In workers’ compensation cases, proving causation between an injury or condition and an employee’s workplace activities is a critical step. However, the burden of proof in these cases is unique to the workers’ compensation system, relying on the standard of “reasonable medical probability.” A recent decision by the Workers’ Compensation Appeals Board (WCAB) underscores the […]
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 […]
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, […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
