CA - Appeals Court Says SCIF Performance Bonus Dispute Is Subject to Arbitration
10/31/2025 |
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A California appellate court said a dispute about whether State Compensation Insurance Fund violated a collective bargaining agreement by giving different bonuses to similarly situated employees is subject to arbitration.
Though State Fund, the Department of Human Resources and a trial court determined that the collective bargaining representative for legal professionals filed a complaint that was not eligible for arbitration, the 3rd District Court of Appeal said the dispute was a grievance that was subject to arbitration under a 2022 memorandum of understanding.
The California Attorneys, A...
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MO - Appeals Court Says COVID Claim Properly Denied as Ordinary Disease of Life
10/31/2025 |
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A Missouri appellate court concluded that a worker failed to prove that his employment placed him at a greater risk of contracting COVID-19 or that a distinct feature of his job caused him to contract the disease.
Facts and procedural history: Gordon Johnson worked as a load coordinator and evening dispatcher for RBX Transportation. In 2020, he was diagnosed with COVID-19.
Johnson alleged that three days before he started feeling symptoms, his manager had a fever and was sneezing and coughing. Johnson said he wore a mask outside of work but did not wear one at the office. He also said h...
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PA - High Court Won't Review Judge's Refusal to Set Aside Errant Benefit Notice
10/31/2025 |
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The Pennsylvania Supreme Court denied a petition to review a judge's refusal to set aside a notice accepting liability for a firefighter's cancer claim that a city had intended to deny.
The Commonwealth Court of Pennsylvania in April ruled that a workers' compensation judge did not abuse her discretion when she refused to set aside a notice of compensation payable that Philadelphia sent to firefighter John Bell regarding his claim for colon cancer.
The city argued that it intended to deny Bell's claim in September 2022 but mistakenly mailed him a notice that it was ...
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NY - Five Corrections Officers Accused of Fraud
10/31/2025 |
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Five current and former state corrections officers were arrested on suspicion of participating in schemes to defraud the New York workers' compensation system, the result of an 18-month probe by the state Inspector General's Office.
The five, who worked as officers at the state's Ulster and Wallkill correctional facilities, allegedly turned in false medical reports of illness or workplace injuries, or double-dipped and worked while receiving benefits, the Inspector General's Office said. The department has previously noted that fraud, sick leave and benefit...
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Press - Industry Veteran David Dubrof Joins Rising Medical Solutions as Chief Growth Officer
10/08/2025 |
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Chicago, IL — October 8, 2025 — Rising Medical Solutions (Rising) is pleased to announce the appointment of David Dubrof as Chief Growth Officer. A seasoned executive with more than 30 years of leadership experience in the workers' compensation, healthcare, and technology sectors, David will spearhead Rising's client acquisition and retention strategies, drive market expansion, and lead the company's high-performing sales and account services teams.
David most recently served as Chief Sales Officer at MyMatrixx, a leading pharmacy benefit management firm...
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CA - Wroten: California Sets the Standard as New Study Links Workplace Injuries to Heat Exposure
By Jon Wroten
10/29/2025 |
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A groundbreaking study published in Environmental Health by researchers from George Washington University and Harvard University has revealed a powerful connection between hot working conditions and an increased risk of workplace injuries.
The findings come as the Occupational Safety and Health Administration moves toward establishing a nationwide heat injury and illness prevention standard — a move long championed in California, the state that first led the nation in heat illness awareness and prevention.
California’s proven leadership in heat safety
For nearly two decades,...
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WA - Double-Dipping Pensioner Must Pay $48,000 in Restitution
10/31/2025 |
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The Washington State Department of Labor and Industries announced that a worker receiving a lifetime pension for a permanent workplace injury was ordered to pay $48,000 in restitution after investigators discovered she was working at a medical transportation company while collecting benefits.
Lemapu Dorothy Seinafo, 56, received a lifetime pension in 2018 for back and shoulder injuries sustained while pulling materials around a jobsite. Doctors determined that her injuries were severe enough that they prevented her from returning to her at-injury position or being retrained for another l...
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NATL. - Benchmark Gensuite Launches AI Product for Environmental Health, Safety
10/31/2025 |
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Benchmark Gensuite on Tuesday announced the launch of an artificial intelligence product to help employers manage their environmental health and safety risks and protocols.
The autonomous, task-executing “AI Agents” can perform real-time EHS workflows, make contextual decisions and continuously learn from user interaction, according to a press release.
The AI Agents “go beyond copilots or chatbots — they act, decide and learn” and “will transform how compliance and sustainability work,” said R. Mukund, CEO at Cincinnati-based Benchmark Gens...
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CA - DWC Adjusts Ambulance Section of Fee Schedule to Remove Expired Add-Ons
10/31/2025 |
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The California Division of Workers' Compensation posted a notice adjusting the ambulance section of the Official Medical Fee Schedule to remove bonus payments that expired Oct. 1.
The ambulance section of the fee schedule included a 22.6% add-on payment for services in "super rural" areas, a 3% increase in base and mileage rates for services originating in "rural areas" and a 2% increase to base and mileage rates for services that originate in "urban areas."
The add-on payments Congress authorized for the federal Medicare system expired Oct. 1.
The di...
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CA - Proposed Rules Would Allow Electronic Filing of All Case Documents
10/31/2025 |
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The California Division of Workers' Compensation posted an informal draft of proposed changes to rules for the Electronic Adjudication Management System that would allow for the electronic filing and service of all case-related documents instead of requiring service by mail.
"These proposed changes will increase the efficiency of EAMS for stakeholders and reduce costs to DWC, parties and members of the public by decreasing expenditures on paper and postage," the division said in a statement.
Proposed rules would require all parties to file documents electronically, with on...
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Press - Jopari Solutions and Verisk Announce Collaboration to Modernize Medical Claims Processing
10/08/2025 |
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CONCORD, Calif. (October 8, 2025) -- Jopari Solutions, a leader in secure electronic medical claims and billing solutions with a claims delivery network of 2.9 million healthcare participants nationwide, and Verisk (Nasdaq: VRSK), a leading strategic data analytics and technology partner to the global insurance industry, today announced a new collaboration aimed at making insurance medical record review faster, more accurate and easier for payers and claims handlers.
This collaboration will bring key artificial intelligence capabilities from Verisk's GenAI- and AI-powered insurance c...
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NV - Webinar to Cover New ODG Formulary
10/31/2025 |
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The Nevada Workers' Compensation Section announced that a Nov. 5 webinar will provide a comprehensive guide for the new Official Disability Guidelines Drug Formulary.
Nevada lawmakers this year passed SB 317, mandating the use of the ODG formulary. The WCS formally adopted the formulary in September with a full implementation date of July 1, 2027.
To ease the transition, the DWC has provided resources, including an index of medications in the ODG treatment guidelines, guidance on navigating and interpreting the formulary, and an overview of how the formulary supports evidence-b...
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CA - Worker Fails to Raise Triable Issue of Fact for Retaliation Claim
10/30/2025 |
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A Trader Joe's employee failed to raise a triable issue of fact about whether she reported a workplace injury or unsafe condition before she was fired, a California appeals court said in affirming a lower court decision dismissing a retaliation claim.
Luz Ortiz alleged that Trader Joe's fired her after she told a supervisor in September 2019 that another worker had hit her brother, also a store employee, with a produce cart.
A couple of days later, she was fired for what the company called unprofessional conduct.
In a 2021 complaint, Ortiz claimed that the company's justif...
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NM - Court Upholds Denial of Worker's Claim for Aggravation Injury
10/30/2025 |
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The New Mexico Court of Appeals upheld the denial of a worker’s claim for an alleged aggravation injury.
Case: Benally v. San Juan Regional Medical Center, No. A-1-CA-42349, 10/22/2025, published.
Facts and procedural history: Arleene Benally worked for the San Juan Regional Medical Center. She filed a workers’ compensation claim, asserting that she had suffered an aggravation of a preexisting condition because of a workplace accident in September 2021. Benally requested benefits and an independent medical examination.
A workers’ compensation judge denied Benally’s r...
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NY - Security Guard Can't Pursue Civil Suit Against Property Owner for Slip and Fall
10/30/2025 |
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A New York appellate court ruled that a security guard could not proceed with a civil suit for damages for her injuries from a slip-and-fall accident against the owner of the facility where it occurred.
Case: McGregor v. Manhattan Nursing Home Realty Inc., No. 158715/21, 10/21/2025, published.
Facts: Taniqua McGregor suffered injuries while working as a security guard at a nursing home owned by Manhattan Nursing Home Realty Inc. when she slipped and fell on a puddle of hand sanitizer in the lobby.
Procedural history: McGregor filed suit against MNHRI, seeking damages. MNHRI moved for s...
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PA - Worker Gives Timely Notice of Claim to Uninsured Employers Guaranty Fund
10/30/2025 |
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The Commonwealth Court of Pennsylvania ruled that an injured worker timely gave notice of his claim to the Uninsured Employers Guaranty Fund within 45 days of learning that his employer lacked workers’ compensation coverage.
Case: Diaz v. Uninsured Employers Guaranty Fund (WCAB), No. 932 CD 2023, filed 08/08/2025, published 10/22/2025.
Facts and procedural history: Vidal Almendarez Diaz was a laborer for Bravo Remodeling. He injured his back at work in July 2019 and notified Bravo the same day.
Diaz hired an attorney in November 2019.
In December 2019, Diaz’s attorney rece...
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WV - Truck Driver Fails to Prove Occupational Pneumoconiosis Claim
10/30/2025 |
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West Virginia’s Intermediate Court of Appeals upheld the denial of a truck driver’s claim for occupational pneumoconiosis.
Case: Henry v. City of Wheeling, No. 25-ICA-136, 10/24/2025, published.
Facts: William Henry went to the hospital in August 2023, complaining of sleep disturbance and shortness of breath.
About two weeks later, Henry returned to the hospital with hypertension and again complained of shortness of breath.
In October 2023, Henry saw Dr. Neal Aulick. Henry reported that in the last six months, his breathing issues had worsened and that he had been hospital...
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NATL. - National Safety Council Says Government Shutdown Puts Workers at Risk
10/30/2025 |
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The inability of Republicans and Democrats to agree on funding government services has resulted in a worker safety shutdown that's threatening the lives of workers throughout the country, the National Council on Occupational Safety and Health said.
Key agencies, including the federal Occupational Safety and Health Administration and the Mine Safety and Health Administration, have been unable to operate at full capacity since the government shutdown started Oct. 1.
Even before the shutdown, worker safety systems were strained by understaffing and underfunding, the organization said. Now, ...
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