Category Archives: WCAB

Mastering QME Panel Replacements: A Deep Dive into California Code of Regulations Section 31.5

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 […]

Understanding California Code of Regulations Section 10545: Petition for Costs in Workers’ Compensation Cases

In the workers’ compensation system, various costs may arise that are not typically recoverable as liens under Labor Code Section 4903. California Code of Regulations Section 10545 outlines the procedure for filing a Petition for Costs when seeking reimbursement for certain expenses or services. This regulation helps parties in a workers’ compensation case—such as employees, […]

Understanding California Code of Regulations Section 10510: Filing Petitions and Answers in Workers’ Compensation Cases

In the context of workers’ compensation defense, procedural rules are essential to ensure that cases progress smoothly through the legal system. One such regulation, California Code of Regulations Section 10510, outlines the correct procedures for filing petitions and answers when requesting action from the Workers’ Compensation Appeals Board (WCAB). Whether you are petitioning for a […]

Second Opinions, Third Opinions, Oh My! A Fun Guide to California Code of Regulations §9767.7 for Workers’ Compensation Defense

When it comes to workers’ compensation, medical disputes can feel like an endless game of “Doctor, Doctor!” Fortunately, California Code of Regulations §9767.7 provides a clear roadmap for when an employee is not quite feeling what the primary treating physician is dishing out. At Yrulegui & Roberts, we love helping employers, insurers, and claims adjusters […]

Navigating California Code of Regulations Section 10550: Dismissing Inactive Workers’ Compensation Cases

In workers’ compensation law, some cases can stall for long periods, either due to inactivity by the applicant or delays in pursuing necessary steps to move the claim forward. To prevent such cases from lingering indefinitely, California Code of Regulations Section 10550 provides a mechanism for dismissing inactive cases after a year of inactivity. This […]

Navigating Labor Code 4062.3: A Defense Attorney’s Guide to Fair Medical Evaluations in Workers’ Compensation Cases

In California’s workers’ compensation system, medical evaluations are often the battleground where key disputes over treatment and disability ratings are resolved. As a defense attorney, protecting the interests of employers and insurance carriers requires a solid understanding of Labor Code 4062.3, which governs communication with medical evaluators, particularly Qualified Medical Evaluators (QMEs) and Agreed Medical […]

Understanding Conditional Payments in Workers’ Compensation and Medicare Set-Asides

Navigating the intersection of workers’ compensation claims and Medicare can be complex, particularly when it comes to understanding the concept of conditional payments. These payments are an essential part of the Medicare Secondary Payer (MSP) rules and play a significant role in the administration of Workers’ Compensation Medicare Set-Asides (WCMSAs). In this blog post, we […]

Understanding the WCRC Review Process: A Crucial Step in Medicare Set-Asides

When dealing with Workers’ Compensation Medicare Set-Asides (WCMSAs), one critical phase that often determines the outcome is the review process conducted by the Workers’ Compensation Review Contractor (WCRC). The WCRC plays a pivotal role in ensuring that Medicare’s interests are protected by thoroughly evaluating the adequacy of proposed WCMSA amounts. This blog post will explain […]

Understanding the Difference Between Lump-Sum and Structured WCMSAs

When it comes to settling workers’ compensation claims that involve Medicare beneficiaries, one crucial aspect that must be considered is the establishment of a Workers’ Compensation Medicare Set-Aside (WCMSA). A WCMSA allocates a portion of the settlement to cover future medical expenses that would otherwise be paid by Medicare. There are two primary ways to […]

Understanding Medicare Set-Asides: When and Why to Submit to CMS

When settling a workers’ compensation claim, particularly when the claimant is a Medicare beneficiary or may soon become one, it is crucial to consider Medicare’s interests regarding future medical expenses. This is where a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) comes into play. A WCMSA is designed to allocate a portion of the workers’ compensation […]