CA - DWC Posts Proposed QME Rules to Forum
05/06/2026 | 0
The California Division of Workers' Compensation proposed an informal draft of rules that would clarify eligibility requirements for qualified medical evaluators and establish parameters for listing offices as remote-only office locations.
Other provisions in the regulations that the division posted to its online forum for a 10-day comment period would revise timelines relating to how the agency responds to applications and administers QME placement exams.
The proposed rules would require providers applying to serve as QMEs to declare under penalty of perjury that they have not previousl...
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A New York appellate court ruled that a worker’s motion to compel a carrier to disclose its underwriting file was properly denied.
Case: Lannon v. Everest National Insurance Co., No. 2025-00148, 04/15/2026, published.
Facts: Steven Lannon worked as a carpenter for McM Homes Inc., a subcontractor working on a project under Bay Creek Builders LLC.
Everest National Insurance Co. was the general liability insurance carrier for McM.
Lannon allegedly suffered injuries while working on the project during Everest’s term of coverage.
Procedural history: Lannon filed suit against Bay Cr...
A New York appellate court upheld a denial of summary judgment on the Labor Law claims by a worker struck by falling bricks.
Case: Romero v. Evergreen Gardens II LLC, No. 2022-02233, 04/15/2026, published.
Facts: Alan Cristian Romero worked for Reliable Masonry Corp., a subcontractor working under Brooklyn GC LLC at a property owned by Evergreen Gardens II LLC.
Romero allegedly suffered injuries when two bricks fell onto his head while he was working.
Procedural history: Romero filed suit against Evergreen and Brooklyn, asserting claims for violations of Labor Law Sections 240(1) and 241(6...
West Virginia’s Intermediate Court of Appeals upheld a finding that a worker was entitled to benefits for a muscle strain.
Case: Triple H Enterprises Inc. v. Reed, No. 25-ICA-433, 04/07/2026, published.
Facts: Bryant Reed worked for Triple H Enterprises Inc. He slipped and fell while carrying a heavy iron pipe at work on March 18, 2024.
Reed completed an accident report stating that he had a “charley horse” on his right leg between his hip and knee. Reed further indicated that he had health insurance and did not need Triple H to pay any medical costs.
Reed later sign...
The "going-and-coming" rule is a foundational doctrine in California workers’ compensation law, defining the boundary between compensable work-related injuries and noncompensable personal risks.
Under this rule, injuries sustained while an employee is commuting to or from work are generally not considered to arise out of and in the course of employment, and therefore are not compensable.
Despite its seemingly bright-line nature, the going-and-coming rule has evolved into a more nuanced doctrine due to a wide range of exceptions, where the employment relationship cont...
A Texas appellate court ruled that a nonsubscribing employer could compel the family of a worker to arbitrate a wrongful death claim arising from a fatal accident.
Case: R&L Carriers Shared Services LLC v. Gonzalez, No. 14-24-00992-CV, 04/30/2026, published.
Facts: R&L Carriers Shared Services LLC is a nonsubscriber under the Texas Workers’ Compensation Act. Shared Services offered a work-related injury plan to its employees, and each Texas employee is automatically deemed a participant when hired.
In addition to the basic benefits that are automatically pr...
The U.S. Department of Labor on Tuesday announced an expansion of pharmacy benefit improvements under the Federal Employees’ Compensation Act, saying the move will extend cost-saving measures, strengthen oversight and improve transparency in prescription drug pricing across several federal workers’ compensation programs.
The changes, led by the department’s Office of Workers’ Compensation Programs, will now apply not only to injured federal workers but also to beneficiaries under the Black Lung Benefits Act, the Longshore and Harbor Workers’ Compensation Act and ...
The Delaware Superior Court upheld the denial of authorization for the victim of a violent robbery to use medical marijuana to treat her psychiatric conditions.
Rhonda Toomey worked for Family Dollar Stores. She was the victim of a violent robbery at her workplace in March 2004.
During the incident, Toomey was restrained with duct tape, threatened and pistol-whipped.
She has not returned to gainful employment since the robbery.
Toomey received an award for a 37% permanent impairment to the brain and total disability benefits for a psychiatric injury.
In April 2024, Toomey filed a pet...
West Virginia’s Intermediate Court of Appeals upheld an increase in a worker’s permanent partial disability award.
Case: Blackhawk Mining LLC v. Stover, No. 25-ICA-365, 04/07/2026, published.
Facts: Glenn Stover worked for Blackhawk Mining LLC. He filed a workers’ compensation claim asserting that he sustained an injury to the ulnar nerve of both wrists from years of using impact wrenches, hammer drills and hydraulic drills.
A claims administrator for Blackhawk’s insurance carrier accepted liability for bilateral carpal tunnel syndrome.
After Stover u...
A New York appellate court overturned the denial of summary judgment on a Labor Law claim by a worker struck by falling debris at a construction site.
Case: Jover v. 1540 Second Realty LLC, No. 21334/16, 04/14/2026, published.
Facts: Carlos Jover suffered injuries while working on a demolition project.
According to Jover, his employer had created holes in each floor of the building, which allowed his co-workers to dump construction debris from higher levels to the first floor.
Jover claimed that his foreman ordered him to clean debris that had clogged the hole on the se...
A New York appellate court ruled that a worker should have been granted summary judgment on his Labor Law claim for his injuries from a fall from a ladder.
Case: Amancha v. 720-730 Fort Washington Avenue Owners Corp., No. 159285/20, 04/14/2026, published.
Facts: Luis Amancha suffered injuries when he fell from a ladder while working on a renovation project. According to Amancha, he was working atop an unsecured A-frame ladder when it suddenly moved and caused him to fall.
Procedural history: Amancha filed suit against 720-730 Fort Washington Avenue Owners Corp. and Gumley-Haft LLC, ass...
The Oregon Workers’ Compensation Division announced that the maximum attorney fee and the threshold used to determine when employment is casual are increasing July 1.
The maximum attorney fee that can be awarded without extraordinary circumstances is increasing to $6,556 from $6,358 to align with the 3.116% increase in the state’s average weekly wage.
The average weekly wage in Oregon increased to $1461.21 from $1,417.06.
The threshold used to determine whether employment is casual and whether the employer is required to carry workers’ compensation will also increase July ...
NATL. - Report: First-Year Workers, Older Employees Pose Highest Injury Risks
While workplace injury rates are declining, those that do happen are becoming more severe, more expensive and are keeping employees off the job longer, with new hires and older workers posing the greatest risks, according to an “injury impact” report released Monday by Travelers.
The annual report, based on more than 1.2 million workers' compensation claims filed between 2021 and 2025, found injured employees missed an average of 80 workdays per claim, even as overall injury frequency trended downward.
First-year employees accounted for roughly 37% of all workplace injuries a...
Sedgwick has named Suzanne Dann as group president, placing her in charge of the company’s major global business lines, including casualty, property Americas, workforce absence and international operations.
The appointment is intended to unify Sedgwick’s core operations under a single global leader while allowing functional teams to further expand capabilities across markets, Sedgwick said. CEO Mike Arbour said the move supports the company’s long-term strategy and global growth ambitions.
Dann joins Sedgwick from Wipro, where she served as CEO of the Americas, overseei...
An Ohio appellate court ruled that a worker’s payment of the Bureau of Workers’ Compensation’s asserted subrogation lien on his third-party settlement did not bar him from demanding a refund for the amount he overpaid.
Lamar Thomas suffered injuries in a work-related car accident. The Bureau of Workers’ Compensation allowed Thomas’ claim for a cervical and lumbar sprain.
Thomas also brought a negligence action against a third party for causing the accident that resulted in his injuries. Following the settlement of his third-party claim, the BWC asserted a right ...
West Virginia’s Intermediate Court of Appeals upheld the denial of a worker’s claim of injury to his neck and shoulder.
Case: Crampton v. Express Services Inc., No. 25-ICA-393, 04/07/2026, published.
Facts: In October 2024, Jack Crampton went to the hospital and complained of severe pain in his left arm that went all the way down to his hand. He reported waking up with shoulder pain radiating down to his wrist about 12 days prior and denied any precipitating injury. Crampton said his symptoms came on suddenly and worsened.
Physician assistant Stephanie Hamilton assessed Crampton...
