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For Differing Reasons – Supreme Court Affirms Mayor v WCAB

Joseph Mayor suffered an industrial injury in December 2013 while working for Ross Valley Sanitation District (Ross Valley). A workers’ compensation judge (WCJ) later found Mayor totally and permanently disabled and issued an award in his favor. On March 23, 2023, Ross Valley timely filed a petition for reconsideration of that award with the Workers’ Compensation Appeals Board (Board). At the time, former Labor Code section 5909 provided that a petition for reconsideration “is deemed to have been denied” by the Board “unless it is acted upon within 60 days from the date of filing.” The WCJ never acted on the petition as required by regulation, and the Board itself took no action within the 60-day window. Seventy-four days after filing, Ross Valley sent a single inquiry letter asking about the petition’s status; the record does not show the Board ever responded.

One hundred forty-four days after the petition was filed, the Board issued an order granting reconsideration, attaching a “Shipley notice” (referencing Shipley v. Workers’ Comp. Appeals Bd. (1992) 7 Cal.App.4th 1104) stating that the Board had not received notice of the petition until around June 15, 2023, roughly 84 days after filing, and that its order would be considered timely if issued within 60 days of that later receipt date. Mayor petitioned the Court of Appeal for a writ of mandate seeking to rescind the Board’s order as untimely and to enforce the WCJ’s original award. While that petition was pending, the Board rescinded and reissued its order, this time explicitly invoking Shipley to justify tolling its own deadline based on an unspecified “administrative irregularity” in receiving the petition — a practice the Board said preserved due process and its constitutional mandate to achieve substantial justice.

Also while the matter was pending, the Legislature passed Assembly Bill 171, amending section 5909 (effective as an urgency measure, later made permanent) to run the Board’s 60-day deadline from the date a trial judge transmits a case to the Board, rather than from the date of filing. The Court of Appeal granted Mayor’s writ petition, holding that the version of section 5909 in effect at the time was mandatory and that the Board exceeded its jurisdiction by granting reconsideration more than 60 days after the petition’s filing. The court followed Zurich American Ins. Co. v. Workers’ Comp. Appeals Bd. (2023) 97 Cal.App.5th 1213, which had reached the same conclusion on similar facts, and read the Legislature’s subsequent amendment as tacit acquiescence in that interpretation. (Mayor v. Workers’ Comp. Appeals Bd. (2024) 104 Cal.App.5th 1297.) The California Supreme Court granted review, and, while review was pending, deferred several other cases raising the same issue, including one, City of Salinas v. Workers’ Comp. Appeals Bd., that had reached the opposite conclusion on whether the deadline is jurisdictional.

In the present case of Mayor v. Workers’ Compensation Appeals Board, No. S287261 (Cal. Sup. Ct., August 2026) — the California Supreme Court affirmed the judgment of the Court of Appeal granting Mayor’s petition for writ of mandate. However it was for somewhat different reasons.

A unanimous Supreme Court first addressed whether former section 5909’s 60-day deadline implicated the Board’s fundamental jurisdiction — a status that, unlike an ordinary mandatory deadline, cannot be waived, forfeited, or excused by equitable considerations. Applying the framework from Kabran v. Sharp Memorial Hospital (2017) 2 Cal.5th 330 and Law Finance Group, LLC v. Key (2023) 14 Cal.5th 932, the Court explained that a deadline is jurisdictional only where the Legislature signals that intent through unusually emphatic language, not merely by setting an exception-free deadline. The Court found no such language in former section 5909, contrasting it with neighboring provisions the Court has held are jurisdictional — section 5900’s requirement that petitions “shall be made only within the time and manner specified,” and section 5950’s 45-day deadline to seek judicial review “within the time limit specified in this section.” Because former section 5909 contained no comparably emphatic language and the Board’s continuing jurisdiction over its own awards is otherwise broadly preserved by section 5803 (limited only by a five-year outer boundary in section 5804), the Court held the 60-day deadline is mandatory but not jurisdictional in the fundamental sense: the Board’s grant-for-study order after the deadline was in excess of its jurisdiction, not void for lack of fundamental power to act at all.

That conclusion did not end the analysis, since even a nonjurisdictional deadline can be closed to equitable tolling if the Legislature so intends. The Court held the Board’s practice of self-tolling its own deadline was unsupported by the statute’s text or purpose. Equitable tolling, the Court explained, is a doctrine that excuses a litigant’s late filing where the litigant gave timely notice, caused no prejudice, and acted reasonably and in good faith — elements that presuppose a party seeking relief from its own deadline, not an adjudicative body extending the time allotted for its own decision. The Board, the Court held, is neither a litigant nor a party, and former section 5909 is not a statute of limitations at all, since it does not fix a deadline for anyone to bring a claim; it simply caps how long the Board has to act. The Court found no precedent applying equitable tolling to an adjudicative body’s own decisional deadline, and held the statute’s plain text — deeming a petition denied by operation of law after 60 days, with no textual exception — was inconsistent with allowing the Board to extend that period on its own initiative.

The Court also limited the reach of Shipley itself, disapproving it to the extent it suggests a categorical due process right to Board review of any timely-filed petition regardless of the 60-day deadline. Shipley, the Court explained, never applied or even mentioned the equitable tolling doctrine; it turned instead on the due process problems created when the Board misplaced a claimant’s file and repeatedly, affirmatively assured him his petition would eventually be considered. The Board could not convert that narrow due-process holding into a general license to toll its own statutory clock whenever an “administrative irregularity” caused it to receive a petition late, particularly where, as here, Ross Valley itself never asserted any due process violation. The Court left open what circumstances might support a due process claim in a future case, but held none was properly before it here.

Finally, the Court held writ relief in the Court of Appeal was the proper vehicle for Mayor’s challenge, rejecting the Board’s argument that Mayor’s only remedy was a later petition for writ of review of a final decision on the merits. Because the Board had already asserted jurisdiction and ruled on the petition when Mayor filed his writ petition, and because forcing an injured worker to wait indefinitely for a final decision would render the 60-day deadline’s protection of an expeditious end to proceedings meaningless, the Court agreed a writ of mandate (more precisely, the Court noted in a footnote, one properly framed as a writ of prohibition) was available to enforce the Board’s ministerial duty to act, if at all, within the statutory window. The Court expressed no view on whether or how Ross Valley might now seek relief from the consequences of the Board’s untimely action, since Ross Valley had not requested any relief of its own before the Court.

In a confusing Footnote 4, the court stated “We express no opinion on the propriety of the grant-for-study practice or whether the Appeals Board is required to issue a final decision on the merits within the 60-day statutory period pursuant to section 5908.5.”

Startup Chaired by Former US Senator Resolves Upcoding Case for $24M

Monogram Health Professional Services PC and its parent, Monogram Health Inc., headquartered in Brentwood, Tennessee, have agreed to pay $2.4 million to resolve allegations that they violated the False Claims Act by causing false diagnosis codes to be submitted to inflate their Medicare Advantage payments. The U.S. Attorney’s Office for the Central District of California announced the settlement August 24, 2026.

Monogram provides in-home care to Medicare beneficiaries enrolled in Medicare Advantage plans, working under contracts with the Medicare Advantage Organizations (MAOs) — the private insurers, such as UnitedHealthcare or Humana, that administer those plans — that pay Monogram more when the patients in its care carry higher “risk scores.” Those risk scores come from CMS’s Hierarchical Conditions Category model, which pays MAOs more for beneficiaries expected to need costlier care based on the diagnoses their providers report; a diagnosis must be documented from an actual face-to-face visit and must have affected the patient’s care at that visit to count. Because Monogram’s own contracts tied its revenue to those same risk scores, the government says the company had a direct financial incentive to report additional diagnoses that inflated them.

Monogram Health Inc. was reportedly founded in 2019 by CEO Michael Uchrin, with backing from Frist Cressey Ventures, the venture firm co-founded by former U.S. Senate Majority Leader and heart-transplant surgeon Bill Frist, who chairs Monogram’s board. The company built its business around in-home, “value-based” care for patients with chronic kidney disease and other overlapping chronic conditions — a model that pairs nephrologists, cardiologists, and other specialists to manage complex patients at home rather than in a clinic, using what the company describes as AI-driven care planning. Monogram grew quickly on the strength of five funding rounds totaling more than $540 million, culminating in a $375 million Series C round in December 2022 led by CVS Health Ventures, Cigna Ventures, Memorial Hermann Health System, and Pura Vida Investments, with additional participation from Humana, TPG Capital, and SCAN Health Plan — a roster that includes several of the very insurers whose Medicare Advantage plans Monogram contracts with. By 2026, industry trackers estimated the company’s annual revenue at roughly $2.2 billion and its footprint at more than 500 employees operating across some 34 states.

The settlement covers the period from January 1, 2021 through December 31, 2023 and resolves allegations that Monogram knowingly submitted diagnosis codes in four specific categories that were not clinically accurate, not supported by the patient’s medical records, or did not actually affect the care given at the visit: HCC 21 (protein-calorie malnutrition), HCC 55 (substance use disorder), HCC 48 (coagulation defects and other blood disorders), and HCC 88 (angina pectoris, a form of chest pain linked to heart disease). Those inflated risk scores, the government says, caused CMS to pay the MAOs more than it should have.

This settlement appears to be Monogram’s first public False Claims Act resolution, but it lands the company squarely inside a pattern of intense federal scrutiny of exactly this kind of Medicare Advantage risk-adjustment coding across the industry in 2025 and 2026. In March 2026, CVS Health’s Aetna unit agreed to pay $117.7 million to settle DOJ allegations that it ran a chart-review program paying coders to find additional diagnoses that boosted patient risk scores, including diagnoses unsupported by medical records. HHS-OIG audits have separately flagged similar “upcoding” concerns at other Medicare Advantage plans, including a 2025 finding against Coventry Health Care of Missouri. Congressional advisers at MedPAC have estimated that upcoding across the industry inflates Medicare Advantage payments by roughly 10% annually relative to traditional Medicare, and the Committee for a Responsible Federal Budget has projected the cumulative overpayment could approach $600 billion over the next decade if unaddressed — figures that help explain why DOJ’s new Task Force to Eliminate Fraud and National Fraud Enforcement Division have made Medicare Advantage risk-adjustment fraud a recurring enforcement target this year, with Kaiser Permanente, Humana, and UnitedHealth Group’s Optum unit all facing related scrutiny in recent years as well. Notably, several of Monogram’s own investors, including CVS and Humana, operate Medicare Advantage plans that could themselves face exposure if a downstream provider’s coding practices inflate the risk scores those plans report to CMS — illustrating how closely intertwined the incentives are across the value-based care ecosystem Monogram operates within.

The case originated as a whistleblower, or qui tam, lawsuit filed by Dr. Ajay Gupta, a physician formerly employed by Monogram, captioned United States ex rel. Dr. Ajay Gupta v. Monogram Health Professional Services, et al., No. 2:22-cv-08758 MWF-JCx, in the U.S. District Court for the Central District of California. Under the False Claims Act’s qui tam provisions, a private individual with knowledge of fraud against the government can file suit on the government’s behalf and share in any recovery; Dr. Gupta will receive approximately $380,000 of the $2.4 million settlement.

As is standard in False Claims Act settlements, DOJ’s release states plainly that the claims resolved are allegations only, and the settlement includes no determination of liability or admission of wrongdoing by Monogram.

Employer Waives Arbitration Right By Litigation Delay

Michael Mitchell, Khiry Crawford, Tyler Echevarria, and Anthony McCune formerly worked for Lilac Solutions, Inc., a company that manufactures lithium-extraction technology. Each had signed an arbitration agreement upon accepting employment. On December 6, 2024, the four plaintiffs sued Lilac and five managerial employees with health-and-safety-related roles (collectively, the Lilac Defendants), alleging thirteen causes of action arising from claimed exposure to harmful chemicals, wrongful termination, and gender and disability discrimination, including five Fair Employment and Housing Act claims. The fifth cause of action, pleaded far more conclusorily than the other twelve, alleged sexual harassment.

Rather than immediately moving to compel arbitration, the Lilac Defendants answered the complaint, asserted their arbitration right only as an affirmative defense, and filed a cross-complaint and amended cross-complaint for trade secret violations, neither of which sought a stay of the case. Over the following three months, they served 12 sets of written discovery, noticed depositions of each plaintiff plus two third parties, served 11 nonparty subpoenas, responded to 33 sets of the plaintiffs’ own discovery requests, and filed seven procedural motions, including motions to seal, to designate the case complex, and for a protective order. Only after the plaintiffs filed an anti-SLAPP motion targeting the amended cross-complaint did the Lilac Defendants, five days later, file their motion to compel arbitration on March 18, 2025, arguing the EFAA did not apply because the sexual harassment claim was not plausibly pled.

The Alameda County Superior Court denied the motion to compel arbitration, finding the Lilac Defendants had waived their contractual right to arbitrate. Drawing on factors from Fleming Distribution Co. v. Younan (2020) 49 Cal.App.5th 73 and Kokubu v. Sudo (2022) 76 Cal.App.5th 1074, the court found the Lilac Defendants’ filing of a cross-complaint and amended cross-complaint without seeking a stay was inconsistent with invoking arbitration, that they had substantially invoked the litigation machinery before seeking arbitration, and that they had taken advantage of judicial discovery procedures unavailable in arbitration. The Lilac Defendants appealed.

In the published case of Mitchell et al. v. Lilac Solutions, Inc., et al., No. A173736 (Cal. Ct. App., 1st Dist., Div. 4, August 2026) — the Court of Appeal affirmed the trial court’s order denying the Lilac Defendants’ motion to compel arbitration.

Writing for a unanimous panel, Justice Streate first addressed the Lilac Defendants’ argument that the trial court relied on outdated law. Before the California Supreme Court’s 2024 decision in Quach v. California Commerce Club, Inc. (2024) 16 Cal.5th 562, California courts applied a six-factor test from St. Agnes Medical Center v. PacifiCare of California (2003) 31 Cal.4th 1187 that required the party opposing arbitration to show prejudice. Quach, following the U.S. Supreme Court’s reasoning in Morgan v. Sundance, Inc. (2022) 596 U.S. 411, abandoned that arbitration-specific prejudice requirement, holding waiver instead requires clear and convincing evidence that a party knew of its contractual right and intentionally relinquished it, based solely on the waiving party’s own words and conduct.

The panel held the trial court’s order was consistent with Quach even though it never cited the decision and predated it only by a matter of months, since courts presume a trial judge knows the governing law absent an affirmative indication otherwise, and nothing in the order relied on the prejudice component Quach eliminated. Because the trial court’s approach was legally sound, the panel applied deferential substantial evidence review rather than the de novo review the Lilac Defendants sought, distinguishing a case where a trial court’s order necessarily predated Quach and thus could not have applied it.

Applying that deferential standard, the panel found each of the three factors the trial court relied on well supported. Filing a cross-complaint and amended cross-complaint without seeking a stay reflected an intentional relinquishment of the right to arbitrate, particularly given the Lilac Defendants’ extensive discovery campaign over three months, which the panel found factually comparable to the litigation conduct that supported waiver in Quach itself. The panel rejected the argument that filing compulsory cross-claims excused this conduct, since the Lilac Defendants’ overall pattern of words and conduct, not just their pleadings, supported the trial court’s finding.

The panel devoted particular attention to the Lilac Defendants’ argument that the EFAA put them in an impossible bind, since existing authority holds that a single viable sexual harassment claim within a complaint renders an entire case nonarbitrable, and they needed time to develop facts undermining the harassment claim before a motion to compel could succeed. The panel found this explanation did not match the record: the scope of discovery went well beyond what a motion targeting the fifth cause of action alone would have required, and the Lilac Defendants never filed or signaled a forthcoming motion for summary adjudication on that claim during the three months before their motion to compel, which followed the plaintiffs’ anti-SLAPP motion by only five days. The panel noted the Lilac Defendants could have sought a stay of proceedings except for narrowly tailored discovery aimed at the harassment allegations, or invoked the trial court’s inherent authority to sequence the case efficiently, but did neither. On this record, the panel found the more natural reading was that the motion to compel arbitration was a reactive litigation countermove to the anti-SLAPP motion rather than a considered EFAA strategy, though the panel emphasized no finding of gamesmanship was necessary to affirm.

Concluding that clear and convincing evidence supported the trial court’s finding that the Lilac Defendants intentionally abandoned their right to arbitrate through their conduct in the case’s early months, the panel affirmed the order denying arbitration and awarded the plaintiffs their costs on appeal.

RAND Reports on Senate Bill 1160’s Impact on Utilization Review

The Division of Workers’ Compensation (DWC) announced August 19, 2026 that it has posted a new RAND Corporation report examining whether Senate Bill 1160 (2016) succeeded at its two original goals: reducing administrative burden on medical providers and speeding up timely, appropriate care for injured workers in the first 30 days after a work injury. The underlying RAND study, conducted by researchers Stephanie Rennane, Sara Heins, Danya Birnbaum, Matthew Forbes, Travis Hubble, and Michael Dworsky under a DIR-funded contract reportedly worth around $300,000, is the first empirical evaluation of the law since it took effect for injuries on or after January 1, 2018.

SB 1160 eliminated prospective utilization review (UR) for select treatments delivered in the first 30 days after a compensable injury — common early-stage care like physical therapy and initial X-rays — so long as the treatment was consistent with the Medical Treatment Utilization Schedule (MTUS) and delivered within an employer’s medical provider network. The law left several categories explicitly subject to prospective UR even within that first month: surgery, pharmaceuticals, imaging other than X-rays, psychological treatment, home health care, and a short list of other services the DWC has since designated by regulation, including several types of spinal injections.

To evaluate the law, RAND combined four data sources spanning January 2017 through January 2024 (one year before SB 1160 and six years after): individual-level treatment-authorization records from two large, unnamed claims administrators covering Northern and Southern California; audit data DIR’s Audit and Enforcement Unit compiles from randomly sampled authorization requests statewide; the state’s Independent Medical Review database, covering 276,119 disputed UR decisions; and medical billing data from the California Workers’ Compensation Information System, which the team mapped against 195 clinical practice guidelines to classify treatment as guideline-concordant or guideline-discordant. Both DIR’s release and RAND’s own executive summary frame the study around the same three questions: Did UR approval rates for early treatment requests change after SB 1160? Did injured workers become more likely to receive guideline-concordant care? Did they receive that care faster?

UR approval rates for treatment requested in the first 30 days after injury “consistently exceeded 90 percent both before and after SB 1160 took effect, with no statistically significant change.” That held true across nearly every treatment category studied, including physical therapy, pharmacy, imaging, consultations, surgery, durable medical equipment, occupational therapy, acupuncture, chiropractic care, immobilizers, and X-rays, in data from at least one of the two claims administrators. RAND attributes the flat approval rates to the same underlying cause: widespread “prior authorization” programs that let providers deliver routine early treatment without ever filing a formal authorization request at all. RAND’s review of 15 publicly posted UR plans found 13 already had such a program, frequently covering the exact treatments SB 1160 targeted, which is the report’s central explanation for why the law’s measured effect on approval rates was so small — for many claims administrators, there was little UR friction left to remove by 2018.

Where the law did move the needle was physical therapy specifically. DIR’s release states that among injured workers with diagnoses for which PT is recommended, “the odds of receiving physical therapy within 30 days were 13 percent higher following the implementation of SB 1160,” and that the average wait for a first PT visit fell from 13.4 days to 11.9 days — figures pulled directly from RAND’s findings. RAND’s fuller report adds that guideline-concordant use of braces and immobilizers rose more modestly (8% higher odds of receipt within 30 days, with no significant change in timing), and that guideline-concordant X-ray receipt showed no significant change at all, which the researchers attribute to X-rays already being commonly pre-authorized before the law.

RAND found a small but statistically significant increase in guideline-discordant acupuncture — acupuncture given for conditions where it isn’t recommended during the acute phase with the odds of receiving it 24% higher after SB 1160, though the overall rate remained low (under 3% of relevant cases throughout the study) and showed no corresponding drop in time-to-treatment, leading the researchers to call its practical significance limited. RAND also documented a small decline in MRI use (7% lower odds) after the law took effect, despite MRI being explicitly excluded from SB 1160’s reduced-review provisions and therefore not something the law should have directly affected; the researchers attribute this to unrelated secular trends, pre-existing changes at individual claims administrators, or COVID-19-era disruption rather than to the law itself, and use it as a caution against reading any post-2018 change as automatically caused by SB 1160.

RAND’s analysis found that the treatment categories excluded from SB 1160 — particularly imaging and psychiatric or psychological services — have substantially lower approval rates than the categories the law already covers, and that most UR activity and denials occur after the 30-day window SB 1160 addresses, not within it. On that basis, RAND recommends DIR: (1) systematically document and standardize the informal prior-authorization exemptions that vary widely across claims administrators; (2) examine whether streamlined UR treatment should extend beyond the first 30 days or be targeted by treatment type and strength of clinical evidence, rather than tied to a fixed time window, since that may better match where UR actually constrains care; and (3) invest in standardized, systemwide UR data infrastructure, since the researchers found no comprehensive database of UR decisions existed and had to reconcile incompatible formats from just two cooperating claims administrators to conduct the study at all.

EFAA Election Mid-Arbitration Ok for New Sexual Harassment Case

Dr. Ding Ding, a Wharton graduate with a pharmacology Ph.D. and over twenty years in biopharmaceutical investment banking, was recruited in 2021 to serve as Chief Financial Officer of Structure Therapeutics, Inc., a clinical drug development company preparing for an initial public offering. Before recruiting her, Structure’s CEO, Dr. Raymond Stevens, had circulated an email describing his “ideal phenotype” for the CFO role using two men as example candidates, though the company’s board pushed for gender diversity in the search. Dr. Ding’s offer of employment required arbitration of all employment disputes with JAMS.

According to her complaint, Dr. Stevens began sidelining Dr. Ding almost immediately after she started, limiting her duties and dismissing her contributions, and in January 2022 relayed unsubstantiated complaints from Wall Street bankers that she was “too aggressive.” On March 7, 2022, Dr. Ding was injured in a domestic violence incident; when she returned to work with visible facial injuries, Dr. Stevens commented that he could “hardly see anything” and repeatedly questioned whether she wanted to reconsider her role given her “transition in life,” while also blocking her from an upcoming executive meeting. Ten days after the incident, Stevens recommended her termination to the board, and Structure terminated her on March 22, 2022, without citing any performance issue; Stevens later testified he relied in part on male bankers’ complaints that she “lectured” them.

Dr. Ding filed an arbitration demand with JAMS in October 2022, asserting discrimination and harassment claims based on national origin and her status as a domestic violence victim. Over the following year, the parties litigated preliminary hearings, discovery, and a discovery dispute, and the arbitrator ruled on choice-of-law issues. During that discovery, Dr. Ding first obtained evidence she says revealed her mistreatment was actually motivated by her sex, including Stevens’s “phenotype” email, the board’s gender-diversity goal, and Stevens’s reliance on male bankers’ complaints. In October 2023, Dr. Ding withdrew from arbitration under a California procedural rule addressing Structure’s late payment of arbitration fees, and JAMS closed its file. She then sued Structure and Stevens in California state court, adding sex discrimination and sex-based hostile work environment claims under California’s Fair Employment and Housing Act (FEHA), along with a claim based on her domestic-violence-victim status.

Structure removed the case to federal court and moved to compel arbitration, arguing the California rule on late arbitration-fee payment was preempted by the Federal Arbitration Act (FAA) and the New York Convention. Dr. Ding countered that regardless of preemption, the arbitration agreement was invalid under the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act of 2021 (EFAA), which lets a person alleging conduct constituting a sexual harassment or sexual assault dispute elect to invalidate a predispute arbitration agreement and proceed in court. The United States District Court for the Northern District of California agreed that the state procedural rule was preempted, but held Dr. Ding had properly elected to proceed under the EFAA based on a plausible sexual harassment allegation, and, after permitting her to add New York law claims, denied Structure’s motion to compel arbitration on that ground.

In the published case of Ding v. Structure Therapeutics, Inc., No. 25-1532 (9th Cir., August 2026) — the Ninth Circuit affirmed the district court’s order denying Structure’s motion to compel arbitration.

Writing for the majority, Judge Sanchez rejected Structure’s argument that a plaintiff is categorically barred from making an EFAA election after first filing non-sexual-harassment claims in arbitration. Reviewing the statute’s text, 9 U.S.C. § 402(a), the panel found nothing limiting when a plaintiff may allege a sexual harassment claim or make her election, and held that because Dr. Ding was not yet “alleging conduct constituting a sexual harassment dispute” when she filed her original arbitration demand, she could not have triggered an EFAA election at that time; she made her one election only when she filed in federal court after discovering the sex-based nature of her treatment. The panel found this reading reinforced by the EFAA’s legislative purpose of giving harassment victims “a real choice” whether to arbitrate, and distinguished the ordinary rule, drawn from Morgan v. Sundance, Inc. (2022) 596 U.S. 411, that federal arbitration policy favors treating arbitration contracts like other contracts rather than fostering arbitration generally.

The panel also rejected Structure’s argument that Dr. Ding waived her EFAA rights by filing in arbitration despite already knowing the facts underlying a sexual harassment claim. Applying ordinary waiver principles — the intentional relinquishment of a known right — the panel held this argument was foreclosed by the district court’s factual finding, reviewed for clear error, that no record evidence showed Dr. Ding knew she had a plausible sexual harassment claim but chose not to bring it when she initiated arbitration.

Turning to the merits, the panel held Dr. Ding plausibly pled a sex-based hostile work environment claim under the FEHA, which in turn qualifies as a “sexual harassment dispute” under the EFAA’s definition. Applying the FEHA standard from Lyle v. Warner Bros. Television Productions (2006) 38 Cal.4th 264 and Hughes v. Pair (2009) 46 Cal.4th 1035, the panel found Dr. Ding alleged severe or pervasive harassment (Stevens’s preference for a male CFO, his adoption of gendered “too aggressive” criticisms, his dismissive comments about her domestic violence injuries, and her termination without any performance-related justification), that the alleged conduct created an objectively and subjectively offensive environment comparable to that in Roby v. McKesson Corp. (2009) 47 Cal.4th 686, and that the conduct was plausibly based on her sex. Because the EFAA invalidates the arbitration agreement as to an entire “case” relating to a sexual harassment dispute rather than claim-by-claim, the panel held Dr. Ding was entitled to bring her whole case, including her national-origin and domestic-violence-based claims, in court.

Judge Rawlinson dissented, arguing the majority’s rule conflicts with the statute’s plain text, its legislative history, and the ordinary legal meaning of “election.” In her view, an employee gets only one election under the EFAA, and Dr. Ding made hers when she filed and substantially litigated her claims in arbitration for over a year, including discovery, stipulations, and discovery disputes, before withdrawing. She would have applied the Ninth Circuit’s arbitration-waiver precedents, including Holley-Gallegly v. TA Operating, LLC (2023) 74 F.4th 997, and pointed to the EFAA’s lack of retroactivity as evidence Congress meant to avoid disrupting ongoing arbitrations, concluding that Dr. Ding’s belated invocation of the statute after extensive arbitration proceedings was not the kind of election the EFAA authorizes.

VA Tops Healthcare System-Wide Pharmaceutical Costs Saving

The Department of Veterans Affairs announced August 13, 2026 that it has secured $10.44 billion in pharmaceutical price reductions so far in fiscal year 2026 through negotiations with drug manufacturers, up from $7.99 billion in all of FY 2025 and $5.23 billion in FY 2024. This is a dollar figure representing the cumulative value of negotiated price cuts on the drugs VA buys most, not a claim that VA’s total pharmacy spending fell by 10%; VA did not publish a percentage change in total drug spending alongside the dollar figure. With that framing in mind, how does VA’s trajectory compare with what other health care payors, including workers’ compensation systems and commercial health insurers, are actually experiencing on pharmacy costs this year?

The short answer is that VA’s negotiated savings are moving in the opposite direction from nearly every other major payor category tracked in 2026 industry data, and the gap is stark. VA’s press release credits its results in part to the second Trump administration’s broader pharmaceutical pricing push, which centers on a “Most Favored Nation” (MFN) policy tying U.S. drug prices to the lowest prices paid by comparable wealthy nations. Under an executive order President Trump signed May 12, 2025, and a series of voluntary company-by-company deals that followed, the administration has now reached MFN agreements with 17 pharmaceutical manufacturers, covering an estimated 86% of the U.S. branded drug market, in exchange for a three-year reprieve from threatened tariffs on their products. The public-facing piece of that effort, the direct-to-consumer platform TrumpRx.gov, launched in 2026 and the White House reported in August 2026 that it had generated roughly $700 million in patient savings, with prescription drug prices down 3.9% since Trump took office and falling every month of 2026, citing GLP-1 medications now available starting around $149 a month and cuts of 50% to 90% or more on drugs including fertility treatments, inhalers, insulin, and cholesterol medications.

Independent health policy analysts describe a narrower picture than the administration’s framing suggests. A June 2026 analysis characterized the MFN push as having “bold aims, but limited impact,” noting the deals mainly affect Medicaid pricing and cash-pay purchases through TrumpRx, while leaving prices largely unchanged for the roughly 92% of Americans who have private insurance, Medicare, or other coverage and fill prescriptions through their normal pharmacy benefit rather than paying cash. Reporting from STAT in early 2026 found that the specific terms of the MFN agreements have not been publicly disclosed by the administration or the companies, and that SEC filings from some participating manufacturers show the deals run for three years, after which their status is unclear. A KFF summary of the policy similarly frames it as one of several efforts underway rather than a comprehensive fix, and independent experts quoted in press coverage have pointed to factors like increased generic competition and discounted GLP-1 drugs, not the MFN deals specifically, as more plausible drivers of any broader price declines. TrumpRx.gov also does not integrate with insurance at all, meaning its savings apply only to the minority of prescriptions paid for in cash.

Set against that federal picture, the two payor categories with hard 2026 data tell very different stories from each other. On the workers’ compensation side, California’s own WCIRB 2025 Losses and Expenses Report shows pharmaceutical costs have been declining as a share of total medical payments for years, falling from 1.8% of medical payments in 2020 to 1.0% in 2025, with total pharmaceutical dollars paid actually dropping slightly, from roughly $60 million in 2024 to $52 million in 2025. That decline predates the Trump administration’s MFN push, which only began in mid-2025, and is generally attributed by industry analysts to workers’ comp-specific factors that have been underway for years: state drug formularies (California’s own formulary took effect in 2018), utilization review, and a long-running reduction in opioid prescribing within workers’ comp claims specifically. In other words, workers’ comp pharmacy costs are falling, but the trend line and its likely causes are largely independent of the federal MFN policy VA is crediting.

Commercial and employer-sponsored health insurance is moving the opposite direction, and sharply so. The 2026 Segal Health Plan Cost Trend Survey, based on responses from insurers, PBMs, and third-party administrators covering more than 80% of the commercially insured and self-insured market, projects prescription drug trend at double digits for 2026, with specialty drug trend running nearly a full percentage point higher than overall drug trend and 62% of that specialty cost growth attributable to utilization rather than price. The Business Group on Health’s 2026 employer survey similarly found employers anticipating an 11% to 12% increase in pharmacy costs heading into 2026. Pharmaceutical Strategies Group’s 2026 Artemetrx State of Specialty Spend and Trend Report, based on 204 million medical claims and 48 million pharmacy claims, put specialty drug trend at 10.8% gross and 12.5% net of rebates in 2025, continuing what it describes as a multi-year run of low double-digit growth, with GLP-1 medications alone nearly doubling their share of pharmacy spend, from 9% to 17%, in two years. None of these commercial-market figures show the kind of reduction VA and the White House are reporting; if anything, industry trend surveys describe 2026 pharmacy cost growth as among the steepest in more than a decade.

Taken together, the comparison suggests VA’s reported savings and the administration’s MFN framework are real but narrow in reach: they show up clearly in VA’s own negotiated federal purchasing and in the cash-pay, direct-to-consumer channel TrumpRx serves, and workers’ comp systems are separately seeing costs fall for reasons that predate and appear largely unrelated to the federal policy. But the commercial insurance market that covers most working-age Americans, where pricing runs through employer plans, PBMs, and rebate structures the MFN deals don’t directly touch, is still projecting double-digit pharmacy cost growth for 2026, suggesting any broader, system-wide slowdown in U.S. drug costs has not yet arrived.

10 States Warn of Fake WCJ or Attorney Comp Fraud Scam

A coordinated impersonation scam targeting injured workers has now prompted official warnings from state workers’ compensation agencies, labor departments, and attorneys general in at least ten states since the start of 2026, with two more states flagging related or adjacent activity. The pattern across nearly every warning is strikingly consistent: scammers posing as workers’ compensation judges, hearing officers, attorneys, or state officials contact injured workers directly and tell them a settlement or benefit payment is ready to be released — but only after a fee is paid first.

Despite the scam’s spread across at least ten states since January 2026, no state agency alert, attorney general release, or industry roundup reviewed identifies a suspect, names a defendant, or reports an arrest tied to the scheme.

According to the state alerts, scammers reach claimants by phone, email, text message, video call, or social media, often using official-looking government seals, letterhead, or even the forged names and signatures of real judges or attorneys to appear legitimate. One especially convincing version stages a fake virtual hearing, walking the claimant through what feels like a real proceeding before a “judge” or “government representative,” only to inform them afterward that a fee must be paid before their benefits or settlement will be released. Tennessee’s Bureau of Workers’ Compensation separately identified a related tactic involving fraudulent “Payment Authorization Forms” that request a claimant’s banking or mailing information under the guise of processing a payout. Legitimate workers’ compensation benefits and settlements never require an injured worker to pay money upfront to receive funds they are owed, and state agencies do not initiate contact with claimants by text message, video call, or social media to request payment or schedule a hearing.

The earliest documented warning came from Colorado’s Division of Workers’ Compensation in January 2026, which alerted injured workers that scammers were posing as the Division itself, the courts, judges, and attorneys to solicit money. Warnings then spread quickly through February: Idaho’s Industrial Commission (February 12) flagged fraudulent settlement notices using fake Department of Labor seals and forged judges’ signatures; Oregon’s Department of Consumer and Business Services (February 12) warned specifically that Spanish-speaking injured workers were being targeted through fake hearings and settlement communications, a warning later confirmed by an actual Oregon case the Oregon Department of Justice addressed directly in April 2026; Tennessee’s Bureau of Workers’ Compensation (February 24, updated May 2026 to likewise flag Spanish-speaking claimants as a specific target) warned of impersonators claiming to represent its Court of Workers’ Compensation Claims; and the Texas Division of Workers’ Compensation (February 25) issued a similar warning about officials being impersonated for fraud schemes. Montana’s Department of Labor and Industry issued its own scam warning around the same time (February 10); Montana was also cited in Oregon’s alert as a state where the scheme had reportedly spread, though Montana’s own posted warning describes a related but seemingly distinct email-phishing scheme rather than an identical match to the hearing/settlement-fee pattern seen elsewhere — worth treating as adjacent rather than confirmed identical.

By April, the pattern had reached Utah, where the state Labor Commission described it as a nationwide scam impersonating the Commission, its Industrial Accidents Division, and federal labor officials, with contact information for the Industrial Accidents Division published in follow-up local coverage. Industry publication WorkersCompensation.com’s April roundup tied the Utah, Oregon, Tennessee, and Texas warnings together as a single emerging national pattern. By late May and into June, North Carolina’s Industrial Commission and Attorney General Jeff Jackson issued a joint warning describing a multi-state operation using fake virtual hearings and official-looking communications, and Washington’s Attorney General issued a preemptive consumer alert in June specifically warning Spanish-speaking workers, noting that while no confirmed Washington cases had yet been reported, the scam’s spread across neighboring Pacific Northwest states warranted getting ahead of it. Minnesota’s Office of Administrative Hearings has also posted an undated alert covering the same pattern.

A July 31, 2026 roundup by claims-industry vendor Ethos Risk, drawing on the same state alerts along with additional reporting, adds two data points worth noting: Arizona’s Industrial Commission issued its own consumer alert (date not independently confirmed in this review) describing the identical impersonation tactics, and Illinois’s Workers’ Compensation Commission is described as continuing to maintain a public alert about scammers posing as judges, attorneys, and state employees, though this review was not able to independently locate that specific IWCC alert page to confirm its current content firsthand.

State agencies and industry sources recommend a consistent set of precautions: legitimate workers’ compensation benefits and settlements never require an upfront payment before funds are released; state agencies do not contact claimants by text message, video call, or social media to request money or schedule a hearing; requests for payment via gift card, wire transfer, or cryptocurrency are a strong indicator of fraud; and any suspicious communication should be verified using independently sourced contact information for the relevant state agency, not a phone number, email, or link contained in the suspicious message itself. The Federal Trade Commission maintains general guidance on recognizing government-impersonation scams that applies to this pattern as well.

FAA Proposed Rule Targets California Meal and Rest Hour Break Law

The Federal Aviation Administration has proposed a rule that would, if finalized, override a line of California court decisions requiring airlines to give California-based flight attendants the same duty-free meal and rest breaks California law guarantees other workers. The proposed rule, published in the Federal Register as Docket FAA-2026-6739, would declare that FAA’s own duty-and-rest regulations for flight crews preempt state and local meal-and-rest-break laws outright — effectively legislating around the litigation losses the agency and the airline industry have suffered in California courts over the past several years.

The FAA’s own rulemaking document identifies exactly which litigation prompted it: “recent litigation – most notably Bernstein v. Virgin America, Inc. 3 F. 4th 1127 and Wilson v. SkyWest Airlines, Inc.(Case No. 3:19-cv-01491)  U.S. District Court for the Northern District of California – over the applicability of State meal and rest break laws to flight attendants has underscored the need” for the rule. Both cases decided California controversies, not a generalized industry complaint.

In Bernstein, a certified class of California-based Virgin America flight attendants sued the airline for failing to provide meal breaks, rest breaks, overtime pay, and compliant wage statements as required under the California Labor Code. Virgin America argued the Federal Aviation Act and the Airline Deregulation Act preempted California’s break requirements as applied to an airline’s flight crews, since a flight attendant must remain available throughout a flight to handle safety duties. The Ninth Circuit rejected that argument on every theory the airline raised — field preemption, conflict preemption, and Airline Deregulation Act preemption — and affirmed summary judgment for the flight attendants on their rest and meal break claims, reasoning that airlines could comply with both federal safety rules and California’s break requirements simply by staffing longer flights with an additional flight attendant. Alaska Airlines, which had acquired Virgin America, petitioned the U.S. Supreme Court for review; the Court denied certiorari on June 30, 2022, leaving the Ninth Circuit’s ruling as binding law within the circuit, over the objection of an amicus brief from the U.S. Chamber of Commerce and several states warning it would create a costly, unworkable patchwork of state rules for a national industry.

Wilson v. SkyWest Airlines followed the same pattern on nearly identical facts. Two California-based SkyWest flight attendants sued over the airline’s alleged failure to provide meal breaks, rest breaks, and proper wage statements. In a 2021 summary judgment order, U.S. District Judge Vince Chhabria held the claims were not preempted, expressly relying on Bernstein as controlling precedent, and rejected SkyWest’s argument that its own on-duty-meal-period side agreements with employees adequately substituted for California’s statutory requirements, granting the flight attendants partial summary judgment on SkyWest’s liability for the break violations. Together, Bernstein and Wilson left airlines operating in California, or employing California-based crews, exposed to Labor Code liability for break violations that federal aviation law did not previously reach.

The FAA’s proposed rule is designed to close that exposure prospectively through regulation rather than further litigation. It would add two new provisions to Title 14 of the Code of Federal Regulations — §§ 117.31(a) and 121.468(a) — stating that FAA’s existing flightcrew and flight attendant duty-and-rest regulations preempt state and local laws covering the same subject matter. Rather than writing new substantive break rules, the FAA is asserting that its existing regulatory scheme already occupies the field. The agency grounds that position in two separate theories: first, that state laws requiring crew to be fully relieved of duty during a break directly conflict with the federal safety expectation that crew remain available throughout a flight to respond to fires, medical emergencies, unruly passengers, or evacuations, an argument the FAA bolsters with data showing lithium-battery-related onboard incidents rose from 39 in 2020 to 93 in 2025; and second, that state meal-and-rest-break laws are independently preempted under the Airline Deregulation Act of 1978 because they have a “significant impact” on airline prices, routes, and services, a standard the statute’s express preemption clause (49 U.S.C. § 41713(b)(1)) sets for state regulation of air carriers.

The proposal frames the inconsistency among state break laws as a matter of “national significance” under Executive Order 13132’s federalism framework, and the agency says it has limited the scope of preemption to the “minimum level necessary” to achieve its safety and economic objectives. Notably, the FAA is not proposing to wipe out existing accommodations built through collective bargaining: the rule acknowledges that some flight attendants already receive negotiated break protections through Railway Labor Act collective bargaining agreements or individual airline policies — the same mechanism California itself recognized in 2023 when it enacted Labor Code amendments (SB 41) exempting flight attendants from the state’s standard break requirements where a qualifying collective bargaining agreement addresses breaks. The FAA is inviting comment on whether a final rule should codify elements of those existing CBA-based approaches, rather than leave crews without CBA coverage, or without such agreements addressing breaks, entirely without a break protection floor.

The rule has drawn immediate attention from aviation labor unions and California officials likely to oppose it during the comment period, given that it would functionally reverse two hard-won court victories through executive rulemaking rather than new legislation. Airlines and industry groups, including some that filed amicus support for Virgin America and SkyWest during the underlying litigation, are expected to support the rule as restoring the uniform national standard they argued for unsuccessfully in court. Comments on the proposal are due September 4, 2026, after which the FAA will need to respond to the comment record before any final rule could take effect — a process that itself is likely to draw legal challenges regardless of the outcome, given the significant stakes for both flight crew working conditions and airline operating costs nationwide.

Gann Fire Triggers Insurance Policy Moratorium Under New Laws

The Gann Fire ignited on August 3, 2026, near Hogan Dam Road and Gann Road outside Valley Springs in Calaveras County. By the time Governor Gavin Newsom proclaimed a State of Emergency for the county on August 6, the fire had burned more than 10,300 acres, forced the evacuation of 1,473 residents with another 1,400 under evacuation warnings, resulted in one fatality, and threatened homes, structures, and electrical transmission and distribution infrastructure serving northern Calaveras County. More than 2,700 personnel, 12 helicopters, 247 fire engines, 46 dozers, and 25 water tenders were deployed to fight the fire. The proclamation directed the California Governor’s Office of Emergency Services (Cal OES) and other state agencies to support local response and recovery efforts, suspended certain public contracting rules to speed access to emergency resources, and followed the state’s prior securing of a federal Fire Management Assistance Grant from FEMA.

That emergency declaration triggered a separate, statutorily defined process at the California Department of Insurance. Under Insurance Code section 675.1, enacted through 2018 legislation (Senate Bill 824), once a state of emergency is declared for a wildfire, insurers are barred from cancelling or refusing to renew residential property insurance policies located within or adjacent to the fire perimeter, for one year from the date of the declaration, based solely on the property being located in a wildfire-affected area. A parallel statute, Insurance Code section 675.55, enacted through 2025 legislation (Senate Bill 547) and effective January 1, 2026, extends the same one-year restriction to certain commercial property insurance policies covering residential or habitational uses — including homeowners associations, condominium associations, long-term rental hotels or motels, apartment complexes, condominium complexes, multifamily dwellings with more than five units, student housing, and senior living facilities.

Under both statutes, the California Department of Forestry and Fire Protection (CAL FIRE), in consultation with Cal OES, determines the fire’s perimeter and supplies that data to the Insurance Commissioner, who then issues a bulletin identifying the specific ZIP Codes subject to the moratorium. On August 14, 2026, Insurance Commissioner Ricardo Lara issued Bulletin 2026-6, identifying 22 ZIP Codes within or adjacent to the Gann Fire perimeter — spanning Calaveras, San Joaquin, Amador, Tuolumne, and Stanislaus counties — as subject to the moratorium for one year beginning August 6, 2026, the date of the Governor’s declaration. The bulletin directs that no admitted or non-admitted insurer may issue a notice of cancellation or non-renewal due to wildfire risk, for the specified duration, for residential property insurance (including homeowners’, condo unit owners’, mobile homeowners’, and renters’ policies) or qualifying commercial property insurance located in those ZIP Codes. The bulletin also directs insurers to offer to rescind any cancellation or non-renewal notices already issued for wildfire risk on or after August 6, 2026 for properties in the affected ZIP Codes, and to offer to reinstate or renew the policies those notices would have terminated.

In an accompanying press release issued the same day, the Department of Insurance stated that the moratorium applies to more than 64,000 residential policyholders in the five affected counties. The release noted this is the first time the commercial-property moratorium under Senate Bill 547 has applied following a wildfire emergency declaration since that law took effect, and stated that Commissioner Lara’s office reported the equivalent residential moratorium mechanism applied to more than 1.2 million homeowners across the state’s wildfire emergencies in 2025. The release also noted that homeowners who have suffered a total property loss in a declared disaster are separately entitled to up to 24 months of protection from non-renewal or cancellation under existing law, a longer period than the one-year moratorium that applies regardless of whether an individual policyholder suffered a loss.

Taken together, the sequence runs as follows: a wildfire triggers a gubernatorial emergency declaration; that declaration activates the statutory ZIP-Code-based insurance moratorium process; CAL FIRE and Cal OES supply fire-perimeter data to the Department of Insurance; and the Insurance Commissioner then issues a bulletin naming the specific ZIP Codes where insurers are barred from cancelling or non-renewing residential and qualifying commercial property policies for one year, regardless of whether a given policyholder’s property was actually damaged.

San Francisco Amends Paid Parental Leave Ordinance

San Francisco has finalized amendments to its Paid Parental Leave Ordinance (PPLO), the decade-old local law requiring covered employers to supplement the wage-replacement benefits new parents receive from California’s Paid Family Leave (PFL) program. Mayor Daniel Lurie signed the amendment, File No. 260451 (Ordinance 162-26), on August 7, 2026, after the legislation was introduced by Supervisor Danny Sauter earlier in the year.

The PPLO itself dates to 2016, when San Francisco became the first jurisdiction in the country to require employers to bring new parents’ pay up to 100% of their normal wages during state-covered bonding leave. Under the ordinance, an employer with 20 or more employees worldwide must pay “Supplemental Compensation” — the gap between an employee’s PFL benefit and their full weekly wage, up to a combined statutory cap ($2,522 per week for claims filed in 2026) — for up to eight weeks, to any employee who works at least eight hours per week within San Francisco, performs at least 40% of their total work hours in the city, and is receiving California PFL benefits to bond with a new child through birth, adoption, or foster placement. Employers with an existing paid parental leave policy that already matches or exceeds what the ordinance requires are exempt from the supplemental-pay obligation.

The amendment’s central change is to the ordinance’s eligibility waiting period. Previously, an employee had to have worked for their employer for at least 180 days before qualifying for PPLO supplemental pay. The amendment cuts that requirement to 90 days — bringing it in line with the 90-day threshold already used under San Francisco’s separate Paid Sick Leave Ordinance. Supervisor Sauter, whose own child was born in March 2025, described the change as intended to make the benefit reachable for lower-wage workers in high-turnover industries, who are statistically less likely to stay with one employer long enough to clear a 180-day threshold. The amendment does not change the ordinance’s other core terms: the eight-week maximum duration, the supplemental-pay calculation method, the combined benefit cap, or employers’ existing obligations to post the required notice, include PPLO information in employee handbooks, and provide the Paid Parental Leave form to employees who give notice they are expecting a child.

The new 90-day standard does not take effect for all covered employers at once. The amendment phases it in based on employer size: employers with 100 or more employees remain subject to the old 180-day requirement through December 31, 2026, with the 90-day standard applying to leave periods beginning January 1, 2027; employers with 20 to 99 employees remain on the 180-day requirement through December 31, 2027, with the 90-day standard applying starting January 1, 2028. Employers with 19 or fewer employees remain outside the ordinance entirely, as under prior law.

On integration with the state program: the PPLO does not replace or duplicate California’s PFL benefit — it supplements it. California PFL, administered by the Employment Development Department (EDD) and funded through employee payroll contributions via State Disability Insurance, pays eligible workers a percentage of their wages (currently roughly 60% to 70%, depending on income) for up to eight weeks to bond with a new child, subject to a statewide weekly cap. The PPLO requires San Francisco employers meeting the size threshold to pay the difference between that state benefit and the employee’s full regular wage, so that the employee receives their normal weekly pay (up to the combined cap) rather than only the partial wage replacement PFL alone provides. To receive the full combined benefit, an employee must apply separately to both programs: first for EDD’s California PFL benefits, and then to their employer for PPLO supplemental compensation, providing the employer with EDD’s determination of the employee’s PFL benefit amount so the employer can calculate the required top-up. Because the PPLO’s Supplemental Compensation is legally tied to what an employee is found eligible to receive under state PFL, San Francisco’s benefit rises and falls with future changes to the state program’s wage-replacement percentage or its weekly benefit cap.

Employers should update parental leave policies and eligibility tracking to reflect the new phase-in schedule and monitor the San Francisco Office of Labor Standards Enforcement’s PPLO webpage for updated posters, forms, and guidance implementing the amendment.

This summary is provided for general informational purposes only and does not constitute legal advice. Employers with questions about specific compliance obligations should consult the full ordinance text and the San Francisco Office of Labor Standards Enforcement directly.