State News

 CONNECTICUT WORKERS’ COMPENSATION COMMISSION NEWS

LEGISLATIVE NEWS

The signature bill of the legislative session is Public Act 26-12 focusing on improving workplace conditions.  The relevant sections for our purposes focus on changes effective 10/1/26. Please see link below to the new statute.

 https://www.cga.ct.gov/2026/act/pa/pdf/2026PA-00012-R00HB-05003-PA.pdf

Teachers and healthcare workers or other employees of a healthcare facility or institution will now receive 100% of their AWW for injuries that result from “any physical or negligent assault.”  This applies to TT and TP.  As the benefit is outlined in 31-307, 31-308(a), it will be non-taxable.

In addition, to such weekly compensation, the amended language borrows in part from 31-236a and includes payment for 1)“any expenses reasonably incurred by such healthcare provider or other employee for medical or other services necessary as a result of such assault.”  (“Other services necessary” does not appear to have been construed previously by the Courts, but would appear to open up the door for a variety of non-medical services.)  

The group also qualifies for continued full salary continuation during the time spent in court proceedings.  It is noted that the employee cannot be charged for personal time, vacation time, or sick leave for such absences.

The definition of “healthcare provider” includes any individual directly or indirectly employed or volunteering for a healthcare facility or institution.  The new law goes on to identify those involved in direct patient care or direct contact with the patient or patient’s family when either collecting or processing information for patient’s forms of records or escorting or directing a patient or patient’s family on healthcare employers’ premises.  This appears to cover almost everyone in the facility.

“Healthcare facility or institution“ means a hospital, nursing home, rest home, home healthcare agency, home health, paid agency, emergency medical services, organization, assisted living services agency, outpatient clinic, outpatient surgical facility, community health center, urgent care facility, medical office owned or operated exclusively by a person or persons licensed pursuant to Section 20–13 (all physicians), dental office, and infirmary operated by an educational institution for the care of students enrolled in and faculty and employees of such institution.

Healthcare facility or institution does not include any facility or institution operated by the State of Connecticut, except the University of Connecticut Health Center.  We expect this covers employees beyond what some legislators may have anticipated.

The legislature had apparently expressed its concern relative to the shortage of workers in some professions.  We believe they were also concerned with being certain that private industry would take steps to reduce on the job assaults.  There does not appear to be much concern, however, with providing the system of compensation for a benefit that is 100% of salary and non-taxable.

The concept of negligent assault will likely be closely examined.  The usual definition is that associated with an extreme recklessness or carelessness, and one would hope that the term will be construed accordingly.  We of course are faced with the court’s interpretation of remedial legislation and the stated policy that the Act’s provisions need to be interpreted broadly.

The use of “or” between physical assault and negligent assault may also cause issue.  Must a physical assault still be intentional?  Again, it seems the legislature was attempting to remove the need for intent by referencing negligent assault.

MEMORANDUM NO. 2026-01

 All payments for Commission Medical Examinations (CMEs) and/or CME no-show fees are due within 45 days of receipt of a properly submitted bill. Failure to make such a timely payment will result in an additional $450 charge.

Bills for CMEs are not required to be submitted on HCFA (CMS-1500) forms and have no specific CPT code requirement. “Properly submitted” means that the bill, accompanied by the report, is submitted to the responsible party indicated on the ALJ’s original order.

CMEs are not subject to discounts, including PPO discounts. The rate for a CME is $900 unless a higher amount is approved by the ordering ALJ. Timely payment of a discounted amount will not negate the additional charge.

Respondents should timely pay any CME no show fee that has been billed pursuant to Commission guidelines. They may then request a hearing to determine whether reimbursement and/or a credit is warranted.

MEMORANDUM NO. 2026-03

Briefs to the Compensation Review Board will now have a page limitation of 35 pages exclusive of party appendices, the cover page, table of contents, table of authorities, or attachments, if any.

MEMORANDUM NO. 2025-09

The Workers' Compensation Commission (WCC) will accept the submission of certain forms and documents electronically through our enhanced GovQA System. The updated system will streamline the form submission process and make it more convenient for everyone involved. Electronic filing is not required. Parties are still welcome to file forms by mail (certified mail where required), fax, or hand-delivery.

Listed below are the forms and documents WCC will accept through the GovQA System:

The following claim forms and documents will be accepted as attachments:

- 30C: Notice of Claim for Compensation

- 30D: Dependent's Notice of Claim for Compensation

- 36: Notice of Intention to Reduce or Discontinue Payments

- 43: Notice to Administrative Law Judge and Employee of Intention to Contest Employee's Right to Compensation Benefits

- 44: Order to Second Injury Fund in Cases of Concurrent Employment

- Brief or Proposed Finding

- Hearing Request

- Hearing CANCELLATION Request

- Lien Notice

- Medical Documentation (in conjunction with a Commission Medical Exam as ordered by WCC)

- Notice of Appearance

- Petition for Review

- Motions

- Stipulation (for Review only - original copies must be brought to hearing)

The following administrative forms and documents will be accepted as attachments:

- 6B: Coverage Election by Employee who is an Officer of a Corporation or a Manager of an LLC

- 6B-1: Coverage Election by Employees who are Members of a Partnership

- 75: Coverage Election by Sole Proprietor

- Claim Filing Location Form/ Notice to Employees

- Medical Care Plan Application for Employer

- Self-Insurance Application

- WCR-1: Rehabilitation Request

Additionally, the following administrative forms may be filled out and submitted directly online:

- Contact Information Change Form (Parties may use this form to make changes to their contact information or add an email address to receive hearing notices electronically)

- Hearing Questionnaire (You must have received a survey number from WCC in order to complete this questionnaire)

Please note that parties submitting these documents to WCC electronically must continue to send physical copies to the other parties to a claim, by certified mail or hand-delivery, if required.

The Commission’s new form submission service is a centralized, secure public records system that builds on the current GovQA information and records requests portal. The GovQA portal allows requestors to track their requests and form submissions, while also standardizing workflows for employees.

GovQA is the largest provider of cloud-based Software as a Service (SaaS) automated workflow solutions for government compliance. Its Public Records Management software handles more requests for state and local governments than any other software provider.

MEMORANDUM NO. 2025-07 

 A new, updated Authorization for Release of Medical Records (PDF) is now available on the Workers’ Compensation Commission website. The form has been revised to be HIPAA compliant, as well as compliant with Connecticut’s Reproductive Rights Shield Law.

The use of WCC’s form is not mandatory. It has been provided for your convenience.  Parties may use another HIPAA compliant form if they prefer.

 MEMORANDUM NO. 2025-08 

Effective October 1, 2025, the Workers' Compensation Commission (WCC) will begin invoicing fees for Freedom of Information Act (FOIA) requests through our enhanced GovQA System. The new process will streamline billing of fees and allow for credit/debit card payments. When a records request incurs fees, the requestor will automatically be notified and receive a copy of the invoice which they can then pay online, through mail, or in-person at one of WCC’s offices.

WCC will only charge a customer the cost of what WCC pays for providing records. For physical copies, the cost is $0.25 per page plus postage, if applicable. Effective October 1, 2025, and subject to State Contract #22PSX0156, the cost to retrieve closed files from archive will now be $23.00 for the first box/file and $1.80 for each additional box/file. Should records need to be returned to archives, the cost will be $1.80 per box/file. Retrieval fees will only be charged for archived claims with a full & final stipulation on file.

MEMORANDUM 2025-02

Effective July 7, 2025, where a claimant cancels a scheduled Commission Medical Examination less than two business days prior to the date of the examination, the Commission recommends that the physician’s office limits the cancellation fee to $300.00. There shall be no cancellation fee assessed for CMEs cancelled more than two business days prior to the exam. Where a claimant fails to attend a Commission Medical Examination and does not call or otherwise alert the physician’s office prior to the appointment time, the Commission recommends that the physician’s office limit the no show fee to $450.00.

In either situation, when determining responsibility for the payment of the late cancellation or no-show fee, the parties and the administrative law judge should implement a fault-based approach that takes into account the circumstances surrounding the claimant’s failure to attend the examination.

MEMORANDUM 2025-04

Memorandum 2025-04 has been issued by Chief Administrative Law Judge Morelli regarding maximum compensation rates.  The Chairman has ordered that the maximum total disability rate for injuries occurring after October 1, 2025 is $1,716.00 (based on the estimated average weekly wage of all employees in Connecticut).  The maximum temporary partial/permanent partial disability rate for accidents after October 1, 2025 is  $1,220.00 (based on the average weekly earnings of production and related workers in manufacturing in Connecticut).

BURIAL EXPENSES

As of January 1, 2026, the burial fee for deaths covered under the Workers’ Compensation Act is   $14,816.74 based on the overall 2025 CPI-W increase for the northeast of 3.1%. Connecticut General Statutes Section 31-306 was amended in 2021 to reflect that the compensation for burial benefits will be adjusted by the percentage increase in the consumer price index for urban wage earners and clerical workers in the Northeast as defined in the United States Department of Labor’s Bureau of Labor 

Statistics.

MILEAGE REIMBURSEMENT

As of January 1, 2026 the mileage reimbursement rate is 72.5 cents per mile.

Previously on January 1, 2025 the mileage reimbursement rate was 70 cents per mile, on January 1, 2024, 67 cents per mile, on January 1, 2023  65.5 cents per mile and as of July 1, 2002  the rate was at 62.5 cents per mile.

WORKERS’ COMPENSATION PORTAL 

 The Commission does have a website where you can look up such information as to whether a hearing is assigned, list of all claims for an employee, status of a Form 36, and interested parties.  This is quite a useful site and is a different website than the Commission’s main site.  It can be found at: 

http://stg-pars.wcc.ct.gov/Default.aspx

 NEW COMPENSATION REVIEW BOARD PANEL

The new CRB panel beginning January 1, 2026 will be Administrative law Judges Colette Griffin and Michael Anderson along with Chief Administrative Law Judge Morelli.

 CASE LAW

ELLSWORTH V. PROSPECT MEDICAL HOLDINGS/WATERBURY HOSPITAL, 6573 CRB-5-25-3 (May 1, 2026)

The claimant, a psychiatric nurse, was attacked at work by a patient and sustained physical injuries to her neck, back, and head. She treated with Dr. Waynik, a psychiatrist. A psychiatric RME was conducted by Dr. Herzog, who later also became a treating physician. Dr. Herzog opined that the claimant sustained a 15% permanent impairment of the brain due to her psychiatric injury. The respondents obtained an RME with neuropsychiatrist Dr. Pier, who determined that the claimant had no cognitive loss and no ratable permanent impairment of the brain. The trial judge credited Dr. Pier’s opinion and found no permanency of the brain. The claimant appealed, arguing that Dr. Pier was not a physician and that his rating opinion could not form the basis for the trial judge’s finding regarding permanency. The CRB affirmed, holding that the neuropsychiatrist’s rating opinion could provide the basis for the trial judge’s finding.

HASSELT V. LUFTHANSA GERMAN AIRLINES, 6575 CRB-7-25-4 (April 24, 2026)

The claimant sustained a compensable lumbar injury in 1994 and remained on temporary total disability (TT) benefits until his death in 2024. After his death, the claimant’s spouse sought permanency benefits for a 25% lumbar spine rating pursuant to Connecticut General Statutes § 31-308(d). A respondent’s medical examiner and a treating physician each assigned a 25% back rating in 1995 and 1996, but no voluntary agreement was issued for that rating. The trial judge found there was no “meeting of the minds” prior to the claimant’s death regarding a permanency award and dismissed the claim for permanency. The CRB reversed, finding that the parties stipulated to the ratings at the formal hearing and that the permanency award had vested. The CRB remanded the matter for a determination of the award and whether the respondents are entitled to a credit against permanency for benefits previously paid to the decedent.

DESIMONE V GRIFFIN HEALTH SERVICES, 6584 CRB-4-25-7 (March 6, 2026)

 The Claimant was employed by Griffin Health Services as an environmental services aide/housekeeping for 25 years.  She had an accepted August 17, 2010 left knee claim.  She underwent a diagnostic arthroscopy with partial meniscectomy on November 22, 2010 and was paid a 3% permanent partial impairment to the left leg.  In 2018, the Claimant sought treatment for her left knee, asserting that the need for treatment, including a total knee replacement surgery on July 23, 2018, was related to the August 17, 2010 date of injury, but also for her right knee alleging a causal relationship due to overuse due to the left knee injury.  She also filed a new March 8, 2018 date of injury for a repetitive trauma injury to the bilateral knees.  During the Formal Hearings, the Respondents accepted that the left knee replacement surgery was compensable as related to the August 17, 2010 date of injury, although contested the extent of indemnity benefits the Claimant was entitled to following that surgery.  The Respondents also denied any liability for the right knee and maintained that the right knee issues and need for treatment were personal in nature and were not related to either a sequela of the August 17, 2010 date of injury or to a March 8, 2018 repetitive trauma claim.  The Trial Judge found that the Claimant-Appellant was totally disabled and entitled to temporary total disability benefits from the date of the surgery 2018 until she was rated on September 23, 2019 and that she was entitled to a 31% impairment with a credit for the 3% previously paid.  The Trial Judge found credible the Respondents’ Medical Examiner’s opinion regarding the right knee, determined that her issues were personal in nature and dismissed the right knee claims under both dates of injury.  The Claimant filed an appeal to the Compensation Review Board arguing that the Trial Judge erred in denying the right knee claims and should have credited the opinions of the treating physicians over the Respondents’ Medical Examiner.  On appeal, the Board held that the Trial Judge properly weighed the medical evidence, that the Trial Judge had the discretion to determine which parts of the medical opinions were more credible and that there was sufficient expert testimony supporting the finding that the right knee condition was not caused by repetitive trauma work activities or due to altered gait.  The Board therefore affirmed the Finding and Decision.  Attorney Maribeth McGloin of SDAZ successfully defended this case.

BRIERLEY V. TARGET, 6574 CRB-1-125-3 (March 13, 2026)

In this case the CRB affirmed an administrative law judge’s finding that a claim was filed timely based on the “totality of the circumstances.”  The claimant was  a store director.  On September 13, 2022 when conducting an inventory the employee was struck in the face by a microwave oven causing him to hyperextend his neck.  A supervisor came to his help the claimant but injured worker continued to work his full shift.  No initial report of the incident was made.  The claimant did not receive immediate medical treatment although he did receive some massage therapy.  The worker was first seen for medical treatment by an APRN on April 5, 2023 for neck pain.  He was thereafter seen by an orthopedic surgeon who suggested PT but also discussed a possible neck fusion.  None of the treatment was paid by the employer or the administrator.  In May/June 2023 the claimant requested that a leader at the employer file an incident report; since he did not receive a positive response the claimant contacted the supervisor of the leader seeking to obtain workers’ compensation.  The supervisor said the leader was handling it. There was evidence of text messages between the leader and the claimant about workers’ compensation. The claimant in August 2023 reached out to Sedgwick, the TPA for the employer,  and requested to file a report of injury.  On September 1, 2023 an incident report was filed electronically with the employer. A video of the incident was uploaded to Sedgwick on September 7, 2023. In September 2023 the claimant had further conversations with the adjuster at Sedgwick who denied the claim.  Form 43’s were filed on September 26, 2023 and August 12, 2024 by Sedgwick; no Form30c was filed within one year of the incident.  The first informal hearing was held on December 4, 2023. In affirming the Judge’s finding that the claim was timely filed the CRB determined that under the “totality of the circumstances” the claimant’s case was filed correctly under General Statutes Section 31-294c.  In distinguishing a similar factual decision that found a claim not timely filed, Izikson v. Protein Sicience Corporation, 156 Conn App. 700 (2015), the CRB noted that in the present case the claimant within one year of the incident had conversations with the adjuster at Sedgwick, something that had not occurred in Izikson notwithstanding that the claimant had been advised to reach out to the adjuster.

PERRELLA V. FUEL CELL ENERGY INC., 6577 CRB-7-25-5 (March 27, 2026)

The Compensation Review Board considered whether an administrative law judge properly apportioned liability among multiple insurers for a claimant’s occupational disease (renal cancer) caused by long-term exposure to trichloroethylene (TCE) during employment. The judge had initially found the claim compensable and later apportioned liability using a weighted apportionment with carrier prior to a certain date being liable for 60% and carriers for employment after that date being liable for 40%.  That decision was no appealed.  The carrier went to a subsequent formal hearing over how to re-apportionment time periods for bankrupt carriers.  The judge used a pro rata calculation and one of the apportionment respondents appealed.  The Board reversed the judge’s decision and stated that the case was bound by res judicata  and that the judge erred by deviating from that established apportionment method. Accordingly, the Board reversed the decision and remanded the matter for recalculation of liability consistent with the prior 60/40 allocation across all relevant periods of exposure.

ACADIA INSURANCE COMPANY V. SHADI ET AL, NNH CV24-6142772 S, Judge Papastavros, Judicial District of New Haven, Superior Court, (February 9, 2026)

This action stems from a claim for reimbursement of workers' compensation benefits brought by Acadia Insurance Company, as subrogee of Baybrook Remodelers, Inc., pursuant to Connecticut General Statute § 31-293(a).  The injured worker, Nicholas Mozisek, was employed as an electrician with Baybrook Remodelers, Inc.  On  May 5, 2023 Mr.Mozisek was operating a 2013 Ford Transit Connect XI owned by Baybrook Remodelers, Inc., in the course of his employment.  He was traveling in the right travel lane, heading eastbound on Boston Post Road in Orange.  At that time, the defendant, Zainab Shadid, was operating a vehicle and was traveling in a southbound direction on Boston Post Road, when he attempted to drive across Boston Post Road and collided suddenly with the vehicle operated by Mr. Mozisek.  

As a result of the collision, Mr. Mozisek sustained injuries and damages and filed a workers' compensation claim related to his injuries.  As a result thereof, Acadia provided Mr. Mozisek with medical attention and has extended sums of money for medical treatment and incidental expenses, and may become obligated to expend further sums for additional medical treatment in the future.  As a further result of the accident, Acadia has become obligation to expend sums of money in payment for compensation directly to Mr. Mozisek and may be obligated to extend further sums in the future as may be awarded by the Workers' Compensation Administrative Law Judge and/or agreed upon by the parties.  To date, Acadia has paid $35,354.25 in workers' compensation benefits.     

Following the accident, the Acadia placed all parties on notice of its statutory lien rights, pursuant to Connecticut General Statute § 31-293(a).  Claimant’s counsel claimed that prior to Acadia’s suit being filed, that he had begun to have settlement discussions with the liability carrier in October of 2023 to tender its $25,000 policy.  However, there was no reported settlement at any time and even if there had been, there would have been no requirement on the party of Acadia to reduce its lien under C.G.S, Sec. 31-293(a), unless the injured worker initiated the action  

With liability being clear and no suit filed, Acadia Insurance Company, as subrogee of Baybrook Remodelers, initiated a direct civil action against the tortfeasors, Manhoor Shadid and Zainab Shadid, on April 4, 2024, with a return date of May 7, 2024. At the same time, Acadia placed Nicholas Mozisek on notice of its lawsuit, inviting Nicholas Mozisek to intervene in said action. On June 4, 2024, claimant counsel, filed a Motion to Intervene on behalf of Nicholas Mozisek in Acadia's direct action, pursuant to Connecticut General Statute § 31-293(a).   

Claimant counsel requested a one-third lien reduction in Acadia’s action and when it became clear that Acadia Insurance was maintaining its full statutory lien rights, the claimant initiated a direct action against the defendants, Manhoor Shadid and Zainab Shadid.

The underlying tortfeasor carries the statutory minimum of coverage in the amount of $25,000.00, with no additional insurance   The tortfeasor policy has been offered and the plaintiff, Acadia Insurance Company, a subrogee of Baybrook Realtors, Inc., maintained that after reimbursement of its lien, there are no additional funds left for the injured worker.  Claimant counsel agreed that his client would not be entitled to a recovery at oral argument on October 28,2025.

In addition to Nicholas Mozisek filing his own direct suit, his counsel filed a motion to consolidate the injured workers’ subsequent direct action with the present action.  (Exhibit F)  That motion to consolidate was denied, presumably due to the fact that Nicholas Mozisek was already an intervening plaintiff in that underlying action.  However, in that motion to consolidate, claimant's counsel implied that the action filed by Nicholas Mozisek was filed first, in identifying it as the “first action” and then later referring to the Acadia action as the “second suit” for purposes of consolidation.  However, to be clear, the third party action was initiated by Acadia Insurance Company on April 4, 2024, with Nicholas Mozisek's direct suit having been filed two-and-a-half months later, on June 18, 2024.  

The issue before the Court was whether claimant counsel was entitled to a fee out of the underlying tortfeasor's policy in the amount of one-third of the proceeds of the $25,000.00 settlement recovered by Acadia.  All parties acknowledge that Nicholas Mozisek is not entitled to any recovery out of the limited tortfeasor’s policy.  The only issue for the court is whether claimant attorney is entitled to a one-third attorneys' fee on the underlying action brought by Acadia against the Defendants 

Judge Papastavros consider the facts in the case and applied Connecticut General Statutes Section 31 – 293 to determine that “because Acadia initiated this action, it’s claim on any proceeds arising from this action shall take precedence. Mozisek did not initiate the action and is therefore not entitled to one third of the proceeds recovered by Acadia. Mozisek’s attorney provided no evidence, testimony, or valid basis to support his claim for attorneys fees and costs, and so is therefore not entitled to the requested amount. Accordingly, Acadia is entitled to the entirety of the proceeds pursuant to its lien.”

Based on the above, Acadia was able to receive the entire policy without any reduction for claimant counsel fees or one third reduction of the lien. This case illustrates that where liability is clear it may be appropriate for the Workers’ Compensation carrier to pursue a direct action against the tortfeasor in order to avoid payment of claimant attorney fees or one third reduction in lien. Attorney Courtney Stabnick of SDAZ successfully prosecuted this subrogation claim.

May 2026

Tennessee Legislature Revises Statutory Standards for Award of Attorney’s Fees

Under the Tennessee Workers’ Compensation Law, the standard model for awarding fees to attorneys who represent injured workers is for the attorney to take the fee out of the employee’s settlement or court award – up to 20%.  However, there are some circumstances where the Court can order the Employer to pay attorney’s fees and costs to the Employee’s attorney.

Under TCA section 50-6-226(d)(1), in addition to the standard 20% attorney fee described above, the Court has authority to order an Employer to pay reasonable attorney’s fees and reasonable costs to the Employee’s attorney when the Employer unreasonably denies a claim or unreasonably fails to pay any type of workers’ compensation benefit.

When that statute was enacted several years ago, there was a concern among Employers that this provision would open the door to frequent attorney fee awards on denied claims, but that did not happen because the Workers’ Compensation Appeals Board interpreted this provision very narrowly. The Board cautioned that attorney’s fees should very rarely be awarded under this provision at the expedited hearing level and should generally be deferred until the compensation hearing at the end of the case. Effectively, that meant that this provision was utilized very infrequently by the Court. But that may be about to change….

Tennessee Governor Bill Lee signed Tennessee Public Chapter 845 on April 27, 2026, which reinforces a Court’s ability to award attorney’s fees and costs under this section – especially at the expedited hearing level. The new law states that if the workers’ compensation judge conducting an expedited hearing concludes that the Employer unreasonably denied the claim or unreasonably failed to provide workers’ compensation benefits, then the court may award attorney’s fees and costs at that time. In addition, if the judge finds that the evidence of such unreasonableness is clear and convincing, then the award of attorney’s fees and costs must not be deferred to the compensation hearing.

This new law applies to injuries on or after July 1, 2026.

Clearly, this new law is intended to make it easier and more likely that a workers’ compensation judge will be able to award attorney’s fees and costs at the expedited hearing level. While the new statute includes a slightly increased “clear and convincing” standard, this still may not be enough to prevent a significant increase in attorney’s fee awards.

Employers and Carriers should take greater caution when denying claims and/or denying the payment of workers’ compensation benefits, and they should ensure that they are analyzing potential awards of attorney’s fees and costs if the denials are not upheld by the Court.

For any questions, please contact:
Fredrick R. Baker, Member
Wimberly Lawson Wright Daves & Jones, PLLC
1420 Neal Street, Suite 201
P.O. Box 655
Cookeville, TN 38503-0655
Phone: 931-372-9123
Fax: 931-372-9181
fbaker@wimberlylawson.com
www.wimberlylawson.com

Overview

The California Division of Workers' Compensation (DWC) has adopted updated regulations governing the utilization review (UR) process under Labor Code § 4610. These regulations, effective April 1, 2026, do not alter the statutory framework itself but build a more detailed administrative layer on top of it — adding new procedural requirements for UR plans, approval and denial communications, and the IMR application process. The changes are designed to increase transparency, standardize decision communications, and tighten documentation requirements.

I. UR Plan Administration (§ 9792.7 and § 9792.7.1)

New UR-01 Cover Form. The DWC has introduced a standardized UR-01 form (§ 9792.7.1) that must be used as a cover page when establishing a new UR plan or submitting any plan modification. The form is available on the DWC's regulations page. Note that a "city" field was inadvertently omitted from the form and is expected to be corrected in April 2026; in the interim, city information should be included in the general address field.

Client List Maintenance. UR organizations are now required to keep their client lists current. Under the updated § 9792.7(c), UROs must identify the claims administrator clients for whom they perform any UR functions. This is a new affirmative obligation, UROs and the claims administrators who contract with them should confirm their processes account for this.

DWC Review and Approval Process. The updated regulations formalize a review and approval process for UR plans under § 9792.7. This is a newly added procedural layer, and organizations should review the regulation text for specific submission and compliance requirements.

II. UR Approval Letters (§ 9792.9.4)

The new regulations impose several additional content requirements for written UR approval decisions:

Documenting Prior Information Requests. If a request for additional information, testing, consultation, or examination preceded the approval, the approval letter must now include both the date the request for such information was made and the date the information was received. This creates a documented audit trail within the approval itself.

Generic Drug Substitution. When a treating physician requests a name-brand drug without specifying "do not substitute" or "dispense as written," the approval of the generic equivalent must affirmatively state "generic substitute authorized" or words to that effect. This standardizes language around formulary substitution and removes ambiguity.

Formulary-Exempt Drug Approvals. If the approved drug is exempt under the MTUS Drug Formulary, the decision must state "Exempt per MTUS Drug Formulary" or equivalent language.

30-Day Exempt Non-Drug Treatment. For approvals of non-drug treatment exempt under the 30-day rule (§ 9792.9.7), the written decision must identify the treatment as a "30-day exemption" or words to that effect.

Practical Impact: These are template-level changes, but they require updates to approval letter workflows. Claims administrators and UROs should audit their current letter templates against these requirements before April 1.

III. UR Denial and Modification Letters (§ 9792.9.5)

Responding to Treating Physician Opinions on Guidelines. This is a notable addition. When a requesting physician expressly includes in the RFA an opinion that prerequisite treatment or guideline criteria should be overlooked or deemed irrelevant, the reviewing UR physician must now provide a specific explanation of why the treating physician's rationale is insufficient. This goes beyond the existing requirement to cite guidelines and clinical reasoning, it requires direct engagement with the treating physician's stated position.

Identification of Liable URAC-Accredited Entity. Adverse UR decisions must now identify the URAC-accredited entity that is liable for the decision. This is a transparency measure and should be incorporated into denial/modification templates.

Updated IMR Appeal Rights Language. The template language in denial and modification letters regarding IMR appeal rights must be updated to conform with § 9792.9.5(e). The DWC has indicated that organizations should work directly with DWC UR staff to accomplish this through the UR plan modification process.

Denials After Extension of Time (Substantive Medical Necessity Finding). Where a denial is based on a substantive medical necessity finding after an extension of time was taken, the denial must now include: a description of the information that was needed, the dates and times the request was made, the manner of the request, and the date the missing information was first received.

Denials Based on Untimely Receipt of Information ("CNC" Denials). For denials issued because requested information, testing, or consultation results were not timely received, the letter must include: the reason for the decision, a specific description of the needed information, the date and time of attempts to contact the physician, and the manner of those attempts. The DWC notes that these requirements are already embedded in Labor Code § 4610(i)(5) and are being restated in the regulations to clarify their application in this context.

IV. IMR Application Updates

The DWC has updated the IMR application form with the following changes:

New Checkboxes. Three checkboxes have been added at the top of the form to categorize the type of dispute: (1) Medication Only – MTUS Formulary Drug List; (2) Retrospective for Exempt Treatment (Non-Drug); and (3) Retrospective for Exempt Treatment (Drug).

Mailing Date Field. A new field has been added under "Disputed Medical Treatment" for the mailing date of the UR determination letter.

Filing Deadline Designation. Claims administrators and UROs must now mark which IMR filing deadline applies. If the dispute involves only a drug listed on the MTUS Formulary Drug List, the deadline is 10 days from the mailing date of the UR determination letter. For all other disputes — including drugs not on the MTUS Formulary Drug List — the deadline is 30 days from the mailing date.

Known Form Errors. The DWC has acknowledged two omissions from the updated IMR application: the Authorized Designated Representative (ARD) form was inadvertently left out, and the "city" field was omitted from various address sections. Both are being corrected. In the interim, organizations should continue including the ARD form with adverse UR decision letters and note city information in the general address fields.

V. Action Items to Consider

The following steps should be evaluated before April 1, 2026:

1. Template Updates. Review and revise all UR approval, denial, and modification letter templates to incorporate the new content requirements, including generic substitution language, formulary exemption designations, 30-day exemption labels, and the identification of the liable URAC-accredited entity.

2. UR Plan Filings. Determine whether a UR plan modification is required and prepare the new UR-01 cover form. Coordinate with DWC UR staff regarding updated IMR appeal rights language.

3. Client List Compliance. UROs should confirm their client lists are current and establish a process for ongoing maintenance under § 9792.7(c).

4. IMR Application Workflow. Update internal processes to account for the revised IMR application, including the new checkboxes, mailing date field, and filing deadline designation. Continue including the ARD form despite its omission from the updated application.

5. Staff Training. Ensure UR physicians and reviewers understand the new requirement to substantively respond to a treating physician's express opinion that guideline prerequisites should be disregarded.

This summary is provided for informational purposes and highlights key operational changes under the DWC's updated UR regulations. It is not a comprehensive restatement of all new requirements. Organizations are strongly encouraged to review the full regulatory text and consult with legal counsel to ensure compliance.

Simon Anderson Law P.C.

701 Market Street, Suite 340, St. Louis, MO  63101

314-621-2828

MISSOURI WORKERS’ COMPENSATION CASE LAW UPDATE

January 2026 – March 2026

Claimant’s Fall Downstairs Not Compensable

Meyer v. National Hospice Management Beacon of Hope Hospice, Injury No. 24-001520

FACTS: The claimant worked as a team assistant and on the date of injury, there was a snow and ice storm. He received a text noting that there was going to be a delayed start possibly at 10:00 am but was advised not to leave home until he heard from his supervisor at 9:30 am to confirm. However, the claimant left for work and arrived in the office parking lot at 9:02 am and went into the office at 9:15 am. He realized he forgot his badge and went back to the car at 9:32 am and fell on snowy and icy stairs outside of the building. Afterwards he received a text at 9:47 am which called off the days’ work for all employees. The claimant admitted he knew the reasons for the delayed start was due to safety concerns of the employees and the hazardous weather conditions. He testified the parking lot at work does not have designated parking for any of the lessees of the building, and the claimant could park wherever he chose. He also noted there were multiple entrances to the building, but most employees used the entrance closest to their office suites. The office manager testified on behalf of the employer that the reason for the delayed start and ultimate cancellation of in person work was for the safety concerns of the employees due to hazardous weather. She did note the employer does not own, maintain, or control the common areas of the office building and the landlord is responsible for maintenance and snow removal from common areas. She also testified the building manager for the landlord contracts with the company for snow and ice removal on the property. The leased property for the employer only begins after entering the second set of doors on the outside of the office building and the snow and ice covered stairs are beyond any of the employer’s leased space. The lease showed that the area the employer leased did not include the outside steps and doors leading into the office building. There was no dispute that the claimant fell on the snow-covered steps in the common area of the building and not in an area leased by the employer.

HOLDING: The ALJ found that the evidence presented did not establish that the risk of falling on snowy and icy stairs was somehow exclusive to the claimant’s performance of work within the course and scope of his job as opposed to the risk source of any individual walking on snow- or ice-covered stairs, whether at work or not. The judge went on to note that the evidence showed that the employer did not own, maintain, or control the exterior of the common areas of the building and when they leased spaced and the landlord has the responsibility for maintenance of the steps, including snow and ice removal. Also, the judge did note that although not critical to the decision, the evidence established that the employer directed the claimant to not report to work until 10:00 am, however, the claimant’s actions were averse to these directions. The judge concluded that the claimant was not in the course and scope of his employment when he fell on the snowy and icy stairs and the extension of premises doctrine was not applicable to this case and therefore, the case was denied. The employer appealed and the Commission affirmed the decision.

Employer Not Responsible for Claimant’s Unauthorized Care as Claimant Did Not Give Employer Opportunity to Control It

Wills v. Fixture Contracting Company, Inc., Injury No. 17-099534

FACTS: The claimant, 41-year-old journeyman carpenter, began working for the employer in the fall of 2015 and his job duties included building cabinets, display fixtures, and countertops. He worked full time and his job required bending at the waist, stooping, lifting from the ground to the work bench, reaching overhead, and bending over to clean up. There was testimony on behalf of the employer showing that the claimant’s work was not as heavy or frequent as he testified but the employer’s evidence did establish the claimant lifted and bent throughout the workday. He developed low back pain in September of 2017, and he initially treated on his own with a chiropractor. He reported his pain and was directed to Concentra; he was signed in but never seen due to the wait. He then went and treated on his own at SSM Health. He was again advised by the employer that if the injury was work related, he had to follow her instructions. He continued to treat on his own and on December 22, 2017, he brought a letter drafted by his attorney to the employer advising that his doctors were talking about surgery and asked if they would pay for his treatment. The claim was reported to the insurance company and authorizations were forwarded and the attorney returned the same. However, the claimant continued to treat on his own and his attorney directed him to Dr. Levy who recommended surgery. The claimant also signed a notice of doctor’s lien on behalf of Attorney Hoffman. The attorney made another demand for treatment on February 8, 2018, and the claimant underwent surgery with Dr. Levy on his own on March 7, 2018. He underwent a second surgery on August 1, 2018. There was no evidence that the claimant requested the employer to offer the second surgery. The claimant did ask for an award for medical bills, which amounted to $248,116.98.

The employer obtained a report from Dr. Bernardi who did not believe that the claimant’s condition was related back to his job duties. The claimant’s attorney obtained a report of Dr. Volarich who did believe that the claimant’s job duties were the prevailing factor in causing his condition and he assessed 40% disability. Dr. DeGrange also testified that the claimant’s condition was work related, as did Dr. Levy.

FINDING: The ALJ did believe that the claimant’s job duties were the prevailing factor in causing his condition. The judge did not award medical as she determined that the claimant did not make a formal demand for treatment until February 14, 2018, when the claimant’s attorney requested the surgery, suggested by Dr. Levy and repeated the same over the next two weeks. The judge noted that the claimant knew the employer was actively collecting medical records but only one week after his last demand and three weeks after the first, the claimant underwent two surgeries with Dr. Levy, thus denying the employer to direct care. The ALJ noted the employer neither failed nor refused to provide treatment before the claimant had surgery. With respect to future medical, the judge noted that the mere possibility that the employee may require treatment in the future is inadequate to establish a right to such treatment. The ALJ found that there was no specific treatment recommended by the experts and that the claimant is not entitled to future medical treatment benefits because he did not establish there was a “reasonable probability” that future medical treatment will be necessary due to the alleged work-related injury. With respect to TTD, the judge did believe the claimant was entitled to TTD during the time he was unable to work, which was supported by Dr. Volarich’s opinion. She also awarded 30% disability referable to the low back. The case was appealed to the Commission, and the Award was affirmed.

Employer/Insurer Responsible for Full Amount of Medical Bills and Should be Paid Directly to Claimant

Chick v. City of Centralia and Treasurer of Missouri as Custodian of the Second Injury Fund, Case No. WD88273 (MO App. 2026)

FACTS: The claimant was an equipment operator for the City from 1995-2016. In February of 2014, he slipped and fell; he was seen by Dr. Runde and referred to an orthopedist. He saw Dr. Young who evaluated the claimant but did not provide treatment. He was sent back to Dr. Runde who suggested a second orthopedic referral but the City refused to authorize additional treatment. He sought treatment on his own with Dr. Mackinnon who performed two surgeries for plexus nerve damage. He also alleged a psychiatric component. He also treated for carpal tunnel syndrome and trigger finger syndrome. He was released from care. Dr. Schlafly provided a ten-pound lifting restriction and the claimant was terminated on April 18, 2026. At a hearing, the ALJ found that the work accident was the prevailing cause of the brachial plexus injury but did not connect the claimant’s carpal tunnel syndrome, trigger finger syndrome, or psychiatric conditions back to the work accident. The ALJ did not find the claimant PTD or the employer responsible for past or future medical. The claimant appealed.

The Commission confirmed that the claimant was not PTD but did believe that the employer was responsible for the treatment for the brachial plexus condition. The Commission noted that the claimant’s health insurance paid for most of the charges and therefore, it did not require the employer to pay the amount charged for the doctor’s treatment to the employee and his attorney but instead ordered the employer/insurer to resolve the charges with the doctor and hospital directly and hold the employee harmless in any collection attempts. The claimant appealed.

HOLDING: The claimant argued that the Commission acted in excess of its powers in directing the City to pay the Award of past medical expenses directly to the medical providers instead of the claimant and the Court agreed. The claimant argued that the Commission’s method provided a credit to his employer for payments made by a collateral source, in this instance the claimant’s private health insurance despite the fact that Section 287.270 expressly prohibits such a credit. The claimant further pointed out that the Commission’s method of reimbursement does not actually reimburse him for the out-of-pocket expenses he incurred, such as deductibles and copays, and therefore, the method of “reimbursement” was inadequate. The Court cited Farmer-Cummings, which addressed responsibility of past medical expenses. It noted that the case held that a claimant is not entitled to compensation for health care provider write offs and fee adjustments that extinguish the claimant’s liability as compensation for amounts for which the employe was not liable would amount to a windfall rather than compensation. The Court noted that the case was clear that any benefits from a collateral source that fell withing Section 287.270 were outside the scope of the defense and the case clarified that the employer was required to reimburse the employee for all medical expenses incurred and that the employer should not receive and advantage for failing to timely pay medical bills incurred at the employee's expense.

The Court noted that it was clear that the Commission considered payments made toward the claimant’s medical bills by the claimant and his private insurer. However, Section 287.270 forbids the Commission from considering and granting the City a credit against its liability for payments made by the claimant or his private insurance. The Court did note that there is support in case law for an approach in which the Commission directs unpaid medical bills for which the employer is liable directly to the medical provider. However, this was not the case here. Therefore, the Commission erred by directing the City to satisfy its liability for past medical in the amount of $32,526.48 to the claimant’s medical providers rather than to the claimant. The issue of attorney’s fees on the past medical was remanded to the Commission.

Commission Decided to Strike Employer/Insurer’s Brief Due to Bogus Citations

Daniel Justin Gazaway v. Nostrum Pharmaceuticals, LLC, Injury No. 22-074974

FACTS: The claimant was employed at the insured from August 2020 until March 25, 2022. He worked on three different machines which compounded calcium acetate. He alleged health problems due to being exposed to dust particles from the calcium acetate. The claimant did undergo various treatments and obtained medical reports concluding that the claimant’s symptoms, which included difficulties breathing, asthma, and sinusitis, were related back to his exposure. The employer did send him to Dr. Bhalla who noted that he really could not comment on causation. The ALJ found that the claimant met his burden in proving that his work was the prevailing factor in causing his condition based on the testimony of two of the claimant’s experts. The judge noted there was no evidence that any other factors contributed to the claimant’s condition. The ALJ assessed 35% disability, found the employer responsible for $114,439.35 in past medical, and did find the employer was also responsible for future medical treatment and past TTD. The employer appealed and the Commission set a briefing schedule.

HOLDING: In reviewing employer/insurer’s brief it noted several citations to non-existent cases, specifically three separate cases. The Commission noted that Missouri Courts have found that filing a brief with bogus citations represents a flagrant violation of duties of candor that all parties owe to a Tribunal. The Commission noted that per its rules the Commission upon its own motion can decline to consider any brief or any portion of a brief that is not filed within accordance with its rules. In light of the fictious references included in the employer/insurer’s brief, the Commission decided to strike the employer/insurer’s brief in its entirety on its own motion. The Commission urged all parties whether members of the bar or pro se to be cognizant that they are aware of this issue and will not permit fraud on the Commission. The Commission did find that the ALJ’s Award was supported by competent and substantial evidence and affirmed the same.

The Nebraska Workers' Compensation Court has announced plans to relocate its Lincoln office later this summer.

The Court will move from its current location at 1010 Lincoln Mall to Center on N, located at 1221 N Street in Lincoln. The new location is just a few blocks from the Court’s existing office.

At this time, the Office of the Court will continue operating from 1010 Lincoln Mall, Suite 100, until further notice. Court officials have indicated that additional updates—including any temporary service adjustments impacting scheduled hearings or trials—will be provided as more information becomes available.

Operations at the Hall of Justice in Omaha, as well as administrative personnel currently located at 1221 N Street, Suite 402, will remain unchanged.

The Court expressed its commitment to continuing to serve the public and looks forward to operating from its new location.

For additional information regarding workers’ compensation in Nebraska, visit the Court’s website or contact the Information Line at 402-471-6468 or 800-599-5155.

On January 1, 2026, the Delaware Family and Medical Leave Insurance Program began to accept claims.

The Delaware Department of Labor has created a forty-page Guide for Employers & Third Party Administrators that discusses eligibility, coverage, and reporting under the program.

The Guide is a helpful document for Employers to understand their responsibilities during the reporting and claims process.

We invite you to contact any attorney in our liability department for assistance in navigating this new administrative claims process in Delaware.

On February 13, 2026, The Alabama Court of Civil Appeals released its opinion in the matter styled Professional Education Services Group, LLC (“PESG”) v. Richard A. Ford., wherein it affirmed a PTD verdict, in part.  The case revolved around Ford’s claim that he sustained a left shoulder injury during his employment with PESG, which rendered him unable to return to his previous work or find other gainful employment. ​

Ford, a former HVAC mechanic, suffered a shoulder injury in June 2019 after tripping and falling at work. ​ Following surgery and treatment, he was assigned sedentary work restrictions, which were incompatible with his previous career in heavy-duty HVAC work. ​ A vocational expert concluded that Ford had a 100% vocational disability and was incapable of obtaining or maintaining competitive employment. ​ The trial court determined that Ford was permanently and totally disabled due to his shoulder injury, not his unrelated heart condition. ​ The court awarded Ford compensation for the remainder of his natural life. ​

PESG appealed the judgment, arguing that the evidence was insufficient to support the finding of permanent total disability. ​ PESG claimed that no medical or expert testimony explicitly stated Ford was incapable of gainful employment and that his heart condition, not his shoulder injury, was the cause of his disability. ​

The Court of Appeals affirmed the trial court’s finding that Ford was permanently and totally disabled due to his shoulder injury. ​ The court noted that Ford’s testimony about his pain and inability to work, combined with the vocational and medical evidence, constituted substantial evidence to support the trial court’s decision. ​ However, the portion of the judgment that awarded Ford PTD for the remainder of his natural life was reversed.  As the Court pointed out, compensation for PTD is limited to the duration of the disability, not the employee’s lifetime. ​

​My Two Cents:

Even with its opinion being release the day before Valentines Day, the Court refused to give much credence to matters of the heart.

About the Author:

This article was prepared by Mike Fish, an attorney with Fish Nelson & Holden, LLC, a law firm dedicated to representing self-insured employers, insurance carriers and funds, and third-party administrators in all matters related to workers’ compensation. Fish Nelson & Holden is a member of the National Workers’ Compensation Defense Network. If you have any questions about this article or Alabama workers’ compensation in general, please contact Fish by e-mailing him at mfish@fishnelson.com or by calling him directly at 205-332-1448.

CALIFORNIA 2026 NEWS

Beginning January 1, 2026, the following laws take effect for all injuries occurring on or after 1/1/26 unless otherwise noted:

·       SB 230 expands rebuttable presumptions for firefighters by extending coverage for cancer, PTSD, and other injuries to firefighters working at commercial airports. It also broadens presumptions for conditions such as pneumonia to firefighters serving at commercial airports, NASA installations, and U.S. Department of Defense facilities, further strengthening presumptive coverage for high-risk public safety work environments.

·       AB 1125 extends the heart injury presumption to peace officers employed by the State Department of State Hospitals, affording them the same presumptive benefits previously limited to officers at Atascadero State Hospital. The change recognizes the comparable occupational risks faced by these workers.

Beginning February 1, 2026, employers are required to provide a stand-alone written notice to current employees and new employees upon hire, in a manner the employer normally uses to communicate job or employment information, with information related to employee rights, including:

• Workers’ compensation benefits (including disability pay and medical care for work-related injuries or illness, and the contact information for the Division of Workers’ Compensation)
• Notice of inspection by immigration agencies. Labor Code 90.2
• Protection against unfair immigration-related practices against a person exercising protected rights. Labor Code 1019-1019.2.
• The right to organize a union or engage in a concerted activity in the workplace, and Constitutional protections when interacting with law enforcement at the workplace (i.e., fourth amendment protection against unreasonable searches and seizure, and fifth amendment protection against self-incrimination and right to due process)
• Rights when interacting with law enforcement at the work place, including immigration.  US Const 4^th and 5^th Amendment. 

D.C. Law 26-42. Parity in Workers’ Compensation Recovery Amendment Act of 2025.

            In July of 2025, the Parity in Workers’ Compensation Recovery Amendment Act of 2025 amended the District of Columbia Workers’ Compensation Act of 1979. This law allows claimants who received an award or payment of compensation in another state to receive compensation for the same injury or death in DC. However, if the claimant was already awarded compensation from the other state, D.C. will reduce the amount they already received from the other state.  This amendment applies to all claims that were still pending as of June 28, 2022 and all claims after that. This law became effective on October 1, 2025.

New D.C. Compensation Rates

The newest D.C. Compensation minimum temporary total disability and permanent partial disability rate as of 1/1/2026 are $463.02. The maximum temporary total disability and permanent partial disability rate as of 1/1/2026 is $1,852.07. Additionally, the maximum penalty for a late payment is now $7,500.

Minimum Wage

Beginning July 1, 2026, the minimum wage in D.C. will increase from $17.95 per hour to $18.40 per hour for all workers, regardless of the size of the employer. As of July 21, 2026, the base minimum wage for tipped employees will increase to $10.30 per hour. This affects workers’ compensation costs for employes because the higher their wages are, the more injured workers can receive.