INDIANA UPDATES OF WORKER’S COMPENSATION BOARD ACTIVITY

Two new judges (Single Hearing Members) have been appointed:

Southeast Indiana

Michael Ooley has been appointed effective June 2, 2026 to serve as Single Hearing Judge in southeastern Indiana from New Albany west up through Terre Haute.

Central Indiana

Steven M. Koers has been transferred from southeast Indiana to the Marion County District which includes Indianapolis and Hamilton County and will serve as Single Hearing Judge for the middle of the state.

Both new judges are members of the Indiana Worker’s Compensation Board which hears all appeals from the six single hearing judges throughout the state.

LEGISLATIVE AND CASE LAW UPDATE

HB Construction and/or Auto Owners Insurance Company v. Labor Commission of Utah and James Beaty 2026 UT 3 (Issued February 26, 2026}

The Utah Supreme Court decision in HB Construction v. Labor Commission will severely restrict workers compensation carrier's for claiming a free ride in Utah on future credits from a third party personal injury recovery. The Court held that if a workers compensation carrier wants to claim an offset against future worker's compensation obligations for medical expenses and disability compensation, it must pay its proportionate share of the employee's litigation costs and attorney fees up front. The Court held the proportionate share of costs and attorney fees is to be calculated on the value of both past-paid and future anticipated benefits. The Court held that a carrier is now strictly required to reimburse the employee for its unpaid share of litigation expenses before it can begin receiving an offset against ongoing medical expenses and disability compensation. Defense Counsel, Insurance adjusters, and subrogation Attorneys will all have to alter how they evaluate third party liens and recoveries.

© Copyright 2026 by Ford G. Scalley, Scalley Reading Bates Hansen & Rasmussen, P.C.

Recently, Florida’s First District Court of Appeal (which handles all workers’ compensation appeals in the state) dramatically changed how the Statute of Limitations is applied in Florida workers’ compensation claims. The SOL is set forth in Section 440.19, Florida Statutes, and provides as follows:

(1) Except to the extent provided elsewhere in this section, all employee petitions for benefits under this chapter shall be barred unless the employee, or the employee’s estate if the employee is deceased, has advised the employer of the injury or death pursuant to s. 440.185(1) and the petition is filed within 2 years after the date on which the employee knew or should have known that the injury or death arose out of work performed in the course and scope of employment.

(2) Payment of any indemnity benefit or the furnishing of remedial treatment, care, or attendance pursuant to either a notice of injury or a petition for benefits shall toll the limitations period set forth above for 1 year from the date of such payment. This tolling period does not apply to the issues of compensability, date of maximum medical improvement, or permanent impairment.

Historically, this has been interpreted to mean that the SOL expires upon the later of two years from the date of the accident or one year from the date of the last provision of benefits. However, in the recent case of Estes v. Palm Beach County School District, the First DCA reshaped the interpretation of Section 440.19 by redefining the word “toll” as it is used in 440.19(2). Under the historic interpretation, the word “toll” is defined as “extend,” meaning that the provision of medical or indemnity benefits extends the expiration of the SOL for one year. In Estes, the Court redefines “toll” to mean “suspend, stop temporarily, or abate.” Specifically, the Court stated “[w]e therefore hold en banc that the tolling provision in § 440.19(2) suspends or stops temporarily the limitations-period clock established in subsection (1), instead of extending separate one-year limitations periods for claimants to file claims in these cases.”

The Court examined how it had previously used “toll” in its prior decisions and found that their earlier decisions did not properly interpret the term as it is used in Section 440.19. They performed a lengthy textual analysis of how “toll” had been used in various prior cases and statutes in other contexts (ex: medical malpractice and property insurance claims) and determined that the correct interpretation of “toll” is to pause, rather than to extend.

In Estes, the claimant was injured on September 30, 2021. She last received authorized treatment on January 26, 2023. Under the historic SOL interpretation, the SOL would have run on January 26, 2024, one year from the last provision of benefits. However, the Court here held that Section 440.19 provides two separate clocks: a one-year clock which begins to run after each provision of benefits and resets upon each additional provision of benefits, and a two-year SOL master clock which does not even begin to run until the one-year clock has expired. The Court stated:

And so, here, under § 440.19, after an employee knows or should have known of a qualifying workplace injury, the two-year limitations-period clock begins to run. But then, if an E/C provides benefits after the injury, the limitations-period clock is stopped while the one-year tolling clock begins running (and then restarts after every subsequent provision of a benefit). The limitations-period clock restarts again one year after the provision of the last benefit.

 Put a different way, the two-year SOL creates a bank of 730 days that must run out before the SOL has expired on a claim. Days are subtracted from this bank only if it has been more than one year since the last provision of benefits. If benefits are provided, a new one-year clock begins to run, and days are not subtracted from the bank until the one-year clock expires. This effectively creates an SOL that is three years from the last provision of benefits minus any time that elapsed between the date of accident and the first provision of benefits.[1] The Employer/Carrier in Estes is seeking review from the Florida Supreme Court, but the two-clock method set forth in Estes remains the applicable SOL for now.

Noah Vollmer

Bleakley Bavol Denman & Grace

nvollmer@bbdglaw.com

813-221-3759 

The New Hampshire Department of Labor will be moving to a new location in the State Office Park, on May 27, 2026. The Department’s new location will be Londergan Hall, 101 Pleasant Street, Concord, NH. The Hearings Bureau and all administrative hearing activity will remain located at the Spaulding Building, 95 Pleasant Street, Concord, NH, until further notice. Hearings and any other meeting scheduled with the Department will remain at 95 Pleasant Street, Concord, NH 03301 unless you are specifically advised otherwise.

Please be aware that, with the exception of the Hearings Bureau, Department of Labor staff and telephone lines may have limited availability, beginning on May 26, 2026, during this transition. You may continue to email the Department of Labor or leave a voicemail message during this transition period. Department staff will respond as quickly as possible once operations resume after May 28, 2026.

Claimant was involved in a 1/27/24 work accident involving an accepted head injury. Claimant later filed a Petition alleging multiple permanencies as follows: 4% to the head, 6% to the visual system, 5% to the vestibular system, 2% to the right upper extremity, and 3% to the lumbar spine. The majority of the allegations were resolved prior to Hearing, inclusive of acceptance of the head and vestibular ratings.

The Board rejected the visual system permanency allegations entirely. The Board found Employer’s medical expert more credible than Claimant’s doctor, as it was not apparent from the deposition testimony that he was aware of well-documented and significant non-work-related visual issues. The Board was also “highly concerned” with claimant’s expert basing his vision rating upon convergence insufficiency symptoms, when nobody was attributing this condition to any specific trauma to the eyes. The defense expert pointed out that convergence insufficiency was due to the concussion/brain injury, and thus was a brain rather than ophthalmologic/eye disorder. The Board agreed with the defense expert that the convergence insufficiency symptoms were covered in the accepted head and vestibular ratings. 

This is an important decision to consider when faced with allegations of multiple different permanencies from the same head injury.

Should you have any questions or concerns regarding this Decision, please contact Nick Bittner or any other attorney in our Workers’ Compensation Department.

Darriel Tynes v. City of Wilmington, IAB Hrg. No. 1543176 (Feb. 6, 2026). 

Case Caption: Crawford v. Spirit Aerosystems Inc., KS Court of Appeals Unpublished No. 128612, March 27, 2026, (cut and paste link to decision below):

https://kadc.org/EmailTracker/LinkTracker.ashx?linkAndRecipientCode=5IBRABvZ1nRMqJDkNvbnMzFKSVGDAo0HDdcpw4RCSlcYaT53tkjs65DNDRYmLI5UZzn6zdvI%2fduhQMJdh8j8x1DVS92S7LjAM8dnyHV8mVw%3d

Case Facts:

Mark Crawford worked at Spirit Aerosystems, Inc. In 2020, he began having neck pain. He claimed he reported his pain to Spirit, but the company did not send him to a doctor. Crawford saw his primary care physician and underwent an MRI, which revealed degenerative changes through his cervical spine. Crawford applied for workers compensation benefits for injuries to his cervical spine caused by repetitively lifting. Crawford's attorney referred him to Dr. Pedro Murati, whom Crawford had seen in 2008 for a previous workers compensation claim. Dr. Murati had, for that claim, diagnosed Crawford with myofascial pain affecting both shoulders and assigned him permanent restrictions. This time, Dr. Murati diagnosed Crawford with myofascial pain syndrome and impingement of the right shoulder, along with cervical polyradiculopathy. Dr. Murati attributed Crawford's injury to his "multiple repetitive traumas at work." Dr. Murati noted that Crawford reported he was completely asymptomatic before this "incident.” Spirit sent Crawford to Dr. Chris Fevurly who opined that the prevailing problem was Crawford's age and his smoking history. Dr. Fevurly did not believe Crawford's work activities were the prevailing factor cause of his condition. The Workers Compensation Court appointed Dr. Terrance Pratt as a neutral physician who determined he could not state with a reasonable degree of medical certainty that Crawford's "multilevel discogenic changes" related to his work activities. Upon referral by his primary care physician, Crawford saw Dr. John Dickerson who concluded that he needed a C3 to C7 anterior cervical discectomy and fusion, and Crawford’s work duties were the prevailing factor in his injury.

The Administrative Law Judge (ALJ), Appeals Board and Kansas Court of Appeals Decisions:

The ALJ ruled Crawford was not entitled to workers compensation benefits because Crawford did not satisfy his burden to show his repetitive job duties were the prevailing factor cause of his claimed work injury condition. The Appeals Board affirmed the ALJ’s decision after reviewing and considering all the medical expert opinions. The Court of Appeals affirmed the total claim denial, concluding that the Board’s decision was supported by substantial competent evidence. The Court of Appeals noted that Dr. Dickerson's failure to review any of Crawford's prior medical records seriously undermined the credibility of his opinions. Additionally, even though Dr. Dickerson ultimately performed surgery on claimant, Dr. Dickerson acknowledged that he "was just going by what [Crawford] said and that his symptoms began when he was injured."  The Court of Appeals noted that the Appeals Board decision denying the claim entirely, considered all the medical evidence, and on appeal the Court of Appeals does not reweigh the evidence or pass on the credibility of witnesses, the Appeals Board decision denying compensability was affirmed.

Case Take Aways For Employers/Carriers/TPA’s:

► The “prevailing factor cause” causation standard, remains a viable total claim denial defense for employers and carriers in Kansas.

► Kansas employers and carriers when defending “prevailing factor cause” claims, should consider not only one defense medical expert IME, (here it was Dr. Fevurly), but seek a second IME defense expert to confirm the initial defense expert IME opinions. This claim was litigated under a previous Kansas statute that allowed for “court ordered neutral physician” IME’s. In 2026, that statute has been changed and severe limits have been placed on court ordered neutral physician IMEs (Dr. Pratt’s winning opinion here relied on by the courts). Employers and carriers should consider retaining one of the physicians in the past typically picked as a “neutral physician” by the ALJ’s, to perform a second defense IME to confirm the initial defense IME “no prevailing factor cause” opinion. 

About the Author: This update was prepared by National Workers’ Compensation Defense Network Kansas member Kim R. Martens of the Wichita, KS firm MARTENS WORK COMP LAW LLC, a law firm dedicated to representing self-insured employers, insurance carriers, and third-party administrators in all matters related to workers compensation before the Kansas Division of Workers Compensation and the Kansas appellate courts. If you have any questions about this submission or Kansas workers compensation in general, please contact Mr. Martens by either e-mailing him at Kim@MartensWorkCompLaw.com or by calling him directly at 316-461-0135.

Division I of the Oklahoma Court of Civil Appeals has published an opinion that interprets the application of old law/new law limits on the award of permanent partial disability. It's a misnomer to call the Administrative Workers' Compensation Act (AWCA) a "new law," because it has now been in effect for 12 years.

The case is Debra Glenn v. City of Tulsa, the claimant was a police officer in Tulsa and had several accidents over a long career. His total amount of PPD awarded was over 100%.  The AWCA does not allow the Commission to award PPD if the claimant has already been awarded 100 %. The problem arose because the law in effect at the time of his old injuries allowed MORE THAN 100 % because the percentage of PPD in a case in which there was a surgery or amputation WAS DEDUCTED FROM THE TOTAL PPD. Those deductions are NOT available under the AWCA.

The Court of Civil Appeals ruled that MORE THAN 100 % PPD can be awarded in a Commission case IF the PPD awarded in old law cases involved surgeries or amputations. Those percentages must be deducted. And, if the new total PPD is under 100 %, more PPD can be awarded for the last injury.

 The opinion looks at all pertinent decisions regarding the old law vs. the new law, i.e. Carlock and Cantwell. Those decisions, plus the oft-cited case of Williams Companies v. Dunkelgod, clearly hold that the law in effect at the time of a claimant's injury controls in workers' compensation matters. The new COCA opinion highlights the language in Dunkelgod:

    "The statutes then in force [the accident date] form a part of the contract and determine the substantive rights and obligations of the parties. No subsequent amendment can operate retrospectively to affect in any way the rights and obligations which are fixed."

 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.