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New Section 111 Reporting Audit Process Begins in 2026

CMS Section 111 refers to the Medicare Secondary Payer (MSP) mandatory reporting requirements under the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). It obligates Responsible Reporting Entities (RREs) – such as liability insurers, no-fault insurers, workers’ compensation plans, and self-insured entities – to report information about Medicare beneficiaries who have primary coverage or receive settlements, judgments, awards, or other payments (including Total Payment Obligation to the Claimant or TPOC, and Ongoing Responsibility for Medicals or ORM). The goal is to ensure Medicare acts as a secondary payer where appropriate and to facilitate recovery of conditional payments.

This year, audits become part of CMS’s enforcement mechanism for Section 111 compliance, specifically targeting Non-Group Health Plans (NGHP) like workers’ compensation, liability, and no-fault insurance. These audits focus on verifying timely reporting of MSP occurrences. According to official CMS guidance, audits commenced in January 2026 and are conducted quarterly thereafter.

New Audit Process

– – Selection: CMS randomly selects 250 new MSP records per quarter from all accepted Section 111 submissions during the review period, plus records from non-Section 111 sources (e.g., self-reports from beneficiaries or providers). The sample is proportionate to the volume of Group Health Plan (GHP) and NGHP records.
– – Focus Areas: Audits check for timeliness, requiring reports within 365 days of key dates like the settlement date, funding delayed beyond TPOC date, or assumption of ORM. Non-Section 111 records are also reviewed if no matching Section 111 report exists within that window.
– – Compliance Review: RREs are notified only if potential non-compliance is identified. They can provide mitigating evidence (e.g., documentation of good-faith efforts). If non-compliance is confirmed, CMS issues an Informal Notice, followed by a Notice of Proposed Determination (with 60 days to request a hearing), and potentially a Final Determination.
– – Timeline Notes: The compliance “clock” started on October 11, 2024, for reportable events on or after that date. Enforcement via Civil Money Penalties (CMPs) applies prospectively from October 11, 2025. First notices of potential CMPs may issue as early as March 2026.

Informal Notice- Intention to Impose a Civil Money Penalty

– – First letter (Notice) issued when a noncompliant record was identified on CMS’ quarterly audit.
– – A CMP is not being assessed at this point, rather, the RRE’s noncompliant record is identified along with the associated information so that an RRE may investigate the record.
– – The process to submit mitigating information, in an attempt to explain or defend technical or administrative issues resulting in the noncompliance is outlined in this letter. Mitigating evidence must be submitted to CMS within 30 days of receipt of the Informal Notice. This is the opportunity for RREs to explain why a CMP should not be imposed.

As of the 2026 adjustment, the maximum daily penalty for NGHP reporting non-compliance is $1,512 (up from $1,428 in 2024).  Late Reporting Timeframe Penalty per Day:

– – More than 1 year but less than 2 years late $357 per day.
– – More than 2 years but less than 3 years late $714 per day.
– – More than 3 years late $1,512 per day.
– – Maximum per instance: $365,000

More information about the new audit process, and compliance with Section 111 is available on the CMS website.

January 26, 2026 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Ventura Staffing Company to Pay $650K for Fake Comp Policies. WorkWhile to Pay $4.1M to Resolve Misclassification Case. Drug Prices Up 4% as PBM Federal/State Regulations Increase. DWC Posts Reminder for Submission of Annual Report of Inventory. California WARN Act Changes Effective January 1, 2026. Congress Proposes Changes to Federal WARN Act. Bristol Myers Squibb & Microsoft AI-Driven Lung Cancer Detection. WCRI Reports on Injectable Therapies in Workers’ Compensation.

Lien Consolidation Orders Require Reasons & Summary of Evidence

Josue Barrios filed a workers’ compensation claim at the Van Nuys WCAB against Nagatoshi Produce USA, Inc. and its insurer, Truck Insurance Exchange. Several medical lien claimants including Tri-County Medical Group, Inc., Tri-City Health Group, Inc., Komberg Chiropractic, and Edward Komberg, D.C. became involved as real parties in interest in the case.

Defendant Farmers Insurance Exchange (not originally part of Barrios’s case but acting on behalf of multiple carriers) filed a Petition for Consolidation and Stay of Liens, alleging that the lien claimants had engaged in improper practices, such as unlawful patient referrals in violation of Labor Code sections 139.3, 139.32, and 3215, and issuing bills or reports with material misrepresentations under section 3820. Multiple other insurance carriers joined this petition, leading to multiple hearings, however no evidence was formally admitted at these hearings, and issues were not explicitly framed for decision.

On October 24, 2025, PWCJ Jeffrey Marrone issued an Order of Consolidation, Designation of Master File, and Notice of Hearing (Consolidation Order), consolidating hundreds of cases for discovery purposes under California Code of Regulations, title 8, section 10396 (Rule 10396), staying the liens, and assigning WCJ Tammy Homen as the judge for the consolidated matter.

The lien claimants petitioned to disqualify WCJ Homen, alleging bias and an undisclosed conflict because her husband, Norman Homen, is a workers’ compensation attorney who had previously referred clients to the lien claimants and had social interactions with Komberg. They also sought reconsideration of the Consolidation Order, arguing it lacked factual findings, failed to show a causal connection between the consolidated cases and the allegations, and violated Rule 10396(a)(3) by not considering potential prejudice or delays. The carriers filed an answer opposing the petition, and both WCJ Homen and PWCJ Marrone submitted reports recommending denial.

In response to the disqualification petition, WCJ Homen filed a Report and Recommendation denying any conflict, stating she and her husband had no financial interest in or involvement with the lien claimants’ businesses, she lacked knowledge of his referrals or clients in these cases, and mere industry interactions did not constitute bias. She noted the small size of the workers’ compensation community and that she had not yet presided over any hearing or expressed opinions on the merits.

PWCJ Marrone’s report on the reconsideration petition affirmed that he had considered Rule 10396’s factors (e.g., common issues, complexity, prejudice, and efficiency) but provided only summary conclusions without detailed legal or factual support.

The Workers’ Compensation Appeals Board issued a multifaceted decision. It denied the lien claimants’ Petition for Disqualification of WCJ Homen, adopting and incorporating her report. It dismissed the Petition for Reconsideration of the Consolidation Order, treating it instead as a Petition for Removal, which it granted. As its Decision After Removal, the WCAB rescinded the Consolidation Order and returned the matter to the trial level for further proceedings consistent with its opinion in the case of Barrios v Nagatoshi Produce -SAU9000031 (January 2026).

The WCAB first addressed the disqualification petition, finding no basis under Labor Code section 5311 or Code of Civil Procedure section 641. It agreed with WCJ Homen that neither she nor her husband had a financial interest, employment relationship, or other disqualifying ties to the lien claimants. The board emphasized that assumptions about bias were insufficient without detailed facts showing enmity or an unqualified opinion on the merits, and that social or industry interactions in the small workers’ compensation community could not broadly disqualify judges. The lien claimants’ subjective perceptions did not meet the standard for impartiality doubts.

For the Consolidation Order, the WCAB found the order violated due process and Labor Code section 5313, which requires a summary of evidence and reasons for determinations, as supported by en banc precedent like Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473 (requiring opinions based on admitted evidence and substantial evidence). Although PWCJ Marrone’s report attempted to cure this by summarizing common issues (e.g., referral violations and misrepresentations), it lacked specific citations to law or facts connecting the hundreds of cases to the allegations, rendering meaningful appellate review impossible.

The WCAB distinguished prior cases like Kenney v. Seguoyah, Inc. 2023 Cal.Wrk.Comp. P.D. LEXIS 37, *3 (where consolidation was for a narrow, specific issue) and Harvard Surgery Center v. WCAB (Yero) (2005) 70 Cal.Comp.Cases 1354 (emphasizing the need for good cause), noting that vague references to statutes were insufficient to justify broad discovery without risking abuse.

New QME Process Regulation Section 55.1 in Effect on April 1

The Division of Workers’ Compensation (DWC) reminds all applicants for reappointment as a Qualified Medical Evaluator (QME) to fully satisfy the continuing education requirements of Labor Code section 55.1. by April 1, 2026.

On February 28, 2024, the Office of Administrative Law (OAL) approved DWC’s regulatory action which adopted new regulation § 55.1. That regulation enacted new educational requirements for Qualified Medical Evaluators seeking reappointment after April 1, 2026. The new criteria include:

    The ability to hold on site educational programs virtually;
    The requirement of 16 hours of continuing education for reappointment as a QME;
    Minimum hour requirements for continuing education in specific areas as follows:
        A minimum of 4 hours of instruction in disability impairment rating;
        A minimum of 3 hours of instruction in medical-legal report writing;
        A minimum of 2 hour of instruction in anti-bias training which meets the qualifications outlined in Section 11(h);
        A minimum of 2 hours of instruction consisting of a review of workers’ compensation case law;
        A minimum of 1 hour of instruction in proper application of the medical-legal fee schedule or in QME adherence to regulatory clerical requirements.
    The ability of a physician to earn a maximum of 2 hours continuing education credit by having their reports reviewed by an approved educational provider.

As of April 1, 2026 regulation § 55.1 will be fully effective. All applications for reappointment as a Qualified Medical Evaluator must fully satisfy the continuing education requirements of section 55.1. The full text of the regulation can be accessed using the Title 8 search.

A list of continuing education providers, some of whom are offering classes that have been accredited to meet the requirements of regulation 55.1, are listed on the DWC website.

QMEs seeking recertification are advised to make sure that the continuing education provider that they choose is in compliance with the requirements of regulation § 55.1.

January 19, 2026 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Court Reverses WCAB in Another “Grant-For-Study” Case. Commutation of Attorney Fees in Lifetime Award Ends After Full Payment. Interstate Commerce Not Required for FAA Arbitration Clause. Employers Face New “Know Your Rights” Handout February Deadline. Public Self-Insured Comp Claims Fell But Losses Hit New Highs. Court Draws Major Distinction Between IFPA Comp & Lability Fraud. Doctor Sentenced to Serve 9 Years and License Revoked. DOJ and Kaiser Permanente Affiliates Resolve Fraud Case for $556M.

Fed Court Uses Rule 23(d) to Limit Arbitration Opt Out Abuse

The plaintiffs, Bo Avery, Phoebe Rogers, Kristy Camilleri, and Jill Unverferth, alleged that TEKsystems, a professional staffing agency that places IT consultants with business clients, had misclassified them as exempt from overtime laws, failing to pay overtime wages or provide required meal and rest breaks in violation of California labor laws. The case was filed initially in California state court but was removed to federal court by TEK. Over the ensuing months, the parties engaged in extensive discovery.

In September 2023, TEK internally approved expanding its longstanding mandatory arbitration policy – previously applied only to external consultants – to include internal employees like the recruiters.

The rollout communications criticized class actions as wasteful, inefficient, and primarily benefiting attorneys, while emphasizing arbitration’s efficiency. They were sent during the holiday season, contained inconsistencies about opt-out procedures and deadlines, and suggested employees consult their own attorneys at personal expense without mentioning free access to class counsel. A separate email targeted putative class members with an opt-out form specifically for remaining in the class action.

Plaintiffs moved for class certification on October 6, 2023, with briefing completing by December 14, 2023. Just five days later, on December 19, 2023, TEK rolled out a new mutual arbitration agreement to its internal employees, including putative class members. This agreement, which covered the claims in the lawsuit, was presented via email and deemed accepted through continued employment after December 31, 2023, unless employees opted out or quit.

Of 164 recipients, only 41 opted out to stay in the class. The class was certified on February 13, 2024, with notices issuing on April 16, 2024, and an opt-out deadline of June 15, 2024. On June 10, 2024 – after plaintiffs had moved for partial summary judgment and just days before the notice period closed – TEK filed a motion to compel arbitration against class members bound by the agreement.

The federal district court in the Northern District of California, denied TEK’s motion to compel arbitration. It found that TEK’s communications rolling out the arbitration agreement threatened the fairness of the litigation by being misleading and omitting key information, such as the availability of free consultation with class counsel and the status of the ongoing class certification process.

The court concluded that these actions subverted Federal Rule of Civil Procedure 23’s opt-out mechanism for class actions, effectively turning it into an opt-in process where inaction bound employees to arbitration and excluded them from the class. Invoking its broad authority under Rule 23(d) to manage class proceedings and ensure fairness, the district court refused to enforce the agreement. As an alternative basis, it also determined that TEK had waived its right to arbitrate by delaying the rollout for over 22 months into the litigation, engaging in a “wait-and-see” approach.

The Ninth Circuit Court of Appeals affirmed the district court’s denial of the motion to compel arbitration, declining to address the waiver issue and focusing instead on the Rule 23(d) grounds in the published case of Avery v TekSystems -3:22-cv-02733-JSC (January 2026)

The panel held that district courts possess the duty and expansive authority under Rule 23(d) to oversee class actions, including the power to invalidate arbitration agreements obtained through communications that undermine the integrity of the proceedings.

The appellate court’s rationale emphasized adherence to Supreme Court precedents, such as Gulf Oil Co. v. Bernard, 452 US 89 – Supreme Court 1981 and Hoffmann-La Roche Inc. v. Sperling, 493 US 165 – Supreme Court 1989 which grant district courts discretion to regulate contacts with class members and protect against abuses that could coerce or mislead them. The panel found TEK’s rollout communications to be inherently threatening to fairness: they disparaged class actions repeatedly as inefficient and attorney-enriching, were timed disruptively during the holidays, included conflicting instructions on how to opt out (such as deeming acceptance via continued employment while also requesting signatures), and implied personal legal costs without disclosing class counsel’s role.

These elements, combined with omissions about the lawsuit’s progress, risked confusing or pressuring class members into forgoing their rights under Rule 23’s opt-out framework, which presumes inclusion unless affirmatively excluded.

The court aligned its holding with similar decisions from the Fourth, Sixth, and Eleventh Circuits, rejecting TEK’s argument that the Federal Arbitration Act preempted such oversight by noting that Rule 23(d) applies neutrally to all contracts and does not disfavor arbitration. Furthermore, the arbitration agreement’s delegation clause – incorporating JAMS Rule 11(b), which assigns arbitrability disputes to the arbitrator – did not preclude the district court’s review, as the challenge targeted the agreement’s overall enforceability under procedural fairness rules rather than a specific provision.

Ultimately, the Ninth Circuit concluded that invalidating the agreement was a narrowly tailored remedy to restore the proper opt-out process, affirming the district court’s decision to safeguard the class action’s integrity.

Current Status of Non-Compete Clauses in Employment Contracts

The Federal Trade Commission (FTC) issued a final rule in April 2024 banning most non-compete agreements in employment contracts, with an effective date of September 4, 2024. However, in the case of Ryan LLC v. FTC (N.D. Tex., Case No. 3:24-cv-00986), U.S. District Judge Ada Brown issued a preliminary injunction in July 2024 blocking the rule’s enforcement, and on August 20, 2024, she issued a final order setting aside the rule nationwide, declaring it unlawful under the Administrative Procedure Act.

The FTC appealed this decision to the U.S. Court of Appeals for the Fifth Circuit (Case No. 24-10951) on October 18, 2024. Briefing proceeded into early 2025, with the FTC filing its opening brief on January 2, 2025, and appellees (including Ryan LLC and the U.S. Chamber of Commerce) responding on February 3, 2025. The FTC then requested and received stays of the proceedings in March and July 2025, extending until September 8, 2025.

On September 5, 2025, following a change in presidential administration, the FTC filed an unopposed motion to voluntarily dismiss the appeal under Federal Rule of Appellate Procedure 42. The Fifth Circuit granted the motion and dismissed the appeal on September 8, 2025, terminating the case. The FTC also dismissed a related appeal in the Eleventh Circuit (Properties of the Villages v. FTC) around the same time, effectively acceding to the vacatur of the non-compete rule.

As of January 2026, the district court’s order remains in effect, and the FTC’s non-compete rule is not enforceable nationwide. The FTC has shifted focus to case-by-case enforcement against unfair non-competes under existing antitrust laws, rather than pursuing a blanket ban. There are no active appeals in this matter, though state laws on non-competes vary and may still restrict their use in certain jurisdictions.

California has one of the strictest policies in the U.S. against non-compete clauses in employment contracts, prioritizing employee mobility and open competition. Under Business and Professions Code Section 16600, any contract that restrains someone from engaging in a lawful profession, trade, or business is generally void and unenforceable. This has been the longstanding rule, but recent legislation has further reinforced and expanded these protections.

In January 2024, two new laws took effect to strengthen the ban:

– – Senate Bill 699 (now codified as Business and Professions Code Section 16600.5): Declares non-compete agreements unlawful (not just void) and prohibits employers from entering into or enforcing them, even if the agreement was signed outside California or for employment outside the state. It also creates a private right of action for employees to sue for damages, injunctive relief, and attorneys’ fees.
– – Assembly Bill 1076 (now codified as Business and Professions Code Section 16600.1): Explicitly prohibits non-compete clauses and required employers to notify current and certain former employees (employed after January 1, 2022) by February 14, 2024, that any existing non-compete provisions are void. Failure to provide this notice can result in civil penalties of up to $2,500 per violation.

While non-competes are largely prohibited in the employment context, there are narrow exceptions under California law:

– – Sale of a business: Non-competes may be enforceable when tied to the sale of a business, goodwill, or ownership interest (Business and Professions Code Sections 16601 and 16602.5).
– – Dissolution of partnerships or LLCs: Limited restrictions may apply upon dissolution or dissociation (Section 16602).These exceptions are interpreted narrowly by courts, and the agreements must be reasonable in scope, duration, and geography to be upheld.

The federal FTC’s attempted nationwide ban on non-competes was struck down in 2024 and abandoned in 2025, but this does not affect California’s independent prohibitions, which remain in full force. Employers are advised to review and revise contracts to ensure compliance, focusing instead on alternatives like non-solicitation clauses (which may be enforceable if narrowly tailored) or enhanced trade secret protections.

For specific situations, consulting a California employment law attorney is strongly recommended, as case law continues to evolve and this is not an authoritative and complete narrative of this law.

The DWC Proposes New Regulation Restricting Depo Fees

The Division of Workers’ Compensation (DWC) has posted proposed ranges for attorney deposition fees to its online forum where members of the public may review and comment on the proposals.

In the California workers’ compensation system, the Workers Compensation Appeals Board (WCAB), a workers’ compensation judge, or any party to the action or proceeding may request the deposition of a witness in matter before the WCAB, pursuant to Labor Code section 5710. If either the employer or the insurance carrier requests that an injured employee be deposed, that injured employee is entitled to receive, among other benefits, “a reasonable allowance for attorney’s fees” if they are represented by an attorney.

Judges have discretion when awarding the fees, which are required to be paid by employer or its insurer. Fees are currently governed by local policy established by presiding judges in each district, which serve as a guide to the parties, but individual attorneys’ fees awards are subject to litigation before WCAB judges. Pursuant to section 5710(b)(4) the Administrative Director of the Division of Workers’ Compensation (DWC) is charged with determining “the range of reasonable fees to be paid.”

The proposed regulation will establish the range of reasonable fees allowable for attorneys representing injured employees when employers or insurers request their depositions. The deposition shall not exceed the following amounts:

(1) An amount not to exceed $500 per hour for attorneys certified as Workers’ Compensation Specialists by the State Bar of California;
(2) An amount not to exceed $450 per hour for attorneys with five or more years of experience in Workers’ Compensation matters in the state of California;
(3) an amount not to exceed $400 per hour for attorneys with fewer than five years of experience in workers’ compensation matters in the state of California;
(4) an amount not to exceed $250 per hour for non-attorney representatives as identified pursuant to Labor Code section 10751.

Incremental Billing Requirements:

(1) Fees authorized under this section shall be billed on an incremental, time-based basis, reflecting actual time reasonably spent preparing the injured employee for deposition and attending the deposition.
(2) Billing increments shall not exceed one-tenth (0.1) of an hour.
(3) Minimum or flat fees are not permitted, and attorneys or representatives shall not bill for time not actually expended.

Fees shall not be sought or awarded for activities including, but not limited to:

(1) General file review;
(2) Travel time or travel expenses;
(3) Review of deposition transcripts;
(4) Administrative or clerical tasks.

The forum can be found online on the DWC forums web page under “current forums.” Comments will be accepted until 5 p.m. on February 13, 2026.

BLS Reports Employer-Reported Workplace Injuries Down 3.1%

According to a new U.S. Bureau of Labor Statistics report, private industry employers reported 2.5 million nonfatal workplace injuries and illnesses in 2024, down 3.1 percent from 2023. This is the lowest number of employer-reported injuries and illnesses for this data series going back to 2003.

This reduction was largely driven by a 26.0% drop in illness cases, which totaled 148,000, including a significant 46.1% decrease in respiratory illnesses to 54,000 – the lowest level since 2019.

The overall incidence rate for total recordable cases (TRC) in private industry fell to 2.3 cases per 100 full-time equivalent (FTE) workers, down from 2.4 in 2023, marking the lowest rate in over two decades. Injuries accounted for the majority, with an incidence rate of 2.2 per 100 FTE workers, while the illness rate decreased to 13.9 cases per 10,000 FTE workers from 19.0 in 2023, and respiratory illnesses dropped to 5.1 per 10,000 FTE workers.

Notable declines in TRC incidence rates occurred across several sectors, including information (0.7 per 100 FTE workers, down from 1.0), health care and social assistance (3.4 per 100 FTE workers, down from 3.6), retail trade, manufacturing, and real estate and rental and leasing.

No industry sector experienced an increase in its TRC rate.

For the biennial period of 2023-2024, cases involving days away from work (DAFW) totaled 1.8 million, comprising 61.5% of days away, restricted, or transferred (DART) cases, with an annualized incidence rate of 86.6 per 10,000 FTE workers and a median of 8 days away. Days of job transfer or restriction (DJTR) cases numbered 1.1 million, or 38.5% of DART cases, with an incidence rate of 54.2 per 10,000 FTE workers and a median of 15 days.

Leading causes of DART cases included overexertion, repetitive motion, and bodily conditions (946,290 cases) and contact incidents (860,050 cases), while exposure to harmful substances and environments resulted in 224,450 cases, with 87.6% requiring at least one day away from work.

Under the updated Occupational Injury and Illness Classification System (OIICS), a new category for novel coronavirus (COVID-19) cases was introduced, showing an annualized DAFW incidence rate of 5.6 per 10,000 FTE workers in private industry for 2023-2024. The highest COVID-19 rates by occupation were in healthcare support (32.4 per 10,000 FTE workers) and healthcare practitioners and technical roles (26.7 per 10,000 FTE workers).

All reported changes were statistically significant at the 95% confidence level, with data for mining incorporating preliminary figures from the Mine Safety and Health Administration.

Study Shows California’s Heat Standard and Reduction in Deaths

California’s 2005 heat standard was an important first step to protect workers. Yet critics argued that the standard contained ambiguous wording that enabled employers to avoid improving working conditions, relied on vulnerable workers to demand breaks, and was not actively enforced by the California Division of Occupational Safety and Health.

In 2010, California responded by launching a statewide initiative aimed at educating workers about their rights, improving compliance among employers, and increasing inspections and enforcement. Labor unions and worker advocates continued to argue for changes, and in 2015, California revised the standard to close loopholes related to rest, water, shade, and enforcement.

Several US states have followed California’s example. Since 2022, Colorado, Maryland, Nevada, Oregon, and Washington have passed new laws that mandate water, shade, and regular rest breaks for all outdoor workers on hot days. In August 2024, the Occupational Safety and Health Administration (OSHA) proposed a new standard that would require similar protections for workers throughout the United States.

A new study just published by Health Affairs compared heat-related deaths among outdoor workers in California with those in neighboring states without standards during the period 1999–20. Researchers obtained data for all 126 counties in Arizona, California, Nevada, and Oregon for the period 1999–20. They identified 6,145 heat-related deaths among outdoor workers during the study period.

Arizona had the highest cumulative number of deaths (2,546), followed by California (2,207), Nevada (1,124), and Oregon (268). The county-year with the highest number of heat-related deaths among outdoor workers was Maricopa County, Arizona, with 233 deaths in 2020. Among counties that reported heat-related deaths among outdoor workers, the mean annual death rate was 0.91 deaths per 100,000 residents. All fifty-eight counties in California were covered by a heat standard starting in 2005, whereas none of the sixty-eight counties in the neighboring states was covered by a heat standard during the study.

Results suggest that the effectiveness of California’s heat standard increased substantially over time. Researchers found no decrease associated with the policy during the initial implementation period (2005–09), but point estimates suggested a 33 percent decrease in heat-related deaths among outdoor workers after increased enforcement (2010–14) and a 51 percent decrease after California’s heat standard revisions went into effect (2015–20). Although these individual period estimates were not statistically significant, a Wald test confirmed that California’s enhanced approach from 2010 onward was associated with a statistically significant decrease in worker deaths.

Our findings offer important lessons for other states regarding the potential promise and pitfalls of heat standards meant to protect outdoor workers. On the one hand, California’s experience suggests that heat standards can reduce heat-related deaths among outdoor workers. On the other hand, it highlights that such policies may have little impact unless they are carefully designed and effectively enforced. A review of recently implemented heat standards suggests that variation in effectiveness is likely: Although Maryland’s 2024 law closely mirrors California’s revised standard, for example, Nevada’s 2024 version lacks a trigger temperature for enforcement”