Category: Daily News

Sudarshan b in Fremont, California. The policy’s “Suit Against Us” provision, tracking the standard fire policy language in Insurance Code section 2071, required that any lawsuit on the policy be brought within one year of the loss, extended to two years for losses related to a declared state of emergency.

In January 2021, after a tenant vacated the property, Kumar discovered water damage and mold in the garage, apparently caused by a leaking water heater, and reported the loss to Mid-Century on February 3, 2021. On February 10, Mid-Century mailed a letter denying coverage for the mold and wear-and-tear damage, but continued investigating potential coverage for related water damage; on February 16, following a follow-up inspection, Mid-Century mailed Kumar a second letter along with a $5,010.93 payment for covered drywall damage, again stating that it had “completed the adjustment” and was “closing” the claim, and that the claim would not be reopened absent written notice.

Over the following two years, Kumar intermittently submitted additional information and a $555,700 rebuild estimate, and Mid-Century responded in writing each time — requesting supporting documentation, quoting the one-year suit provision, and in an April 2021 letter stating it would “be happy to reopen” the claim if Kumar provided the requested materials within the policy deadline. Kumar never provided that documentation, and Mid-Century’s contractor-verification efforts and a July 2021 engineering inspection both confirmed no additional coverage existed.

On January 18, 2023, one day after his last email exchange with Mid-Century, Kumar, representing himself, sued for breach of contract, breach of the covenant of good faith and fair dealing, misrepresentation, fraud, and unfair competition, seeking repair costs and loss-of-use damages.

Mid-Century moved for summary judgment on the ground that Kumar’s suit was barred by the policy’s one-year limitations period. Kumar opposed, arguing Mid-Century never issued an “unequivocal” denial sufficient to end the tolling period, and alternatively that the limitations period was equitably tolled, that Mid-Century was estopped from asserting the defense, and that the COVID-19 state of emergency extended the deadline to two years. In support, Kumar submitted a declaration stating that unidentified Mid-Century representatives told him orally in early 2021 that he had two years to sue, and that his limited English proficiency required him to rely on those oral statements over the written notices.

The Alameda County Superior Court granted summary judgment, finding Mid-Century’s February 2021 correspondence an unequivocal denial that started the one-year clock, making Kumar’s January 2023 complaint untimely, and entered judgment for Mid-Century in March 2025.

In the published case of Kumar v. Mid-Century Insurance Company, No. A173097 (Cal. Ct. App., 1st Dist., Div. 2, July 2026) — the Court of Appeal affirmed the trial court’s grant of summary judgment in favor of Mid-Century. This opinion was originally filed on June 30, 2026 and was not initially certified for publication; on July 22, 2026, the First Appellate District, Division Two, ordered it published in the Official Reports. It is now citable authority.

The summary judgment was reviewed de novo, applying the settled rule that an insurance policy’s limitations period is tolled “from the time the insured files a timely notice … to the time the insurer formally denies the claim in writing,” citing Hydro-Mill Co., Inc. v. Hayward, Tilton & Rolapp Ins. Associates, Inc. (2004) 115 Cal.App.4th 1145 and Prudential-LMI Com. Insurance v. Superior Court (1990) 51 Cal.3d 674. That formal-denial requirement means an “unequivocal” written denial, and neither an insurer’s invitation for further information nor an insured’s request for reconsideration reopens the tolling period, citing Migliore v. Mid-Century Ins. Co. (2002) 97 Cal.App.4th 592 and Singh v. Allstate Ins. Co. (1998) 63 Cal.App.4th 135.

Applying that framework, the panel held Mid-Century’s February 16, 2021 letter — which stated the adjustment was complete, the claim was closed, and it would not be reopened absent written notice, while accompanying a settlement payment — was an unequivocal denial as a matter of law, eliminating any pending claim to which tolling could still apply. The court rejected Kumar’s argument that Mid-Century’s repeated invitations for additional information created ambiguity, explaining that Migliore squarely rejected the identical argument on nearly identical facts, and that Kumar’s own subjective understanding of the correspondence was not a basis for finding a denial equivocal. Because the record showed at least five separate written statements from Mid-Century that the claim was closed, each accompanied by the “Suit Against Us” language, the court found no triable issue on this point.

The panel likewise rejected Kumar’s remaining defenses. His estoppel argument failed both because he never pleaded estoppel in his complaint, foreclosing it as a basis to oppose summary judgment, and because Mid-Century’s invitations to submit further information, made only in response to Kumar’s own requests and paired with repeated disclosure of the limitations period, could not support the intent-to-mislead element estoppel requires. Finally, the panel held Kumar’s fraud, misrepresentation, and unfair competition claims were, at their core, claims seeking policy benefits and therefore governed by the same one-year period, since “the applicable limitations period is determined by the gravamen of the complaint rather than the named cause of action,” citing Jang v. State Farm Fire & Casualty Co. (2000) 80 Cal.App.4th 1291 — and that Kumar had, in any event, forfeited any argument for treating those claims as independent torts by failing to raise it in the trial court.

The Centers for Medicare & Medicaid Services has begun the machinery that, for the first time in the roughly 15-year history of mandatory Section 111 reporting, can turn a late Medicare Secondary Payer filing into a real dollar penalty. According to CMS’s own civil money penalty guidance pages, the agency began randomly auditing Section 111 records in January 2026 and is now working through its first round of noncompliance notices to insurers, self-insured employers, and workers’ compensation payers.

The penalties trace back to a final rule CMS published in the Federal Register on October 11, 2023, which took effect December 11, 2023, became applicable to new coverage events on October 11, 2024, and became enforceable, meaning penalties could actually attach, on October 11, 2025. The rule fills in details that Congress left to CMS’s discretion when it authorized penalties for Section 111 noncompliance back in 2013’s SMART Act.

Under the final rule, CMS narrowed what can trigger a penalty considerably from what it originally proposed. Early drafts would have allowed penalties for late reporting, for reporting that contradicted an entity’s earlier submissions during a recovery dispute, and for exceeding a data-quality error threshold in four of eight consecutive quarters. In the final version, CMS dropped the latter two triggers entirely; the sole basis for a civil money penalty now is late reporting, measured against a 365-day deadline running from a settlement date or the date an entity assumes ongoing responsibility for a claimant’s medical care.

The dollar amounts differ depending on the type of reporting entity. Group health plans face a flat penalty, currently $1,512 per day of noncompliance after inflation adjustment, with no discretion for CMS to reduce it, since the statute sets that rate directly. Non-group health plan entities, meaning liability insurers, no-fault carriers, and workers’ compensation payers, are subject to a tiered structure instead: $378 per day (2025, inflation-adjusted) for a record reported one to two years late, $756 per day for two to three years late, and $1,512 per day beyond three years, capped at $365,000 for any single record. CMS says it adopted the tiered approach, rather than mirroring the flat GHP rate, specifically in response to industry comments asking that penalty size track the severity of the delay.

To find violations, CMS is not scanning every submission. Instead, beginning in January 2026 and continuing every quarter, the agency randomly selects 250 records nationwide from newly accepted Section 111 filings, proportioned to reflect the actual mix of GHP and NGHP submissions that quarter. With roughly 20,800 active reporting entities registered, any individual company’s odds of being pulled into a given quarter’s sample are low, though CMS notes multiple records from the same entity can theoretically be selected.

An entity flagged in the audit receives an Informal Notice first, not an actual penalty, and has 30 days to submit mitigating evidence, such as documentation that a delay stemmed from a technical issue outside its control or from a beneficiary who refused to provide identifying information despite good-faith outreach. If CMS rejects that explanation or receives no response, the case proceeds to a formal Notice of Proposed Determination, and the entity can request a hearing before an administrative law judge within 60 days, followed by a further appeal to the Departmental Appeals Board’s Appellate Division. Notices go only to the entity’s Authorized Representative and Account Manager on file, according to CMS, and outdated contact information is not treated as an acceptable defense.

CMS reportedly told attendees at a January 15, 2026 webinar that its first informal notices for liability and no-fault claims were expected to go out in March 2026. Workers’ compensation reporting is on a delayed track: because CMS added new Medicare Set-Aside data fields to workers’ comp reporting requirements in April 2025, the earliest date CMS could issue a workers’-comp-related penalty notice is July 2026, according to that same account of CMS’s guidance. Those dates come from CMS’s public webinar remarks as relayed by outside counsel, not from the final rule’s text itself, and CMS’s own published materials describe the audit and notice cadence in general terms without committing to those specific calendar dates.

For employers and the insurance industry, the practical takeaway is that a rule which has existed on paper for more than two years is now generating actual audit activity, with real money attached for the first time. Self-insured employers and carriers that serve as Responsible Reporting Entities have reason to confirm their Section 111 profile contacts are current, and to review internal procedures with any third-party reporting agents, since CMS notices go to the RRE itself and reporting agents are not copied.

CMS’s own regulatory impact analysis, included in the final rule, flagged that the agency does not expect the penalty regime to be economically significant. Modeling the rule against 2022 reporting behavior, CMS estimated a worst-case aggregate of $128.8 million in penalties across the entire industry in a given year, below the $200 million threshold that would have required a fuller economic impact analysis, and CMS cautioned that the 2022 data likely overstates typical noncompliance since it predates entities’ efforts to come into compliance ahead of the rule.

This summary is for general informational purposes only; readers should consult the primary CMS guidance and Federal Register final rule linked above for complete, current data and methodology.

A new RAND Corporation study, Examining the Impact of Senate Bill 1160 on Utilization Review and Medical Treatment in California Workers’ Compensation, offers the first empirical look at whether a decade-old reform aimed at speeding up early medical care for injured workers actually worked. The report, published July 20, 2026 and sponsored by the California Department of Industrial Relations (DIR), finds that the 2016 law delivered a modest, measurable improvement in one key treatment area — but that utilization review (UR) was rarely the barrier the law was designed to remove in the first place.

Senate Bill 1160, enacted in 2016 and effective for injuries on or after January 1, 2018, exempted certain treatments provided in the first 30 days after a work injury from prospective UR — the process by which claims administrators approve, modify, or deny a treatment recommendation before care is delivered. Under the law, treatment for an accepted, compensable injury that is consistent with the Medical Treatment Utilization Schedule (MTUS) and delivered by a provider in the employer’s medical provider network is automatically authorized during that first month, without needing prospective sign-off. Claims administrators can still review those treatments retrospectively to check MTUS consistency, and a provider found to have a pattern of inconsistent care can be required to go back through prospective UR. The exemption reaches common early-stage treatments such as physical therapy and initial X-rays, but Labor Code section 4610(c), as amended by SB 1160, carved out several categories that remain subject to prospective UR even in the first 30 days, including surgery, pharmaceuticals, imaging other than X-rays, psychological treatment, home health care, and certain injections. All employers remain required to maintain a UR plan consistent with Labor Code section 4610 and its implementing regulations at 8 California Code of Regulations section 9792.6 et seq.

To evaluate the law’s effects, the RAND team — led by Stephanie Rennane and Michael Dworsky — combined four data sources: individual-level treatment-authorization records from two large claims administrators covering Northern and Southern California, statewide Independent Medical Review (IMR) data from DIR, DIR’s own UR audit reports, and medical billing data from the California Workers’ Compensation Information System (WCIS). The study period ran from January 2017 through January 2024, covering a full year before the law’s effective date and six years after. Researchers used interrupted time-series models to test for statistically significant shifts in UR approval rates, receipt of guideline-concordant care, and time to first treatment, before and after the January 1, 2018 implementation date.

The headline finding is that UR approval rates for treatment requested in the first 30 days after injury were already high before the law took effect — consistently above 90% at both claims administrators the researchers studied — and did not change in any statistically meaningful way afterward. That held true across nearly every treatment category the researchers examined, including physical therapy, imaging, surgery, and durable medical equipment. Approval rates for requests submitted later in a claim, by contrast, ran several percentage points lower throughout the study period, and treatment categories that SB 1160 left subject to full prospective review — imaging other than X-rays, injections, and psychiatric or psychological services — consistently showed the lowest approval rates of all, in the 70% to 90% range depending on the data source and category. In other words, the study suggests UR was rarely denying or slowing early, routine care even before SB 1160 removed the requirement to review it in advance. The researchers also found that many claims administrators already ran informal “prior authorization” programs that let common early treatments bypass the formal request-for-authorization process entirely, further reducing the friction SB 1160 was designed to eliminate.

Where the law did leave a measurable mark was physical therapy. Among injured workers with diagnoses for which physical therapy is clinically recommended, the odds of receiving it within 30 days of injury rose 13% after SB 1160 took effect, and the average time to a first physical therapy visit within that window dropped from 13.4 days before the law to 11.9 days after. Guideline-concordant use of braces and other immobilizers also rose modestly, with 8% higher odds of receipt within 30 days, though the timing of that care didn’t measurably speed up. Effects elsewhere were smaller and more mixed: receipt of guideline-concordant X-rays didn’t change significantly, consistent with X-rays already being commonly pre-authorized before the law; guideline-discordant acupuncture — treatment given for diagnoses where it isn’t recommended — actually rose 24% in relative terms after the law, though it remained rare in absolute terms, staying under 3% of cases throughout the study; and MRI use in the first 30 days declined slightly even though MRIs were explicitly excluded from SB 1160’s reduced-review provisions, a pattern the researchers attribute to unrelated trends rather than the law itself. Overall, the study concludes that SB 1160’s clearest, most defensible effect was on physical therapy access, and that the modest size of the effects generally reflects a system in which common early treatment was already flowing fairly freely before the reform.

The report closes with three recommendations for DIR and the Legislature. First, DIR should systematically document the informal prior-authorization programs claims administrators already run, since the report found meaningful, unexplained variation in which treatments different administrators pre-approve without any authorization request at all. Second, because most UR activity and most denials happen well after the first 30 days — and because treatments SB 1160 left fully subject to prospective review, particularly imaging and psychological services, have distinctly lower approval rates — the report suggests the Legislature examine whether reduced-review treatment could be extended further into a claim, or targeted more by treatment type and evidence strength than by a fixed 30-day window. Third, the researchers recommend DIR build out its planned systemwide UR database with standardized diagnosis and procedure codes and consistent claim identifiers, arguing that the absence of any comprehensive, uniform dataset on UR decisions was itself one of the central limitations of this study and remains an obstacle to evaluating future reforms.

Employers Preferred Insurance Company issued a workers’ compensation policy to Purchase Green Artificial Grass covering May 5, 2020 to May 5, 2021 (the 2020 policy), followed by a renewal policy covering May 5, 2021 to May 5, 2022 (the 2021 policy). Like most workers’ comp policies, the premium quoted was only an estimate; the final premium would be calculated later based on the insured’s actual payroll, verified through an audit. The 2021 policy required Purchase Green to keep and turn over payroll records on request and to give the insurer access to perform a “payroll verification audit.” A separate endorsement warned that if the insured failed to provide access within 90 days after a policy’s expiration, it would owe a penalty premium of three times the estimated annual premium, plus the insurer’s audit-related costs if it still failed to respond after a third request over at least 90 days; the insurer would then notify the insured of that failure by certified mail, after which the insured would owe the premium and costs within 30 days, while still retaining up to three years to provide records and have its premium corrected.

After the 2020 policy expired, Employers Preferred sent Purchase Green repeated letters and emails in May, June, and August 2021 requesting payroll records, followed by a certified letter on August 5, 2021 (delivered August 10) formally notifying Purchase Green of its failure to provide access. That same day, Employers Preferred sent a notice cancelling the 2021 policy effective September 14, 2021, citing Purchase Green’s failure to cooperate with the final audit. Purchase Green never responded with payroll records during this period; its owner later testified he did not recall receiving any of the communications, including the cancellation notice. On February 3, 2022, a Purchase Green employee was injured and filed a workers’ compensation claim; Purchase Green paid its outstanding audit-related charges on February 18, 2022, but Employers Preferred denied the claim in May 2022 on the ground that the 2021 policy had already been canceled before the injury occurred.

The issue of insurance coverage proceeded to arbitration consistent with the Workers’ Compensation Appeals Board Rules. The arbitrator ruled the cancellation was ineffective, reasoning that neither the policy nor the Insurance Code precisely defined what conduct amounts to a “failure to permit” a payroll audit, and that cancelling a policy outright should require something more concrete than silence following three notices and the passage of 90 days. On reconsideration, the arbitrator adhered to that view, and on June 13, 2025, the Board adopted the arbitrator’s recommendation and denied Employers Preferred’s petition for reconsideration. Employers Preferred then petitioned the Court of Appeal for a writ of review challenging the Board’s decision, and the court issued the writ.

In the unpublished decision of Employers Preferred Insurance Company v. Workers’ Compensation Appeals Board No. C104263 (Cal. Ct. App., 3d Dist., July 2026) — the Court of Appeal annulled the Board’s June 13, 2025 order and remanded the matter to the Board for further proceedings.

Writing for a unanimous panel, Justice Robie reviewed the policy’s interpretation de novo, since insurance policies are ordinary contracts subject to the usual rules of contract interpretation, citing Bank of the West v. Superior Court (1992) 2 Cal.4th 1254 and Bay Cities Paving & Grading, Inc. v. Lawyers’ Mutual Insurance Co. (1993) 5 Cal.4th 854. Under Insurance Code section 676.8, a cancellation notice is effective for an insured’s “[f]ailure to permit the insurer to audit payroll as required by the terms of the policy,” but the statute lets the policy’s own terms define what that failure looks like. The panel agreed with the arbitrator that neither the policy’s main audit provision nor Insurance Code section 11760.1 (which separately allows a premium penalty for failing to provide audit access) used the exact phrase “failure to permit an audit,” and that several different deadlines appeared in the audit provision — 90 days before a penalty premium attaches, a further period before costs are added, 30 days after a certified letter before the increased premium is enforceable, and up to three years to still provide records and have the premium corrected.

But the court held that gap was not decisive. Citing the general rule that a contract should be interpreted reasonably and need not spell out every term with precision, citing Quantification Settlement Agreement Cases (2011) 201 Cal.App.4th 758 and Civil Code section 1643, the panel explained that the audit provision used the word “fail” throughout — failure to provide access within 90 days, failure after a third request, failure to show a compelling business reason — and expressly described the certified-letter notice as informing the insured of its “failure to provide access.” The only reasonable reading, the court held, was that the parties intended the certified-letter stage, not the later three-year window, to mark the point of “failure” that could justify cancelling a subsequent policy; reading the provision otherwise would let an insured delay a new policy’s cancellation for roughly 1,000 additional days, an outcome the panel found unreasonable given the policy’s one-year term. Because Purchase Green never responded to any of the insurer’s requests and never offered a compelling business reason for its silence, the court held Employers Preferred’s cancellation, sent 35 days after the certified letter was delivered, satisfied both the 2021 policy and section 676.8. The panel added that not every contractual phrase must be independently defined to avoid ambiguity, citing Bay Cities Paving, and that courts should not manufacture ambiguity where a strained reading is the only way to find it.

The panel went on to reject Purchase Green’s three alternative arguments for invalidating the cancellation. It rejected the argument that the Insurance Code required Employers Preferred to conduct “personal outreach” rather than automated notices, because Purchase Green never showed the policy’s own language required anything beyond what the insurer did. It rejected the argument that Purchase Green’s failure to respond had to be shown to be intentional or willful, holding that the policy’s obligation was to affirmatively provide records once requested, regardless of motive. And it rejected Purchase Green’s equitable estoppel argument — based on a February 8, 2022 letter that incorrectly listed the 2021 policy’s coverage period as running through May 2022 — because equitable estoppel requires detrimental reliance, citing Honeywell v. Workers’ Compensation Appeals Board (2005) 35 Cal.4th 24, and that letter was sent five days after the employee’s injury, so Purchase Green could not have relied on it at the time coverage mattered. On that basis, the panel annulled the Board’s order and remanded for further proceedings, with costs to Employers Preferred.

Maria Lopez Rodriguez worked as a medical receptionist for Kern County Hospital Authority, permissibly self-insured and administered by Adminsure, Inc. She claimed a psychiatric injury arising out of and in the course of her employment on November 15, 2017, attributing her symptoms to ongoing conduct by her supervisor, Marie Ruffin.

A qualified medical evaluator (QME), Dr. Greg Hirokawa, took a history in which applicant described her supervisor searching for reasons to reprimand her, denying her a requested transfer, standing over her while giving instructions, and asking coworkers how often applicant used the restroom, among other incidents she said had gone on for roughly 18 to 24 months. Dr. Hirokawa diagnosed an anxiety disorder and opined that work stress was the predominant (greater than 50%) cause of applicant’s psychological symptoms, and that personnel actions by her supervisor accounted for roughly 80% of that work stress — but he left it to the trier of fact to determine whether the supervisor’s actions were lawful, nondiscriminatory, and in good faith

The workers’ compensation administrative law judge (WCJ) found that applicant sustained a psychiatric injury arising out of and in the course of employment, and that her claim was not barred by the good faith personnel action defense under Labor Code section 3208.3(h). In the accompanying Opinion on Decision, the WCJ identified four incidents — the shoulder grab, the shortened lunch, the church-toys directive, and the yelling — and stated that, while defense witnesses had described other incidents that were good faith personnel actions, the incidents applicant testified to were not, and so did not bar her claim. The WCJ adopted Dr. Hirokawa’s causation opinion in full. Kern County Hospital Authority filed a timely petition for reconsideration, arguing the WCJ misapplied the good faith personnel action defense and that the decision was not supported by substantial evidence.

In the appended Opinion on Decision (Opinion), the WCJ addressed the good faith personnel action defense by simply stating “While Defendant witnesses discussed other incidents that were good-faith personnel actions, those discussed by Applicant were are (sic) not good-faith- personnel actions. This defense does not bar the claim of Applicant based on the incidents Applicant testified to.”

The WCJ adopted Dr. Hirokawa’s opinion on causation, stating: AOE/COE – Parts of the Body Injured “Dr. Hirokawa stated that the predominant cause of Applicant’s symptoms were from work stress. Approximately 80 percent of that stress was due to personnel actions by Applicant’s supervisor. Dr. Hirokawa left it to the trier of fact to determine if the supervisor’s actions were legal, non-discriminatory, and non-retaliatory. These actions are being found not to be good-faith-personnel actions. Based on Dr. Hirokawa’s report, Applicant has suffered industrial injury to the psyche.”

In the panel decision of Rodriguez v. Kern County Hospital Authority, ADJ11141161 (Cal. Workers’ Comp. Appeals Bd., July 2026) — the WCAB granted reconsideration and rescinded the WCJ’s Findings and Orders in their entirety, returning the matter to the trial level for further proceedings.

The panel applied the four-step framework the Board adopted in its en banc decision in Rolda v. Pitney Bowes, Inc. (2001) 66 Cal.Comp.Cases 241, for evaluating a psychiatric injury claim once an employer raises the good faith personnel action defense under Labor Code section 3208.3. Under Rolda, the WCJ must determine, in sequence: whether the claimed injury involves actual events of employment; whether those events were the predominant (over 50%) cause of the injury; whether any of those events were personnel actions that were lawful, nondiscriminatory, and in good faith; and, if so, whether those good faith personnel actions were a “substantial cause” — 35% to 40% of all causation — of the injury. The first two steps are applicant’s burden; the latter two are the employer’s. The panel found the first two steps effectively conceded, since defendant did not dispute that applicant’s described incidents were actual events of employment or that Dr. Hirokawa had found predominant industrial causation.

The problem, the panel explained, arose at the third step. The point of that step is to sort the actual events of employment into those that were good faith personnel actions and those that were not, but the WCJ’s Opinion on Decision never made clear which of applicant’s described incidents — which the panel noted seemed to include more than the four specifically discussed — the WCJ was treating as the operative events, or why. Citing the Board’s en banc decision in Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, and Labor Code section 5313, the panel explained that a WCJ’s opinion must refer with specificity to the evidence relied upon and clearly set out the reasons for the decision on each issue, so that the parties and the Board can meaningfully evaluate it on reconsideration; a decision must be based on admitted evidence in the record and supported by substantial evidence, citing Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162, among other cases.

That gap mattered because of what the fourth Rolda step requires. Unlike the “predominant cause” inquiry, which looks only at causation as to all events combined, the “substantial cause” inquiry requires the evaluating physician to parse out the individual events found to be good faith personnel actions and assign a percentage of causation to each. Dr. Hirokawa’s report discussed several potential contributing factors but did not analyze each one individually or assign percentages, and the panel reasoned that any such breakdown would necessarily be unreliable if the physician did not know, because the WCJ had never clearly said, which events actually qualified as good faith personnel actions. The panel also noted, in a footnote, that whether a given event is a “personnel action” taken in “good faith” is a factual and legal determination for the WCJ to make, not the QME — so Dr. Hirokawa’s own use of that label in his report, offered before the WCJ made any such finding, could not substitute for the missing determination, citing County of Sacramento v. Workers’ Comp. Appeals Bd. (Brooks) (2013) 215 Cal.App.4th 785.

Concluding that the record could not currently support a finding either way on whether the good faith personnel action defense barred the claim, the panel held the correct course was to develop the record further rather than resolve the issue on an incomplete record, citing the Board’s en banc decision in McDuffie v. Los Angeles County Metropolitan Transit Authority (2002) 67 Cal.Comp.Cases 138 and a recent panel decision reaching the same conclusion on similar facts, Silva v. Department of Transportation Headquarters Operations (2025, ADJ13014565). The Board directed that, on remand, the parties return to Dr. Hirokawa for supplemental reporting under Labor Code section 5701, or that the WCJ appoint a regular physician if his further reporting does not constitute substantial evidence, while noting the parties always retain the option of proceeding by agreed medical evaluator instead. On that basis, the panel rescinded the WCJ’s Findings and Orders and returned the matter to the trial level.