CA - Carrier Loses Claims Against Counsel for Widow Who Fraudulently Sought LHWCA Benefits
01/05/2026 | 0
A California appellate court upheld the dismissal of an insurance carrier’s claims against an attorney and his firm for representing a widow who fraudulently sought benefits under the Longshore & Harbor Workers’ Compensation Act.
Veronica McRae filed a claim against the U.S. Department of Labor, seeking benefits under the Longshore & Harbor Workers’ Compensation Act for the death of her alleged husband following an injury he suffered during his employment at the Port of Oakland.
The parties participated in mediation and reached a settlement resolving McRae’s c...
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A Louisiana appellate court ruled that an automobile liability insurance provider had no duty to cover an insured’s employee for his alleged injuries from a motor vehicle accident.
Case: Carter v. Blue Hill Specialty Insurance Co., No. 2025 CA 0515, 12/17/2025, published.
Facts and procedural history: Deshun Carter filed a personal injury action against Forward Loads LLC and its automobile liability provider, Blue Hill Specialty Insurance Co. He also named Jamar Hooker, Talish Josie Watts and USAA General Indemnity Co. as defendants.
Carter alleged that on Jan. 11, 2023, he was a pass...
West Virginia’s Intermediate Court of Appeals upheld the closure of a worker’s claim for temporary total disability benefits after a doctor opined that he had reached maximum medical improvement and was capable of returning to work.
Case: Newborn v. Gestamp North America Inc., No. 25-ICA-179, 12/04/2025, published.
Facts: Everick Newborn worked for Gestamp North America Inc. He injured his back at work in February 2024. Newborn sought treatment and was diagnosed with an acute lumbar myofascial strain.
A claims administrator for Gestamp’s insurance carrier accepted liabilit...
A New York appellate court partially revived a worker’s Labor Law claim for his alleged injuries from tripping over asphalt debris at a construction site.
Case: Ceja v. Posillico Civil Inc., No. 158010/18, 12/11/2025, published.
Facts: Consolidated Edison Co. of New York served as the general contractor on a project to repair a gas line to a private residence. Con Ed delegated the repair work to Posillico Civil Inc.
Posillico then contracted with Morley Mechanical Inc. for laborers. Morley surrendered control over its workers, and Posillico assumed supervision and control over the wor...
Well, it seemed like a good idea at the time.
It was 1945, World War II had been won, and our soldiers were returning home — many with crippling, permanent disabilities. Out of this history sprang California’s Subsequent Injuries Benefits Trust Fund.
Why do we need SIBTF?
The SIBTF is administered by the Division of Workers’ Compensation and covers the gap in PD compensation when a work injury increases an employee’s overall prior disability from an earlier, older injury. For instance, the prior injury could range from a previous work injury o...
HI - State Supreme Court Revives Comp Claim Over Fractured Nose
The Hawaii Supreme Court ruled that a rental-car employee who fractured her nose in a workplace vehicle collision is entitled to workers' compensation coverage, rejecting the employer’s argument that the injury was not work-related.
In Lane v. Avis Budget Group Inc., the court held that Avis Budget Group failed to present substantial evidence to overcome the statutory presumption that Roxanne Lane’s nasal fracture was caused by a 2014 on-the-job accident, when another vehicle backed into the Avis van she was driving at Honolulu’s airport.
Lane testified that the im...
The Washington State Department of Labor and Industries said two construction companies face more than $300,000 in combined fines for allegedly exposing a crew of concrete workers to life-threatening cave-ins and excavation hazards and ignoring an order to stop work at the site.
The department said employees of VS Concrete were working next to a 22-foot-high, nearly vertical dirt wall without adequate cave-in protection. The workers were in a gap next to a concrete foundation with no way to escape if the dirt wall collapsed.
L&I said it issued a stop-work order, ...
The average rate charged for workers' compensation coverage in California stabilized during the first nine months of 2025, with no evidence of an immediate cost increase following the first rate hike in a decade, according to the Workers' Compensation Insurance Rating Bureau.
Average charged rates fell steadily from $3.19 per $100 of payroll in 2014 to $1.56 in 2024, the WCIRB said in its latest quarterly experience report.
"Based on the first nine months of 2025, rates remain flat compared to 2024, indicating the downward trend has stabilized," the bureau said.
The ...
The Michigan Court of Appeals ruled that an employer against whom a workers’ compensation claim has been made is an “interested party” entitled to confidential unemployment records concerning the claimant.
Case: Kollinger v. Miller Broach Inc., No. 368368, Washington v. Euclid Industries Inc., No. 368543, Bellamy v. Sundance Beverage Co., No. 368704, 12/16/2025, published.
Facts and procedural history: Christopher Kollinger, Marvin Washington and David Belamy Jr. separately filed workers’ compensation claims against their respective employers.
The employers iss...
A New York appellate court ruled that the Workers’ Compensation Board needed to revisit a worker’s request for reopening and/or a rehearing since it failed to address all the basis she had raised for relief the first time around.
Case: Matter of Fuller-Astarita v. ABA Transportation Holding Co., No. CV-24-0366, 12/11/2025, published.
Facts: Joanne Fuller-Astarita worked for the ABA Transportation Holding Co. as a bus driver’s assistant. She suffered injuries after being struck by a bus owned by her employer in 2016.
Procedural history: ABA filed a workers’ compensati...
The Commonwealth Court of Pennsylvania ruled that a worker missed the deadline to appeal the termination of his benefits by one day, and that his appeals were therefore properly dismissed as untimely.
Case: Gamble v. Maxim Healthcare Services Inc. (WCAB), No. 1136 C.D. 2024, 12/17/2025, unpublished.
Facts and procedural history: Jonathan Gamble Jr. worked for Maxim Healthcare Services Inc. He suffered an injury at work in May 2022.
Maxim issued a notice of temporary compensation payable for a head injury in June 2022. It then issued a notice stopping temporary compensation in July 2022, fol...
West Virginia’s Intermediate Court of Appeals upheld an award of benefits for a healthcare worker’s inhalation injury.
Case: West Virginia United Health System Inc. v. Miner, No. 25-ICA-247, 12/04/2025, published.
Facts: Brooke Miner worked for the West Virginia United Health System Inc. She filed a workers’ compensation claim asserting she had suffered injuries in January 2014 as a result of exposure to vapor of suspected formalin.
Miner received medical treatment, and a physical examination revealed tonsillar swelling and palatal edema as well as a small amount of erythe...
The California Division of Workers' Compensation announced that the Office of Administrative Law approved its rules to exempt certain treatments and prescriptions from utilization review.
The division said the regulations primarily implement UR exemptions under SB 1160 for certain treatment provided within the first 30 days after an injury, as well as an exemption for formulary drugs under AB 1124.
Approved rules also enforce statutory accreditation requirements and strengthen the division's oversight of UR plans.
"The UR regulations aim to align the review process ...
The Court of Appeal for the 2nd District of California ruled that an injured deputy sheriff was properly denied a service-connected disability retirement due to his unreasonable refusal to undergo recommended medical treatment.
Alberto Mendoza worked as a deputy sheriff for Ventura County and was assigned to the Todd Road Jail Facility.
On Dec. 30, 2014, Mendoza slipped while going up stairs at the facility. He allegedly experienced back pain after this incident.
Mendoza underwent a magnetic resonance imaging scan of his lumbar spine on May 20, 2015. The results showed degenerative disc dis...
A New York appellate court revived a worker’s Labor Law claims against the owner of a single-family dwelling.
Case: Sanchez v. 12E63 LLC, No. 2024-00623, 12/10/2025, published.
Facts: Santos Miguel Espinal Sanchez allegedly suffered injuries while performing construction work on premises owned by 12E63 LLC.
Procedural history: Sanchez filed suit against 12E63 LLC, asserting claims for violations of Labor Law Sections 200 and 241(6).
Section 200 codifies the common-law duty to provide a safe workplace.
Section 241(6) imposes nondelegable duties on owners, general contractors and...
The Iowa Court of Appeals ruled that a worker’s failure to petition for judicial review meant a district court lacked jurisdiction to hear her challenges to a denial of alternate medical care.
Case: Towns v. Silver Oaks Nursing and Rehabilitation LLC, No. 25-0310, 12/17/2025, published.
Facts and procedural history: Latoyia Towns worked for Silver Oaks Nursing and Rehabilitation LLC. After she injured her shoulder at work, Towns was dissatisfied with her employer’s stance on recommendations from her primary care physician, and she filed a petition for alternate medical care. ...
