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 […]
Introduction When a California law enforcement officer sustains two separate workplace injuries—especially if those injuries overlap in time—how should Labor Code § 4850 “leave of absence” benefits be applied? That is the question at the heart of Agaiby v. City of Culver City (2024 Cal. Wrk. Comp. P.D. LEXIS 382), a recent Workers’ Compensation Appeals […]
Introduction A recent panel decision out of the California Workers’ Compensation Appeals Board—Robasciotti v. Maxim Healthcare (2024 Cal. Wrk. Comp. P.D. LEXIS 365)—provides important lessons on how multiple impairments may be combined or “added” when rating an injured worker’s permanent disability. In particular, it underscores the continued importance of the “Kite doctrine,” which allows for […]
1. Apportionment Pitfalls and Documentation Key TrendMany recent WCAB decisions have emphasized the need for clear, well-supported medical opinions on apportionment. Panels repeatedly admonished parties where physicians simply assigned percentages with inadequate rationales or failed to distinguish non-industrial from industrial factors. Adjusters often faced delays and higher litigation costs when an inadequate physician report triggered […]
In a recent panel decision, the Workers’ Compensation Appeals Board (WCAB) offered a cautionary tale for claims administrators and insurance carriers on how a seemingly straightforward denial can inadvertently fail to trigger the one-year statute of limitations (SOL). Although Bracy v. State of California is not binding precedent, it provides valuable insights into best practices […]
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 […]
