California Court Holds Tribal Health Provider Immune From WCAB Claim

A California workers’ compensation claim may fall outside the jurisdiction of the Workers’ Compensation Appeals Board when the employer is an entity entitled to tribal sovereign immunity.

In United Indian Health Services, Inc./Tribal First v. Workers’ Compensation Appeals Board (Hemstead) (2025) 111 Cal.App.5th 1064, the First District Court of Appeal held that United Indian Health Services was an “arm of the tribe” and therefore immune from a state workers’ compensation proceeding. The California Supreme Court later denied review, and the WCAB ultimately dismissed the state claim for lack of jurisdiction.

Read the published opinion on CourtListener.

How the Jurisdictional Dispute Arose

Deborah Hemstead alleged that she was injured in 2014 while working as a medical assistant for United Indian Health Services. She initially received benefits and treatment through the organization’s tribal workers’ compensation system. After a dispute arose, she filed a claim in California’s state workers’ compensation system.

United Indian argued that tribal sovereign immunity prevented the WCAB from adjudicating the claim. A workers’ compensation judge rejected the immunity defense after applying California’s five-factor “arm of the tribe” test. The WCAB denied reconsideration and adopted the judge’s analysis. United Indian then obtained appellate review.

What Is the “Arm of the Tribe” Test?

Indian tribes possess sovereign immunity from suit unless Congress abrogates that immunity or the tribe waives it. Immunity may also protect a related entity when the entity functions as an arm of the tribe.

California courts evaluate five nonexclusive factors: how the entity was created, whether the tribe intended to share its immunity, the entity’s purpose, the degree of tribal control, and the financial relationship between the entity and the tribe. No single factor automatically controls. The ultimate question is whether extending immunity would further tribal self-governance and self-sufficiency.

How United Indian Health Services Was Organized

The California Rural Indian Health Board was formed by 18 tribes to administer health services under the federal Indian Self-Determination and Education Assistance Act. Participating tribes authorized the Health Board to contract with United Indian Health Services to provide care to tribal members in and around Humboldt and Del Norte Counties.

United Indian was organized as a California nonprofit rather than under tribal law. That fact weighed against immunity to some degree, but it did not decide the case. Several tribes helped create the organization and authorized it to deliver healthcare under the federal self-determination framework. The court concluded that those circumstances tipped the creation factor toward immunity.

Healthcare Purpose and Tribal Control Favored Immunity

The court gave significant weight to United Indian’s mission. Providing healthcare to tribal communities directly advances tribal welfare, self-sufficiency, and self-government. Unlike a remote commercial venture operated primarily by outsiders, United Indian performed a core governmental and community function.

The participating tribes also exercised meaningful control. Each federally recognized participating tribe selected a representative to United Indian’s board of directors. The tribes appointed a majority of the board, which oversaw the organization’s affairs, approved contracts, received reports, and addressed litigation. The tribes also retained approval authority over the healthcare arrangements made on their behalf.

The presence of additional elected board members did not negate the tribes’ majority control. The appellate court found that the workers’ compensation judge had placed too much weight on the fact that not every director was directly appointed by a tribe.

The Financial Relationship Also Supported Immunity

United Indian received federal healthcare funding through the California Rural Indian Health Board. Although a judgment against United Indian would not necessarily be collected directly from a tribal treasury, it would reduce the funds available to provide healthcare to tribal members.

That practical consequence mattered. Tribal immunity is not limited to cases in which a judgment would formally reach a tribe’s bank account. A substantial diversion of federally supported healthcare resources can undermine the same interests in tribal self-governance and self-sufficiency that immunity protects.

Express Intent Was Not Required to Carry the Analysis

The record contained little express documentation stating that participating tribes intended to share their immunity with United Indian. The court treated that factor as weighing somewhat against immunity.

It did not end the inquiry. The remaining factors—the organization’s creation by tribes, its central healthcare purpose, tribal control, and the effect of liability on tribal health resources—showed that United Indian functioned as an arm of the tribes it served.

What the Court Did—and Did Not—Decide

The Court of Appeal reversed the WCAB’s denial of reconsideration and remanded for proceedings consistent with its holding that United Indian was immune. The court did not decide whether United Indian independently qualified as a “tribal organization” under the federal self-determination statute. Its decision rested on the arm-of-the-tribe doctrine.

The opinion was modified and certified for publication on June 10, 2025, without changing the judgment. The California Supreme Court denied review on September 17, 2025. On May 7, 2026, the WCAB issued its decision after remittitur, concluding that sovereign immunity deprived it of jurisdiction to adjudicate Hemstead’s state-law claim.

Practical Takeaways for Workers and Tribal Employers

The decision does not establish that every organization serving Native American communities is immune from state workers’ compensation proceedings. The analysis remains entity-specific and fact-intensive.

Workers and counsel should identify the employer’s legal structure, governing documents, tribal resolutions, funding source, management, and any tribal compensation system early in the case. Tribal employers and affiliated entities, meanwhile, should maintain clear records showing how participating tribes create, control, fund, and benefit from the organization.

When tribal immunity applies, the state WCAB may not be available even when the worker alleges an otherwise compensable industrial injury. That makes it especially important to investigate promptly whether relief exists under a tribal compensation program or another authorized process.