OH - Split Court Says Bureau Can't Recoup Payments Made After Worker Reached MMI
04/09/2026 | 0
A divided Ohio appellate court ruled that the Bureau of Workers’ Compensation could not recoup temporary total disability benefits paid to a worker after she had reached maximum medical improvement.
Elizabeth Kurtz worked for CG-HHC LLC. She suffered injuries at work in April 2023. The Industrial Commission allowed her workers’ compensation claim for neck and back sprains and granted temporary total disability benefits.
In January 2024, the Bureau of Workers’ Compensation requested termination of Kurtz's TTD, asserting that she had reached maximum medical impr...
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The Montana Workers’ Compensation Court turned down reconsideration of a worker's denied request for penalties over a carrier’s late settlement payment.
Case: Simone v. Old Republic Insurance Co., No. PI-2025-0000776-WCI, 03/06/2026, published.
Facts and procedural history: Scott Simone suffered injuries at work in December 2022. His employer had workers’ compensation coverage from Old Republic Insurance Co.
Simone and Old Republic entered into a settlement of his entitlement to benefits in April 2025. The settlement provided that Old Republic would pay ...
A New York appellate court ruled that a worker should have been granted summary judgment on his Labor Law claim for his fall from a ladder.
Case: Robles v. 53-63 Walton LLC, No. 24281/17, 03/17/2026, published.
Facts: Lenicio Robles allegedly suffered injuries when he fell from a ladder while working on a construction project.
Robles said he was given access to only one ladder, which he described as "loose" and lacking rubber feet; that all four feet of the ladder were on the floor; and that the ladder shifted while he used it.
Procedural history: Robles filed suit agai...
A New York appellate court ruled that a worker was entitled to only partial summary judgment on his Labor Law claim for a trip-and-fall accident.
Case: Lackenbauer v. 162 Fifth Avenue Associates LLC, No. 161333/18, 03/17/2026, published.
Facts: Eric Lackenbauer allegedly suffered injuries while working on a construction project when he tripped on a pile of materials and fell.
Procedural history: Lackenbauer filed suit against L&K Partners Inc., asserting a claim for a violation of Labor Law Section 241(6).
Section 241(6) imposes nondelegable duties on owners, general contractors and th...
NATL. - Networks Shift From Cost Tool to Care Driver in Workers' Comp
Medical provider networks are increasingly shaping how care is delivered, how disputes are avoided and how quickly injured employees recover, in addition to reducing costs in workers' compensation systems, according to industry experts.
A study released this month by Waltham, Massachusetts-based Workers Compensation Research Institute found that claims treated within networks had 26% lower total costs, faster access to care and shorter disability durations than out-of-network claims.
The findings reinforce long-held views that networks can control medical spending but also point to deepe...
Oregon Gov. Tina Kotek signed a bill giving nurse practitioners and physician associates the same treatment authority in the workers' compensation system as physicians and surgeons.
Kotek on Tuesday signed HB 4040, which expands the definition of "attending physician" to include nurse practitioners and physician associates.
Attending physicians provide direct care and create treatment plans for injured workers. They also determine whether a person is too injured to work and authorize time off, determine the date that a worker reaches maximum medical improvement, define function...
The California Division of Workers’ Compensation updated sections of the Official Medical Fee Schedule covering hospital departments and ambulatory surgical centers to conform to changes in the Medicare payment system.
The division said the order updating the hospital outpatient departments and ASC section of the fee schedule adopted:
The CMS Medicare Hospital Outpatient Prospective Payment System April 2026 “Addendum A” and “Addendum B.”
The CMS Ambulatory Surgical Center Payment System, April 2026 ASC Approved HCPCS Code and Payment Rates — column A e...
The Workers' Compensation Insurance Rating Bureau of California's Actuarial Committee is scheduled to discuss the Sept. 1 pure premium rate filing at a meeting Tuesday.
Members of the committee will review diagnostics for the first quarter of 2026, insurer experience through the end of 2025 and a study of recent increases in cumulative trauma claims.
The committee will also review loss adjustment expense experience and alternative loss projections, as well as an update on medical severity trends.
Recommendations from the Actuarial Committee will be reviewed by the WCIRB&#...
The Missouri Court of Appeals upheld an award of more than $2 million in attorney fees to an injured worker who prevailed on his disability discrimination and retaliation claims.
The appellate court also awarded more than $111,000 in additional fees for successfully defending the attorney fee award on appeal.
Scott Caldwell worked for UniFirst Corp. He injured his back at work, which resulted in difficulties performing his job as a district service manager.
Although UniFirst initially provided Caldwell with reasonable accommodations to assist him in completing his duties, it ...
An Ohio appellate court upheld the dismissal of a widow’s claim for a roofing foreman's fatal injuries from a fall.
Case: Adams v. Kline & Kavali Mechanical Contractors LLC, No. 31429, 03/11/2026, published.
Facts: Ryan Adams worked as a foreman roofer for Building Technicians Corp.
He fell 20 feet through a roof two days before Christmas in 2020. Adams suffered serious injuries, and he died in October 2023.
BTC was the contractor completing a roof replacement project at Fairlawn Service Center Building No. 5 when the accident happened. Building No. 5 has five roofs, and...
A New York appellate court upheld a grant of summary judgment for a worker on his Labor Law claim for his injuries from a fall into a hole.
Case: Calle v. 686 Broadway Realty LLC, No. 158597/19, 03/17/2026, published.
Facts: Jeffry Calle worked for Branch Restoration Inc. He allegedly suffered injuries while performing asbestos abatement work on a construction project. Schimenti Construction Co. LLC served as the general contractor.
According to Calle, an unsecured wooden plank moved while he was at the site, causing him to fall into a hole and sustain injuries.
Procedural history: Calle f...
A New York appellate court ruled that a worker was not entitled to summary judgment on his Labor Law claim for a fall on a staircase, but a third-party defendant should have been granted summary judgment on the indemnification and contract claims against it.
Case: Calix v. The Union Theological Seminary in the City of New York, No. 152806/20, 03/17/2026, published.
Facts: Luis Romero Calix allegedly suffered injuries while working on a construction project when he fell on a staircase.
According to Calix, there was an elevator in the building, but it was being used for a protracted period, w...
A federal program aimed at protecting workers from heat-related injuries is set to expire today, April 8, raising concerns about enforcement gaps heading into the summer months.
In 2022, the federal Occupational Safety and Health Administration launched the national emphasis program, allowing the agency to inspect high-risk workplaces to prevent heat-related injuries and deaths. The program resulted in about 7,000 inspections in industries with high risks of exposure to extreme heat.
Jessica E. Martinez, executive director of the National Council for Occupational Safety and Health, said allo...
The Workers' Compensation Insurance Rating Bureau of California on Tuesday announced that its special inspection fee will increase to $500 per location from $200, effective July 1.
The WCIRB conducts special inspections to determine and confirm the correct industrial classifications applicable to a policyholder's business.
Special inspections are outside of the WCIRB's routing inspection selection process and are scheduled at the request of an insurer, broker or agent. The party requesting the inspection is charged the fee.
The WCIRB said the increased fee aligns with ...
The New Mexico Workers' Compensation Administration on Tuesday adopted rules that it said will provide more clarity when awarding attorney fees and eliminate a provision that inadvertently limits communications with case managers.
Changes to the attorney fee rules require that all petitions for fees equal to or above the cap include a discussion of a multiple factors, including the time and effort the attorney expended in the case and the attorney's experience, skill and reputation; the extent to which issues were contested and the novelty or complexity of those issues; the relat...
