- No Jurisdiction Over Subro Lien After Employee Dismisses Lawsuiton September 29, 2026 at 9:13 AM
In February 2016, Jennifer Slamer was working for Southern California Permanente Medical Group (SCPMG) when she suffered disabling respiratory injuries from exposure to a disinfectant made by Ecolab, Inc. SCPMG resolved her workers’ compensation claim in the administrative system. In May 2017, Slamer and her husband sued Ecolab, SCPMG, and related entities in San Bernardino County Superior Court. SCPMG and its affiliates were dismissed from the civil case with prejudice after a series of demurrers and summary judgment motions. The judgment dismissing SCPMG was entered on April 11, 2022.
The Slamers went to trial against Ecolab alone. Before the case went to the jury, they reached a confidential settlement with Ecolab on April 19, 2023. On June 1, 2023, they voluntarily dismissed the entire action with prejudice.
While the case was pending, SCPMG continued paying benefits. It filed several notices of lien against any recovery under Labor Code § 3856(b). After the settlement, the Slamers refused SCPMG’s requests for reimbursement, and mediation failed. On February 16, 2024, more than eight months after the dismissal, SCPMG filed a motion for reimbursement.
The Slamers opposed the motion on several grounds. They argued the lien had to be reduced by SCPMG’s comparative fault and by an equitable share of their attorney fees and costs. They declined to disclose the settlement amount, but they stipulated that it exceeded the lien plus their fees and costs. On April 18, 2025, the trial court granted SCPMG’s motion. It ordered the Slamers to reimburse the full lien amount plus interest.
In the unpublished case of Slamer v. Southern California Permanente Medical Group, No. D086908 (September 2026) the Court of Appeal reversed and remanded. It directed the trial court to enter a new order denying SCPMG’s reimbursement motion for lack of jurisdiction. The Slamers were awarded their costs on appeal.
The Slamers raised several challenges on appeal: that the motion came too late, that SCPMG’s comparative fault was never decided, that fees were not properly allocated, and that pre-order interest was awarded in error. While the appeal was pending, the panel identified a threshold problem on its own and asked the parties for supplemental briefing. The question was whether the trial court had any jurisdiction to act after the entire case had been voluntarily dismissed with prejudice. The court concluded it did not. Because that answer resolved the appeal, the panel did not reach the other issues.
The court began with the statutory framework. An injured worker’s remedy against the employer is generally limited to workers’ compensation, but the worker may sue a third-party tortfeasor. To prevent double recovery, the employer may assert a lien on the worker’s judgment or settlement. That lien may be reduced for the employer’s own comparative negligence, and for a share of fees and costs under Labor Code § 3860(c) when the recovery was obtained solely through the employee’s attorney. The panel emphasized the timing requirement: the employer must apply for an order paying the lien before the judgment is satisfied or the action is dismissed. It cited Labor Code § 3857 and Abdala v. Aziz (1992) 3 Cal.App.4th 369, among other authorities. SCPMG did not meet that deadline. Once the Slamers filed their dismissal, the action ended and the court lost jurisdiction, except for limited matters such as costs and statutory fees (Harris v. Billings (1993) 16 Cal.App.4th 1396). An order entered without jurisdiction is void.
The panel rejected each of SCPMG’s four counterarguments. First, SCPMG argued the Slamers forfeited the timeliness issue by not raising it in the trial court. The panel disagreed. A challenge to subject matter jurisdiction may be raised for the first time on appeal. SCPMG also pointed to a possible factual dispute over whether the settlement funds had been fully disbursed. The court found that dispute irrelevant, because no one disputed that the dismissal came first.
Second, SCPMG argued the Slamers had acknowledged its lien efforts and agreed the court could keep jurisdiction. The panel held that parties cannot confer subject matter jurisdiction by consent, waiver, or estoppel. It quoted Viejo Bancorp, Inc. v. Wood (1989) 217 Cal.App.3d 200 for the rule that a court “cannot ‘retain’ jurisdiction it has lost.” SCPMG also relied on the lien-motion provision in Code of Civil Procedure § 664.6(f)(1). The court found that provision inapplicable for two reasons. It did not take effect until January 1, 2025, and it does not apply retroactively. And even if it did apply, it covers dismissals without prejudice, not dismissals with prejudice like this one.
Third, SCPMG argued the trial court had expressly retained jurisdiction under § 664.6 to enforce the settlement. Under Wackeen v. Malis (2002) 97 Cal.App.4th 429, a request to retain jurisdiction must meet three conditions. It must be made while the case is pending. It must be in a signed writing or stated orally before the court. And it must be express, clear, and unambiguous. The courtroom exchanges and minute-order entry SCPMG cited did not meet that standard. Separately, SCPMG could not use § 664.6 in any event. It had been dismissed from the case in 2022, which made it a stranger to the action, and only a party to a settlement may invoke that statute.
Fourth, SCPMG argued that the Enforcement of Judgments Law (Code Civ. Proc., § 708.410 et seq.) applied through Labor Code § 3862. Under that law, a lienholder is treated as a party, and the debtor cannot dismiss without the creditor’s consent. The panel explained that § 3862 reaches only a lien that has been allowed and perfected. A lien is not “allowed” until the court grants the employer’s application, which may require deciding comparative fault and fee allocation first. Here, the order allowing the lien did not issue until April 2025, nearly two years after the dismissal. By then the action was no longer pending: the time to appeal the dismissal had expired in November 2023. The court cited Maniago v. Desert Cardiology Consultants’ Medical Group, Inc. (2026) 20 Cal.5th 91 for the principle that a voluntary dismissal with prejudice terminates the action. Because SCPMG never perfected its lien before the dismissal, the Slamers did not need its consent to dismiss.
The panel expressly took no position on whether any other remedy remains available to SCPMG. For employers and carriers, the case is a reminder that a filed notice of lien is not enough. The employer must obtain a court order allowing the lien, or a properly made request for the court to retain jurisdiction, before the employee’s third-party action is dismissed. This is especially important once the employer has been dismissed from the case as a defendant.
This is an unpublished opinion of the California Court of Appeal, under California Rules of Court, rule 8.1115(a), courts and parties generally may not cite it or rely on it. It is not a decision of the Workers’ Compensation Appeals Board. It is however relevant to the Worker's Compensation community as illustrative of existing law.
- Correctional Officer Pleads No Contest in SCIF WC Fraud Caseon September 29, 2026 at 9:13 AM
A former correctional officer at Salinas Valley State Prison has pleaded no contest to felony workers’ compensation insurance fraud and admitted the loss exceeded $100,000, the Monterey County District Attorney’s Office announced. The defendant, 43-year-old Lorena Hernandez Alvarado of King City, is scheduled for sentencing on October 22, 2026. District Attorney also reported that Alvarado pleaded guilty in two unrelated DUI cases.
According to the District Attorney’s press release, the case began with a workplace injury claim Alvarado filed in April 2021. She reported injuring her shoulder, neck, back, and knees while holding a heavy shield to protect herself from liquid an inmate had thrown at her. State Compensation Insurance Fund, which the release identifies as the prison’s insurer, accepted the claim. Alvarado never returned to work and collected well over $100,000 in wage-replacement and medical benefits.
Prosecutors say an Internal Affairs investigation by the California Department of Corrections and Rehabilitation later found that Alvarado had not used a shield during the April 2021 incident. The same investigation concluded that she had fabricated an earlier workplace injury in 2019, which she attributed to a struggle with an inmate. That 2019 claim was denied. The District Attorney’s Workers’ Compensation Fraud Unit then charged her with two felony counts of insurance fraud. The release does not name the specific statutes charged or say whether the plea covered one count or both. CDCR Investigator Adam Jimenez and District Attorney Workers’ Compensation Insurance Fraud Investigator Jennifer Mendoza handled the investigation.
County fraud units like Monterey’s are largely funded by California employers themselves. The California Department of Insurance awards annual grants to district attorneys to investigate and prosecute workers’ compensation fraud, and those grants are paid for through assessments on employers. The department describes claimant fraud as one of several categories the grants target, along with medical provider fraud, employer premium fraud, and insider fraud.
The account of the underlying conduct comes from the District Attorney’s release and the CDCR investigation it describes; no court findings or defense statements were available. Sentencing has not yet occurred, and the release does not say whether prosecutors will seek restitution to State Fund or how much.
- Estoppel Cannot Create Coverage Insurance Policy Does Not Provideon September 28, 2026 at 2:09 PM
John Linsao and Brian Walters owned a home in Sherman Oaks at the bottom of a ravine below a steep hillside. They had an all-risk homeowners policy from First American Property & Casualty Insurance Company and a separate flood and mud policy from another carrier. The First American policy excluded loss caused by weather conditions, earth movement such as mudslides, acts or decisions of any person or government body, and faulty, inadequate, or defective planning, design, workmanship, or construction, whether on or off the insured premises.
In 2019 a contractor, Melt Construction, was building a large house on an upslope lot. The City of Los Angeles approved plans requiring Melt to build a retaining wall along the road. A neighbor complained about how the wall would look. The City then asked Melt to pause work on the wall while design changes were considered, although it never issued a formal stop order. When work stopped, about 15 feet of the wall had not been built. That section consisted only of drilled caisson holes with rebar in them.
In December 2019 a rainstorm hit while construction was still paused. Melt placed about 75 sandbags at the unfinished end of the wall. Runoff ran along the wall to its open end and cut a gully directly toward the rear of the insured home. The water overwhelmed the home’s drainage, cracked the home’s own retaining wall, and pushed water, mud, and debris into the house. The damage made the home uninhabitable.
First American denied the claim in January 2020 under the earth movement exclusion. Linsao is a lawyer with insurance industry experience, and he argued that Melt’s negligence was the cause of the loss. First American then reopened the claim. According to evidence the homeowners submitted, several First American employees told Linsao in June 2020 that the loss was covered. The insurer also issued a $20,000 advance for living expenses. Within days, however, a claims vice president and outside counsel wrote that coverage had not been confirmed. In early July, Linsao took out a $200,000 loan to pay for repairs and living expenses. On July 24, 2020, First American issued a final denial. It concluded that earth movement, water, third-party negligence, and weather, all excluded perils, had combined to cause the loss.
The homeowners and two family members sued First American for breach of contract, breach of the implied covenant of good faith and fair dealing, intentional infliction of emotional distress, and fraud. The fraud claim was based on First American’s website, which marketed the policy as comprehensive while recommending separate flood coverage. The plaintiffs also sued the City, Melt, and others in a separate action, and they later settled with the other insurers.
The trial court granted First American’s motion for summary judgment. It rejected the estoppel argument and held that the undisputed facts brought the loss within one or more exclusions, focusing mainly on the inadequate construction exclusion. It held that the contract, implied covenant, and emotional distress claims failed because there was no coverage. It also found that the evidence did not support several elements of the fraud claim.
In the Published Case of Linsao v. First American Property & Casualty Insurance Company, Case No. B340746 (September, 2026). The Court of Appeal affirmed the summary judgment in full and awarded First American its costs on appeal. The California Court of Appeal filed this opinion as unpublished on August 27, 2026, and then certified it for publication on September 23, 2026, so it is now citable precedent
The panel first addressed efficient proximate cause. Under State Farm Fire & Casualty Co. v. Von Der Lieth (1991) 54 Cal.3d 1123, a loss caused by a combination of covered and excluded perils is covered if a covered peril was the predominant cause. The homeowners argued that a jury could still decide which cause predominated. The court held that a factual dispute over which cause predominated does not defeat summary judgment when every possible predominant cause is excluded, following Brodkin v. State Farm Fire & Casualty Co. (1989) 217 Cal.App.3d 210.
The court identified four candidate causes: the storm, the mudslide, Melt’s construction activity, and the neighbor’s complaint. The homeowners did not argue on appeal that the storm or the mudslide was a covered cause. The court held that the neighbor’s complaint could not be the efficient proximate cause as a matter of law. The complaint was at most a “but for” cause that started a chain of events. It could not have damaged the home on its own, and treating it as a separate peril merely recharacterized Melt’s conduct.
On Melt’s conduct, the court read “inadequate” according to its ordinary dictionary meaning: insufficient or not capable of serving its purpose. Relying on Wilson v. Farmers Ins. Exchange (2002) 102 Cal.App.4th 1171, which held that an unfinished home renovation was plainly inadequate construction, the court concluded that a retaining wall missing a 15-foot section cannot function as a retaining wall. The homeowners argued that Melt paused at the City’s request and was not at fault. The court rejected that argument because the exclusion requires only inadequacy, not negligence or blame. Because the exclusion is not ambiguous, the rule that ambiguous exclusions are construed against the insurer did not apply. The court also noted that nothing requires a homeowners policy to cover risks created by an unfinished construction project on neighboring property.
Next, the court rejected the estoppel argument. It agreed that the evidence raised a triable issue about whether First American’s employees told the homeowners the loss was covered and whether the homeowners relied on those statements. Even so, the court held that estoppel cannot create coverage that the policy does not provide. The homeowners relied on Tomerlin v. Canadian Indemnity Co. (1964) 61 Cal.2d 638 and Miller v. Elite Ins. Co. (1980) 100 Cal.App.3d 739. The court explained that those were liability insurance cases in which the insured gave up alternative ways of defending or resolving a lawsuit because of the insurer’s conduct. It noted that Dollinger DeAnza Associates v. Chicago Title Ins. Co. (2011) 199 Cal.App.4th 1132 had limited that exception to liability insurers. The panel did not decide whether the exception could ever reach first-party coverage, because these homeowners gave up no alternatives. They pursued both a flood claim and a lawsuit against Melt and others. At most, the loan might support a claim for the cost of borrowing under promissory estoppel, a theory the homeowners had expressly disclaimed.
The court then held that bad faith in the investigation of a claim that is not covered is not actionable. Under Waller v. Truck Ins. Exchange, Inc. (1995) 11 Cal.4th 1, the implied covenant has no independent existence apart from the contract benefits due. The court expressly adopted Benavides v. State Farm General Ins. Co. (2006) 136 Cal.App.4th 1241, holding that without coverage there is no tort liability for how a first-party claim was investigated, whether the theory is framed as breach of the implied covenant or as emotional distress. It declined to follow dicta in earlier cases suggesting that an insurer might sometimes be liable for bad faith even without coverage.
Finally, the court affirmed summary judgment on the fraud claim. The website accurately described the range of coverage First American generally offers and said nothing about the terms of the plaintiffs’ particular policy. In addition, no reasonable insured could rely on general marketing statements over the express terms of the policy they purchased.
- California Comp Grows More Expensive Faster Than National Systemson September 28, 2026 at 2:09 PM
California’s workers’ compensation system paid $13.88 billion in benefits in 2023, a 7.1% jump from the prior year and nearly double the 3.8% growth recorded nationally, according to a review of new National Academy of Social Insurance (NASI) data released September 24, 2026 by the California Workers’ Compensation Institute (CWCI). The $916 million increase lifted California’s share of all U.S. workers’ compensation benefit payments to 21.7%, up from 21% in 2022.
The CWCI analysis draws on NASI’s 28th annual report, Workers’ Compensation: Benefits, Costs, and Coverage, 2023 Data, published August 11, 2026. NASI, a Washington, D.C.-based nonprofit, took over the national workers’ compensation data series formerly produced by the Social Security Administration and describes its report as the only comprehensive source of benefit, coverage, and employer-cost data for all 50 states, the District of Columbia, and federal programs. NASI builds its estimates largely from state agency responses to an Academy questionnaire, supplemented by insurer premium data from A.M. Best and the National Association of Insurance Commissioners and by data from the National Council on Compensation Insurance.
The CWCI review highlights how outsized California’s system is relative to its workforce. The state accounted for 11.9% of the nation’s covered jobs and 14.3% of covered payroll in 2023, yet more than a fifth of all benefits paid — meaning its share of benefit dollars ran roughly one and a half times its share of payroll. California’s total exceeded the combined benefit payments of New York, Florida, and Washington, the states ranked second through fourth, and was nearly four times the $3.52 billion paid under federal programs. Payments were split almost evenly between medical and indemnity benefits, at about $6.95 billion each.
The growth in benefits came even as California’s job base barely moved. Covered employment in the state rose just 0.6% to nearly 17.8 million jobs, compared with 2.3% growth nationwide, according to the CWCI review.
The national picture in NASI’s report offers useful contrast. Across the country, workers’ compensation programs covered nearly 150 million jobs and close to $11 trillion in wages in 2023, surpassing pre-pandemic levels, and paid $64.1 billion in total benefits, with medical care making up more than 47% of that amount. Total employer costs reached $106.6 billion, up 3.5% from 2022. But because payroll grew faster than benefits and costs, NASI found that both measures kept falling when adjusted for covered wages; employer costs came to roughly 98 cents per $100 of covered payroll. Thirty-six jurisdictions saw total benefits per $100 of payroll decline between 2022 and 2023, and 43 saw employer costs per $100 of payroll decline. Private insurers paid 55.6% of benefits nationally, self-insured employers 25.6%, the 22 state funds 13.3%, and the federal government 5.5%.
For California employers and carriers, the findings reinforce a theme running through recent industry research: the state’s system is growing more expensive faster than the national system as a whole. The NASI data arrive on the heels of a separate CWCI loss development study released September 17, 2026, which concluded that the pandemic disrupted but did not halt steady growth in California medical and indemnity claim costs, and that medical costs may be accelerating in the post-pandemic period.
Readers should keep several limitations in mind. The figures reflect benefits paid during calendar year 2023 regardless of when the underlying injuries occurred, so they do not track the cost of any particular group of claims. The data are also nearly three years old by the time of publication, and NASI’s numbers are estimates assembled from multiple sources, with its methodology materials noting that costs and benefits recorded in a given year are not perfectly aligned (see NASI’s Sources, Methods, and State Summaries from the prior edition). The California-specific figures in this story come from Business Insurance’s account of the CWCI review rather than from the CWCI release itself; readers can check the national figures directly against NASI’s executive summary and full state-by-state dataset.
- Policy Cancellation OK For Nonpayment of Earned or Unearned Premiumon September 24, 2026 at 2:16 PM
State Compensation Insurance Fund (State Fund) had insured Dynamic Nutraceutical, Inc. for many years. The policy at issue ran from January 1, 2012 to January 1, 2013, with a total estimated annual premium of $640 and a required deposit premium of the same amount. On January 20, 2012, State Fund sent Dynamic a notice revising the required deposit. It told Dynamic to pay $71.20. The decision does not explain the difference between the two figures.
On February 21, 2012, State Fund sent a notice cancelling the policy effective March 8, 2012 for failure to pay premium when due, citing the $71.20 balance. Dynamic's principal testified that he did not recall receiving the notice until much later, because at the time he was caring for his mother, who had cancer and was frequently hospitalized. He found the letter in June and then sent State Fund a check for $71.20.
The policy listed nonpayment of premium as a ground for cancellation. State Fund had attached letters telling policyholders that, starting January 1, 2012, it would no longer send cancellation warning letters and would move to a new billing system built around a premium deposit. Nicolas Garcia's workers' compensation claim against Dynamic turned on whether the policy was still in force. The decision does not state his date of injury. The Uninsured Employers Benefits Trust Fund was among the parties served.
In a February 2, 2026 Findings and Order, the arbitrator found that part of Dynamic's deposit premium remained unpaid as of February 21, 2012. However, the arbitrator also found that State Fund had not shown any unpaid earned premium, meaning premium for coverage already provided. The arbitrator concluded that neither the policy nor Insurance Code § 676.8 allows cancellation on 10 days' notice for an unpaid deposit premium. He declared the cancellation void and returned the case to the trial level to address injury and benefits. His later report recommended that State Fund's petition for reconsideration be denied, and Dynamic filed no answer.
In the panel decision of Nicolas Garcia v. Dynamic Nutraceutical, Inc.; State Compensation Insurance Fund, ADJ9109258, (September 2026), the Board panel (Commissioners Paul F. Kelly, Katherine Williams Dodd, and Joseph V. Capurro) granted reconsideration and rescinded the arbitrator's decision. It substituted a finding that State Fund properly canceled the policy on March 8, 2012 because Dynamic failed to make a required premium payment when due.
The panel first confirmed that its decision was timely. Under the version of Labor Code § 5909 in effect from July 2, 2024 through June 30, 2026, the Board had 60 days from the case's transmission on July 15, 2026 to act. That period ended on a Sunday, so the deadline moved to Monday, September 14, 2026 under Cal. Code Regs., tit. 8, § 10600(b). The arbitrator's report had been served months before the transmission, so serving it did not give the parties notice that the 60-day clock had started. However, the district office's July 15 minutes of hearing did give that notice.
On the merits, the panel held that the statute and the policy were both unambiguous. Section 676.8(b)(1) allows cancellation for the policyholder's failure to make any premium payment when due. The panel reasoned that the statute makes no distinction between earned and unearned premium and does not exempt a premium deposit. It read the word “any” as removing doubt that every kind of premium payment is covered. The policy likewise allowed cancellation for nonpayment of premium without distinguishing between types of premium. Neither the statute nor the policy sets a minimum amount, so it did not matter that the shortfall was only $71.20.
The panel said the arbitrator's distinction between deposit and earned premium went well beyond the plain meaning and obvious purpose of requiring timely payment. It cited the Third District's recent published decision in Employers Preferred Ins. Co. v. Workers' Comp. Appeals Bd. (2026) 122 Cal.App.5th 467 for the rule that courts will not adopt strained readings to create ambiguity. That case also upheld a carrier's cancellation of a policy. The panel also found the notice procedurally sound: § 676.8(c) requires at least 10 days' written notice for nonpayment, and State Fund gave 15.
Finally, the panel admonished State Fund's counsel for citing an unpublished Court of Appeal opinion to explain what a deposit premium is. Under California Rules of Court, rule 8.1115, unpublished opinions generally may not be cited or relied on in other cases. The panel found that none of the rule's exceptions applied.
- WCAB Moves CT Liability Window - Releasing 2014 Carrieron September 24, 2026 at 2:16 PM
Guadalupe Gutierrez worked for almost 40 years as a cemetery groundskeeper in Colma for Hills of Eternity/Home of Peace Management Group. American Family Home Insurance Company (AFH) insured the employer during calendar year 2014, and Insurance Company of the West (ICW) insured it during 2015. Gutierrez had three claims pending. The first was an admitted specific back injury on April 12, 2015, for which ICW furnished benefits. The second was a cumulative trauma claim, filed in November 2016, alleging back injury over the year ending April 12, 2015. The third was a separate claim that was ultimately denied.
In October 2019, Gutierrez elected on the record to proceed against AFH on the cumulative trauma claim under Labor Code § 5500.5(c). In a February 3, 2020 report, the agreed medical evaluator, Dr. William Campbell, concluded that Gutierrez had suffered specific injuries on January 1 and April 12, 2015. He also concluded that the back condition reflected cumulative trauma over almost four decades of heavy work, during which Gutierrez had worked through many unreported smaller injuries. In a later report, Dr. Campbell addressed whether Gutierrez's harmful exposure ended in November 2015 or continued until he stopped working on April 27, 2016. He pointed to treatment records showing that all work restrictions were lifted from November 3, 2015 onward, and concluded the exposure continued through April 27, 2016.
In a November 2022 decision, the workers' compensation judge (WCJ) found both the specific injury and the cumulative trauma injury compensable. For the cumulative trauma claim, the WCJ used the pleaded end date of April 12, 2015 to set the one-year liability period under § 5500.5. The WCJ did not include a formal finding on the date of injury under Labor Code § 5412. However, the WCJ's opinion reasoned that because Gutierrez had a disabling specific injury on April 12, 2015, he must have known that same day that his disability was work-related. The WCJ awarded 46 percent permanent disability, future medical care, and attorney fees on the cumulative trauma claim against the employer, AFH, and ICW jointly and severally. The WCJ deferred the questions of which insurer would administer benefits and how the insurers would share costs.
AFH petitioned for reconsideration. It argued that both the last date of harmful exposure and the date of injury fell in April 2016, which would put the liability period entirely outside AFH's 2014 coverage. ICW petitioned separately, arguing that Gutierrez's 2019 election against AFH meant AFH alone should be liable, so the administration and contribution issues should not have been deferred.
In the panel decision of Guadalupe Gutierrez v. Hills of Eternity/Home of Peace Management Group, ADJ10656667, ADJ10656647, ADJ13080462 (September 2026), the Board panel (Deputy Commissioner Anne Schmitz, Chair Katherine A. Zalewski, and Commissioner JosÉ H. Razo) rescinded the WCJ's decision and substituted new findings on the cumulative trauma claim. The last day of harmful exposure is April 27, 2016. The § 5412 date of injury is February 3, 2020. The § 5500.5 liability period is the 365 days ending April 27, 2016. The panel removed AFH from the award and made the award, including the 46 percent permanent disability, joint and several against the employer and ICW only. It deferred all other issues on that claim and returned the matter to the trial level. The WCJ's findings on the specific injury and the denied third claim were carried forward.
On the end of the exposure period, the panel noted that § 5500.5(a) limits cumulative trauma liability to employers and insurers during the year before the last date of harmful exposure or the § 5412 date of injury, whichever comes first. Dr. Campbell had squarely addressed whether the exposure ended in November 2015 or April 2016. Because his opinion, and the work-status records it relied on, were uncontroverted, the panel saw no good reason to reject it. It cited Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775 and fixed the last exposure date at April 27, 2016.
On the date of injury, the panel held that the WCJ applied the wrong test. A cumulative trauma injury, as defined in Labor Code § 3208.1, occurs when its combined effect ripens into compensable disability and the worker knows, or reasonably should know, that the disability was caused by work. The panel relied on Federal Ins. Co. v. Workers' Comp. Appeals Bd. (2013) 221 Cal.App.4th 1116 and State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Rodarte) (2004) 119 Cal.App.4th 998. Knowing that a specific incident was work-related is not the same as knowing that years of cumulative trauma caused a disability. Under City of Fresno v. Workers' Comp. Appeals Bd. (Johnson) (1985) 163 Cal.App.3d 467, a worker is generally not presumed to have that knowledge without medical confirmation. The panel found no evidence that Gutierrez knew or should have known of a disabling cumulative injury before Dr. Campbell's February 3, 2020 report. Because the April 27, 2016 exposure date came first, it controls the liability window.
On ICW's argument, the panel agreed with the WCJ. Under § 5500.5(c) and Colonial Ins. Co. v. Industrial Acc. Com. (Pedroza) (1946) 29 Cal.2d 79, an injured worker may elect to proceed against any one of several liable insurers. But that election does not relieve any other insurer of its liability, so deferring administration and contribution was proper. The panel then noted that its own findings moved the liability period entirely outside AFH's 2014 coverage, so the record no longer supported any award against AFH. That left ICW, which covered 2015, jointly liable with the employer. The panel added that ICW may still identify whichever insurer covered the employer in 2016, join it in the case, and seek contribution.
- 9th Circuit Rules 2013 Insurance Code Notice Mandate Not Retroactiveon September 23, 2026 at 12:27 PM
In 2007, New York Life Insurance and Annuity Corporation issued a life insurance policy to Mr. Linhart, who owned the policy and named his wife, Barbara Linhart, as sole beneficiary. The policy did not require fixed premium payments, but Mr. Linhart had to pay enough to keep the policy's account value above the insurer's monthly deduction charge, which covered the monthly cost of coverage plus fees.
In 2012, the Legislature enacted Insurance Code § 10113.71 and Insurance Code § 10113.72, effective January 1, 2013. Together they created a mandatory grace period and pre-termination notice rules for life policies. Subdivision (a) of § 10113.72 bars an individual life policy from being issued or delivered until the applicant has been given the right to designate a third person to receive lapse or termination notices, and requires the insurer to give each applicant a form for that purpose. Subdivision (b) requires the insurer to remind the policy owner annually of the right to make or change a designation, and subdivision (c) requires at least 30 days' notice before a policy lapses for nonpayment.
Starting in August 2013, the insurer sent Mr. Linhart an annual policy summary that included notice of his right to designate a third party to receive lapse notices. It never sent a standalone designation form, and Mr. Linhart never named a designee. On June 1, 2021, the policy entered a grace period because the account value could not cover the monthly charges. The insurer mailed a notice telling Mr. Linhart he needed to make a sufficient payment by August 3, 2021. The policy lapsed on that date, and Mr. Linhart died four days later. When his estate asked about benefits, the insurer responded that the policy had lapsed and declined to pay.
Barbara Linhart filed a putative class action alleging that the insurer violated § 10113.72(a) by failing to send designation forms to owners of policies issued before 2013. According to the district court's order, her amended complaint pleaded claims for breach of contract and breach of the implied covenant of good faith and fair dealing. The district court granted summary judgment to the insurer, concluding that under the plain language of § 10113.72(a) and the California Supreme Court's decision in McHugh v. Protective Life Ins. Co. (2021) 12 Cal.5th 213, the insurer had no duty to send Mr. Linhart a designation form. The court then denied class certification. Ms. Linhart appealed under 28 U.S.C. § 1291.
In the published case of Linhart v. New York Life Insurance and Annuity Corporation, No. 25-490 (September 2026), a Ninth Circuit panel affirmed the summary judgment for the insurer. The panel held that life insurers are not required to send § 10113.72(a) designation forms to owners of policies issued before the statute took effect on January 1, 2013.
The panel treated the question as already answered by the California Supreme Court, whose interpretation of state law binds federal courts. In McHugh, the high court stated that § 10113.72(a) “unmistakably applies only to new policies.” McHugh reasoned that the subdivision repeatedly refers to the “applicant” rather than the “policy owner,” and that its command that a policy shall not be issued or delivered until the designation right is given signals forward-looking application. Because Mr. Linhart's 2007 policy was not a new policy, the panel concluded that subdivision (a) never applied to it, and the insurer had no obligation to send him a form while he was alive.
Ms. Linhart relied on other language in McHugh holding that §§ 10113.71 and 10113.72 apply to all policies in force when they took effect, regardless of issue date. The panel found that argument unpersuasive. It explained that McHugh's general statement about the sections as a whole does not answer whether one particular subdivision reaches existing policies. Subdivisions (b) and (c) impose ongoing notice obligations that can sensibly apply to every in-force policy, while subdivision (a) is tied to a single moment, the application process before a policy issues. Requiring pre-issuance forms for policies already issued, the panel wrote, would make nonsense of subdivision (a)'s text. The panel added that McHugh's description of the provisions as a single, unified pre-termination notice scheme supports, rather than undercuts, reading the subdivisions to operate differently.
The opinion addressed only subdivision (a). It did not decide whether the insurer's annual policy summaries satisfied subdivision (b) or whether its grace-period notice satisfied § 10113.71 or § 10113.72(c), as those issues were not the basis of the appeal. For insurers administering pre-2013 individual life policies in California, the ruling confirms that the pre-issuance designation form requirement does not apply retroactively, while McHugh's holding that the ongoing notice and grace-period protections apply to all policies in force on January 1, 2013 remains in place.
- Flight Surgeon/QME Named "Hidden Gem" at 2026 Comp Conferenceon September 23, 2026 at 12:27 PM
Dr. Leslie Cadet is a former U.S. Air Force flight surgeon who was named Air Force Global Strike Command's 2015 Command Flight Surgeon of the Year, was just named one of two 2026 “Hidden Gems” among the 12 professionals honored at the second annual Work Comp Changemaker© Awards. The awards were presented at the ELEVATE® Work Comp Conference at the Hotel del Coronado in Coronado, California this September.
The honorees were announced on the Deconstructing Comp website. The organizers say the Hidden Gem category recognizes professionals whose leadership is quiet but has a significant effect on the industry. Dr. Cadet, a board-certified occupational and environmental medicine physician, QME, educator, and entrepreneur, shares the designation with Nicholas Fonner, a workers' compensation case manager at Brooks Rehabilitation.
According to her honoree profile on the Deconstructing Comp website, Dr. Cadet began her career in the Air Force as a flight surgeon and occupational health consultant. The profile says her work supported 1,080 combat missions and 2,000 airlift missions in support of Operations Inherent Resolve and Enduring Freedom. As medical director of her flight medicine clinic, she led a 23-person team that cared for more than 700 beneficiaries and supported the medical readiness of about 5,100 active-duty personnel. Her patients included aviators, aircraft mechanics, intelligence personnel, and other service members working in specialized, high-demand jobs. In addition to the Command Flight Surgeon of the Year award, she was named her squadron's 2015 Company Grade Officer of the Year.
After leaving the military, Dr. Cadet completed a residency in occupational and environmental medicine at the Harvard T.H. Chan School of Public Health and earned a Master of Public Health degree there. She later served as Employee Health Medical Director at Loma Linda University Health. She still teaches as an assistant professor at the Loma Linda University School of Medicine and as an attending physician in its occupational and environmental medicine residency program. According to her profile, the residents she trains named her Teacher of the Year in 2022, 2023, 2024, and 2026.
Her current work is aimed directly at employers and claims professionals. Dr. Cadet founded and leads ASCEND Occupational Medicine Consulting, a physician-led firm that works with self-insured employers, claims professionals, attorneys, and others on complex workers' compensation claims. Her profile says the firm provides medical oversight of those claims. That work includes testing whether diagnoses and treatment plans are supported by objective evidence, identifying barriers to recovery, setting realistic recovery timelines, and strengthening return-to-work plans so claims do not slide into prolonged disability. The profile describes the gap she is trying to close this way: claims decisions are usually guided by financial, claims-handling, and legal experts, but often without a physician at the table. Her approach, as the profile summarizes it, favors appropriate care over more care, function over disability, and early intervention over letting a claim grow more complex.
Ten other professionals were named 2026 Work Comp Changemaker© Honorees. They are Catherine Benavidez of Injury Management Organization; Anthony Culpepper, Jr., of Employer Defense Group and the African American Workers' Compensation Professionals; Dr. Geralyn Datz of Southern Behavioral Medicine Associates; Dr. Steven Feinberg of Feinberg Medical Group; Kimberly George of Sedgwick; Agnes Hoeberling of AvonRisk; Kirsten Kaiser Kus of Downey, Lenkov, Milstein & Kus Law Firm; Roberta Serena Mike of Strategic Comp and the Workers' Compensation Career Mentorship Group; Dave Taylor of Charter Communications; and Licia Thompson-Young of Licia Thompson Coaching & Consulting. Profiles of all honorees are on the Deconstructing Comp website.
The awards were created by Yvonne Guibert and Rafael Gonzalez, co-hosts of the Deconstructing Comp Podcast. They are not lifetime achievement awards. Instead, they recognize emerging and established professionals for their leadership, impact, integrity, and mentorship over the past two to five years. According to the organizers, honorees are chosen by an advisory committee of workers' compensation professionals in three rounds. First, each committee member nominates five people. Next, each member champions two nominees they did not nominate, interviews them, and presents them to the committee. Finally, the committee ranks the finalists, and the rankings determine the honorees. Guibert described this year's class as “people to watch” in the release.
And Dr. Cadet, thank you so very much for your service to our country.
- Insurance Payment Service Accused of Illegal Price Fixingon September 22, 2026 at 9:54 AM
MultiPlan Corporation was founded in 1980 in New York City as a hospital network aimed at giving patients access to care and controlling costs when they went outside a narrow insurance network. Over the following decades it built out a preferred provider organization (PPO) business and grew through consolidation into a national network.
In April 2024, a New York Times investigation by Chris Hamby ("Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill") reported that MultiPlan and the insurers using its services shared a financial incentive to push reimbursements as low as possible, since both parties' fees rose as the amount paid to providers fell — leaving patients exposed to larger balance bills.
The article resulted in a wave of private antitrust litigation from hospital systems and providers, which was consolidated into the multidistrict litigation In re MultiPlan Health Insurance Provider Litigation in the Northern District of Illinois — the same MDL whose 2025 ruling on a motion to dismiss the Court of Appeal relied on in this VHS Liquidating Trust case. In February 2025, amid this litigation and reputational pressure, the company rebranded from MultiPlan to Claritev Corporation, moving its NYSE ticker from MPLN to CTEV.
Last June, the Arizona AG announced a lawsuit against MultiPlan and several large health insurers, alleging they quietly built and operated a system that slashed payments to doctors and hospitals — and left Arizonans having to pay more for out-of-network care.
In this September 2026 published California court of appeal decision, VHS Liquidating Trust is the bankruptcy liquidator for Verity Health System of California, a former not-for-profit operator of six hospitals in the San Francisco, Los Angeles and San Jose areas that went bankrupt in 2018. Verity, like other hospitals, was paid for patient care by a mix of patients, government payors, and private insurers. Where a hospital has no contract covering a particular service, the service is billed as “out-of-network” (OON), and the insurer typically reimburses the provider at a rate based on the “usual, customary, and reasonable” (UCR) rate for the area.
Based on these allegations, VHS sued MultiPlan (without naming the insurers, who had separately compelled arbitration) for horizontal price fixing, price tampering, and unlawful exchange of competitively sensitive information under the Cartwright Act (Bus. & Prof. Code § 16700 et seq.), plus a derivative Unfair Competition Law claim.
VHS's complaint alleges that MultiPlan Corporation (now Claritev Corporation), which markets algorithm-driven data analytics to health insurers, offers a “repricing” service that insurers use to set OON reimbursement rates. Insurers send MultiPlan a claim; MultiPlan's proprietary algorithm, built on a pooled database of roughly a billion claims from more than 700 insurers, recommends a price; and MultiPlan then presents that price to the provider on a take-it-or-leave-it basis. By 2020 MultiPlan was repricing 370,000 OON claims per day, and insurers reportedly followed its recommendations without human review 87 percent of the time. VHS alleges this scheme is the successor to an earlier practice, involving a MultiPlan predecessor called Ingenix, that a 2009 New York Attorney General enforcement action forced to shut down. VHS contends that MultiPlan operates as the "hub" of a "hub, spoke, and rim" conspiracy: insurers (the spokes) know from MultiPlan's own public statements that their competitors also submit sensitive claims data to MultiPlan and follow its recommended prices the vast majority of the time, giving each insurer the assurance it needs to accept suppressed rates without fear that a rival will out-compete it by paying more.
The San Francisco County Superior Court sustained MultiPlan's demurrer to the entire complaint without leave to amend. The trial court reasoned that an insurer's reimbursement for OON services is not a standalone product or service but is simply part of the insurance policy the insurer already owes its subscriber; without a discrete product, the court held, there is no "price" that the Cartwright Act's price-fixing and price-tampering provisions can reach. Because the information-exchange claims and the UCL claim were premised on the same theory, those fell with the price-fixing claims, and final judgment was entered for MultiPlan.
In the published case of VHS Liquidating Trust v. MultiPlan Corporation et al., No. A171914 (1st Dist., Div. 3, Sept. 2026): Reversed and remanded. The Court of Appeal held that OON reimbursements are not categorically exempt from Cartwright Act scrutiny, reversed the judgment on the demurrer, and sent the case back to the trial court to consider MultiPlan's remaining, unaddressed arguments in the first instance.
Writing for a unanimous panel, the court held that the trial court's exemption for OON reimbursements has no basis in the Cartwright Act's text or in case law. The statute broadly prohibits combinations that fix or tamper with the price of an "article, commodity or transportation," and California courts have long read it to cover services as well, and to reach buyers' price-fixing (not just sellers'). The court reasoned that an insurer's contractual duty to its subscriber and its separate market transaction with a provider are analytically distinct: just as a general contractor's obligation to a homeowner does not exempt its payments to subcontractors from antitrust scrutiny, an insurer's coverage promise to its subscriber does not exempt its reimbursement negotiations with providers.
Because no California case had addressed the question directly, the court also surveyed federal authority, noting that under the Cartwright Act federal precedent is instructive but not binding, since the Act is "broader in range and deeper in reach" than the Sherman Act (Cianci v. Superior Court (1985) 40 Cal.3d 903, 920). The court declined to follow three federal district court decisions the trial court had relied on—Franco v. Connecticut General Life Insurance Co. (D.N.J. 2011) 818 F.Supp.2d 792, In re Aetna UCR Litigation (D.N.J. 2015), and Pacific Recovery Solutions v. Cigna Behavioral Health, Inc. (N.D. Cal. 2021)—because those cases analyzed the question from the perspective of insurance subscribers, not providers, and did not address whether a provider-insurer transaction could itself be price-fixed. Instead, the court found persuasive the federal multidistrict litigation against MultiPlan itself, where the presiding judge rejected the identical argument as a "sleight of hand" that analyzed the wrong market (In re MultiPlan Health Insurance Provider Litigation (N.D. Ill. 2025) 789 F.Supp.3d 614).
The court further relied on U.S. Supreme Court and First Circuit authority holding that an insurer's payments to providers are legally distinct from its coverage obligations to policyholders. In Group Life & Health Insurance Co. v. Royal Drug Co. (1979) 440 U.S. 205, the Supreme Court held that an insurer's pharmacy reimbursement agreements were "merely arrangements for the purchase of goods and services," separate from the insurer's obligations under its policies. In Kartell v. Blue Shield of Massachusetts, Inc. (1st Cir. 1984) 749 F.2d 922, the First Circuit similarly held that any distinction between "purchasing" and "insurance reimbursement" is "irrelevant for antitrust purposes." Applying that same logic, the panel concluded it would be illogical to hold that providers can be liable for fixing the prices they charge insurers, but insurers cannot be liable for fixing the prices they pay providers.
Because it reversed on this threshold ground, the court did not reach MultiPlan's other arguments, including one based on the Knox-Keene Act, and remanded for the trial court to address them in the first instance. In a footnote, the court added—without resting its holding on the point—that it viewed the trial court's rule as posing a policy concern, since it would exempt a significant portion of the healthcare industry from antitrust scrutiny at a time when courts have also been reluctant to let insurance subscribers challenge similar conduct.
- Guilty Plea in $400K Medi-Cal Fraud Case Results in 2 Year Sentenceon September 22, 2026 at 9:54 AM
The California Attorney General announced that Maki Martinez-Gruninger pled guilty to a felony charge of defrauding the Medi-Cal program and will serve two years in state prison for stealing more than $400,000 from the State of California through a scheme that exploited a disabled family member.
California’s In-Home Supportive Services program, known almost universally as IHSS, is the state’s main way of paying for help in the home so that older adults, people who are blind, and people with disabilities—including children—can stay where they live instead of moving into a nursing home or other institution.
IHSS grew out of the independent-living and disability-rights movements of the 1970s and remains one of the largest consumer-directed personal-care programs in the country. Recipients are not patients waiting for an agency to assign a worker; they are the employer. They choose who comes through the door, train that person, set the schedule, and can fire them. About seven in ten hire a family member.
Today the program reaches on the order of 850,000 to 900,000 Californians. It is a Medi-Cal benefit, which means federal Medicaid dollars cover a large share of the cost, with the state and each of the 58 counties paying the rest. The California Department of Social Services sets the rules; county social workers do the day-to-day work.
The California Department of Justice received a complaint alleging that Martinez-Gruninger fraudulently claimed to be the In-Home Support Services provider for a disabled family member. According to the complainant — who was the individual's sole caregiver — they discovered in December 2019 that Martinez-Gruninger secretly applied to be the disabled family member's In-Home Support Services provider in November 2007. As a result, Martinez-Gruninger allegedly submitted false claims to the IHSS program for over a decade.
The investigation determined that Martinez-Gruninger unlawfully took the State of California's Medi-Cal program money, intended to defraud the State of California, and presented false IHSS and Respite Care claims for payment totaling $413,643.30.
She pled guilty to a single felony count of Medi-Cal false claims.
The Division of Medi-Cal Fraud & Elder Abuse is a division within the Department of Justice whose mission is to protect the public and the state’s Medi-Cal program from those who defraud taxpayers and divert state health care resources. The investigation was made possible through the collaboration of government agencies and those who reported incidences of Medi-Cal fraud or elder abuse.
The Medi-Cal Fraud & Elder Abuse receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling nearly $78 million for Federal Fiscal Year 2026. The remaining 25 percent, totaling nearly $26 million for Federal Fiscal Year 2026, is funded by the California Attorney General’s Office. Federal Fiscal Year 2026 is from October 1, 2025 through September 30, 2026.
- No Jurisdiction Over Subro Lien After Employee Dismisses Lawsuiton September 29, 2026 at 9:13 AM
In February 2016, Jennifer Slamer was working for Southern California Permanente Medical Group (SCPMG) when she suffered disabling respiratory injuries from exposure to a disinfectant made by Ecolab, Inc. SCPMG resolved her workers’ compensation claim in the administrative system. In May 2017, Slamer and her husband sued Ecolab, SCPMG, and related entities in San Bernardino County Superior Court. SCPMG and its affiliates were dismissed from the civil case with prejudice after a series of demurrers and summary judgment motions. The judgment dismissing SCPMG was entered on April 11, 2022.
The Slamers went to trial against Ecolab alone. Before the case went to the jury, they reached a confidential settlement with Ecolab on April 19, 2023. On June 1, 2023, they voluntarily dismissed the entire action with prejudice.
While the case was pending, SCPMG continued paying benefits. It filed several notices of lien against any recovery under Labor Code § 3856(b). After the settlement, the Slamers refused SCPMG’s requests for reimbursement, and mediation failed. On February 16, 2024, more than eight months after the dismissal, SCPMG filed a motion for reimbursement.
The Slamers opposed the motion on several grounds. They argued the lien had to be reduced by SCPMG’s comparative fault and by an equitable share of their attorney fees and costs. They declined to disclose the settlement amount, but they stipulated that it exceeded the lien plus their fees and costs. On April 18, 2025, the trial court granted SCPMG’s motion. It ordered the Slamers to reimburse the full lien amount plus interest.
In the unpublished case of Slamer v. Southern California Permanente Medical Group, No. D086908 (September 2026) the Court of Appeal reversed and remanded. It directed the trial court to enter a new order denying SCPMG’s reimbursement motion for lack of jurisdiction. The Slamers were awarded their costs on appeal.
The Slamers raised several challenges on appeal: that the motion came too late, that SCPMG’s comparative fault was never decided, that fees were not properly allocated, and that pre-order interest was awarded in error. While the appeal was pending, the panel identified a threshold problem on its own and asked the parties for supplemental briefing. The question was whether the trial court had any jurisdiction to act after the entire case had been voluntarily dismissed with prejudice. The court concluded it did not. Because that answer resolved the appeal, the panel did not reach the other issues.
The court began with the statutory framework. An injured worker’s remedy against the employer is generally limited to workers’ compensation, but the worker may sue a third-party tortfeasor. To prevent double recovery, the employer may assert a lien on the worker’s judgment or settlement. That lien may be reduced for the employer’s own comparative negligence, and for a share of fees and costs under Labor Code § 3860(c) when the recovery was obtained solely through the employee’s attorney. The panel emphasized the timing requirement: the employer must apply for an order paying the lien before the judgment is satisfied or the action is dismissed. It cited Labor Code § 3857 and Abdala v. Aziz (1992) 3 Cal.App.4th 369, among other authorities. SCPMG did not meet that deadline. Once the Slamers filed their dismissal, the action ended and the court lost jurisdiction, except for limited matters such as costs and statutory fees (Harris v. Billings (1993) 16 Cal.App.4th 1396). An order entered without jurisdiction is void.
The panel rejected each of SCPMG’s four counterarguments. First, SCPMG argued the Slamers forfeited the timeliness issue by not raising it in the trial court. The panel disagreed. A challenge to subject matter jurisdiction may be raised for the first time on appeal. SCPMG also pointed to a possible factual dispute over whether the settlement funds had been fully disbursed. The court found that dispute irrelevant, because no one disputed that the dismissal came first.
Second, SCPMG argued the Slamers had acknowledged its lien efforts and agreed the court could keep jurisdiction. The panel held that parties cannot confer subject matter jurisdiction by consent, waiver, or estoppel. It quoted Viejo Bancorp, Inc. v. Wood (1989) 217 Cal.App.3d 200 for the rule that a court “cannot ‘retain’ jurisdiction it has lost.” SCPMG also relied on the lien-motion provision in Code of Civil Procedure § 664.6(f)(1). The court found that provision inapplicable for two reasons. It did not take effect until January 1, 2025, and it does not apply retroactively. And even if it did apply, it covers dismissals without prejudice, not dismissals with prejudice like this one.
Third, SCPMG argued the trial court had expressly retained jurisdiction under § 664.6 to enforce the settlement. Under Wackeen v. Malis (2002) 97 Cal.App.4th 429, a request to retain jurisdiction must meet three conditions. It must be made while the case is pending. It must be in a signed writing or stated orally before the court. And it must be express, clear, and unambiguous. The courtroom exchanges and minute-order entry SCPMG cited did not meet that standard. Separately, SCPMG could not use § 664.6 in any event. It had been dismissed from the case in 2022, which made it a stranger to the action, and only a party to a settlement may invoke that statute.
Fourth, SCPMG argued that the Enforcement of Judgments Law (Code Civ. Proc., § 708.410 et seq.) applied through Labor Code § 3862. Under that law, a lienholder is treated as a party, and the debtor cannot dismiss without the creditor’s consent. The panel explained that § 3862 reaches only a lien that has been allowed and perfected. A lien is not “allowed” until the court grants the employer’s application, which may require deciding comparative fault and fee allocation first. Here, the order allowing the lien did not issue until April 2025, nearly two years after the dismissal. By then the action was no longer pending: the time to appeal the dismissal had expired in November 2023. The court cited Maniago v. Desert Cardiology Consultants’ Medical Group, Inc. (2026) 20 Cal.5th 91 for the principle that a voluntary dismissal with prejudice terminates the action. Because SCPMG never perfected its lien before the dismissal, the Slamers did not need its consent to dismiss.
The panel expressly took no position on whether any other remedy remains available to SCPMG. For employers and carriers, the case is a reminder that a filed notice of lien is not enough. The employer must obtain a court order allowing the lien, or a properly made request for the court to retain jurisdiction, before the employee’s third-party action is dismissed. This is especially important once the employer has been dismissed from the case as a defendant.
This is an unpublished opinion of the California Court of Appeal, under California Rules of Court, rule 8.1115(a), courts and parties generally may not cite it or rely on it. It is not a decision of the Workers’ Compensation Appeals Board. It is however relevant to the Worker's Compensation community as illustrative of existing law. - Correctional Officer Pleads No Contest in SCIF WC Fraud Caseon September 29, 2026 at 9:13 AM
A former correctional officer at Salinas Valley State Prison has pleaded no contest to felony workers’ compensation insurance fraud and admitted the loss exceeded $100,000, the Monterey County District Attorney’s Office announced. The defendant, 43-year-old Lorena Hernandez Alvarado of King City, is scheduled for sentencing on October 22, 2026. District Attorney also reported that Alvarado pleaded guilty in two unrelated DUI cases.
According to the District Attorney’s press release, the case began with a workplace injury claim Alvarado filed in April 2021. She reported injuring her shoulder, neck, back, and knees while holding a heavy shield to protect herself from liquid an inmate had thrown at her. State Compensation Insurance Fund, which the release identifies as the prison’s insurer, accepted the claim. Alvarado never returned to work and collected well over $100,000 in wage-replacement and medical benefits.
Prosecutors say an Internal Affairs investigation by the California Department of Corrections and Rehabilitation later found that Alvarado had not used a shield during the April 2021 incident. The same investigation concluded that she had fabricated an earlier workplace injury in 2019, which she attributed to a struggle with an inmate. That 2019 claim was denied. The District Attorney’s Workers’ Compensation Fraud Unit then charged her with two felony counts of insurance fraud. The release does not name the specific statutes charged or say whether the plea covered one count or both. CDCR Investigator Adam Jimenez and District Attorney Workers’ Compensation Insurance Fraud Investigator Jennifer Mendoza handled the investigation.
County fraud units like Monterey’s are largely funded by California employers themselves. The California Department of Insurance awards annual grants to district attorneys to investigate and prosecute workers’ compensation fraud, and those grants are paid for through assessments on employers. The department describes claimant fraud as one of several categories the grants target, along with medical provider fraud, employer premium fraud, and insider fraud.
The account of the underlying conduct comes from the District Attorney’s release and the CDCR investigation it describes; no court findings or defense statements were available. Sentencing has not yet occurred, and the release does not say whether prosecutors will seek restitution to State Fund or how much. - Estoppel Cannot Create Coverage Insurance Policy Does Not Provideon September 28, 2026 at 2:09 PM
John Linsao and Brian Walters owned a home in Sherman Oaks at the bottom of a ravine below a steep hillside. They had an all-risk homeowners policy from First American Property & Casualty Insurance Company and a separate flood and mud policy from another carrier. The First American policy excluded loss caused by weather conditions, earth movement such as mudslides, acts or decisions of any person or government body, and faulty, inadequate, or defective planning, design, workmanship, or construction, whether on or off the insured premises.
In 2019 a contractor, Melt Construction, was building a large house on an upslope lot. The City of Los Angeles approved plans requiring Melt to build a retaining wall along the road. A neighbor complained about how the wall would look. The City then asked Melt to pause work on the wall while design changes were considered, although it never issued a formal stop order. When work stopped, about 15 feet of the wall had not been built. That section consisted only of drilled caisson holes with rebar in them.
In December 2019 a rainstorm hit while construction was still paused. Melt placed about 75 sandbags at the unfinished end of the wall. Runoff ran along the wall to its open end and cut a gully directly toward the rear of the insured home. The water overwhelmed the home’s drainage, cracked the home’s own retaining wall, and pushed water, mud, and debris into the house. The damage made the home uninhabitable.
First American denied the claim in January 2020 under the earth movement exclusion. Linsao is a lawyer with insurance industry experience, and he argued that Melt’s negligence was the cause of the loss. First American then reopened the claim. According to evidence the homeowners submitted, several First American employees told Linsao in June 2020 that the loss was covered. The insurer also issued a $20,000 advance for living expenses. Within days, however, a claims vice president and outside counsel wrote that coverage had not been confirmed. In early July, Linsao took out a $200,000 loan to pay for repairs and living expenses. On July 24, 2020, First American issued a final denial. It concluded that earth movement, water, third-party negligence, and weather, all excluded perils, had combined to cause the loss.
The homeowners and two family members sued First American for breach of contract, breach of the implied covenant of good faith and fair dealing, intentional infliction of emotional distress, and fraud. The fraud claim was based on First American’s website, which marketed the policy as comprehensive while recommending separate flood coverage. The plaintiffs also sued the City, Melt, and others in a separate action, and they later settled with the other insurers.
The trial court granted First American’s motion for summary judgment. It rejected the estoppel argument and held that the undisputed facts brought the loss within one or more exclusions, focusing mainly on the inadequate construction exclusion. It held that the contract, implied covenant, and emotional distress claims failed because there was no coverage. It also found that the evidence did not support several elements of the fraud claim.
In the Published Case of Linsao v. First American Property & Casualty Insurance Company, Case No. B340746 (September, 2026). The Court of Appeal affirmed the summary judgment in full and awarded First American its costs on appeal. The California Court of Appeal filed this opinion as unpublished on August 27, 2026, and then certified it for publication on September 23, 2026, so it is now citable precedent
The panel first addressed efficient proximate cause. Under State Farm Fire & Casualty Co. v. Von Der Lieth (1991) 54 Cal.3d 1123, a loss caused by a combination of covered and excluded perils is covered if a covered peril was the predominant cause. The homeowners argued that a jury could still decide which cause predominated. The court held that a factual dispute over which cause predominated does not defeat summary judgment when every possible predominant cause is excluded, following Brodkin v. State Farm Fire & Casualty Co. (1989) 217 Cal.App.3d 210.
The court identified four candidate causes: the storm, the mudslide, Melt’s construction activity, and the neighbor’s complaint. The homeowners did not argue on appeal that the storm or the mudslide was a covered cause. The court held that the neighbor’s complaint could not be the efficient proximate cause as a matter of law. The complaint was at most a “but for” cause that started a chain of events. It could not have damaged the home on its own, and treating it as a separate peril merely recharacterized Melt’s conduct.
On Melt’s conduct, the court read “inadequate” according to its ordinary dictionary meaning: insufficient or not capable of serving its purpose. Relying on Wilson v. Farmers Ins. Exchange (2002) 102 Cal.App.4th 1171, which held that an unfinished home renovation was plainly inadequate construction, the court concluded that a retaining wall missing a 15-foot section cannot function as a retaining wall. The homeowners argued that Melt paused at the City’s request and was not at fault. The court rejected that argument because the exclusion requires only inadequacy, not negligence or blame. Because the exclusion is not ambiguous, the rule that ambiguous exclusions are construed against the insurer did not apply. The court also noted that nothing requires a homeowners policy to cover risks created by an unfinished construction project on neighboring property.
Next, the court rejected the estoppel argument. It agreed that the evidence raised a triable issue about whether First American’s employees told the homeowners the loss was covered and whether the homeowners relied on those statements. Even so, the court held that estoppel cannot create coverage that the policy does not provide. The homeowners relied on Tomerlin v. Canadian Indemnity Co. (1964) 61 Cal.2d 638 and Miller v. Elite Ins. Co. (1980) 100 Cal.App.3d 739. The court explained that those were liability insurance cases in which the insured gave up alternative ways of defending or resolving a lawsuit because of the insurer’s conduct. It noted that Dollinger DeAnza Associates v. Chicago Title Ins. Co. (2011) 199 Cal.App.4th 1132 had limited that exception to liability insurers. The panel did not decide whether the exception could ever reach first-party coverage, because these homeowners gave up no alternatives. They pursued both a flood claim and a lawsuit against Melt and others. At most, the loan might support a claim for the cost of borrowing under promissory estoppel, a theory the homeowners had expressly disclaimed.
The court then held that bad faith in the investigation of a claim that is not covered is not actionable. Under Waller v. Truck Ins. Exchange, Inc. (1995) 11 Cal.4th 1, the implied covenant has no independent existence apart from the contract benefits due. The court expressly adopted Benavides v. State Farm General Ins. Co. (2006) 136 Cal.App.4th 1241, holding that without coverage there is no tort liability for how a first-party claim was investigated, whether the theory is framed as breach of the implied covenant or as emotional distress. It declined to follow dicta in earlier cases suggesting that an insurer might sometimes be liable for bad faith even without coverage.
Finally, the court affirmed summary judgment on the fraud claim. The website accurately described the range of coverage First American generally offers and said nothing about the terms of the plaintiffs’ particular policy. In addition, no reasonable insured could rely on general marketing statements over the express terms of the policy they purchased. - California Comp Grows More Expensive Faster Than National Systemson September 28, 2026 at 2:09 PM
California’s workers’ compensation system paid $13.88 billion in benefits in 2023, a 7.1% jump from the prior year and nearly double the 3.8% growth recorded nationally, according to a review of new National Academy of Social Insurance (NASI) data released September 24, 2026 by the California Workers’ Compensation Institute (CWCI). The $916 million increase lifted California’s share of all U.S. workers’ compensation benefit payments to 21.7%, up from 21% in 2022.
The CWCI analysis draws on NASI’s 28th annual report, Workers’ Compensation: Benefits, Costs, and Coverage, 2023 Data, published August 11, 2026. NASI, a Washington, D.C.-based nonprofit, took over the national workers’ compensation data series formerly produced by the Social Security Administration and describes its report as the only comprehensive source of benefit, coverage, and employer-cost data for all 50 states, the District of Columbia, and federal programs. NASI builds its estimates largely from state agency responses to an Academy questionnaire, supplemented by insurer premium data from A.M. Best and the National Association of Insurance Commissioners and by data from the National Council on Compensation Insurance.
The CWCI review highlights how outsized California’s system is relative to its workforce. The state accounted for 11.9% of the nation’s covered jobs and 14.3% of covered payroll in 2023, yet more than a fifth of all benefits paid — meaning its share of benefit dollars ran roughly one and a half times its share of payroll. California’s total exceeded the combined benefit payments of New York, Florida, and Washington, the states ranked second through fourth, and was nearly four times the $3.52 billion paid under federal programs. Payments were split almost evenly between medical and indemnity benefits, at about $6.95 billion each.
The growth in benefits came even as California’s job base barely moved. Covered employment in the state rose just 0.6% to nearly 17.8 million jobs, compared with 2.3% growth nationwide, according to the CWCI review.
The national picture in NASI’s report offers useful contrast. Across the country, workers’ compensation programs covered nearly 150 million jobs and close to $11 trillion in wages in 2023, surpassing pre-pandemic levels, and paid $64.1 billion in total benefits, with medical care making up more than 47% of that amount. Total employer costs reached $106.6 billion, up 3.5% from 2022. But because payroll grew faster than benefits and costs, NASI found that both measures kept falling when adjusted for covered wages; employer costs came to roughly 98 cents per $100 of covered payroll. Thirty-six jurisdictions saw total benefits per $100 of payroll decline between 2022 and 2023, and 43 saw employer costs per $100 of payroll decline. Private insurers paid 55.6% of benefits nationally, self-insured employers 25.6%, the 22 state funds 13.3%, and the federal government 5.5%.
For California employers and carriers, the findings reinforce a theme running through recent industry research: the state’s system is growing more expensive faster than the national system as a whole. The NASI data arrive on the heels of a separate CWCI loss development study released September 17, 2026, which concluded that the pandemic disrupted but did not halt steady growth in California medical and indemnity claim costs, and that medical costs may be accelerating in the post-pandemic period.
Readers should keep several limitations in mind. The figures reflect benefits paid during calendar year 2023 regardless of when the underlying injuries occurred, so they do not track the cost of any particular group of claims. The data are also nearly three years old by the time of publication, and NASI’s numbers are estimates assembled from multiple sources, with its methodology materials noting that costs and benefits recorded in a given year are not perfectly aligned (see NASI’s Sources, Methods, and State Summaries from the prior edition). The California-specific figures in this story come from Business Insurance’s account of the CWCI review rather than from the CWCI release itself; readers can check the national figures directly against NASI’s executive summary and full state-by-state dataset. - Policy Cancellation OK For Nonpayment of Earned or Unearned Premiumon September 24, 2026 at 2:16 PM
State Compensation Insurance Fund (State Fund) had insured Dynamic Nutraceutical, Inc. for many years. The policy at issue ran from January 1, 2012 to January 1, 2013, with a total estimated annual premium of $640 and a required deposit premium of the same amount. On January 20, 2012, State Fund sent Dynamic a notice revising the required deposit. It told Dynamic to pay $71.20. The decision does not explain the difference between the two figures.
On February 21, 2012, State Fund sent a notice cancelling the policy effective March 8, 2012 for failure to pay premium when due, citing the $71.20 balance. Dynamic's principal testified that he did not recall receiving the notice until much later, because at the time he was caring for his mother, who had cancer and was frequently hospitalized. He found the letter in June and then sent State Fund a check for $71.20.
The policy listed nonpayment of premium as a ground for cancellation. State Fund had attached letters telling policyholders that, starting January 1, 2012, it would no longer send cancellation warning letters and would move to a new billing system built around a premium deposit. Nicolas Garcia's workers' compensation claim against Dynamic turned on whether the policy was still in force. The decision does not state his date of injury. The Uninsured Employers Benefits Trust Fund was among the parties served.
In a February 2, 2026 Findings and Order, the arbitrator found that part of Dynamic's deposit premium remained unpaid as of February 21, 2012. However, the arbitrator also found that State Fund had not shown any unpaid earned premium, meaning premium for coverage already provided. The arbitrator concluded that neither the policy nor Insurance Code § 676.8 allows cancellation on 10 days' notice for an unpaid deposit premium. He declared the cancellation void and returned the case to the trial level to address injury and benefits. His later report recommended that State Fund's petition for reconsideration be denied, and Dynamic filed no answer.
In the panel decision of Nicolas Garcia v. Dynamic Nutraceutical, Inc.; State Compensation Insurance Fund, ADJ9109258, (September 2026), the Board panel (Commissioners Paul F. Kelly, Katherine Williams Dodd, and Joseph V. Capurro) granted reconsideration and rescinded the arbitrator's decision. It substituted a finding that State Fund properly canceled the policy on March 8, 2012 because Dynamic failed to make a required premium payment when due.
The panel first confirmed that its decision was timely. Under the version of Labor Code § 5909 in effect from July 2, 2024 through June 30, 2026, the Board had 60 days from the case's transmission on July 15, 2026 to act. That period ended on a Sunday, so the deadline moved to Monday, September 14, 2026 under Cal. Code Regs., tit. 8, § 10600(b). The arbitrator's report had been served months before the transmission, so serving it did not give the parties notice that the 60-day clock had started. However, the district office's July 15 minutes of hearing did give that notice.
On the merits, the panel held that the statute and the policy were both unambiguous. Section 676.8(b)(1) allows cancellation for the policyholder's failure to make any premium payment when due. The panel reasoned that the statute makes no distinction between earned and unearned premium and does not exempt a premium deposit. It read the word “any” as removing doubt that every kind of premium payment is covered. The policy likewise allowed cancellation for nonpayment of premium without distinguishing between types of premium. Neither the statute nor the policy sets a minimum amount, so it did not matter that the shortfall was only $71.20.
The panel said the arbitrator's distinction between deposit and earned premium went well beyond the plain meaning and obvious purpose of requiring timely payment. It cited the Third District's recent published decision in Employers Preferred Ins. Co. v. Workers' Comp. Appeals Bd. (2026) 122 Cal.App.5th 467 for the rule that courts will not adopt strained readings to create ambiguity. That case also upheld a carrier's cancellation of a policy. The panel also found the notice procedurally sound: § 676.8(c) requires at least 10 days' written notice for nonpayment, and State Fund gave 15.
Finally, the panel admonished State Fund's counsel for citing an unpublished Court of Appeal opinion to explain what a deposit premium is. Under California Rules of Court, rule 8.1115, unpublished opinions generally may not be cited or relied on in other cases. The panel found that none of the rule's exceptions applied. - WCAB Moves CT Liability Window - Releasing 2014 Carrieron September 24, 2026 at 2:16 PM
Guadalupe Gutierrez worked for almost 40 years as a cemetery groundskeeper in Colma for Hills of Eternity/Home of Peace Management Group. American Family Home Insurance Company (AFH) insured the employer during calendar year 2014, and Insurance Company of the West (ICW) insured it during 2015. Gutierrez had three claims pending. The first was an admitted specific back injury on April 12, 2015, for which ICW furnished benefits. The second was a cumulative trauma claim, filed in November 2016, alleging back injury over the year ending April 12, 2015. The third was a separate claim that was ultimately denied.
In October 2019, Gutierrez elected on the record to proceed against AFH on the cumulative trauma claim under Labor Code § 5500.5(c). In a February 3, 2020 report, the agreed medical evaluator, Dr. William Campbell, concluded that Gutierrez had suffered specific injuries on January 1 and April 12, 2015. He also concluded that the back condition reflected cumulative trauma over almost four decades of heavy work, during which Gutierrez had worked through many unreported smaller injuries. In a later report, Dr. Campbell addressed whether Gutierrez's harmful exposure ended in November 2015 or continued until he stopped working on April 27, 2016. He pointed to treatment records showing that all work restrictions were lifted from November 3, 2015 onward, and concluded the exposure continued through April 27, 2016.
In a November 2022 decision, the workers' compensation judge (WCJ) found both the specific injury and the cumulative trauma injury compensable. For the cumulative trauma claim, the WCJ used the pleaded end date of April 12, 2015 to set the one-year liability period under § 5500.5. The WCJ did not include a formal finding on the date of injury under Labor Code § 5412. However, the WCJ's opinion reasoned that because Gutierrez had a disabling specific injury on April 12, 2015, he must have known that same day that his disability was work-related. The WCJ awarded 46 percent permanent disability, future medical care, and attorney fees on the cumulative trauma claim against the employer, AFH, and ICW jointly and severally. The WCJ deferred the questions of which insurer would administer benefits and how the insurers would share costs.
AFH petitioned for reconsideration. It argued that both the last date of harmful exposure and the date of injury fell in April 2016, which would put the liability period entirely outside AFH's 2014 coverage. ICW petitioned separately, arguing that Gutierrez's 2019 election against AFH meant AFH alone should be liable, so the administration and contribution issues should not have been deferred.
In the panel decision of Guadalupe Gutierrez v. Hills of Eternity/Home of Peace Management Group, ADJ10656667, ADJ10656647, ADJ13080462 (September 2026), the Board panel (Deputy Commissioner Anne Schmitz, Chair Katherine A. Zalewski, and Commissioner JosÉ H. Razo) rescinded the WCJ's decision and substituted new findings on the cumulative trauma claim. The last day of harmful exposure is April 27, 2016. The § 5412 date of injury is February 3, 2020. The § 5500.5 liability period is the 365 days ending April 27, 2016. The panel removed AFH from the award and made the award, including the 46 percent permanent disability, joint and several against the employer and ICW only. It deferred all other issues on that claim and returned the matter to the trial level. The WCJ's findings on the specific injury and the denied third claim were carried forward.
On the end of the exposure period, the panel noted that § 5500.5(a) limits cumulative trauma liability to employers and insurers during the year before the last date of harmful exposure or the § 5412 date of injury, whichever comes first. Dr. Campbell had squarely addressed whether the exposure ended in November 2015 or April 2016. Because his opinion, and the work-status records it relied on, were uncontroverted, the panel saw no good reason to reject it. It cited Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775 and fixed the last exposure date at April 27, 2016.
On the date of injury, the panel held that the WCJ applied the wrong test. A cumulative trauma injury, as defined in Labor Code § 3208.1, occurs when its combined effect ripens into compensable disability and the worker knows, or reasonably should know, that the disability was caused by work. The panel relied on Federal Ins. Co. v. Workers' Comp. Appeals Bd. (2013) 221 Cal.App.4th 1116 and State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Rodarte) (2004) 119 Cal.App.4th 998. Knowing that a specific incident was work-related is not the same as knowing that years of cumulative trauma caused a disability. Under City of Fresno v. Workers' Comp. Appeals Bd. (Johnson) (1985) 163 Cal.App.3d 467, a worker is generally not presumed to have that knowledge without medical confirmation. The panel found no evidence that Gutierrez knew or should have known of a disabling cumulative injury before Dr. Campbell's February 3, 2020 report. Because the April 27, 2016 exposure date came first, it controls the liability window.
On ICW's argument, the panel agreed with the WCJ. Under § 5500.5(c) and Colonial Ins. Co. v. Industrial Acc. Com. (Pedroza) (1946) 29 Cal.2d 79, an injured worker may elect to proceed against any one of several liable insurers. But that election does not relieve any other insurer of its liability, so deferring administration and contribution was proper. The panel then noted that its own findings moved the liability period entirely outside AFH's 2014 coverage, so the record no longer supported any award against AFH. That left ICW, which covered 2015, jointly liable with the employer. The panel added that ICW may still identify whichever insurer covered the employer in 2016, join it in the case, and seek contribution. - 9th Circuit Rules 2013 Insurance Code Notice Mandate Not Retroactiveon September 23, 2026 at 12:27 PM
In 2007, New York Life Insurance and Annuity Corporation issued a life insurance policy to Mr. Linhart, who owned the policy and named his wife, Barbara Linhart, as sole beneficiary. The policy did not require fixed premium payments, but Mr. Linhart had to pay enough to keep the policy's account value above the insurer's monthly deduction charge, which covered the monthly cost of coverage plus fees.
In 2012, the Legislature enacted Insurance Code § 10113.71 and Insurance Code § 10113.72, effective January 1, 2013. Together they created a mandatory grace period and pre-termination notice rules for life policies. Subdivision (a) of § 10113.72 bars an individual life policy from being issued or delivered until the applicant has been given the right to designate a third person to receive lapse or termination notices, and requires the insurer to give each applicant a form for that purpose. Subdivision (b) requires the insurer to remind the policy owner annually of the right to make or change a designation, and subdivision (c) requires at least 30 days' notice before a policy lapses for nonpayment.
Starting in August 2013, the insurer sent Mr. Linhart an annual policy summary that included notice of his right to designate a third party to receive lapse notices. It never sent a standalone designation form, and Mr. Linhart never named a designee. On June 1, 2021, the policy entered a grace period because the account value could not cover the monthly charges. The insurer mailed a notice telling Mr. Linhart he needed to make a sufficient payment by August 3, 2021. The policy lapsed on that date, and Mr. Linhart died four days later. When his estate asked about benefits, the insurer responded that the policy had lapsed and declined to pay.
Barbara Linhart filed a putative class action alleging that the insurer violated § 10113.72(a) by failing to send designation forms to owners of policies issued before 2013. According to the district court's order, her amended complaint pleaded claims for breach of contract and breach of the implied covenant of good faith and fair dealing. The district court granted summary judgment to the insurer, concluding that under the plain language of § 10113.72(a) and the California Supreme Court's decision in McHugh v. Protective Life Ins. Co. (2021) 12 Cal.5th 213, the insurer had no duty to send Mr. Linhart a designation form. The court then denied class certification. Ms. Linhart appealed under 28 U.S.C. § 1291.
In the published case of Linhart v. New York Life Insurance and Annuity Corporation, No. 25-490 (September 2026), a Ninth Circuit panel affirmed the summary judgment for the insurer. The panel held that life insurers are not required to send § 10113.72(a) designation forms to owners of policies issued before the statute took effect on January 1, 2013.
The panel treated the question as already answered by the California Supreme Court, whose interpretation of state law binds federal courts. In McHugh, the high court stated that § 10113.72(a) “unmistakably applies only to new policies.” McHugh reasoned that the subdivision repeatedly refers to the “applicant” rather than the “policy owner,” and that its command that a policy shall not be issued or delivered until the designation right is given signals forward-looking application. Because Mr. Linhart's 2007 policy was not a new policy, the panel concluded that subdivision (a) never applied to it, and the insurer had no obligation to send him a form while he was alive.
Ms. Linhart relied on other language in McHugh holding that §§ 10113.71 and 10113.72 apply to all policies in force when they took effect, regardless of issue date. The panel found that argument unpersuasive. It explained that McHugh's general statement about the sections as a whole does not answer whether one particular subdivision reaches existing policies. Subdivisions (b) and (c) impose ongoing notice obligations that can sensibly apply to every in-force policy, while subdivision (a) is tied to a single moment, the application process before a policy issues. Requiring pre-issuance forms for policies already issued, the panel wrote, would make nonsense of subdivision (a)'s text. The panel added that McHugh's description of the provisions as a single, unified pre-termination notice scheme supports, rather than undercuts, reading the subdivisions to operate differently.
The opinion addressed only subdivision (a). It did not decide whether the insurer's annual policy summaries satisfied subdivision (b) or whether its grace-period notice satisfied § 10113.71 or § 10113.72(c), as those issues were not the basis of the appeal. For insurers administering pre-2013 individual life policies in California, the ruling confirms that the pre-issuance designation form requirement does not apply retroactively, while McHugh's holding that the ongoing notice and grace-period protections apply to all policies in force on January 1, 2013 remains in place. - Flight Surgeon/QME Named "Hidden Gem" at 2026 Comp Conferenceon September 23, 2026 at 12:27 PM
Dr. Leslie Cadet is a former U.S. Air Force flight surgeon who was named Air Force Global Strike Command's 2015 Command Flight Surgeon of the Year, was just named one of two 2026 “Hidden Gems” among the 12 professionals honored at the second annual Work Comp Changemaker© Awards. The awards were presented at the ELEVATE® Work Comp Conference at the Hotel del Coronado in Coronado, California this September.
The honorees were announced on the Deconstructing Comp website. The organizers say the Hidden Gem category recognizes professionals whose leadership is quiet but has a significant effect on the industry. Dr. Cadet, a board-certified occupational and environmental medicine physician, QME, educator, and entrepreneur, shares the designation with Nicholas Fonner, a workers' compensation case manager at Brooks Rehabilitation.
According to her honoree profile on the Deconstructing Comp website, Dr. Cadet began her career in the Air Force as a flight surgeon and occupational health consultant. The profile says her work supported 1,080 combat missions and 2,000 airlift missions in support of Operations Inherent Resolve and Enduring Freedom. As medical director of her flight medicine clinic, she led a 23-person team that cared for more than 700 beneficiaries and supported the medical readiness of about 5,100 active-duty personnel. Her patients included aviators, aircraft mechanics, intelligence personnel, and other service members working in specialized, high-demand jobs. In addition to the Command Flight Surgeon of the Year award, she was named her squadron's 2015 Company Grade Officer of the Year.
After leaving the military, Dr. Cadet completed a residency in occupational and environmental medicine at the Harvard T.H. Chan School of Public Health and earned a Master of Public Health degree there. She later served as Employee Health Medical Director at Loma Linda University Health. She still teaches as an assistant professor at the Loma Linda University School of Medicine and as an attending physician in its occupational and environmental medicine residency program. According to her profile, the residents she trains named her Teacher of the Year in 2022, 2023, 2024, and 2026.
Her current work is aimed directly at employers and claims professionals. Dr. Cadet founded and leads ASCEND Occupational Medicine Consulting, a physician-led firm that works with self-insured employers, claims professionals, attorneys, and others on complex workers' compensation claims. Her profile says the firm provides medical oversight of those claims. That work includes testing whether diagnoses and treatment plans are supported by objective evidence, identifying barriers to recovery, setting realistic recovery timelines, and strengthening return-to-work plans so claims do not slide into prolonged disability. The profile describes the gap she is trying to close this way: claims decisions are usually guided by financial, claims-handling, and legal experts, but often without a physician at the table. Her approach, as the profile summarizes it, favors appropriate care over more care, function over disability, and early intervention over letting a claim grow more complex.
Ten other professionals were named 2026 Work Comp Changemaker© Honorees. They are Catherine Benavidez of Injury Management Organization; Anthony Culpepper, Jr., of Employer Defense Group and the African American Workers' Compensation Professionals; Dr. Geralyn Datz of Southern Behavioral Medicine Associates; Dr. Steven Feinberg of Feinberg Medical Group; Kimberly George of Sedgwick; Agnes Hoeberling of AvonRisk; Kirsten Kaiser Kus of Downey, Lenkov, Milstein & Kus Law Firm; Roberta Serena Mike of Strategic Comp and the Workers' Compensation Career Mentorship Group; Dave Taylor of Charter Communications; and Licia Thompson-Young of Licia Thompson Coaching & Consulting. Profiles of all honorees are on the Deconstructing Comp website.
The awards were created by Yvonne Guibert and Rafael Gonzalez, co-hosts of the Deconstructing Comp Podcast. They are not lifetime achievement awards. Instead, they recognize emerging and established professionals for their leadership, impact, integrity, and mentorship over the past two to five years. According to the organizers, honorees are chosen by an advisory committee of workers' compensation professionals in three rounds. First, each committee member nominates five people. Next, each member champions two nominees they did not nominate, interviews them, and presents them to the committee. Finally, the committee ranks the finalists, and the rankings determine the honorees. Guibert described this year's class as “people to watch” in the release.
And Dr. Cadet, thank you so very much for your service to our country. - Insurance Payment Service Accused of Illegal Price Fixingon September 22, 2026 at 9:54 AM
MultiPlan Corporation was founded in 1980 in New York City as a hospital network aimed at giving patients access to care and controlling costs when they went outside a narrow insurance network. Over the following decades it built out a preferred provider organization (PPO) business and grew through consolidation into a national network.
In April 2024, a New York Times investigation by Chris Hamby ("Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill") reported that MultiPlan and the insurers using its services shared a financial incentive to push reimbursements as low as possible, since both parties' fees rose as the amount paid to providers fell — leaving patients exposed to larger balance bills.
The article resulted in a wave of private antitrust litigation from hospital systems and providers, which was consolidated into the multidistrict litigation In re MultiPlan Health Insurance Provider Litigation in the Northern District of Illinois — the same MDL whose 2025 ruling on a motion to dismiss the Court of Appeal relied on in this VHS Liquidating Trust case. In February 2025, amid this litigation and reputational pressure, the company rebranded from MultiPlan to Claritev Corporation, moving its NYSE ticker from MPLN to CTEV.
Last June, the Arizona AG announced a lawsuit against MultiPlan and several large health insurers, alleging they quietly built and operated a system that slashed payments to doctors and hospitals — and left Arizonans having to pay more for out-of-network care.
In this September 2026 published California court of appeal decision, VHS Liquidating Trust is the bankruptcy liquidator for Verity Health System of California, a former not-for-profit operator of six hospitals in the San Francisco, Los Angeles and San Jose areas that went bankrupt in 2018. Verity, like other hospitals, was paid for patient care by a mix of patients, government payors, and private insurers. Where a hospital has no contract covering a particular service, the service is billed as “out-of-network” (OON), and the insurer typically reimburses the provider at a rate based on the “usual, customary, and reasonable” (UCR) rate for the area.
Based on these allegations, VHS sued MultiPlan (without naming the insurers, who had separately compelled arbitration) for horizontal price fixing, price tampering, and unlawful exchange of competitively sensitive information under the Cartwright Act (Bus. & Prof. Code § 16700 et seq.), plus a derivative Unfair Competition Law claim.
VHS's complaint alleges that MultiPlan Corporation (now Claritev Corporation), which markets algorithm-driven data analytics to health insurers, offers a “repricing” service that insurers use to set OON reimbursement rates. Insurers send MultiPlan a claim; MultiPlan's proprietary algorithm, built on a pooled database of roughly a billion claims from more than 700 insurers, recommends a price; and MultiPlan then presents that price to the provider on a take-it-or-leave-it basis. By 2020 MultiPlan was repricing 370,000 OON claims per day, and insurers reportedly followed its recommendations without human review 87 percent of the time. VHS alleges this scheme is the successor to an earlier practice, involving a MultiPlan predecessor called Ingenix, that a 2009 New York Attorney General enforcement action forced to shut down. VHS contends that MultiPlan operates as the "hub" of a "hub, spoke, and rim" conspiracy: insurers (the spokes) know from MultiPlan's own public statements that their competitors also submit sensitive claims data to MultiPlan and follow its recommended prices the vast majority of the time, giving each insurer the assurance it needs to accept suppressed rates without fear that a rival will out-compete it by paying more.
The San Francisco County Superior Court sustained MultiPlan's demurrer to the entire complaint without leave to amend. The trial court reasoned that an insurer's reimbursement for OON services is not a standalone product or service but is simply part of the insurance policy the insurer already owes its subscriber; without a discrete product, the court held, there is no "price" that the Cartwright Act's price-fixing and price-tampering provisions can reach. Because the information-exchange claims and the UCL claim were premised on the same theory, those fell with the price-fixing claims, and final judgment was entered for MultiPlan.
In the published case of VHS Liquidating Trust v. MultiPlan Corporation et al., No. A171914 (1st Dist., Div. 3, Sept. 2026): Reversed and remanded. The Court of Appeal held that OON reimbursements are not categorically exempt from Cartwright Act scrutiny, reversed the judgment on the demurrer, and sent the case back to the trial court to consider MultiPlan's remaining, unaddressed arguments in the first instance.
Writing for a unanimous panel, the court held that the trial court's exemption for OON reimbursements has no basis in the Cartwright Act's text or in case law. The statute broadly prohibits combinations that fix or tamper with the price of an "article, commodity or transportation," and California courts have long read it to cover services as well, and to reach buyers' price-fixing (not just sellers'). The court reasoned that an insurer's contractual duty to its subscriber and its separate market transaction with a provider are analytically distinct: just as a general contractor's obligation to a homeowner does not exempt its payments to subcontractors from antitrust scrutiny, an insurer's coverage promise to its subscriber does not exempt its reimbursement negotiations with providers.
Because no California case had addressed the question directly, the court also surveyed federal authority, noting that under the Cartwright Act federal precedent is instructive but not binding, since the Act is "broader in range and deeper in reach" than the Sherman Act (Cianci v. Superior Court (1985) 40 Cal.3d 903, 920). The court declined to follow three federal district court decisions the trial court had relied on—Franco v. Connecticut General Life Insurance Co. (D.N.J. 2011) 818 F.Supp.2d 792, In re Aetna UCR Litigation (D.N.J. 2015), and Pacific Recovery Solutions v. Cigna Behavioral Health, Inc. (N.D. Cal. 2021)—because those cases analyzed the question from the perspective of insurance subscribers, not providers, and did not address whether a provider-insurer transaction could itself be price-fixed. Instead, the court found persuasive the federal multidistrict litigation against MultiPlan itself, where the presiding judge rejected the identical argument as a "sleight of hand" that analyzed the wrong market (In re MultiPlan Health Insurance Provider Litigation (N.D. Ill. 2025) 789 F.Supp.3d 614).
The court further relied on U.S. Supreme Court and First Circuit authority holding that an insurer's payments to providers are legally distinct from its coverage obligations to policyholders. In Group Life & Health Insurance Co. v. Royal Drug Co. (1979) 440 U.S. 205, the Supreme Court held that an insurer's pharmacy reimbursement agreements were "merely arrangements for the purchase of goods and services," separate from the insurer's obligations under its policies. In Kartell v. Blue Shield of Massachusetts, Inc. (1st Cir. 1984) 749 F.2d 922, the First Circuit similarly held that any distinction between "purchasing" and "insurance reimbursement" is "irrelevant for antitrust purposes." Applying that same logic, the panel concluded it would be illogical to hold that providers can be liable for fixing the prices they charge insurers, but insurers cannot be liable for fixing the prices they pay providers.
Because it reversed on this threshold ground, the court did not reach MultiPlan's other arguments, including one based on the Knox-Keene Act, and remanded for the trial court to address them in the first instance. In a footnote, the court added—without resting its holding on the point—that it viewed the trial court's rule as posing a policy concern, since it would exempt a significant portion of the healthcare industry from antitrust scrutiny at a time when courts have also been reluctant to let insurance subscribers challenge similar conduct. - Guilty Plea in $400K Medi-Cal Fraud Case Results in 2 Year Sentenceon September 22, 2026 at 9:54 AM
The California Attorney General announced that Maki Martinez-Gruninger pled guilty to a felony charge of defrauding the Medi-Cal program and will serve two years in state prison for stealing more than $400,000 from the State of California through a scheme that exploited a disabled family member.
California’s In-Home Supportive Services program, known almost universally as IHSS, is the state’s main way of paying for help in the home so that older adults, people who are blind, and people with disabilities—including children—can stay where they live instead of moving into a nursing home or other institution.
IHSS grew out of the independent-living and disability-rights movements of the 1970s and remains one of the largest consumer-directed personal-care programs in the country. Recipients are not patients waiting for an agency to assign a worker; they are the employer. They choose who comes through the door, train that person, set the schedule, and can fire them. About seven in ten hire a family member.
Today the program reaches on the order of 850,000 to 900,000 Californians. It is a Medi-Cal benefit, which means federal Medicaid dollars cover a large share of the cost, with the state and each of the 58 counties paying the rest. The California Department of Social Services sets the rules; county social workers do the day-to-day work.
The California Department of Justice received a complaint alleging that Martinez-Gruninger fraudulently claimed to be the In-Home Support Services provider for a disabled family member. According to the complainant — who was the individual's sole caregiver — they discovered in December 2019 that Martinez-Gruninger secretly applied to be the disabled family member's In-Home Support Services provider in November 2007. As a result, Martinez-Gruninger allegedly submitted false claims to the IHSS program for over a decade.
The investigation determined that Martinez-Gruninger unlawfully took the State of California's Medi-Cal program money, intended to defraud the State of California, and presented false IHSS and Respite Care claims for payment totaling $413,643.30.
She pled guilty to a single felony count of Medi-Cal false claims.
The Division of Medi-Cal Fraud & Elder Abuse is a division within the Department of Justice whose mission is to protect the public and the state’s Medi-Cal program from those who defraud taxpayers and divert state health care resources. The investigation was made possible through the collaboration of government agencies and those who reported incidences of Medi-Cal fraud or elder abuse.
The Medi-Cal Fraud & Elder Abuse receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling nearly $78 million for Federal Fiscal Year 2026. The remaining 25 percent, totaling nearly $26 million for Federal Fiscal Year 2026, is funded by the California Attorney General’s Office. Federal Fiscal Year 2026 is from October 1, 2025 through September 30, 2026.