CA - Court Says Employer's Failure to Provide Payroll Records Justified Policy Cancellation
08/07/2026 | 0
A California appeals court on Thursday held that a workers’ compensation insurer properly canceled an employer’s policy after the employer failed to respond to repeated requests for payroll records needed for a premium audit, reversing a Workers’ Compensation Appeals Board ruling to the contrary.
Although the exact phrase "failure to permit an audit" is not defined in the Insurance Code and was not defined in the policy, the Court of Appeal for the 3rd District of California said provisions in the policy imposed a clear obligation to provide payroll records upon re
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The Washington Court of Appeals upheld an offset against a worker’s temporary total disability benefits based on her receipt of Social Security disability insurance benefits.
Case: Smith-Gill v. Department of Labor & Industries, No. 60535-0-II. 08/04/2026, unpublished.
Facts and procedural history: Kimberly Smith-Gill contracted bacterial meningitis as a young child. It caused brain damage that resulted in difficulties with reading, writing and comprehending paperwork.
In 1994, Smith-Gill began receiving Social Security disability benefits for her condition.
In 2018, she sus
An Ohio appellate court partially revived a Bureau of Workers' Compensation employee’s claim of disability discrimination against his employer.
Case: O’Brien v. BWC, No. 25AP-608, 08/04/2026, published.
Facts: Hagen O’Brien worked for the Bureau of Workers' Compensation as a specialist handling cases involving interstate jurisdiction.
In 2020, O’Brien’s workload allegedly increased because some CSS employees were reassigned to COVID-19 occupational disease claims, which exacerbated his stress and anxiety.
In April 2021, Melody Dials became O&rsquo
A federal appellate court ruled that an insurance carrier did not have a duty to defend an employer from a lawsuit by the estate of a worker who was killed on the job.
Case: Insurance Co. of the West v. High Performance Alloys Inc., No. 25-1327, 08/04/2026, published.
Facts: Insurance Co. of the West issued a workers’ compensation and employers’ liability insurance policy to High Performance Alloys Inc. that was effective from October 2021 to October 2022.
The employer’s liability portion of the policy applied to “bodily injury by accident” and excluded
Jacksonville, FL – July 10, 2026 – PhysNet welcomes Michelle Despres, PT, EMBA as Chief Operating Officer, strengthening its leadership team as the company enters its next stage of national growth.
A licensed physical therapist and seasoned healthcare executive, Michelle brings a strong blend of clinical insight, operational leadership, and people-centered strategy. S
DISCLAIMER: The article is for the 2027 edition of "Lawyer’s Guide to the AMA Guides and California Workers' Compensation" and is excerpted from the manuscript. The opinions expressed in this document are those of the authors and not of the Department of Industrial Relations, Division of Workers’ Compensation, or the Workers’ Compensation Appeals Board.
Introduction
The en banc decision in Vigil v. County of Kern has generated substantial discussion among physicians and attorneys regarding when permanent impairments should be added and when they should be
A federal appellate court denied an employer’s petition for review of an award of black lung benefits to its employee.
Case: Bluff Spur Coal Corp. v. OWCP, No. 24-2181, 08/04/2026, unpublished.
Facts and procedural history: An administrative law judge awarded black lung benefits to Frederick Bateman, payable by Bluff Spur Coal Corp.
The ALJ premised the award on findings that Bateman was totally disabled and had never smoked.
The Benefits Review Board affirmed the award.
Bluff Spur petitioned the U.S. 4th Circuit Court of Appeals for review.
Analysis: The U.S. 4th Circuit Court of
PA - Insurer Can't Deny Comp Coverage After Agent's False Certificate for Dish Network
A Pennsylvania appeals court on Tuesday ruled that a satellite dish installer was an employee, not an independent contractor, but that Dish Network should not have been held liable as his statutory employer because an insurer’s agent falsely certified that workers' compensation coverage was in place.
According to the ruling in J&S Technology Solutions Inc. v. Gonzalez, Wilben Gonzalez suffered disabling injuries in October 2019 when he fell from a ladder while installing a Dish Network satellite dish, a job contracted by J&S Technology Solutions.
The Commonwealth Court
The California Assembly Appropriations Committee sent to its suspense file a bill that aims to reduce premium fraud by allowing insurers and the Employment Development Department to compare wage data.
SB 536, by Sen. Bob Archuletta, D-Pico Rivera, would allow carriers to submit wage records and employee counts and require EDD to identify discrepancies in the submitted information as compared to information maintained by the department.
EDD would also be required to report any discrepancies to the submitting carrier.
The bill would also allow EDD to provide carriers with detailed payro
The California Supreme Court rejected a strict exhaustion requirement as a prerequisite for insureds to bring claims against excess carriers.
"We conclude that an insured may state a viable cause of action for declaratory relief regarding coverage and liability under an excess insurance policy even if all the underlying insurance coverage has not yet been exhausted," the high court said in Fox Paine & Company LLC et al. v. Twin City Fire Insurance Co. et al. "While insureds in this position must adequately plead their covered losses, the relevant principles governing the av
The Washington Court of Appeals reinstated a citation against a staffing agency for failing to train its workers on asbestos hazards and for failing to file a related accident-prevention program.
Case: Department of Labor & Industries v. Tradesmen International LLC, No. 87759-3-I, 08/03/2026, unpublished.
Facts: Tradesmen International LLC leases temporary workers to other companies, most often in the construction industry.
Pacific West Construction contracted with Tradesmen to provide workers at its jobsites in 2015. The contract provided that Pacific would be solely res
The Commonwealth Court ruled that a police officer’s claim for benefits based on his contraction of COVID-19 was barred by res judicata.
Case: Bolds v. City of Philadelphia (WCAB), No. 179 C.D. 2025, 08/04/2026, unpublished.
Facts: William Bolds worked as a police officer for the City of Philadelphia. He tested positive for COVID-19 in March 2020.
The city designated the time Bolds missed from work as “E-time,” or excused time.
The city created the E-time designation during the pandemic to provide its employees full pay without depleting sick or vacation time.
In January
A federal appellate court upheld the denial of a security contractor’s claim for a psychological injury from his work in Iraq.
Case: Morales v. U.S. Department of Labor, No. 25-1112, 08/03/2026, unpublished.
Facts: Alberto Franco Morales, a native and resident of Peru, began working in Iraq as a border security guard for Triple Canopy Inc. in 2008.
According to Morales, he experienced several traumatic incidents during his employment, including a December 2008 mortar attack that caused workers to be thrown into the air, a 2009 mortar strike approximately 70 meters from his position&nb
A Texas appellate court ruled that the family of a deceased worker needed to bring claims against his employer’s insurance carrier before the Division of Workers’ Compensation.
Case: In re Zurich American Insurance Co., No. 04-26-00339-CV, 07/31/2026, published.
Facts: Eliseo Barrera died after he allegedly suffered injuries while working for Mesa Southern CWS Acquisition LP.
His family members alleged that Barrera promptly reported his injuries and was told by his supervisor that he needed to seek a medical evaluation from a workers’ compensation and occupational health s
The Workers' Compensation Insurance Rating Bureau of California on Wednesday published loss-sensitive advisory plan tables for policies taking effect on or after Sept. 1.
The WCIRB develops advisory plans that describe eligibility, rules and parameters for retrospective rating, large-risk deductible and small-deductible policies. They are submitted to the insurance commissioner for informational purposes only.
Advisory plans are not regulations and have not been approved. WCIRB creates them as a resource for members.
"Insurers should independently evaluate whether to use these plan
The Washington Court of Appeals rejected challenges to the reduction in compensation based on the survivorship options that two permanently and totally disabled workers selected for their pensions and their receipt of Social Security benefits.
James Lorkowski sustained an injury in the course of employment, and the Department of Labor & Industries found that he was permanently and totally disabled. The department approved him for pension benefits beginning in August 2020.
The department sent Lorkowski a letter informing him that because he was married, he could choose from opti
The Illinois Appellate Court overturned a pension board’s denial of a police officer’s application for a line-of-duty disability pension.
Case: Guess v. Board of Trustees of the Dolton Police Pension Fund, No. 1-25-1327, 08/03/2026, unpublished.
Facts: Theresa Guess served as a police officer in the Village of Dolton. In March 2020, she applied to the Board of Trustees of the Dolton Police Pension Fund to receive line-of-duty disability benefits.
Guess claimed that she had begun experiencing disabling seizures as a result of a motor vehicle collision in September 2018.
Tha
