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Rand Reports on SB 1160 Effectiveness on UR and Medical Treatment

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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.

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Glenmark Pharmaceuticals Resolves Price Fixing Case for $29.6M

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The California Attorney General has joined a coalition of 48 states and territories in a $29.6 million settlement with generic drug maker Glenmark Pharmaceuticals, resolving California’s and the other states’ claims that Glenmark took part in a sprawling, years-long conspiracy among generic drug manufacturers to fix prices, allocate customers, and rig bids across the industry. The California Attorney General announced the deal on July 16, 2026, calling the conduct at issue a straightforward harm to consumers and the marketplace. As part of the agreement, Glenmark also agreed to cooperate with the states’ ongoing litigation against dozens of remaining corporate and individual defendants and to adopt internal antitrust-compliance reforms.

The Glenmark settlement is the latest development in litigation that traces back nearly a decade. In December 2016, the Connecticut Attorney General and a group of other states filed the first of what would become three related civil complaints, alleging that six generic drug manufacturers, later expanded to 18 corporate defendants and two individual defendants, conspired over 15 generic drugs. A second complaint followed in 2019, naming Teva Pharmaceuticals and roughly 21 other major generic manufacturers, along with 16 individual senior executives, over a far larger set of 116 drugs. A third complaint, filed in 2020 and captioned Connecticut et al. v. Sandoz, Inc. et al., No. 3:20-cv-00802 (D. Conn.), targets 26 corporate defendants and 10 individual defendants over roughly 80 topical generic drugs used to treat skin conditions — a category the states say accounts for billions of dollars in annual U.S. sales. All three actions were originally filed in the District of Connecticut but were transferred for pretrial proceedings to the multidistrict litigation captioned In re: Generic Pharmaceuticals Pricing Antitrust Litigation, MDL No. 2724, in the U.S. District Court for the Eastern District of Pennsylvania, before the topical-drug case was remanded back to Connecticut, where it is now proceeding before U.S. District Judge Michael P. Shea.

The states describe their case as resting on an unusually deep evidentiary record: more than 20 million documents, a phone-records database covering millions of call detail records tied to more than 600 sales and pricing personnel across the generics industry, and testimony from multiple cooperating witnesses, including a two-volume notebook kept by one cooperator memorializing years of calls and internal meetings with competitors. According to the states’ filings, industry executives allegedly coordinated through industry dinners, golf outings, and frequent calls and texts, using phrases like “fair share” and “playing nice in the sandbox” to describe an informal, industry-wide understanding not to undercut each other on price.

The Connecticut case has continued to move forward even as individual defendants settle out. Court records show that in an October 2025 summary judgment ruling, Judge Shea addressed defense arguments that some of the states’ claims were barred by laches and the statute of limitations, narrowing the case in part while leaving the bulk of it intact. More significantly, in a December 2025 ruling, the court denied the defendants’ motion for summary judgment on whether an “overarching conspiracy” existed among the 26 corporate defendants that would make them jointly and severally liable, allowing the states’ central theory of the case to proceed toward trial. Along the way, individual states have seen mixed results on procedural motions — for example, Florida was permitted to withdraw certain claims in July 2025, while Tennessee’s state-law claims survived a motion to dismiss in April 2025.

Glenmark is not the first defendant to resolve its exposure short of trial. Two former Heritage Pharmaceuticals executives, Jeffery Glazer and Jason Malek, reached cooperation agreements early in the litigation. Heritage and Apotex settled in 2024 for a combined $49.1 million; Lannett and Bausch Health settled in February 2026 for a combined $17.85 million; and Glenmark’s $29.6 million settlement now brings total recoveries from settled defendants to roughly $96 million. Under the settlement, consumers and other purchasers who bought a generic drug manufactured by Glenmark, Lannett, Bausch, Apotex, or Heritage between May 2009 and December 2019 may be eligible for compensation, with claims administered through a dedicated hotline and the states’ joint case website, AGGenericDrugs.com.

As for what remains: the states’ press materials indicate that roughly 30 corporate defendants and 25 individual executives are still contesting the litigation across the three complaints, with seven additional pharmaceutical executives now cooperating as witnesses. The topical-drug case is expected to be the first of the three complaints to go to trial, with the states and reporting from other participating attorneys general offices projecting a trial date in Hartford sometime in late 2026 or early 2027, though no firm date had been set as of this settlement’s announcement. The other two complaints — covering the original 15-drug case and the larger 116-drug Teva-led case — remain pending behind the topical-drug case in the litigation queue.

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Appellate Court Reverses WCAB and Approves Policy Cancellation

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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.

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California Overhauls Subsequent Injuries Benefits Trust Fund

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Governor Gavin Newsom has signed sweeping changes to California’s Subsequent Injuries Benefits Trust Fund (SIBTF), capping an 18-month fight over a workers’ compensation program that grew, by the state’s own account, until it rivaled the size of the entire standard workers’ compensation system.

SIBTF dates to 1945, when California created it to encourage employers to hire disabled World War II veterans: if a worker with a pre-existing disability suffered a new, unrelated workplace injury and the combination left them severely disabled, the fund — not the employer — would cover the added cost. For decades it was a minor corner of the system. That changed over the past ten years. According to the Legislative Analyst’s Office, in a July 2025 report, the fund “now rivals the size of the standard workers’ compensation system but with looser standards, broader eligibility, and more generous benefits.” Employer assessments that funded SIBTF rose from roughly $14 million in 2015 to nearly $850 million by 2025, and a 2024 RAND Corporation study commissioned by the Department of Industrial Relations put the fund’s total potential future liability at $7.9 billion, with a plausible range of $6.4 billion to $10.5 billion. The RAND and LAO reports both pointed to a 2020 Workers’ Compensation Appeals Board en banc decision, Todd v. Subsequent Injuries Benefits Trust Fund, as a major driver, finding that it had significantly loosened the disability-combination rules that determine who qualifies.

That backdrop is what prompted the law. In October 2025, Newsom vetoed an earlier, narrower reform bill, AB 1329 by Assemblymember Liz Ortega, D-San Leandro, saying it did not go far enough. In his veto message, Newsom wrote that the program had “expanded beyond its original purpose” and directed the Department of Industrial Relations and the Division of Workers’ Compensation to build a comprehensive reform plan for the 2026-27 budget cycle. That plan arrived as proposed budget trailer bill language in early 2026 and, after months of committee hearings, became Senate Bill 171, the “Labor” trailer bill attached to this year’s state budget.

The bill was contentious throughout. Business and public-employer groups, including a coalition of counties, cities, and industry associations, backed the changes; in an April 2026 letter, that coalition urged lawmakers to “take swift action to pass this bill through the budget process.” Labor and injured-worker advocates pushed back hard on both the substance and the process. The Coalition of California Injured Workers, a coalition of labor organizations, public safety associations, and injured-worker advocacy groups, publicly urged the Governor and Legislature to strip the SIBTF provisions out of the budget trailer bill entirely and instead send them through the regular legislative process, where they would get full committee vetting and public input. The group cited a poll it commissioned finding that 64% of likely California voters opposed the proposed SIBTF changes once informed of their impact, and that 79% believed reforms of this scope should not be fast-tracked through a budget trailer bill. Assemblymember Ortega’s California Applicants’ Attorneys Association allies raised a related but somewhat more measured concern: at a June 17, 2026 hearing before the Senate Labor, Public Employment and Retirement Committee, former Assemblymember Alberto Torrico, testifying for the CAAA, acknowledged “there is a serious problem with the SIBTF” but argued its roots include understaffing at the agency as much as the Todd decision, and Ortega continued pushing a competing, less sweeping bill, AB 1576, through the same period. Separately, a self-described investigative outlet, The Jacobi Journal, published an analysis in January 2026 disputing the RAND report’s headline $7.9 billion liability figure, arguing that adjusting the study’s discount-rate and payout assumptions would put the real number closer to $1.25 billion — a claim RAND and DIR have not publicly conceded, but one opponents of the trailer bill cited as reason to doubt the urgency behind it.

Despite that opposition, SB 171 passed the Legislature along largely party-line-adjacent budget votes in the final days of June 2026 and was enrolled to the Governor’s desk on June 30. Newsom signed it on Monday, July 13, 2026.

As signed, SB 171 changes SIBTF eligibility and claims-handling in several concrete ways. It adds a statutory definition of “labor disabling” to the Labor Code for the first time, limiting qualifying pre-existing disabilities to impairments that caused a loss of earnings, interfered with the worker’s ability to do their job, or otherwise had a demonstrable impact on their capacity to work — replacing a looser, case-law-based standard. It requires that the existence of a pre-existing disability be proven by substantial evidence drawn from medical records, testimony, or other evidence that predates the subsequent work injury, rather than being established after the fact. It also excludes the future-earning-capacity adjustment and the 1.4 permanent-disability multiplier from the calculation used to determine whether a worker clears the eligibility threshold, and it codifies clearer standards for calculating benefit amounts once eligibility is established. On process, the bill shifts responsibility for paying SIBTF awards from the State Compensation Insurance Fund to the Director of Industrial Relations, acting as trustee of the fund, and it clarifies that workers have five years from a subsequent injury, or six months from the resolution of the permanent disability portion of that injury claim, whichever is later, to file a SIBTF claim. Separately, the bill permanently removes the sunset date on a related provision, Labor Code section 5909, which gives the Workers’ Compensation Appeals Board 60 days from receiving a case file to act on a petition for reconsideration.

The new SIBTF eligibility rules took effect immediately upon signing, since SB 171 is a budget-related bill declared to take effect immediately, but they do not apply retroactively across the board. The law exempts claims that had already reached a specified procedural stage as of June 1, 2026, as well as any claim filed on or before July 1, 2020, from the new standards, leaving those claims to be decided under the prior rules. The new eligibility and calculation provisions are also not permanent as written: the bill makes them inoperative on July 1, 2031, and repeals them outright as of January 1, 2032, meaning the Legislature will need to revisit the program again before the decade is out.

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July 13, 2026 – News Podcast

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Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Cal Supreme Court Clarifies Federal Court Two-Dismissal Rule. 3rd DCA Adopts 2nd DCA Cook Decision on Overbroad Arbitration Agmts. Workplace Restraining Order Affirmed Against School Board Member. OSHA Citation Extends to Hospital’s Management Company. Federal Anti-Arbitration Law Applies to FEHA Sexual Orientation Case. Lawyers Held to State Bar Ethics Civility Provisions in Pro-Per Cases. 9th Circuit Interprets the EFAA’s Application Timing Provisions. Intense Opposition Kills Proposed Law Limiting Athletes’ Claims.

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QME to Assign Percent Causation of Good Faith Personnel Action Event

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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.

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Grand Jury Says Ventura County Has Best in Class Claims Program

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The Ventura County Civil Grand Jury has released a new report, Setting the Record Straight on Presumptive Workers’ Compensation Claims, examining how Ventura County processes “presumptive” workers’ compensation claims for deputy sheriffs and firefighters — and largely vindicating the county’s recent overhaul of that process while flagging structural problems baked into state law itself.

Presumptive claims exist for “safety workers,” a category the Legislature created in 1937 for law enforcement officers, firefighters, and similar high-risk public employees (Cal. Gov. Code, §§ 20390–20416). For a defined list of conditions — including heart trouble, hernia, pneumonia, cancer, tuberculosis, and blood-borne infections — the law presumes the injury or illness arose out of employment, shifting the burden onto the employer to rebut that presumption rather than requiring the worker to prove causation (Cal. Lab. Code, §§ 3212–3214). The Grand Jury notes this framework traces to a genuine, decades-old scientific dispute over whether stress and physical exertion cause conditions like heart disease and cancer, a dispute it says has only been resolved by research in recent years; the report cites the California Supreme Court’s 1978 decision in City and County of San Francisco v. Workers’ Compensation Appeals Board, which addressed the “persisting cleavage in medical theory” that made these claims so contentious.

The Grand Jury’s investigation was prompted by longstanding complaints from Ventura County Sheriff’s Office (VCSO) deputies that presumptive claims were being denied without justification, that treatment was delayed, and that filing a claim effectively required hiring a lawyer. The jury found those perceptions were rooted in real problems, but concluded that Ventura County Risk Management has substantially fixed them since 2023 through a series of administrative changes: eliminating the requirement that injured workers choose a doctor from a restricted network; a “FastTrack” arrangement with Ventura Orthopedics that sends deputies straight to evaluation and treatment for duty-belt-related back injuries with no utilization review; automatic pre-approval of diagnostic tests ordered by a treating physician; guaranteed access to three major Southern California cancer centers (City of Hope, USC Norris, and UCLA Jonsson) for approved cancer claims; the option to substitute a chosen specialist’s second opinion for a formal Qualified Medical Evaluator (QME) in some cases; and the addition of three claims examiners dedicated specifically to VCSO and Ventura County Fire Department (VCFD) claims.

The county’s own data shows the payoff: the share of workers’ comp claimants who retained a lawyer fell from 65% before 2023 to 22% between 2023 and the end of 2025, and insurance rates for the two safety departments have declined for three consecutive years.

Even so, the report identifies a structural flaw in state law that county-level administrative fixes cannot solve. When a QME’s opinion is needed to resolve a disputed claim, the jury found, the examiner routinely cannot meet the 75-day statutory deadline, leaving both the county and the worker in limbo. The report also flags a related problem: California’s QME system struggles to recruit specialists in fields like oncology and cardiology, and the jury cites an example of a Ventura County deputy with a serious back injury whose QME opinion came from a podiatrist, plus a case in which a claim was kicked back over a data-entry date error despite two accompanying documents showing the correct date.

The jury’s numbers give a sense of scale: between January 2023 and October 2025, only 39 of VCSO’s 578 workers’ compensation claims were presumptive claims. Of those 39, only 10 were accepted quickly (an average of 13 days), 14 were accepted within the 75-day window, and 15 were denied within that window; of the denials, 8 were later reversed once new supporting evidence came in, and 7 remain denied and undisputed — five of those seven were COVID-19 claims, which are no longer covered by the presumption.

The report makes ten findings and ten recommendations, aimed mainly at the VCSO, County Risk Management, and the Board of Supervisors, with response deadlines running through the end of 2026. Among them: formalize regular communication between VCSO and Risk Management (R-01, R-02); train HR staff and supervisors on presumptive-claims rules (R-03); proactively educate deputies on their claims-process rights and responsibilities within three years of hire (R-04); create a dedicated advocate role within VCSO to guide injured deputies through the claims and treatment process, modeled on a similar role VCFD already uses (R-05); better publicize the state Division of Workers’ Compensation’s Information and Assistance Unit, a free advocacy resource for claimants that the jury found is underused (R-06); add preventive health screening and wellness programs for deputies similar to VCFD’s (R-07); build out more substantive “light duty” assignments for recovering deputies (R-08); have the County Auditor-Controller finally audit the cost of covering deputies’ leaves of absence with overtime, which the Sheriff’s Office estimates runs into the millions annually but has never been formally measured (R-09); and, notably, petition state lawmakers to reconcile the mismatched 75-day and 90-plus-day statutory deadlines (R-10).

The Grand Jury closes by commending both Ventura County Risk Management and VCFD by name for building what it calls a “best-in-class” claims program, while cautioning that the county’s improvements can’t by themselves fix a claims timeline that state law itself sets up to fail. Responses are required from the Board of Supervisors within 90 days and from the Sheriff and County Auditor-Controller within 60 days; responses are invited but not required from the County Executive Officer and the VCFD Chief.

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California First State to Launch AI-Unemployment Tracker (CAIT)

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California has become the first state in the nation to launch a public tool tracking whether artificial intelligence is showing up in the unemployment line. The California AI-Unemployment Tracker (CAIT), unveiled June 25, 2026, links unemployment insurance claims data with occupational AI-exposure measures to monitor, in near real time, whether workers in AI-exposed jobs are losing work at elevated rates. The tracker was built through a partnership between the Governor’s Office, the state’s Employment Development Department (EDD), and the nonpartisan California Policy Lab at the University of California, and it is also hosted directly on the EDD’s own website.

The tracker is accompanied by a detailed research report, Tracking AI-Related Job Loss Using Unemployment Insurance Claims Data in California, prepared by a team of researchers at the Policy Lab’s UCLA site, along with a companion technical appendix laying out the underlying methodology. Governor Gavin Newsom framed the launch as part of a broader effort to get ahead of AI’s labor-market effects, saying California intends to lead by “reimagining how we prepare” the state through governance and policy rather than simply watching from the sidelines.

At the center of the tool is a straightforward but data-intensive idea: take every initial unemployment insurance claim filed in California since January 2017, match each claimant’s self-reported prior occupation to a score reflecting how exposed that occupation is to AI, and then track claim volumes over time by exposure level, education, age, gender, race and ethnicity, industry, and region. Claimants are sorted into three exposure tiers — high, moderate, and low — based on the top, middle, and bottom quartiles of the exposure scores. High-exposure occupations, the top 25%, include roles such as customer service representatives and software developers; low-exposure occupations, the bottom 25%, include jobs such as heavy truck drivers and nursing assistants.

The researchers use two separate exposure measures rather than one. The first, called Potential AI Exposure, asks whether large language models are theoretically capable of cutting the time needed to complete an occupation’s tasks by at least half; it comes from a widely cited 2024 study, GPTs Are GPTs, published in Science by a team of OpenAI and academic researchers. The second, called Observed AI Exposure, instead measures how often an occupation’s tasks actually show up in real usage of Anthropic’s Claude, drawing on the Anthropic Economic Index, a 2025 research effort analyzing millions of anonymized Claude conversations. The report notes that results are largely consistent whether the theoretical or the observed measure is used, and cautions that either measure captures only whether a job’s tasks could be or have been touched by AI — not whether AI actually caused any particular layoff. The tracker also excludes the pandemic-era claims surge from March 2020 through January 2022 from its trend comparisons, since that spike would otherwise swamp any post-ChatGPT pattern.

The June 2026 release’s first finding is, on its face, reassuring: looking at all unemployment claims statewide, there is no evidence of a broad-based surge in layoffs among AI-exposed workers since the release of ChatGPT-3.5 in late 2022, and the overall share of claims coming from AI-exposed occupations has not risen in a statistically meaningful way relative to before the pandemic. The report notes this lines up with existing national estimates, including Yale Budget Lab’s analysis of Current Population Survey data, which similarly finds no nationwide link between AI exposure and unemployment so far.

But the tracker’s second and third findings complicate that reassurance considerably. Unemployment claims among college-educated workers in highly AI-exposed occupations rose after ChatGPT-3.5’s release and have stayed elevated through May 2026, even as claims among similarly educated workers in low-exposure jobs showed no comparable shift. The effect is sharpest at the top of the credential ladder: claims among workers with master’s degrees or PhDs in highly AI-exposed occupations climbed from a baseline of about 13,000 per month in November 2022 to a range of 16,000 to 22,000 per month by mid-2023, and have remained in that elevated band since. Geographically and sectorally, the pattern concentrates where AI adoption itself has concentrated: claims from AI-exposed workers in the San Francisco Bay Area show a sharp, sustained increase relative to pre-pandemic levels, and claims in AI-exposed technology sectors — particularly Professional Services — have likewise stayed elevated, though the report notes claims in the Information sector spiked temporarily before settling back to pre-generative-AI levels in late 2025.

Report co-author Ben Hyman, a senior researcher at the Policy Lab, summed up the tension in the findings: the state is not seeing large-scale AI-related layoffs, but is seeing a real pattern among highly educated workers in the Bay Area and in tech-heavy sectors that will bear continued watching. Co-author Till von Wachter, a UCLA economics professor and the Policy Lab’s UCLA faculty director, cast the tool’s value as replacing speculation about AI’s labor-market effects with an evidence base policymakers can act on before disruptions spread further.

The report is careful to flag the limits of what unemployment insurance data can show. UI claims miss workers who never file — because they are unaware of the program, land a new job quickly, leave the labor force, are ineligible because of immigration status or self-employment, or, for younger workers, have not yet accumulated enough qualifying earnings. Occupation codes are self-reported at the time of filing and unverified, small-count data cells are suppressed under standard confidentiality rules, and monthly figures are described as preliminary and subject to revision as late claims are processed. The authors are explicit that the tracker is a descriptive early-warning signal rather than causal proof that AI is driving any specific job loss.

Practically, the tracker itself is a public, interactive dashboard built on Tableau, embedded on the Policy Lab’s site and mirrored on the EDD’s, and it will be refreshed monthly. The underlying tabulated data are also released for public download in an accessibility-compliant Excel file, and the Policy Lab has published a separate FAQ document addressing common questions about definitions and methodology. For California employers and workers’-compensation professionals, the tracker offers an early, if imperfect, gauge of where AI-linked displacement is concentrating by sector and region — useful context for anticipating claims trends even though, as its own authors stress, it cannot yet say whether AI caused any individual worker’s job loss.

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San Jose Road Rage Driver Sentenced for Insurance Fraud

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Kenneth Pham Tran, 54, of San Jose, was sentenced after dashcam footage showed him initiating a road rage incident, which resulted in him being rear-ended by a semi-truck. Tran attempted to hide his wrongdoing and profit from the accident he caused by filing a fraudulent insurance claim to collect an undeserved payout. Tran was sentenced to 60 days in county jail, two years of probation, and is ordered to pay over $4,000 in restitution.

On January 28, 2025,Tran was driving his white Jeep Wrangler Rubicon on Highway 101 near the Alum Rock Avenue onramp in San Jose. Furious because he felt he’d been cut off, Tran caught up to a semi-truck at the Story Road underpass and “brake checked” it twice, slamming on his brakes just in front of the truck. When the truck driver tried to change lanes to get away, Tran maneuvered back in front of the truck and brake-checked a third time — and this time the truck driver couldn’t stop in time and rear-ended the Jeep

The Department of Insurance Task Force opened an investigation after receiving a referral from San Jose CHP who first investigated the collision and reported the incident. The initial investigation found Tran had filed a claim with Progressive Insurance alleging the back of his white Jeep Wrangler Rubicon was damaged after being rear-ended by a semi-truck while he was stopped in traffic. In his claim he also stated the driver of the semi-truck refused to pull over and exchange insurance information.

During the investigation, Task Force members discovered an independent witness who placed a separate 911 call reporting they had to swerve out of the way of a white Jeep Wrangler Rubicon that was driving recklessly and “break checking” a semi-truck on the 101 freeway in San Jose. According to the witness, the driver of the Jeep, Tran, began swerving in and out of lanes to keep the semi-truck behind his vehicle. Tran held the brakes several times before the semi-truck struck the back of his vehicle. The witness stated it looked as though the semi-truck would not have been able to prevent the collision.

The entire road rage incident was captured on the semi-truck’s dashcam. Investigators were able to obtain the footage and found evidence that Tran had initiated the crash because he felt he had been cut off by the semi-truck. The footage also corroborated the account of the witness who called 911.

Tran was found guilty by a jury on one count of felony insurance fraud, one count of felony vandalism, and one misdemeanor count of reckless driving. He was sentenced to 60 days in county jail, two years of probation, and ordered to pay over $4,000 in restitution — specifically $1,200 to Progressive Insurance and $3,000 to Morgan Hill-based Bill Jacobsen Trucking.

This case was prosecuted by the Santa Clara County District Attorney’s Office.“Road rage. Reckless driving. Insurance fraud. This person made a lot of bad decisions,” District Attorney Jeff Rosen said. “Count to 10 before you commit fraud in Santa Clara County.”

The Department of Insurance urges drivers who believe they may have been victims of a road rage incident to insist on a police report and document as much information about the collision as possible including using a cell phone to take photos or videos of the post-collision damage. If a dashcam was being used, save any footage of the incident and be sure to ask the peace officer at the scene to positively identify everyone involved. All suspicious collisions should be reported to your local law enforcement agency or to the California Department of Insurance by calling 800-927-4357 or visiting our website at insurance.ca.gov.  

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9th Circuit Reviews ADA Atty Fees in High Frequency Litigant Case

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LaSandra Price has Parkinson’s disease and uses a wheelchair for mobility. Between August and September 2021, she visited a Family Dollar store in Fontana, California, owned by Wael Diab, on four occasions and encountered accessibility barriers each time, including poorly marked disabled parking spaces, uneven walkways, and aisles that were too narrow. Price sued Diab and the store under the Americans with Disabilities Act (ADA) and California’s Unruh Civil Rights Act, Cal. Civ. Code § 51. (The district court separately declined supplemental jurisdiction over the Unruh Act claim after finding Price to be a “high-frequency litigant,” a ruling not at issue on appeal.) Neither Diab nor the store responded to the complaint, and the clerk entered defaults against both.

Price moved for default judgment and a specific injunction requiring accessible paths of travel, accessible parking spaces, compliant signage, and an accessible entrance within 180 days. The district court granted the motion, observing that Price’s proposed order was, if anything, narrower than what her complaint had sought, and entered the injunction essentially as requested. Price then moved for $9,364 in attorney’s fees and costs ($8,872 for 31.2 hours of work, plus $492 in costs) under the ADA’s fee-shifting provision, 42 U.S.C. § 12205, supporting the motion with billing records, a declaration from counsel, and a third-party survey of prevailing rates.

The district court denied Price’s fee motion in full, holding she was not a “prevailing party” under section 12205 because the injunction required Diab and the store to do only what the ADA already required them to do. The court acknowledged that courts routinely treat ADA plaintiffs who obtain default judgment and injunctive relief as prevailing parties, and that Ninth Circuit precedent “appear[s] to presume prevailing-party status” in that situation, but concluded that none of those precedents had squarely analyzed the question. The court further found that even if Price were a prevailing party, her requested fees were unreasonable: her motion appeared to be recycled nearly whole-cloth from a different case, resulting in incorrect male pronouns for Price throughout, and the court questioned the hours billed. The court did not reach what a reasonable fee would be if Price prevailed.

In the published case of  Price v. Diab, No. 25-713 (9th Cir., July 2026) — the Ninth Circuit reversed the district court’s order denying Price’s motion for attorney’s fees and remanded for further proceedings on the fee motion.

The panel held, after reviewing the prevailing-party question de novo, that Price prevailed by virtue of the final injunctive relief she obtained. Under Farrar v. Hobby (1992) 506 U.S. 103, a plaintiff prevails when relief on the merits materially alters the legal relationship between the parties by modifying the defendant’s behavior in a way that directly benefits the plaintiff, and the Supreme Court has since confirmed in Lackey v. Stinnie (2025) 604 U.S. 192 that an enforceable court order conclusively resolving the parties’ rights on the merits satisfies that test. Price’s injunction, which forced Diab and the store to take specific, enforceable steps to improve accessibility, did exactly that.

The panel held the district court’s contrary conclusion rested on a misreading of Fischer v. SJB-P.D. Inc. (9th Cir. 2000) 214 F.3d 1115. The district court had seized on language in Fischer stating that a plaintiff’s legal relationship with a defendant changes because the plaintiff can force the defendant to do something it otherwise would not have to do, reading that to mean an injunction merely requiring compliance with preexisting law does not confer prevailing-party status. But the panel explained that sentence in Fischer referred back to the settled principle that a material alteration occurs when a plaintiff becomes entitled to enforce a judgment or settlement against a defendant — and Fischer itself rejected the same “the defendant already had to comply with the law” argument that the district court accepted here, holding that the Supreme Court has never framed the prevailing-party inquiry in terms of whether a defendant’s underlying legal duty changed. The panel found this reasoning reinforced by the Supreme Court’s per curiam decision in Lefemine v. Wideman (2012) 568 U.S. 1, which reversed a court of appeals that had denied fees on the theory that an injunction “merely ordered defendants to comply with the law.”

The panel also rejected two narrower grounds the district court had invoked. First, relying on Fischer and on the Supreme Court’s decision in Buckhannon Board & Care Home, Inc. v. West Virginia Department of Health and Human Resources (2001) 532 U.S. 598, the panel confirmed that a plaintiff can be a prevailing party based exclusively on injunctive relief, without any award of money damages. Second, the panel held that a default judgment is itself an enforceable judgment on the merits sufficient to confer prevailing-party status, citing Vogel v. Harbor Plaza Center, LLC (9th Cir. 2018) 893 F.3d 1152, and that the relief Price obtained was not the kind of merely technical, insignificant victory that Farrar found insufficient.

On the amount of fees, the panel left that determination to the district court in the first instance but addressed one argument along the way. Price’s counsel had not disputed reusing a fee-motion template from a different case, but argued on appeal that the resulting errors, including the incorrect pronouns, were “irrelevant editing mistakes.” The panel rejected that characterization, explaining that such errors reflect a lack of diligence relevant to the quality of representation courts may weigh in setting a reasonable fee. The panel noted its own precedent allows a reduced fee award in a “straightforward” ADA case with boilerplate pleadings and little opposition, citing Shayler v. 1310 PCH, LLC (9th Cir. 2022) 51 F.4th 1015, and left it to the district court to weigh those concerns in calculating a reasonable award now that Price has been confirmed as the prevailing party.

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