MICHAEL SULLIVAN & ASSOCIATES BLOG

Under the judicially created going and coming rule, an employee's injury while commuting to and from work is not compensable under the workers' compensation system, absent special or extraordinary circumstances. That's because long ago, the California Supreme Court believed that an employee going to and from the place of employment did not render any service for the employer. (Ocean Accident and Guarantee Co. v. IAC (1916) 173 Cal. 313, 322.)

But, "In an effort to create a sharp line of demarcation as to when the employee's commute terminates and the course of employment commences, courts adopted the premises line rule, which provides that the employment relationship generally commences once the employee enters the employer's premises." (Wright v. State of California (2015) 233 Cal. App. 4th 1218, 1231.) Injuries occurring after an employee has arrived on the employer's premises generally are presumed compensable as arising in the course of employment. Moreover, what constitutes the employer's premises has been broadly interpreted. The Supreme Court has stated, "The employer's premises include his parking lot as well as plant or office, and once the employee has reached the premises, employment is not interrupted by crossing public property while traveling from one part of the premises to another." (General Insurance Co. v. WCAB (Chairez) (1976) 16 Cal. 3d 595, 598-599.)

It’s the December Rhino Round-up! Last month was filled with camaraderie, laughter, and an unforgettable firm-wide holiday party!

If you'd like to join MS&A at one of our upcoming events, just follow us on one of our social media channels--we're on LinkedIn, Instagram, Facebook, and X. We'd love to have you attend one of our events!

In 2020, the California Legislature passed Senate Bill 1159 (SB 1159), which established a rebuttable presumption for specified employees that illness or death resulting from COVID-19 arose out of and in the course of employment. The presumptions were established in Labor Code §§ 3212.86, LC 3212.87 and LC 3212.88.

In the Senate Floor Analysis for SB 1159, the Legislature believed that the burden of fighting COVID-19 had fallen disproportionately on a small group of workers in both the private and public sectors. The presumptions were enacted to reduce the barriers to accessing the workers’ compensation system for essential workers suffering from COVID-19.^[1] So for several years, the COVID-19 presumptions made it easier for many workers to prove entitlement to workers' compensation benefits for illnesses related to COVID-19.

The Workers' Compensation Appeals Board (WCAB) has historically and increasingly faced a struggle to handle the volume of cases that come its way. As a result, too often it has failed to take action on a filed petition for reconsideration within the statutorily required 60 days. To date, parties have been protected from that failure because it was deemed a due process right to have the petition reviewed by the WCAB. Currently, scores and perhaps hundreds of cases are in that situation. In a new appellate court case, Zurich American Insurance Co. v. WCAB, it all seems to have changed, leaving all those parties without a remedy, and changing the reconsideration demands on practitioners.

Michael Sullivan & Associates is once again proud to support Children's Hospital Los Angeles! On November 11th, CHLA will be holding its annual Pedal4Kids fundraiser at Cyclebar in Santa Monica.The event will raise funds to support the Division of Urology, funding world class surgical care, education, family support, and research. The Division of Urology at CHLA, #6 in the Best Hospitals US News and World Report, is one of the busiest and most comprehensive programs of its kind. CHLA physicians care for 12,000 patients and perform more than 3,000 surgeries annually.

If you can't join us at the Pedal4Kids event this year, please consider donating to CHLA on our "Rhino's Team" web page on the CHLA site. We hope to see you on November 11th!

In our ongoing effort to better serve you and adapt to the changing needs of the workers’ compensation industry, we're proud to announce the official launch of our Audit Services department. Over the past few years, several respected self-insured employers and third-party administrators have approached us, either in the aftermath of a challenging audit or in preparation for an anticipated one, seeking our expertise and guidance in navigating the complex world of audits and regulatory compliance. Led by Senior Partner, Pilar Mitchell, our dedicated team of attorneys and industry experts has not only successfully guided numerous companies through these intricate OSIP and DWC audit processes but has also demonstrated how engaging our team early can significantly amplify the effectiveness of our assistance.

We’re excited to announce that our Employers’ Legal Lounge podcast is now live! Episode 1, with special guest Tara Fournier, is ready to listen to on your favorite podcast app or website — just visit the podcast's web page for links.

Tune in every month as Michael Sullivan & Associates attorney, Eric De Wames, and a rotating roster of guest experts discuss the most recent developments, emerging trends, and effective strategies within California's dynamic employment law environment. Each month, Eric will dive deep into the most recent cases, legislation, and general trends to provide you with valuable insights and guidance for navigating the complex world of employment regulations in the Golden State.

An employer must conduct utilization review (UR) to determine whether to approve, modify or deny a request for treatment. If the medical services have not been provided, Labor Code 4610(i)(1) normally requires the UR determination to be made within "five normal business days from the receipt of a request for authorization for medical treatment and supporting information reasonably necessary to make the determination, but in no event more than 14 days from the date of the medical treatment recommendation by the physician." California Code of Regulations § 9792.9.1(c)(3) generally requires prospective or concurrent UR decisions to be made within five business days from the date of receipt of the completed DWC form RFA (request for authorization).