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 […]
Death benefits under California’s workers’ compensation laws can be a complex area for employers and claims adjusters to navigate. Understanding how the Labor Code treats “total” and “partial” dependency is vital for accurate benefit calculation, appropriate benefit distribution, and overall claims resolution. Below is an overview tailored to those who regularly handle claims—focusing on the […]
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 […]
