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Kaiser School of Medicine adds Pepperdine MD/MBA Program

The Kaiser Permanente Bernard J. Tyson School of Medicine reported that is devoted to offering an outstanding, forward-thinking medical education. Its curriculum is built on the three pillars of Biomedical Science, Clinical Science, and Health Systems Science. Students think broadly about the ways care can be more effective for everyone and learn how to advocate for better health in homes, schools, workplaces, neighborhoods, and society.

The school says that it incorporates many of the most innovative and effective educational practices available today. In addition, the school’s future physicians learn the knowledge and skills essential to the highest quality patient care and the transformation of the nation’s healthcare so that all people thrive. Learn more at medschool.kp.org.

Pepperdine Graziadio Business School just announced a groundbreaking partnership with Kaiser Permanente Bernard J. Tyson School of Medicine to launch a new MD/MBA program to equip future physicians with critical business and leadership skills.

The integrated MD/MBA program will provide medical students with the tools to navigate today’s complex healthcare landscape, manage financial resources effectively, and lead systemic change within healthcare organizations. This innovative collaboration reflects a growing demand for physicians who are not only clinically skilled but also capable of making strategic decisions grounded in business principles.

“This innovative partnership between Kaiser Permanente School of Medicine and Pepperdine Graziadio Business School represents a forward-thinking approach to medical education,” said Dr. Clemens Kownatzki, Associate Dean of Academic Programs and Associate Professor of Finance at Pepperdine Graziadio.

Over the years, many physicians in our Executive MBA programs have shared their desire to better understand business and organizational management. A common reflection we hear is, ‘I wish I had done my MBA much earlier in my career.’ This dual-degree program allows medical students to gain that critical business knowledge at the outset of their careers,” Kownatzki added.

This new program aligns perfectly with our mission to prepare physician leaders who can drive meaningful change in health care,” said Dr. Paul J. Chung, Chair of Health Systems Science and Professor at Kaiser Permanente Bernard J. Tyson School of Medicine. “By providing opportunities for interested students to combine medical training with business education, we’re equipping them to lead not only in clinical teams but also in boardrooms, health systems, and policy arenas. Our collaboration with Pepperdine Graziadio reflects a shared commitment to shaping the future of healthcare leadership.”

Karen Jackson, Head of Partnership Development at the Pepperdine Graziadio Business School, added, “The MD/MBA program offers a unique opportunity for medical students to jumpstart their professional growth. Unlike traditional paths where clinicians return to business school later in life, this program allows students to integrate business knowledge with their medical education from the start. We’re honored to collaborate with Kaiser Permanente Bernard J. Tyson School of Medicine on this impactful initiative.”

NVIDIA Fraud Expert Charged in Health Plan Fraud scheme

The Santa Clara County District Attorney’s Office has charged a San Jose fraud prevention expert with submitting more than 150 fraudulent healthcare claims for over $100,000 against her tech company’s health plan.

Faranak Firozan, 47, faces numerous felony charges, including altering medical records with fraudulent intent and preparing false statements in connection with insurance claims. She also faces an Aggravated White-Collar Crime Enhancement. Firozan will be arraigned on July 15, 2025, in Department 23, at 1:30 p.m., at the Hall of Justice in San Jose. If convicted, she could face years in prison and would be ordered to pay any outstanding restitution.

Firozan was a senior manager of privacy and security at NVIDIA and regularly spoke as an expert on fraud prevention. She is accused of submitting 167 fraudulent claims, many of which were entirely made-up, between November 2020 and January 2024 to NVIDIA’s self-insured health plan, which is administered by Cigna.

“It’s crucial for everyone, especially those who are experts in fraud prevention, to uphold the same standards they promote,” District Attorney Jeff Rosen said. “We are grateful for our partners in this investigation that brought this serious matter to light.”

Firozan’s scheme was unraveled through subpoenas, provider interviews, and bank records in a joint investigation by the DA’s Bureau of Investigations (BOI) and the California Department of Insurance (CDI).

In August 2024, CDI received a suspected fraudulent claim referral from Cigna. Firozan had been flagged previously in Cigna’s system in October 2023 after she submitted a large amount of reimbursement claims in one month. Many of the claims featured handwritten codes.

“Insurance fraud drives up costs for everyone and erodes trust in the system,” said Insurance Commissioner Ricardo Lara. “When someone entrusted with preventing fraud is accused of committing it, that betrayal must be met with accountability. I commend our investigators and the Santa Clara County DA’s Office for their strong partnership in this case.”

Firozan is accused of altering bills by changing service dates and often fabricating entire documents. Providers verified that services listed in her claims were either not performed at all or were duplicated claims.

On her LinkedIn page, Firozan described herself as an expert in abuse prevention systems and fraud investigations for financial institutions. In 2020, she provided training on cyber laundering for the Information Systems Security Association Silicon Valley Chapter.

The DA’s Office and CDI urge anyone with further information on this case or any similar fraud matters to contact BOI Investigator Kathleen Rak at krak1@dao.sccgov.org. The DA’s Office emphasizes the importance of maintaining the integrity of insurance systems and its dedication to prosecuting fraudulent activities to the fullest extent of the law.

Fugitive Physician Sentenced in $1.5M Health Care Fraud Scheme

A California physician was sentenced in Los Angeles to 54 months in prison for health care fraud arising from her false home health certifications and related fraudulent billings to Medicare. She is a fugitive and was sentenced in absentia.

According to court documents, Lilit Gagikovna Baltaian, 61, of Porter Ranch, was a physician licensed to practice in California and an enrolled Medicare provider. From approximately January 2012 to July 2018, she falsely certified patients to receive home health care from at least four Los Angeles area home health agencies. These certifications were used by the home health agencies to fraudulently bill Medicare.

In some instances, Baltaian pre-signed blank, undated physician certification forms knowing that the home health agencies would falsify the forms to make appear that she had seen the Medicare beneficiaries and made clinical findings to support the need for home health care, when she had done neither. Baltaian received cash payments related to these referrals and also separately billed Medicare for signing the fraudulent certifications.

Between January 2012 and July 2018, four home health agencies used Baltaian’s false certifications to submit fraudulent claims to Medicare, resulting in loss to the government estimated at $1,497,159.64.

Baltaian pleaded guilty to one count of health care fraud on Nov. 21, 2024. At sentencing, she was also ordered to pay $1,497,159.64 in restitution.

Matthew R. Galeotti, Head of the Justice Department’s Criminal Division, U.S. Attorney Bilal A. Essayli for the Central District of California, Assistant Director in Charge Akil Davis of the FBI Los Angeles Field Office and Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

The FBI and HHS-OIG are investigating the case.Trial Attorney Matthew Belz of the Criminal Division’s Fraud Section is prosecuting the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal health care programs and private insurers more than $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes.

June 9, 2025 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: W.C. Exclusivity Ends Janitor’s Intentional Injury at School Case. Home Depot Settles Overnight Overtime Wages Case for $3.35M. Court of Appeal Declines to Apply Federal FEHA Attorney Fee Scrutiny. SoCal Hospice Operators Arrested for $3.8M Fraud. Munir Uwaydah Entity Loses $2.25M Legal Malpractice Case. Reserve LAPD Officer & Brother Face Insurance Fraud Charges. Former Attorney Tom Girardi Gets 7 Years for Defrauding Clients. Sutter Health Expands California Rural Health Care Access.

Employer Sues Injured Worker’s Firm for Malicious Prosecution

Victoria Flores worked as a packer for Parter Medical. In February 2018, she submitted a claim for workers’ compensation related to an injury to her right hand and wrist, and was placed on medical leave. Flores hired The Dominguez Firm, LLP to handle her claim. Jace H. Kim, Carlos Andres Perez and Javier Ramirez were associate attorneys of the Dominguez Firm.

Flores received medical treatment and physical therapy and, in early 2019, underwent surgery on her right hand and wrist from Dr. Liz Stark. In June 2019, Dr. Stephen Nichols, the panel qualified medical examiner appointed to Flores’s case, issued his report. Dr. Nichols said Flores suffered from “severe osteoarthritis” and would continue to need occupational therapy. In his opinion, Flores should be precluded from “lifting, carrying, pushing and pulling objects in excess of 20 pounds on a frequent basis.”

On September 4, 2019, Attorney Robert Choi, representing Republic Indemnity Company of California (Republic Indemnity), sent a letter to attorney Juan Dominguez of the Dominguez Firm, proposing settlement options for Flores’s claim in light of Dr. Nichols’s report. Choi said, “Your client has the option of clarifying further with [Dr. Nichols], to move forward with the interactive process with the employer to address Dr. Stark’s permanent work restrictions, and then to finalize her case by way of a Stipulated Award with future care. [¶] However, I have been authorized to offer your client a Compromise and Release settlement” if Flores agreed to submit a voluntary resignation from her employment with Parter Medical in return for the lump sum settlement.

Thereafter, Choi and Attorney Allan Carvalho of the Dominguez Firm discussed settlement options via e-mail. The Dominguez Firm initially proposed that Flores sign a release acknowledging her “separation” from Parter Medical. Choi said that separation language would not be acceptable and that Flores would need to resign from her employment with Parter Medical. The Dominguez Firm acquiesced and forwarded to Choi a resignation signed by Flores. The document was titled “Voluntary Resignation From Employment” and stated that Flores was resigning “voluntarily and of [her] own free will without undue influence or coercion of any kind.” Flores received a payment of $60,000 in settlement of her claim. The settlement was approved by the Workers’ Compensation Appeals Board.

After settling her workers’ compensation claim, Flores, still represented by the Dominguez Firm, filed a civil complaint against Parter Medical alleging six causes of action: (1) discrimination in violation of FEHA; (2) retaliation in violation of FEHA; (3) failure to prevent discrimination and retaliation in violation of FEHA; (4) failure to accommodate in violation of FEHA; (5) failure to engage in good faith interactive process in violation of FEHA; and (6) wrongful termination in violation of public policy.

At her deposition, Flores admitted she signed the resignation at the Dominguez Firm in connection with settling her workers’ compensation claim. But she also testified that before signing it, she had called about getting her job back and was told “there wasn’t any more work for me there. And they told me that I was not to show up there, I was not to call there, and they hung up on me.” Flores said she spoke with “Lina at human resources” and she said there was no more work for her because she had hired an attorney.

On September 22, 2021, Parter Medical sent a letter to the Dominguez Firm asserting that based on Flores’s admissions that she had voluntarily resigned, it was clear she had not been terminated and the Dominguez Firm had “engaged in malicious prosecution” in filing the action. Parter Medical requested a dismissal of the action.

Flores did not dismiss the action, and Parter Medical subsequently moved for summary judgment. In August 2022, summary judgment was granted in favor of Parter Medical in the underlying action. Parter Medical then filed this action for malicious prosecution against the Dominguez Firm and individual defendants Kim, Perez and Ramirez. Parter Medical alleged the Dominguez Firm initiated each of the six causes of action in the underlying action without probable cause and with malice.

Defendants in the malicious prosecution action filed their anti-SLAPP motion in October 2023, arguing they brought and maintained the underlying action with a good faith belief the action was tenable. Defendants requested the trial court to strike the entire complaint as to all defendants, as to each cause of action individually, or alternatively as to all allegations of malicious prosecution that occurred before September 22, 2021 (the date Parter Medical sent the letter to defendants about Flores’s deposition admissions).

The trial court denied their motion, and the defendants appealed. The Court of Appeal affirmed the trial court in the unpublished case of Parter Medical Products v. The Dominguez Firm CA2/8 – B335336 (June 2025)

To defeat defendants’ motion, Parter Medical was required to demonstrate its malicious prosecution action was “ ‘both legally sufficient and supported by a sufficient prima facie showing of facts to sustain’ ” a judgment in its favor if its evidence was credited. (Wilson v. Parker, Covert & Chidester (2002) 28 Cal.4th 811, 821 (Wilson).)

The Court of Appeal concluded that “There is no dispute the grant of summary judgment in favor of Parter Medical was a favorable termination of the underlying action. Defendants’ anti-SLAPP motion contested only the existence of the elements of probable cause and malice. We conclude Parter Medical met its burden of showing the requisite minimal merit to proceed with its malicious prosecution action.”

“Defendants argue that just because the underlying action did not survive summary judgment does not mean the action was legally untenable. This is unquestionably true, but it does not answer the question of whether a reasonable attorney, knowing what the Dominguez Firm knew from its representation of Flores in the workers’ compensation proceeding, would have thought the claims against Parter Medical were legally tenable.”

The showing by Parter Medical adequately establishes, for purposes of defeating the motion, that the Dominguez Firm and its attorneys knew, from its representation of Flores in the workers’ compensation proceeding, that she had resigned and had not been terminated and that she had physical limitations that impacted her ability to continue to do her job as a packer. The reasonable inference from that evidence is that the claims against Parter Medical were knowingly pursued for the improper purpose of attempting to obtain additional monies from Parter Medical without regard to the merit of the wrongful termination and FEHA claims.”

Physician Pleads Guilty for Ketamine Sales to Actor Matthew Perry

Matthew Langford Perry was an American and Canadian actor, comedian, director and screenwriter. He gained international fame for starring as Chandler Bing on the NBC television sitcom Friends (1994–2004). Perry also appeared on Ally McBeal (2002) and received Primetime Emmy Award nominations for his performances in The West Wing (2003) and The Ron Clark Story (2006). He played a leading role in the NBC series Studio 60 on the Sunset Strip (2006–2007), and also became known for his leading film roles in Fools Rush In (1997), Almost Heroes (1998), Three to Tango (1999), The Whole Nine Yards (2000), Serving Sara (2002), The Whole Ten Yards (2004), and 17 Again (2009).

In his memoirs, Perry wrote that by age 14, he had become an alcoholic. He became addicted to Vicodin after a jet ski accident in 1997. In February 2001, Perry paused productions of Friends and Serving Sara for two months so that he could enter in-patient rehabilitation for his addictions to Vicodin, methadone, amphetamines, and alcohol. He said later that, due to his substance use disorder, he had no memory of three years of his work on Friends. Perry faked pain to get a prescription for 1,800 milligrams of hydrocodone per day and was having daily ketamine infusions. In 2022, he estimated that he had spent $9 million on his addiction, including 14 stomach surgeries, 15 stays in rehab and therapy twice a week for 30 years and had attended approximately 6,000 Alcoholics Anonymous meetings.

On October 28, 2023, Perry was found unresponsive in a hot tub at his home in Pacific Palisades. On December 15, 2023, Perry’s death was revealed to have occurred due to acute effects of ketamine. On August 15, 2024, indictments and charges were filed against five people: Perry’s personal assistant, two doctors, and two drug dealers (including TV director Erik Fleming), alleging involvement in the distribution of ketamine that caused the death of Perry and one other person.

Three of the accused agreed to plead guilty,with two, Fleming and Perry’s former assistant Kenneth Iwamasa, having their guilty pleas entered into court soon after being charged. Iwamasa pleaded guilty on August 7, 2024, as did Fleming the following day. During a court hearing on August 30, 2024, it was agreed that former doctor Mark Chavez, who had signed a plea agreement but had not yet officially entered it into court, would have his guilty plea accepted. He now awaits sentencing in September 2025.

The second doctor, Salvador Plasencia, just agreed to plead guilty on June 17, 2025. Plasencia admitted to illegally supplying Perry with approximately 20 vials of ketamine, ketamine lozenges, and syringes between September 30 and October 12, 2023, for about $55,000. He distributed the drug outside the scope of legitimate medical practice, including teaching Perry’s live-in assistant, Kenneth Iwamasa, how to inject ketamine, administering injections himself (including in a Long Beach parking lot), and leaving vials for self-administration without proper monitoring. On October 12, 2023, Plasencia witnessed Perry experience a severe reaction (high blood pressure and “freezing up”) but still left additional vials with Iwamasa.

Plasencia operated and was the owner of an urgent care clinic, Malibu Canyon Urgent Care LLC, located in Malibu, California, and worked with Dr. Mark Chavez, who supplied ketamine from his former clinic and obtained additional amounts through fraudulent means. Text messages revealed Plasencia’s intent to exploit Perry, referring to him as a “moron” and discussing how much he would pay.

On September 30, 2023, Plasencia was introduced to Matthew Perry by one of Plasencia’s own patients who stated that Perry was a “high profile person” who was seeking ketamine and was willing to pay “cash and lots of thousands” for ketamine treatment. Plasencia subsequently contacted Perry and requested a telehealth visit.

The same day Plasencia contacted Mark Chavez, a medical doctor who had previously owned a ketamine clinic in Costa Mesa, to discuss Perry’s request for ketamine. After Chavez confirmed he had ketamine vials and lozenges that he could immediately sell to Plasencia, he informed Perry that he could provide him with 9, “maybe 18,” doses of ketamine. Perry agreed that Plasencia would deliver the ketamine to Perry’s residence.

In mid-October, Iwamasa had also allegedly begun buying ketamine from Jasveen Sangha, a.k.a. “The Ketamine Queen,” and one of her associates, Erik Fleming. The ketamine that ended up killing Perry had been obtained from them. Fleming also has pleaded guilty. Sangha is scheduled to go on trial in August 2025.

June 2, 2025 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: $147M Verdict Against Johnson & Johnson in SoCal Antitrust Case. No Retroactive Application for PAGA One Year Statute of Limitations. San Diego Dermatologist Faces 22 Charges for $1.3M Fraud. Chula Vista Man Pleads Guilty in $51M DME Kickback Scheme. Woman Arrested for Staged Carjacking and Insurance Fraud. Prominent SoCal “Rehab Riviera” Founder and Ex-CEO Arrested. WCRI Studies Variations in Hospital Outpatient Payments Growth. OSHA Updates its Inspection Program Focus.

Two Employment Contracts Must Be Read Together For Adhesion

Cross Country Staffing, Inc. is a “comprehensive health care staffing company” that “recruits and places healthcare professionals in virtually every specialty and area of experience in hospitals globally.” Plaintiffs Isabel Silva, Alejandro Garcia, and Janai Velasco are all former or current employees of Cross Country Staffing.

At the time plaintiffs started their employment with Cross Country Staffing, each signed the same two contracts – namely, (1) an “Arbitration Agreement” and (2) an “Employment Agreement.”

In August 2023 plaintiffs filed a lawsuit alleging putative class and representative claims for (1) failure to pay wages (in violation of Labor Code sections 204, 510, 1182.12, 1194, 1194.2, 1197, 1197.1, and 1198), (2) failure to provide meal periods (in violation of Labor Code sections 512 and 226.7), (3) failure to provide rest periods (in violation of Labor Code section 226.7), (4) failure to reimburse business expenses (in violation of Labor Code section 2802), (5) failure to provide accurate itemized wage statements (in violation of Labor Code section 226), (6) waiting time penalties (under Labor Code sections 201 through 203), (7) unfair competition (under Business and Professions Code section 17200), and (8) violations of PAGA (under Labor Code section 2698 et seq.).

Cross Country Staffing filed a motion to compel arbitration. In its moving papers, Cross Country Staffing included only the Arbitration Agreement; it did not include, or make any mention of, the Employment Agreement. Plaintiffs opposed the motion, arguing that the Arbitration Agreement must be read together with the Employment Agreement, and that the Arbitration Agreement when read with the Employment Agreement was unconscionable and hence unenforceable in its entirety.

The trial court issued a 10-page order denying Cross Country Staffing’s motion to compel arbitration. First, the court ruled that it would read the Arbitration Agreement in light of the Employment Agreement because “both [were] executed on a single day as part of the employee’s hiring, and [because] both . . . govern dispute resolution as part of the overall employment relationship. Because the unconscionability rendered the entire Arbitration Agreement unenforceable, the court denied Cross Country Staffing’s motion to compel arbitration.

The Court of Appeal affirmed the trial court’s order in the published case of Silva et al. v. Cross Country Healthcare, Inc. et al. -B337435 CA2/5 (June, 2025).

Cross Country Staffing challenges the trial court’s order denying its motion to compel arbitration. The review on appeal entails three questions: (1) Did the trial court correctly construe the Arbitration Agreement together with the Employment Agreement; if so, (2) did the trial court correctly conclude that the Arbitration Agreement is unconscionable; and if so, (3) did the trial court abuse its discretion in declining to sever the unconscionable terms and, instead, in declaring the Arbitration Agreement unenforceable?

Civil Code section 1642 provides that “[s]everal contracts relating to the same matters, between the same parties, and made as parts of substantially one transaction, are to be taken together.”

“The recent decision in Alberto v. Cambrian Homecare (2023) 91 Cal.App.5th 482, is directly on point. In that case, the plaintiff signed two contracts as part of the hiring process namely, (1) an arbitration agreement, and (2) a confidentiality agreement.”

“Invoking section 1642, the appellate court in Alberto had “no difficulty concluding” that the two agreements “should be read together” because “both [were] separate aspects of a single primary transaction—[the employee’s] hiring” and “both governed, ultimately, the same issue—how to resolve disputes arising between [the employee] and [the employer] arising from . . . employment.” (Id. at pp. 490- 491.) “Failing to read them together,” the court in Alberto continued, “artificially segments the parties’ contractual relationship” and “fails to account for the overall dispute resolution process the parties agreed upon.” (Id. at p. 491.)

Substantial evidence supports the trial court’s finding that section 1642 applies such that the Arbitration Agreement must be read together with the Employment Agreement.

We agree with Alberto, and publish to reject the further defenses raised by the employer in this case to what we view as an indefensible end-run around precedent. We accordingly affirm the trial court’s order finding the employer’s arbitration agreement unenforceable and denying the employer’s motion to compel arbitration.”

DOI Launches Investigation of State Farm Fire Claim Handling

The California Insurance Commissioner announced a formal investigation into State Farm’s handling of thousands of insurance claims from wildfire survivors affected by the Palisades and Eaton wildfires. The California Department of Insurance has initiated a Market Conduct Examination of State Farm General Insurance Company, expanding its ongoing investigation into consumer complaints against the insurer.

A Market Conduct Examination is one of the Department’s most effective tools, involving a thorough, fact-based review that typically takes several months. The Department is currently at a different stage in the claims process for these wildfires, which allows for a more comprehensive regulatory review for an examination of this magnitude and importance. Insurers are now making payment decisions, enabling the Department to evaluate adjuster practices and thoroughly assess State Farm’s methods across a wide range of claims handling.

While the Department has received general allegations from wildfire survivor groups regarding State Farm’s processing of claims, a formal complaint is needed for the Department to take action and advocate for consumers. Complaints can be submitted at insurance.ca.gov or by calling 800-927-HELP.

Some troubling patterns that my staff will investigate include the frequent reassignment of multiple adjusters with little continuity in communication, inconsistent management of similar claims, and inadequate record-keeping or information-sharing among claims teams. These issues create unnecessary stress, prolong recovery, and erode trust,” said Commissioner Lara. “The strongest evidence we can present is the voice of consumers themselves. I urge any wildfire survivor facing delayed payments, claim disputes, multiple adjusters, smoke damage issues, or any other problems to file a formal complaint with my Department.”

Since January, the Department has already recovered more than $40 million for survivors of the Eaton and Palisades fires through its intervention on formal consumer complaints. As of May 12, 2025, insurance companies have paid out nearly $17 billion to residential and commercial insurance policyholders impacted by the Eaton and Palisades Fires.

One area of growing concern relates to how some insurers, including State Farm, are handling smoke damage claims. The unprecedented urban impact of these wildfires has created new challenges and a lack of consistency as to how insurance companies are handling these claims — leading to confusion and delays for homeowners.

In response to concerns over how smoke claims are being handled, The Insurance Commissioner announced the creation of a Smoke Claims & Remediation Task Force last month, bringing together public health experts, remediation specialists, and consumer advocates to develop fair, science-based, and consistent standards for smoke remediation.

The Insurance Commissioner’s action is part of a multi-pronged effort to expand insurance options for consumers and require more accountability for all companies in the insurance market. A strong, accountable insurance market supports recovery from wildfire and other climate-driven risks.

No Obligation to Give Notice of 5 Year Statute to Reopen Award

Based upon a stipulated Award of May 27, 2015 it was found that while employed on December 19, 2013 as a tower technician by Pearce Services Inc., Andres Hernandez sustained industrial injury to the left knee causing temporary disability from June 23, 2014 to July 6, 2014, permanent disability of 14%, and the need for further medical treatment.

On August 13, 2015, defendant sent applicant a notice that permanent disability payments were ending because the full amount of the stipulated Award had been paid. The notice sent contained all the information required by Administrative Rule 9812(d). (Cal. Code Regs., tit. 8, § 9812, subd. (d).)

Applicant apparently continued to be provided medical care for his injury on an industrial basis and underwent surgery on October 30, 2018. Defendant reinitiated temporary disability benefits commencing November 3, 2018. On November 14, 2018, defendant sent a notice of resumed temporary disability benefit payments pursuant to Administrative Rule 9812(b) (Cal. Code Regs., tit. 8, § 9812, subd. (b)). Defendant then determined that applicant was entitled to temporary disability benefits at a higher rate pursuant to Labor Code section 4661.5 and sent the appropriate notice on November 28, 2018 pursuant to Administrative Rule 9812(c) (Cal. Code Regs., tit. 8, § 9812, subd. (c).)

On December 17, 2018, defendant sent applicant a notice that temporary disability benefits were ending pursuant to Labor Code section 4656(c)(2) which states that, save exceptions not applicable to the current case, temporary disability indemnity is payable only within five years of the date of injury. Defendant sent applicant a notice that complied with Administrative Rule 9812(d) (Cal. Code Regs., tit. 8, § 9812, subd. (d).)

Additionally, along with the notice that temporary disability was ending, defendant sent a notice pursuant to Administrative Rule 9812(e) (Cal. Code Regs., tit. 8, § 9812, subd. (e)) that applicant’s condition was not yet permanent and stationary and that: “[I]t is too soon to tell if you will have any permanent disability from your injury. I will be checking with your doctor until your condition is permanent and stationary. At that time, your doctor will determine whether you have any permanent disability and if there will be a need for future medical care. I expect to have my information by 3/16/19. I will notify you of the status of permanent disability at that time.”

On February 19, 2019, Hernandez filed a Petition to Reopen alleging that he underwent surgery of his left knee in October of 2018 and that his condition had significantly worsened since the issuance of the stipulated Award. On December 23, 2019 the WCJ found that Hernandez’s Petition to Reopen was barred by the five-year statute of limitations contained in Labor Code section 5410.

After filing a Petition for Reconsideration, the WCAB affirmed the WCJ’s decision in the case of Hernandez v Pearce Services Inc. -ADJ9972218 (May 2025).

Applicant argues that that the statute of limitations should be tolled because he was “misled” by defendant’s claims examiner into not timely filing a petition to reopen. In other contexts, the mere furnishing of benefits without an unequivocal denial in and of itself tolls the statute of limitations.

For instance in McDaniel v. Workers’ Comp. Appeals Bd. (1990) 218 Cal.App.3d 1011 [55 Cal.Comp.Cases 72], the Court of Appeal held that when a defendant provides medical treatment benefits knowing of a potential claim for workers’ compensation benefits, the provision of treatment tolls the one-year limitation period of Labor Code section 5405(c) and triggers the five year period of Labor Code section 5410, running from the date of injury. Only after an explicit unequivocal denial of liability does the statute revert to one year from the denial.

The WCAB noted however that “while McDaniel and similar cases find that the mere furnishing of benefits tolls the one-year statute of limitations found in Labor Code section 5405 for the initial claim of benefits, these claims still remain subject to the five-year statute found in section 5410. While the liberal rules of pleading and construction of the workers’ compensation system militate in favor of tolling of the one-year statute, once five years from the date of injury has elapsed the initial interest favoring an injured worker’s right to present their case on the merits must also be balanced against the interest in finality.”

As the Supreme Court explained in Nickelsberg v. Workers’ Comp. Appeals Bd. (1991) 54 Cal.3d 288, 299 [56 Cal.Comp.Cases 476], section 5410 does ‘not express a mere concern for barring stale claims. The statute[] express[es] legislative concern for certainty and finality in the determination of compensation benefit obligations.’ “

Here, there was no legal obligation to inform applicant of the upcoming five-year statute, and, in any case, there was no evidence that the claims representative intentionally withheld this information. Defendant merely paid the legally required benefits and provided the legally required notices.”