TD) […]
When assigning permanent impairment for a spinal injury under the AMA Guides, 5th Edition, two primary pathways emerge: the Diagnosis-Related Estimates (DRE) method and the Range of Motion (ROM) method. The stakes are high for claims adjusters, as choosing the proper approach—and scrutinizing the results—can drastically impact claim reserves and settlement strategies. Below is a […]
California Labor Code §3600(a)(10) provides employers and insurers a valuable defense when workers’ compensation claims are filed after an employee has received notice of termination or layoff. However, this post-termination defense is not absolute. Cumulative trauma (CT) claims, particularly those hinging on the “date of injury” under Labor Code §5412, can pose unique challenges. Below […]
In California workers’ compensation law, most injuries that occur in the workplace or arise out of an employee’s job duties are considered compensable under the “arising out of and occurring in the course of employment” (AOE/COE) standard. However, certain circumstances can remove an injury from coverage—even if it happened during work hours or on the […]
(A Humorous Look at the Intersection of Brackets and Claims Adjusting) I might not walk in your well-heeled shoes (or well-worn loafers) as a claims adjuster, but I see you. You are out there balancing a mountain of case files while your co-workers argue over which 13-seed is destined to wreck everyone’s bracket. So, from […]
