THE EVER-CHANGING MEDICAL LEGAL-FEE SCHEDULE

From time to time the DWC feels the need to intervene in not only how the workers’ compensation system is running but also, how people get paid in the workers’ compensation system. What that usually means as defendants, employers and third-party administrators is more work, and sometimes there is no cost savings. The DWC has […]

CALIFORNIA WORKERS’ COMPENSATION DEFENSE: LABOR CODE SECTION 3208.3 AND “SUDDEN AND EXTRAORDINARY” CLAIMS

Under California law, an employee may bring a workers’ compensation claim for a mental or emotional injury. Under California Labor Code Section 3208.3, a “psychiatric injury shall be compensable if it is a mental disorder which causes disability or need for medical treatment” and certain other criteria are satisfied. Under the statute, employees are generally […]

WORKERS’ COMPENSATION FRAUD

In California, businesses, non-profit organizations, and legal entities are required to provide no-fault workers’ compensation insurance coverage to their employees. When someone is hurt on the job, they can pursue a workers’ compensation claim. Unfortunately, not all employees play by the rules. Workers’ compensation fraud remains a significant problem in our state. The California legislature […]

CALIFORNIA WORKERS’ COMPENSATION COMMITTEE VOTES FOR A 2.7% INCREASE TO PREMIUMS

According to a report from the Insurance Journal, the committee governing the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has voted to move forward with a 2.7% increase to the “pure premium” of workers’ compensation rates. The governing committee of the WCIRB cited both the COVID-19 pandemic and other structural changes as significant factors […]

DEMYSTIFYING CALIFORNIA WORKERS’ COMPENSATION BILLING: WHAT ARE EORS?

Workers’ compensation claims are complicated, especially when it comes to the issue of resolving bills from medical providers. You may have come across an unfamiliar industry-specific term — EOR. As defined in the state’s Workers’ Compensation Medical Billing and Payment Guide, Explanations of Review (EORs) are the “explanation of payment or the denial of payment” […]

JOINING THE UNINSURED EMPLOYERS BENEFITS TRUST FUND

California mandates that employers must provide workers’ compensation insurance coverage for their employees. Uninsured employers face serious liability risks. Among other things, an uninsured California employer may face civil liability through a personal injury lawsuit, financial sanctions from the state, and even criminal penalties. As a general rule, an uninsured employers’ workers’ compensation claim starts […]

WORKERS’ COMPENSATION DEFENSE IN CALIFORNIA: UNDERSTANDING A CLAIMANT’S DUTY TO DISCLOSE

On February 3, 2021, the California Department of Insurance announced workers’ compensation fraud charges against a Kern County man accused of bilking an insurance company. According to the allegations raised by the agency, this man unlawfully failed to disclose a previous work-related injury in an effort to collect workers’ compensation benefits that he did not […]

LABOR CODE SECTION 4062.3: INFORMATION VS. COMMUNICATION

As described by the California Department of Industrial Relations (DIR), Qualified Medical Evaluators (QMEs) are trained physicians who have been certified by our state’s Division of Workers’ Compensation to examine and evaluate injured workers. In general, QMEs are brought in to resolve outstanding questions about the nature/severity of an employee’s injury. All parties to a […]

CALIFORNIA WORKERS’ COMPENSATION DEFENSE: CUMULATIVE TRAUMA AND THE STATUTE OF LIMITATIONS

California employers are required to provide no-fault workers’ compensation benefits to their workers. State-mandated workers’ compensation insurance must offer coverage for two distinct injuries — specific and cumulative trauma. Whereas a specific injury is linked to an accident, cumulative trauma develops gradually over time. For several different reasons, cumulative trauma claims are complicated. One way […]

PROPOSED CALIFORNIA BILL WOULD CREATE NEW WORKERS’ COMPENSATION PRESUMPTION FOR ‘HOSPITAL EMPLOYEES’

In January, State Senator Dave Cortese (D-Santa Clara County) and State Assembly member Ash Kalra (D-San Jose) introduced Senate Bill 213 (SB-213) in the California State Legislature. If passed into law, the bill would rewrite the state’s Labor Code to create a new “rebuttable presumption” that certain injuries, illnesses, and ailments that develop or manifest […]