CA - MPN Rules Would Add Penalties, Tighten Provider Requirements
10/26/2026 | 0
The California Division of Workers' Compensation on Friday proposed revised medical provider network rules that would add penalties for specified violations, strengthen requirements for documenting physician participation and give regulators additional grounds to suspend or revoke networks.
MPNs could face a new $1,000 administrative penalty each time a workers' compensation judge or the Workers' Compensation Appeals Board finds that authorization for treatment was unreasonably delayed because of a network error.
The division is also proposing a $500 penalty for failure to provid
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A California appellate court ruled that an employer was not entitled to relief from its default judgment against him for failing to pay his workers’ compensation premiums.
Case: Creditors Adjustment Bureau Inc. v. Halajian, No. F090331, 10/20/2026, unpublished.
Facts and procedural history: The Creditors Adjustment Bureau Inc., as the assignee for the State Compensation Insurance Fund, filed a complaint in Fresno County Superior Court against Barry Halajian.
The complaint alleged that Halajian did business as Industrial Electrical and that he owed SCIF $86,858.26 for four workers&rsqu
The Workers' Compensation Ethics Committee reported one finding of judicial misconduct in its latest annual report.
The committee reports that it considered and resolved three pending complaints from 2024. Of the 32 new complaints filed in 2025, the committee considered 30 and resolved 27, according to the report published Thursday.
Of the 30 cases considered, 11 resulted in investigations.
As with last year's report, the 2025 summary of committee activity does not describe any of the complaints in any detail.
Before 2023, the committee's annual reports included a section title
The California Division of Workers' Compensation posted an order revising the hospital outpatient department and ambulatory surgical center fee schedule to reflect changes made by Medicare.
The DWC on Thursday announced that it adopted the Centers for Medicare & Medicaid Services "Ambulatory Surgical Center Payment Rates — Addenda" updated Oct. 13.
The update applies to services provided on or after Oct. 1.
Earlier in October, the division announced updates to the hospital outpatient and ASC section of the fee schedule that adopted:
The CMS Medicare Hospital Outpa
California’s Uninsured Employers Benefits Trust Fund serves an important function: to cover treatment and benefits for injured workers whose employers illegally failed to secure comp coverage.
Unfortunately, UEBTF can make it an administrative nightmare for providers to treat the workers it exists to support.
In addition to disregarding payment rules and deadlines (given its murky status as a quasi-claims administrator), UEBTF will not reimburse a provider until the underlying case in chief has been settled, potentially creating sig
Evelyn V. McGill, executive director of the Virginia Workers’ Compensation Commission, is retiring Jan. 1 after nearly 14 years with the organization.
McGill joined the commission in 2013 and has helped it navigate significant growth and change, the WCC said, and the organization has maintained a "top workplace" designation for six consecutive years under her leadership.
“Evelyn is the architect of this organization’s success," said Wesley G. Marshall, chairman of the commission. "She is a steady and thoughtful
A California appellate court has ordered publication of its decision finding that a trial judge could not order an injured worker to reimburse her employer, since the employer did not perfect its lien before she negotiated a settlement and dismissed her case against a third-party tortfeasor.
The case, Slamer v. Southern California Permanente Medical Group, No. D086908, was released last month as an unpublished opinion.
Only published opinions are binding precedent in California.
Jennifer Slamer requested that the opinion be published on Oct. 16, and the court granted her request o
The Alabama Supreme Court upheld a verdict that an employer fired an injured employee in retaliation for filing a workers’ compensation claim, but the trial judge must explain the rejection of the employer’s challenge.
Case: Envoy Air Inc. v. Creagh, No. SC-2025-0022, 10/16/2026, published.
Facts: Jada Creagh worked for Envoy Air Inc. She injured her shoulder in a fall at work in October 2018.
Creagh reported the injury to her shift supervisor, who allegedly told her that "the last person who had reported getting hurt on the job was no longer there."
Pursuan
A New York appellate court upheld an award of death benefits for a bus driver who suffered a medical event and crashed.
Case: Greek v. Dansville Central School District, Nos. CV-23-2419 and CV-24-1269, 10/15/2026, published.
Facts: Walter Greek worked as a bus driver for the Dansville Central School District.
In April 2022, he was under the care of a cardiologist for premature ventricular contractions and cardiomyopathy, and these conditions had been found to pose no imminent risk of a syncopal episode or other symptoms that would affect his ability to safely operate a commercial vehic
A New York appellate court ruled that a Labor Law defendant should have been granted leave to renew its motion for summary judgment.
Case: Cullinan v. New York University, No. 159762/16, 10/15/2026, published.
Facts and procedural history: Patrick Cullinan suffered injuries while working on a construction project. He filed suit against New York University and Turner Construction Co. for negligence and violations of the Labor Law.
Turner moved for summary judgment dismissing the claims against it. New York County Supreme Court Justice Robert R. Reed denied the motion.
After court-ordered de
Providers treating injured workers in California have received nearly as many bill review decisions ordering additional reimbursement through the first nine months of 2026 than they did in either of the last two years for which data is available.
Information posted to the Division of Workers' Compensation website shows that 2,643 IBR decisions issued from January through September awarded providers a combined $4.72 million. The DWC said figure includes $515,385 in filing fees.
In its latest IBR report, released in February, the division said 2,792 decisions in 2023 and 2,795 decisi
The death of a worker who fell through a skylight led to a spate of roofing citations from the Washington State Department of Labor & Industries.
L&I cited Leslie & Campbell Inc. $48,803 for the death of a worker who plunged more than 25 feet through an unguarded skylight to a concrete floor of a warehouse. Investigators determined that the company did not identify or train its workers on the danger posed by skylights.
“A worker died because their employer failed to protect them,” said Craig Blackwood, assistant director for L&I’s Division of Occup
The International Association of Industrial Accident Boards and Commissions is holding a webinar on Dec. 8 to discuss the upcoming premium rate ranking report published by the Oregon Department of Consumer and Business Services.
The biennial report compares workers' compensation premiums across the country, using Oregon's mix of industries to standardize the comparison.
Although designed to measure how Oregon compares with other states, the report is sometimes viewed as a ranking of the most affordable states for workers' compensation coverage, particularly by states that fare we
The California Supreme Court on Wednesday ordered the 6th District Court of Appeal to revisit a 2025 decision holding that equitable tolling can be used to extend the deadline for the Workers' Compensation Appeals Board to act on petitions for reconsideration in light of the high court's recent decision in Mayor.
The high court in November 2025 granted a petition to review the 6th DCA's August 2025 ruling in City of Salinas et al. v. WCAB, holding that the board did not err when it granted Lance D. Miraco's petition for reconsideration more than 60 days after he filed it.
A federal court in California dismissed a retaliation complaint that a worker filed against Amazon, saying it was sparsely detailed, hard to follow and failed to adequately allege the requisite elements of his various claims.
Khoja Sohil Samadi, in a complaint initially filed in Sacramento County Superior Court, alleged that he was injured when a large box landed on his foot while working for Amazon. He claimed that his requests for medical treatment were denied.
Samadi alleged that he was harassed daily by a manager who is identified only by the first name of Joseph, and he r
The Delaware Department of Insurance announced an average 3.99% loss cost reduction, effective Dec. 1.
The department also announced that the residual market will see an average rate reduction of 4.11%.
The department said this is the 10th consecutive rate reduction. It also noted that the new rates will take effect the same day as Senate Bill 248.
The bill updates the Workplace Safety Program to ensure that employers can access full premium savings. The department said earlier legislative changes inadvertently led to lower discounts, and SB 248 creates the ability for companies t
