Author: WorkCompAcademy

Richard Todd, a former police officer, sustained a cumulative trauma injury arising out of and in the course of his employment with the City of Los Angeles to his kidneys, heart, psyche, and in the form of hypertension during the period from January 1, 1990 through November 25, 2009.

A Findings and Award issued on March 6, 2012 against the employer of 64% permanent disability as a result of applicant’s injury to his kidneys, heart, and in the form of hypertension. After filing a petition to reopen, the parties stipulated to 68% permanent disability, In addition, there had been five prior stipulated awards in unrelated cases. Together, Todd made an argument for a 100% permanent disability award against the Subsequent Injuries Benefits Trust Fund.

The WCJ found that the sum of applicant’s successive disabilities entitled applicant to permanent and total disability.

The sole issue presented by the SIBTF Petition for Reconsideration was whether the WCJ correctly combined applicant’s prior and subsequent permanent disabilities under section 4751 by adding them to find that applicant is permanently and totally disabled. The WCJ findings were affirmed in the en banc decision of Todd v Subsequent Injuries Benefits Trust Fund.

SIBTF is a state fund that provides benefits to employees with preexisting permanent disability who sustain subsequent industrial disability. The preexisting disability may be congenital, developmental, pathological, or due to either an industrial or nonindustrial accident. It must be “independently capable of supporting an award” of permanent disability, “as distinguished from [a] condition rendered disabling only as the result of ‘lighting up’ by the second injury.” There is no specific statute of limitations with respect to the filing of an application against SIBTF.

Once the threshold requirements are met, section L.C. 4751 provides that applicant “shall be paid in addition to the compensation due under this code for the permanent partial disability caused by the last injury compensation for the remainder of the combined permanent disability existing after the last injury . . . .”

The Court of Appeal’s decision in Bookout v. Workers’ Comp. Appeals Bd. (1976) 62 Cal.App.3d 214 [41 Cal.Comp.Cases 595], addressed the issue of how to determine the “combined permanent disability” as specified in section 4751.

The use of the MDT or CVC to combine multiple impairments or permanent disabilities with respect to the rating of single injuries, but not to combine successive permanent disabilities related to prior and subsequent injuries under section 4751. Under section 4751, non-overlapping successive permanent disabilities are to be added.

SIBTF is liable, under section 4751, for the total amount of the “combined permanent disability,” less the amount due to applicant from the subsequent injury and less credits allowable under section 4753.

What role have pharmaceutical companies played in fueling America’s epidemic of opioid addiction, and how have they and their stockholders profited?

This question has been answered by a new PBS documentary, Opioids Inc., documenting how one drug company bribed doctors, committed insurance fraud and made millions for Wall Street investors pushing a highly addictive opioid painkiller – and how it then became the first pharmaceutical company to have its CEO sentenced to prison time in federal court in connection with the opioid crisis.

The company was Insys Therapeutics, the CEO was John Kapoor, and the drug was Subsys, a fast-acting fentanyl-based spray that is 50 to 100 times stronger than heroin. Approved for treating cancer pain, it was prescribed much more generally, helping the company’s sales reach more than $300 million at their peak and stock prices on Wall Street surging.

Opioids, Inc. examines how federal prosecutors prepared the case against Insys by pursuing a novel strategy, using anti-racketeering laws designed to fight organized crime and working their way up the company’s ranks – and how they ultimately arrived at a “smoking gun”: a spreadsheet ordered by Kapoor that showed how Insys tracked the money that went to doctors, and what the company got in return.

The documentary tells the inside story of the corruption behind Insys’ spectacular rise – a scheme that federal prosecutors said went all the way to the top, and that involved paying doctors to prescribe extreme doses of Subsys to their patients – and how investors looked the other way.

A former sales representatives from Kapoor’s company describe a culture of unbridled greed, detailing how they targeted high-prescribing doctors and nurse practitioners known as “whales.”

“It wasn’t about cancer patients. It was about getting as many people as you could on the drug,” says former sales representative April Moore, adding, “Low doses aren’t that much money. Higher dose, more money.”

The company even held contests for the sales team: the higher the doses they got doctors to write, the larger the cash prize – despite the dangers to patients.

At the same time, the company was misleading insurers to approve prescriptions of the drug: “None of what we were saying was truthful,” a former prior authorization specialist says. “We’re just pocketing the money off of a prescription that should’ve never been approved anyway. That’s insurance fraud.”

Opioids, Inc. will be available to watch in full at pbs.org/frontline, on YouTube, and in the PBS Video App. An in-depth Financial Times story will publish at FT.com and at pbs.org/frontline.

Noe Abarca worked for Citizens of Humanity in their quality control department, inspecting boxes of jeans. He suffered an an industrial injury with a work restriction. After the work restriction expired, Citizens fired Abarca.

Abarca sued Citizens and prevailed on his claims for retaliation, disability discrimination, failure to prevent discrimination and retaliation under the Fair Employment and Housing Act (FEHA), and wrongful termination.

The jury found that, while Citizens had other nondiscriminatory reasons for terminating Abarca, its ultimate decision to fire him was based on discrimination and constituted conduct that was malicious, oppressive, or fraudulent.

The jury awarded Abarca $100,000 in compensatory damages: $35,000 for past lost earnings; $20,000 in other past economic loss; $45,000 in past noneconomic loss including mental suffering; and nothing for future noneconomic loss. The jury also awarded Abarca $550,000 in punitive damages.

Abarca’s attorneys represented him on a contingency basis, with no retainer. Abarca moved for an award of attorney fees in the amount of $1,652,255, plus a multiplier of 2.0, for a total of $3,304,510 under Government Code section 12965, subdivision (b).

The trial court awarded Abarca attorney fees in the sum of $1,084,160 pursuant to Code of Civil Procedure sections 1032 and 1033.5 and Government Code section 12965, subdivision (b).

The trial court did not reduce the number of hours billed, finding them reasonable and noting that “[t]his case was litigated to the hilt. Defendant litigated every possible issue, in this court’s opinion, at times, excessively. If the number of hours here is exceptional, that is the reason why. An exceptional number of hours is required to overcome an exceptionally tenacious defense.”

The trial court did, however, find Abarca’s attorneys’ hourly rates excessive, reducing the hourly rates of three attorneys from $700 to $450, another’s rate from $700 to $500, an associate’s rate from $350 to $300, and the rate of two paralegals from $200 to $125. The trial court also denied Abarca’s request for a multiplier.

With the exception of clerical mathematical errors, the Court of Appeal affirmed the award of fees and costs in the unpublished case of Abarca v Citizens United.

A laundry list of errors were asserted by Citizens, and the discussion in the Opinion is an excellent treatise on the award of fees and costs in FEHA litigation. It concluded that “It is disingenuous to engage in aggressive litigation tactics and then complain about the fees those tactics generated from the opposing side.”

A joint effort by the California Department of Insurance and the Orange County District Attorney’s Office has led to charges against five defendants in connection with a fraud ring allegedly designed to traffic vulnerable substance abuse patients from outside California into treatment facilities in Orange and Riverside counties and to bilk insurance companies out of millions of dollars.

Authorities charged Jeremy Ryan, 42, of Orange, Daniel Reaman, 41, of Mount Rainier, Maryland, Richard Roberts, 61, of Stockton, Reiner Nusbaum, 54, of San Clemente, and Michael Castanon, 56, of San Juan Capistrano, with multiple felony counts including insurance fraud, money laundering, and conspiracy.

The defendants face between 12 years, 8 months and 21 years and four months in prison for their alleged involvement in a scheme that resulted in $60 million in fraudulent billing and $11.7 million in insurance losses.

Authorities allege that Ryan, Reaman, and five previously charged defendants used mass media marketing campaigns to identify addicted “clients” from across the country who were seeking treatment. The conspirators and their witting employees then falsified clients’ health care insurance applications to circumvent California residency requirements and closed enrollment periods, employed a money-laundering scheme they devised to conceal their involvement in paying clients’ insurance premiums, and trafficked their clients into Southern California treatment facilities.

The conspirators allegedly used their own nonprofit, Healthcare Relief Foundation, and exploited the unwitting non-profit, StopB4UStart, to conceal their involvement in funding their scheme.

Authorities further allege they conspired with the owners and employees of over 17 substance treatment facilities, including facilities owned by defendants Roberts, Nusbaum and Castanon, to traffic clients into these facilities in order to collect thousands of dollars on their investment in unlawful, per-client, kickbacks.

Roberts, Nusbaum, and previously charged conspirators owned and operated RNR Recovery and Diamond Recovery, both Orange and Riverside County businesses offering inpatient detox treatment and residential sober living and assistance. Castanon owned and operated Luminance Recovery Center, a San Juan Capistrano based treatment facility.

Deputy District Attorney James Bilek of the Insurance Fraud Unit at the Orange County District Attorney’s Office is prosecuting this case.