CA - WCIRB: Medical and Related Service Costs Increased 5% in 2025
09/02/2026 | 0
Medical and related service costs per claim increased in 2025, driven by increases in both the average prices paid per transaction and the number of transactions per claim, according to a new report by the Workers' Compensation Insurance Rating Bureau of California. The WCIRB reports that the average amount paid per claim for medical services, which includes direct treatment as well as medical-legal and copy shop expenses, was 19% higher in 2025 than in 2014, the baseline year used in the report. The average amount paid per transaction was 52% higher in 2025 than the baseline. While the Read More
The Connecticut Appellate Court upheld the denial of a certified nursing assistant’s claims, as her alleged injuries did not constitute an occupational disease and were therefore time-barred.
Case: Callahan v. iCare Health Management LLC, No. AC 48286, 08/25/2026, published.
Facts and procedural history: Tachica Callahan worked for iCare Health Management LLC as a certified nursing assistant. She suffered injuries at work in June 2017 from a “lifting incident.”
Callahan filed a workers’ compensation claim in October 2017, which was settled in November 2019.
Between
The Virginia Court of Appeals ruled that a worker was entitled to repair of his leg prosthesis that was damaged in an on-the-job accident, but he was not entitled to a replacement.
Case: Hill v. Regal Entertainment, No. 0962-25-4, 08/25/2026, unpublished.
Facts: Brien Hill worked at a movie theater for Regal Entertainment. He slipped at work in June 2023 and his leg prosthesis struck a rack, causing damage.
Hill left work two hours early that day, but he did not otherwise miss any time from work.
He later went to see Dr. Marc Chodos who completed a referral for the repair of his pros
West Virginia’s Intermediate Court of Appeals partially overturned the denial of a worker’s requests to expand his claim to include additional conditions and for referrals to a cardiologist, gastroenterologist and vascular surgeon.
Case: O’Neal v. Eastern Materials LLC, No. 25-ICA-499, 08/27/2026, published.
Facts: Ronnie O’Neal worked for Eastern Materials LLC. He was hospitalized with a left diabetic foot infection in May 2024 after reporting that he stepped on a piece of metal at work about three weeks prior, which punctured his foot.
His claim was accepted a
We have all had experience with primary treating physicians who operate a little bit on the lazy side with respect to their PR-2 reporting.
Oftentimes, this laziness takes the form of “cut-and-paste” reporting where it’s difficult to decipher what the details are from this latest visit, versus those of prior visits. Other times, there are no changes to the report at all other than a recommendation to refill prescription medications. But what about when the PR-2 report fails to address something significant, specifically work status and work restrictions?
Under Labor Cod
A New York appellate court upheld a decision to vacate a Labor Law defendant’s default and the denial of summary judgment against the co-defendant.
Case: Hernandez-Torres v. RJR Realty Associates LLC, Nos. 2024-11005 and 2025-02037, 08/26/2026, published.
Facts and procedural history: Jose Hernandez-Torres allegedly suffered injuries while working on a construction project in August 2021.
He filed suit against RJR Realty Associates LLC and the Cofire Asphalt Corp., asserting claims for violations of the Labor Law,
Hernandez-Torres later moved for leave to enter a default judgment aga
The National Council on Compensation Insurance on Tuesday announced that Chief External Relations Officer Mark Mileusnic plans to retire in the first quarter of 2027.
NCCI said Mileusnic's focus on building strong partnerships and developing high-performing teams has left a lasting impact on both NCCI and the broader industry.
He has played a central role in strengthening relationships with carriers, regulators and industry stakeholders, NCCI said.
"Throughout his tenure, he has been instrumental in advancing customer operations, enhancing engagement across the industry, and re
A federal appellate court upheld a black lung benefits award, finding a coal miner's employment caused legal pneumoconiosis that substantially contributed to his being totally disabled.
Richard Estudillo worked as an electrician in underground coal mines from 1973 until 1985.
He first experienced breathing problems in 1985 and a doctor diagnosed him with a 25% pulmonary impairment.
Estudillo filed a claim for black lung benefits in 2020.
An administrative law judge determined Estudillo had legal pneumoconiosis rather than clinical pneumoconiosis because his chest X-ray evidence did not
A Texas appellate court upheld the dismissal of a worker’s challenge to the calculation of his temporary income benefit rate as moot.
Case: Davis v. American Casualty Co. of Reading PA, No. 07-26-00005-CV, 08/26/2026, published.
Facts and procedural history: Donald Davis suffered an on-the-job injury in 2003 for which he received workers’ compensation benefits from the American Casualty Co. of Reading PA.
In 2008, Davis disputed the amount of his temporary income benefits, asserting that ACC had underpaid him. He initiated administrative proceedings to resolve the issue at the T
A New York appellate court ruled declined to dismiss a malpractice suit alleging a law firm mishandled a workers’ compensation claim.
Case: Puccio v. Hoffman, Wachtell & Rao LLP, No. 2025-00992, 08/26/2026, published.
Facts and procedural history: The law firm of Hoffman, Wachtell & Rao LLP represented Anthony Puccio in a workers’ compensation matter. Puccio later sued the firm for malpractice.
The firm moved for dismissal based upon documentary evidence.
Westchester County Supreme Court Justice Janet C. Malone denied the motion.
Analysis: The Appellate Division’
West Virginia’s Intermediate Court of Appeals upheld a $1,500 penalty against a claims administrator for failing to act on an independent medical examiner’s report within 30 days.
Case: State Auto Insurance Co. v. Hunter, No. 25-ICA-491, 08/27/2026, published.
Facts and procedural history: In October 2024, ExamWorks issued a notice of an independent medical exam to a workers’ compensation claimant, on behalf of State Auto Insurance Co., which was serving as the claims administrator for Milbank Insurance Co.
Dr. Samuel E. Perry then issued a report to ExamWorks noting that
The Division of Workers' Compensation will update studies on employer participation and access to care in 2027, according to a notice posted in the Texas Register.
The division's Workers' Compensation Research and Evaluation Group proposed two topics for its 2027 research agenda.
The first is an update of a study estimating how many employers participate in the state's workers' compensation system and how many opt out. The second is an update of an analysis of injured workers' access to medical care, including an assessment of certified workers' compensation healt
Rand said in a new report that contradictory findings about provider participation trends and access to care in California's workers' compensation system "pose somewhat of a puzzle."
"We found flat or slightly declining participation for individual providers overall in workers’ compensation, which included declines in participation among key provider types (physicians, chiropractors and psychologists) and physician specialties (primary care, orthopedic surgeons and other surgeons) with substantial workers’ compensation participation," Rand sai
The Ohio Bureau of Workers' Compensation, in announcing its latest dividend Friday, said it has returned more money to employers since 2019 than it collected in premiums.
BWC announced that its board of directors approved a $1 billion dividend, which represents about 90% of premiums paid in policy year 2022. The latest distribution brings to $10.2 billion the total returned to employers over the last seven years.
"Employers have now been sent more in dividends than they have paid in workers’ compensation premiums since 2019," the BWC said in a statement.
Checks will be d
The U.S. Occupational Safety and Health Administration fined a brickmaker in Pennsylvania nearly half a million dollars for allegedly knowingly exposing its workers to unsafe levels of respirable silica dust.
OSHA said it cited General Shale Brick Inc. for three "willful" violations, four "serious" violations and one repeat violation, and proposed penalties of $496,528.
The agency said General Shale Brick knew workers at its plant, where molded bricks are made, breathed in silica dust above safe limits but failed to fix the problem or require them to wear r
The Tennessee Workers' Compensation Appeals Board affirmed a decision finding that a worker failed to prove that her alleged mental health injuries were primarily caused by an event leading to what a reasonable person would consider a sudden or unusual mental stimulus.
Case: Jolicia S. Rhodes v. Allstate Insurance Co. et al., 2025-60-3095, 08/27/2026, published.
Facts: Jolicia S. Rhodes was a claims representative in the total loss division of Allstate Insurance Co. when her workload increased in 2022.
She requested a modified workload and schedule flexibility as an accommodation for pr