NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.
For employers and their workers compensation insurance carriers, the denial of a claim for permanent total disability (PTD) benefits prompts a major sigh of relief. However, it’s important to manage expectations by keeping in mind that a claimant may be allowed to relitigate the issue of whether they’re entitled to PTD benefits if the claimant proves that their physical condition has changed since their initial claim for PTD was denied.
This issue was considered in MHM Support Servs. v. Miller, 2025 Ark. App. 546, where Claimant Tammy Miller filed a claim alleging permanent and total disability due to compensable injuries she sustained in January 2016 despite a previous ruling denying that Miller was entitled to PTD benefits as a result of her compensable injuries. Respondents argued that the issue had already been decided and could not be adjudicated for a second time based on the legal doctrine known as res judicata which bars relitigation of a judicial or administrative determination unless there is a change following the Order. However, the presiding Administrative Law Judge, Full Commission, and Court of Appeals disagreed with Respondents, finding that Miller’s second claim for PTD benefits was not barred by res judicata because she proved that her physical condition had changed after the Commission made its first ruling denying PTD benefits in August 2021.
In an Opinion filed on November 12, 2025, the Arkansas Court of Appeals affirmed the ALJ’s and Full Commission’s award of PTD benefits reasoning that she presented objective evidence supporting several new conditions and injuries that she was diagnosed with after her first claim for PTD benefits was denied in August of 2021. The Court of Appeals also relied heavily on the ruling made by an ALJ in June of 2022 finding that Miller had entered into a second healing period a few months after her first PTD claim was denied when she began to suffer complications from the surgery she previously had to repair her compensable hip injury including a partial torn tendon and pelvic floor dysfunction that her surgeon attributed to the hip injury. Given that Respondents did not appeal the ALJ’s Opinion awarding Miller TTD benefits for her second healing period, the Court found no merit in Respondents’ argument that Miller had failed to establish a change in her condition sufficient to warrant a second adjudication for PTD benefits, and instead considered the ALJ’s Opinion to be clear evidence that Miller’s physical condition had changed following the Commission’s initial PTD determination.
The WCA will be implementing amendments to Parts 4 and 7 of the WCA rules effective April 7, 2026. Redline versions of the proposed changes are available on the WCA website.
Proposed changes to Part 4. More specifically, Rule 11.4.4.15
regarding approval of attorney fees. The change adds criteria or factors to
list on contested attorney fee applications or petitions seeking attorney fees
in excess of the statutory cap. The factors include the time and effort
expended by the attorney, the extent to which issues in the case were
contested, ability, skill and experience of the attorney, relative success of
the outcome, etc. The list is not meant to be exhaustive as the final factor
listed is “any other relevant information for the determination of the attorney
fee award in question.”
Proposed changes to Part 7. More specifically, Part 11.4.7.12 regarding payment for health care services and case management. The change eliminates the requirement that a case management contractor give reasonable notice and an opportunity to the worker or worker’s attorney to be present during or to participate in, any and all contact by the case management with a provider.
© Copyright 2026 by Craig Campos Ritsema Law, LLC. All
rights reserved. Reprinted with permission.
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The Division has issued a few
important updates recently. On October 24, 2025, the Division relocated to 707
17th St., Suite 2300, Denver, CO 80202-3404. As part of the move,
the Division has updated its external documents and webpages to reflect the new
address. There has also been a change regarding the Electronic Data Interchange
(EDI) transition. Starting July 9, 2026, carriers and third-party
administrators (TPAs) can submit claims using the EDI 3.1 format. July 8, 2026,
is the last day to submit EDI data with EDI 1.0 standards. Also, effective
January 1, 2026, mileage has been updated from 0.60 to 0.63, and Rules 16 and
18 have been updated.
In 2015, Claimant sustained a thoracic spine injury while employed for Belvedere Fire Company. He was compensated for thoracic spine permanency. He voluntarily closed the claim by global commutation in 2018. In 2023, while working for the City of Wilmington, climbing stairs with a pack of gear during a call, he felt pain in his thoracic spine area, missed several weeks from work, and received conservative care to the thoracic spine area. Claimant filed a Petition seeking acknowledgement of the 2023 injury, relying on the opinion of claimant’s family physician. Employer denied the claim based upon the factual circumstances of the event, and medical opinion of Dr. Samuel Matz. Board Hearing was held. The Board issued a Decision accepting Employer’s position that the successive workers’ compensation carrier standard set forth in Nally v. Standard Distributing, 630 A.2d 640 (Del. 1993), applied, denying the Petition, as claimant failed to satisfy that there was both (1) an untoward event, that (2) was the proximate cause of a new injury.
Claimant appealed to the Superior Court, arguing Nally does not apply when the first work injury claim is resolved by global commutation, and in the alternative, asserting that if Nally applies, the Board applied it incorrectly. The Superior Court rejected both arguments.
Claimant appealed to the Delaware Supreme Court. On 12/4/25, the Court issued a Decision affirming the Board’s ruling. The Court was clear that Nally assigns liability between successive insurance carriers in cases where an employee seeks compensation for a work-related injury that is causally related to an injury compensated by a previous employer or carrier. In order to shift liability, Nally requires an (1) untoward event and (2) new injury. The question of whether Nally was correctly applied was not a close one. As Dr. Matz testified, the injury was to the same area of the spine, and diagnoses very similar. The nuance of claimant’s first claim being commuted does not mean that the Board applied the wrong standard. The fact that there was no record evidence of symptoms for several years pre-2023 injury also did not change the standard, especially considering claimant’s acceptance of compensation for a permanent injury associated with the 2015 claim, which presupposes that the injury had not healed.
Should you have any questions regarding this Decision, please contact Greg Skolnik, or any other attorney in our Workers’ Compensation Department.
Corey Ferrell v. City of Wilmington, No. 152, 2025 (Del. Dec. 4, 2025).
The Oklahoma Supreme
Court found recently there is no limit on the number of Form A's that an
injured worker can be granted to change the treating physician, as long as the
Administrative Law Judge agrees.
In the case of St. Anthony v. Goodwin, 2026 OK 3, the Court examined 85A O.S. Sec. 56(B) which the insurance carrier argued allowed only one Form A per case. The ALJ ordered a second Form A. That was appealed, and the ALJ's decision was reversed 2-1 by the Court of Civil Appeals. The Supreme Court granted certiorari and reversed COCA.
Justice Kane, writing for the 6-2 majority, said the statute does not say what happens after the ALJ grants the first automatic Form A. The Supreme Court said it should be up to the ALJ to determine if further changes of the treating physician for different body parts are warranted. Justice Kane wrote:
"The
statute does not limit the number of applications that may be filed, the number
of changes that may be ordered per claim, or the number of changes per injured
body part. Nor does the statute require the ALJ to order one change per body
part."
Bottomline, the ALJ and the Commission shall make the judgment call on changes in the treating physician based upon the facts in each individual case. The case grants the ALJ a lot of discretion regarding the treating physician on a claim.
Death investigation professionals aka last responders must have a powerful
lobby. DWC adopted rule amendments that take effect January 29, 2026 to
implement Texas Labor Code Section 504.057 which requires expedited medical
benefits and accelerated medical dispute resolution for claims for medical
benefits by a “death investigation professional” who sustains a serious bodily
injury in the course and scope of employment, and requires that the death
investigation professional inform DWC and the independent review organization
that a contested case hearing or appeal involves a death investigation
professional.
When the legislature enacts laws that provide preferential treatment for such a
narrowly defined class of injured workers, it can cause more problems than it
solves with increased regulatory complexity, among other things. We
recommend doing a study in a year or two to see how many times these new “last
responder” rules are invoked. Let us know your prediction!
Copyright 2026, Stone Loughlin & Swanson, LLP
DWC announced that its 2026
initiatives include online medical fee dispute submissions, remote interpreters
for CCHs, a pilot program to explore the use of AI-based interpretation tools,
and use of AI for a customer service knowledge base.
If you haven’t spotted the trend yet, the watchword here is “AI,” the use of
which is gradually encroaching on the practice of law, as it is in so many
other fields. For all AI’s benefits, there is reason to worry about his
increasing presence.
AI has the capacity to invent facts and create information that does not exist
to support its response and/or to appease the perceived bias of the user. One
well-known example is of a lawyer who sued Colombian airline Avianca several
years ago, alleging that a food and beverage cart injured his client’s knee
while he was onboard a flight. The lawyer submitted a brief using ChatGPT to do
his legal research, but the AI tool invented case law entitled Martinez v Delta
Air Lines, Zicherman v Korean Air Lines, and Varghese v China Southern
Airlines. When Avianca’s attorneys informed the judge that they could not
locate the cases cited, the plaintiff’s lawyer had to ‘fess up and admit he had
used ChatGPT. He said he asked ChatGPT to cite its sources and AI responded
that the cases could be located in the Westlaw and LexisNexis databases. The
judge ultimately sanctioned the lawyer and his law firm.
Likewise, our firm has received communications from opposing attorneys who have
relied extensively on AI programs to generate their correspondence, a great
deal of which proved to be incorrect. Citations to the Texas Labor Code
and Texas Administrative Code are often out-of-date, or otherwise
non-existent. Case law and Appeals Panel Decisions have similarly been
misinterpreted and misquoted. It has been our experience that checking
and correcting AI-generated documents often offsets the supposed time saved in
relying on it in the first place.
AI as a tool for collating data remains in its infancy, and as with any infant,
it requires constant supervision. While there are benefits to its use,
there are substantial risks, too, and for that reason it is the policy of this
firm not to rely on it in any capacity.
Copyright 2026, Stone Loughlin & Swanson, LLP
At the DWC Quarterly Stakeholder Meeting held on January 21,
2026, the DWC reported on their 2025 accomplishments and their plans for 2026.
Online Tools
New online tools introduced by the DWC over the last year include:
Copyright 2026, Stone Loughlin & Swanson, LLP
Commissioner of Insurance Cassie Brown retired after more than
four years overseeing the Texas Department of Insurance. Governor Greg Abbott
appointed Amanda Crawford in her stead to oversee the department, for a term
set to expire on 2/1/27. Ms. Crawford was serving as the executive director of
the Department of Information Resources and is Texas’ chief information
officer. It remains to be seen if and how the change in leadership at TDI will
impact DWC since it is technically a division within the Department of
Insurance.
In ALJ news, Barham Richard has joined the DWC as a traveling Administrative
Law Judge based out of Austin. Mr. Richard has an extensive background serving
as legal counsel for the Texas Commission on Environmental Quality, Lone Star
Legal Aid, and the Texas Office of Public Utility Counsel. He most recently
served as a Senior Staff Attorney for the Texas Medical Board. We are glad to
have him join us in the wonderful world of workers’ compensation!
Congratulations are also in order to Christina Figueroa, Sarah Hart, and Avery
Fortenberry, all of whom have been recently promoted from PROs to BROs. We look
forward to working with them all during our Benefit Review Conferences.
Change is also afoot in Lubbock, where the DWC is searching for a new home for
its offices and seems set on giving up its lovely quarters at 22 Briercroft
Office Park. For those who have never made the attempt, trying to locate
the Lubbock Field Office for the first time is something of a right-of-passage
hazing ritual among system participants, obscured as it is behind trees and
secreted away along the side of the building. Hopefully the new location
is a bit more conspicuous!
Copyright 2026, Stone Loughlin & Swanson, LLP
Workers’ compensation
insurers just secured a major victory in the Texas air ambulance
litigation. On January 16, 2026, the State Office of Administrative
Hearings (SOAH) issued decisions in the two major groups of air ambulance cases
pending at SOAH.
In both cases, the Administrative Law Judges (ALJs) found that for the years in
issue from 2011 – 2013, fair and reasonable reimbursement for the base rate
ranges from 128.8% to 139.3% of Medicare and the mileage rate ranges from
119.1% to 128.8%. The ALJs rejected the air ambulance providers’ proposed
reimbursement that ranged up to more than 500% of Medicare for the average
total rate. SOAH previously rejected the air ambulance providers’ argument that
the federal Airline Deregulation Act (ADA) preempts the “fair and reasonable”
reimbursement standard and therefore, they should be paid their full billed
charges.
The decisions issued by SOAH in these cases are notable for the depth of their
analysis, each over a hundred pages, which followed a four-day hearing in the
first case and a three-day hearing in the second case, both with numerous
expert and fact witnesses. Texas Mutual, which has around a 40% market
share, should be commended for doing the heavy lifting in these cases.
The air ambulance providers, which are private equity-owned, will likely appeal
these latest SOAH decisions in their ongoing effort to extract more money from
the Texas workers’ compensation system.
As of December 2025, there are 2,183
air ambulance disputes at DWC, dating back to at least 2014, and this number
will continue to rise as the air ambulance providers file new disputes.
Copyright 2026, Stone Loughlin & Swanson, LLP