From the Desk Of: Scott M. Tilley, Esq. President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization A Contractor Told an Injured Worker to Lie About His Job. He's Now Facing Felony Fraud Charges. A San Francisco construction company owner allegedly coached an injured employee to deny he even worked there, then denied it himself when the claim came in. He's now charged with multiple felonies, and the cas

From the Desk Of: Scott M. Tilley, Esq. President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization WCIRB Says 2025 Comp Costs Hit a 127% Combined Ratio. That's the Worst in Two Decades. For every dollar California carriers collected in workers' comp premium in 2025, they paid out $1.27 in losses and expenses. That gap is now in its second straight year above 120%, and it's a direct preview of how hard

From the Desk Of: Scott M. Tilley, Esq. President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization Prepaid Debit Cards for Indemnity Payments Are Here to Stay. Update Your Consent Language Now. The pilot program that let California employers pay indemnity benefits by prepaid debit card was set to expire January 1, 2027. It won't now. That changes how you should be documenting consent and payment-method

From the Desk Of: Scott M. Tilley President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization A bill that would have given insurers a new tool against premium fraud just got shelved for the year, but the idea behind it isn't going away. Carriers should treat this as a preview of where fraud-reporting obligations are headed, not as a closed file. SB 536 would amend Insurance Code section 1877.3 to requir

From the Desk Of: Scott M. Tilley President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization A decade after Sacramento exempted early medical treatment from prospective utilization review, RAND just checked whether it worked. The short answer for claims managers: don't expect SB 1160's UR carve-out to move your numbers much, but do expect it to keep coming up in physical therapy disputes. DWC announced

From the Desk Of: Scott M. Tilley President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization Stall long enough on records requests in a California comp case, and a judge can find you acted with malice — and make you pay for it personally, not just for the claim. That's the lesson from a WCAB ruling against Lyft that every self-insured employer and TPA handling contested claims should read closely. The

From the Desk Of: Scott M. Tilley, Esq. President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization Comp Rates Are Going Up 6.6% on September 1. Here's What's Actually Driving It. Insurance Commissioner Ricardo Lara approved a new workers' compensation advisory pure premium rate of $1.65 per $100 of payroll on July 10, 2026, a 6.6% increase over 2025, effective for new and renewal policies starting Sept

From the Desk Of: Scott M. Tilley, Esq. President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization Effective April 1, 2026, California implemented a significant overhaul of its Workers’ Compensation Utilization Review (UR) system. Driven by Senate Bill 1160 and Assembly Bill 1124, these updates represent the most substantial changes to the UR and penalty structure since its inception. The primary objec

From the Desk Of: Scott M. Tilley, Esq. President, Managing Attorney Certified Specialist Workers' Compensation Law The State Bar of California Board of Legal Specialization In the current Workers' Compensation Appeals Board (WCAB) landscape, we are seeing a significant uptick in Qualified Medical Evaluator (QME) reports that lack substantial medical evidence. These reports often rely on "broad-brush" conclusions rather than specific clinical findings, yet they frequently ser

Needless to say, the current pandemic has caused a number of changes at the WCAB, and one of those is a delay in receiving decisions from...

A word of advice: Just because the applicant’s counsel objects to a letter sent to the applicant pursuant to CCR section 10550 advising...

From the Desk of: Barry A. Saperstein Shareholder Managing Attorney, Northern & Central California Certified Specialist, Workers’ Compensation Law, The State Bar of California Board of Legal Specialization. As I work from home during the nadir (hopefully) of the greatest pandemic of my lifetime, I am reading recent workers' compensation fraud cases. I wonder how some people try to "work the system" without fear they will be caught. In this day and age of computer technology a

From the Desk of: Bruce A. Little Managing Attorney, Los Angeles County Every once in a while, you have an applicant who helps you out. I had a recent case in which one of the applicant’s allegations involved hearing loss in her right ear, which she blamed on a history of exposure to the loud noise of machinery for more than a decade. The applicant wore earplugs at work and had annual audiogram tests. When she was first seen by the ENT panel QME, it was determined that she h

I received a notification from a certain Applicant Attorney's office that his clients were going to audio record QME evaluations...

Okay, so this isn't a story about good and evil. I needed a good title to draw you in and get you to read about a case you really should...

I begin this article with a brief history lesson. In 1996, Proposition 215, the Compassionate Use Act of 1996, was approved by 65% of the...

If you haven't felt the pain of non-IBR litigation, you are in for a treat...

You might recall the King case from our case law update of several years ago. It was a BIG DEAL. We worried as we told you the decision...

Labor Code §4610 provides the ground rules for the Utilization Review (UR) process. This section first appeared in the Labor Code in 2003...

I recently had a trial at the Riverside WCAB. The applicant was without transportation and was coming in from Compton, California...

As our country inches closer and closer to legalizing marijuana for recreational use, the issue of what role the budding medication plays...

As you might recall, Labor Code section 4656 was amended in 2007 and changed the time limitations for TTD. Previously, for dates of...

1. The California Court of Appeal issued a rare published decision in Zhu v. WCAB (2016) Cal.App.4th (6-20-17). This opinion is so new...

Some of you might remember a case a few years ago called Navarro v. City of Montebello (79 Cal. Comp. Cases 418). That 2014 case confirmed..