Author: WorkCompAcademy

State Fund implemented a comprehensive opioid-reduction strategy that took a two-pronged approach, which included: 1) early prevention in new cases and 2) reduction of chronic opioid usage in existing cases.

“The opioid-reduction plan implemented by our Chief Medical Officer, Dr. Dinesh Govindarao, and his team has been remarkably successful,” said Vern Steiner, President and CEO of State Fund. “Through this effort, we have helped to improve – and potentially save – the lives of many injured workers, while also reducing expenses in the workers’ compensation system for California businesses.”

The strategy also included elements such as a peer-to-peer physician review program, education for injured workers and treating physicians, and a functional restoration program for injured workers taking chronic, high levels of opioids. Additional results include:

– The number of patients taking high doses of opioids over the past four years has decreased from 1,458 to 186.
– 74 percent reduction in expenditures on opioids prescribed to injured workers covered by State Fund.

“Peer-to-peer education of prescribing physicians has been instrumental in the success of State Fund’s opioid-reduction program,” said Dr. Dinesh Govindarao, Chief Medical Officer of State Fund. “Not all providers have adequate training on pain management and opioid prescribing, and many patients don’t understand the impacts of their medications, which is why education about appropriate and alternative treatments, such as cognitive behavioral therapy, has been a key focus area for our program.”

State Fund will continue to focus on reducing opioids by:

– Expanding its chronic pain program to reach even more injured workers
– Adopting the Division of Workers’ Compensation guidelines, which limits initial opioid prescriptions to four days, and
– Updating its online physician training modules for treating acute and chronic pain.

State Fund’s opioid-reduction program is one way the organization fulfills its purpose to provide fairly priced workers’ compensation insurance, make workplaces safe and restore injured workers.

Anyone who is interested in more information about the State Fund program may contact Jennifer Vargen by dialing 415-263-5419.

The Riverside District Attorney’s Office has charged a QME with offices in Corona and Wildomar with seven felonies related to a workers’ compensation insurance fraud scheme.

Dr. Sanjoy Banerjee, DOB: 12-1-75, of Corona, was charged on May 29, 2018, with two counts of insurance fraud and five counts of perjury. Dr. Banerjee has since posted bail and is scheduled to be arraigned on July 7, 2018, at 8:30 a.m. in Dept. 61 at the Hall of Justice in Riverside.

Banerjee claims on his website that he is the Founder and Medical Director of Pacific Pain Care.

He graduated medical school from Imperial College, School of Medicine in London, England. Completed his Anesthesiology Residency at University of Rochester N.Y. and ACGME accredited Pain Management Fellowship Program from the University of California at Davis.

He says he is triple board bertified in Anesthesiology, Pain Medicine and Addiction Medicine.. He is also a Qualified Medical Evaluator for the State of California Workers compensation system for both his Widomar and Corona office addresses.

He also claims on his website that he holds a Clinical Faculty position for the Adventist Health Family Practice Program and is an Assistant Professor in the Department of Medicine at Loma Linda University Medical Center as well as an Assistant Clinical Professor for the Department of Medicine at U.C. Riverside School of Medicine.

An investigation conducted by the DA’s Bureau of Investigation found that from November 2014 through December 2016, Banerjee, a Wildomar- and Corona-based workers’ compensation pain management doctor, allegedly illegally self-referred workers’ compensation patients to a clinical laboratory and an office-based surgical center he owned.

Through that laboratory and surgical center, Dr. Banerjee allegedly billed more than $180,000 for urine toxicology testing and/or epidural injections.

Dr. Banerjee also reportedly signed at least five doctor’s reports declaring under penalty of perjury he had not referred patients to his own companies. The investigation revealed that Dr. Banerjee referred some of his workers’ compensation patients to his business, Rochester Imperial Surgical Center, which was located in a patient exam room inside the Pacific Pain Care office suite in Wildomar.

The case, RIF1802535 is being prosecuted by Deputy DA Kristen Allison of the DA’s Insurance Fraud Team.

The U.S. Supreme Court declined to hear the petition filed by Liberty Mutual subsidiaries for relief from changes to New York workers’ compensation law that the company says may cost carriers as much as one billion dollars.

Liberty argues in its Petition for Writ of Certiorari filed in the high court this February, that the State of New York has operated a special workers’ compensation insurance fund for cases that reopen after being closed for a statutorily defined period, with the goal of protecting employers and their insurance carriers from bearing the costs of unforeseeable changes in the status of beneficiaries’ work-related medical conditions.

For decades, Section 25-a of the New York Workers’ Compensation Law (“WCL”) has required employers to support the fund through annual assessments and assigned the fund exclusive financial liability for reopened cases.

Correspondingly, the WCL exempted employers from the duty to obtain insurance to cover claims meeting Section 25-a’s prerequisites, and insurance carriers’ state-approved workers’ compensation policies defined the scope of coverage accordingly: They did not cover Section 25-a cases.

Likewise, Liberty Mutual claims the state-approved premiums that employers paid carriers for workers’ compensation insurance did not account for potential liability in Section 25-a cases, nor did the amount of loss reserves carriers maintained under state insurance law and generally accepted actuarial principles.

In 2013 the New York Legislature amended the WCL, closing the fund to cases reopened in 2014 or later.

As a result, carriers became liable for future reopened cases, regardless of whether the cases arose under a future workers’ compensation insurance policy or a preexisting one.

According to the legislative history, this amendment was intended to save New York businesses hundreds of millions of dollars in assessments per year by eliminating what the Legislature perceived to be a double charge for Section 25-a claims: once in the form of assessments paid to the fund, and once in the form of premiums paid to carriers – who, in the State’s view, received a “windfall,” since they would not incur liability for Section 25-a cases.

But Liberty Mutual says that rationale was obviously wrong. “It was clear then and it is undisputed now that carriers’ premiums were not computed to compensate them, and did not compensate them, for Section 25-a liability”.

Instead, Liberty says the real effect of the amendment is to impose on carriers a new liability for cases they had specifically excluded from their preexisting state-approved policies and that they had not been paid to cover.

According to the state-designated entity responsible for computing workers’ compensation costs, the amendment’s closure of the fund to future reopened cases under preexisting policies will inflict on carriers a staggering “unfunded liability” of over $1 billion.

The New York Court of Appeals rejected the Liberty Mutual subsidiary challenges to the amendment under the Contracts, Due Process, and Takings Clauses of the U.S. Constitution.

Amicus briefs were filed in the U.S. Supreme Court case by the Property Casualty Insurance Association and the Washington Legal Foundation.

Nonetheless, the U.S. Supreme Court declined to issue a Writ of Certiorari. They will not look into the matter or issue a ruling on the merits, which means the lower court holding applies. Not a good day for New York workers’ compensation insurance carriers.

On May 22, In an important 5-4 decision, the U.S. Supreme Court held that class or collective action waivers, particularly in wage/hour cases, and contained in arbitration agreements between employers and employees are valid and enforceable.

Companies can use arbitration clauses in employment contracts to prohibit workers from banding together to take legal action over workplace issues. The vote was 5 to 4, with the court’s more conservative justices in the majority. The court’s decision in Epic Systems Corp v Lewis could affect some 25 million employment contracts.

And perhaps the first victory for an employer under this new case law involves an Uber driver who claims in a federal case pending in New York that the ride-hailing company illegally charged him and other drivers a workers’ compensation fee. On May 31, the United States District court ordered that he must pursue his argument in arbitration as an individual, not a class action.

Gustavo Camilo agreed to arbitrate any disputes with Uber Technologies Inc. on “an individual basis only,” Judge Alvin K. Hellerstein of the U.S. District Court for the Southern District of New York said. Camilo therefore can’t proceed with a class action alleging various theories against the company.

The drivers sue on three counts; breach of contract, unjust enrichment and unlawful wage deduction. The class action suit was filed in the Supreme Court of the State of New York, and was timely removed to federal court under the Class Action Fairness Act.They demanded a jury trial, and seek reimbursement and restitution.

Uber moved to compel arbitration of the claims alleged against the Uber Defendants, to strike Plaintiff’s class allegation, and to dismiss the Complaint, on the basis of the arbitration and class waiver clause contained in Plaintiffs agreement with Uber.

In first registering as an Uber driver, a prospective driver must agree to a technology services agreement with Uber. Plaintiff signed an agreement with Uber requiring that all disputes or issues, including the question of arbitrability, be resolved through binding arbitration.The arbitration provision contains a class waiver, preventing the arbitrator from considering claims on a class or representative basis

In ruling on the motion, the court referenced the new Supreme Court decision when it said “More recently, and subsequent to the briefing in this case, the Supreme Court held that waivers of class actions are valid and not precluded by Section 7 of the NLRA, 29 U.S.C. § 157. See Epic Sys. Corp. v. Lewis, No. 16-285, 2018 WL 2292444 (U.S. May 21, 2018).”

Accordingly the court ordered “Plaintiff is directed to arbitrate his claims on an individual basis and this action will be stayed pending the arbitration.”

A new report published by CHSWC describes work undertaken by the RAND Corporation for the Department of Industrial Relations (DIR) to evaluate California’s Return-to-Work (RTW) Fund as it approaches its third year of implementation. This research builds directly on a number of past RAND studies for DIR and the Commission on Health and Safety and Workers’ Compensation (CHSWC).

Senate Bill (SB) 863 sought to improve the adequacy of permanent partial disability benefits by raising the maximum weekly PPD benefit and by increasing disability ratings for selected injuries; both changes would lead to more generous PPD benefits. To address remaining concerns about the adequacy and targeting of PPD benefits, SB 863 also instructed the Director of the Department of Industrial Relations (DIR) to design and implement a new $120 million program named the Return-to-Work Supplement Program (RTWSP). It was established on April 13, 2015.

California’s Return-to-Work Supplement Program (RTWSP) is a new benefit for permanently disabled workers who suffer disproportionately high earnings loss in comparison to their workers’ compensation benefits. The RTWSP provides a one-time $5,000 payment to workers who cannot return to work following a permanently disabling workplace injury.

DIR has authority to adjust the design and implementation of the RTWSP through additional regulations. To determine the need for modifications to the program, DIR asked RAND to evaluate the RTWSP’s performance and suggest improvements. RAND conducted an evaluation of the program’s performance and identified options for improving the RTWSP. The study included an environmental scan, stakeholder interviews, and analysis of program data. RAND also held a Technical Advisory Group meeting with key stakeholders.

RAND found that the RTWSP is performing well on several dimensions. The eligibility criteria have accurately targeted workers with more severe disability and program administration is efficient, with little evidence of fraud or abuse.

However, take-up of the program is low: in a sample of eligible workers, just over half applied to receive the benefit. The most important factor predicting access to the program was legal representation, suggesting that many workers are failing to navigate the process on their own despite the intent of the program’s designers. RAND also found that the eligible population is larger than initially anticipated, a trend driven in part by rising utilization of California’s voucher-based vocational rehabilitation benefit (the Supplemental Job Displacement Benefit).

Based on these findings, RAND recommends that modifications to the RTWSP focus on increasing program take-up among currently eligible workers. DIR could accomplish this by making issuance of the Return-to-Work Supplement automatic, or through outreach and notification efforts. DIR should also improve monitoring of SJDB voucher issuance to track emerging changes in the RTWSP-eligible population and to facilitate oversight of the SJDB.