- No Duty for Employer to Accommodate Undisclosed Mental Disabilityon May 26, 2026 at 2:32 PM
Target Corporation hired Daniel Husband in October 2020 as a fulfillment expert at its Burbank store. Although Target's new-hire materials explained that the company would attempt to accommodate known physical or mental limitations, Husband did not disclose to any Target official that he had been diagnosed with bipolar I disorder. He worked without incident for approximately 20 months.
Things changed in the summer of 2022. On June 9, 2022, Husband entered the store while off duty and became visibly upset with an employee; the employee reported that Husband used profanity, though Husband denied it. He was verbally counseled and later received a written memo.
On July 7, 2022, Husband arrived for his night shift looking deflated, then suddenly became angry. He recounted hitting himself in the temple and said that his fulfillment workload was "laughing at him." He became highly emotional, pointed fingers, and yelled at a coworker. His supervisor, Daniel Abts, sent him home. Abts found the behavior "somewhat disturbing" and emailed store leadership expressing concern for Husband's "mental state."
The next evening, July 8, Husband arrived shaking, distraught, and breathing heavily. He told Abts he thought he had "killed" his stepmother by speaking a word and asked whether he had killed anyone at the store. Abts found the statements "very irrational" and "very disturbing," believed Husband "needed help," and sent him home with a recommendation that he see a doctor or psychiatric professional. Husband and his father returned to the store that night and again the next morning, July 9, insisting Husband was "fine." During the July 9 meeting with store leadership, managers reported that Husband erupted with profanity directed at Target, though Husband's father denied the outburst occurred.
Later on July 9, Target's store director, human resources lead, and district HR business partner decided to terminate Husband for violating the company's workplace violence policy. At that time, Husband had never informed Target of his bipolar disorder or requested any accommodations. On July 10 — after the termination decision had been made but before Husband was informed — he arrived barefoot at the store, entered the employee-only area, grabbed security keys, ran out, claimed to be someone else, threw the keys at an employee, and began to disrobe. On July 18, Husband submitted a medical note clearing him to return to work but disclosing no diagnosis; he was informed that day of his termination. Subsequent requests for reinstatement, including a September 2022 letter from counsel asserting disability discrimination, went unanswered.
Husband sued Target under the Fair Employment and Housing Act (FEHA) for disability discrimination, failure to provide reasonable accommodation, and failure to engage in the interactive process. Target moved for summary judgment. The trial court granted the motion, ruling that Target had no knowledge of Husband's mental disability when it decided to terminate him because there was more than one reasonable interpretation of his workplace conduct, and that Husband had never disclosed his disability or requested accommodation. The court also found that Target had a legitimate, nondiscriminatory reason for the termination — a genuine belief that Husband had made threats or engaged in violence against coworkers in violation of company policy.
The Second District Court of Appeal affirmed in the published case of Husband v. Target Corporation, -No. B342334 (May 2026).
The opinion addresses a question at the intersection of all three FEHA theories: under what circumstances will an employer be charged with knowledge of an undisclosed mental disability based solely on its own observations? The court held that, as a matter of law, two incidents of aggressive, emotional, and irrational behavior were insufficient to impute such knowledge.
For a FEHA discrimination claim, the court applied the standard from Brundage v. Hahn (1997) 57 Cal.App.4th 228, 237: when an employee has not disclosed a disability, the employer is charged with knowledge only when "the fact of disability is the only reasonable interpretation of the known facts." For failure-to-accommodate and interactive-process claims, the court applied the related standard from Pensinger v. Bowsmith, Inc. (1998) 60 Cal.App.4th 709, 724–725, and Soria v. Univision Radio Los Angeles, Inc. (2016) 5 Cal.App.5th 570, 601: an employer's duty is triggered only when observed symptoms "are so obviously manifestations of an underlying disability" that the existence of a disability "always follows" from them.
The court acknowledged that Husband's conduct was consistent with a mental disability but concluded it was not uniquely indicative of one. His behavior could also reasonably be attributed to the effects of illegal substances, a combination of medications, or sleep deprivation — a point Husband himself conceded during his deposition. Abts's subjective impression that Husband "needed help" and might benefit from seeing a psychiatric professional did not change the analysis. The standard is objective, the court emphasized, and one untrained supervisor's speculation does not establish that a mental disability was the only reasonable interpretation of the facts. Allowing a co-worker's subjective opinion to control would make employer liability turn on the vagaries of individual workplace knowledge and willingness to speculate.
The court rejected Husband's reliance on Ninth Circuit decisions equating conduct caused by a disability with the disability itself, including Gambini v. Total Renal Care, Inc. (9th Cir. 2007) 486 F.3d 1087, 1093. Adopting that framework, the court reasoned, would effectively require every front-line supervisor to have mastered the Diagnostic and Statistical Manual — an unwarranted assumption that would vastly expand FEHA liability beyond its purpose.
- DWC Posts RAND Report on Medical-Legal Processon May 26, 2026 at 2:32 PM
The Division of Workers' Compensation (DWC) announced the release of a comprehensive RAND research report evaluating the effectiveness and long-term sustainability of California’s workers’ compensation Medical-Legal process. The study, conducted by RAND and funded by the California Department of Industrial Relations (DIR), provides a data-driven assessment of the Qualified Medical Evaluator (QME) system and its critical role in resolving workers’ compensation disputes.
A 2019 State audit of the QME system produced several recommendations aimed at increasing the availability of Medical-Legal evaluators within California’s workers’ compensation system. In 2024, DWC adopted regulations intended to improve the functioning of the QME process.
This RAND study was commissioned to assess whether the current Medical-Legal process continues to fulfill its original legislative intent and remains sustainable in its current form. The research examined several key questions, including ten high level questions:
1. Is there a mismatch between the supply and demand of QMEs across specialties and geographic areas?
2. What is the best way to recruit and retain QMEs?
3. How have recent changes to the QME reimbursement structure impacted overall costs to the workers’ compensation system, and should additional changes be considered?
4. What have been the impacts of structural changes to QME selection, and should additional changes be considered?
5. How can medical record delivery to QMEs be improved?
6. How has the quality of Med-Legal reports changed since 2012, and what is the best way to ensure the quality of QME reports?
7. Are the time frames built into the QME process appropriate and being met?
8. Are remote telehealth/remote health evaluations being used appropriately, and should any changes regulating their use be considered?
9. How have litigation practices in the Med-Legal system changed since 2012?
10. What role have medical management companies (MMCs) played in the Med-Legal process?
The findings are expected to help inform future rulemaking efforts aimed at improving the Medical-Legal evaluation system. Some examples of the findings contained in the 172 page report include:
The RAND report stated "[O]ur first high-level recommendation is to increase the number of QMEs with office locations in rural areas and in underrepresented specialties."
It went on to say "we noted substantial increases in the number of follow-up reports and depositions from 2020 to 2021. A follow-up report or deposition generally means that the QME report did not address all of the Med-Legal questions in a case. This could sometimes, but not always, arise from an issue with report quality."
And on the topic of medical management companies the report stated "MMCs can be a valuable resource to the Med-Legal system, performing key administrative functions that allow QMEs to maintain multiple offices. This, in turn, allows IWs to receive QME evaluations closer to their home. Some MMCs also provide mentorship and report review, which, if done well, could contribute to improved quality of reports. MMCs also may help recruit new QMEs."
RAND has posted its report, Qualified Medical Evaluators and the Medical-Legal Process in California Workers’ Compensation, on its website.
- WCIRB Publishes it Quarterly Experience Report Q4 2025on May 21, 2026 at 2:32 PM
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has published its latest Quarterly Experience Report, offering an updated view of statewide insurer experience valued as of December 31, 2025. The report reflects recent trends in premium, rates and system costs based on insurer-reported data.
Key findings from the report include:
- - Written premiums in calendar years 2022 through 2025 are relatively stable compared to large swings during the pandemic.
- - Average charged rates have declined steadily since 2014, reaching a historical low in 2025. The smaller decreases in the past two years suggest this trend may be leveling off.
- - The projected loss and allocated loss adjustment expense (ALAE) ratio for accident year 2025 (95%) is generally consistent with 2024 (94%).
- - The combined ratio rose 3 points in 2025 to 129%, its highest level in over 20 years. Recent increases are driven by higher claim frequency and higher loss and loss adjustment expense (LAE) costs, with relatively stable earned premium.
- - Combined ratios have exceeded 110% for the past five years. The last sustained period above 100% was prior to the Senate Bill No. 863 (SB 863) reforms.
- - Closing rates declined beginning in the second quarter of 2020 due to the pandemic and have trended lower since 2023, likely reflecting higher volumes of CT claims and increased litigation, which prolongs the claims process. The closing rate is 32.8% in 2025.
- - Since 2022, increases in indemnity claim frequency have been driven by growth in the frequency of CT claims. Excluding CT claims, recent changes have been more modest.
- - In 2025, overall frequency remains above the long- term trend due to continued elevated reporting of CT claims.
- - After increasing for eight consecutive years, projected total loss and ALAE severity is generally flat in 2025, but remains 29% above 2016.
- - ALAE severities have seen significant increases each year since 2021, with an 11% increase in 2025.
- - Following a modest increase in accident year 2024, projected indemnity severity declined slightly by 1% in accident year 2025. Indemnity severity in 2025 is 27% higher than 2016.
- - Average medical-legal costs per claim have increased sharply since 2022. This reflects both higher utilization and a continued increase in average payment per service, particularly for medical record review.
- - Recent increases are also associated with growth in CT claims, which have higher utilization of medical-legal services, as well as increased use of services involving psychological or psychiatric evaluations. Medical-legal cost increases are also more pronounced in Southern California.
The information presented reflects a compilation of individual insurer submissions of information to the WCIRB. While the individual insurer data submissions are regularly checked for consistency and comparability with other data submitted by the insurer as well as with data submitted by other insurers, the WCIRB wrote it can make no warranty with respect to the information provided by third parties.
- DWC Releases Independent Medical Review Report for 2025on May 21, 2026 at 2:32 PM
The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have released the annual report on the Department’s Independent Medical Review (IMR) program.
IMR is the medical dispute resolution process for California’s workers’ compensation system that resolves disputes over medical treatment for injured workers. The report summarizes IMR activity in 2025, the thirteenth year since the program was implemented.
The organization that administers the program, Maximus Federal Services, Inc., received 201,037 IMR applications and issued 152,351 final determination letters, each addressing one or more medical necessity disputes. Throughout the year, the organization issued decisions an average of six to seven days after receiving all required medical records.
Highlights from the report include:
Nearly 91% of all unique IMR filings were deemed eligible for review, slightly higher than the percentage in 2024.
Pharmaceutical requests accounted for 31% of all treatment requests submitted for IMR, representing a slightly smaller share of total service requests than in previous years.
Opioids comprised 22% of all pharmaceutical requests.
Treatment request denials were overturned at an overall rate of 10.2%, down from 12.7% in 2024. Program services, behavioral and mental health services, and evaluation had the highest overturn rates.
Guidelines in the Medical Treatment Utilization Schedule continued to serve as the primary resource for determining medical necessity.
The report is posted on the DIR website: 2026 Independent Medical Review (IMR) Annual Report: Analysis of 2025 Data.
DIR’s Division of Workers’ Compensation monitors the administration of workers’ compensation claims and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers’ compensation benefits.
- Stepchild Entitled to Conclusive Presumption of Total Dependencyon May 20, 2026 at 1:11 PM
Scott Eskra was employed by AF Builders, Inc., when he was struck and killed by a falling tree on March 7, 2018. He was survived by his biological daughter, Ariana Eskra, then a minor, and his wife, Brandy Eskra. Also living in his household were Brandy's two children from a prior relationship: Jovie Fischer, who was nine years old and living with Scott and Brandy approximately 20 to 23 days per month, and Austin Evenson, who had graduated high school and joined the Marine Corps but still maintained a room at the family home.
Nearly five years after Scott's death, Ariana Eskra filed an application for death benefits. Brandy Eskra was later joined as an applicant, followed by Jovie Fischer and Austin Evenson. The case required three separate trials to resolve preliminary issues — including statute of limitations questions, evidentiary disputes over a premarital agreement, and the need for additional financial records — before the dependency determinations could be made.
At trial, the evidence established that Brandy Eskra earned approximately $14,000 per year working two to two-and-a-half days per week as a hairdresser. Coworkers at the same salon corroborated that she could not have earned $30,000 per year. Scott Eskra had paid for housing, food, utilities, and other household expenses. Jovie Fischer's biological father had been paying child support until late 2017, and a court-ordered support obligation was issued in December 2017. Austin Evenson was earning roughly $800 every two weeks in the Marine Corps but received occasional financial support from Scott, including gas money, hunting trip expenses, and a plane ticket to visit.
The WCJ issued findings on February 13, 2026, ruling that Brandy Eskra was a presumptive total dependent under Labor Code section 3501(b), which creates a conclusive presumption of total dependency for a surviving spouse who earned $30,000 or less in the twelve months before the employee's death. The WCJ found that both Jovie Fischer and Austin Evenson were partial dependents, reasoning that Jovie did not qualify for the conclusive presumption under section 3501(a) because she was not Scott Eskra's biological or adopted child, and because she had other sources of support including her biological father's child support payments.
The WCAB denied Ariana Eskra's petition for reconsideration and granted Brandy Eskra's petition in the panel decision of Eskra v. AF Builders, Inc., - ADJ17262790 (May 2026). The Board affirmed the WCJ's findings in all respects except one: it amended the decision to find that Jovie Fischer was a presumptive total dependent under Labor Code section 3501(a), not merely a partial dependent. The finding regarding Austin Evenson as a partial dependent was affirmed. Commissioner Razo dissented.
On Brandy Eskra's total dependency, the Board upheld the WCJ's finding without difficulty. The unrebutted evidence — Brandy's own testimony, corroborating testimony from two coworkers, and the 2017 tax return showing gross income of $20,695 — established that she earned well under $30,000 in the year before Scott's death. The Board rejected Ariana Eskra's challenge to the tax return's admission, noting that the WCJ had relied on both documentary evidence and consistent testimony from multiple witnesses.
On the premarital agreement, the Board affirmed its exclusion. The death benefits claim did not exist at the time the agreement was signed, the claim was not the decedent's property to dispose of, and in any event workers' compensation benefits cannot be released without a WCJ's order approving and finding adequacy of consideration — none of which occurred here.
On Jovie Fischer's dependency status, the Board broke from the WCJ. The central question was whether a non-biological, unadopted child living in the decedent's household qualifies as a "child" under section 3501(a), which creates a conclusive presumption of total dependency for a child under 18 living with a deceased employee-parent at the time of injury.
Following its own reasoning in the panel decision Franco, dec'd v. Orange County Plastering Co., Inc., 2025 Cal. Wrk. Comp. P.D. LEXIS 258 (Appeals Board Panel Decision, July 14, 2025), the Board held that the plain and ordinary meaning of "child" includes stepchildren. The Board drew support from section 3503, which lists stepchildren among those who may qualify as dependents, and from section 3202, which mandates liberal construction of workers' compensation law to extend benefits to injured workers and their dependents.
The Board also cited State Compensation Ins. Fund v. Workers' Comp. Appeals Bd. (Asher) (1993) 19 Cal.App.4th 1645, which applied similar reasoning to conclude that minor grandchildren are entitled to extended death benefits. Because Jovie was living with the decedent at the time of his fatal injury, section 3501(a) applied regardless of whether she sometimes visited her biological father or whether that father paid child support.
On Austin Evenson, the Board agreed with the WCJ that he was a partial dependent. Although Austin was a good-faith member of the household under section 3503 and received some financial support from the decedent, he was over 18 and earning his own income in the Marine Corps, so the conclusive presumption of section 3501(a) did not apply. The exact amount of his dependency was deferred.
Commissioner Razo dissented on the Jovie Fischer issue, adopting the WCJ's reasoning. He emphasized that Jovie was not living full-time with the decedent and that her biological father was paying child support, making a finding of total dependency inappropriate in his view. He would have left the WCJ's partial dependency finding in place.
- When Can Treating Physician Use Narrative Report for RFA Forms?on May 20, 2026 at 1:11 PM
The Division of Workers' Compensation (DWC) has adopted updated regulations regarding Utilization Review (UR), which became effective April 1, 2026. These regulations, designed to streamline and standardize the medical treatment authorization process, are available on the DWC website.
In light of these updates, the DWC has received several inquiries regarding whether the use of the DWC Form RFA (Request for Authorization) is mandatory for treating physicians.
Pursuant to California Code of Regulations, title 8, section 9792.6.1, a "Request for Authorization" is formally defined as a written request for a specific course of proposed medical treatment. The regulations mandate that this request be set forth on the DWC Form RFA (as found in section 9785.5) and completed by the treating physician.
The standardized use of the DWC Form RFA is a critical regulatory requirement intended to ensure clear, consistent communication between medical providers and claims administrators, thereby reducing delays in the delivery of necessary medical care.
While the DWC Form RFA is the primary standard, a narrative report may serve as a functional equivalent only under specific conditions outlined in CCR section 9792.9.1(b) and 9792.6.1(u):
- - Mutual Acceptance: The claims administrator (CA) must voluntarily agree to accept a narrative report in lieu of the formal DWC Form RFA.
- - Minimum Content Standards: To be deemed "completed," the narrative report must contain all essential data elements required by law, including:
- - Clear identification of both the employee and the requesting provider.
- - Specific identification of all recommended treatments on the first page of the narrative.
- - Substantiating documentation created no earlier than 30 days prior to the request.
- - Treating Physician’s Signature: The report must be signed by the physician (electronic signatures are permitted by agreement of the parties).
DWC reminds all stakeholders that failure to provide a "completed" request (one that lacks specificity or the required substantiating documentation) may impact the timelines for UR decisions and the overall adjudication of treatment requests.
- Eleven Insurance Commissioner Candidates on June 2 Primary Balloton May 19, 2026 at 4:12 PM
Eleven candidates are running in the top-two primary for insurance commissioner of California on June 2, 2026. Five have led in media attention: Stacy Korsgaden (R), Ben Allen (D), Steven Bradford (D), Jane Kim (D), and Patrick Wolff (D). Incumbent Ricardo Lara (D) is term-limited and is retiring from public office.
Stacy Korsgaden has warned she would crack down on insurance fraud and conduct a full audit of the California Department of Insurance if elected. Korsgaden is a licensed insurance professional (License #0750748) since 1988, small business owner, and lifelong Californian. And according to a report by the New York Post “[t]he reason that I’m running is that we have a situation that I cannot sit back anymore and watch, the inexperience in the policies that are being implemented throughout the state. That’s why I’m getting involved,” she said during a town hall in Tuolumne County.
Ben Allen is currently sitting on the California Senate. Allen wrote on his official candidate statement "I have a long track record of success working for the public interest: In the State Senate, I've taken on insurance industry lobbyists, passed some of the nation's strongest consumer protection laws, and led efforts to invest $10 billion in wildfire prevention, water infrastructure improvements, and climate resilience. As Insurance Commissioner, my #1 priority will be putting consumers first. That means: Holding polluters accountable: I'll make corporate polluters financially responsible for climate damages that drive up insurance costs."
Allen is frequently described as a strong contender or frontrunner. He has significant fundraising (~$1.5M+ raised), high-profile endorsements (e.g., Adam Schiff), and experience in wildfire-affected areas. Recent endorsements (e.g., from newspapers) position him as a top choice.
Steven Bradford is a former State Senator where he sat on the State Legislature's Insurance Committee where he helped build consensus on complex regulatory challenges. His plan "includes bringing transparency to insurance pricing, rewarding people who protect their homes, rebuilding the insurance market in high risk areas, and making rates make sense. Bradford will support safer moves for the most at-risk, modernize the Department of Insurance, and put equity front and center."
Jane Kim is a civil rights attorney, organizer and consumer advocate. "As Insurance Commissioner, I'll cap excessive profits and freeze your rates when you file a claim. I'll create a public Disaster Insurance for All program so we are protected when fires, floods or earthquakes strike. I'll crack down on illegal price-fixing, stop insurers from using credit scores to deny coverage, and fight for guaranteed healthcare for every child in California." Kim is backed by progressives (e.g., Bernie Sanders ties via Working Families Party)
Patrick Wolff wrote that "[f]rom 2001–2005, I worked at a major bank where I built a home and auto ins urance brokerage. Since 2005, I have worked as a financial analyst where, among other sectors, I analyzed insurance markets and companies." According to his website "I have a plan to solve our state’s insurance crisis by holding insurance companies accountable, increasing choice and competition, and improving transparency."
Lower profile candidates include Republican Sean Lee. Lee conducted scientific research at JPL / NASA through Caltech, developing a disciplined, data-driven approach to analyzing complex problems. He later applied those analytical skills in the insurance and financial services industries. He supports transparency, accountability, and effective oversight of insurance practices. Lee also supports the responsible use of emerging technologies, including artificial intelligence and lnsurTech, to improve efficiency and combat fraud.
Republican Robert P Howell unsuccessfully competed for Insurance Commissioner Ricardo Lara. He has been the CEO of a Silicon Valley cybersecurity manufacturing company. He wrote " I will hold insurance companies accountable to the rules and challenge abusive practices. I will implement an “Insurance Payers Bill of Rights” to protect policyholders from unfair cancellations and unjustified rate increases."
Eduardo “Lalo” Vargas is the Peace and Freedom party candidate. He wrote "I pledge to freeze insurance rates and lower premiums, to investigate and hold insurance executives accountable for exploitative claim procedures, and to fight for a public insurance system that guarantees full and fair coverage for all."
Republican candidate Merritt Farren is a California wildfire survivor, former Amazon lawyer, and former head of legal, guest claims, and security operations for the Disneyland Resort. He wrote " I want to bring the customer-centric innovation I've learned to California insurance regulation."
Keith Davis (American Independent) and Eric Aarnio do not have candidate statements on the official ballot. Both are lower-profile candidates compared to the leading Democrats and more prominent Republicans. Davis is an insurance agent from Riverside California. He emphasizes being a consumer advocate rather than aligned with big insurance companies. He has a campaign website (gokeithdavis.com) and has been active in interviews and outreach.
Eric Aarnio is a Republican, and a contractor from Sacramento with no prior elected office or formal insurance industry background. He has a very low-profile campaign (no website or social media listed in questionnaires) and minimal media presence.
- Owner of Health Care Software Company Convicted for $1B Fraudon May 19, 2026 at 4:12 PM
A federal jury convicted the founder and owner of HealthSplash for his role in operating a platform that generated false doctors’ orders and prescriptions to defraud Medicare and other federal health care benefit programs out of more than $1 billion.
According to court documents and evidence presented at trial, Brett Blackman, 42, of Johnson County, Kansas, and his co-conspirators aggressively targeted hundreds of thousands of Medicare beneficiaries to get them to accept medically unnecessary orthotic braces and other items. They then arranged for purported telemedicine doctors to sign bogus prescription orders for these items, so that their co-conspirators could bill Medicare for them. All told, Blackman and his co-conspirators billed Medicare and other federal health care benefit programs over $1 billion for this unnecessary equipment.
Blackman owned, controlled, and was the CEO of HealthSplash, which acquired Power Mobility Doctor Rx, LLC (DMERx) in September 2017. DMERx was an internet-based platform that generated false and fraudulent doctors’ orders for durable medical equipment (DME) and prescriptions for other items. As part of the scheme, Blackman and his co-conspirators connected pharmacies, DME suppliers, and marketers with telemedicine companies that would accept illegal kickbacks and bribes in exchange for signed doctors’ orders created using the DMERx platform. Blackman and his co-conspirators took a cut for themselves in exchange for the referrals.
The fraudulent doctors’ orders and prescriptions generated by DMERx falsely represented that a doctor had actually examined and treated the Medicare beneficiaries when, in fact, the doctors were simply paid to sign orders and prescriptions without any meaningful interaction with the beneficiary, and in some cases, no interaction at all. Doctors signed these orders and prescriptions without regard to whether the equipment was medically necessary. Testimony and evidence presented at trial from an undercover agent who posed as a Medicare beneficiary showed the scheme in action—starting with a foreign call center that pushed the undercover agent to agree to multiple braces to a doctor signing bogus orders for the braces using Blackman’s DMERx platform. The doctor’s order for one of these undercover agent beneficiaries claimed that the doctor conducted various tests that can only be performed in person even though the doctor never even spoke with the undercover agent “patient.”
The DME suppliers and pharmacies that were paying illegal kickbacks for these orders billed Medicare and other insurers for more than $1 billion. Medicare and the other insurers paid more than $450 million based on these claims. According to evidence presented at trial, Blackman and his co-conspirators concealed the scheme through sham contracts and by manipulating the doctors’ orders to avoid Medicare audits.
The jury convicted Blackman of conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive health care kickbacks, and conspiracy to defraud the United States and to make false statements in connection with health care matters. Blackman’s co-defendant, Gary Cox, was convicted in a prior trial and sentenced to 15 years in prison.
Blackman faces a maximum penalty of 20 years in prison for the conspiracy to commit health care fraud and wire fraud conviction, five years for the conspiracy to pay and receive health care kickbacks conviction, and five years for the conspiracy to defraud the United States and to make false statements in connection with health care matters conviction. A sentencing hearing has been scheduled for August 26, 2026. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
“The Department of Justice crushed one of the most egregious fraud schemes in Florida history,” said Acting Attorney General Todd Blanche. “This illegitimate operation stole more than $1 billion from American taxpayers — including hundreds of thousands of Medicare beneficiaries. This was cold, calculated, industrial-scale theft targeting the sick and elderly, coercing vulnerable people into buying unnecessary medical equipment. We will not rest until every fraudster ripping off the American people is held accountable.”
- Employer's $257K Attorney Fee Award Against Employee Affirmedon May 18, 2026 at 11:07 AM
Nick Miletak was hired to participate in Royal Coach Tours' student driver trainee program. On the day formal classroom instruction was set to begin, Miletak showed up, handed in his resignation, and demanded compensation for time he had been available before the formal training started. Royal Coach refused but still paid him for 11 hours of classroom time he had logged during informal training.
About a week after resigning, Miletak filed a civil lawsuit against Royal Coach alleging five causes of action. After Royal Coach demurred, Miletak filed an amended complaint asserting two claims: promissory estoppel and constructive discharge. Following a court trial, judgment was entered in Royal Coach's favor. Miletak appealed, and the Sixth District affirmed. Royal Coach then sued Miletak for malicious prosecution.
A bench trial was held on the malicious prosecution claim without a court reporter present. The trial court issued a statement of decision finding that Miletak's prior employment action had terminated in Royal Coach's favor, that Miletak lacked probable cause to bring the claims, that he pursued the action with malice, and that Royal Coach suffered damages. The court awarded Royal Coach $257,197.53, including punitive damages.
Miletak subsequently filed motions for a new trial, to dismiss, and to vacate the judgment. The trial court denied each one.
The Sixth District Court of Appeal affirmed the judgment in its entirety in the unpublished case of Royal Coach Tours, Inc. v. Miletak, -H052687 (May 2026). Miletak raised thirteen separate contentions on appeal; the court rejected all of them.
Miletak appealed in pro per. The court's analysis was shaped throughout by Miletak's repeated failure to meet basic appellate requirements — providing adequate record citations, presenting developed legal arguments, and confining his claims to matters in the record. The court invoked the principle from Jameson v. Desta (2018) 5 Cal.5th 594, 609, that the burden falls on the appellant to demonstrate error on the basis of the record presented.
On personal jurisdiction, Miletak argued the trial court lost jurisdiction when he relocated to Florida. The court held that once a trial court acquires jurisdiction over a party, that jurisdiction continues to final judgment and is not defeated by the party's relocation, citing Goldman v. Simpson (2008) 160 Cal.App.4th 255, 263–264. Miletak's reliance on Daimler AG v. Bauman (2014) 571 U.S. 117 was misplaced because that case addressed an entirely different question about claims by foreign plaintiffs against a foreign defendant.
On the absence of a court reporter, Miletak claimed he requested one at trial. But the settled statement, the order denying his new trial motion, and the trial court's own statements at the settled statement hearing all indicated that no such request was made. Without record evidence of a request, the court found no error.
On the denial of a jury trial, the record showed Miletak failed to timely request a jury or demonstrate that his partial fee waiver covered jury fees. The court applied TriCoast Builders, Inc. v. Fonnegra (2024) 15 Cal.5th 766, which holds that a litigant challenging the denial of relief from a jury waiver for the first time on appeal must show prejudice — something Miletak never attempted.
On probable cause, the central substantive issue, Miletak argued that the denial of Royal Coach's nonsuit motion in the underlying employment action conclusively established probable cause under the interim adverse judgment rule. The court disagreed. Drawing on Parrish v. Latham & Watkins (2017) 3 Cal.5th 767 and Wilson v. Parker, Covert & Chidester (2002) 28 Cal.4th 811, the court explained that the interim adverse judgment rule applies only to rulings on the merits, not those resting on procedural or technical grounds. Here, the nonsuit motion was denied based on Miletak's opening statement — before any evidence was presented — so the denial said nothing about the substantive merits of his promissory estoppel claim.
The court also noted that Miletak attributed a fabricated quotation to Parrish, claiming that probable cause for any single claim insulates the entire suit. The California Supreme Court has held precisely the opposite: a malicious prosecution suit may be maintained where even one of several claims in the prior action lacked probable cause. See Crowley v. Katleman (1994) 8 Cal.4th 666, 671.
On the remaining issues — evidentiary rulings, judicial bias, fraud on the court, the settled statement, denial of writ petitions, and the prior anti-SLAPP appeal — the court found each contention either unsupported by record citations, procedurally forfeited, or substantively without merit. Multiple claims were deemed waived under Duarte v. Chino Community Hospital (1999) 72 Cal.App.4th 849, 856, for failure to cite the record.
- Major Drug Maker to Pay $13.6M to Resolve Kickback Caseon May 18, 2026 at 11:07 AM
Takeda Pharmaceuticals U.S.A., Inc. is the U.S. subsidiary of Takeda Pharmaceutical Company Limited, a major global biopharmaceutical company headquartered in Osaka, Japan It is one of the world’s leading R&D-driven pharmaceutical companies, with a strong emphasis on oncology, rare diseases, neuroscience, gastroenterology (and inflammation), plasma-derived therapies, immunology, and vaccines.
The company has a major presence, including its global hub and research center in Cambridge, Massachusetts (making Takeda the largest life sciences employer in the state). It has sites in 39 states and employs more than 20,000 people in the U.S. (part of ~50,000 worldwide).
Takeda Pharmaceuticals, U.S.A., Inc. has agreed to pay $13,670,921 to resolve allegations that it knowingly caused the submission of false claims to Medicare and other federal health care programs by paying kickbacks to healthcare providers to induce prescriptions of Trintellix, an antidepressant medication that Takeda marketed and sold to treat major depressive disorder.
Trintellix (vortioxetine) is a prescription antidepressant medication used to treat Major Depressive Disorder (MDD) in adults. It is marketed in the U.S. by Takeda Pharmaceuticals (in collaboration with H. Lundbeck A/S, which originally developed it).
The civil settlement resolves allegations that, from January 2014 to October 2020, Takeda paid improper remuneration, including in the form of speaker honoraria and meals at high-end restaurants, to healthcare professionals to induce them to prescribe the antidepressant medication Trintellix in violation of the Anti-Kickback Statute.
The United States contends that Takeda selected certain healthcare providers to be part of the Trintellix speaker bureau and provided them paid speaking opportunities with the intent that the speaker honoraria and meals would induce them to prescribe Trintellix. The government further contends that certain prescribers who attended multiple programs on the same topic and received meals and drinks from Takeda received no educational benefit from attending duplicate programs.
Takeda (including its subsidiaries and predecessors like TAP) has faced other False Claims Act (FCA) allegations, Medicaid fraud claims, kickback-related matters, and similar government program issues in the U.S.
- - 2001 TAP Pharmaceuticals Settlement (Lupron): Takeda's former joint venture with Abbott (TAP) paid $875 million to resolve criminal and civil charges. Allegations included providing free drug samples to doctors who then billed Medicare/Medicaid, kickbacks, and improper pricing. This was one of the largest pharma fraud settlements at the time.
- - In 2023 Takeda subsidiaries (along with others from the Shire acquisition) agreed to pay a combined ~$42.7 million to resolve Texas Medicaid Fraud Prevention Act claims. Allegations involved providing improper nursing/reimbursement support and paying nurse educators to recommend Vyvanse to Medicaid providers (~2014–2015). This was a whistleblower-initiated case.
Takeda paid ~$2.4 billion in 2015 to settle thousands of U.S. lawsuits alleging the diabetes drug caused bladder cancer and that risks were inadequately disclosed. Some claims involved marketing practices, but these were primarily personal injury/product liability.
- No Duty for Employer to Accommodate Undisclosed Mental Disabilityon May 26, 2026 at 2:32 PM
Target Corporation hired Daniel Husband in October 2020 as a fulfillment expert at its Burbank store. Although Target's new-hire materials explained that the company would attempt to accommodate known physical or mental limitations, Husband did not disclose to any Target official that he had been diagnosed with bipolar I disorder. He worked without incident for approximately 20 months.
Things changed in the summer of 2022. On June 9, 2022, Husband entered the store while off duty and became visibly upset with an employee; the employee reported that Husband used profanity, though Husband denied it. He was verbally counseled and later received a written memo.
On July 7, 2022, Husband arrived for his night shift looking deflated, then suddenly became angry. He recounted hitting himself in the temple and said that his fulfillment workload was "laughing at him." He became highly emotional, pointed fingers, and yelled at a coworker. His supervisor, Daniel Abts, sent him home. Abts found the behavior "somewhat disturbing" and emailed store leadership expressing concern for Husband's "mental state."
The next evening, July 8, Husband arrived shaking, distraught, and breathing heavily. He told Abts he thought he had "killed" his stepmother by speaking a word and asked whether he had killed anyone at the store. Abts found the statements "very irrational" and "very disturbing," believed Husband "needed help," and sent him home with a recommendation that he see a doctor or psychiatric professional. Husband and his father returned to the store that night and again the next morning, July 9, insisting Husband was "fine." During the July 9 meeting with store leadership, managers reported that Husband erupted with profanity directed at Target, though Husband's father denied the outburst occurred.
Later on July 9, Target's store director, human resources lead, and district HR business partner decided to terminate Husband for violating the company's workplace violence policy. At that time, Husband had never informed Target of his bipolar disorder or requested any accommodations. On July 10 — after the termination decision had been made but before Husband was informed — he arrived barefoot at the store, entered the employee-only area, grabbed security keys, ran out, claimed to be someone else, threw the keys at an employee, and began to disrobe. On July 18, Husband submitted a medical note clearing him to return to work but disclosing no diagnosis; he was informed that day of his termination. Subsequent requests for reinstatement, including a September 2022 letter from counsel asserting disability discrimination, went unanswered.
Husband sued Target under the Fair Employment and Housing Act (FEHA) for disability discrimination, failure to provide reasonable accommodation, and failure to engage in the interactive process. Target moved for summary judgment. The trial court granted the motion, ruling that Target had no knowledge of Husband's mental disability when it decided to terminate him because there was more than one reasonable interpretation of his workplace conduct, and that Husband had never disclosed his disability or requested accommodation. The court also found that Target had a legitimate, nondiscriminatory reason for the termination — a genuine belief that Husband had made threats or engaged in violence against coworkers in violation of company policy.
The Second District Court of Appeal affirmed in the published case of Husband v. Target Corporation, -No. B342334 (May 2026).
The opinion addresses a question at the intersection of all three FEHA theories: under what circumstances will an employer be charged with knowledge of an undisclosed mental disability based solely on its own observations? The court held that, as a matter of law, two incidents of aggressive, emotional, and irrational behavior were insufficient to impute such knowledge.
For a FEHA discrimination claim, the court applied the standard from Brundage v. Hahn (1997) 57 Cal.App.4th 228, 237: when an employee has not disclosed a disability, the employer is charged with knowledge only when "the fact of disability is the only reasonable interpretation of the known facts." For failure-to-accommodate and interactive-process claims, the court applied the related standard from Pensinger v. Bowsmith, Inc. (1998) 60 Cal.App.4th 709, 724–725, and Soria v. Univision Radio Los Angeles, Inc. (2016) 5 Cal.App.5th 570, 601: an employer's duty is triggered only when observed symptoms "are so obviously manifestations of an underlying disability" that the existence of a disability "always follows" from them.
The court acknowledged that Husband's conduct was consistent with a mental disability but concluded it was not uniquely indicative of one. His behavior could also reasonably be attributed to the effects of illegal substances, a combination of medications, or sleep deprivation — a point Husband himself conceded during his deposition. Abts's subjective impression that Husband "needed help" and might benefit from seeing a psychiatric professional did not change the analysis. The standard is objective, the court emphasized, and one untrained supervisor's speculation does not establish that a mental disability was the only reasonable interpretation of the facts. Allowing a co-worker's subjective opinion to control would make employer liability turn on the vagaries of individual workplace knowledge and willingness to speculate.
The court rejected Husband's reliance on Ninth Circuit decisions equating conduct caused by a disability with the disability itself, including Gambini v. Total Renal Care, Inc. (9th Cir. 2007) 486 F.3d 1087, 1093. Adopting that framework, the court reasoned, would effectively require every front-line supervisor to have mastered the Diagnostic and Statistical Manual — an unwarranted assumption that would vastly expand FEHA liability beyond its purpose. - DWC Posts RAND Report on Medical-Legal Processon May 26, 2026 at 2:32 PM
The Division of Workers' Compensation (DWC) announced the release of a comprehensive RAND research report evaluating the effectiveness and long-term sustainability of California’s workers’ compensation Medical-Legal process. The study, conducted by RAND and funded by the California Department of Industrial Relations (DIR), provides a data-driven assessment of the Qualified Medical Evaluator (QME) system and its critical role in resolving workers’ compensation disputes.
A 2019 State audit of the QME system produced several recommendations aimed at increasing the availability of Medical-Legal evaluators within California’s workers’ compensation system. In 2024, DWC adopted regulations intended to improve the functioning of the QME process.
This RAND study was commissioned to assess whether the current Medical-Legal process continues to fulfill its original legislative intent and remains sustainable in its current form. The research examined several key questions, including ten high level questions:
1. Is there a mismatch between the supply and demand of QMEs across specialties and geographic areas?
2. What is the best way to recruit and retain QMEs?
3. How have recent changes to the QME reimbursement structure impacted overall costs to the workers’ compensation system, and should additional changes be considered?
4. What have been the impacts of structural changes to QME selection, and should additional changes be considered?
5. How can medical record delivery to QMEs be improved?
6. How has the quality of Med-Legal reports changed since 2012, and what is the best way to ensure the quality of QME reports?
7. Are the time frames built into the QME process appropriate and being met?
8. Are remote telehealth/remote health evaluations being used appropriately, and should any changes regulating their use be considered?
9. How have litigation practices in the Med-Legal system changed since 2012?
10. What role have medical management companies (MMCs) played in the Med-Legal process?
The findings are expected to help inform future rulemaking efforts aimed at improving the Medical-Legal evaluation system. Some examples of the findings contained in the 172 page report include:
The RAND report stated "[O]ur first high-level recommendation is to increase the number of QMEs with office locations in rural areas and in underrepresented specialties."
It went on to say "we noted substantial increases in the number of follow-up reports and depositions from 2020 to 2021. A follow-up report or deposition generally means that the QME report did not address all of the Med-Legal questions in a case. This could sometimes, but not always, arise from an issue with report quality."
And on the topic of medical management companies the report stated "MMCs can be a valuable resource to the Med-Legal system, performing key administrative functions that allow QMEs to maintain multiple offices. This, in turn, allows IWs to receive QME evaluations closer to their home. Some MMCs also provide mentorship and report review, which, if done well, could contribute to improved quality of reports. MMCs also may help recruit new QMEs."
RAND has posted its report, Qualified Medical Evaluators and the Medical-Legal Process in California Workers’ Compensation, on its website. - WCIRB Publishes it Quarterly Experience Report Q4 2025on May 21, 2026 at 2:32 PM
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has published its latest Quarterly Experience Report, offering an updated view of statewide insurer experience valued as of December 31, 2025. The report reflects recent trends in premium, rates and system costs based on insurer-reported data.
Key findings from the report include:
- - Written premiums in calendar years 2022 through 2025 are relatively stable compared to large swings during the pandemic.
- - Average charged rates have declined steadily since 2014, reaching a historical low in 2025. The smaller decreases in the past two years suggest this trend may be leveling off.
- - The projected loss and allocated loss adjustment expense (ALAE) ratio for accident year 2025 (95%) is generally consistent with 2024 (94%).
- - The combined ratio rose 3 points in 2025 to 129%, its highest level in over 20 years. Recent increases are driven by higher claim frequency and higher loss and loss adjustment expense (LAE) costs, with relatively stable earned premium.
- - Combined ratios have exceeded 110% for the past five years. The last sustained period above 100% was prior to the Senate Bill No. 863 (SB 863) reforms.
- - Closing rates declined beginning in the second quarter of 2020 due to the pandemic and have trended lower since 2023, likely reflecting higher volumes of CT claims and increased litigation, which prolongs the claims process. The closing rate is 32.8% in 2025.
- - Since 2022, increases in indemnity claim frequency have been driven by growth in the frequency of CT claims. Excluding CT claims, recent changes have been more modest.
- - In 2025, overall frequency remains above the long- term trend due to continued elevated reporting of CT claims.
- - After increasing for eight consecutive years, projected total loss and ALAE severity is generally flat in 2025, but remains 29% above 2016.
- - ALAE severities have seen significant increases each year since 2021, with an 11% increase in 2025.
- - Following a modest increase in accident year 2024, projected indemnity severity declined slightly by 1% in accident year 2025. Indemnity severity in 2025 is 27% higher than 2016.
- - Average medical-legal costs per claim have increased sharply since 2022. This reflects both higher utilization and a continued increase in average payment per service, particularly for medical record review.
- - Recent increases are also associated with growth in CT claims, which have higher utilization of medical-legal services, as well as increased use of services involving psychological or psychiatric evaluations. Medical-legal cost increases are also more pronounced in Southern California.
The information presented reflects a compilation of individual insurer submissions of information to the WCIRB. While the individual insurer data submissions are regularly checked for consistency and comparability with other data submitted by the insurer as well as with data submitted by other insurers, the WCIRB wrote it can make no warranty with respect to the information provided by third parties. - DWC Releases Independent Medical Review Report for 2025on May 21, 2026 at 2:32 PM
The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have released the annual report on the Department’s Independent Medical Review (IMR) program.
IMR is the medical dispute resolution process for California’s workers’ compensation system that resolves disputes over medical treatment for injured workers. The report summarizes IMR activity in 2025, the thirteenth year since the program was implemented.
The organization that administers the program, Maximus Federal Services, Inc., received 201,037 IMR applications and issued 152,351 final determination letters, each addressing one or more medical necessity disputes. Throughout the year, the organization issued decisions an average of six to seven days after receiving all required medical records.
Highlights from the report include:
Nearly 91% of all unique IMR filings were deemed eligible for review, slightly higher than the percentage in 2024.
Pharmaceutical requests accounted for 31% of all treatment requests submitted for IMR, representing a slightly smaller share of total service requests than in previous years.
Opioids comprised 22% of all pharmaceutical requests.
Treatment request denials were overturned at an overall rate of 10.2%, down from 12.7% in 2024. Program services, behavioral and mental health services, and evaluation had the highest overturn rates.
Guidelines in the Medical Treatment Utilization Schedule continued to serve as the primary resource for determining medical necessity.
The report is posted on the DIR website: 2026 Independent Medical Review (IMR) Annual Report: Analysis of 2025 Data.
DIR’s Division of Workers’ Compensation monitors the administration of workers’ compensation claims and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers’ compensation benefits. - Stepchild Entitled to Conclusive Presumption of Total Dependencyon May 20, 2026 at 1:11 PM
Scott Eskra was employed by AF Builders, Inc., when he was struck and killed by a falling tree on March 7, 2018. He was survived by his biological daughter, Ariana Eskra, then a minor, and his wife, Brandy Eskra. Also living in his household were Brandy's two children from a prior relationship: Jovie Fischer, who was nine years old and living with Scott and Brandy approximately 20 to 23 days per month, and Austin Evenson, who had graduated high school and joined the Marine Corps but still maintained a room at the family home.
Nearly five years after Scott's death, Ariana Eskra filed an application for death benefits. Brandy Eskra was later joined as an applicant, followed by Jovie Fischer and Austin Evenson. The case required three separate trials to resolve preliminary issues — including statute of limitations questions, evidentiary disputes over a premarital agreement, and the need for additional financial records — before the dependency determinations could be made.
At trial, the evidence established that Brandy Eskra earned approximately $14,000 per year working two to two-and-a-half days per week as a hairdresser. Coworkers at the same salon corroborated that she could not have earned $30,000 per year. Scott Eskra had paid for housing, food, utilities, and other household expenses. Jovie Fischer's biological father had been paying child support until late 2017, and a court-ordered support obligation was issued in December 2017. Austin Evenson was earning roughly $800 every two weeks in the Marine Corps but received occasional financial support from Scott, including gas money, hunting trip expenses, and a plane ticket to visit.
The WCJ issued findings on February 13, 2026, ruling that Brandy Eskra was a presumptive total dependent under Labor Code section 3501(b), which creates a conclusive presumption of total dependency for a surviving spouse who earned $30,000 or less in the twelve months before the employee's death. The WCJ found that both Jovie Fischer and Austin Evenson were partial dependents, reasoning that Jovie did not qualify for the conclusive presumption under section 3501(a) because she was not Scott Eskra's biological or adopted child, and because she had other sources of support including her biological father's child support payments.
The WCAB denied Ariana Eskra's petition for reconsideration and granted Brandy Eskra's petition in the panel decision of Eskra v. AF Builders, Inc., - ADJ17262790 (May 2026). The Board affirmed the WCJ's findings in all respects except one: it amended the decision to find that Jovie Fischer was a presumptive total dependent under Labor Code section 3501(a), not merely a partial dependent. The finding regarding Austin Evenson as a partial dependent was affirmed. Commissioner Razo dissented.
On Brandy Eskra's total dependency, the Board upheld the WCJ's finding without difficulty. The unrebutted evidence — Brandy's own testimony, corroborating testimony from two coworkers, and the 2017 tax return showing gross income of $20,695 — established that she earned well under $30,000 in the year before Scott's death. The Board rejected Ariana Eskra's challenge to the tax return's admission, noting that the WCJ had relied on both documentary evidence and consistent testimony from multiple witnesses.
On the premarital agreement, the Board affirmed its exclusion. The death benefits claim did not exist at the time the agreement was signed, the claim was not the decedent's property to dispose of, and in any event workers' compensation benefits cannot be released without a WCJ's order approving and finding adequacy of consideration — none of which occurred here.
On Jovie Fischer's dependency status, the Board broke from the WCJ. The central question was whether a non-biological, unadopted child living in the decedent's household qualifies as a "child" under section 3501(a), which creates a conclusive presumption of total dependency for a child under 18 living with a deceased employee-parent at the time of injury.
Following its own reasoning in the panel decision Franco, dec'd v. Orange County Plastering Co., Inc., 2025 Cal. Wrk. Comp. P.D. LEXIS 258 (Appeals Board Panel Decision, July 14, 2025), the Board held that the plain and ordinary meaning of "child" includes stepchildren. The Board drew support from section 3503, which lists stepchildren among those who may qualify as dependents, and from section 3202, which mandates liberal construction of workers' compensation law to extend benefits to injured workers and their dependents.
The Board also cited State Compensation Ins. Fund v. Workers' Comp. Appeals Bd. (Asher) (1993) 19 Cal.App.4th 1645, which applied similar reasoning to conclude that minor grandchildren are entitled to extended death benefits. Because Jovie was living with the decedent at the time of his fatal injury, section 3501(a) applied regardless of whether she sometimes visited her biological father or whether that father paid child support.
On Austin Evenson, the Board agreed with the WCJ that he was a partial dependent. Although Austin was a good-faith member of the household under section 3503 and received some financial support from the decedent, he was over 18 and earning his own income in the Marine Corps, so the conclusive presumption of section 3501(a) did not apply. The exact amount of his dependency was deferred.
Commissioner Razo dissented on the Jovie Fischer issue, adopting the WCJ's reasoning. He emphasized that Jovie was not living full-time with the decedent and that her biological father was paying child support, making a finding of total dependency inappropriate in his view. He would have left the WCJ's partial dependency finding in place. - When Can Treating Physician Use Narrative Report for RFA Forms?on May 20, 2026 at 1:11 PM
The Division of Workers' Compensation (DWC) has adopted updated regulations regarding Utilization Review (UR), which became effective April 1, 2026. These regulations, designed to streamline and standardize the medical treatment authorization process, are available on the DWC website.
In light of these updates, the DWC has received several inquiries regarding whether the use of the DWC Form RFA (Request for Authorization) is mandatory for treating physicians.
Pursuant to California Code of Regulations, title 8, section 9792.6.1, a "Request for Authorization" is formally defined as a written request for a specific course of proposed medical treatment. The regulations mandate that this request be set forth on the DWC Form RFA (as found in section 9785.5) and completed by the treating physician.
The standardized use of the DWC Form RFA is a critical regulatory requirement intended to ensure clear, consistent communication between medical providers and claims administrators, thereby reducing delays in the delivery of necessary medical care.
While the DWC Form RFA is the primary standard, a narrative report may serve as a functional equivalent only under specific conditions outlined in CCR section 9792.9.1(b) and 9792.6.1(u):
- - Mutual Acceptance: The claims administrator (CA) must voluntarily agree to accept a narrative report in lieu of the formal DWC Form RFA.
- - Minimum Content Standards: To be deemed "completed," the narrative report must contain all essential data elements required by law, including:
- - Clear identification of both the employee and the requesting provider.
- - Specific identification of all recommended treatments on the first page of the narrative.
- - Substantiating documentation created no earlier than 30 days prior to the request.
- - Treating Physician’s Signature: The report must be signed by the physician (electronic signatures are permitted by agreement of the parties).
DWC reminds all stakeholders that failure to provide a "completed" request (one that lacks specificity or the required substantiating documentation) may impact the timelines for UR decisions and the overall adjudication of treatment requests. - Eleven Insurance Commissioner Candidates on June 2 Primary Balloton May 19, 2026 at 4:12 PM
Eleven candidates are running in the top-two primary for insurance commissioner of California on June 2, 2026. Five have led in media attention: Stacy Korsgaden (R), Ben Allen (D), Steven Bradford (D), Jane Kim (D), and Patrick Wolff (D). Incumbent Ricardo Lara (D) is term-limited and is retiring from public office.
Stacy Korsgaden has warned she would crack down on insurance fraud and conduct a full audit of the California Department of Insurance if elected. Korsgaden is a licensed insurance professional (License #0750748) since 1988, small business owner, and lifelong Californian. And according to a report by the New York Post “[t]he reason that I’m running is that we have a situation that I cannot sit back anymore and watch, the inexperience in the policies that are being implemented throughout the state. That’s why I’m getting involved,” she said during a town hall in Tuolumne County.
Ben Allen is currently sitting on the California Senate. Allen wrote on his official candidate statement "I have a long track record of success working for the public interest: In the State Senate, I've taken on insurance industry lobbyists, passed some of the nation's strongest consumer protection laws, and led efforts to invest $10 billion in wildfire prevention, water infrastructure improvements, and climate resilience. As Insurance Commissioner, my #1 priority will be putting consumers first. That means: Holding polluters accountable: I'll make corporate polluters financially responsible for climate damages that drive up insurance costs."
Allen is frequently described as a strong contender or frontrunner. He has significant fundraising (~$1.5M+ raised), high-profile endorsements (e.g., Adam Schiff), and experience in wildfire-affected areas. Recent endorsements (e.g., from newspapers) position him as a top choice.
Steven Bradford is a former State Senator where he sat on the State Legislature's Insurance Committee where he helped build consensus on complex regulatory challenges. His plan "includes bringing transparency to insurance pricing, rewarding people who protect their homes, rebuilding the insurance market in high risk areas, and making rates make sense. Bradford will support safer moves for the most at-risk, modernize the Department of Insurance, and put equity front and center."
Jane Kim is a civil rights attorney, organizer and consumer advocate. "As Insurance Commissioner, I'll cap excessive profits and freeze your rates when you file a claim. I'll create a public Disaster Insurance for All program so we are protected when fires, floods or earthquakes strike. I'll crack down on illegal price-fixing, stop insurers from using credit scores to deny coverage, and fight for guaranteed healthcare for every child in California." Kim is backed by progressives (e.g., Bernie Sanders ties via Working Families Party)
Patrick Wolff wrote that "[f]rom 2001–2005, I worked at a major bank where I built a home and auto ins urance brokerage. Since 2005, I have worked as a financial analyst where, among other sectors, I analyzed insurance markets and companies." According to his website "I have a plan to solve our state’s insurance crisis by holding insurance companies accountable, increasing choice and competition, and improving transparency."
Lower profile candidates include Republican Sean Lee. Lee conducted scientific research at JPL / NASA through Caltech, developing a disciplined, data-driven approach to analyzing complex problems. He later applied those analytical skills in the insurance and financial services industries. He supports transparency, accountability, and effective oversight of insurance practices. Lee also supports the responsible use of emerging technologies, including artificial intelligence and lnsurTech, to improve efficiency and combat fraud.
Republican Robert P Howell unsuccessfully competed for Insurance Commissioner Ricardo Lara. He has been the CEO of a Silicon Valley cybersecurity manufacturing company. He wrote " I will hold insurance companies accountable to the rules and challenge abusive practices. I will implement an “Insurance Payers Bill of Rights” to protect policyholders from unfair cancellations and unjustified rate increases."
Eduardo “Lalo” Vargas is the Peace and Freedom party candidate. He wrote "I pledge to freeze insurance rates and lower premiums, to investigate and hold insurance executives accountable for exploitative claim procedures, and to fight for a public insurance system that guarantees full and fair coverage for all."
Republican candidate Merritt Farren is a California wildfire survivor, former Amazon lawyer, and former head of legal, guest claims, and security operations for the Disneyland Resort. He wrote " I want to bring the customer-centric innovation I've learned to California insurance regulation."
Keith Davis (American Independent) and Eric Aarnio do not have candidate statements on the official ballot. Both are lower-profile candidates compared to the leading Democrats and more prominent Republicans. Davis is an insurance agent from Riverside California. He emphasizes being a consumer advocate rather than aligned with big insurance companies. He has a campaign website (gokeithdavis.com) and has been active in interviews and outreach.
Eric Aarnio is a Republican, and a contractor from Sacramento with no prior elected office or formal insurance industry background. He has a very low-profile campaign (no website or social media listed in questionnaires) and minimal media presence. - Owner of Health Care Software Company Convicted for $1B Fraudon May 19, 2026 at 4:12 PM
A federal jury convicted the founder and owner of HealthSplash for his role in operating a platform that generated false doctors’ orders and prescriptions to defraud Medicare and other federal health care benefit programs out of more than $1 billion.
According to court documents and evidence presented at trial, Brett Blackman, 42, of Johnson County, Kansas, and his co-conspirators aggressively targeted hundreds of thousands of Medicare beneficiaries to get them to accept medically unnecessary orthotic braces and other items. They then arranged for purported telemedicine doctors to sign bogus prescription orders for these items, so that their co-conspirators could bill Medicare for them. All told, Blackman and his co-conspirators billed Medicare and other federal health care benefit programs over $1 billion for this unnecessary equipment.
Blackman owned, controlled, and was the CEO of HealthSplash, which acquired Power Mobility Doctor Rx, LLC (DMERx) in September 2017. DMERx was an internet-based platform that generated false and fraudulent doctors’ orders for durable medical equipment (DME) and prescriptions for other items. As part of the scheme, Blackman and his co-conspirators connected pharmacies, DME suppliers, and marketers with telemedicine companies that would accept illegal kickbacks and bribes in exchange for signed doctors’ orders created using the DMERx platform. Blackman and his co-conspirators took a cut for themselves in exchange for the referrals.
The fraudulent doctors’ orders and prescriptions generated by DMERx falsely represented that a doctor had actually examined and treated the Medicare beneficiaries when, in fact, the doctors were simply paid to sign orders and prescriptions without any meaningful interaction with the beneficiary, and in some cases, no interaction at all. Doctors signed these orders and prescriptions without regard to whether the equipment was medically necessary. Testimony and evidence presented at trial from an undercover agent who posed as a Medicare beneficiary showed the scheme in action—starting with a foreign call center that pushed the undercover agent to agree to multiple braces to a doctor signing bogus orders for the braces using Blackman’s DMERx platform. The doctor’s order for one of these undercover agent beneficiaries claimed that the doctor conducted various tests that can only be performed in person even though the doctor never even spoke with the undercover agent “patient.”
The DME suppliers and pharmacies that were paying illegal kickbacks for these orders billed Medicare and other insurers for more than $1 billion. Medicare and the other insurers paid more than $450 million based on these claims. According to evidence presented at trial, Blackman and his co-conspirators concealed the scheme through sham contracts and by manipulating the doctors’ orders to avoid Medicare audits.
The jury convicted Blackman of conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive health care kickbacks, and conspiracy to defraud the United States and to make false statements in connection with health care matters. Blackman’s co-defendant, Gary Cox, was convicted in a prior trial and sentenced to 15 years in prison.
Blackman faces a maximum penalty of 20 years in prison for the conspiracy to commit health care fraud and wire fraud conviction, five years for the conspiracy to pay and receive health care kickbacks conviction, and five years for the conspiracy to defraud the United States and to make false statements in connection with health care matters conviction. A sentencing hearing has been scheduled for August 26, 2026. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
“The Department of Justice crushed one of the most egregious fraud schemes in Florida history,” said Acting Attorney General Todd Blanche. “This illegitimate operation stole more than $1 billion from American taxpayers — including hundreds of thousands of Medicare beneficiaries. This was cold, calculated, industrial-scale theft targeting the sick and elderly, coercing vulnerable people into buying unnecessary medical equipment. We will not rest until every fraudster ripping off the American people is held accountable.” - Employer's $257K Attorney Fee Award Against Employee Affirmedon May 18, 2026 at 11:07 AM
Nick Miletak was hired to participate in Royal Coach Tours' student driver trainee program. On the day formal classroom instruction was set to begin, Miletak showed up, handed in his resignation, and demanded compensation for time he had been available before the formal training started. Royal Coach refused but still paid him for 11 hours of classroom time he had logged during informal training.
About a week after resigning, Miletak filed a civil lawsuit against Royal Coach alleging five causes of action. After Royal Coach demurred, Miletak filed an amended complaint asserting two claims: promissory estoppel and constructive discharge. Following a court trial, judgment was entered in Royal Coach's favor. Miletak appealed, and the Sixth District affirmed. Royal Coach then sued Miletak for malicious prosecution.
A bench trial was held on the malicious prosecution claim without a court reporter present. The trial court issued a statement of decision finding that Miletak's prior employment action had terminated in Royal Coach's favor, that Miletak lacked probable cause to bring the claims, that he pursued the action with malice, and that Royal Coach suffered damages. The court awarded Royal Coach $257,197.53, including punitive damages.
Miletak subsequently filed motions for a new trial, to dismiss, and to vacate the judgment. The trial court denied each one.
The Sixth District Court of Appeal affirmed the judgment in its entirety in the unpublished case of Royal Coach Tours, Inc. v. Miletak, -H052687 (May 2026). Miletak raised thirteen separate contentions on appeal; the court rejected all of them.
Miletak appealed in pro per. The court's analysis was shaped throughout by Miletak's repeated failure to meet basic appellate requirements — providing adequate record citations, presenting developed legal arguments, and confining his claims to matters in the record. The court invoked the principle from Jameson v. Desta (2018) 5 Cal.5th 594, 609, that the burden falls on the appellant to demonstrate error on the basis of the record presented.
On personal jurisdiction, Miletak argued the trial court lost jurisdiction when he relocated to Florida. The court held that once a trial court acquires jurisdiction over a party, that jurisdiction continues to final judgment and is not defeated by the party's relocation, citing Goldman v. Simpson (2008) 160 Cal.App.4th 255, 263–264. Miletak's reliance on Daimler AG v. Bauman (2014) 571 U.S. 117 was misplaced because that case addressed an entirely different question about claims by foreign plaintiffs against a foreign defendant.
On the absence of a court reporter, Miletak claimed he requested one at trial. But the settled statement, the order denying his new trial motion, and the trial court's own statements at the settled statement hearing all indicated that no such request was made. Without record evidence of a request, the court found no error.
On the denial of a jury trial, the record showed Miletak failed to timely request a jury or demonstrate that his partial fee waiver covered jury fees. The court applied TriCoast Builders, Inc. v. Fonnegra (2024) 15 Cal.5th 766, which holds that a litigant challenging the denial of relief from a jury waiver for the first time on appeal must show prejudice — something Miletak never attempted.
On probable cause, the central substantive issue, Miletak argued that the denial of Royal Coach's nonsuit motion in the underlying employment action conclusively established probable cause under the interim adverse judgment rule. The court disagreed. Drawing on Parrish v. Latham & Watkins (2017) 3 Cal.5th 767 and Wilson v. Parker, Covert & Chidester (2002) 28 Cal.4th 811, the court explained that the interim adverse judgment rule applies only to rulings on the merits, not those resting on procedural or technical grounds. Here, the nonsuit motion was denied based on Miletak's opening statement — before any evidence was presented — so the denial said nothing about the substantive merits of his promissory estoppel claim.
The court also noted that Miletak attributed a fabricated quotation to Parrish, claiming that probable cause for any single claim insulates the entire suit. The California Supreme Court has held precisely the opposite: a malicious prosecution suit may be maintained where even one of several claims in the prior action lacked probable cause. See Crowley v. Katleman (1994) 8 Cal.4th 666, 671.
On the remaining issues — evidentiary rulings, judicial bias, fraud on the court, the settled statement, denial of writ petitions, and the prior anti-SLAPP appeal — the court found each contention either unsupported by record citations, procedurally forfeited, or substantively without merit. Multiple claims were deemed waived under Duarte v. Chino Community Hospital (1999) 72 Cal.App.4th 849, 856, for failure to cite the record. - Major Drug Maker to Pay $13.6M to Resolve Kickback Caseon May 18, 2026 at 11:07 AM
Takeda Pharmaceuticals U.S.A., Inc. is the U.S. subsidiary of Takeda Pharmaceutical Company Limited, a major global biopharmaceutical company headquartered in Osaka, Japan It is one of the world’s leading R&D-driven pharmaceutical companies, with a strong emphasis on oncology, rare diseases, neuroscience, gastroenterology (and inflammation), plasma-derived therapies, immunology, and vaccines.
The company has a major presence, including its global hub and research center in Cambridge, Massachusetts (making Takeda the largest life sciences employer in the state). It has sites in 39 states and employs more than 20,000 people in the U.S. (part of ~50,000 worldwide).
Takeda Pharmaceuticals, U.S.A., Inc. has agreed to pay $13,670,921 to resolve allegations that it knowingly caused the submission of false claims to Medicare and other federal health care programs by paying kickbacks to healthcare providers to induce prescriptions of Trintellix, an antidepressant medication that Takeda marketed and sold to treat major depressive disorder.
Trintellix (vortioxetine) is a prescription antidepressant medication used to treat Major Depressive Disorder (MDD) in adults. It is marketed in the U.S. by Takeda Pharmaceuticals (in collaboration with H. Lundbeck A/S, which originally developed it).
The civil settlement resolves allegations that, from January 2014 to October 2020, Takeda paid improper remuneration, including in the form of speaker honoraria and meals at high-end restaurants, to healthcare professionals to induce them to prescribe the antidepressant medication Trintellix in violation of the Anti-Kickback Statute.
The United States contends that Takeda selected certain healthcare providers to be part of the Trintellix speaker bureau and provided them paid speaking opportunities with the intent that the speaker honoraria and meals would induce them to prescribe Trintellix. The government further contends that certain prescribers who attended multiple programs on the same topic and received meals and drinks from Takeda received no educational benefit from attending duplicate programs.
Takeda (including its subsidiaries and predecessors like TAP) has faced other False Claims Act (FCA) allegations, Medicaid fraud claims, kickback-related matters, and similar government program issues in the U.S.
- - 2001 TAP Pharmaceuticals Settlement (Lupron): Takeda's former joint venture with Abbott (TAP) paid $875 million to resolve criminal and civil charges. Allegations included providing free drug samples to doctors who then billed Medicare/Medicaid, kickbacks, and improper pricing. This was one of the largest pharma fraud settlements at the time.
- - In 2023 Takeda subsidiaries (along with others from the Shire acquisition) agreed to pay a combined ~$42.7 million to resolve Texas Medicaid Fraud Prevention Act claims. Allegations involved providing improper nursing/reimbursement support and paying nurse educators to recommend Vyvanse to Medicaid providers (~2014–2015). This was a whistleblower-initiated case.
Takeda paid ~$2.4 billion in 2015 to settle thousands of U.S. lawsuits alleging the diabetes drug caused bladder cancer and that risks were inadequately disclosed. Some claims involved marketing practices, but these were primarily personal injury/product liability.