Author: WorkCompAcademy

Former chiropractor Peyman Heidary allegedly owned and oversaw a network of medical clinics to generate fraudulent billings to workers’ compensation and insurance carriers.

As a non-attorney, he also allegedly controlled the day-to-day operations of various law firms, including California Injury Lawyers.He allegedly controlled or directed hiring and firing, legal decision making, and income flow to and from the law firm. Codefendants Cary Abramowitz, a lawyer, and Ana Solis allegedly assisted Heidary in these operations.

Heidary also allegedly formed and controlled several health clinics in Southern California. Each was staffed by front and back room support staff for scheduling and basic medical services .

Included were chiropractors operating as primary treating physicians, allegedly providing blanket, cookie-cutter services to each patient at Heidary’s direction and making as many medical specialist referrals as possible. Despite their qualifications, they also wrote medical legal reports using Heidary’s templates, the most expensive report in workers’ compensation.

Medical doctors, or specialists, allegedly provided blanket treatment and medlegals on Heidary’s orders. Billings were made in each provider’s name, and payments were made to their accounts. However, Heidary required fee-splitting and he was the only one allowed to withdraw funds. Heidary also had the doctors sell their accounts-receivables (AR) to him, which he then sold to third parties.

Under the alleged fraud scheme, injured workers appeared at the law firm, which would fill out boilerplate paperwork and, on Heidary’s order, direct the workers to one of his clinics to begin treatment. At the clinic, the workers underwent treatments, regardless of need, such as massage, chiropractic, acupuncture, psychiatric and other services. After the maximum number of visits, they were discharged regardless of medical status.

A Riverside County grand jury returned an indictment against Heidary and his codefendants Cary Abramowitz, Ana Solis, and Gladys Ross. The criminal defendants filed a demurrer, and later a motion to dismiss this indictment, challenging in part whether they had received notice of the charges and whether the indictment improperly aggregated multiple acts into single counts. The trial court denied both requests. Heidary appealed.

The Court of Appeal summarily denied the petition on August 8, 2017. On October 11, 2017, the California Supreme Court intervened directing the Court of Appeal to address these issues. After this ordered review, the trial court ruling was affirmed by the Court of Appeal in the published case of Heidary v Superior Court.

Petitioner argues that the insurance fraud counts do not state specifics as to any single act, but aggregate claims of fraudulent acts by individual insurer, one insurer per count.

The Court of Appeal reviewed the indictment, the grand jury transcript, and exhibits submitted to the grand jury. The People took the testimony of the insurers’ fraud managers, or their representatives (such as in-house data analysts or third-party managers who collected the data for the responses), before the grand jury to walk through the spreadsheets and explain the data within them.

The reviewed materials meet the simplified California pleading rules and the due process requirements.

The Court concluded by noting “To the extent that petitioner continues to claim that the indictment, along with the grand jury transcript and exhibits, does not provide him notice of the charges against him, the court can only conclude that it is because petitioner is turning a blind eye while advancing his argument. Between the indictment, the contents of the thorough and detailed grand jury transcript, and the exhibits presented to the grand jury and contained in the record (including the record here), due process has been satisfied and petitioner has been given adequate notice of the charges against him. ”

Although there has been an overall decline in workers’ compensation claims, the frequency of claims for motor vehicle accidents (MVA) has increased in recent years.

According to the National Council on Compensation Insurance (NCCI) in a new report, these accidents can be very severe and are responsible for a significant portion of fatal workers’ compensation claims.

“While workers compensation claims have been declining, motor vehicle accidents have been on the rise over the last five years,” said Jim Davis, author of the paper and NCCI director and actuary. “These often involve very serious injuries that can take their toll on injured workers and their families.” An MVA claim is 12 times more likely to result in a fatality than a non-MVA claim.

NCCI actuaries found that from 2011 to 2016, the frequency of all claims declined by 17.6 percent, while the frequency of MVA claims increased by five percent. Additionally, 41 percent of fatal workers’ compensation claims were the result of a motor vehicle.

As expected, certain classifications, which are predominantly based on the use of motor vehicles, such as truckers, taxi drivers, and salespersons, generate the majority of MVA claims.

According to the workers’ compensation rating organization, motor vehicle accident claims cost 80 percent to 100 percent more than the average claim because they involve severe injuries. These claims also tend to represent a higher share of the costliest claims. Over a five-year period, motor vehicle claims accounted for 28 percent of workers’ compensation claims above $500,000, versus just five percent of all claims.

While numerous factors may explain the rise in accidents, the NCCI report notes that it is “striking how the increasing popularity and use of smartphones coincides with this growing trend” of motor vehicle accidents. By the end of 2010, approximately 27 percent of all cell phones were smartphones but by the end of 2016, that figure had tripled to 81 percent, the report notes.

According to a publication by the National Safety Council, a minimum of 27% of crashes involve drivers talking and texting on cell phones. However, the report also states that “there is strong evidence to support that underreporting of driver cell phone use in crashes is resulting in a substantial underestimation of the magnitude of the public safety threat.”

The increase in motor vehicle accidents is not limited to workers’ compensation. NCCI found a similar pattern in the general population, with accidents generally increasing over the same time period, along with an increase in the number of traffic accident fatalities.

Anthony Dennis sustained an industrial injury to his right wrist on October 29, 2013 while working as an inmate laborer for the California Department of Corrections and Rehabilitation. His claim settled via Stipulation and Award for 31 % permanent disability on September 11, 2017.

Prior to the settlement, on May 15, 2017 the Department of Corrections sent a Notice of Offer of Modified Work stating that applicant had voluntarily terminated his employment since he had been released from prison after .the injury occurred. Dennis disputed the offer of work and requested a dispute resolution before the Administrative Director on September 19, 2017.

The parties never received a response from the AD. Thus Dennis filed a DOR to address the matter on February 5, 2018 as well as a “Petition for Grant of Supplemental Job Displacement Benefit.”

Defendant claimed at trial that if applicant’s DOR/Appeal of the Administrative Directors presumed denial was not timely. The WCJ found that it was not and thus, the ADs determination ( denial) was final, and denied the Petition for the SJDB Benefit.

Dennis filed for Reconsideration of this finding and also arguing that he is eligible to the voucher. The WCAB granted the Petition and ordered that he be provided with a SJDB Voucher in the case of Dennis v. California Department of Corrections and Rehabilitation.

The parties never received a finding from the Administrative Director; therefore the request was deemed denied on December 8, 2017 pursuant to 17 8 CCR 10133.54(±). An appeal of the denial was to be filed by December 28, 2017 per 8 CCR 10133.54(g).

Applicant filed his Petition for Grant of Supplemental Job Displacement Benefit on February 5, 2018, well after the time allotted per the regulations. 8 CCR 10133.54(g) states “Either party may appeal the determination of the administrative director by filing a written petition together with a declaration of readiness to proceed pursuant to section 10250 within twenty days after a request is deemed denied” .

The WCJ found that applicant is barred from SJDB because applicant failed to timely appeal the Administrative Director’s presumed denial of his request.

However, section 5300 statutorily vests the Appeals Board with the exclusive jurisdiction to adjudicate claims regarding the “recovery of compensation, or concerning any right or liability arising out of or incidental thereto” of injuries that “arise out of and in the course” of employment This exclusive jurisdiction extends to inmates who sustained injury arising out of and in the course of assigned employment. (§ 3370.)

Furthermore, section 4658.7(h) does nqt abrogate the Appeals Board ability to adjudicate disputes that arise under this subdivision. Section 4658.7(h) limits the Administrative Director to adopting regulations “for the administration of this section” and does not extent the Administrative Director’s authority to adjudicate SJDB disputes.

Thus, irrespective of Rule 10133.54, the Appeals Board maintains exclusive jurisdiction, to adjudicate the issue of whether applicant is entitled to the benefits under the SJDB program.

While defendant timely sent applicant a Notice offering regular, modified, or alternative work, such offer was not a bona fide job offer because applicant was released from prison and could not return to prison for employment.

This decision may have further implications in terms of other dispute resolution functions of the AD, such as IMR.  

Gadolinium contrast media are chemical substances used in magnetic resonance imaging (MRI) scans. When injected into the body, gadolinium contrast medium enhances and improves the quality of the MRI images. It is used in about 1 in 3 of MRI scans

Three MRI contrast agents have been approved for clinical use in the United States as of 1994. Six more MRI contrast agents were approved by FDA for clinical use from 1995 through 2017.

Radiologists and patients began to question the safety of gadolinium a few years ago when a study came out in late 2014 showing the agent is deposited and retained in the brain.This, combined with a small percentage of patients who claim their health was harmed following gadolinium exams, has sparked a big debate in radiology over the safety of these agents.

There are numerous patient-created groups on social media that discuss MRI gadolinium toxicity issues, which have raise public awareness on the topic of possible connections with previously unknown gadolinium side effects.

The biggest public relations boost for these patients came in November 2017 when action movie actor Chuck Norris filed a lawsuit against a contrast vendor and the contrast distributor for allegedly poisoning his wife Gena. She had several contrast MRI exams and the suit alleges numerous adverse health effects began after these exams. Norris is seeking $10 million in damage.

The suit alleges she contracted what is being called “gadolinium deposition disease.” It is a term often used by patients who claim they now have chronic health problems from their contrast MRI exams. However, the term is not accepted by many in the medical community because of the lack of scientific evidence showing a direct connection with the contrast agents.

The lawsuit described Gena’s symptoms as burning pain throughout her body, violent shaking, numbness, tingling, weakness, cognitive deficits, kidney damage and trouble breathing. These symptoms are similar to others often reported in patient social media groups.

The FDA stated there is no clinical evidence that directly links gadolinium retention to adverse health effects in patients with normal kidney function, and the FDA has concluded that the benefit of all approved GBCAs continues to outweigh any potential risks.

However, in July 2017, the European Medicines Agency (EMA) issued a final opinion that recommended restricting the use of some linear gadolinium-based contrast agents (GBCAs) and suspending the marketing authorizations of others, citing concerns about gadolinium deposition.

Patients that say they were harmed by gadolinium agents often argue they were never given any sort of informed consent documents to sign warning them of gadolinium’s potential hazards. Experts speaking at Radiological Society of North America (RSNA) 2017 said this might be easier said than done.

Worker’s Compensation Claims Administrators need to be aware of these risks, which may cause a compensable consequence injury to an injured worker. Utilization Review vendors should carefully review a RFA for a contrast study, and consider safer alternatives when they are available.

Some MRI vendors have touted new technologies like black blood imaging, or new protocols that can reduce or eliminate the need for MRI contrast. However, some types of exams still require the use of gadolinium in order to answer the clinical questions the MRI is supposed to answer. There is ongoing research to find alternatives, but currently there is no good alternative for all the things that the gadolinium can help with.