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Stalled Workers’ Comp Fraud Bill Amended Before Hearing

A proposal to help insurers fight workers’ comp premium fraud was amended by Members ahead of a hearing before the Assembly Insurance Committee scheduled for later this morning. The legislation, designed to provide insurers with greater access to the payroll records employers submit to the Employment Development Department, was narrowed in a bid to advance … Read More »

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California Supreme Court Considers Equitable Tolling

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 … Read More »

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California’s Combined Ratio Reaches Two-Decade High

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 latest industry data. This level hasn’t been seen in California workers’ comp since 2001. The industry’s year-end 2025 results show that California’s accident year combined … Read More »

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Narrowing Contractors Workers’ Comp Exemption

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 … Read More »

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Workers’ Comp Profitability Continues

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 … Read More »

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10% of Injured Workers Shortchanged

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 … Read More »

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Plaintiff Faces Workers’ Comp Exclusivity

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 … Read More »

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Workers’ Comp Fraudster Linked To $270M Medi-Cal Fraud

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 … Read More »

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