Justices at the California Supreme Court heard from both sides in a dispute over a Workers’ Compensation Appeals Board decision to act on a petition for reconsideration after the 60-day statutory clock had run out. The Board relied on a 30-year-old precedent to grant a petition that had not been delivered to it in time …
The 2025 accident year combined ratio for California’s workers’ comp system may be one for the record books. The accident year combined ratio is projected at 129% based on the …
The Contractors State Licensing Board is proposing to limit the workers’ comp exemption to sole proprietorships only. The Board’s choice excludes limited partnerships, limited liability corporations, joint ventures, and others who can presently apply for the exemption and maintain a license. CSLB detailed its plan to apply the exemption only to sole proprietors in a …
The national workers’ comp industry reported underwriting profit for the 12th consecutive year in 2025, with a calendar-year combined ratio of 91%. The industry’s loss ratio was under 50% for the ninth straight year. The release of $4.5 billion in redundant reserves helped elevate the calendar-year results. National Council on Compensation Insurance chief actuary Donna …
The Division of Workers’ Compensation’s 2024 audits of claims shops found that over 10% of randomly selected claims had unpaid benefits owed to injured workers. Overall, 271 workers were owed an average of $1,625 each (or a total of $440,714), but the amounts varied greatly by adjuster. Applicant’s attorneys routinely cite an injured worker’s inability …
The Fourth District Court of Appeal ruled that a lower court was correct to dismiss an injured employee’s lawsuit alleging fraud and violations of California’s unfair competition law and the federal RICO Act. The court says the actions of the third-party administrators, claims adjuster, and provider were all covered under the Workers’ Compensation Act’s exclusive …
Federal prosecutors secured a guilty plea in a $270 million Medi-Cal fraud scheme that submitted fraudulent bills for high-cost compounded medications made from generic ingredients that were not medically necessary or, in many cases, not even provided. It was a page straight out of the workers’ compensation fraud handbook – literally. Pleading guilty was Paul …
The Yolo County District Attorney filed criminal charges, including conspiracy and murder, against individuals connected to a deadly explosion last year that killed seven workers. Included among the charges are allegations that the business ownership was cheating on its workers’ comp insurance by paying workers in cash and not reporting the payroll to lower its …