Deborah Hemsted’s workers’ compensation claim is based on an injury she sustained on September 24, 2014, when she was a Medical Assistant III for United Indian Health Service at Arcata, California.

The history of the United Indian Health Services began in 1968. It was a time when Native activism coincided with the nation-wide Civil Rights Movement and the Office of Economic Opportunity programs. Together these factors helped create a new era of self-determination for Indian peoples.

Hemsted first received benefits and treatment for her injury through United Indian’s tribal workers’ compensation system. After a dispute arose, Hemsted filed a claim with the state workers’ compensation system. United Indian took the position that, in light of its tribal immunity, California’s workers’ compensation system lacked jurisdiction to adjudicate the claim.

In a March 2024 decision, the workers’ compensation administrative law judge (ALJ) rejected United Indian’s claim of sovereign immunity after applying the California Supreme Court Miami Nation’s five-factor arm-of-the-tribe test. (People v. Miami Nation Enterprises (2016) 2 Cal.5th 222.)

With respect to United Indian’s method of creation, the ALJ found that it was a California non-profit created through the Indian Health Board and authorized by several tribes, including federally recognized tribes, to provide health services to their members. The ALJ observed that eight or nine tribes have sanctioned United Indian as their health provider. The ALJ noted that most of the tribal resolutions did not specifically designate United Indian as a tribal organization. Based on these circumstances, the ALJ concluded that United Indian’s method of creation weighed against sovereign immunity.

As to the question of intent, the ALJ found no evidence that the tribes intended to share their sovereign immunity with United Indian. The ALJ held that United Indian’s purpose – to serve the health needs of Indians in Humboldt and Del Norte Counties – weighed in favor of sovereign immunity.

As for control, the ALJ concluded that “[c]ontrol weighs against sovereign immunity because the Board [of Directors of United Indian] consisted of tribal members and others who may or may not be tribal members.”

With respect to the financial relationship between United Indian and the tribes, the ALJ found United Indian was not funded by the tribes, but instead by grants obtained by the Indian Health Board and distributed to United Indian. The ALJ reasoned that, because United Indian is incorporated separately from the tribes, “any action against [United Indian] would not threaten the tribes’ resources, nor the resources of the members of the board.” The judge therefore concluded that this factor weighed against immunity.

In her report on reconsideration, the ALJ recommended that the Board deny United Indian’s request for reconsideration. The ALJ appeared to change her view on the funding factor, stating: “Defendant’s argument on Reconsideration with regard to funding is well made. The[ir] point [that] any monies lost through suit would not be available to [United Indian] to provide medical treatment to the tribes weighs in favor of sovereign immunity.” However, the ALJ’s overall assessment remained that United Indian had failed to establish its entitlement to sovereign immunity.

Denying United Indian’s reconsideration request, the Board adopted and incorporated the ALJ’s report on reconsideration. The Board found no abuse of discretion in the ALJ’s rejection of United Indian’s claim of sovereign immunity.

The Court of Appeal granted a petition for writ of review, and reversed the Boards decision in the unpublished case of United Indian Health etc. v. Workers’ Comp. Appeals Bd. – A170950 – (May 2025).

“No one Miami Nation factor of the five-factor test is dispositive.” Whether sovereign immunity applies to an entity is a question of law reviewed de novo. (Miami Nation, supra, 2 Cal.5th at p. 250.) the Court of Appeal also applid the de novo standard when interpreting written instruments, except to the extent that the interpretation turns on conflicting extrinsic evidence.

Considering both the law and the circumstances under which United Indian was formed (Miami Nation, supra, 2 Cal.5th at pp. 245-246), the method of creation factor weighs somewhat in favor of sovereign immunity.

The ALJ concluded the tribes had no intent to share their sovereign immunity with United Indian. The record contained no tribal documents stating the tribes’ intent to extend sovereign immunity to United Indian. “However, that even absent express statements of a tribe’s intent, tribal intent may be inferred from the tribe’s actions or other circumstances.” And as United Indian asserts, it may be possible to infer the intent to share tribal immunity based on the fact that the tribes established and sanctioned United Indian to provide healthcare services to tribe members under a federal system intended to further tribal self-governance.

The Court of Appeal agreed with the ALJ that United Indian’s provision of health care serves a purpose central to tribal self-sufficiency and self-governance, weighing in favor of sovereign immunity

The control factor also weighs in favor of sovereign immunity. The tribes participate in the management and control of United Indian in at least three respects.

Finally, the financial relationship factor likewise weighs in favor of immunity. Miami Nation makes clear that where a judgment against the tribal entity would significantly reduce tribal resources, sovereign immunity is appropriate, even if the tribe’s treasury is not directly affected.

“In sum, although there is no express evidence that United Indian’s participating tribes intended to share their immunity, the remaining factors reflect that United Indian is an arm of the tribes that it serves.”