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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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WCAB Panel Holds That Email Notification Is Sufficient for QME Strike

Posted by:  Sure S. Log
Topics: LC 4062.2 striking process striking a QME QME selection process electronic strike email strike first-class mail

Labor Code § 4062.2 establishes the rules for requesting a panel of qualified medical evaluators (QMEs) when an employee is represented by an attorney. After a panel is obtained, LC 4062.2(c) states, "Within 10 days of assignment of the panel by the administrative director, each party may strike one name from the panel." The statute does not describe the appropriate method for exercising a strike, but it adds, "The administrative director may prescribe the form, the manner, or both, by which the parties shall conduct the selection process." Although the administrative director has adopted regulations related to the QME selection process in the California Code of Regulations (CCR) 29 et seq, none of the regulations discusses the striking process.

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WCAB Panels Clarify Scope of Physician-Patient Privilege

Posted by:  Sure S. Log
Topics: discovery physician-patient privilege protective order Allison medical records privacy waiver overbroad subpoena

The physician-patient privilege is not absolute in workers' compensation, but neither is a defendant's right to discovery. Although filing a claim waives the privilege for conditions placed at issue, foundational cases, such as Allison v. WCAB, 72 Cal. App. 4th 654, established that this waiver does not grant defendants unfettered access to an applicant's entire medical history. That creates a constant tension between an applicant's constitutional right to privacy and a defendant's right to relevant information.

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4th District Court of Appeal Clarifies Jurisdiction over Professional Athlete Claims

Posted by:  Sure S. Log
Topics: cumulative trauma CT jurisdiction professional athlete football exception LC 3600.5 Atlanta Falcons Gandy statutory interpretation exemption

The scope of California's jurisdiction over cumulative trauma claims filed by professional athletes has long been a contentious issue. California workers' compensation laws are generally more liberal than laws in other states. So professional athletes commonly file workers' compensation claims in California, even when they have a limited connection to the state and have long histories of playing for out-of-state teams.

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