CA - WCIRB's New Utilization Measure Recasts Medical Cost Trends
11/02/2026 | 0
The Workers' Compensation Insurance Rating Bureau on Friday announced a new methodology for measuring physician services utilization that produces substantially different results than its traditional measurement based on the number of medical transactions per claim.
The WCIRB said in its report, "A New Measure of Medical Service Utilization: Physician Services and the Factors Driving Change," that under its new resource-based measurement, "utilization" of physician services increased 8% from 2020 through 2025, compared with a 5% decline using the traditional measuremen
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The Commonwealth Court of Pennsylvania upheld the suspension of an injured volunteer firefighter’s benefits based on the availability of jobs within his vocational and physical capabilities.
Case: Waldman v. Limerick Fire Department (WCAB), No. 1706 C.D. 2024, 10/21/2026, unpublished.
Facts: Steven Waldman injured his back in 2020 while serving as a volunteer firefighter for the Limerick Fire Department.
The department issued a notice of compensation payable for a low-back strain.
In March 2023, the department filed a suspension petition and a petition to modify Waldman’s benef
The North Carolina Court of Appeals ruled that a worker’s settlement of his claim deprived the Workers’ Compensation Commission of jurisdiction over a dispute as to the identity of his statutory employer.
Case: Bridges v. J.L. Rothrock Inc., No. COA26-175, 10/21/2026, unpublished.
Facts and procedural history: Bobby Bridges Jr. injured his back in September 2015. At the time, he was party to a contract with J.L. Rothrock Inc., wherein Rothrock leased a truck owned by Bridges and entered him in the American Emerald Transportation Services Inc. insurance program for workers’
The Maryland Court of Appeals upheld a jury’s verdict finding that a former professional football player’s compensable leg injury caused him to develop a back injury.
Case: In the Matter of Adeboyejo, No. 1040, 10/21/2026, unpublished.
Facts: Quincy Adeboyejo signed with the Baltimore Ravens as an undrafted free agent in May 2017. He injured his left thigh while running during the team’s rookie minicamp event in May 2018.
Adeboyejo underwent surgery for his injury, then participated in physical therapy, used crutches and walked with a limp. During this postoperative p
Workers’ compensation subrogation is one of the few areas of insurance recovery in which a carrier can have a perfectly valid statutory right to reimbursement and still walk away empty-handed.
In many states, the law imposes procedural requirements that can be just as important as the underlying right to recover. A missed deadline, an improperly perfected lien, an unanticipated settlement, an overlooked assignment or a failure to intervene can turn a substantial reimbursement opportunity into an expensive lesson. A recently published California appellate decision illustrates ju
A New York appellate court ruled that a worker allegedly injured by a falling piece of plywood was not entitled to summary judgment on his Labor Law claim.
Case: Buitrago v. Cascade 553 LLC, No. 2025-05553, 10/21/2026, published.
Facts: David Buitrago allegedly was injured while working at a construction site when a piece of plywood fell and struck him on the head.
Procedural history: Buitrago filed suit against Cascade 553 LLC, asserting a claim for a violation of Labor Law Section 240(1).
Section 240(1) imposes absolute liability on property owners, general contractors or their agents fo
A New York appellate court ruled that a worker should have been granted summary judgment on his Labor Law claim for injuries from falling from a ladder.
Case: Evaristo v. GH 441 1st Fee LLC, No. 2024-13474, 10/21/2026, published.
Facts: Roberto Evaristo allegedly was injured during the demolition of a bathroom ceiling in an apartment unit.
According to Evaristo, he had climbed an A-frame ladder to perform the demolition. The ladder malfunctioned, causing him to fall.
The apartment building was owned by GH 441 1st Fee LLC, and AKI Renovations Group Inc. was the general c
The Workers' Compensation Board of Indiana announced that it will use the same formulas for the 2027 Second Injury Fund assessment as it used for the 2026 assessment.
The board said an assessment is necessary because the fund's balance before Nov. 1 was less than 135% of the previous year's payments, as required by state law.
As of Friday, the fund had paid about $6.9 million in benefits, leaving a remaining balance of about $3.9 million.
Total payments for 2025 were about $7.8 million.
The board has not yet released the amount of the 2027 assessment or the individual assessmen
The California Division of Workers' Compensation updated its proposed attorney fee rules for depositions to provide payment for travel time and transcript review, remove an incremental billing requirement and reduce payments for attorneys with less than 10 years of experience.
The maximum hourly attorney fee for depositions would remain $500 for those who are certified as workers' compensation specialists by the State Bar under revised rules released Wednesday. That rate is unchanged from the rules that the division proposed in January to implement the provision in SB 1160 r
The Iowa Court of Appeals affirmed a finding that a worker who turned down a higher-paying job was limited to a recovery of permanent disability benefits based on his functional impairment, but that the workers’ compensation commissioner erred in determining the ratings.
Case: Wooff v. Nine Park Lane Inc., No. 25-1433, 10/21/2026, published.
Facts: Michael Wooff began working for Menefee Drywall, which provides commercial and residential drywalling and finishing services, in 1993.
In August 2019, Wooff reported pain in his neck and shoulder to Menefee. At the time of his injury, Wooff
The Kentucky Supreme Court upheld a determination that a diabetic worker’s fall caused an injury to his right hip and thigh and a subsequent infection.
Case: Scott Waste Service v. Eaton, No. 2026-SC-0078-WC, 10/22/2026, unpublished.
Facts: Joshua Eaton worked for Scott Waste Service. He fell while working in January 2022. Eaton immediately reported the fall to his supervisor; however, he did not fill out an incident report because his supervisor was busy.
Eaton was 41 at the time and had insulin-dependent diabetes. He had previously been treated for abscesses on his buttocks and
The Oregon Court of Appeals rejected a worker’s challenge to a finding that he had received an overpayment of benefits after he had returned to part-time modified work.
Case: Stacey v. Cascade Steel Rolling Mills-Schnitzer Steel, No. 1010, 10/21/2026, published.
Facts: Johnny Stacey suffered a back injury while working as a crane operator for Cascade Steel Rolling Mills-Schnitzer Steel in July 2023. He returned to part-time modified work as a bundler operator in May 2024.
Cascade used ESIS as its claims administrator, which paid Stacey temporary total disability benefits aft
A New York appellate court ruled that a worker struck by a falling post was entitled to summary judgment on his Labor Law claim.
Case: Liao v. Sheng Sheng Construction Inc., No. 2025-00306, 10/21/2026, published.
Facts: Haoan Liao was injured at a construction site when a 10-foot post fell on him.
Efin Management Corp. and Sheng Sheng Construction Inc. were the general contractors for the project, and HW Manhattan One LLC owned the property under construction.
Procedural history: Liao filed suit against Efin, Sheng and HW, asserting a claim for a violation of Labor Law Section 240(1).
Sec
The paper pulp plant where a worker was killed earlier this year has been cited again for safety violations and faces $77,800 in fines from the Washington State Department of Labor & Industries.
L&I's investigation is the second of two that were open after a tank failed on May 26 and left a man dead at Nippon Dynawave's plant in Longview.
In April, a worker had to wade through a sea of pulp as hot as 145 degrees Fahrenheit as it spilled from an unintentionally open valve. The pulp was 3 feet deep, covering a 4-foot sinkhole that the worker fell into. He came da
EverPeak Insurance announced Thursday that it has named Patrick K. Daley as chief underwriting officer.
Daley brings more than three decades of experience managing large, complex and nonstandard risks at major insurance carriers, EverPeak said.
In his new role, he will oversee underwriting strategy and quality standards across EverPeak’s product lines, with initial priorities focused on scaling the middle-market workers' compensation portfolio and relaunching Attune’s Business Owner's Policy product.
Daley most recently served as head of underwriting services at Glat
The Court of Appeals of Georgia ruled that Delta Airlines failed to comply with the requirement to attach a recent medical report establishing that Jorge Lamar had been released to work.
Though Delta cited a July 2023 medical report indicating that Lamar could work with a restriction on lifting more than 15 pounds, the court said the lifting restriction dated to at least September 2022.
"If the 15-pound weight restriction was sufficient to clear Lamar to return to work with restrictions, then the employer/insurer should have provided notice of such release after the first time the docto