CA - 9th Circuit Affirms Stay in Breach of Contract Case Pending Outcome of WCAB Proceedings
09/11/2026 | 0
The U.S. Court of Appeals for the 9th Circuit, in an unpublished decision, affirmed a district court's decision to stay a tort claim alleging a carrier refused to pay benefits pending the outcome of proceedings before California's Workers' Compensation Appeals Board.
Grigsby & Associates Inc. sued State Farm Fire and Casualty Co. in 2025 for breach of contract and breach of good and fair dealing in Alameda County Superior Court. The case was removed to the U.S. District Court for Northern California.
The complaint alleges that State Farm provided workers' compensation cov
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The Workers' Compensation Court of Montana ordered an injured worker to attend a second independent medical exam, finding that the carrier's request was relevant to the claim and appropriate to its handling.
Case: Madison Jordon v. XL Specialty Insurance Co., 2026 MTWCC 7, 09/08/2026, published.
Facts and procedural history: Madison Jordan suffered an accepted cervical strain in a workplace fall in August 2023. The claim was closed within days of the accident.
In October 2023, Jordan went to the hospital reporting jaw issues that included pain, locking and a temporomandibular j
The owner of a New York asbestos removal company was charged with premium fraud for allegedly misrepresenting his company's payroll, the number of employees and the type of work they were doing.
The Suffolk County District Attorney's Office said Joseph Arthurs, 56, and his company, VGN Enterprise Corp., were arraigned Wednesday on charges of "penalties for fraudulent practices" and "effect of failure to secure compensation," both Class E felonies. Prosecutors allege that the fraud resulted in underpayment of premiums by more than $160,000.
According to a statement
Kids' Chance of California announced that it has awarded $304,299 in scholarships to 45 students for the 2026-27 academic year.
The scholarships were awarded to 13 new recipients and 32 reapplicants, the organization said.
Kids’ Chance of California is a nonprofit organization that provides scholarships to children of those who were seriously injured or killed as a result of a work-related accident.
It has awarded 418 scholarships worth $2.6 million since it was founded in 2012.
More information about Kids’ Chance of California is here.
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The Actuarial Committee for the Workers' Compensation Insurance Rating Bureau of California will review insurer experience valued as of June 30, as well as a pair of studies into severity trends and large deductible policies when it meets Wednesday.
The committee will discuss the WCIRB's ongoing review of components driving indemnity severity based on an analysis of data collected from subsequent reports of injury.
The Actuarial Committee will review preliminary exhibits separating indemnity payments into temporary total disability, permanent disability, settlements and other compone
A trial court in Kentucky held that the Department of Workers' Claims violated the state's Open Records Act by refusing to provide a copy of its medical fee schedule and insisting that it be purchased from a contractor.
Franklin Circuit Court Judge Phillip J. Shepherd granted summary judgment in favor of D1 Data Solutions, which does business as RefMed, finding that the department willfully withheld records that the medical pricing data aggregator should have been provided with in response to its March 2026 request.
The Department of Workers' Claims in 2024 entered an $85,01
The Montana Workers’ Compensation Court ruled that a worker’s preexisting conditions must be considered in a physician’s approval of a job analysis report serving as the basis for converting temporary total disability benefits to permanent partial disability benefits.
Case: Crisler v. Zurich American Insurance Co., No. PI-2025-0000974-WCI, 09/01/2026, published.
Facts and procedural history: In April 2019, the Workers’ Compensation Court approved the settlement of Robert Crisler Jr.’s workers’ compensation claim for a back injury. The settlement
A New York appellate court upheld a determination that a bricklayer had not knowingly provided false information about his medical history in his workers’ compensation claim.
Case: Loja-Saula v. Cosan Construction Corp. (WCAB), No. CV-25-0822, 09/03/2026, published.
Facts and procedural history: Luis Loja-Saula worked for Cosan Construction Corp. as a bricklayer. He filed a workers’ compensation claim for injuries he sustained in April 2022 when a piece of cinder block fell on him.
A workers’ compensation law judge established the claim for injuries to Loja-Saula&rsqu
The Illinois Appellate Court found that a pension board denied a former police officer due process in terminating his duty disability benefits, and that the board’s conclusion that he was no longer disabled was against the manifest weight of the evidence.
Case: Mahan v. Marion Police Pension Board, No. 5-26-0066, 09/02/2026, unpublished.
Facts and procedural history: Joshua Mahan began working for the Marion Police Department in 2007. He was injured in the line of duty in 2011 and applied for line-of-duty disability pension benefits.
His application was granted in 2012.
Subsequent di
The West Virginia Supreme Court overturned the denial of a retired dump truck driver’s claim for occupational pneumoconiosis benefits.
Case: Kessler v. West Virginia Paving Inc., No. 26-178, 09/02/2026, published.
Facts: Joseph Kessler worked as a dump truck driver for West Virginia Paving Inc., making deliveries for its quarry from 2013 to 2022.
In July 2024, Kessler underwent chest X-rays. Dr. Kathleen A. DePonte opined that they showed insufficient parenchymal or pleural changes to establish a diagnosis of occupational pneumoconiosis.
In August 2024, Dr. Richard Spencer and p
The California Applicants' Attorneys Association is hosting a webinar on Oct. 2 to discuss the Subsequent Injuries Benefits Trust Fund.
In July, Gov. Gavin Newsom signed SB 171, tightening eligibility standards for SIBTF claims.
The bill, which applies to claims filed after July 1, 2020, that have not been procedurally advanced by June 1, 2026, requires that qualifying preexisting conditions be labor-disabling and documented in medical evidence at the time of the second injury, and that medical-legal evidence supporting an SIBTF application be collected during the claim process for
The Oregon Department of Consumer and Business Services on Wednesday proposed a 2.1% average pure premium rate increase for 2027.
Under the proposal, the average pure premium rate would increase to 92 cents per $100 of payroll from 89 cents.
The department said the increase is necessary as a result of the temporary total disability benefit increase in SB 1519.
Currently, TTD benefits are paid at 66.67% of the state average weekly wage. Starting Jan. 1, the weekly compensation rate for wages up to 75% of the average weekly wage will increase to 75%, while the compensation rate for wages that
Tower MSA is holding a webinar on Wednesday to discuss Medicare reporting issues that can slow workers' compensation claim settlements.
Tower said the webinar will cover topics including:
Medicare Section 111 reporting issues, including how reporting inconsistencies can create problems at the settlement table and what should be addressed before settlement.
Why unresolved Medicare conditional payment claims can delay closing and how to resolve them proactively.
How ongoing responsibility for medicals can complicate settlement and what needs to happen before that responsibility is
The New Hampshire Supreme Court ruled that employers and carriers seeking reimbursement from the Special Fund for Second Injuries must notify the commissioner of the Department of Labor of a possible claim within 100 weeks from the date of injury.
While the high court didn't explicitly describe the elements of proper notice, it reversed a Compensation Appeals Board decision that found department officials should have inferred a claim notice from handwritten memos submitted with benefit payment notices.
"The statute places the onus on the employer or carrier to notify the commi
A Missouri appellate court upheld a decision by the Labor and Industrial Relations Commission to reduce a worker’s permanent partial disability rating from 25% to 7%.
Case: Barnett v. Kawasaki Motors MFG Corp. USA, No. WD88459, 09/01/2026, published.
Facts: Bradley Barnett worked for Kawasaki Motors MFG Corp. USA. He injured his right shoulder while at work in June 2023.
Barnett underwent diagnostic imaging, which revealed a large right shoulder rotator cuff tear. He had surgery to repair the shoulder and then participated in extensive physical therapy.
In January 2024, Barnett