Menu Close

Author: WorkCompAcademy

No Pay for Uninsured Contractor Even After Retroactive Reinstatement

Balfour Beatty Construction, LLC was hired by a local school district to construct a two-story classroom building at an elementary school. In June 2017, Balfour Beatty hired ABI as a subcontractor to perform concrete, framing, and structural steel work on the project and agreed to pay ABI over $700,000 for its work.

When ABI began its work on the project in August 2017, it had a workers’ compensation insurance policy issued through State Compensation Insurance Fund. In December 2017, State Fund sent ABI a notice of cancellation, informing ABI that its 2017 2018 workers’ compensation policy would be canceled in January 2018 if ABI did not pay approximately $33,000 in outstanding premiums. ABI received the notice, but failed to pay, and its policy was canceled. ABI refused to pay outstanding insurance premiums charged on a prior policy, since ABI believed (correctly as it turns out) it was being overcharged

As a result of the policy cancellation, ABI’s contractor’s license was suspended by operation of law on January 25, 2018, due to ABI’s “failure . . . to . . . maintain workers’ compensation insurance coverage.” (Bus. & Prof. Code, §7125.2.) The Contractors’ State License Board gave ABI notice of the license suspension on January 29 and informed ABI that its contractor’s license would be suspended if ABI failed to submit a valid insurance certificate or exemption certificate within 45 days. (See § 7125.2, subd. (b) [requiring registrar to give notice of license suspension].) ABI did neither. In mid-March, the Board sent ABI a letter notifying ABI that its license had been retroactively suspended effective January 25 under section 7125.2.

Mr. Vo, ABI’s principal,filed an “Exemption from Workers Compensation” form with the Board in early April 2018, declaring under penalty of perjury that ABI does not need workers’ compensation insurance because it does “not employ anyone.” This was false. As Vo later admitted at trial, ABI had at least nine employees working on the project at the time. Vo nonetheless decided to falsely claim the exemption because ABI was heavily invested in the project and he did not want to lose money. Upon receipt of the exemption form, the Board reinstated ABI’s license effective April 5, 2018.

As for the construction project, Balfour Beatty refused to pay ABI for its work. Accordingly, in May 2019, ABI sued Balfour Beatty and several construction bonding surety companies for fraud, breach of contract, quantum meruit, recovery against bonds, and statutory penalties. Balfour Beatty cross-complained against ABI and Vo for fraud, express indemnity, and equitable indemnity. Balfour Beatty also asserted as its 31st affirmative defense that ABI “was not properly licensed at all times as required by Business and Professions Code section 7031,” and as a result “is barred from recovering payment for any labor, materials or equipment furnished to the project.”

Several years into that litigation, ABI settled its old premium dispute with its workers’ compensation insurer and had the canceled policy retroactively reinstated as part of the settlement. ABI then applied to the Contractors’ State License Board for retroactive reinstatement of its contractor’s license, asserting that ABI’s failure to file a certificate of workers’ compensation coverage had been “due to circumstances beyond [its] control,” in that the policy had been canceled “unbeknownst to” ABI. The Board accepted ABI’s representation and retroactively reinstated its contractor’s license under Bus. & Prof. Code, § 7125.1.

In November 2022, the trial court held a bench trial on the bifurcated issue of Defendants’ 31st affirmative defense – ABI’s failure to be duly licensed. During trial, State Fund’s underwriting manager admitted that State Fund had overcharged ABI for premiums, that State Fund generally does not cancel a policy for nonpayment of a bill until the dispute over the bill is resolved, that State Fund should not have canceled ABI’s 2017-2018 policy, and that ABI’s license suspension occurred because of the way State Fund handled the dispute.

The trial court found in favor of Defendants on the 31st affirmative defense, concluding ABI was “not ‘a duly licensed contractor at all times during the performance’ of the contract” and therefore “may not ‘bring or maintain’ this action ‘or recover’ compensation for its work.” Defendants filed a motion for attorney fees under Civil Code section 1717 and the subcontract’s prevailing party fee provision, and also filed motions to tax costs. After granting the motions in part, the trial court entered an amended judgment in favor of Defendants and against ABI, which included an award of over $270,000 in costs and over $1.55 million in attorney fees to Defendants.

The Court of Appeal affirmed in the published case of American Building Innovations v. Balfour Beatty Construction -G062471 (Sept 2024).

This appeal involves the interplay of several statutes and what circumstances are “beyond the control of the licensee” for purposes of retroactive license reinstatement. In this case ABI was fully aware it was unlicensed and uninsured, and nevertheless continued its work.

The Court of Appeal concluded section 7031 does indeed bar ABI’s current claims. A suspended contractor’s license can be retroactively reinstated under Bus. & Prof. Code, § 7125.1 only if “the failure to have a certificate on file was due to circumstances beyond the control of the licensee.” (Id., subd. (b).)

In this case, the lapse in coverage was not beyond ABI’s control. The record “demonstrates the policy cancellation occurred because ABI chose not to pay billed insurance premiums. ABI learned of the policy cancellation days after it took effect, yet ABI did not procure replacement coverage until years later when it settled the premium dispute with its insurer”.

The insurer’s retroactive reinstatement of the policy following that settlement was essentially meaningless because it occurred long after the statute of limitations ran on any workers’ compensation claims, rendering the coverage illusory.”

“As the prevailing party in that action, Defendants are entitled to attorney fees; the fee award must therefore be affirmed.”

After 9 Years, 3 Jury Trials, 2 Appeals – Attorney Fees are Far More Than Award

Plaintiff T.J. Simers was a well-known and sometimes controversial columnist for Los Angeles Times Communications LLC. In August 2013, plaintiff was demoted to a senior reporter. Shortly thereafter, he obtained a position as a columnist with a rival newspaper and filed this action against The Times for constructive termination and age and disability discrimination in violation of the Fair Employment and Housing Act (FEHA; Gov. Code, § 12900 et seq.).

There have been three jury trials in this case.

In the first trial, the jury found defendant was liable for both discrimination and constructive termination. The jury awarded plaintiff $2,137,391 in economic damages for harm caused by his constructive termination, and $5 million in noneconomic damages, without identifying which noneconomic damages were caused by the constructive termination and which were caused by the discrimination. The trial court granted defendant’s motion for judgment notwithstanding the verdict (JNOV) on plaintiff’s constructive termination claim and granted a new trial on noneconomic damages.

Both parties appealed. The Court of Appeal affirmed the trial court’s orders and remanded the case for a new trial on damages for plaintiff’s demotion. (Simers v. Los Angeles Times Communications LLC (2018) 18 Cal.App.5th 1248 (Simers).)

In the second trial, the jury awarded plaintiff $15.4 million in noneconomic damages. The trial court, however, granted defendant’s motion for a new trial on two grounds.

In the third trial, again the only issue was the amount of noneconomic damages plaintiff could recover for his demotion. Plaintiff’s counsel asked the jury to return a verdict between $30 and $50 million, and defense counsel argued that an award between $500,000 and $1 million was reasonable. The jury returned a verdict of $1.25 million. The jury’s verdict was the exact amount of an offer defendant made on December 7, 2021, shortly before the third trial began, to settle under Code of Civil Procedure section 998 (section 998).

In June 2022, defendant paid plaintiff $1,292,123.29 in partial satisfaction of the judgment.

In May 2022, plaintiff filed a motion for attorney fees, requesting fees of more than $15.5 million. This consisted of $7,860,475, based on hours spent multiplied by hourly rates (the “lodestar” amount), with a 2.0 multiplier based on contingent risk and other factors. The time spent included time on all three trials and on the appeals after the first trial.Plaintiff claimed costs of $577,890.29.

Defendant opposed the attorney fee motion. Among other contentions, defendant argued that section 998 precluded any fee recovery after the December 7, 2021 section 998 offer; that plaintiff could not recover fees for work on the second trial because that would reward plaintiff for his counsel’s egregious misconduct; and that plaintiff could not recover fees for the appeals after the first trial because he did not prevail on his appeal and this court’s disposition stated that the parties would bear their own costs.

The trial court awarded plaintiff $3,264,906 in attorney fees. The court granted defendant’s motion to tax costs in part, allowing plaintiff to recover $210,882.55 in costs. The defendant and the plaintiff both appealed. After the briefs were filed in these appeals, plaintiff T.J. Simers passed away. The motion of Virginia Simers, the sole beneficiary and executor of Mr. Simers’s will, to substitute herself as plaintiff was granted.

The Court of Appeal found “no abuse of discretion in any part of the trial court’s order” in the published case of Simers v. Los Angeles Times Communications LLC -B323715 (August 2024)

The primary issue is the defendant’s contention that the plaintiff should not have recovered any fees for counsel’s work on the second trial, because the third trial was necessitated by counsel’s misconduct in closing argument at the second trial. Defendant also challenges fees awarded for certain work on plaintiff’s unsuccessful appeal after the first trial.

Plaintiff contends he should recover his attorney fees for this appeal, despite the trial court’s order that he cannot recover any fees or costs incurred after he rejected the defendant’s offer of compromise on December 7, 2021, shortly before the third trial, and failed to obtain a more favorable judgment.

“Section 998 expressly requires the court to exclude postoffer costs in determining whether the plaintiff has obtained a more favorable judgment than the offer. (§ 998, subd. (c)(2)(A).) That is exactly what the trial court did.”

The Court off Appeal said it “cannot find any failure to ‘adequately’ or ‘independently’ consider the factors defendant raises. The court clearly stated that it considered the misconduct that necessitated a third trial in making its award of fees that ‘as a whole are reasonable.’ We find no basis to conclude the trial court abused its discretion.”

Court of Appeal Again Limits WCAB Jurisdiction on Reconsideration to 60 Days

On March 2, 2023, a workers’ compensation administrative law judge (WCJ) issued an award of total permanent disability in favor of Mayor based on an industrial injury he suffered in December 2013 during his employment by Ross Valley.

Ross Valley filed a petition for reconsideration with the Board on March 23, 2023. The Board’s electronic filing system, Electronic Adjudication Management System (EAMS), showed it was received the same day. Mayor filed his answer to the petition on April 3, 2023.

At the time, former Labor Code section 5909 stated, “A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date of filing.” On June 5, 2023, 74 days after Ross Valley filed its petition, Ross Valley wrote to the Board, inquiring about the status of its petition and noting that it had been more than 60 days since Ross Valley had filed it.

On July 19, 2023, Mayor requested a hearing to enforce the WCJ’s award.

On August 14, 2023, 144 days after Ross Valley filed its petition, the Board issued a document titled, “Opinion and Order Granting Petition for Reconsideration.” Attached to the Board’s order granting reconsideration was a document titled, “Notice Pursuant to Shipley v. Workers’ Comp. Appeals Bd. (1992) 7 Cal.App.4th 1104 [57 Cal.Comp.Cases 493].” This notice states, “Reconsideration has been sought with regard to the decision filed on March 2, 2023. Labor Code section 5909 provides that a petition for reconsideration is deemed denied unless the Workers’ Compensation Appeals Board (Appeals Board) acts on the petition within 60 days of filing. (Lab. Code, § 5909.) The petition(s) was filed on March 23, 2023. The Appeals Board first received notice of the petition(s) on or about June 15, 2023. (Shipley v. Workers’ Comp. Appeals Bd. (1992) 7 Cal.App.4th 1104 [57 Cal.Comp.Cases 493] [allowing tolling as a matter of due process.].) The Opinion and Order Granting Petition for Reconsideration filed simultaneously with this Notice may be considered timely if issued within 60 days of the Appeals Board receiving notice of the petition(s). (Id.)”

Mayor wrote to the Board in September 2023, asking it to clarify why it first received notice of the petition on June 15, 2023, when Ross Valley filed it on March 23, 2023.

After receiving no reply, Mayor filed his petition for writ of mandate on January 9, 2024, asking the Court of Appeal  to direct the Board to rescind its order granting reconsideration because former section 5909 dictated that the Board lost jurisdiction over the matter 60 days after Ross Valley filed its petition for reconsideration. On January 26, 2024, the Board issued a document titled, “Opinion and Order Granting Petition for Reconsideration and Decision After Reconsideration.” The Board then reconsidered and rescinded that order and issued a revised version on February 2, 2024. The revised order stated that the Board was rescinding the WCJ’s award and returning the matter to the trial level for further proceedings.

According to the revised order, “due to an administrative irregularity” that was not the fault of either party, the Board did not receive Ross Valley’s petition for reconsideration until more than 60 days after the date Ross Valley filed it, March 23, 2023. EAMS, which the Board does not control, does not give the Board direct notification of filings. Instead, the staff of the district office must manually notify the Board that a party is requesting reconsideration and transmit the case to the Board. Mistakes and delays from “normal human error” can thwart the manual transmission of information from the district offices to the Board. When this occurred, the Board’s practice was to treat the 60-day deadline in former section 5909 as tolled and issue a decision on the petition within 60 days of receipt of the petition. The Board’s order stated that Ross Valley secured a statutory right to reconsideration upon timely filing its petition for reconsideration, so its conduct “is not and should not be at issue.”

The Court of Appeal agreed with Mayor and the recent decision in Zurich American Ins. Co. v. Workers’ Comp. Appeals Bd. (2023) 97 Cal.App.5th 1213 (Zurich) that the Board’s action after 60 days exceeded its jurisdiction in the published case of Mayor v. Workers’ Compensation Appeals Bd A169465 (August 2024).

Mayor argues that when the Board failed to act on Ross Valley’s petition for 60 days, former section 5909 dictated that it was denied by operation of law. According to Mayor, the Board’s attempt to grant the petition on August 14, 2023, 144 days after it was filed, was therefore in excess of its jurisdiction and must be set aside. Zurich American Ins. Co. v. Workers’ Comp. Appeals Bd recently accepted this argument in factual and procedural circumstances essentially identical to those here, and Mayor urged the Court of Appeal to follow it.

The Board, conversely, seeks to minimize, distinguish, or refute Zurich’s reasoning on a variety of grounds. Thus the Court of Appeal began by reviewing it and the legal principles it applied. After doing so it concluded that for “the reasons Zurich set forth at length, we agree with Mayor that former section 5909 was mandatory and the Board exceeded its jurisdiction in purporting to grant Ross Valley’s petition after 60 days had passed since Ross Valley filed it.

It went on to say that the “Board’s various attempts to avoid or defeat Zurich’s reasoning are unpersuasive.” Among other reasons the Opinion said “Given the goal of average or substantial, but expeditious, justice in workers’ compensation proceedings, opposing parties need not subordinate their rights to prompt resolution of disputes to accommodate open-ended delays that the Board claims are necessary for it to rule on petitions for reconsideration.” In doing so, it overruled anything said in Shipley v. Workers’ Comp. Appeals Bd to the contrary.

It must be noted that while Mayor’s petition was pending in the Court of Appeal, the Legislature enacted Assembly Bill 171 which amended former Labor Code section 5909 which now states, “(a) A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board. [¶] (b)(1) When a trial judge transmits a case to the appeals board, the trial judge shall provide notice to the parties of the case and the appeals board. [¶] (2) For purposes of paragraph (1), service of the accompanying report, pursuant to subdivision (b) of Section 5900, shall constitute providing notice. [¶] (c) This section shall remain in effect only until July 1, 2026, and as of that date is repealed.” The former version of section 5909 is currently set to be reinstated on July 1, 2026.

Cal/OSHA Cites 9 Employers $168K For Silica Health and Safety Violations

California’s Division of Occupational Safety and Health (Cal/OSHA) cited nine employers in Sun Valley within the greater Los Angeles area following efforts to address the growing number of silicosis cases among stone workers in California.

As California faces an increase in silicosis cases among stone workers, Cal/OSHA continues ramping up enforcement efforts and today announced citing nine more employers, this time in Sun Valley. The safety violations include over $168,000 in fines. Cal/OSHA cited the following employers:

– – Miguel Clavel – Total Fine: $18,320
– – Gasper Marble and Tile – Total Fine: $18,785
– – Jose Sandoval Marble and Granite – Total Fine: $18,785
– – Valley Marble – Total Fine: $18,785
– – Edward Ponce – Total Fine: $18,785
– – Durango Marble – Total Fine: $18,785
– – Nacho Brothers Marble Inc. – Total Fine: $18,785
– – M & M Three Marble Inc. – Total Fine: $18,785
– – LB Quality Stone Experts Inc. – Total Fine: $18,785

The Van Nuys District Office conducted inspections and it was determined that all the employers were in violation of multiple Title 8 Safety and Health Regulations, including failure to use methods to effectively suppress dust and failed to provide their employees with full-face, tight-fitting power air purifying respirators.

Cal/OSHA’s workplace safety laws and emergency temporary standard are key components to ensure that workers are safe. Increasing awareness to employers and employees of the dangerous effects of inhaling respirable crystalline silica dust from tasks like grinding, drilling and cutting, can help save lives and avoid incurable health conditions like silicosis, lung cancer and kidney diseases.

With cases of silicosis increasing across the state, Cal/OSHA has intensified its enforcement and education efforts. In December of last year an emergency temporary standard was adopted to enhance existing guidelines for respirable crystalline silica hazards. The Occupational Safety and Health Standards Board (OSHSB) voted to readopt the emergency temporary standard at its August 15 meeting.

DIR and Cal/OSHA recently launched a bilingual public awareness and education campaign that offers employers and workers resources and information about the proper use of safety equipment and safe worksite practices. The campaign website, worksafewithsilica.org, also provides vital information for workers on workplace safety rights and how to report safety violations.

Since 2019, the California Department of Public Health (CDPH) has confirmed a total of 176 cases of silicosis related to engineered stone, including at least 13 deaths and at least 19 individuals who have undergone a lung transplant. A total of 105 of the 176 cases occurred in Los Angeles County, with the remainder occurring in other parts of the state.

August 26, 2024 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Court Ends New FTC Rule Banning Employer Non-Compete Agreements. 9th Circuit Decision Continues “Judicial Hostility” to Employer Arbitration. Workers File Class Actions Against Employers for Excessive PBM Drug Costs. Separate Public Entities Exempt From Wage Order and PAGA Claims. Former CHP Officer Arrested for Workers’ Compensation Fraud. SJDB School Owner and Counselors Face $1M Fraud & Kickback Charges. Huntington Beach Company Succeeds With First Artificial Heart Transplant. MIT Researchers Study Why Laws are Written in an Incomprehensible Style.

Jury Finds Infamous Plaintiff Lawyer Tom Girardi Guilty of Defrauding Clients

Disbarred 85 year old plaintiffs’ personal injury attorney Thomas Vincent Girard,of Seal Beach California, was found guilty this week of leading a years-long scheme in which he embezzled tens of millions of dollars of money that belonged to his clients, some of whom awaited payment for treatment of severe physical injuries.He was found guilty of four counts of wire fraud.

Throughout his more than 50-year career, Girardi had two claims to fame: he played a key role in winning a $333 million settlement for residents of Hinkley, California, in their lawsuit against Pacific Gas & Electric, a case that later became the basis for the film “Erin Brockovich.” Decades later, he and his wife Erika Jayne were cast on the reality show “Real Housewives of Beverly Hills.”

According to evidence presented at a 13-day trial, Girardi – a once-powerful figure in California’s legal community – ran the now-defunct law firm Girardi Keese. For years, Girardi misappropriated and embezzled millions of dollars from client trust accounts at his law firm. The scheme involved defendant Girardi stealing millions of dollars in client settlement funds and failing to pay Girardi Keese clients – some of whom had suffered serious injuries in accidents – the money they were owed.

In carrying out this scheme, from October 2010 to late 2020, Girardi provided a litany of lies for failure to pay clients and directed a law firm employee to pay previously defrauded clients or other unrelated expenditures. Girardi sent lulling communications to the clients that, among other things, falsely denied that the settlement proceeds had been paid and falsely claimed that Girardi Keese could not pay the settlement proceeds to clients until certain purported requirements had been met. These bogus requirements included addressing supposed tax obligations, settling bankruptcy claims, obtaining supposedly necessary authorizations from judges, and satisfying other debts.

Girardi diverted tens of millions of dollars from his law firm’s operating account to pay illegitimate expenses, including more than $25 million to pay the expenses of EJ Global, a company formed by his wife related to her entertainment career, as well as spent millions of dollars of Girardi Keese funds on private jet travel, jewelry, luxury cars, and exclusive golf and social clubs.

At the end of 2020, as Girardi and his law firm faced mounting legal problems related to his years-long theft of client funds, Girardi Keese was forced into involuntary bankruptcy. The State Bar of California disbarred Girardi in July 2022.

United States District Judge Josephine L. Staton scheduled a December 6 sentencing hearing, at which time Girardi will face a statutory maximum sentence of 20 years in federal prison for each count.

Relatedly, co-defendant Christopher Kazuo Kamon, 50, formerly of Encino and Palos Verdes and who was residing in The Bahamas at the time of his November 2022 arrest on a federal criminal complaint, awaits trial in this matter in January 2025.

Kamon, the former chief financial officer at Girardi Keese, is charged with multiple fraud counts for allegedly aiding and abetting Girardi’s scheme to defraud clients. Kamon allegedly also embezzled millions of dollars from the law firm’s accounts for his own personal enrichment. Kamon, who remains in federal custody, has pleaded not guilty to these charges.

Girardi, Kamon, and David R. Lira, Girardi’s son-in-law and a former lawyer at Girardi Keese, also face federal fraud charges in Chicago. Trial in that case is scheduled for March 3, 2025.

2,325 People Died From Heat Last Year, Mostly In The Desert Southwest

Researchers from the Department of Public Health, University of Texas at San Antonio, Department of Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland, Department of Human Development and Family Studies, and Pennsylvania State University, State College analyzed all deaths from 1999 to 2023.

The data search was then reduced to deaths in which the International Statistical Classification of Diseases and Related Health Problems, 10th Revision code was P81 (environmental hyperthermia of newborn), T67 (effects of heat and light), or X30 (exposure to excessive natural heat) as either the underlying cause or as a contributing cause of death, as recorded in the Multiple Cause of Death file.

Data were accessed through the Centers for Disease Control and Prevention’s WONDER platform,which combines death counts with population estimates produced by the US Census Bureau to calculate mortality rates.

For each year, researchers extracted age-adjusted mortality rates (AAMRs) per 100,000 person-years for heat-related deaths. The AAMR accounts for differences due to age structures, allowing direct comparisons across time. The approach of analyzing cause-specific mortality rates rather than excess mortality is warranted because the excess mortality methodology is subject to confounding from the COVID-19 pandemic from 2020 to 2023. This study used publicly available, deidentified aggregate data; thus, it was not considered human subjects research.

Joinpoint version 5.2.0 (National Cancer Institute) regression6 was used to analyze AAMRs to assess trends and determine elbow points where the trend began to shift to a new trajectory. Results of joinpoint analyses are reported as average annual percentage change (AAPC) in rates with 95% CIs.

The resulting new study just published in the Journal of the American Medical Association found that heat-related mortality rates in the US increased between 1999 and 2023, especially during the last 7 years. This study is the first to the knowledge of the authors to demonstrate a reversal of this trend from 2016 to 2023.

Recent studies have found exposure to extreme heat to be associated with mortality, with variability by age, sex, and race and ethnicity. Recent research suggests that heat-related mortality risk is increasing globally, but formal analyses of heat-related mortality trends in the US through 2023 are lacking.

This study examined trends in heat-related mortality rates in the US population from 1999 to 2023. From 1999 to 2023, 21,518 deaths were recorded as heat-related underlying or contributing cause of death.

The warmest average temperature recorded since 1850 occurred in 2023. The lowest number of heat-related deaths in the study period was 311 in 2004, whereas the highest, 2325, was in 2023. The number of heat-related deaths showed year-to-year variability, with spikes in 2006 and 2011, before showing steady increases after 2016.

These results align with site-specific data analyzed in a global study that suggest increases in heat-related mortality.As temperatures continue to rise because of climate change,he recent increasing trend is likely to continue.

Study limitations include the potential for misclassification of causes of death, leading to possible underestimation of heat-related mortality rates; potential bias from increasing awareness over time; and lack of data for vulnerable subgroups.

The researchers concluded by saying “Local authorities in high-risk areas should consider investing in the expansion of access to hydration centers and public cooling centers or other buildings with air conditioning.”

Appellate Case Shows Web of Entities in Biggest Comp Fraud Schemes

In 2010, Ari Resnik Resnick and Dr. Ismael Silva, an orthopedic surgery specialist, discussed forming a factoring business to purchase medical accounts receivable, including workers’ compensation liens, from healthcare treatment providers at a discount and then collect on them. They agreed to each invest $500,000 into the new company.

Silva owned or controlled several entities even if he is not formally named as an officer, owner, or manager, including cross-defendants Healthcare Management Associates, Inc.(HMA), National Intra-Operative Monitoring, Inc. (NIOM), Orangewood Surgical Center, LLC (Orangewood), Starbase, Inc. (Starbase), and American Financial Investment Services, Inc. (AFIS), and non-parties Healthpointe Medical Group, Inc. (Healthpointe) and ProCare.

Other than NIOM and Healthpointe, these companies were headed, on paper, by Silva’s relatives, including cross-defendants Mary Aviles for HMA, James Aviles for Orangewood and ProCare, and Silva’s son, Geli Silva (Geli) for AFIS and Starbase, and non-party Medina for ProCare.

Healthcare Financial Solutions, LLC was a company that factored healthcare-related receivables. When the parties that formed it, Ari Resnick through R.O.A.R. Management Company, Inc. and Dr. Ismael Silva, Jr. through Healthcare Management Associates, Inc, could not agree how to dissolve it, litigation commenced. HMA sued Resnick, ROAR, and another Resnick-owned company for breach of the HFS operating agreement, theft of trade secrets, and various business-related torts.

Resnick and ROAR (the Resnick parties) filed a cross-complaint against HMA and another individual for declaratory relief and breach of fiduciary duty. The Resnick parties assert that during the litigation they learned that a decade’s worth of Silva’s past assurances, including his statements about the lack of merit to numerous prior civil suits and a criminal case against Silva, were untrue.

The Resnick parties then filed a first amended cross-complaint (FAXC), asserting Racketeer Influenced and Corrupt Organizations Act (RICO; 18 U.S.C. § 1961 et seq.) claims and a civil fraud cause of action against Silva and others allegedly affiliated with him based on Silva’s alleged misrepresentations. Silva and the cross-defendants named in these RICO and fraud claims either filed or joined in an anti-SLAPP motion to strike portions of the FAXC. Silva and his fellow cross-defendants argued certain allegations of the FAXC described statements made in connection with prior litigation and, thus, were protected activity. They further argued the Resnick parties had not demonstrated that these claims had minimal merit.

The trial court denied the special motion to strike. It found the challenged allegations were not protected activity because they related to statements about judicial proceedings and not to statements made in connection with judicial proceedings. As its analysis of the first prong of section 425.16 was dispositive, the court did not address whether the Resnick parties’ claims had minimal merit.

Silva and his fellow cross-defendants argued on appeal that the trial court erred because statements made about legal proceedings to interested nonparties are protected conduct under the anti-SLAPP statute, and the Resnick parties failed to show those allegations have minimal merit.

The Resnick parties counter that the trial court properly denied the special motion to strike because the challenged portions of the FAXC are only context or evidence of the wrongs complained of, and do not supply the elements of any cause of action. To the extent any of the subject allegations involve protected activity, the Resnick parties have abandoned any effort on appeal to contend such claims have minimal merit. Instead, the Resnick parties argue the appropriate disposition would be to strike only those claims involving protected activity and not their causes of action, which they contend they can state without any stricken allegations.

The allegations challenged by the special motion to strike fall into four categories: (1) statements Silva or other cross-defendants made about other lawsuits to interested parties; (2) statements Silva made in other lawsuits (most of which he made in an unrelated family law divorce case); (3) information the Resnick parties learned from the other lawsuits; and (4) allegations that appear to have nothing to do with any prior lawsuit.

As to the first category, case law establishes that statements by a litigant about a lawsuit to an interested person are protected conduct and, here, those protected statements supply at least one element of the RICO and fraud causes of action alleged in the FAXC. However, as to the remaining categories, none of the allegations concerning litigation-related statements supply an element of the challenged claims.

Accordingly, the Court of Appeal reversed in part, and remand with instructions to strike only the statements in the first category. It affirmed the denial of the special motion to strike as to the remaining allegations in the unpublished case of Healthcare Management v. R.O.A.R. Management -B330809 (August 2024)

Of interest to the workers’ compensation community are the allegations of the FAXC. The FAXC alleged that as a result of the litigation, the Resnick parties more closely scrutinized Silva’s representations and actions since 2010, ” ‘connect[ed] the dots,’ ” and determined cross-defendants had defrauded them. The allegations also show the inter relatedness and entanglement of the multitude of organizations that were involved. And that Silva, his companies, and his family members were involved in lawsuits and a criminal prosecution.

The list of “dots” connected by the Resnik parties begins by learning that in 2011, a physician at Healthpointe sued it and Silva in Orange County Superior Court, asserting claims that included fraud and breach of contract. Among other things, the physician alleged that Silva overbilled insurance companies for physician services at Healthpointe, pressured physicians to perform unnecessary medical procedures, and concealed conflicts of interest from Healthpointe patients. The FAXC does not state when the Resnick parties learned of this lawsuit or that Silva made any representations to Resnick about this lawsuit.

On October 16, 2013, WorkCompCentral, a workers’ compensation industry publication, reported that Healthpointe was involved in a qui tam case asserting it had overbilled for procedures and devices, used counterfeit medical implant hardware, and paid illegal kickbacks to doctors. The publication further asserted Silva controlled Healthpointe. In response to this article, Silva reassured Resnick there was no problem with HFS continuing to accept business generated by Healthpointe. However, HFS scaled back its purchase of liens from Healthpointe. Silva and Mary Aviles formed ProCare, which accepted lien referrals from Healthpointe.

In May 2015, Resnick discovered that Silva, Starbase, and Healthpointe had been named in a civil RICO lawsuit filed by the State Compensation Insurance Fund (SCIF). When Resnick emailed Silva about the lawsuit, Silva assured Resnick that the allegations were not true, but that they might have to deal with bad publicity.

In 2017, the Orange County District Attorney filed a felony complaint against Silva and Geli for fraud and kickbacks related to patient and client referrals. The complaint asserted that Healthpointe doctors referred workers’ compensation applicants for urine toxicology tests administered by Christopher King and Tanya Moreland King, and Silva aided the Kings in submitting fraudulent claims for payment. In exchange, the Kings made payments to Starbase. Resnick learned about the lawsuit, but Silva assured Resnick that Starbase and AFIS would cooperate to protect HFS and that Geli, but not Starbase, had been named as a criminal defendant.

SoCal Federal Whistleblower Pilot Program to Flesh Out High-Level Crimes

United States Attorney Martin Estrada announced that the U.S. Attorney’s Office for the Central District of California (USAO-CDCA) has implemented a new Voluntary Self-Disclosure, Whistleblower Pilot Program encouraging individuals to disclose criminal conduct undertaken by or through companies, exchanges, and other institutions.

The program, which is effective immediately, is designed to prompt individuals to come forward about previously unknown fraud, bribery, and other misconduct. It does so by setting forth conditions under which the voluntary self-disclosure (VSD) of misconduct to the USAO-CDCA, coupled with the agreement to fully cooperate in the investigation of others involved, may make the disclosing individual eligible to avoid prosecution.

The program applies to circumstances where an individual voluntarily discloses to the USAO-CDCA information regarding criminal conduct undertaken by or through public or private companies, exchanges, financial institutions, investment advisers, or investment funds involving fraud or corporate control failures or affecting market integrity, or criminal conduct involving state or local bribery or fraud relating to federal, state, or local funds. It is designed to facilitate the investigation of misconduct that is not already known to the USAO-CDCA and target those equally or more culpable in the misconduct, and only offers benefits to those who did not play a leading role in the misconduct, and who are not corporate CEOs or those in similar positions of control or federal, state, or local officials.

This Pilot Program provides transparency regarding the circumstances in which USAO-CDCA prosecutors will offer deferred or non-prosecution agreements (DPAs or NPAs) to incentivize individuals (and their counsel) to provide original and actionable information. Receiving such information will help us investigate and prosecute criminal conduct that might otherwise go undetected or be impossible to prove, and will, in turn, further encourage companies to create compliance programs that help prevent, detect, and remediate misconduct and to report misconduct when it occurs.

Under the VSD pilot program, the USAO-CDCA will enter into a DPA or NPA in exchange for the individual’s cooperation where the following conditions are met:

– – The misconduct has not previously been made public and is not already known to our Office or to any component of the Department of Justice;
– – The individual voluntarily discloses the criminal conduct to our Office and not in response to a government inquiry, and prior to imminent threat of disclosure or government investigation;
– – The individual is able to provide substantial assistance in the investigation and prosecution of at least one equally or more culpable persons, did not play a leading role in the disclosed conduct, and is prepared to cooperate fully with this Office in its investigation and prosecution of the disclosed conduct, including by providing testimony if requested;
– – The individual truthfully and completely discloses all criminal conduct in which the individual has participated and of which the individual is aware;
– – The individual is not a federal, state, or local elected or appointed and confirmed official; not an official or agent of a federal investigative or federal law enforcement agency; or is not the CEO or equivalent, or a person who otherwise exercises primary control – regardless of title – over the operations of a public or private company; and
– – The individual has not engaged in any criminal conduct that involves: the use of force or violence, any sex offense involving fraud, force, or coercion, or a minor, any offense involving terrorism or implicating national security or foreign affairs and does not have a previous felony conviction or a conviction of any kind for conduct involving fraud or dishonesty.

In instances in which an individual discloses such information, but does not meet the above requirements, prosecutors may consider exercising – with supervisory approval – discretion to extend a DPA or NPA.

To self-disclose pursuant to this policy, please email: USACAC.VDP@usdoj.gov.

Man Sentenced to 7 Years for Defrauding Buyers of Medical-Grade Gloves

An Orange County man was sentenced to 87 months in federal prison for defrauding companies who in mid-2020 paid more than $3 million for COVID-related medical protective equipment that was never delivered.

Christopher John Badsey, 63, of Lake Forest, was sentenced by United States District Judge Josephine L. Staton, who also ordered him to pay $1,938,990 in restitution.

Badsey pleaded guilty in April 2023 to four counts of wire fraud.

In June and July of 2020, Badsey lied to three victim companies when he told them he had access to millions of boxes of nitrile gloves through his Irvine-based company, First Defense International Security Services Corp. (FDI).

This type of personal protective equipment was in high demand and short supply during the early months of the COVID-19 pandemic.

Badsey agreed by contract to sell millions of boxes of gloves to each of the three companies. But he told the companies’ representatives that before they could inspect the gloves, which he claimed were stored in a Los Angeles warehouse, the companies would be required to pay deposits of upwards of $1 million to FDI.

In fact, Badsey did not have any gloves stored in any warehouse.

Badsey instructed the companies to wire the deposits to accounts controlled by himself, FDI or a co-schemer. Relying on Badsey’s false statements, the companies wired a total of $3,231,990 to these accounts.

After receiving the deposits, Badsey allegedly instructed victims to travel to the Los Angeles area, where he claimed the gloves were stored in a warehouse. But when victims attempted to visit the warehouse, Badsey and other FDI employees allegedly provided excuses as to why the gloves could neither be inspected, nor delivered, to the victims.

Nitrile gloves were never provided to the victims, and Badsey is alleged to have absconded with the deposit money. Badsey used the deposit money to make expensive purchases, all while stringing would-be purchasers along with false stories, including absurd claims that government agents were blocking access to his warehouse of gloves, prosecutors argued in a sentencing memorandum.

He has forfeited all title and interest in money or items derived from his crimes, including a yacht, a pontoon boat, two Mercedes-Benz automobiles, two Ford pickup trucks, an RV, a tractor, three ATVs, miscellaneous fishing equipment, and $58,923 in cash.

The FBI investigated this matter.  Assistant United States Attorneys Kristin N. Spencer and Melissa S. Rabbani of the Santa Ana Branch Office prosecuted this case.