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Special Report: California Supreme Court Holds That the Workers' Compensation Appeals Board May Not Equitably Toll Its Own Deadline to Act on Petitions for Reconsideration

Posted by:  Sure S. Log
Topics: Reconsideration Petition for Reconsideration LC 5909 Writ of Mandate Shipley jurisdiction jurisdictional Mayor 60-day deadline deemed denied mandatory deadline equitable tolling Supreme Court self-tolling grant-for-study

Labor Code § 5909 governs the time within which the WCAB must act on a petition for reconsideration. Under the former version of the statute, a petition for reconsideration "is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date of filing." Under this provision, if a petition for reconsideration is not acted on within the 60-day period, it is deemed denied by operation of law.

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Workers' Compensation Appeals Board Clarifies Jurisdiction Over Remote Workers Injured Outside California

Posted by:  Sure S. Log
Topics: jurisdiction LC 3600.5 waiver subject matter jurisdiction hired in California LC 5305 out-of-state injury LC 5300 remote work regularly employed in California choice of law venue

The Workers' Compensation Appeals Board (WCAB) is a creature of statute, and its subject matter jurisdiction is limited to the grants of authority conferred by the Legislature. Although it generally has jurisdiction over all injuries occurring within California, it has limited jurisdiction for injuries occurring outside of the state. Subject matter jurisdiction over injuries occurring outside California is governed primarily by two statutes. Labor Code § 3600.5(a) extends jurisdiction to out-of-state injuries when the employee was hired or is regularly working in California. LC 5305 separately confers jurisdiction when the employee is a California resident at the time of injury and the contract of hire was made in California. The residency requirement of LC 5305 has long been recognized as unconstitutional, leaving the contract of hire as its operative element in practice. So, the Labor Code gives the appeals board jurisdiction over claims for out-of-state injuries when either (1) the...

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WCAB Defines Boundaries of Special Risk Exception to Going and Coming Rule

Posted by:  Sure S. Log
Topics: Going and Coming Rule AOE/COE distinctive risk zone of employment commute ingress egress necessary means of access premise line rule special risk exception quantitatively greater risk Chairez LC 3600

Injuries sustained during an employee's commute to or from work generally are not compensable under the "going and coming" rule, which deems that such injuries do not arise out of and in the course of employment. The rule, however, has been described as having a "tortuous history," and has numerous exceptions, which make it difficult to uniformly apply. (Price v. WCAB (1984) 37 Cal. 3d 559, 565.)

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Special Report: Workers' Compensation Appeals Board En Banc Clarifies Scope of WCJ Authority to Review Settlements

Posted by:  Sure S. Log
Topics: C&R Medical Evidence due process compromise and release disqualification judicial bias order suspending action LC 5001 settlement approval attorney fees en banc adequacy review OSA CCR 10700 stipulation

A workers' compensation compromise and release (C&R) agreement is not enforceable until approved by the Workers' Compensation Appeals Board (LC 5001). (For the purposes of this article, “the WCAB” refers to the Workers’ Compensation Appeals Board generally, including the workers’ compensation judge, and “appeals board” refers specifically to the appellate judicial tribunal within the WCAB.) Under CCR 10700, the WCAB is affirmatively required to inquire into the adequacy of all C&R agreements and may set a hearing to take evidence when necessary to determine whether a settlement should be approved or disapproved.

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Workers' Compensation Appeals Board Limits Application of Collateral Estoppel in Body Part Injury Claims

Posted by:  Sure S. Log
Topics: res judicata collateral estoppel final order LC 5803 body parts conform to proof LC 5815 amended application actually litigated compensable consequence reopen pleadings necessarily decided

The doctrines of res judicata and collateral estoppel can bar parties from re-litigating claims and issues that were decided previously in workers' compensation proceedings. Res judicata, or claim preclusion, acts to bar claims that were, or should have been, advanced in a previous suit involving the same parties. It arises if a second suit: (1) involves the same cause of action; (2) is between the same parties; and (3) occurs after a final judgment on the merits. (DKN Holdings LLC v. Faerber (2015) 61 Cal. 4th 813, 824.)

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Special Report: DWC Clarifies Mandatory Use of Request for Authorization Form and Requirements for Complete RFA

Posted by:  Sure S. Log
Topics: Utilization Review Request for Authorization CCR 9792.9.1 narrative report incomplete RFA completed request claims administrator UR process DWC Form RFA CCR 9792.6.1

The utilization review (UR) process begins when a claims administrator receives a completed request for authorization from a treating physician. Under the updated UR regulations that became effective April 1, 2026, California Code of Regulations (CCR), Title 8, § 9792.6.1(u) defines what constitutes a valid "request for authorization," and specifies the conditions under which a request is deemed "completed" for purposes of triggering the UR clock. CCR 9792.9.1(b) addresses the claims administrator's obligations on receipt of a request that does not meet the definition of a completed request.

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WCAB Clarifies Analysis for QME Replacement After Relocation

Posted by:  Sure S. Log
Topics: QME replacement QME LC 4062.3 reevaluation multifactorial analysis travel reasonable geographic distance CCR 34 geographic distance same evaluator

Once a qualified medical evaluator (QME) has been selected in a represented case, California Code of Regulation (CCR) 34(b) explains that any subsequent evaluation may be performed at a different medical office of the selected QME if that office is listed with the medical director and is "within a reasonable geographic distance from the injured worker's residence." Labor Code § 4062.3(k) further directs that, after a medical evaluation is prepared, the parties "shall utilize the same medical evaluator who prepared the previous evaluation to resolve the medical dispute" to the extent possible. Together, those provisions reflect a strong preference for continuity of the medical-legal evaluator, and they set the framework for disputes that arise when a QME relocates his or her practice.

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WCAB Clarifies Valid Objection to Treating Physician Report Under LC 4061

Posted by:  Sure S. Log
Topics: PTP Permanent Disability LC 4062.2 Primary Treating Physician QME panel LC 4062 valid objection QME panel validity LC 4061 objection treating physician report future medical care

In accepted cases, Labor Codes 4061 and 4062 establish the procedures by which parties may dispute a medical determination made by a primary treating physician (PTP) and, when the employee is represented by an attorney, obtain a comprehensive medical evaluation through the qualified medical evaluator (QME) panel process under LC 4062.2. Under LC 4061(b), a valid objection may be raised to a PTP's medical determination "concerning the existence or extent of permanent impairment and limitations or the need for future medical care." Under LC 4062(a), objections to medical determinations may be raised to issues not covered by LC 4061 (for example, ongoing temporary disability, body parts injured, work restriction).

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SPECIAL REPORT: DWC Overhauls Utilization Review Regulations

Posted by:  Sure S. Log
Topics: Utilization Review UR 30-day exemption regulations penalties drug formulary administrative regulations utilization review investigations

Effective April 1, 2026, the Division of Workers’ Compensation (DWC) adopts a comprehensive and extensive set of new regulations governing utilization review (UR), independent medical review (IMR) and physician reporting. The regulations are available on the DWC's rulemaking page.

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Significant Panel Decision Clarifies Commutation of Attorney Fees from Lifetime Awards

Posted by:  Sure S. Log
Topics: Permanent Disability permanent total disability jurisdiction to enforce side of the award horizontal commutation LC 5803 LC 5804 continuing jurisdiction life pension commutation lateral commutation

Permanent disability benefits often are commuted to pay the fees of an applicant's attorney. Usually, the Workers' Compensation Appeals Board (WCAB) will order attorney fees to be commuted from the "far end" of the permanent disability award. That means the WCAB will commute a sufficient number of payments at the end of the award so that a lump sum can be issued to the attorney immediately without disrupting the flow of benefits to the injured worker. That reduces the number of weekly permanent disability payments made to an injured worker, and allows the attorney to receive the entire fee up front.

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