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DWC Launches Free Course for Physicians

The Division of Workers’ Compensation just launched an updated free online education course for physicians treating patients in the California workers’ compensation system.

“Caring for California’s Injured Workers: Using California’s Medical Treatment Utilization Schedule (MTUS) 2019” is one of a series of education modules developed for medical doctors, chiropractors and nurses. The course is also available to anyone else wishing to learn about the MTUS, and a completion certificate is available.

The MTUS is the primary source of guidance for treating physicians and physician reviewers for the evaluation and treatment of injured workers. It incorporates evidence-based treatment guidelines of the American College of Occupational and Environmental Medicine (ACOEM), which are published by the ReedGroup.

“All medical providers who treat injured California workers should understand and follow the MTUS. The online course is a convenient tool for providers to learn how to use the treatment guidelines and formulary that are designed to improve medical outcomes for injured workers,” said DWC Executive Medical Director Dr. Raymond Meister.

Medical doctors, chiropractors and nurses who take the course will receive up to one and a half hours of free CME credit. Qualified medical evaluators (QMEs) may report up to one and one half hours of credit for QME reappointment. The course is also available to anyone else wishing to learn about the MTUS, and a completion certificate is available.

The education module covers:

— What the MTUS is, how to use it, and how you may be able to obtain free online access to the MTUS-ACOEM treatment guidelines
— How to navigate the MTUS-ACOEM treatment guidelines and apply recommendations for patient care
— The MTUS Drug Formulary
— When to consider recommendations outside of the MTUS guidelines for the care of your patient
— The role of utilization review (UR) and independent medical review (IMR) physicians

Access to the physician education module can be found on the DWC website.

City Atty Sues Instacart Using ABC Employment Test

San Diego City Attorney Mara Elliott has filed a lawsuit against grocery delivery company Instacart, alleging the tech giant has misclassified its employees as independent contractors.

The suit comes three days after new legislation, called Assembly Bill 5, cleared the California Legislature, spurring panic among gig economy giants such as Uber and Lyft. The bill is now on its way to the desk of Gov. Gavin Newsom, who has previously pledged his support. Should the bill be signed into law, it would prevent many companies from classifying their workers as independent contractors rather than employees.

According to the report in the San Diego Tribune, Elliott’s lawsuit is asking for Instacart’s workers to receive compensation retroactively, including payment for things like minimum wage, overtime pay, meal breaks and expense reimbursement. The suit also alleges Instacart evaded paying workers compensation and unemployment insurance, along with state and federal payroll taxes.

Instacart did not respond to a request for comment by publication time.

San Francisco-based Instacart is a grocery delivery service that operates nationally and has a presence in San Diego. Its app allows customers to place grocery orders online, which are then purchased and delivered by a “shopper” who drives the order directly to their home.

The suit alleges that Instacart shoppers do not qualify as independent contractors under a 2018 California Supreme Court decision (Dynamex Operations West, Inc. v. Superior Court). It’s the Dynamex case that spurred AB 5 to move its way through the state legislature this year, sponsored by San Diego Democrat Lorena Gonzalez.

Procopio law partner Tyler Paetkau, who practices employment law, said AB 5 would change the game entirely for companies hiring contract workers. Employers used to have a lot of wiggle room to classify workers as independent contractors. This new bill now tightens the definition of an independent contractor. The most notable difference is that employers cannot use contractors unless the person’s work is “outside the normal business activities” of the hiring company.

Elliott’s suit alleges Instacart does not meet the criteria outlined in Dynamex, which AB 5 mirrors.

“Shoppers perform work that is directly within the course of Instacart’s business model, including ‘groceries delivered in as little as one hour,’” stated a City Attorney’s Office news release. “Shoppers are essential to providing the core service the company offers.”

Proponents of AB 5 say the legislation will improve labor conditions for gig economy workers, forcing companies to offer benefits and protections that a normal employee would be granted – such as minimum wage, paid sick days and health insurance benefits. Opponents say the bill invokes outdated views of “employment,” hampering the millions of Californians who want flexible work.

Lawsuits seeking retroactive restitution could be a major challenge for companies throughout the state, Paetkau said, especially small businesses that have adopted the gig economy model popularized by Uber and Lyft.

“A lot of these companies are startups,” Paetkau said. “They have some funding but limited resources. The worst thing that can happen to them is a lawsuit or claim. Especially involving multiple workers. This could wipe them out.”

Opioid Drugmakers Seek to Recuse Federal Judge

Lawyers for cities and counties suing drug companies over the opioid epidemic on Monday objected to a bid by pharmaceutical distributors and pharmacies to disqualify the federal judge overseeing the cases, saying it had no basis and came too late.

The plaintiffs’ lawyers moved swiftly to fight the request companies including AmerisourceBergen Corp (ABC.N), Cardinal Health Inc (CAH.N) and McKesson Corp (MCK.N) had made on Saturday for U.S. District Judge Dan Polster in Cleveland, Ohio, to step aside from the litigation.

In Monday’s brief, lawyers for the plaintiffs said the defendants had waived their ability to seek Polster’s recusal, noting they were relying on statements he made more than a year ago to belatedly seek his disqualification.

“If these Defendants really thought recusal was necessary, they were required to raise the issue sooner – much sooner,” the plaintiffs’ lawyers wrote.

The companies had argued in Saturday’s motion that Polster, who has long pushed for a settlement that could “do something meaningful to abate this crisis,” had made a series of public statements since 2018 that could cause a reasonable person to question his impartiality.

They said those statements, made in court hearings and media interviews, raised the prospect that he had improperly prejudged their liability ahead of the first trial on Oct. 21 involving two Ohio counties seeking $8 billion.

In Monday’s brief, the plaintiffs’ lawyers said the companies did not take action when Polster made those comments and actively participated in court-overseen settlement talks without objection.

Polster “has at no time expressed improper or biased views about the liability of any defendant, much less views based on extra-judicial sources,” the lawyers wrote.

The companies who joined Saturday’s motion also include CVS Health Corp (CVS.N) and Walmart Inc (WMT.N). The defendants did not respond to requests for comment.

OxyContin maker Purdue Pharma, one of the lead defendants, filed for bankruptcy protection on Monday after reaching a tentative deal to resolve claims in the federal litigation and by 24 U.S. states.

Benefits Approved for O.C. Deputies Injured in Las Vegas

The Orange County Register reports that county officials say they will stand behind their sheriff’s deputies who are injured while trying to help others, even when they’re off duty and out of state. County supervisors voted Sept. 10, to extend workers compensation benefits to sworn employees who were hurt during the 2017 mass shooting at the Route 91 Harvest Festival in Las Vegas, and to county law enforcement caught up in future domestic terrorism events who use their training to protect civilians or assist local first responders.

Off-duty officers from several Southern California communities were attending the Las Vegas concert when a gunman fired on the crowd. Some were shot or received other injuries while leading people to safety, helping secure the area and providing others aid.

Orange County rejected workers comp claims filed by four of its deputies who were hurt, because California law at the time specifically referred to peace-keeping activities “anywhere in this state,” but did not mention actions outside the state’s boundaries.

A bill from Assemblyman Tom Daly, D-Anaheim, that passed in 2018 clarified the law so that California peace officers injured off duty while responding to out-of-state crimes and life-threatening emergencies can collect public injury benefits. Now, Orange County has enshrined in its own policies that officers in good standing hurt in the Las Vegas shooting or such future incidents are eligible for workers compensation.

The new policy’s cost to county taxpayers is unknown because it will depend on how many claims are filed and what benefits are awarded.

Deputy Mark Seamans, hit by gunfire, was among the Orange County deputies whose claims were initially rejected. As Seamans told a reporter shortly after the incident, he never stopped to worry about his own safety while pulling people out of harm’s way. “The switch turned on, and it became everything we train for,” he said at the time.

The county’s new policy doesn’t guarantee off-duty deputies’ claims will be paid, only that they’ll be considered even if the incident takes place in another state. The policy would not apply to claims of psychological injury or events outside the U.S. On Wednesday, a county spokeswoman said two claims by officers who were shot in Las Vegas are due to be approved.

Since Daly’s bill passed last year, San Bernardino County accepted a claim from one deputy injured at the Route 91 festival, county spokeswoman Felisa Cardona said. California Peace Officers Association spokesman Shaun Rundle said he wasn’t aware of other agencies making policy changes as Orange County did.

TTD Rates to Increase 3.84% Next Year

The Division of Workers’ Compensation (DWC) announces that the 2020 minimum and maximum temporary total disability (TTD) rates will increase on January 1, 2020. The minimum TTD rate will increase from $187.71 to $194.91 and the maximum TTD rate will increase from $1,251.38 to $1,299.43 per week.

Labor Code section 4453(a) (10) requires the rate for TTD be increased by an amount equal to percentage increase in the State Average Weekly Wage (SAWW) as compared to the prior year. The SAWW is defined as the average weekly wage paid to employees covered by unemployment insurance as reported by the U.S. Department of Labor for California for the 12 months ending March 31 in the year preceding the injury. In the 12 months ending March 31, 2019, the SAWW increased from $1,290 to $1,325 – an increase of 3.84013 percent.

Under Labor Code section 4659(c), workers with a date of injury on or after January 1, 2003 who are receiving life pension (LP) or permanent total disability (PTD) benefits are also entitled to have their weekly LP or PTD rate adjusted based on the SAWW.

SAWW figures may be verified using the U.S. Department of Labor’s Unemployment Insurance Data Base. #

Saturday is Not a “Working Day” for UR Time Limits

Puni Pa’u suffered an admitted injury while working for the Department of Forestry. His PTP requested authorization for radio frequency ablation, a type of medical treatment, for an accepted injury to his back. The RFA was was received by EK Health on March 12, 2018, a Monday. EK Health denied the request for treatment on March 19, 2018, also a Monday.

Applicant made a second request for the same treatment; this request was received on April 16, 2018, a Monday, and denied on April 23, 2018, also a Monday.

Applicant filed a Declaration of Readiness to Proceed, alleging that both UR denials were late, and therefore that the WCAB had jurisdiction to award him the medical care he sought.

The core of the parties’ dispute was over whether defendant had complied with the requirement to render a decision within “five working days,” as mandated by Labor Code section 4610. The WCJ found in pertinent part that defendant timely denied applicant’s requests for treatment via Utilization Review (UR). The WCJ concluded that the UR denials were timely because Saturdays and Sundays are not working days under the meaning of the Labor Code section 4610.

Applicant contends on reconsideration that the UR denials were untimely because Saturday is a working day for purposes of Labor Code section 4610, and therefore that the Workers’ Compensation Appeals Board (WCAB) has jurisdiction over the dispute and that the WCJ should have awarded applicant the requested treatment.

The WCAB affirmed the conclusion of the WCJ in the Significant Panel Decision of Puni Pa’u v Department of Forestry.

Although Saturday is a business day under Civil Code section 9, it is not a working day under Labor Code section 4610, because Labor Code section 4610 does not incorporate the definition of business day found in Civil Code section 9. Applying the principles of statutory interpretation, we determine that the phrase “working day” found in Labor Code section 4610 does not include Saturdays based upon its standard modern usage, as reflected in dictionary definitions, statutory and regulatory enactments, and judicial decisions. Moreover, even if Saturday were a working day, the UR decisions in this case would still be timely based upon Code of Civil Procedure section 12a, which extends the deadline for performance of acts that fall due on a Saturday.

SB 731 Limits to Apportionment Remains in Committee

This year the California Legislature again introduced legislation poised to limit apportionment in several ways with SB 731. The proposed law adds a sentence to LC 4663 (c) “The approximate percentage of the permanent disability caused by other factors shall not include consideration of race, religious creed, color, national origin, age, gender, marital status, sex, sexual identity, sexual orientation, or genetic characteristics.”

The proposed law was likely a response to a few recent decisions that have enhanced the ability of employers to obtain apportionment of permanent disability. However the court successes may be short lived as a new proposed law is rapidly gaining momentum in the California Legislature to limit or water down apportionment law adopted in 2004 by S.B. 899.

In April 2017, the Court of Appeal published its decision in the City of Jackson v WCAB (Rice) which confirmed apportionment to genetic factors. Christopher Rice was a police officer who suffered a spine injury. A PQME found that genetic factors were significant factors in his permanent impairment. The Court of Appeal reversed the WCAB which refused to allow apportionment to genetics.

In December 2018, the Court of Appeal published its decision in City of Petaluma v WCAB and Aaron Lindh. In that case a PQME concluded that 85 percent of his disability was due to a previously asymptomatic, underlying condition. The ALJ, however, rejected apportionment and reconsideration was denied by the WCAB. The Court of Appeal reversed, and granted apportionment finding that the requirement that the asymptomatic preexisting condition will, in and of itself, naturally progress to disable the claimant. was “the law prior to 2004” and is no longer a requirement for apportionment to an underlying condition.

SB 731 has been passed by the California Senate on 5/19/2019, and sent to the State Assembly as of 5/22/2019.  On 5/30/2019 the bill was sent to the Insurance Committee, and as of the end of the legislative session this year, has not had a finding by that Committee.  Thus SB 731 will not be passed this year.

Similar bills were passed by the legislature and then vetoed by Governors Arnold Schwarzenegger and Jerry Brown for many years. It is likely that SB 731 will be passed by the legislature the next legislative session. It is not clear what response Governor Gavin Newsom will have if it is passed. However, the bill is not yet an urgency bill, so the effective date would be no earlier than January 1, 2021 if passed and signed next year.  Employers who have cases in litigation involving apportionment issues would have more than one year to bring those cases to a conclusion.

ABC Employment Test Passed by Legislature

The state Senate voted in favor of the bill – dubbed Assembly Bill 5 (AB5) – that would ensure gig economy workers in companies like Uber, Lyft, and DoorDash are entitled to minimum wage, workers‘ compensation, and other benefits.

The contentious bill was passed in a 29 to 11 vote as the legislative session was about to end for the year. AB5 had passed the State Assembly on May 29 with a 53-11 vote. It is expected to be signed by California Governor Gavin Newsom, and will go into effect starting January 1, 2020.

The business models of these companies are already under severe strain. Although the extent to which AB5 could impact these platforms is unknown, it’s expected to drive their labor costs up by 30 percent, according to a report by San Francisco Chronicle.

Last month, Uber reported a record second quarter loss of $5.2 billion, its largest ever quarterly loss. The company laid off 435 employees across its engineering and product teams yesterday, on top of the 400 marketing team employees who were handed pink slips in late July in an attempt to cut costs.

Litigation is now likely to follow passage of the new law. Uber said Wednesday that it was confident that its drivers will retain their independent status when the measure goes into effect on Jan. 1. “Several previous rulings have found that drivers’ work is outside the usual course of Uber’s business, which is serving as a technology platform for several different types of digital marketplaces,” said Tony West, Uber’s chief legal officer. He added that the company was “no stranger to legal battles.”

California has at least one million workers who work as contractors and are likely to be affected by the measure, including nail salon workers, janitors and construction workers. Unlike contractors, employees are covered by minimum-wage and overtime laws. Businesses must also contribute to unemployment insurance and workers’ compensation funds on their employees’ behalf.

In California, religious groups said they feared that small churches and synagogues would not be able to afford making pastors and rabbis employees. Winemakers and franchise owners said they were worried they could be ensnared by the law, too.

Historically, if workers thought they had been misclassified as a contractor, it was up to them to fight the classification in court. But the bill allows cities to sue companies that don’t comply.

San Francisco’s city attorney, Dennis Herrera, has indicated that he may take action. “Ensuring workers are treated fairly is one of the trademarks of this office,” he said in a statement.

And California may be only the beginning, as lawmakers elsewhere, including New York, move to embrace such policies. Legislators in Oregon and Washington State said they believed that California’s approval gave new momentum to similar bills that they had drafted.

Purdue Pharma $12B Settlement Offer Moves Ahead

OxyContin maker Purdue Pharma LP has reached a tentative multibillion-dollar agreement with some plaintiffs aimed at settling thousands of lawsuits over its alleged role in the U.S. opioid crisis, Reuters reported on Wednesday, citing people familiar with the matter.

On Wednesday, lead lawyers representing more than 2,000 cities, counties and other plaintiffs suing Purdue, along with 23 states and three U.S. territories, were on board with an offer from the company and its controlling Sackler family to settle lawsuits in a deal valued at up to $12 billion, the people said.

More than a dozen other states remain opposed or uncommitted to the deal, setting the stage for a legal battle over Purdue’s efforts to contain the litigation in bankruptcy court. New York, Massachusetts and Connecticut, where privately-held Purdue is based, are among states opposed to the current offer and have pushed the family to guarantee $4.5 billion, the people said.

Last weekend, the Sacklers “refused to budge” after attorneys general in North Carolina and Tennessee presented them with counterproposals they said had widespread support from other states, according to correspondence reviewed by Reuters.

With negotiations over the family’s contribution to a settlement at loggerheads, Purdue is preparing to file for bankruptcy protection as soon as this weekend or next with the outlines of a settlement in hand.

Purdue would then ask a U.S. bankruptcy judge to halt litigation while settlement discussions continue, a move some states said they are likely to challenge. A bankruptcy judge could force holdouts to accept a settlement as part of Purdue’s reorganization plan if enough other plaintiffs agree.

In a related development, a federal judge on Wednesday approved the substance of a proposal by lawyers representing cities and counties suing drug companies over the U.S. opioid epidemic that would bring every state and municipality in the country into their settlement talks.

U.S. District Judge Dan Polster, in Cleveland, Ohio, federal court, said that the plan, which was opposed by 37 states and the District of Columbia, “does not interfere with the states settling their own cases any way they want.”

“This process simply provides an option – and in the court’s opinion, it is a powerful, creative and helpful one,” the judge wrote.

The proposal, part of litigation consolidating about 2,000 lawsuits against opioid manufacturers, retailers and others seeking damages for the epidemic, calls for creating a class of up to 3,000 counties and 30,000 cities, towns and villages that could vote on whether to accept any settlement the plaintiffs reach with the defendants.

Insurance Commissioner Under More Ethical Scrutiny

Both Politico and now the Los Angeles Times report concerns about California’s state insurance commissioner who has stuck taxpayers with thousands of dollars in bills to cover the cost of renting an apartment in Sacramento while he maintains his primary residence in Los Angeles – a break from other statewide elected officials that is alarming ethics watchdogs.

And Lara’s decision to file for rental reimbursement breaks precedent with two previous insurance commissioners. Republican Steve Poizner, who is from the Bay Area, did not charge living expenses to the state during his tenure as insurance commissioner. Neither did Democrat Dave Jones, though he did not have to commute far as a Sacramento resident.

Gov. Arnold Schwarzenegger, whose main residence was in Southern California, lived at the Hyatt Regency while in Sacramento but had his expenses paid by an outside foundation. Gov. Gavin Newsom, a former San Francisco mayor, recently moved from the Bay Area to a Sacramento suburb with his family at his own expense.

The revelation could add another headache for Commissioner Ricardo Lara, who is already under scrutiny for his campaign fundraising and perceived coziness with the insurance industry.

The Sacramento Bee claims the California’s top regulator of insurance companies sought campaign contributions from the industry and partied with one of its lobbyists after winning his election last year, according to records and social media posts obtained by The Sacramento Bee.

Three months after taking office, Insurance Commissioner Ricardo Lara scheduled a March 12 lunch with insurance company executives with a pending matter before his department.

A memo to the commissioner said the meeting had a specific purpose: “Relationship building” for his re-election campaign.

Executives “will be joining you for a relationship-building lunch in support of your Ricardo Lara for Insurance Commissioner 2022 campaign,” fundraising consultant Dan Weitzman wrote in the memo.

Lara had pledged not to take money from the insurance industry as he ran for the post last year.

Weeks following the lunch, he broke his promise. In April, he accepted more than $50,000 in campaign donations from insurance representatives and their spouses. Some of the money came from out-of-state donors who have ties to one of the companies scheduled to be represented at the lunch.

Social media posts shared with The Bee show Lara also counts insurance lobbyists among his friends. The former state lawmaker partied with a Farmers Insurance lobbyist in London on New Year’s Eve just a week before his inauguration.

And the San Francisco Chronicle characterizes his apology about the contribution ethical problems and blame shifting on his staff as “underwhelming.”