CA - Committee Passes SIBTF Bill Amid Competing Reform Proposal
04/23/2026 |
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The Assembly Insurance Committee on Wednesday advanced a bill to overhaul the state's second-injury fund, opting to move a measure the governor has already vetoed as a counterweight to reforms the administration is pursuing through a budget trailer bill.
While lobbyists for employers championed the governor's plan as the best way to address nearly a decade of rapidly escalating costs, supporters of AB 1576 said their bill includes a series of smaller changes to control rising Subsequent Injuries Benefits Trust Fund costs without gutting the program.
AB 1576, by Assemblymember Li...
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OH - BWC's Premium Rebate Distribution Methods Don't Violate Equal Protection
04/23/2026 |
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An Ohio appellate court ruled that the Bureau of Workers’ Compensation’s method of distributing premium rebates does not violate principles of equal protection.
Case: CPC Parts Delivery LLC v. BWC, No. 25AP-403, Mahle Behr Dayton LLC v. BWC, Nos. 25AP-406 and 25AP-408, 03/26/2026, published.
Facts and procedural history: CPC Parts Delivery LLC and Mahle Behr Dayton LLC separately filed claims against the Bureau of Workers’ Compensation, challenging its method of calculating premium rebates issued to certain employers participating in the BWC Fund for the policy years e...
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NY - Court Affirms Summary Dismissal of Construction Worker's Claim
04/23/2026 |
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A New York appellate court upheld the summary dismissal of a worker’s Labor Law claims for his injuries from falling into a trench.
Case: Estrella v. BMG Monroe I LLC, No. 2024-07375, 04/01/2026, published.
Facts: BMG Monroe I LLC hired Verticon II LLC to serve as the general contractor for a construction project at a property owned by BMG.
Verticon subcontracted the framing work to Upstate Framing Inc., which further subcontracted the work to Plaza Construction.
Manuel Antonio Estrella worked for Plaza as part of a crew installing plywood floors in a house as part of the BMG project...
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MS - Plumbing Foreman Fails to Establish Compensable Shoulder Injury
04/23/2026 |
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The Mississippi Court of Appeals upheld a determination that a plumbing foreman did not suffer a compensable shoulder injury.
Case: Smith v. Dennis Wright & Son Plumbing, No. 2025-WC-00046-COA, 03/31/2026, published.
Facts: Benjamin Smith worked for Dennis Wright & Son Plumbing as a foreman. He suffered injuries at work in February 2020 when the trencher he was operating struck a root and threw him to the ground.
Smith initially sought treatment from Mary Martin, a chiropractor. He reported pain in his back and neck.
Smith eventually sought treatment from other medical and chi...
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Press - Los Angeles County District Attorney's Office Secures Conviction of IHSS Caregiver
03/27/2026 |
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The Special Investigative Unit of RJN Investigations, Inc. was recently notified by the Los Angeles County District Attorney's Office of their successful prosecution in the case of People of California v M. Lopez based upon a documented fraud referral. In this case, the claimant was employed as a caretaker of the California Department of Social Services — I.H.S.S. At the time of the claimant's deposition, he appeared wearing a back support and ambulating with the aid of a cane. Proactively, the Senior Claims Examiner authorized the RJN SIU Department to perform RUSH ...
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CA - Barthel: Challenging Dishonesty in the Work Comp System
By Donald R. Barthel
04/20/2026 |
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The Buddha reportedly said, “Three things cannot be long hidden: the sun, the moon, and the truth.”
There are only a couple of problems with this. First, although I found it on the internet (so it must be correct, right?), further research confirms this attribution cannot be authenticated. Second, there is — sadly — much evidence to contradict Buddha’s (or whoever’s) assertion.
For example, there is no credible, ABA-backed study estimating the extent to which perjury and fraud soil our legal system. However, anyone who has worked in the workers&rs...
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WV - Court Upholds Denial of Worker's Request to Expand Claim
04/23/2026 |
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West Virginia’s Intermediate Court of Appeals upheld the denial of a worker’s request to expand the scope of her claim and to receive additional treatment.
Case: Bolen v. Raleigh County Board of Education, No. 25-ICA-312, 04/07/2026, published.
Facts: Deborah Bolen worked for the Raleigh County Board of Education. She filed a workers’ compensation claim, asserting that she injured her lower back in September 2023 while lifting a stroller.
Before this incident, Bolen had claims relating to back injuries and received treatment for degenerative back issues.
Physician assista...
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NY - Bill Would Exclude Unpaid Student Interns From Comp
04/23/2026 |
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Legislation introduced Tuesday in the New York Senate would amend state law to exclude unpaid student interns from workers' compensation coverage.
S. 9998 proposes revising the New York Workers’ Compensation Law to clarify that unpaid student interns “shall not be deemed to be employed or engaged in employment” under the statute, effectively removing them from mandatory workers' compensation protections.
The legislation defines a student intern as an individual enrolled in an educational program at a public or private secondary school, charter school or bo...
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CO - Bill Would Create Process for Experience Modification Updates
04/23/2026 |
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Colorado lawmakers are proposing a process for employers and licensed insurance producers to update an experience modification factor when actual payments on a closed claim are lower than the loss reserves previously reported by the carrier.
SB 175, introduced Tuesday, would give employers and producers a limited right to request a correction between the time a claim is reported to a rating bureau and 31 days after the employer's effective rating date.
Changes to an experience modification factor could be requested only when actual paid costs are lower than the reported estimated costs, ...
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CA - Fraud, Unfair Competition Claims Not Sufficient to Escape Exclusivity
04/22/2026 |
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A California appeals court ruled that workers' compensation is the exclusive remedy for an injured worker's claim that a third-party administrator, claims handler and a doctor conspired to improperly characterize the nature of her injuries and need for ongoing treatment or work accommodations.
"If the alleged acts are a normal part of, or collateral to, the workers' compensation process, and the motive behind the acts does not violate a fundamental policy of the state, the cause of action is barred," the 4th District Court of Appeal said in an unpublished decision handed...
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Press - Turning Claims Documents into Decisions
03/24/2026 |
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Wisedocs Launches Decision Intelligence Platform Built for the Claims Lifecycle - Helping Carriers, TPAs, and Legal Teams Close Files Faster and Reserve with Confidence.
Miami, FL - Claims teams face a compounding problem: nuclear verdicts, social inflation, and litigation funding have raised the cost of a wrong decision to its highest level in a generation. Meanwhile, claims professionals spend 40-60% of their time organizing, reading, and searching documents before making a single claim decision.
Wisedocs today introduced an AI-powered decision intelligence platform built...
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NY - Alleged Alter Ego of Worker's Employer Fails to Prove Exclusivity Defense
04/22/2026 |
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A New York appellate court ruled that workers’ compensation exclusivity did not shield a company as a matter of law without a showing that it was the alter ego of the worker’s employer.
Case: Hernandez-Morataya v. M&L Equities Auto LLC, No. 2024-07654, 04/01/2026, published.
Facts: Francisco Hernandez-Morataya worked for M&L Car Services Inc. as a car wash attendant. He allegedly suffered injuries at work when he was struck by a customer’s vehicle.
Procedural history: Hernandez-Morataya filed suit against M&L Equities Auto LLC, the owner of the property where t...
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WV - Worker With Electrical Burns, Amputated Toe Gets 37% PPD Award
04/22/2026 |
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West Virginia’s Intermediate Court of Appeals upheld a 37% permanent partial disability award for a worker’s electric shock injuries resulting in burns to roughly 3.5% of his body and the amputation of his big toe.
Case: Superior Home Specialists v. Sindledecker, No. 25-ICA-371, 04/07/2026, published.
Facts: Michael Sindledecker worked for Superior Home Specialists. He suffered an electric shock injury on June 6, 2022, while holding on to a gutter that touched a power line.
On June 13, 2022, Dr. Carrie Sims performed excision of the burns and preparation of the wound beds o...
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OR - Court: Board Applied Incorrect Standard to Deny Worker's PPD Claim
04/22/2026 |
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The Oregon Court of Appeals said the Workers’ Compensation Board applied the wrong standard to deny a worker permanent partial disability benefits at claim closure.
Case: Okon v. Broadspire, No. 225, 03/25/2026, published.
Facts and procedural history: Inemesit Okon worked for Broadspire. He suffered injuries at work in January 2022. Broadspire accepted liability for a disabling lumbar sprain, lumbar strain, sacroiliac joint sprain and pelvic strain.
In February 2023, Okon was deemed medically stationary by her attending physician.
The physician saw Okon again in July 2023 and c...
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DE - Board Properly Reduces Benefits for Worker Capable of Returning to Job Market
04/22/2026 |
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The Delaware Superior Court upheld the reduction of a worker’s benefits for her injuries from a fall based on the evidence that she was physically capable of returning to work and that jobs were available to her.
Case: Scruggs v. Just Food for Dogs, No. N25A-05-002 SSA, 03/26/2026, published.
Facts: Joyce Scruggs worked as a sanitation supervisor for Just Food for Dogs. She suffered injuries when she tripped over a hose and fell.
Procedural history: Scruggs began receiving partial disability payments in 2023, which JFFD petitioned to reduce in July 2024. Scruggs separately petitioned ...
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CA - Lawmaker Removes Filing Deadline, Prohibited Conditions From Amended SIBTF Bill
04/22/2026 |
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A California lawmaker pared back proposed reforms to the Subsequent Injuries Benefits Trust Fund, removing provisions that would establish filing deadlines and prohibit the consideration of certain conditions in eligibility decisions.
Assemblymember Liz Ortega, D-San Leandro, amended AB 1576 on Monday to eliminate a provision that would have required SIBTF claims to be filed within five years from the date of the subsequent compensable injury or one year from the date that the Workers' Compensation Appeals Board determines the level of permanent disability.
Ortega also stripped from the ...
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CT - High Court: Subrogation Rights Extend to Derivative Third-Party Recoveries
04/21/2026 |
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The Connecticut Supreme Court on Monday held that employers are generally entitled to a lien on the net amount of third-party settlement proceeds deriving from a compensable occupational disease, even if most of the settlements were based on nonoccupational exposure.
The portion of damages for loss of consortium is not subject to a lien because workers' compensation doesn't compensate such damages, but an employer's rights generally mirror its workers' compensation payment obligations, the court reasoned.
"The decedent’s occupational disease consequently was fully ...
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PA - Property Owner Can't Collaterally Appeal Denial of Request for Stay
04/21/2026 |
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The Pennsylvania Superior Court denied a property owner’s attempt to take a collateral appeal of its denied request for a stay while the Workers’ Compensation Appeal Board determines whether the owner qualifies as the statutory employer of an injured worker.
Case: Geronimo v. Commonwealth Environmental Systems LP, No. 31 EDA 2025, 03/23/2026, published.
Facts and procedural history: Justo Acala Geronimo, a temporary laborer, filed a civil suit against Commonwealth Environmental Systems LP and Golden Eagle Staffing.
Geronimo alleged that he suffered injuries in February...
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