MICHAEL SULLIVAN & ASSOCIATES BLOG

The scope of California's jurisdiction over cumulative trauma claims filed by professional athletes has long been a contentious issue. California workers' compensation laws are generally more liberal than laws in other states. So professional athletes commonly file workers' compensation claims in California, even when they have a limited connection to the state and have long histories of playing for out-of-state teams.

In 2013, the Legislature passed AB 1309, which amended Labor Code § 3600.5 to limit workers' compensation claims in California by out-of-state professional athletes. The bill was intended to address a loophole in the California workers' compensation system that was deemed to be detrimental to state interests and to its sports teams. Specifically, as a result of the "last employer over which California has jurisdiction" rule, California teams were facing cumulative injury claims from players with extremely minimal California contacts, but substantial playing histories for teams in other states. In addition, out-of-state sports teams were having claims filed against them in California, resulting in several consequences including: (1) clogging the WCAB with cases that should be filed in another state, thereby delaying cases of California employees; (2) forcing insured California employers to absorb rapidly escalating costs being incurred by CIGA; and (3) increasing pressure on insurers to raise workers' compensation rates in California to cover the rising and unanticipated costs.

In an important development, the well-known Patterson case has been reversed by a Court of Appeal. Patterson is the significant panel decision that held that certain types of continuing care were not subject to utilization review (UR) and independent medical review (IMR). This decision, Illinois Midwest Insurance Agency LLC v. WCAB (Rodriguez) has held that the Patterson reasoning was inapposite of the statutory language, and has subjected continuing care to UR/IMR.

BACKGROUND

With the enactment of Senate Bill 863 in 2012, the California Legislature established the independent medical review (IMR) process. It became effective for all treatment requests Jan. 1, 2013. The IMR process replaced judicial review as the method to appeal UR decisions regarding all proposed medical care. Under the statutory scheme, all proposed medical care is to be requested by a physician submitting a request for authorization (RFA). That request is reviewed by UR, and may be appealed only to IMR. Judicial review of such care for reasonableness was no longer allowed (later case law established the sole exception — being for late UR).

California Code of Regulations, Title 8, § 30 establishes the process by which a party may request a panel of qualified medical evaluators (QMEs) from the DWC Medical Unit. CCR 30(b) applies when an employee is represented by an attorney. It requires a party requesting a panel to provide specified information, including the claim number.

Previously, the Workers’ Compensation Appeals Board (WCAB) has been inconsistent as to whether a party's failure to provide the correct claim number renders a panel request invalid. In Sidahmed v. Alameda County Counsel, 2024 Cal. Wrk. Comp. P.D. LEXIS 103, the WCAB held that a defendant's failure to provide the correct claim number rendered its request for the issuance of a panel of QMEs void ab initio. But later, it held in Salamat v. SBM Site Services, 2025 Cal. Wrk. Comp. P.D. LEXIS 28, that an applicant's request for a panel was not invalid, even though she mistakenly listed a specific injury claim number on the panel request rather than the intended cumulative injury claim number, stating, "To find otherwise would place form over substance."

For more than two decades, the law governing the identification of liable parties has been shaped by the Workers' Compensation Appeals Board’s en banc decisions in Coldiron v. Compuware Corp. In Coldiron I,^[1] the WCAB held that a third-party administrator (TPA) has a duty to disclose the identity of its client — whether a self-insured employer or an insurance carrier. Crucially, if the client is an insurance carrier, the TPA also must disclose whether the policy includes a "high self-insured retention," a large deductible or any other provision that affects the identity of the entity ultimately liable for payment. The WCAB warned that failure to do so could result in sanctions.

In Coldiron II,^[2] the WCAB declined to impose sanctions, as it was a case of first impression, but reiterated that the disclosure holdings remained in full force and effect.

The use of sub rosa surveillance video is a powerful tool in workers' compensation, often used to challenge an applicant’s credibility regarding the claimed level of disability. The timing and procedure for providing such evidence can be a point of significant dispute.

The Workers' Compensation Appeals Board (WCAB) has long recognized that a defendant may withhold surveillance video until after an applicant's deposition. In Downing v. City of Hayward (1988) 16 CWCR 76 (panel decision), the WCAB explained:

The use of artificial intelligence (AI) is increasing throughout society, and its use in law is no exception. AI provides tools for lawyers to quickly and effectively deliver legal services. Many lawyers use AI for both routine and complicated legal tasks, and those who do not risk falling behind.

As an emerging technology, however, AI is not infallible. Even the most advanced AI models have limitations and might not be familiar with all of the procedural and substantive court rules. A recent Workers' Compensation Appeals Board (WCAB) panel decision illustrates the dangers of relying entirely on AI to draft legal pleadings, and provides a stark warning about attorney oversight in an era of increasing reliance on AI.

Effective Jan. 1, 2022, the Workers' Compensation Appeals Board (WCAB) adopted regulations regarding electronic hearings. Remote hearings initially were used during the COVID-19 pandemic, but because such proceedings increased access to the workers' compensation system for parties, their representatives and the public, the WCAB believed that making the changes permanent would benefit the public and the administration of the workers' compensation adjudicatory system.

California Code of Regulations, Title 8, § 10745 states that the WCAB "may order that hearings be conducted electronically." CCR 10750 states that a notice of hearing must include "whether the hearing will be conducted electronically and how to access any electronic hearing."

The procedural rules governing discovery in workers' compensation cases serve critical purposes in ensuring fair and efficient adjudication. In particular, Labor Code 5502(d)(3) establishes that discovery closes on the date of the mandatory settlement conference (MSC), with strict limitations on the admission of evidence not disclosed in pretrial conference statements. Those rules are fundamental to the workers' compensation system's goal of expeditious resolution while maintaining due process protections.

On May 16, 2025, the 3rd District Court of Appeal in DPR Construction v. WCAB (McClanahan) (2025) 111 Cal. App. 5th 1136 issued a decision clarifying the discovery rules and addressing the standards for credibility findings under LC 5313. The decision was certified for publication June 11, 2025, ensuring its precedential value across California's workers' compensation system.