Starting January 1, 2026, California’s SB 291 takes a firmer approach to uninsured contractors by increasing penalties and strengthening enforcement of workers’ compensation coverage in the construction industry. SB 291 requires the Contractors State License Board (CSLB) to confirm that contractors claiming an exemption truly have no employees. The goal is simple: reduce fraud, make sure workers are properly covered, and improve accountability across the industry.
While SB 291 doesn’t change QME laws or reporting standards, it tackles a long-standing issue in construction claims, delayed or disputed insurance coverage. Those delays often push orthopedic evaluations far down the road, complicating medical-legal decision-making and making it harder to evaluate injuries accurately.
Orthopaedic QMEs are often asked to evaluate cases only after coverage disputes are resolved, sometimes months or even years after the alleged injury. By encouraging earlier confirmation of coverage, SB 291 is expected to reduce these delays and allow orthopedic evaluations to take place closer to the reported date of injury. Earlier assessments generally lead to more reliable physical findings, better imaging correlation, and more accurate functional evaluations, all critical to well-supported orthopedic opinions.
Construction injuries frequently involve high-force events, repetitive loading, and multi-joint complaints that change over time. When claim timelines are clearer and employment histories are better documented, Orthopaedic QMEs are better positioned to determine whether the findings match the claimed mechanism of injury or instead reflect preexisting or degenerative conditions. This distinction is especially important in cases involving cumulative trauma or prior industrial injuries.
Ultimately, SB 291 doesn’t change how Orthopaedic QMEs practice, but it does aim to improve the conditions under which orthopedic medical-legal evaluations are performed. By promoting insurance compliance and reducing administrative uncertainty beginning in 2026, the law supports a workers’ compensation system where orthopedic opinions are issued earlier, based on clearer records, and better equipped to resolve disputes fairly and efficiently.