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Former Firefighter to Serve 90 Days and Pay $130K for Comp Fraud

The Ventura County District Attorney’s office announced that former Ventura County firefighter, 34 year old Perry Adam Lieber, of Santa Barbara, was sentenced to 90 days in jail and 24 months of felony probation after pleading guilty to felony workers’ compensation fraud in violation of Insurance Code section 1871.4(a).

Lieber admitted as part of his guilty plea, that he made false material statements for the purpose of obtaining disability and other benefits to which he was not entitled during a prior workers’ compensation claim with the Ventura County Fire Department. Victim agencies York Risk Services and the County of Ventura sustained losses in excess of $186,082.

Chief Mark Lorenzen of the Ventura County Fire Department said Lieber resigned from the agency last March. According to a report in the Ventura County Star at the time of his arrest, the Chief said the department was not surprised by the charges the DA’s office has brought against Mr. Lieber. “We were aware of a number of irregularities during the last portion of his career. We brought those to the attention of the county risk management unit.”

In addition to the jail sentence, Lieber was immediately ordered to pay $100,000 in victim restitution and $30,000 in fines.

The court also ordered multiple financial accounts controlled by Lieber that were previously frozen by the court be liquidated to satisfy its order.

A hearing relating to additional restitution still owed to the victim agencies is scheduled for March 4, 2021, at 9:00 a.m. in courtroom 26 of the Ventura County Superior Court.

January 11, 2021 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Unapproved Comp Policy Arbitration “Side Agreements” Unenforceable. PhRMA Loses Challenge to California Drug Transparency Law. Ohio AG Claims OptumRX Knowingly Overcharged State. Irvine Diagnostic Lab Pays $358K to Resolve False Claim Charges. Union Head to Serve 12 Years for Stealing Health Plan Funds. DWC Allows Walk-Through Documents at Local Offices. Workplace Deaths (Non-Pandemic) Rose 2% in 2019. L.A. and San Francisco Order $5/hr “Hero Pay” for Grocery Workers. Cal-SARA – a New Non-Profit – Seeks Staffing Agency Reform. SCIF Says Happy New Year With $39M Dividend.

Public Hearing Set for Adoption of COVID-19 Treatment Guideline

The Division of Workers’ Compensation (DWC) has issued a notice of conference call public hearing for a proposed evidence-based update to the Medical Treatment Utilization Schedule (MTUS), which can be found at California Code of Regulations, title 8, section 9792.24.7.

The conference call public hearing is scheduled for Thursday, February 18, at 10 a.m. and members of the public may attend by calling 866-390-1828 and using access code 5497535#. Members of the public may review and comment on the proposed updates. Written comments must be submitted no later than February 18. Please see the proposed regulation page for direction for submitting written comments.

The proposed evidence-based update to the MTUS incorporate by reference the latest published guideline from American College of Occupational and Environmental Medicine (ACOEM) for the following:

Coronavirus (COVID-19) Guideline (ACOEM December 14, 2020)

The 99 page guideline contains an analysis of the effectiveness of COVID-19 treatment using the following:

— Hydroxychloroquine and Chloroquine.
— Azithromycin.
— Favipiravir.
— lopinavir-ritonavir.
— Remdesivir.
— low-Molecular-Weight Heparin.
— IL-6 Receptor Antagonists (Tocilizumab, Sarilumab, and Siltuximab).
— Baricitinib.
— Casirivimab plus lmdevimab.
— Bamlanivimab.
— Convalescent COVID-19 Antibodies.
— Glucocorticosteroids.
— Interferon Beta-lb.
— Ribavirin.
— Zinc.
— Vitamin D.

The proposed evidence-based update to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the update online.

Man Arrested for $3.5M N95 Mask Fraud with Bay Area victims

Federal prosecutors for the Northern District of California filed an indictment charging defendant Rodney L. Stevenson II with wire fraud, mail fraud, and money laundering for his operation of an e-commerce site that claimed to have N95 masks for sale during the current COVID-19 epidemic.

Stevenson operated EM General, a company created in September 2019, which purported to sell N95 masks with N99 filters. At the onset of the COVID-19 pandemic in February 2020, EM General and its website, controlled by Stevenson, advertised that it had N95 masks “in stock” and available for shipping.

EM General sold many of these masks for as much as $24.95 each. Also according to the indictment, to bolster the legitimacy of EM General, Stevenson created a professional-looking website that included the names, backstories, and stock photographs of a group of fake EM General executives.

It also falsely described how long the company had been in business, its sales volume, and its reputation. Stevenson also used fictitious names in emails to customers.

The indictment alleges that, as the pandemic worsened and demand for N95 masks increased dramatically, EM General’s sales skyrocketed. EM General’s total sales from approximately on or about February 11, 2020, to approximately on or about March 8, 2020, were approximately $3,500,000 involving over 25,000 customers, the vast majority of which were sales of N95 masks that were never delivered to customers. This amount included over $900,000 in sales on February 28, 2020, alone.

Bay Area residents thought they were buying much needed N95 masks from EM General, but according to the criminal complaint Stevenson had no intention of delivering masks. “What’s described in the complaint is a consumer nightmare of fake web pages and false promises,” said US Attorney for the Northern District of California, David Anderson.

Stevenson and EM General delivered almost none of the masks. Instead, when customers complained and asked for refunds, Stevenson, at times communicating with Gmail accounts he created under the names of fake identities, generally refused to refund customers and instead offered a series of lies to fraudulently prolong his scheme while he continued selling masks.

These lies included that EM General could not offer refunds because it had already paid for the customer’s order from a manufacturer, that products would ship soon, and that customers would receive tracking orders soon. For a small number of customers, Stevenson eventually fraudulently substituted masks that did not meet the standards set by the National Institutes of Occupational Safety and Health for N95 or N99 masks, meaning that they did not filter out 95 or 99 percent of particulate matter from the air.

Stevenson is charged with nine counts of wire fraud, in violation of 21 U.S.C. § 1343; one count of mail fraud, in violation of 18 U.S.C. § 1341; five count of laundering of monetary instruments, in violation of 18 U.S.C. § 1956(a)(1)(A)(i); and one count of money laundering, in violation of 18 U.S.C. § 1957.

CWCI Report Shows COVID Comp Claims Tripled Prior Months

A California Workers’ Compensation Institute analysis of claims reported to the state Division of Workers’ Compensation as of January 11 shows that the number of COVID-19 claims in the California workers’ compensation system more than tripled between October and November, then jumped another 64.2% to a record 23,483 claims in December. A new projection shows that the December total could climb to 37,573 cases once claims that are yet to be filed or still under investigation are added to the tally.

The latest figures show that after falling to a 6-month low in September, monthly COVID-19 claim counts began trending up in October as the fall wave of coronavirus cases hit the state.

Although not all November and December claims have been reported, the initial data from those months shows that as of the January 11, the DWC had recorded 14,298 COVID-19 claims with November injury dates, and a record 23,483 COVID-19 claims from December.

That year-end surge pushed the number of COVID-19 claims reported to the DWC for accident year (AY) 2020 to 93,470, which is 15.7% of all 2020 claims reported to the state, though with the recent spike, that proportion rose to 28.7% of all work injury claims reported for November and 47.4% of all claims reported for December.

The AY 2020 COVID-19 claim count includes 464 death claims — up 21.7% from the 381 death claims reported as of December 28 — which means COVID-19 death claims accounted for nearly half (48.0%) of the 966 work-related death claims recorded by the state for AY 2020.

Additional year-end claims continue to be filed, and CWCI’s projected COVID-19 claim count based on historical claim development that accounts for delays in COVID-19 claim reporting estimates that ultimately there will be 16,872 claims from November, and 37,573 claims from December, far surpassing the previous monthly record of 15,537 COVID-19 claims projected for July.

With hundreds of thousands of California jobs lost during the pandemic, and many workers in the state continuing to work remotely, DWC has recorded only 594,840 work injury claims for AY 2020, down 13.5% from 667,942 claims for AY 2019, despite the addition of the 93,470 COVID-19 claims.

However, the year-over-year decline in claim volume is only 6.5% if CWCI’s updated projection of the ultimate claim count for AY 2020 is used.

Other recent results show that health care workers’ share of the COVID-19 claims has declined from 44.7% in the first quarter of 2020 to 28.8% in the fourth quarter; males and younger workers continue to account for a growing share of the COVID-19 claims; and COVID-19 claim denial rates hit a 6-month high of 36.9% in October, though the denial data on claims from the last two months of 2020 is too green to be reliable.

Denial rates vary significantly by industry, with October claim denial rates ranging from 12.8% for utility workers to 66.8% for transportation workers. Many COVID-19 claims are denied because the claimants do not test positive for the virus.

The latest results on California workers’ comp COVID-19 claims are from the January 11 update to CWCI’s COVID-19/Non-COVID-19 Interactive Claim App, which integrates data from CWCI, DWC, and the Bureau of Labor and Statistics to provide information on California work injury claims from comparable periods of 2019 and 2020. The app is updated biweekly and is available to the public here.

Camarillo Insurance Brokers Face $687K Premium Fraud Charges

Licensed insurance agents Robert Farmer, 65, of Camarillo, and Marion Urcan, 67, of Agoura Hills, were arraigned  in Los Angeles County Superior Court on multiple counts of grand theft after allegedly accepting over $687,000 in insurance premium payments from business owners and misappropriating the money for their personal use.

Farmer and Urcan, doing business as Centerpointe Insurance Services Limited in Camarillo, accepted insurance premium payments from two towing companies in the Los Angeles area.

On June 20, 2019, the California Department of Insurance received a complaint from the owner of one of the towing companies that alleged Centerpointe Insurance Services Limited accepted two checks totaling $391,000 for the company’s commercial auto insurance policy, but Farmer and Urcan did not forward these premium payments to the insurance company.

On December 20, 2019, the Department received a complaint from the other towing company that alleged Centerpointe embezzled a $50,000 down payment made toward the renewal of the towing company’s commercial auto insurance policy.

An investigation by the Department of Insurance revealed Farmer and Urcan accepted over $687,000 in total from the two towing companies but never sent the payments to an insurance company to secure liability insurance for either business owner, leaving them vulnerable to catastrophic loss.

The Department of Insurance is taking the appropriate administrative action against the licensees. Anyone who has been victimized or knows someone who has been victimized by either Farmer or Urcan, please call 661-253-7500.

They are scheduled to return to court on March 5, 2021. This case is being prosecuted by the Los Angeles County District Attorney’s Office.

Union Asks Supreme Court to Invalidate Prop 22 Gig Measure

A major labor union and several ride-hailing drivers are suing to overturn a newly passed ballot measure classifying gig workers as independent contractors in California.

The Washington Post reports that the groups filed suit Tuesday in California’s Supreme Court, alleging Proposition 22 violates the state constitution and limits the power of state legislators to implement certain worker protections they are authorized to grant.

The suit, filed by Service Employees International Union and a group of ride-hailing drivers, asks the state Supreme Court to invalidate Prop 22, which cemented gig driver’s status as independent contractors after more than 58 percent of voters supported it in November.

They argue the measure limits state legislators’ ability to implement a system of workers’ compensation in defiance of their constitutional authority to do so. It also argues that the proposition unconstitutionally defines what comprises an amendment to the measure, as well as violating a rule limiting ballot measures to a single subject to prevent voter confusion.

The Protect App-Based Drivers and Services coalition, which represents gig companies such as Uber, Lyft and Doordash, criticized the lawsuit in a statement attributed to Uber driver Jim Pyatt, an activist who has worked in favor of Prop 22.

The groups that filed the suit, which also include SEIU California State Council, took particular issue with the measure’s inclusion of a provision requiring a seven-eighths legislative supermajority to amend and even define what constitutes an amendment. That authority, they say, is vested with the courts.

The lawsuit blasts the measure’s drafters as having “impermissibly” usurped this Court’s authority to ‘say what the law is’ by determining what constitutes an ‘amendment.’”

Further, they argued, they violated the single-subject rule by “burying these cryptic amendment provisions on subjects not substantively addressed in the measure, and in language that most voters would not understand.”

They said they were suing in the state Supreme Court rather than a lower court because the issues were of broad public importance and required a speedy resolution to minimize harm to gig workers.

Staffing Company Sues for Fraudulent Comp Insurance

Simplified Labor Staffing Solutions, Inc. and Simplified Staffing Labor Solutions, LLC are sister entities that provide staffing services, that is, secure payroll services, insurance coverage, licenses, and corporate benefits.

Ashish Wahi owns Simplified. Michael Dougan is its chief financial officer. A major expense in their business operation is paying for workers’ compensation insurance.

Simplified initiated litigation against Trinity Risk Management, LLC, affiliated entities Knight Management Group, Inc. and H.J. Knight International Insurance Agency, Inc., and other named defendants. Simplified alleged fraud-based claims related to workers’ compensation insurance it had purchased from defendants who sell workers’ compensation insurance to staffing companies.

Simplified filed a first amended complaint against defendants, and added Captive Resources, Inc. as another named defendant.

Simplified alleged defendants conspired to induce Simplified to purchase their worker’s compensation insurance through them by claiming that after one year of paying surcharges on the actual premiums for the coverage they required, Simplified would then earn “steep discounts on worker’s compensation coverage.” Defendants “purported to offer underwriting of insurance risk without being a licensed insurance company, and/or offered for sale insurance coverage as a broker without being a licensed broker . . . or by means of misrepresenting the actual party they represented.

The defendants filed a cross-complaint against Simplified, alleging eight causes of action, including defamation. The cross-complainants alleged Simplified and/or Wahi were approximately $2 million dollars in arrears on Simplified’s workers’ compensation payments.

Simplified filed a special motion to strike the defamation cause of action from the cross-complaint as a strategic lawsuit against public participation under the anti-SLAPP statute. The trial court granted Simplified’s special motion to strike and the court of appeal affirmed in the unpublished case of Trinity Risk etc. v. Simplified Labor.

The purpose of the anti-SLAPP law is not to insulate defendants from any liability for claims arising from the protected rights of petition or speech. It only provides a procedure for weeding out, at an early stage, meritless claims arising from protected activity.

The wording of the statute protects the right of litigants to the utmost freedom of access to the courts without fear of being harassed subsequently by derivative tort actions. The law provides that it “shall be construed broadly.”

WCAB Significant Panel Decision Evaluates Remote Trials

Limin Gao filed an Application for Adjudication, alleging a psyche injury while employed by Chevron from May 2, 2014 to July 2, 2015.

The matter proceeded to trial on March 10, 2020. Gao provided in-person testimony, both direct and on cross-examination, flying in from her current residence in Ontario, Canada in order to do so.

Because the trial could not be completed in one session, the trial was continued to June 9, 2020, with in-person testimony contemplated from several defense witnesses.

In light of the Covid-19 pandemic, WCAB District Offices stopped conducting in-person trials as of March 16, 2020. Beginning May 4, 2020, WCAB District Offices began to hear trials on the case-in-chief remotely, via phone link.

On May 7, 2020, the State of California’s Governor, Gavin Newsom, issued Executive Order N-63-20 which essentially suspended the requirement that a witness testify in person under certain conditions and circumstances.

As the June 9, 20201 trial date approached, the parties made clear they had very different ideas about how the case should proceed. Applicant favored proceeding via remote testimony, while defendant objected, requesting a continuance until in-person testimony could be elicited from its three rebuttal witnesses.

The WCJ issued the Order Continuing September 1, 2020 Trial, stating that due process required continuing the trial to allow for in-person testimony from defendant’s witnesses, because applicant had previously given in-person testimony. Limin Gao Petitioned for Removal to have the WCAB rule on the legality of the WCJ order continuing the hearing. The panel reversed and remanded in the significant panel decision of Limin Gao v Chevron Corporation.

The WCAB ruled that “each case must be resolved according to its own particular circumstances, and it would therefore be inappropriate to institute a blanket rule that it is per se unreasonable to continue a case to allow for in-person testimony.

“However, in consideration of Executive Order N-63-20, the purposes of the workers’ compensation system, and current conditions, the default position should be that trials proceed remotely, in the absence of some clear reason why the facts of a specific case require a continuance. Moreover, as the party seeking the continuance, the burden should be on defendant in this case to demonstrate why a continuance is required.

April QME Examination Now In-home by Computer

The Division of Workers’ Compensation (DWC) is now accepting applications for the Qualified Medical Evaluator (QME) examination for April 17, 2021.

DWC will offer in-home computer-based testing (CBT) for the April 2021 QME examination using Proctor U.

Candidates who are interested in taking the CBT exam and have the minimum system requirements should indicate so on the application. CPS HR Consulting, the vendor managing the QME Exam, will notify interested candidates of the registration and scheduling process.

DWC will continue to offer an in-person examination in Northern and Southern California on April 17, 2021 following the guidelines and recommendations by the CDC and California Department of Public Health. The test sites will be announced on the Registration Notices.

Application and Registration packet for the QME exam may be downloaded from the DWC website.

Applicants may also contact the Medical Unit at 510-286-3700 to request an application via U.S. mail, email or fax. The deadline for filing the exam applications is March 4, 2021. No applications will be accepted after this postmarked date.

For more information, contact the Medical Unit at 510-286-3700 or by email at QMETest@dir.ca.gov..