- California Receives $4.1M From Gilead Sciences for Illegal Kickbackson July 17, 2025 at 11:49 AM
Gilead Sciences, Inc. is an American biopharmaceutical company headquartered in Foster City, California, that focuses on researching and developing antiviral drugs used in the treatment of HIV/AIDS, hepatitis B, hepatitis C, influenza, and COVID-19, including ledipasvir/sofosbuvir and sofosbuvir. Gilead is a member of the Nasdaq-100 and the S&P 100.
California joined a coalition of 48 other attorneys general in securing $202 million from Gilead Sciences, Inc. (Gilead), for running an illegal kickback scheme to promote its HIV medications. Gilead allegedly violated federal law by illegally providing incentives – including awards, meals, and travel expenses – to healthcare providers to prescribe Gilead’s medications, resulting in millions of dollars of false claims submitted to government health care programs, including Medi-Cal.
The settlement in principle, reached in coordination with the U.S. Department of Justice and approved by the U.S. District Court for the Southern District of New York, provides $49 million for Medicaid programs nationwide, including $4,118,184 for California, with the remainder going to Medicare, Tricare, and the AIDS Drug Assistance Program (ADAP).
From January 2011 to November 2017, Gilead allegedly violated federal anti-kickback laws by providing gifts to healthcare providers who attended and spoke at promotional speaker programs for Gilead’s HIV drugs: Stribild, Genvoya, Complera, Odefsey, Descovy, and Biktarvy. Gilead paid high-volume prescribers tens to hundreds of thousands of dollars to present as “HIV Speakers.” The company also covered travel expenses for speakers, including those traveling long distances and to attractive destinations, such as Hawaii, Miami, and New Orleans, and hosted dinners at high-end restaurants.
Gilead’s internal compliance mechanisms failed to halt these violations. The company’s internal policies and procedures failed to prevent its sales representatives from improperly offering incentives to induce prescriptions.
The Division of Medi-Cal Fraud and Elder Abuse receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $69,244,976 for Federal fiscal year (FY) 2025. The remaining 25 percent is funded by the State of California. FY 2025 is from October 1, 2024 through September 30, 2025.
Gilead Sciences has had at least one prior problem with resolving claims for illegal kickbacks. Back in 2020 Gilead agreed to pay $97 million to resolve claims that it violated the False Claims Act by illegally using a foundation, Caring Voice Coalition (CVC), as a conduit to pay the Medicare co-pays for its own drug, Letairis.
In that prior case the government alleged that Gilead used CVC, which claimed 501(c)(3) status for tax purposes, as a conduit to pay the co-pay obligations of thousands of Medicare patients taking Letairis, which is approved to treat pulmonary arterial hypertension (PAH). According to the government’s allegations, Gilead used CVC to cover the patients’ co-pays in order to induce those patients’ purchases of Letairis. Gilead knew that the prices it set for Letairis otherwise could have posed a barrier to those purchases.
- Liberty Mutual Releases 2025 Workplace Safety Indexon July 17, 2025 at 11:49 AM
Liberty Mutual Insurance has released its 2025 Workplace Safety Index, revealing the leading causes and financial impact of the most serious workplace injuries in the US.
For 25 years the Index has identified the top ten causes of workplace injuries - those causing an employee to miss more than five days of work - and ranked them by their medical and lost-wage payments. These ten causes account for over 86% of the total cost of all workplace injuries, $58.78B.
“The Index provides employers a trusted roadmap for improving workplace safety,” said Liberty Mutual Senior Vice President and General Manager, Risk Control, Dorothy Doyle. “We’re proud to provide this important report, which offers valuable data and insights to help employers prevent injuries and manage risks more effectively, underscoring our commitment to protecting workers and supporting safer, more resilient businesses.”
Its objective data and actionable insights have never been more important because companies today face fewer but more expensive workplace injuries. In fact, the rate of serious workplace accidents fell by about 40 percent over the 25 years represented by the Index, while the total cost of workers compensation benefits increased by 30 percent, according to data from the Bureau of Labor Statistics and National Academy of Social Insurance. Key Findings:
Top Injury Causes:
- - Overexertion involving outside sources remains the #1 cause, accounting for $13.7 billion in costs, largely due to manual material handling.
- - Falls on the same level is the #2 cause, with $10.5 billion in costs, emphasizing the need for slip, trip, and fall prevention strategies.
- - Struck by object or equipment and Falls to a lower level also continue to be major injury drivers, together accounting for nearly $11.6 billion in costs.
- - Injuries due to Other exertions and bodily reactions, Roadway incidents, and Caught-in or compressed by equipment also feature prominently in the top 10, underlining the diverse risks present in today’s workplaces.
Consistency of findings 2001-2025:
- - Overexertion and Falls on same level have been the #1 and #2 causes in each Index.
- - Seven of this year’s top 10 injury causes appeared in all 25 indices.
Liberty Mutual also produces eight industry-specific indices detailing injury causes and costs in Manufacturing, Construction, Healthcare & Social Services, Professional & Business Services, Retail, Wholesale, Leisure & Hospitality and Transportation & Warehousing.
The Liberty Mutual Workplace Safety Index is based on information from Liberty Mutual, customized data from the U.S. Bureau of Labor Statistics (BLS) Office of Safety, Health, and Working Conditions, and the National Academy of Social Insurance (NASI). BLS non-fatal injury data are analyzed with the Liberty Mutual data to determine which events caused employees to miss more than five days of work, and then to rank those events by workers compensation costs, which are then scaled to the NASI total cost. To capture accurate injury cost data, each index is based on data three years prior. Accordingly, the 2025 index reflects 2022 data.
- Private Self-Insured Claim Counts Are Down But Losses Are Upon July 16, 2025 at 1:28 PM
California’s private self-insured employers reported 7,026 fewer workers’ compensation claims in 2024 than in 2023 (-7.4%), pushing private self-insured claim frequency to a 4-year low, but for the second year in a row the average paid and incurred losses on these claims increased, driving total paid and incurred losses higher according to a California Workers’ Compensation Institute (CWCI) review of initial data from the state Office of Self-Insurance Plans (OSIP).
The annual summary of private self-insured data posted on OSIP’s website last week, offers an initial snapshot of California private, self-insured claims experience for cases reported in 2024, noting the number of covered employees, medical-only and indemnity claim counts, and total paid and incurred losses on those claims through the end of the year. The 2024 summary shows the experience of private self-insured employers who covered 2.25 million California employees last year (down from 2.34 million in the 2023 first report) and who reported 87,360 claims in 2023, down from 94,386 claims in the 2023 initial report.
According to the latest summary, private self-insured employers reported 45,170 medical-only claims in 2024 (down 7.1% from 48,404 in 2023, the first full year following pandemic), though that was still 3.2% above the 43,779 med-only claims noted in 2020, when med-only claim volume plummeted during the brief, pandemic-driven recession. At the same time, the number of private self-insured indemnity claims, which spiked during the pandemic due to the flood of COVID-19 lost-time claims then fell 13.0% as COVID claim volume dropped in 2023, fell for the second year in a row, declining by 8.2% to 42,190 claims in 2024.
The 2024 claim count translates to an overall frequency rate of 3.88 claims (2.01 med-only and 1.87 indemnity) per 100 private self-insured employees, down from an overall rate of 4.03 in 2023 (2.07 med-only and 1.96 indemnity), marking the second consecutive year-over-year decline in private self-insured claim frequency, and pushing the overall rate to the lowest level since 2020.
Despite decreasing claim volume and claim frequency, private self-insured’s first report total paid and incurred losses both increased for the second year in a row last year. Paid losses on the 2024 private self-insured claims through the end of the year totaled $353.6 million, up 3.9% from the first report total for 2023, as total paid medical increased by $10.2 million (6.1%) to $177.6 million, and total paid indemnity (primarily temporary disability payments) increased by $3.2 million (1.9%) to $176.0 million. First report total incurred losses (paid benefits plus reserves for future payments) on 2024 private self-insured claims rose to $934.3 million, up $30.6 million, or 3.5% from the 2023 total, as first report incurred medical increased by $39.8 million (7.9%) to $542.3 million and total incurred indemnity increased by $30.6 million (8.5%) to $392.0 million.
Even though there were 7,026 fewer private self-insured claims in 2024 than in 2023 (including 3,792 fewer indemnity claims) the growth in private self-insureds’ total paid and incurred losses in 2024 can be traced to the growth in average paid and incurred losses at the first report, as average paid losses per claim rose 12.3% to $4,047 while average incurred losses rose 16.8% to $10,695.
OSIP’s summary of private self-insured’s calendar year 2024 data, follows the December 2024 release of public self-insured claims data for fiscal year 2023/2024. OSIP private and public self-insured claim summaries from the past 20 years are posted at https://www.dir.ca.gov/SIP/StatewideTotals.html. CWCI members and subscribers may log on to the Communications section of the CWCI website www.cwci.org to view a summary Bulletin with more details, analyses, and graphics.
- DOI Warns State Leaders About Rising Comp Costson July 16, 2025 at 1:28 PM
The California Insurance Commissioner issued a letter to state leaders alerting them to growing costs in California’s workers’ compensation system, which can impact California businesses.
This action follows the Commissioner’s adoption of a new Workers’ Compensation Insurance Claims Cost Benchmark and an Average Advisory Pure Premium Rate, which reflects an 8.7% increase over last year’s approved rate.
This year, there was consensus among actuarial experts that costs are rising and a meaningful increase in the average pure premium rate is justified and supported by the data. Experts on behalf of the California Department of Insurance, the Workers’ Compensation Insurance Rating Bureau (Bureau), and the Bureau’s public members differed only slightly on how much the rate should increase – a departure after more than a decade of steady or decreasing average advisory pure premium rates.
The Department’s experts recommended an average advisory pure premium rate of $1.52 per $100 of payroll, which was adopted by the Commissioner. The adopted rate is advisory, meaning that insurance companies are not bound by it and are free to set their own rates. The new rate will be effective on September 1, 2025.
Higher medical treatment and medical-legal costs, a greater number of projected cumulative trauma claims, and escalating costs associated with adjusting claims have all resulted in deteriorating accident year combined ratios, while at the same time, the rates charged by insurers have remained low. The Bureau’s projected combined ratio for accident year 2024 is estimated to be 123% - the highest level in nearly 15 years - and surpasses levels seen prior to the implementation of the SB 863 reforms that began in 2012.
“The Governor and Legislature acted over a decade ago to enact far-reaching reforms that have helped to reduce workers’ compensation rates,” wrote Commissioner Lara in his letter to Governor Newsom, Senate President Pro Tempore Mike McGuire, and Assembly Speaker Robert Rivas.
“For the past decade, the pure premium rates adopted by myself and the previous insurance commissioner have shown continued progress toward reducing excessive costs in the system while protecting injured workers. Because higher insurance rates can affect businesses’ ability to hire and sustain financial growth, it is important to be aware of early warning signs and respond appropriately.”
“We must be proactive in analyzing and addressing these early warning signs of a shift in market conditions in order to foster a vibrant and competitive insurance marketplace,” said Commissioner Lara. “Our workers’ compensation system is designed to help injured workers and keep costs down for employers. These considerations should guide us in striving for data-driven solutions.”
- 70% of Cases Have Spontaneous Resorption of Herniated Discon July 15, 2025 at 10:05 AM
According to a study published this year in the Journal of Inflammation Research - Mechanisms and Factors Influencing Resorption of Herniated Part of Lumbar Disc Herniation: Comprehensive Review - Lumbar disc herniation (LDH) is a common condition causing low back pain, radiating leg pain, and neurological symptoms.
Clinically, the phenomenon of spontaneous shrinkage or disappearance of a herniated disc without surgical intervention is called resorption. Spontaneous resorption of herniated disc material without surgical intervention is a well-documented phenomenon, occurring in approximately 70% of cases, offering a basis for conservative treatment.
Here are some of the mechanisms that play a role in resorption:
- - Inflammation and Macrophage Infiltration: The herniated nucleus pulposus (NP) is recognized as a foreign antigen, triggering an autoimmune response. Macrophages, particularly M1-type (pro-inflammatory) and M2-type (anti-inflammatory), infiltrate the herniated tissue. M1 macrophages produce pro-inflammatory cytokines (e.g., TNF-α, IL-1β, IL-6), which stimulate matrix metalloproteinases (MMPs) like MMP-3 and MMP-7. These enzymes degrade collagen and proteoglycans, facilitating resorption. M2 macrophages support tissue repair and resolution of inflammation in later stages.
- - Neovascularization: New blood vessel formation around the herniated disc enhances macrophage access and nutrient supply, aiding resorption. Cytokines such as vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (bFGF) drive angiogenesis.
- - Apoptosis and Autophagy: Programmed cell death (apoptosis) and autophagy (cellular self-degradation) in the herniated tissue contribute to its breakdown. The Fas-FasL pathway mediates apoptosis, reducing disc volume.
- - Dehydration and Retraction: Dehydration of the NP reduces disc volume, while mechanical retraction of the herniated material back into the annulus fibrosus may occur, particularly in cases with intact fibrous rings.
- - Matrix Degradation: MMPs, activated by inflammatory mediators, break down the extracellular matrix of the herniated disc, accelerating resorption.
And there are several factors that influence resorption:
- - Herniation Type and Size: Extruded and sequestered discs are more likely to resorb (87.77% and 66.91% incidence, respectively) compared to protruded (37.53%) or bulging discs (13.33%). Larger herniations, particularly those exceeding 50% of the spinal canal diameter ("giant" herniations), show higher resorption rates due to greater exposure to epidural vessels
- - Posterior Longitudinal Ligament (PLL) Integrity: Rupture of the PLL allows the NP to contact epidural vessels, promoting resorption. Intact PLL may hinder this process.
- - Composition of Herniated Tissue: Discs with a higher proportion of NP (high water content) are more prone to resorption than those with cartilaginous endplate material or Modic changes, which resist vascularization and macrophage infiltration.
- - Rim Enhancement on MRI: Greater rim enhancement on gadolinium-enhanced MRI indicates increased neovascularization and inflammation, predicting higher resorption likelihood.
- - Sagittal Parameters and Posture: Studies suggest that lumbar spine alignment, such as greater L4 posterior vertebral height and sacral slope, correlates with faster resorption, possibly due to biomechanical influences.
- - Disease Duration and Age: Shorter disease duration and younger age are associated with higher resorption rates, likely due to more robust immune responses and tissue plasticity.
- - Inflammatory Mediators: The balance of pro-inflammatory (e.g., TNF-α) and anti-inflammatory mediators influences resorption speed. High levels of MMPs and chemokines enhance matrix degradation.
Spontaneous resorption of LDH is a complex process driven by inflammation, macrophage activity, neovascularization, apoptosis, autophagy, and dehydration. Predictive factors such as herniation size, type, PLL rupture, and MRI rim enhancement guide clinical decision-making. Conservative treatments show promise in promoting resorption, reducing the need for surgery. Further research is needed to refine predictive models and optimize non-surgical strategies.
- OSHA Updates Penalty Guidelines to Support Small Businesson July 15, 2025 at 10:05 AM
The U.S. Department of Labor has updated its guidance on penalty and debt collection procedures in the Occupational Safety and Health Administration's Field Operations Manual in an effort to minimize the burden on small businesses and increase prompt hazard abatement.
"All employers should be offered the opportunity to comply with regulations that help maintain a safe working environment,” said Deputy Secretary of Labor Keith Sonderling. “Small employers who are working in good faith to comply with complex federal laws should not face the same penalties as large employers with abundant resources. By lowering penalties on small employers, we are supporting the entrepreneurs that drive our economy and giving them the tools they need to keep our workers safe and healthy on the job while keeping them accountable."
The new policy, outlined in the Penalties and Debt Collection section of OSHA’s Field Operations Manual, increases penalty reductions for small employers, making it easier for small businesses to invest resources in compliance and hazard abatement.
For example, a penalty reduction level of 70%, which was previously only applicable for businesses with 10 or fewer employees, will now be expanded to include businesses who employ up to 25 employees. The revisions also include new guidelines for a 15% penalty reduction for employers who immediately take steps to address or correct a hazard.
Additionally, the updated policy expands the penalty reduction for employers without a history of serious, willful, repeat, or failure-to-abate OSHA violations. Under OSHA’s revised policy, employers who have never been inspected by federal OSHA or an OSHA State Plan, as well as employers who have been inspected in the previous five years and had no serious, willful, or failure-to-abate violations, are eligible for a 20% penalty reduction.
The new policies are effective immediately. Penalties issued before July 14, 2025, will remain under the previous penalty structure. Open investigations in which penalties have not yet been issued are covered by the new guidance.
OSHA retains the right to withhold penalty reductions where penalty adjustments do not advance the goals of the Occupational Safety and Health Act.
- SIBTF Now Pays More PD Than Core WorkComp Systemon July 14, 2025 at 5:15 PM
The Legislative Analyst's Office (LAO) has provided fiscal and policy advice to the Legislature for 75 years. It is known for its fiscal and programmatic expertise and nonpartisan analyses of the state budget. The office serves as the "eyes and ears" for the Legislature to ensure that the executive branch is implementing legislative policy in a cost efficient and effective manner.
The LAO just published a new analysis of the Subsequent Injury Benefit Trust Fund (SIBTF), which was created as a narrow supplement to California’s workers’ compensation system. The state first enacted SIBTF to offset employers’ workers’ compensation costs for veterans and other workers whose serious pre-existing disabilities made a new work injury more disabling and, therefore, more expensive. The program had the effect of providing additional lifetime benefits to a small number of workers facing steep barriers to employment.
Over time, however, SIBTF has grown dramatically in both size and scope. Today, it operates alongside the standard workers’ compensation system but with broader eligibility, less rigorous standards, and more generous benefits.
SIBTF claims are paid out of the state fund, but the fund itself is supported by a tax that employers pay on their workers’ compensation insurance premiums. (This tax is sometimes referred to as an assessment.) All employers pay the same tax rate, levied as a flat percentage of the employers’ insurance premium total. Insurers collect the tax as part of the premium payments and remit the collections to the state. Employers that self-insure for workers’ compensation remit a commensurate payment to the state. The statewide SIBTF employer tax totaled $848 million in 2024-25.
In recent years, the SIBTF program has evolved from a narrowly focused benefit to support a small number of severely injured workers into a much larger and broader disability benefits program. Many more workers file claims with SIBTF today than a decade ago. These claims typically pay more generous benefits than standard workers’ compensation and many include compensation for common chronic illnesses, as opposed to severe pre-existing disabilities. The result is a benefit program that now rivals standard workers’ compensation in size and that may no longer align with the program’s original legislative intent.
Between 2005 and 2015, the state received about 1,000 SIBTF claims annually and was able to process roughly half of those claims each year. The number of injured worker submitting SIBTF claims has increased in recent years. The state now receives around 3,000 SIBTF claims per year, of which it has been able to process 500 to 1,000 claims annually. Submitted claims are held as “case inventory” until state staff can process and initiate benefit payments. The state’s case inventory of unprocessed SIBTF claims now sits at roughly 25,000 claims.
Insured employers pay roughly $1.4 billion in permanent disability payments. Self-insured employers - private and public - likely add another $500 million to $1 billion. Together, total annual permanent disability payouts under the standard workers’ compensation system likely total about $2 billion. SIBTF, once a relatively small program, now pays more permanent disability payments ($2 billion to $3 billion) than the state’s core workers’ compensation program.
SIBTF claim payments and associated medical and legal payments have increased rapidly in recent years, resulting in annual increases in the employer paid taxes that replenish the SIBTF. The 2024-25 tax is expected to generate $850 million, nearly double the amount necessary to replenish the fund in the prior year. However, the current employer tax does not fully capture employers’ financial exposure to SIBTF claims because most claims each year go unprocessed. In recent years, the state has processed between 500 and 800 claims annually, or roughly one fifth of all incoming claims.
This means current employer tax rates only reflect a small portion of claims submitted, masking the full fiscal effect to come. Should the state progress through the backlog of SIBTF claims at a faster rate, employers’ annual taxes will grow commensurately.
Looking broadly at incoming claims each year, employers likely face lifetime SIBTF costs totaling $2 billion to $3 billion for each cohort of claims that injured workers submit each year. If the number of claims remains steady at around 3,000 per year and the state processes all incoming claims, the annual employer tax would climb to $2 billion to $3 billion before stabilizing near that level.
At the conclusion of the report, the LAO suggests "the Legislature look to refocus SIBTF to more closely align with its original purpose. To do so, the Legislature would need to reassess several dimensions of the program. Key options include: (1) establishing stricter criteria for pre-existing conditions, (2) returning the eligibility threshold to only cover moderate and severe work injuries, (3) requiring that pre-existing conditions were previously documented, (4) requiring claims to be reviewed by an agreed-upon physician, (5) limiting SIBTF to pre-existing disabilities that actually worsen the work injury, and (6) revisiting how multiple conditions are added together. We also recommend the Legislature consider fast-tracking backlogged claims from workers with the most severe pre-existing conditions."
- Westminster Seeks $600K in Civil Fraud Case Against Former Copon July 14, 2025 at 5:15 PM
A former Westminster police officer, 39 year old Nicole Brown who lives in Riverside, has been charged with nine felony counts of making a fraudulent statement to obtain compensation, six felony counts of making a fraudulent insurance benefit claim, and one felony enhancement of committing an aggravated while collar crime over $100,000. She faces a maximum sentence of 22 years in state prison if convicted on all counts.
Brown’s stepfather, 57 year old Peter Gregory Schuman who lives in Buena Park, has been charged with one felony count of making a fraudulent insurance benefit claim and one felony count of assisting, abetting, conspiring with and soliciting a person in unlawful act. He faces a maximum sentence of eight years in state prison if convicted on all counts. As an attorney licensed by the State of California, he may also suffer discipline by the State Bar of California.
While out on Total Temporary Disability, Brown cost the city of Westminster more than $600,000, which included Brown’s full salary – tax-free – and her medical expenses.
During her time on TTD Brown’s ongoing complaints were headaches, dizziness, sensitivity to light and noise, problems processing thoughts and words, and an inability to work on the computer or do any screentime.
Despite her representations to doctors and the City of Westminster regarding her inability to work as a police officer due to her injury, on April 29, 2023, Brown was seen by several people who knew she was off work on total disability as she was dancing and drinking at the Stagecoach Music Festival, with more than 75,000 people in attendance with loud music and bright lights everywhere and temperatures in excess of 100 degrees.
In addition to facing the 15 felony charges, the City of Westminster has now filed a civil lawsuit against the former police officer after the Westminster City Council voted unanimously to seek to recover all of the funds - over $600,000 - as well as hold the officer accountable for this breech of public trust. The City of Westminster filed the lawsuit on July 8, 2025, naming Nicole Brown of Riverside.
The lawsuit seeks repayment of all disability and medical payments, benefits, and other funds unlawfully obtained by Brown; and seeks to recover costs associated with investigation and prosecution of the lawsuit.
“This former police officer has betrayed the public trust. We owe it to our residents and to the honest, hard-working officers in our police department to seek to recover these funds,” said Mayor Chi Charlie Nguyen. “Our residents count on us to protect their taxpayer dollars and ensure that employees who are actually injured receive the support they need to recover. Fraud will not be tolerated in Westminster.”
- Proposed Bipartisan Law Limits Small Business Predatory ADA Claimson July 10, 2025 at 7:17 PM
California Senate Bill 84 if past by the California legislature "prohibits a construction-related accessibility claim for statutory damages from being initiated in a legal proceeding against a defendant unless the defendant has: 1) been served with a letter specifying each alleged violation of a construction-related accessibility standard; and 2) the alleged violations have not been corrected within 120 days of service.
This bill also provides that a defendant is not liable for statutory damages, costs, or plaintiff’s attorney’s fees for an alleged violation that is corrected within 120 days of service of a letter. The provisions of this bill apply to a defendant who employs 50 or fewer individuals as of the date of the receipt of the letter or for any period over the past three years from the date of the receipt of the letter."
According to the authors of SB 84 since "the pandemic there has been a surge in ADA lawsuits filed across California, typically by very few repeat plaintiffs. Two plaintiffs filed more than 1,000 combined ADA lawsuits across California from 2020-2021 and are some of the most frequent filers in Northern California, according to an NBC Bay area analysis. In 2021, California had more disability access lawsuits filed than the remaining 49 states, combined."
"Across the state, businesses are being targeted for failing to be in compliance with disability access guidelines, resulting in lawsuits that cost the business thousands, and put money in the pockets of serial plaintiffs without ever actually improving accessibility to people with disabilities.
Amongst the suits filed are those for a bathroom mirror being one and a half inches too high, the handicap sign on a restroom being the wrong shape, and the color of the handicap parking space sign not being the specified shade of blue."
"Because California law provides that the plaintiff is entitled to a minimum damages that can start as high as $4,000 per violation, triple the damages, and may be awarded attorney’s fees, mom-and-pop businesses are finding themselves fixing a $10 mirror, but owing tens of thousands of dollars to the plaintiff’s attorneys for their fees."
"The average settlement can be as much as $14,000, but the cost of litigating will easily cost hundreds of thousands of dollars in legal fees. This leads to businesses settling out of court for far more than what it would cost to repair the violation. As such, this problem is putting many small businesses out-of-business, and its further adding to the stigma that California is a bad place to open a business and create jobs. Balance must be struck to protect both our disabled population, as well as business owners being targeted from untoward use of the law. SB 84 strikes this balance by placing the emphasis on increased access through curing an alleged violation."
This bill is author sponsored and supported by the Civil Justice Association of California and other business organizations. The bill is opposed by Disability Rights California and other organizations that support the civil rights of disabled people.
According to a report on the proposed law by Courthouse News, Senator Roger Niello, a Fair Oaks Republican and coauthor of the bill said "The predatory law firms have accelerated their abuse all over the state.” Senators from both sides of the aisle have joined Niello as coauthors.
The report goes on to say "Democrats stood by Niello’s side, signing onto his bill and urging its passage. State Senator Aisha Wahab, a Silicon Valley Democrat, said she had discussions about the bipartisan effort last fall, working on the best way to correct the problem. Wahab wants to ensure those with disabilities have proper access while helping small business owners."
“I do hope to see that move all the way to the governor’s desk,” she added.
- Physicians Owned Malpractice Insurer Buys NYSE Listed Comp Carrieron July 10, 2025 at 7:17 PM
The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, and ProAssurance Corporation (NYSE: PRA), an industry-leading specialty insurer with extensive expertise in medical liability, products liability for medical technology and life sciences, and workers’ compensation insurance, announced earlier this year that they have entered into a definitive agreement under which ProAssurance will be acquired by The Doctors Company.
The Doctors Company is part of TDC Group (tdcg.com), the nation’s largest physician- owned provider of insurance and risk management solutions. TDC Group serves the full continuum of care, from individual clinicians to academic medical systems—with over 110,000 healthcare professionals and organizations nationwide - with annual revenue of $1.5 billion and more than $8 billion in assets.
Under the terms of the agreement, ProAssurance stockholders will receive $25.00 in cash per share, representing an approximately 60% premium to the closing price per share of ProAssurance common stock on March 18, 2025, the last trading day prior to today’s announcement, with a transaction value of approximately $1.3 billion. The combined company will have assets of approximately $12 billion.
The transaction has not yet closed. However, on June 24, 2025, ProAssurance announced that its stockholders overwhelmingly approved the acquisition, with over 99% of votes cast in favor.
On July 2, 2025, the U.S. Federal Trade Commission granted early termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act, satisfying a key condition for the merger. However, the transaction still requires additional regulatory approvals, including from insurance regulators in the states where ProAssurance’s insurance subsidiaries are domiciled.
Currently the acquisition is expected to close in the first half of 2026, subject to remaining regulatory approvals and other customary closing conditions. The deal is not subject to a financing condition. Upon completion, ProAssurance will become a wholly owned subsidiary of The Doctors Company and will be delisted from the New York Stock Exchange.
Both companies continue to operate independently until the transaction is finalized.
The deal has been noted for its strategic benefits, combining the second- and fourth-largest medical professional liability insurers in the U.S., but some analysts have raised concerns about ProAssurance’s valuation. Raymond James downgraded ProAssurance’s stock rating to “Underperform” and Citizens JMP to “Market Perform,” citing a high 2025 estimated earnings per share multiple compared to industry peers.
AM Best has maintained the Financial Strength Rating of A (Excellent) for both ProAssurance and The Doctors Company, with no immediate changes expected due to the acquisition. Both entities will be monitored independently during the transaction period.
- California Receives $4.1M From Gilead Sciences for Illegal Kickbackson July 17, 2025 at 11:49 AM
Gilead Sciences, Inc. is an American biopharmaceutical company headquartered in Foster City, California, that focuses on researching and developing antiviral drugs used in the treatment of HIV/AIDS, hepatitis B, hepatitis C, influenza, and COVID-19, including ledipasvir/sofosbuvir and sofosbuvir. Gilead is a member of the Nasdaq-100 and the S&P 100.
California joined a coalition of 48 other attorneys general in securing $202 million from Gilead Sciences, Inc. (Gilead), for running an illegal kickback scheme to promote its HIV medications. Gilead allegedly violated federal law by illegally providing incentives – including awards, meals, and travel expenses – to healthcare providers to prescribe Gilead’s medications, resulting in millions of dollars of false claims submitted to government health care programs, including Medi-Cal.
The settlement in principle, reached in coordination with the U.S. Department of Justice and approved by the U.S. District Court for the Southern District of New York, provides $49 million for Medicaid programs nationwide, including $4,118,184 for California, with the remainder going to Medicare, Tricare, and the AIDS Drug Assistance Program (ADAP).
From January 2011 to November 2017, Gilead allegedly violated federal anti-kickback laws by providing gifts to healthcare providers who attended and spoke at promotional speaker programs for Gilead’s HIV drugs: Stribild, Genvoya, Complera, Odefsey, Descovy, and Biktarvy. Gilead paid high-volume prescribers tens to hundreds of thousands of dollars to present as “HIV Speakers.” The company also covered travel expenses for speakers, including those traveling long distances and to attractive destinations, such as Hawaii, Miami, and New Orleans, and hosted dinners at high-end restaurants.
Gilead’s internal compliance mechanisms failed to halt these violations. The company’s internal policies and procedures failed to prevent its sales representatives from improperly offering incentives to induce prescriptions.
The Division of Medi-Cal Fraud and Elder Abuse receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $69,244,976 for Federal fiscal year (FY) 2025. The remaining 25 percent is funded by the State of California. FY 2025 is from October 1, 2024 through September 30, 2025.
Gilead Sciences has had at least one prior problem with resolving claims for illegal kickbacks. Back in 2020 Gilead agreed to pay $97 million to resolve claims that it violated the False Claims Act by illegally using a foundation, Caring Voice Coalition (CVC), as a conduit to pay the Medicare co-pays for its own drug, Letairis.
In that prior case the government alleged that Gilead used CVC, which claimed 501(c)(3) status for tax purposes, as a conduit to pay the co-pay obligations of thousands of Medicare patients taking Letairis, which is approved to treat pulmonary arterial hypertension (PAH). According to the government’s allegations, Gilead used CVC to cover the patients’ co-pays in order to induce those patients’ purchases of Letairis. Gilead knew that the prices it set for Letairis otherwise could have posed a barrier to those purchases. - Liberty Mutual Releases 2025 Workplace Safety Indexon July 17, 2025 at 11:49 AM
Liberty Mutual Insurance has released its 2025 Workplace Safety Index, revealing the leading causes and financial impact of the most serious workplace injuries in the US.
For 25 years the Index has identified the top ten causes of workplace injuries - those causing an employee to miss more than five days of work - and ranked them by their medical and lost-wage payments. These ten causes account for over 86% of the total cost of all workplace injuries, $58.78B.
“The Index provides employers a trusted roadmap for improving workplace safety,” said Liberty Mutual Senior Vice President and General Manager, Risk Control, Dorothy Doyle. “We’re proud to provide this important report, which offers valuable data and insights to help employers prevent injuries and manage risks more effectively, underscoring our commitment to protecting workers and supporting safer, more resilient businesses.”
Its objective data and actionable insights have never been more important because companies today face fewer but more expensive workplace injuries. In fact, the rate of serious workplace accidents fell by about 40 percent over the 25 years represented by the Index, while the total cost of workers compensation benefits increased by 30 percent, according to data from the Bureau of Labor Statistics and National Academy of Social Insurance. Key Findings:
Top Injury Causes:
- - Overexertion involving outside sources remains the #1 cause, accounting for $13.7 billion in costs, largely due to manual material handling.
- - Falls on the same level is the #2 cause, with $10.5 billion in costs, emphasizing the need for slip, trip, and fall prevention strategies.
- - Struck by object or equipment and Falls to a lower level also continue to be major injury drivers, together accounting for nearly $11.6 billion in costs.
- - Injuries due to Other exertions and bodily reactions, Roadway incidents, and Caught-in or compressed by equipment also feature prominently in the top 10, underlining the diverse risks present in today’s workplaces.
Consistency of findings 2001-2025:
- - Overexertion and Falls on same level have been the #1 and #2 causes in each Index.
- - Seven of this year’s top 10 injury causes appeared in all 25 indices.
Liberty Mutual also produces eight industry-specific indices detailing injury causes and costs in Manufacturing, Construction, Healthcare & Social Services, Professional & Business Services, Retail, Wholesale, Leisure & Hospitality and Transportation & Warehousing.
The Liberty Mutual Workplace Safety Index is based on information from Liberty Mutual, customized data from the U.S. Bureau of Labor Statistics (BLS) Office of Safety, Health, and Working Conditions, and the National Academy of Social Insurance (NASI). BLS non-fatal injury data are analyzed with the Liberty Mutual data to determine which events caused employees to miss more than five days of work, and then to rank those events by workers compensation costs, which are then scaled to the NASI total cost. To capture accurate injury cost data, each index is based on data three years prior. Accordingly, the 2025 index reflects 2022 data. - Private Self-Insured Claim Counts Are Down But Losses Are Upon July 16, 2025 at 1:28 PM
California’s private self-insured employers reported 7,026 fewer workers’ compensation claims in 2024 than in 2023 (-7.4%), pushing private self-insured claim frequency to a 4-year low, but for the second year in a row the average paid and incurred losses on these claims increased, driving total paid and incurred losses higher according to a California Workers’ Compensation Institute (CWCI) review of initial data from the state Office of Self-Insurance Plans (OSIP).
The annual summary of private self-insured data posted on OSIP’s website last week, offers an initial snapshot of California private, self-insured claims experience for cases reported in 2024, noting the number of covered employees, medical-only and indemnity claim counts, and total paid and incurred losses on those claims through the end of the year. The 2024 summary shows the experience of private self-insured employers who covered 2.25 million California employees last year (down from 2.34 million in the 2023 first report) and who reported 87,360 claims in 2023, down from 94,386 claims in the 2023 initial report.
According to the latest summary, private self-insured employers reported 45,170 medical-only claims in 2024 (down 7.1% from 48,404 in 2023, the first full year following pandemic), though that was still 3.2% above the 43,779 med-only claims noted in 2020, when med-only claim volume plummeted during the brief, pandemic-driven recession. At the same time, the number of private self-insured indemnity claims, which spiked during the pandemic due to the flood of COVID-19 lost-time claims then fell 13.0% as COVID claim volume dropped in 2023, fell for the second year in a row, declining by 8.2% to 42,190 claims in 2024.
The 2024 claim count translates to an overall frequency rate of 3.88 claims (2.01 med-only and 1.87 indemnity) per 100 private self-insured employees, down from an overall rate of 4.03 in 2023 (2.07 med-only and 1.96 indemnity), marking the second consecutive year-over-year decline in private self-insured claim frequency, and pushing the overall rate to the lowest level since 2020.
Despite decreasing claim volume and claim frequency, private self-insured’s first report total paid and incurred losses both increased for the second year in a row last year. Paid losses on the 2024 private self-insured claims through the end of the year totaled $353.6 million, up 3.9% from the first report total for 2023, as total paid medical increased by $10.2 million (6.1%) to $177.6 million, and total paid indemnity (primarily temporary disability payments) increased by $3.2 million (1.9%) to $176.0 million. First report total incurred losses (paid benefits plus reserves for future payments) on 2024 private self-insured claims rose to $934.3 million, up $30.6 million, or 3.5% from the 2023 total, as first report incurred medical increased by $39.8 million (7.9%) to $542.3 million and total incurred indemnity increased by $30.6 million (8.5%) to $392.0 million.
Even though there were 7,026 fewer private self-insured claims in 2024 than in 2023 (including 3,792 fewer indemnity claims) the growth in private self-insureds’ total paid and incurred losses in 2024 can be traced to the growth in average paid and incurred losses at the first report, as average paid losses per claim rose 12.3% to $4,047 while average incurred losses rose 16.8% to $10,695.
OSIP’s summary of private self-insured’s calendar year 2024 data, follows the December 2024 release of public self-insured claims data for fiscal year 2023/2024. OSIP private and public self-insured claim summaries from the past 20 years are posted at https://www.dir.ca.gov/SIP/StatewideTotals.html. CWCI members and subscribers may log on to the Communications section of the CWCI website www.cwci.org to view a summary Bulletin with more details, analyses, and graphics. - DOI Warns State Leaders About Rising Comp Costson July 16, 2025 at 1:28 PM
The California Insurance Commissioner issued a letter to state leaders alerting them to growing costs in California’s workers’ compensation system, which can impact California businesses.
This action follows the Commissioner’s adoption of a new Workers’ Compensation Insurance Claims Cost Benchmark and an Average Advisory Pure Premium Rate, which reflects an 8.7% increase over last year’s approved rate.
This year, there was consensus among actuarial experts that costs are rising and a meaningful increase in the average pure premium rate is justified and supported by the data. Experts on behalf of the California Department of Insurance, the Workers’ Compensation Insurance Rating Bureau (Bureau), and the Bureau’s public members differed only slightly on how much the rate should increase – a departure after more than a decade of steady or decreasing average advisory pure premium rates.
The Department’s experts recommended an average advisory pure premium rate of $1.52 per $100 of payroll, which was adopted by the Commissioner. The adopted rate is advisory, meaning that insurance companies are not bound by it and are free to set their own rates. The new rate will be effective on September 1, 2025.
Higher medical treatment and medical-legal costs, a greater number of projected cumulative trauma claims, and escalating costs associated with adjusting claims have all resulted in deteriorating accident year combined ratios, while at the same time, the rates charged by insurers have remained low. The Bureau’s projected combined ratio for accident year 2024 is estimated to be 123% - the highest level in nearly 15 years - and surpasses levels seen prior to the implementation of the SB 863 reforms that began in 2012.
“The Governor and Legislature acted over a decade ago to enact far-reaching reforms that have helped to reduce workers’ compensation rates,” wrote Commissioner Lara in his letter to Governor Newsom, Senate President Pro Tempore Mike McGuire, and Assembly Speaker Robert Rivas.
“For the past decade, the pure premium rates adopted by myself and the previous insurance commissioner have shown continued progress toward reducing excessive costs in the system while protecting injured workers. Because higher insurance rates can affect businesses’ ability to hire and sustain financial growth, it is important to be aware of early warning signs and respond appropriately.”
“We must be proactive in analyzing and addressing these early warning signs of a shift in market conditions in order to foster a vibrant and competitive insurance marketplace,” said Commissioner Lara. “Our workers’ compensation system is designed to help injured workers and keep costs down for employers. These considerations should guide us in striving for data-driven solutions.” - 70% of Cases Have Spontaneous Resorption of Herniated Discon July 15, 2025 at 10:05 AM
According to a study published this year in the Journal of Inflammation Research - Mechanisms and Factors Influencing Resorption of Herniated Part of Lumbar Disc Herniation: Comprehensive Review - Lumbar disc herniation (LDH) is a common condition causing low back pain, radiating leg pain, and neurological symptoms.
Clinically, the phenomenon of spontaneous shrinkage or disappearance of a herniated disc without surgical intervention is called resorption. Spontaneous resorption of herniated disc material without surgical intervention is a well-documented phenomenon, occurring in approximately 70% of cases, offering a basis for conservative treatment.
Here are some of the mechanisms that play a role in resorption:
- - Inflammation and Macrophage Infiltration: The herniated nucleus pulposus (NP) is recognized as a foreign antigen, triggering an autoimmune response. Macrophages, particularly M1-type (pro-inflammatory) and M2-type (anti-inflammatory), infiltrate the herniated tissue. M1 macrophages produce pro-inflammatory cytokines (e.g., TNF-α, IL-1β, IL-6), which stimulate matrix metalloproteinases (MMPs) like MMP-3 and MMP-7. These enzymes degrade collagen and proteoglycans, facilitating resorption. M2 macrophages support tissue repair and resolution of inflammation in later stages.
- - Neovascularization: New blood vessel formation around the herniated disc enhances macrophage access and nutrient supply, aiding resorption. Cytokines such as vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (bFGF) drive angiogenesis.
- - Apoptosis and Autophagy: Programmed cell death (apoptosis) and autophagy (cellular self-degradation) in the herniated tissue contribute to its breakdown. The Fas-FasL pathway mediates apoptosis, reducing disc volume.
- - Dehydration and Retraction: Dehydration of the NP reduces disc volume, while mechanical retraction of the herniated material back into the annulus fibrosus may occur, particularly in cases with intact fibrous rings.
- - Matrix Degradation: MMPs, activated by inflammatory mediators, break down the extracellular matrix of the herniated disc, accelerating resorption.
And there are several factors that influence resorption:
- - Herniation Type and Size: Extruded and sequestered discs are more likely to resorb (87.77% and 66.91% incidence, respectively) compared to protruded (37.53%) or bulging discs (13.33%). Larger herniations, particularly those exceeding 50% of the spinal canal diameter ("giant" herniations), show higher resorption rates due to greater exposure to epidural vessels
- - Posterior Longitudinal Ligament (PLL) Integrity: Rupture of the PLL allows the NP to contact epidural vessels, promoting resorption. Intact PLL may hinder this process.
- - Composition of Herniated Tissue: Discs with a higher proportion of NP (high water content) are more prone to resorption than those with cartilaginous endplate material or Modic changes, which resist vascularization and macrophage infiltration.
- - Rim Enhancement on MRI: Greater rim enhancement on gadolinium-enhanced MRI indicates increased neovascularization and inflammation, predicting higher resorption likelihood.
- - Sagittal Parameters and Posture: Studies suggest that lumbar spine alignment, such as greater L4 posterior vertebral height and sacral slope, correlates with faster resorption, possibly due to biomechanical influences.
- - Disease Duration and Age: Shorter disease duration and younger age are associated with higher resorption rates, likely due to more robust immune responses and tissue plasticity.
- - Inflammatory Mediators: The balance of pro-inflammatory (e.g., TNF-α) and anti-inflammatory mediators influences resorption speed. High levels of MMPs and chemokines enhance matrix degradation.
Spontaneous resorption of LDH is a complex process driven by inflammation, macrophage activity, neovascularization, apoptosis, autophagy, and dehydration. Predictive factors such as herniation size, type, PLL rupture, and MRI rim enhancement guide clinical decision-making. Conservative treatments show promise in promoting resorption, reducing the need for surgery. Further research is needed to refine predictive models and optimize non-surgical strategies. - OSHA Updates Penalty Guidelines to Support Small Businesson July 15, 2025 at 10:05 AM
The U.S. Department of Labor has updated its guidance on penalty and debt collection procedures in the Occupational Safety and Health Administration's Field Operations Manual in an effort to minimize the burden on small businesses and increase prompt hazard abatement.
"All employers should be offered the opportunity to comply with regulations that help maintain a safe working environment,” said Deputy Secretary of Labor Keith Sonderling. “Small employers who are working in good faith to comply with complex federal laws should not face the same penalties as large employers with abundant resources. By lowering penalties on small employers, we are supporting the entrepreneurs that drive our economy and giving them the tools they need to keep our workers safe and healthy on the job while keeping them accountable."
The new policy, outlined in the Penalties and Debt Collection section of OSHA’s Field Operations Manual, increases penalty reductions for small employers, making it easier for small businesses to invest resources in compliance and hazard abatement.
For example, a penalty reduction level of 70%, which was previously only applicable for businesses with 10 or fewer employees, will now be expanded to include businesses who employ up to 25 employees. The revisions also include new guidelines for a 15% penalty reduction for employers who immediately take steps to address or correct a hazard.
Additionally, the updated policy expands the penalty reduction for employers without a history of serious, willful, repeat, or failure-to-abate OSHA violations. Under OSHA’s revised policy, employers who have never been inspected by federal OSHA or an OSHA State Plan, as well as employers who have been inspected in the previous five years and had no serious, willful, or failure-to-abate violations, are eligible for a 20% penalty reduction.
The new policies are effective immediately. Penalties issued before July 14, 2025, will remain under the previous penalty structure. Open investigations in which penalties have not yet been issued are covered by the new guidance.
OSHA retains the right to withhold penalty reductions where penalty adjustments do not advance the goals of the Occupational Safety and Health Act. - SIBTF Now Pays More PD Than Core WorkComp Systemon July 14, 2025 at 5:15 PM
The Legislative Analyst's Office (LAO) has provided fiscal and policy advice to the Legislature for 75 years. It is known for its fiscal and programmatic expertise and nonpartisan analyses of the state budget. The office serves as the "eyes and ears" for the Legislature to ensure that the executive branch is implementing legislative policy in a cost efficient and effective manner.
The LAO just published a new analysis of the Subsequent Injury Benefit Trust Fund (SIBTF), which was created as a narrow supplement to California’s workers’ compensation system. The state first enacted SIBTF to offset employers’ workers’ compensation costs for veterans and other workers whose serious pre-existing disabilities made a new work injury more disabling and, therefore, more expensive. The program had the effect of providing additional lifetime benefits to a small number of workers facing steep barriers to employment.
Over time, however, SIBTF has grown dramatically in both size and scope. Today, it operates alongside the standard workers’ compensation system but with broader eligibility, less rigorous standards, and more generous benefits.
SIBTF claims are paid out of the state fund, but the fund itself is supported by a tax that employers pay on their workers’ compensation insurance premiums. (This tax is sometimes referred to as an assessment.) All employers pay the same tax rate, levied as a flat percentage of the employers’ insurance premium total. Insurers collect the tax as part of the premium payments and remit the collections to the state. Employers that self-insure for workers’ compensation remit a commensurate payment to the state. The statewide SIBTF employer tax totaled $848 million in 2024-25.
In recent years, the SIBTF program has evolved from a narrowly focused benefit to support a small number of severely injured workers into a much larger and broader disability benefits program. Many more workers file claims with SIBTF today than a decade ago. These claims typically pay more generous benefits than standard workers’ compensation and many include compensation for common chronic illnesses, as opposed to severe pre-existing disabilities. The result is a benefit program that now rivals standard workers’ compensation in size and that may no longer align with the program’s original legislative intent.
Between 2005 and 2015, the state received about 1,000 SIBTF claims annually and was able to process roughly half of those claims each year. The number of injured worker submitting SIBTF claims has increased in recent years. The state now receives around 3,000 SIBTF claims per year, of which it has been able to process 500 to 1,000 claims annually. Submitted claims are held as “case inventory” until state staff can process and initiate benefit payments. The state’s case inventory of unprocessed SIBTF claims now sits at roughly 25,000 claims.
Insured employers pay roughly $1.4 billion in permanent disability payments. Self-insured employers - private and public - likely add another $500 million to $1 billion. Together, total annual permanent disability payouts under the standard workers’ compensation system likely total about $2 billion. SIBTF, once a relatively small program, now pays more permanent disability payments ($2 billion to $3 billion) than the state’s core workers’ compensation program.
SIBTF claim payments and associated medical and legal payments have increased rapidly in recent years, resulting in annual increases in the employer paid taxes that replenish the SIBTF. The 2024-25 tax is expected to generate $850 million, nearly double the amount necessary to replenish the fund in the prior year. However, the current employer tax does not fully capture employers’ financial exposure to SIBTF claims because most claims each year go unprocessed. In recent years, the state has processed between 500 and 800 claims annually, or roughly one fifth of all incoming claims.
This means current employer tax rates only reflect a small portion of claims submitted, masking the full fiscal effect to come. Should the state progress through the backlog of SIBTF claims at a faster rate, employers’ annual taxes will grow commensurately.
Looking broadly at incoming claims each year, employers likely face lifetime SIBTF costs totaling $2 billion to $3 billion for each cohort of claims that injured workers submit each year. If the number of claims remains steady at around 3,000 per year and the state processes all incoming claims, the annual employer tax would climb to $2 billion to $3 billion before stabilizing near that level.
At the conclusion of the report, the LAO suggests "the Legislature look to refocus SIBTF to more closely align with its original purpose. To do so, the Legislature would need to reassess several dimensions of the program. Key options include: (1) establishing stricter criteria for pre-existing conditions, (2) returning the eligibility threshold to only cover moderate and severe work injuries, (3) requiring that pre-existing conditions were previously documented, (4) requiring claims to be reviewed by an agreed-upon physician, (5) limiting SIBTF to pre-existing disabilities that actually worsen the work injury, and (6) revisiting how multiple conditions are added together. We also recommend the Legislature consider fast-tracking backlogged claims from workers with the most severe pre-existing conditions."
- Westminster Seeks $600K in Civil Fraud Case Against Former Copon July 14, 2025 at 5:15 PM
A former Westminster police officer, 39 year old Nicole Brown who lives in Riverside, has been charged with nine felony counts of making a fraudulent statement to obtain compensation, six felony counts of making a fraudulent insurance benefit claim, and one felony enhancement of committing an aggravated while collar crime over $100,000. She faces a maximum sentence of 22 years in state prison if convicted on all counts.
Brown’s stepfather, 57 year old Peter Gregory Schuman who lives in Buena Park, has been charged with one felony count of making a fraudulent insurance benefit claim and one felony count of assisting, abetting, conspiring with and soliciting a person in unlawful act. He faces a maximum sentence of eight years in state prison if convicted on all counts. As an attorney licensed by the State of California, he may also suffer discipline by the State Bar of California.
While out on Total Temporary Disability, Brown cost the city of Westminster more than $600,000, which included Brown’s full salary – tax-free – and her medical expenses.
During her time on TTD Brown’s ongoing complaints were headaches, dizziness, sensitivity to light and noise, problems processing thoughts and words, and an inability to work on the computer or do any screentime.
Despite her representations to doctors and the City of Westminster regarding her inability to work as a police officer due to her injury, on April 29, 2023, Brown was seen by several people who knew she was off work on total disability as she was dancing and drinking at the Stagecoach Music Festival, with more than 75,000 people in attendance with loud music and bright lights everywhere and temperatures in excess of 100 degrees.
In addition to facing the 15 felony charges, the City of Westminster has now filed a civil lawsuit against the former police officer after the Westminster City Council voted unanimously to seek to recover all of the funds - over $600,000 - as well as hold the officer accountable for this breech of public trust. The City of Westminster filed the lawsuit on July 8, 2025, naming Nicole Brown of Riverside.
The lawsuit seeks repayment of all disability and medical payments, benefits, and other funds unlawfully obtained by Brown; and seeks to recover costs associated with investigation and prosecution of the lawsuit.
“This former police officer has betrayed the public trust. We owe it to our residents and to the honest, hard-working officers in our police department to seek to recover these funds,” said Mayor Chi Charlie Nguyen. “Our residents count on us to protect their taxpayer dollars and ensure that employees who are actually injured receive the support they need to recover. Fraud will not be tolerated in Westminster.” - Proposed Bipartisan Law Limits Small Business Predatory ADA Claimson July 10, 2025 at 7:17 PM
California Senate Bill 84 if past by the California legislature "prohibits a construction-related accessibility claim for statutory damages from being initiated in a legal proceeding against a defendant unless the defendant has: 1) been served with a letter specifying each alleged violation of a construction-related accessibility standard; and 2) the alleged violations have not been corrected within 120 days of service.
This bill also provides that a defendant is not liable for statutory damages, costs, or plaintiff’s attorney’s fees for an alleged violation that is corrected within 120 days of service of a letter. The provisions of this bill apply to a defendant who employs 50 or fewer individuals as of the date of the receipt of the letter or for any period over the past three years from the date of the receipt of the letter."
According to the authors of SB 84 since "the pandemic there has been a surge in ADA lawsuits filed across California, typically by very few repeat plaintiffs. Two plaintiffs filed more than 1,000 combined ADA lawsuits across California from 2020-2021 and are some of the most frequent filers in Northern California, according to an NBC Bay area analysis. In 2021, California had more disability access lawsuits filed than the remaining 49 states, combined."
"Across the state, businesses are being targeted for failing to be in compliance with disability access guidelines, resulting in lawsuits that cost the business thousands, and put money in the pockets of serial plaintiffs without ever actually improving accessibility to people with disabilities.
Amongst the suits filed are those for a bathroom mirror being one and a half inches too high, the handicap sign on a restroom being the wrong shape, and the color of the handicap parking space sign not being the specified shade of blue."
"Because California law provides that the plaintiff is entitled to a minimum damages that can start as high as $4,000 per violation, triple the damages, and may be awarded attorney’s fees, mom-and-pop businesses are finding themselves fixing a $10 mirror, but owing tens of thousands of dollars to the plaintiff’s attorneys for their fees."
"The average settlement can be as much as $14,000, but the cost of litigating will easily cost hundreds of thousands of dollars in legal fees. This leads to businesses settling out of court for far more than what it would cost to repair the violation. As such, this problem is putting many small businesses out-of-business, and its further adding to the stigma that California is a bad place to open a business and create jobs. Balance must be struck to protect both our disabled population, as well as business owners being targeted from untoward use of the law. SB 84 strikes this balance by placing the emphasis on increased access through curing an alleged violation."
This bill is author sponsored and supported by the Civil Justice Association of California and other business organizations. The bill is opposed by Disability Rights California and other organizations that support the civil rights of disabled people.
According to a report on the proposed law by Courthouse News, Senator Roger Niello, a Fair Oaks Republican and coauthor of the bill said "The predatory law firms have accelerated their abuse all over the state.” Senators from both sides of the aisle have joined Niello as coauthors.
The report goes on to say "Democrats stood by Niello’s side, signing onto his bill and urging its passage. State Senator Aisha Wahab, a Silicon Valley Democrat, said she had discussions about the bipartisan effort last fall, working on the best way to correct the problem. Wahab wants to ensure those with disabilities have proper access while helping small business owners."
“I do hope to see that move all the way to the governor’s desk,” she added. - Physicians Owned Malpractice Insurer Buys NYSE Listed Comp Carrieron July 10, 2025 at 7:17 PM
The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, and ProAssurance Corporation (NYSE: PRA), an industry-leading specialty insurer with extensive expertise in medical liability, products liability for medical technology and life sciences, and workers’ compensation insurance, announced earlier this year that they have entered into a definitive agreement under which ProAssurance will be acquired by The Doctors Company.
The Doctors Company is part of TDC Group (tdcg.com), the nation’s largest physician- owned provider of insurance and risk management solutions. TDC Group serves the full continuum of care, from individual clinicians to academic medical systems—with over 110,000 healthcare professionals and organizations nationwide - with annual revenue of $1.5 billion and more than $8 billion in assets.
Under the terms of the agreement, ProAssurance stockholders will receive $25.00 in cash per share, representing an approximately 60% premium to the closing price per share of ProAssurance common stock on March 18, 2025, the last trading day prior to today’s announcement, with a transaction value of approximately $1.3 billion. The combined company will have assets of approximately $12 billion.
The transaction has not yet closed. However, on June 24, 2025, ProAssurance announced that its stockholders overwhelmingly approved the acquisition, with over 99% of votes cast in favor.
On July 2, 2025, the U.S. Federal Trade Commission granted early termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act, satisfying a key condition for the merger. However, the transaction still requires additional regulatory approvals, including from insurance regulators in the states where ProAssurance’s insurance subsidiaries are domiciled.
Currently the acquisition is expected to close in the first half of 2026, subject to remaining regulatory approvals and other customary closing conditions. The deal is not subject to a financing condition. Upon completion, ProAssurance will become a wholly owned subsidiary of The Doctors Company and will be delisted from the New York Stock Exchange.
Both companies continue to operate independently until the transaction is finalized.
The deal has been noted for its strategic benefits, combining the second- and fourth-largest medical professional liability insurers in the U.S., but some analysts have raised concerns about ProAssurance’s valuation. Raymond James downgraded ProAssurance’s stock rating to “Underperform” and Citizens JMP to “Market Perform,” citing a high 2025 estimated earnings per share multiple compared to industry peers.
AM Best has maintained the Financial Strength Rating of A (Excellent) for both ProAssurance and The Doctors Company, with no immediate changes expected due to the acquisition. Both entities will be monitored independently during the transaction period.