New rules governing payment for medical-legal evaluations are taking effect April 1, 2021. These new rules will significantly increase the cost of such evaluations. Because these fees relate to evaluations for the purpose of proving or disproving a contested claim the charges may also be applicable to reports by primary treating physicians as well as QMEs and AMEs.

It can come as an unpleasant surprise to see a bill of only a few hundred dollars mushroom into a claim for payment of a few thousand dollars, when a medical-legal provider adds not only penalties and interest, but also “costs, sanctions, and attorney’s fees” to its payment demand.

The Sixth Appellate District recently ruled in County of Santa Clara v. WCAB (Justice) that defendants are entitled to non-industrial apportionment of permanent disability due to total knee replacements, thus limiting the prior holding of Hikida.

On October 30, 2019, the Court of Appeal, Fourth Appellate District certified for publication a decision regarding excess insurance coverage and the California Superior Court’s right to characterize an applicant’s injury differently than the Workers’ Compensation of Appeals Board following an Award of benefits. California Ins. Guarantee Assn. v. San Diego County Schools Risk Management Joint Powers Authority 2019 Cal. App. LEXIS 1070.

On December 10, 2018, The Court of Appeal, First Appellate District, filed its opinion on the case City of Petaluma (Lindh) v. WCAB, and certified it for publication.

The Workers’ Compensation Appeals Board granted reconsideration in the case of Jose Nieves v. City of Hayward (ADJ8731516), and on October 17, 2018, issued its opinion and decision upholding the trial judge’s apportionment in reliance on Labor Code Section 4664.

In the latest case to weigh in on who is an employee and who is not, we have the case Garcia v. Border Transportation Group just issued on October 22 and decided by the California Fourth Appellate District and certified for partial publication. The case clarifies that the 1989 California Supreme Court case of S.G. Borello & Sons, Inc. v. Department of Industrial Relations still defines the factors to be used to determine who is an employee and who is an independent contractor in the workers’ compensation arena.

The Court of Appeal, Third Appellate District granted the defendant’s Petition for Writ of Review on the following question: Must a finding of permanent total disability be made in accordance with Labor Code Section 4660 or does Section 4662(b) provide a separate path to such a finding? The Court made it clear that Section 4660 provides the methodology to finding an award of permanent total disability “in accordance with the fact” as stated in Section 4662(b). The Court held that application of Section 4660 is mandatory. Section 4660 applies the 5th Edition of the AMA Guides.

On August 23, 2018, the California Supreme Court held in King v. Comppartners, Inc. et. al. (2018) that a utilization review doctor stands in the shoes of the employer while performing duties within the scope of the workers’ compensation scheme and thus may not be sued in tort unless the act falls outside of what is encompassed within the compensation bargain.

On April 30, 2018, the California Supreme Court dealt a blow to the so-called “gig economy”* by adopting use of the ABC Test as used in other jurisdictions for purposes of ascertaining whether a worker is an employee or an independent contractor.