What Injured Workers Must Know About Alternative Dispute Resolution (ADR) Carve-Outs in California
When you’ve suffered a job-injury and you’re headed into the world of workers’ compensation, you probably expect the familiar route: claim-form, medical care, temporary disability, possible permanent disability, and resolution through the Workers’ Compensation Appeals Board (WCAB).
But there’s a different path — one that many don’t write about, understand, or recognise until it’s too late: the ADR (Alternative Dispute Resolution) carve-out system.
In this article we explain how it works, why it matters, and why you should have attorneys like us — David, A. Lee & Michael E. Lee at Lee Partners Law —to review your case immediately if your employer is in one of these programs.
What is an ADR (Carve-Out) Program?
In California, the Legislature authorised alternate workers’ compensation dispute-resolution systems under specific statutes.
For example:
California Labor Code Section 3201.5 allows a union and employer to establish an ADR system that supplements or replaces parts of the regular system in the construction industry.
A related statute, California Labor Code Section 3201.7, extends ADR options beyond construction to other industries under collective bargaining agreements.
These systems are often dubbed “carve-out” programs because they carve the claim handling out of the normal WCAB path.
In short: if your employer and union opted into one of these programs (and had it approved by the California Division of Workers’ Compensation (DWC) or similar) then your case may not be handled under the regular workers’ compensation process.
The rules are often altered signifigantly.
Key Differences That Injured Workers Must Know
If you find yourself subject to an ADR program, the differences are substantial. Here are the main ones:
1. Jurisdiction
Under a valid carve-out ADR program, the WCAB may not have jurisdiction over your claim in the usual way. Instead, the program’s rules (mediation, arbitration, ombudsman) will govern.
If you wrongly file at the WCAB instead of the ADR forum, your claim may be dismissed and if you miss a timeline in the ADR program, you will be time barred from bringing a legitmate serious injury claim.
2. Deadlines and procedural rules
Each ADR program writes its own rules: its own deadlines, its own list of providers, its own medical‐evaluation processes. These deadlines are often much tighter and more fatal if missed. For instance, in one ADR program the employee has 30 days to request a panel of mutual doctors if they disagree with the primary treating physician’s findings. If you don’t, you’re stuck.
Because the rule-set is private (between employer/union/insurer) it’s critical to review it as soon as you are in the program.
The rules are often confusing, byzantine, and many Work Comp Attorneys do not even understand them. That’s why having a certified expert who can quickly read, digest, and understand the rules is key.
3. Medical evaluations, treating physicians, and conservative doctors
Many ADR programs negotiate exclusive‐provider lists, clinic panels, or insurer/union‐approved doctors. That means you may be sent to a very conservative occupational clinic whose findings you don’t realise you can challenge.
In the normal WCAB system you might have more latitude (although still many pitfalls). In ADR you may have fewer options or a stricter process to change doctors or challenge doctors. Some programs require you to use a panel of Qualified Medical Evaluators (QMEs) selected under the ADR rules.
4. Role of ombudsman / mediator / arbitrator
Many ADR programs introduce new steps: an ombudsman (neutral assistance for injured workers), mediation / arbitration. For example, the City of Los Angeles Personnel Department ADR Program uses an ombudsman, mediators and binding arbitrators instead of the Judges at the Workers’ Compensation Appeals Board. The mediators are essentially the Judges.
5. Representation by an attorney
One of the biggest misunderstandings: yes, you can have an attorney represent you in ADR — you should. Even if you’ve been through workers’ compensation before, ADR is a different animal. At Lee Partners Law we immediately review the ADR rules when a client is in one of these programs to make sure deadlines are met and rights preserved.
Why This Matters for Injured Workers
If you’re an injured worker (outside of healthcare workers, who we’re not covering here) and you think your employer may have opted into an ADR carve-out, it’s critical for three main reasons:
You could lose rights by accident. Because the ADR program may have deadlines or procedural traps you’re not familiar with. If you miss a deadline (e.g., the 30 day panel request you referenced) you may lose the ability to challenge medical findings, change treating doctors, or dispute causation.
You may underestimate the conservatism of provider selection. If you are sent to an occupational clinic that is very conservative, you may be pushed to settle early or accept a low permanent disability (“WPI” rating) or minimal future care. At Lee Partners Law we understand the importance of the AMA Guides 5th Edition in setting whole person impairment (WPI) in workers’ compensation and we apply it whether in ADR or standard system.
You need prompt attorney review. Because the carve-out rules can change the forum, the process, the deadlines. Simply assuming the “regular” workers’ compensation path could be a costly mistake. We at Lee Partners Law excel in all workers’ compensation cases and don’t shy away from ADR. But the moment you identify you may be in an ADR program, you need to act. We also ensure the doctors that must be appealed, are.
Common ADR Programs You May Encounter
As you mentioned, a few of the known ADR carve‐out programs:
Samuel Hale Workers’ Comp ADR Program (union/contractor carve-out)
The City of Los Angeles ADR Program (for certain civilian and police sworn employees)
Programs through major unions and employer groups
If your employer is part of a union agreement or safety group that mentions “alternative workers’ compensation dispute resolution” or “carve‐out,” you likely are in one of these programs.
What You Should Do (Checklist)
If you think you are in an ADR carve‐out program, here’s what to do:
Immediately ask your employer or union whether your work-injury claim is subject to a carve-out ADR program (i.e., under Labor Code § 3201.5 or § 3201.7).
Get a copy of the ADR rules: deadlines, mediator/ombudsman/arbitrator roster, medical provider list, change-doctor rights, QME/AME rules, etc.
Have an attorney review the rules and compare to your case facts (injury, medical treatment, potential permanent impairment, return to work issues).
Ask whether you were automatically enrolled in the ADR program (sometimes the agreement is set before your injury).
Calendar all deadlines from the ADR rules and make sure you comply. A missed deadline can be fatal.
Don’t assume you cannot change doctors or challenge opinions — many ADR programs allow it but under tighter windows.
Obtain and preserve all medical records, treatment logs, communications. Even in ADR you’ll need strong documentation to fight for WPI (using the AMA Guides 5th Edition) and future care.
If you’re unsure whether you’re in ADR or the regular WCAB system, get legal help to confirm quickly. The forum matters.
Why Choose Lee Partners Law for ADR Cases
At Lee Partners Law, we are experienced with both standard workers’ compensation and ADR carve-out cases. When a client is in an ADR program we:
Immediately review the applicable ADR rules upon intake.
Identify the deadlines and procedural traps up front.
Evaluate the medical evidence, potential impairment under the AMA Guides 5th Edition, and future care needs.
Advocate aggressively for the injured worker’s rights — not shying away because the program is “tight” or “fast-moving.”
Provide timely communication and ensure you understand the differences between ADR and the regular system.
If you’re an injured worker and suspect you may be in an ADR program — call or text us at Lee Partners Law. The difference in the process can affect your rights, your medical care, and your long-term disability benefits.
Final Thoughts
Alternative Dispute Resolution carve-out programs under California’s Labor Code (such as § 3201.5 and § 3201.7) are legitimate systems, but they come with significantly different rules, tighter deadlines, and unique pitfalls compared to the standard workers’ compensation track.
If you’re injured on the job and your employer has opted into one of these programs, or you’re unsure — don’t wait. Time is of the essence. At Lee Partners Law we review these matters right away for our clients so that no deadline is missed and no opportunity for benefits is lost.
We serve all of Southern California, Los Angeles, Inland Empire, Ventura County, Santa Barbara, The High Desert, Palmdale, and Riverside.
CALL TEXT, OR EMAIL US FOR A FREE CONSULTATION TODAY AT 310-295-0822