A former San Mateo County sheriff’s deputy who collected more than $61,000 in workers’ compensation benefits for an elbow injury has been sentenced to five months in county jail. Surveillance video showed him lifting, driving, and working out hard at the gym. Jorden Tuiveta Faatiga, 35, of Patterson, was sentenced on Tuesday, September 29, 2026, according to the San Mateo County District Attorney’s Office, as reported by KRON4 and by Bay City News in the Redwood City Pulse. Faatiga pleaded no contest on April 30 to felony charges of workers’ compensation fraud and filing a false document. San Mateo County Superior Court Judge Jeffrey Jackson placed him on two years of supervised probation, conditioned on serving five months in the county jail. He was also ordered to pay $61,534.02 in restitution to the County of San Mateo. According to KRON4, the District Attorney’s Office said he has already repaid $40,000 of that amount. Faatiga remains out of custody and has been ordered to surrender at the county jail on January 9, 2027. According to the prosecutors’ account, the case began in October 2024, when Faatiga reported an on-duty injury to his right elbow and filed a workers’ compensation claim. He then worked in a modified-duty assignment through February 2025 while receiving benefits. Investigators from the District Attorney’s Workers’ Compensation Fraud Unit reviewed surveillance video that, prosecutors said, showed him using the supposedly injured elbow in ways that contradicted the restrictions he had described to his treating physician. The activities included lifting, driving, and intense gym workouts. Prosecutors also said he regularly misrepresented his symptoms to doctors in order to keep receiving benefits. The conviction also ended Faatiga’s law enforcement career. The California Commission on Peace Officer Standards and Training (POST) disqualified his peace officer certification in August 2026. That makes him ineligible to serve as a peace officer anywhere in California, according to KRON4 and the Redwood City Pulse. The case drew wide attention when the plea was first announced. The National Insurance Crime Bureau highlighted it in its regional news roundup, citing earlier reporting by KTVU. The same Bay City News account of the sentencing also ran in The Almanac. For public employers and claims administrators, the case is a familiar pattern with a notable twist. Surveillance that contradicts reported work restrictions is a common basis for claimant fraud prosecutions. Here, though, the claimant kept working in a modified role and still faced felony charges, apparently based on how he described his condition to his doctors. The case also shows the collateral consequences a fraud conviction can carry for public safety employees: apart from jail and restitution, Faatiga lost his peace officer certification. All descriptions of Faatiga’s conduct come from the District Attorney’s Office as relayed in news coverage. His defense attorney was not available for comment, according to the Redwood City Pulse. The District Attorney’s original announcement could not be located on the office’s website, so this account relies on news outlets that reported from it. The sources do not specify the exact statutes charged ...

On Sept. 17, a grand jury indicted Nouman Mustafa, 36, of Torrance, and Mohsin Khan, 40, of Bakersfield, on multiple counts of health care fraud and aggravated identity theft for submitting millions of dollars in fraudulent claims for durable medical equipment to Medicare, U.S. Attorney Eric Grant announced today. On Feb. 11, 2026, Mustafa was arrested on a criminal complaint at the Los Angeles International Airport while trying to board a one-way flight to Pakistan. Khan was arrested at his home in Bakersfield and will make his initial court appearance today. According to court records, Mustafa and Khan are Pakistani nationals with dual United States citizenship who have worked in the United States as security guards, warehouse managers, and licensed insurance agents. From January 2025 through January 2026, they created a series of shell companies designed to look like legitimate durable medical equipment (DME) companies. In reality, none of the companies had physical storefronts, warehouses, or any locations where legitimate business could have been conducted. Mustafa and Khan then used these companies to quickly submit more than $3.5 million in fraudulent claims to Medicare. They typically relied on one company for only a few weeks or months until its claims began getting denied for suspected fraud, at which point they shifted to the next company. Mustafa and Khan got the information to file the fraudulent claims from their contacts in Pakistan and elsewhere. This information included details about real Medicare beneficiaries and their doctors. The defendants kept approximately 30% of the proceeds and sent the remainder back to their contacts. The U.S. Department of Health and Human Services Office of Inspector General conducted the investigation with assistance from the Bakersfield Police Department. Assistant U.S. Attorneys Arelis Clemente and Joseph Barton are prosecuting the case. If convicted, Mustafa and Khan face up to 10 years in prison and a fine of up to $250,000 for each of the health care fraud counts and a mandatory minimum of two years in prison, consecutive to the sentences they receive for any other counts, for each of the aggravated identity theft counts. Any sentence, however, would be determined at the discretion of the court after consideration of any applicable statutory factors and the federal Sentencing Guidelines, which take into account a number of variables. The charges are only allegations; the defendants are presumed innocent until and unless proven guilty beyond a reasonable doubt ...

Farzana Chaudhry worked for the California Department of Corrections and Rehabilitation (CDCR) beginning in 2007. Most recently she was a dental assistant at the California Medical Facility in Vacaville, which provides dental care to inmates. Starting in April 2018, she raised safety concerns about contaminated protective equipment and sterilization practices, both internally and in a series of complaints to Cal/OSHA. One of those complaints led to a Cal/OSHA inspection and a $450 fine. Chaudhry alleged that management retaliated against her over the next several years. According to her complaint, a supervisor gave her a critical letter of instruction in July 2018, and she was passed over for an acting supervisory role. She was suspended without pay for a month from December 2019 to January 2020. In 2020, she received a counseling record over her sterilization practices, was twice asked for doctor’s notes for sick days, and was accused of wearing a mask incorrectly. In September 2020, Chaudhry presented a claim to the State under the Government Claims Act, and the State rejected it. CDCR fired her in November 2020, and she sued in April 2021. The State Personnel Board (SPB) overturned the firing, and she returned to work in January 2022. Chaudhry alleged that after her return, her supervisor obstructed her work. CDCR then fired her again in February 2022, withdrew that dismissal, and reinstated her effective August 29, 2022. She resigned on her first day back. She presented a second government claim covering the resignation in January 2023 and amended her lawsuit in May 2023. Separately, in the fall of 2021, Chaudhry filed a retaliation complaint with the SPB under the California Whistleblower Protection Act (Gov. Code, § 8547 et seq.). She exhausted that administrative process in March 2022. She then added a Whistleblower Protection Act claim to her lawsuit in May 2022. Chaudhry sued the State, CDCR, and three individual supervisors. Her operative complaint alleged retaliation under Labor Code § 1102.5, retaliation under the Whistleblower Protection Act, and constructive discharge in violation of public policy. In December 2024, weeks before the scheduled trial, the defendants moved for judgment on the pleadings. The Solano County Superior Court granted the motion in full, dismissed every claim without leave to amend, and entered judgment for all defendants. In the published case of Chaudhry v. State of California, No. A173501 (September 2026). The Court of Appeal affirmed in part and reversed in part. It affirmed the judgment in favor of the three individual supervisors on every claim. As to the State and CDCR, it affirmed the dismissal of the Whistleblower Protection Act claim and the constructive discharge claim, which Chaudhry did not challenge on appeal. It reversed the judgment on the § 1102.5 retaliation claim against the State and CDCR, which will go forward on a constructive discharge theory. The court first addressed whether Chaudhry had met the claim presentation requirement of the Government Claims Act. The court held that her September 2020 claim was untimely as to the conduct it described. The acts within the six-month window before that claim were too minor to count as adverse employment actions. These included the doctor’s note requests, the mask accusation, and a counseling record with no alleged consequences. The court also rejected Chaudhry’s argument that the earlier conduct formed a continuing violation extending into that window. Applying the test from Richards v. CH2M Hill, Inc. (2001) 26 Cal.4th 798, the court found two problems. First, the acts were not reasonably frequent: more than a year passed between July 2018 and October 2019 with no alleged retaliation. Second, the unpaid suspension, which ended in January 2020, was a permanent, completed act. It should have made clear that informal efforts to stop the retaliation were futile. Her claim accrued at that point, so a claim presented in September 2020 came too late. The court rejected her argument that a temporary suspension lacks permanence. It reasoned that on that view, only outright termination would ever qualify. Her January 2023 claim was a different matter. The court held that Chaudhry adequately alleged a constructive discharge in August 2022, within six months of that claim. A jury could find that the sequence of events would compel a reasonable employee to resign. That sequence was the November 2020 firing, obstruction after her reinstatement, a second firing less than a month later, and a later rescission of that firing. The court observed that no employee should have to endure repeated baseless retaliatory terminations combined with efforts to sabotage her work. The court rejected the defendants’ argument that constructive discharge was a backdoor way to revive time-barred terminations. A constructive discharge is the employer’s own act, and it occurs when the employee resigns, even if the conditions that caused it began earlier. The theory also does not strip employers of their defense under Labor Code § 1102.6. On remand, the State and CDCR can still try to prove by clear and convincing evidence that they had legitimate, independent reasons for the firings and other actions. Next, the court resolved the open question of individual liability. Section 1102.5(b) bars retaliation by an employer “or any person acting on behalf of the employer.” That language was added in 2013. Chaudhry argued that it reaches individual supervisors. The court agreed that the words alone could support her reading. But it found the statute ambiguous when read alongside related provisions. Section 1104 makes the employer responsible for its managers’ acts. Section 1105 speaks of recovering damages from the employer. Section 1102.6 gives the burden-shifting defense only to employers, which would make little sense if supervisors could be sued too. To resolve the ambiguity, the court looked to legislative history. The 2013 amendments were aimed at employers and their attorneys who threatened to report workers to immigration authorities, and nothing in the history mentions suing supervisors personally. The court then relied on Jones v. Lodge at Torrey Pines Partnership (2008) 42 Cal.4th 1158. There, the Supreme Court held that similar “person” language in FEHA’s anti-retaliation provision does not create individual liability. Jones built on Reno v. Baird (1998) 18 Cal.4th 640, which reached the same result for discrimination claims. The panel found most of those decisions’ policy concerns equally applicable to § 1102.5. Supervisors must make personnel decisions as part of their jobs, and personal liability would add little to plaintiffs’ recovery. It would also chill management and create conflicts between supervisors and employers. The panel noted that its holding matches the view of more than 30 federal district court decisions. It declined to follow the two federal cases that went the other way. On the Whistleblower Protection Act claim, the court held that Chaudhry had not properly exhausted her administrative remedies. Under Government Code § 8547.8(c), a damages action is not available unless the employee has first filed a complaint with the SPB. Chaudhry filed her lawsuit in April 2021, based on the same facts, before she went to the SPB. She could not satisfy the requirement by filing what the court called a placeholder complaint, going to the SPB, and then amending to add the claim. Relying on Bjorndal v. Superior Court (2012) 211 Cal.App.4th 1100, the court explained that allowing this would defeat the point of the administrative process. That process exists to resolve disputes before litigation begins. The court noted that employees can avoid this trap by filing with the SPB at the same time as, or promptly after, presenting their Government Claims Act claim. Because Chaudhry identified no facts that could cure the defect, the court denied leave to amend ...

Rotator cuff tears rank among the most common and most expensive shoulder injuries workers' compensation claims professionals see, and the surgery used to fix them fails at a surprisingly high rate — published estimates range from roughly 11 percent to as high as 94 percent depending on tear size, tissue quality, and patient age. On August 31, 2026, medical device giant Stryker announced a definitive agreement to acquire ZuriMED, a Zurich-based company whose FiberLocker System is designed to directly address one of the most common reasons those repairs fail. A rotator cuff tear occurs when one or more of the tendons connecting the shoulder muscles to the upper arm bone tears away from its attachment point, often from a fall, a sudden overhead strain, or cumulative wear from repetitive overhead work — all common workers' compensation injury mechanisms. Surgical repair typically involves reattaching the torn tendon to bone using suture anchors, small devices implanted in the bone that hold stitches passed through the tendon. The problem is that the tendon tissue itself is often the weak link. In many patients, particularly those with larger or more chronic tears, degenerated or poor-quality tendon tissue cannot hold sutures securely, and the repair can pull through or re-tear before the tendon has had time to biologically heal back to bone. This failure mode — suture pull-through in weakened tissue — is distinct from anchor failure or surgical technique error, and it has proven difficult to solve through suture or anchor design alone. ZuriMED's FiberLocker System, which received FDA 510(k) clearance in late 2024, is a soft-tissue augmentation technology in which a polyester patch is applied over the repaired tendon during or after surgery and secured to the surrounding tissue. The device is designed to reinforce the connection between the sutures and the tendon, distributing mechanical load across a broader area of tissue rather than concentrating stress at the suture points, with the goal of reducing the specific failure mode of sutures cutting through weakened tendon. According to Stryker's announcement, the company will add the commercialized FiberLocker System to its existing shoulder portfolio, supporting both sports medicine and arthroplasty applications. Financial terms were not disclosed, and the deal remains subject to customary closing conditions, with ZuriMED continuing to operate as a separate entity until closing. Andy Pierce, Stryker's Group President of MedSurg and Neurotechnology, said the technology "addresses an important clinical need within shoulder care," and the company has characterized rotator cuff augmentation as one of the fastest-growing segments within sports medicine. Rotator cuff injuries will remain a persistent and costly category of workers' compensation claims regardless of how this particular acquisition plays out, but the broader trend it reflects — device manufacturers investing specifically in technologies aimed at reducing surgical failure rates rather than only expanding surgical volume — is one claims professionals should continue to track. As FiberLocker and similar augmentation technologies see wider adoption following Stryker's acquisition, expect more surgeons to raise augmentation as a treatment option, and expect the evidentiary record on its real-world effectiveness to grow correspondingly. Claims professionals reviewing shoulder treatment requests should ask what tear characteristics are driving a given surgical recommendation and whether augmentation, if proposed, is supported by the claimant's specific clinical picture rather than applied as a routine add-on ...

In February 2016, Jennifer Slamer was working for Southern California Permanente Medical Group (SCPMG) when she suffered disabling respiratory injuries from exposure to a disinfectant made by Ecolab, Inc. SCPMG resolved her workers’ compensation claim in the administrative system. In May 2017, Slamer and her husband sued Ecolab, SCPMG, and related entities in San Bernardino County Superior Court. SCPMG and its affiliates were dismissed from the civil case with prejudice after a series of demurrers and summary judgment motions. The judgment dismissing SCPMG was entered on April 11, 2022. The Slamers went to trial against Ecolab alone. Before the case went to the jury, they reached a confidential settlement with Ecolab on April 19, 2023. On June 1, 2023, they voluntarily dismissed the entire action with prejudice. While the case was pending, SCPMG continued paying benefits. It filed several notices of lien against any recovery under Labor Code § 3856(b). After the settlement, the Slamers refused SCPMG’s requests for reimbursement, and mediation failed. On February 16, 2024, more than eight months after the dismissal, SCPMG filed a motion for reimbursement. The Slamers opposed the motion on several grounds. They argued the lien had to be reduced by SCPMG’s comparative fault and by an equitable share of their attorney fees and costs. They declined to disclose the settlement amount, but they stipulated that it exceeded the lien plus their fees and costs. On April 18, 2025, the trial court granted SCPMG’s motion. It ordered the Slamers to reimburse the full lien amount plus interest. In the unpublished case of Slamer v. Southern California Permanente Medical Group, No. D086908 (September 2026) the Court of Appeal reversed and remanded. It directed the trial court to enter a new order denying SCPMG’s reimbursement motion for lack of jurisdiction. The Slamers were awarded their costs on appeal. The Slamers raised several challenges on appeal: that the motion came too late, that SCPMG’s comparative fault was never decided, that fees were not properly allocated, and that pre-order interest was awarded in error. While the appeal was pending, the panel identified a threshold problem on its own and asked the parties for supplemental briefing. The question was whether the trial court had any jurisdiction to act after the entire case had been voluntarily dismissed with prejudice. The court concluded it did not. Because that answer resolved the appeal, the panel did not reach the other issues. The court began with the statutory framework. An injured worker’s remedy against the employer is generally limited to workers’ compensation, but the worker may sue a third-party tortfeasor. To prevent double recovery, the employer may assert a lien on the worker’s judgment or settlement. That lien may be reduced for the employer’s own comparative negligence, and for a share of fees and costs under Labor Code § 3860(c) when the recovery was obtained solely through the employee’s attorney. The panel emphasized the timing requirement: the employer must apply for an order paying the lien before the judgment is satisfied or the action is dismissed. It cited Labor Code § 3857 and Abdala v. Aziz (1992) 3 Cal.App.4th 369, among other authorities. SCPMG did not meet that deadline. Once the Slamers filed their dismissal, the action ended and the court lost jurisdiction, except for limited matters such as costs and statutory fees (Harris v. Billings (1993) 16 Cal.App.4th 1396). An order entered without jurisdiction is void. The panel rejected each of SCPMG’s four counterarguments. First, SCPMG argued the Slamers forfeited the timeliness issue by not raising it in the trial court. The panel disagreed. A challenge to subject matter jurisdiction may be raised for the first time on appeal. SCPMG also pointed to a possible factual dispute over whether the settlement funds had been fully disbursed. The court found that dispute irrelevant, because no one disputed that the dismissal came first. Second, SCPMG argued the Slamers had acknowledged its lien efforts and agreed the court could keep jurisdiction. The panel held that parties cannot confer subject matter jurisdiction by consent, waiver, or estoppel. It quoted Viejo Bancorp, Inc. v. Wood (1989) 217 Cal.App.3d 200 for the rule that a court “cannot ‘retain’ jurisdiction it has lost.” SCPMG also relied on the lien-motion provision in Code of Civil Procedure § 664.6(f)(1). The court found that provision inapplicable for two reasons. It did not take effect until January 1, 2025, and it does not apply retroactively. And even if it did apply, it covers dismissals without prejudice, not dismissals with prejudice like this one. Third, SCPMG argued the trial court had expressly retained jurisdiction under § 664.6 to enforce the settlement. Under Wackeen v. Malis (2002) 97 Cal.App.4th 429, a request to retain jurisdiction must meet three conditions. It must be made while the case is pending. It must be in a signed writing or stated orally before the court. And it must be express, clear, and unambiguous. The courtroom exchanges and minute-order entry SCPMG cited did not meet that standard. Separately, SCPMG could not use § 664.6 in any event. It had been dismissed from the case in 2022, which made it a stranger to the action, and only a party to a settlement may invoke that statute. Fourth, SCPMG argued that the Enforcement of Judgments Law (Code Civ. Proc., § 708.410 et seq.) applied through Labor Code § 3862. Under that law, a lienholder is treated as a party, and the debtor cannot dismiss without the creditor’s consent. The panel explained that § 3862 reaches only a lien that has been allowed and perfected. A lien is not “allowed” until the court grants the employer’s application, which may require deciding comparative fault and fee allocation first. Here, the order allowing the lien did not issue until April 2025, nearly two years after the dismissal. By then the action was no longer pending: the time to appeal the dismissal had expired in November 2023. The court cited Maniago v. Desert Cardiology Consultants’ Medical Group, Inc. (2026) 20 Cal.5th 91 for the principle that a voluntary dismissal with prejudice terminates the action. Because SCPMG never perfected its lien before the dismissal, the Slamers did not need its consent to dismiss. The panel expressly took no position on whether any other remedy remains available to SCPMG. For employers and carriers, the case is a reminder that a filed notice of lien is not enough. The employer must obtain a court order allowing the lien, or a properly made request for the court to retain jurisdiction, before the employee’s third-party action is dismissed. This is especially important once the employer has been dismissed from the case as a defendant. This is an unpublished opinion of the California Court of Appeal, under California Rules of Court, rule 8.1115(a), courts and parties generally may not cite it or rely on it. It is not a decision of the Workers’ Compensation Appeals Board. It is however relevant to the Worker's Compensation community as illustrative of existing law ...

A former correctional officer at Salinas Valley State Prison has pleaded no contest to felony workers’ compensation insurance fraud and admitted the loss exceeded $100,000, the Monterey County District Attorney’s Office announced. The defendant, 43-year-old Lorena Hernandez Alvarado of King City, is scheduled for sentencing on October 22, 2026. District Attorney also reported that Alvarado pleaded guilty in two unrelated DUI cases. According to the District Attorney’s press release, the case began with a workplace injury claim Alvarado filed in April 2021. She reported injuring her shoulder, neck, back, and knees while holding a heavy shield to protect herself from liquid an inmate had thrown at her. State Compensation Insurance Fund, which the release identifies as the prison’s insurer, accepted the claim. Alvarado never returned to work and collected well over $100,000 in wage-replacement and medical benefits. Prosecutors say an Internal Affairs investigation by the California Department of Corrections and Rehabilitation later found that Alvarado had not used a shield during the April 2021 incident. The same investigation concluded that she had fabricated an earlier workplace injury in 2019, which she attributed to a struggle with an inmate. That 2019 claim was denied. The District Attorney’s Workers’ Compensation Fraud Unit then charged her with two felony counts of insurance fraud. The release does not name the specific statutes charged or say whether the plea covered one count or both. CDCR Investigator Adam Jimenez and District Attorney Workers’ Compensation Insurance Fraud Investigator Jennifer Mendoza handled the investigation. County fraud units like Monterey’s are largely funded by California employers themselves. The California Department of Insurance awards annual grants to district attorneys to investigate and prosecute workers’ compensation fraud, and those grants are paid for through assessments on employers. The department describes claimant fraud as one of several categories the grants target, along with medical provider fraud, employer premium fraud, and insider fraud. The account of the underlying conduct comes from the District Attorney’s release and the CDCR investigation it describes; no court findings or defense statements were available. Sentencing has not yet occurred, and the release does not say whether prosecutors will seek restitution to State Fund or how much ...

John Linsao and Brian Walters owned a home in Sherman Oaks at the bottom of a ravine below a steep hillside. They had an all-risk homeowners policy from First American Property & Casualty Insurance Company and a separate flood and mud policy from another carrier. The First American policy excluded loss caused by weather conditions, earth movement such as mudslides, acts or decisions of any person or government body, and faulty, inadequate, or defective planning, design, workmanship, or construction, whether on or off the insured premises. In 2019 a contractor, Melt Construction, was building a large house on an upslope lot. The City of Los Angeles approved plans requiring Melt to build a retaining wall along the road. A neighbor complained about how the wall would look. The City then asked Melt to pause work on the wall while design changes were considered, although it never issued a formal stop order. When work stopped, about 15 feet of the wall had not been built. That section consisted only of drilled caisson holes with rebar in them. In December 2019 a rainstorm hit while construction was still paused. Melt placed about 75 sandbags at the unfinished end of the wall. Runoff ran along the wall to its open end and cut a gully directly toward the rear of the insured home. The water overwhelmed the home’s drainage, cracked the home’s own retaining wall, and pushed water, mud, and debris into the house. The damage made the home uninhabitable. First American denied the claim in January 2020 under the earth movement exclusion. Linsao is a lawyer with insurance industry experience, and he argued that Melt’s negligence was the cause of the loss. First American then reopened the claim. According to evidence the homeowners submitted, several First American employees told Linsao in June 2020 that the loss was covered. The insurer also issued a $20,000 advance for living expenses. Within days, however, a claims vice president and outside counsel wrote that coverage had not been confirmed. In early July, Linsao took out a $200,000 loan to pay for repairs and living expenses. On July 24, 2020, First American issued a final denial. It concluded that earth movement, water, third-party negligence, and weather, all excluded perils, had combined to cause the loss. The homeowners and two family members sued First American for breach of contract, breach of the implied covenant of good faith and fair dealing, intentional infliction of emotional distress, and fraud. The fraud claim was based on First American’s website, which marketed the policy as comprehensive while recommending separate flood coverage. The plaintiffs also sued the City, Melt, and others in a separate action, and they later settled with the other insurers. The trial court granted First American’s motion for summary judgment. It rejected the estoppel argument and held that the undisputed facts brought the loss within one or more exclusions, focusing mainly on the inadequate construction exclusion. It held that the contract, implied covenant, and emotional distress claims failed because there was no coverage. It also found that the evidence did not support several elements of the fraud claim. In the Published Case of Linsao v. First American Property & Casualty Insurance Company, Case No. B340746 (September, 2026). The Court of Appeal affirmed the summary judgment in full and awarded First American its costs on appeal. The California Court of Appeal filed this opinion as unpublished on August 27, 2026, and then certified it for publication on September 23, 2026, so it is now citable precedent The panel first addressed efficient proximate cause. Under State Farm Fire & Casualty Co. v. Von Der Lieth (1991) 54 Cal.3d 1123, a loss caused by a combination of covered and excluded perils is covered if a covered peril was the predominant cause. The homeowners argued that a jury could still decide which cause predominated. The court held that a factual dispute over which cause predominated does not defeat summary judgment when every possible predominant cause is excluded, following Brodkin v. State Farm Fire & Casualty Co. (1989) 217 Cal.App.3d 210. The court identified four candidate causes: the storm, the mudslide, Melt’s construction activity, and the neighbor’s complaint. The homeowners did not argue on appeal that the storm or the mudslide was a covered cause. The court held that the neighbor’s complaint could not be the efficient proximate cause as a matter of law. The complaint was at most a “but for” cause that started a chain of events. It could not have damaged the home on its own, and treating it as a separate peril merely recharacterized Melt’s conduct. On Melt’s conduct, the court read “inadequate” according to its ordinary dictionary meaning: insufficient or not capable of serving its purpose. Relying on Wilson v. Farmers Ins. Exchange (2002) 102 Cal.App.4th 1171, which held that an unfinished home renovation was plainly inadequate construction, the court concluded that a retaining wall missing a 15-foot section cannot function as a retaining wall. The homeowners argued that Melt paused at the City’s request and was not at fault. The court rejected that argument because the exclusion requires only inadequacy, not negligence or blame. Because the exclusion is not ambiguous, the rule that ambiguous exclusions are construed against the insurer did not apply. The court also noted that nothing requires a homeowners policy to cover risks created by an unfinished construction project on neighboring property. Next, the court rejected the estoppel argument. It agreed that the evidence raised a triable issue about whether First American’s employees told the homeowners the loss was covered and whether the homeowners relied on those statements. Even so, the court held that estoppel cannot create coverage that the policy does not provide. The homeowners relied on Tomerlin v. Canadian Indemnity Co. (1964) 61 Cal.2d 638 and Miller v. Elite Ins. Co. (1980) 100 Cal.App.3d 739. The court explained that those were liability insurance cases in which the insured gave up alternative ways of defending or resolving a lawsuit because of the insurer’s conduct. It noted that Dollinger DeAnza Associates v. Chicago Title Ins. Co. (2011) 199 Cal.App.4th 1132 had limited that exception to liability insurers. The panel did not decide whether the exception could ever reach first-party coverage, because these homeowners gave up no alternatives. They pursued both a flood claim and a lawsuit against Melt and others. At most, the loan might support a claim for the cost of borrowing under promissory estoppel, a theory the homeowners had expressly disclaimed. The court then held that bad faith in the investigation of a claim that is not covered is not actionable. Under Waller v. Truck Ins. Exchange, Inc. (1995) 11 Cal.4th 1, the implied covenant has no independent existence apart from the contract benefits due. The court expressly adopted Benavides v. State Farm General Ins. Co. (2006) 136 Cal.App.4th 1241, holding that without coverage there is no tort liability for how a first-party claim was investigated, whether the theory is framed as breach of the implied covenant or as emotional distress. It declined to follow dicta in earlier cases suggesting that an insurer might sometimes be liable for bad faith even without coverage. Finally, the court affirmed summary judgment on the fraud claim. The website accurately described the range of coverage First American generally offers and said nothing about the terms of the plaintiffs’ particular policy. In addition, no reasonable insured could rely on general marketing statements over the express terms of the policy they purchased ...

California’s workers’ compensation system paid $13.88 billion in benefits in 2023, a 7.1% jump from the prior year and nearly double the 3.8% growth recorded nationally, according to a review of new National Academy of Social Insurance (NASI) data released September 24, 2026 by the California Workers’ Compensation Institute (CWCI). The $916 million increase lifted California’s share of all U.S. workers’ compensation benefit payments to 21.7%, up from 21% in 2022. The CWCI analysis draws on NASI’s 28th annual report, Workers’ Compensation: Benefits, Costs, and Coverage, 2023 Data, published August 11, 2026. NASI, a Washington, D.C.-based nonprofit, took over the national workers’ compensation data series formerly produced by the Social Security Administration and describes its report as the only comprehensive source of benefit, coverage, and employer-cost data for all 50 states, the District of Columbia, and federal programs. NASI builds its estimates largely from state agency responses to an Academy questionnaire, supplemented by insurer premium data from A.M. Best and the National Association of Insurance Commissioners and by data from the National Council on Compensation Insurance. The CWCI review highlights how outsized California’s system is relative to its workforce. The state accounted for 11.9% of the nation’s covered jobs and 14.3% of covered payroll in 2023, yet more than a fifth of all benefits paid — meaning its share of benefit dollars ran roughly one and a half times its share of payroll. California’s total exceeded the combined benefit payments of New York, Florida, and Washington, the states ranked second through fourth, and was nearly four times the $3.52 billion paid under federal programs. Payments were split almost evenly between medical and indemnity benefits, at about $6.95 billion each. The growth in benefits came even as California’s job base barely moved. Covered employment in the state rose just 0.6% to nearly 17.8 million jobs, compared with 2.3% growth nationwide, according to the CWCI review. The national picture in NASI’s report offers useful contrast. Across the country, workers’ compensation programs covered nearly 150 million jobs and close to $11 trillion in wages in 2023, surpassing pre-pandemic levels, and paid $64.1 billion in total benefits, with medical care making up more than 47% of that amount. Total employer costs reached $106.6 billion, up 3.5% from 2022. But because payroll grew faster than benefits and costs, NASI found that both measures kept falling when adjusted for covered wages; employer costs came to roughly 98 cents per $100 of covered payroll. Thirty-six jurisdictions saw total benefits per $100 of payroll decline between 2022 and 2023, and 43 saw employer costs per $100 of payroll decline. Private insurers paid 55.6% of benefits nationally, self-insured employers 25.6%, the 22 state funds 13.3%, and the federal government 5.5%. For California employers and carriers, the findings reinforce a theme running through recent industry research: the state’s system is growing more expensive faster than the national system as a whole. The NASI data arrive on the heels of a separate CWCI loss development study released September 17, 2026, which concluded that the pandemic disrupted but did not halt steady growth in California medical and indemnity claim costs, and that medical costs may be accelerating in the post-pandemic period. Readers should keep several limitations in mind. The figures reflect benefits paid during calendar year 2023 regardless of when the underlying injuries occurred, so they do not track the cost of any particular group of claims. The data are also nearly three years old by the time of publication, and NASI’s numbers are estimates assembled from multiple sources, with its methodology materials noting that costs and benefits recorded in a given year are not perfectly aligned (see NASI’s Sources, Methods, and State Summaries from the prior edition). The California-specific figures in this story come from Business Insurance’s account of the CWCI review rather than from the CWCI release itself; readers can check the national figures directly against NASI’s executive summary and full state-by-state dataset ...

State Compensation Insurance Fund (State Fund) had insured Dynamic Nutraceutical, Inc. for many years. The policy at issue ran from January 1, 2012 to January 1, 2013, with a total estimated annual premium of $640 and a required deposit premium of the same amount. On January 20, 2012, State Fund sent Dynamic a notice revising the required deposit. It told Dynamic to pay $71.20. The decision does not explain the difference between the two figures. On February 21, 2012, State Fund sent a notice cancelling the policy effective March 8, 2012 for failure to pay premium when due, citing the $71.20 balance. Dynamic's principal testified that he did not recall receiving the notice until much later, because at the time he was caring for his mother, who had cancer and was frequently hospitalized. He found the letter in June and then sent State Fund a check for $71.20. The policy listed nonpayment of premium as a ground for cancellation. State Fund had attached letters telling policyholders that, starting January 1, 2012, it would no longer send cancellation warning letters and would move to a new billing system built around a premium deposit. Nicolas Garcia's workers' compensation claim against Dynamic turned on whether the policy was still in force. The decision does not state his date of injury. The Uninsured Employers Benefits Trust Fund was among the parties served. In a February 2, 2026 Findings and Order, the arbitrator found that part of Dynamic's deposit premium remained unpaid as of February 21, 2012. However, the arbitrator also found that State Fund had not shown any unpaid earned premium, meaning premium for coverage already provided. The arbitrator concluded that neither the policy nor Insurance Code § 676.8 allows cancellation on 10 days' notice for an unpaid deposit premium. He declared the cancellation void and returned the case to the trial level to address injury and benefits. His later report recommended that State Fund's petition for reconsideration be denied, and Dynamic filed no answer. In the panel decision of Nicolas Garcia v. Dynamic Nutraceutical, Inc.; State Compensation Insurance Fund, ADJ9109258, (September 2026), the Board panel (Commissioners Paul F. Kelly, Katherine Williams Dodd, and Joseph V. Capurro) granted reconsideration and rescinded the arbitrator's decision. It substituted a finding that State Fund properly canceled the policy on March 8, 2012 because Dynamic failed to make a required premium payment when due. The panel first confirmed that its decision was timely. Under the version of Labor Code § 5909 in effect from July 2, 2024 through June 30, 2026, the Board had 60 days from the case's transmission on July 15, 2026 to act. That period ended on a Sunday, so the deadline moved to Monday, September 14, 2026 under Cal. Code Regs., tit. 8, § 10600(b). The arbitrator's report had been served months before the transmission, so serving it did not give the parties notice that the 60-day clock had started. However, the district office's July 15 minutes of hearing did give that notice. On the merits, the panel held that the statute and the policy were both unambiguous. Section 676.8(b)(1) allows cancellation for the policyholder's failure to make any premium payment when due. The panel reasoned that the statute makes no distinction between earned and unearned premium and does not exempt a premium deposit. It read the word “any” as removing doubt that every kind of premium payment is covered. The policy likewise allowed cancellation for nonpayment of premium without distinguishing between types of premium. Neither the statute nor the policy sets a minimum amount, so it did not matter that the shortfall was only $71.20. The panel said the arbitrator's distinction between deposit and earned premium went well beyond the plain meaning and obvious purpose of requiring timely payment. It cited the Third District's recent published decision in Employers Preferred Ins. Co. v. Workers' Comp. Appeals Bd. (2026) 122 Cal.App.5th 467 for the rule that courts will not adopt strained readings to create ambiguity. That case also upheld a carrier's cancellation of a policy. The panel also found the notice procedurally sound: § 676.8(c) requires at least 10 days' written notice for nonpayment, and State Fund gave 15. Finally, the panel admonished State Fund's counsel for citing an unpublished Court of Appeal opinion to explain what a deposit premium is. Under California Rules of Court, rule 8.1115, unpublished opinions generally may not be cited or relied on in other cases. The panel found that none of the rule's exceptions applied ...

Guadalupe Gutierrez worked for almost 40 years as a cemetery groundskeeper in Colma for Hills of Eternity/Home of Peace Management Group. American Family Home Insurance Company (AFH) insured the employer during calendar year 2014, and Insurance Company of the West (ICW) insured it during 2015. Gutierrez had three claims pending. The first was an admitted specific back injury on April 12, 2015, for which ICW furnished benefits. The second was a cumulative trauma claim, filed in November 2016, alleging back injury over the year ending April 12, 2015. The third was a separate claim that was ultimately denied. In October 2019, Gutierrez elected on the record to proceed against AFH on the cumulative trauma claim under Labor Code § 5500.5(c). In a February 3, 2020 report, the agreed medical evaluator, Dr. William Campbell, concluded that Gutierrez had suffered specific injuries on January 1 and April 12, 2015. He also concluded that the back condition reflected cumulative trauma over almost four decades of heavy work, during which Gutierrez had worked through many unreported smaller injuries. In a later report, Dr. Campbell addressed whether Gutierrez's harmful exposure ended in November 2015 or continued until he stopped working on April 27, 2016. He pointed to treatment records showing that all work restrictions were lifted from November 3, 2015 onward, and concluded the exposure continued through April 27, 2016. In a November 2022 decision, the workers' compensation judge (WCJ) found both the specific injury and the cumulative trauma injury compensable. For the cumulative trauma claim, the WCJ used the pleaded end date of April 12, 2015 to set the one-year liability period under § 5500.5. The WCJ did not include a formal finding on the date of injury under Labor Code § 5412. However, the WCJ's opinion reasoned that because Gutierrez had a disabling specific injury on April 12, 2015, he must have known that same day that his disability was work-related. The WCJ awarded 46 percent permanent disability, future medical care, and attorney fees on the cumulative trauma claim against the employer, AFH, and ICW jointly and severally. The WCJ deferred the questions of which insurer would administer benefits and how the insurers would share costs. AFH petitioned for reconsideration. It argued that both the last date of harmful exposure and the date of injury fell in April 2016, which would put the liability period entirely outside AFH's 2014 coverage. ICW petitioned separately, arguing that Gutierrez's 2019 election against AFH meant AFH alone should be liable, so the administration and contribution issues should not have been deferred. In the panel decision of Guadalupe Gutierrez v. Hills of Eternity/Home of Peace Management Group, ADJ10656667, ADJ10656647, ADJ13080462 (September 2026), the Board panel (Deputy Commissioner Anne Schmitz, Chair Katherine A. Zalewski, and Commissioner JosÉ H. Razo) rescinded the WCJ's decision and substituted new findings on the cumulative trauma claim. The last day of harmful exposure is April 27, 2016. The § 5412 date of injury is February 3, 2020. The § 5500.5 liability period is the 365 days ending April 27, 2016. The panel removed AFH from the award and made the award, including the 46 percent permanent disability, joint and several against the employer and ICW only. It deferred all other issues on that claim and returned the matter to the trial level. The WCJ's findings on the specific injury and the denied third claim were carried forward. On the end of the exposure period, the panel noted that § 5500.5(a) limits cumulative trauma liability to employers and insurers during the year before the last date of harmful exposure or the § 5412 date of injury, whichever comes first. Dr. Campbell had squarely addressed whether the exposure ended in November 2015 or April 2016. Because his opinion, and the work-status records it relied on, were uncontroverted, the panel saw no good reason to reject it. It cited Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775 and fixed the last exposure date at April 27, 2016. On the date of injury, the panel held that the WCJ applied the wrong test. A cumulative trauma injury, as defined in Labor Code § 3208.1, occurs when its combined effect ripens into compensable disability and the worker knows, or reasonably should know, that the disability was caused by work. The panel relied on Federal Ins. Co. v. Workers' Comp. Appeals Bd. (2013) 221 Cal.App.4th 1116 and State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Rodarte) (2004) 119 Cal.App.4th 998. Knowing that a specific incident was work-related is not the same as knowing that years of cumulative trauma caused a disability. Under City of Fresno v. Workers' Comp. Appeals Bd. (Johnson) (1985) 163 Cal.App.3d 467, a worker is generally not presumed to have that knowledge without medical confirmation. The panel found no evidence that Gutierrez knew or should have known of a disabling cumulative injury before Dr. Campbell's February 3, 2020 report. Because the April 27, 2016 exposure date came first, it controls the liability window. On ICW's argument, the panel agreed with the WCJ. Under § 5500.5(c) and Colonial Ins. Co. v. Industrial Acc. Com. (Pedroza) (1946) 29 Cal.2d 79, an injured worker may elect to proceed against any one of several liable insurers. But that election does not relieve any other insurer of its liability, so deferring administration and contribution was proper. The panel then noted that its own findings moved the liability period entirely outside AFH's 2014 coverage, so the record no longer supported any award against AFH. That left ICW, which covered 2015, jointly liable with the employer. The panel added that ICW may still identify whichever insurer covered the employer in 2016, join it in the case, and seek contribution ...