Tag Archive | Workers Compensation
January 9, 2026  

An Orange County Judge Pleads Guilty in Workers’ Comp Fraud Case

Right here in our own backyard, a rare and high-profile workers’ compensation fraud case just went down.

Orange County Superior Court Judge Israel Claustro has agreed to plead guilty to federal mail fraud. This fraud is tied to California’s Subsequent Injuries Benefits Trust Fund (SIBTF). The program provides financial support to injured workers with pre-existing impairments.

Before and during his time on the bench, Claustro operated Liberty Medical Group, a business that arranged medical-legal evaluations for SIBTF cases. Federal prosecutors say Claustro secretly continued using Dr. Kevin Tien Do for report preparation and record review. This occurred even after Do was suspended from the workers’ comp system in 2018. The suspension was due to a prior health-care fraud conviction.

According to federal filings:

  • Claustro paid Do over $300,000
  • Liberty billed the SIBTF more than $3 million
  • Do’s involvement was concealed from regulators

Claustro will resign as part of his plea agreement. While the charge carries up to 20 years in prison, prosecutors are recommending probation and home confinement.

This case stands out for three reasons:

  1. Unusual defendant: Cases involving sitting judges are extremely uncommon.
  2. Program vulnerability: Medical-legal reporting remains a pressure point in California’s workers’ compensation system.
  3. System trust: Fraud drains resources from injured workers and erodes confidence in public benefit programs.

Claimant and provider fraud get most of the attention. However, this case illustrates that workers’ compensation fraud risks exist at every level. It reinforces the need for oversight, credentialing, and compliance throughout the ecosystem. Because at the end of the day, businesses are paying the costs of those that fraud the system!!

-JK

December 20, 2025  

California Workers’ Compensation Market Is Hardening

After nearly a decade of soft market conditions and falling premiums, California’s workers’ compensation landscape is experiencing a significant shift.

According to multiple industry sources, including the 2026 US Workers’ Compensation Market Outlook from Risk & Insurance, California’s combined loss ratio reached 127% in 2024. This is the highest level in more than two decades. That means carriers are projected to pay $1.27 in losses and expenses for every $1.00 in premium earned which is triggering a rate response and stricter underwriting practices.

Because California represents nearly 25% of the national workers’ compensation market, what happens here influences pricing, underwriting, and coverage trends nationwide.

Why California Costs Are Rising

Several key factors are currently reshaping the workers’ compensation landscape in California according to Risk & Insurance:

  • Medical and Legal Cost Inflation: Rising medical pricing, medical-legal billing charges, and indemnity costs are driving severity higher.
  • Cumulative Trauma Claims: CT claims now account for nearly 25% of California indemnity claims, far above national averages, increasing claim complexity and cost.
  • Remote Litigation (“Telelegal”): Virtual hearings have expanded litigation activity statewide, increasing defense costs and frequency.
  • Wage Inflation: When wages go up, workers’ comp benefits increase too, especially disability payments, and it’s even more noticeable with California’s minimum wage increases.

These combined influences have reversed the pattern of declining rates, resulting in increased premium expenses across the state.

How This Is Changing Underwriting

Carriers are tightening their approach and returning to more disciplined underwriting including:

  • Higher minimum premiums
  • Fewer discretionary credits
  • More frequent debits on experience mods
  • Net renewal increases of 20% or more, even on clean accounts

Here’s my advice for California employers and their 2026 workers’ comp renewals:

  • Start early: 90+ days before expiration
  • Review loss runs and reserves carefully: inconsistencies can be costly
  • Clearly describe your risk management strategies, focusing on your safety programs and return-to-work protocols for employees.
  • Check your payroll and class codes: small mistakes can lead to significant costs

As your broker, I am committed to a proactive, strategic approach to your workers’ comp renewals, going beyond reactive tactics. This allows us to address potential issues upfront, ensuring the best outcomes for your business.

By working together, we can create impactful risk narratives, making your work comp insurance more desirable for underwriters. We can also adopt a proactive strategy to uncover cost-effective solutions through audits and in-depth reviews of safety documentation, guaranteeing the most favorable pricing and coverage.

Workers’ comp in California is at a turning point and the employers who plan ahead will be the ones who control cost, maintain coverage, and avoid last-minute surprises in 2026.

August 21, 2025  

California Workers’ Compensation: First Rate Increase in a Decade

For the first time in 10 years, California’s workers’ compensation rates are increasing.

The state has approved an 8.7% rate increase, driven by sharply rising claim costs and industry-wide financial strain.

The Workers’ Compensation Insurance Rating Bureau (WCIRB) projects the 2024 Accident Year Combined Ratio at 127%. This is the highest ratio since 2001.

Put simply, carriers are paying out $1.27 for every $1.00 of premium collected, which is unsustainable without pricing adjustments.

Why Are Costs Rising?

There are three major culprits behind the jump in workers’ compensation costs:

  1. Cumulative Trauma (CT) Claims
    CT claims are injuries that occur over time rather than from a single incident. They are rising rapidly. These claims are more complex, harder to close, and often stay open for years, adding significant cost to the system.
  2. Rising Medical Costs
    After years of stability, medical costs turned sharply upward in the past year. Factors include higher provider charges, more advanced (and expensive) treatments, and longer recovery times.
  3. Increased Litigation
    Loss adjustment expenses are climbing as litigation becomes more common. Disputes over claims often extend case duration’s and increase settlement values.

Together, these trends are straining the workers’ comp system. Unfortunately, employers will start to feel the impact as a result. It shows in the form of higher premiums.

What This Means for Employers

If you’re a California employer, expect workers’ comp pricing to firm in the coming policy renewal cycles. While legislation may eventually need to address systemic cost drivers, the immediate impact is higher insurance costs.

Now [and always] is the time to:

  • Focus on claims prevention: Invest in workplace safety programs and early intervention for injuries.
  • Review your claims history: Cumulative trauma claims often arise when small issues aren’t addressed quickly.
  • Work with an experienced broker: Having the right advocate can help you navigate pricing changes. They can also help you in exploring coverage options. Additionally, they implement risk management strategies to control costs.

My Take

While rate increases are never welcome news, disciplined carriers and proactive employers can still manage costs effectively. As your broker, our role is to help you stay ahead of these changes. We control risks and make sure you’re partnered with carriers who remain stable, consistent, and service-oriented. This is crucial in a hardening market.

-JK