Author: WorkCompAcademy

California’s Labor Enforcement Task Force (LETF) is a coalition of California state agencies formed in 2012 to combat the underground economy. The task force operates under the direction of the Department of Industrial Relations (DIR) and conducts monthly inspections in high-risk industries. LETF member partners include DIR divisions Cal/OSHA and the Labor Commissioner’s Office, officially known as the Division of Labor Standards Enforcement, the Contractors State License Board, the Employment Development Department, the California Department of Insurance, the Bureau of Automotive Repair, Alcoholic Beverage Control and the California Department of Tax and Fee Administration.

This week, California’s Labor Enforcement Task Force has discovered safety violations during targeted inspections that put workers in immediate danger of fatal and serious injuries, including amputation and lacerations. The task force issued orders shutting down dangerous machinery at seven high-risk work sites in Southern California, including four car wash and three manufacturing businesses.

At four car washes, task force inspectors discovered that industrial water extractors for towels did not have functioning interlock devices to stop the machines when the door is unlocked or open. Inspectors issued stop orders known as Orders Prohibiting Use to Pasadena Auto Wash, Baldwin Park Hand Car Wash and Star Auto Spa in El Monte, and Fair Oaks Car Wash in Altadena.

Cal/OSHA removed the stop orders at Pasadena Auto Wash and Fair Oaks Car Wash after the machinery was adequately repaired. The other two businesses have not corrected the hazards.

Inspectors also cited Baldwin Park Hand Car Wash $6,000 for violation of child labor laws after finding minors working in dangerous occupations. “LETF monitors not only for safety violations, but also for violations of wage, tax and licensing laws,” added LETF Chief Dominic Forrest. “We issue stop orders when we find hazards that require immediate action to prevent serious injury and we also offer information that helps employers understand and follow their responsibilities.”

Imminent safety hazards were also discovered when LETF inspected three manufacturing companies located in Santa Ana: Maximum Security Safes, Trinity Window Fashions and Pierre’s Fine Carpentry. Inspectors issued orders to shut down woodworking table saws that were not properly guarded. The orders were subsequently lifted after the hazards were corrected.

LETF inspectors also issued stop-work orders and cited Trinity Window Fashions $3,000 and Pierre’s Fine Carpentry $1,500 for failure to maintain workers’ compensation insurance. The orders were lifted after the companies provided proof of insurance.

A federal grand jury has indicted South Bay doctor and PQME Venkat Aachi, charging him with distributing hydrocodone outside the scope of his professional practice and without a legitimate medical need, and with health care fraud related to the submission of false and fraudulent claims regarding the health care benefits.

Aachi is listed on the DIR database as a PQME in Physical Medicine and Rehabilitation with offices in San Jose and Campbell California.

According to the indictment filed October 9, 2018, and unsealed Friday, October 12, 2018, on six occasions from November 27, 2017, through March 5, 2018, Aachi knowingly distributed hydrocodone to two individuals knowing that the distribution was outside the scope of his professional practice and not for a legitimate medical purpose.

Further, on July 2, 2018, Aachi allegedly submitted to an insurance company a false and fraudulent claim for payment for healthcare benefits, items, and services.

Aachi made an initial appearance on October 12, 2018, before U.S. Magistrate Judge Virginia K DeMarchi. At that time, he was arraigned on the indictment, entered a plea of not guilty, and was released on bond. Aachi is scheduled to appear next before Magistrate Judge DeMarchi on October 22, 2018, for a further bond hearing.

If convicted, Aachi faces a maximum 20 years in prison and a one-million dollar fine for each of the six distribution counts and an additional 10 years in prison for the insurance fraud count.

Assistant U.S. Attorney Shailika Kotiya is prosecuting the case with the assistance of Rawaty Yim.

This prosecution is the result of investigations by the DEA, FBI, HHS-OIG, and the California Department of Justice Bureau of Medi Cal Fraud and Elder Abuse (BMFEA).

Through the BMFEA, the California Department of Justice regularly works with other law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi Cal program against a wide variety of healthcare providers, including doctors and pharmaceutical companies.

This case was investigated and prosecuted by member agencies of the Organized Crime Drug Enforcement Task Force, a focused multi-agency, multi-jurisdictional task force investigating and prosecuting the most significant drug trafficking organizations throughout the United States by leveraging the combined expertise of federal, state, and local law enforcement agencies.

Two Illinois-based nonprofit risk pools, who provide more than 203 local municipalities and other public entities with workers’ compensation and employee healthcare insurance, filed a joint lawsuit in the Circuit Court of Cook County against leading opioid manufacturers, distributors, professional associations, and prescribers. It is the first opioid lawsuit brought by insurance risk pools in Illinois.

The Intergovernmental Risk Management Agency (IRMA) and Intergovernmental Personnel Benefit Cooperative (IPBC), seek injunctive relief and financial compensation from defendants to recoup substantial costs resulting from the far-reaching impact of the over-prescription and abuse of opioid medication. IPBC’s costs include vast expenditures on hospitalizations due to overdose, addiction treatment services, and overdose reversal medications, while IRMA has paid millions of dollars in cases involving injured workers who were unnecessarily given long-term opioid prescriptions to treat chronic pain.

The suit alleges opioid manufacturers, including Purdue Pharma, Allergan, and Teva, engaged in aggressive and deceptive marketing campaigns; distributors including AmerisourceBergen, Cardinal Health, and McKesson failed to act as gatekeepers against overprescribing the addictive narcotics; professional organizations including Chicago-based American Academy of Pain Medicine and American Pain Society deceptively promoted the use of opioids for chronic pain management; and suburban Chicago doctors Paul Madison and Joseph Giacchino served as “pill mills,” doling out opioids to anyone who came through the door of their clinic.

The 217 page civil complaint  alleges that the defendants’ plan to flood the Illinois market with opioid medication worked: in 2015, eight million opioid prescriptions were filled in Illinois, the equivalent of 60 prescriptions per 100 people.

The lawsuit is the latest step in a proactive multi-pronged strategy IPBC and IRMA have enacted to address and reduce opioid abuse in their members’ employee communities.

“This lawsuit is about real costs incurred directly as a result of the opioid epidemic. We have seen fully employed, respectable public employees with work injuries who were prescribed opioids unnecessarily and became addicted, ultimately rendering them unable to return to work and costing our members millions,” said IRMA Executive Director Margo Ely. “Opioid abuse and addiction has cost our members through not only lost productivity, but very sad stories of lost careers and lives.”

“As a taxpayer-supported health insurance provider to public entities across Illinois, we have a fiduciary obligation to aggressively seek to recoup the millions of dollars in claim costs that have been wasted due to over-prescription of opioid medications and addiction treatment,” said IPBC Executive Director Dave Cook. “The impact of long-term opioid use and abuse has been significant to our organization financially, and to many of our members who have suffered as a result of defendants’ egregious behavior.”

Founded in 1979, the Intergovernmental Risk Management Agency (IRMA) was the first municipal risk pool in Illinois, and today, provides comprehensive risk management services, including workers’ compensation coverage, for 72 municipal groups in northeastern Illinois.

The Intergovernmental Personnel Benefit Cooperative (IPBC) is a public risk entity pool established in 1979 by Chicago area municipalities to administer some or all of the personnel benefit programs offered by participating members to employees and retirees.

Two Illinois-based nonprofit risk pools, who provide more than 203 local municipalities and other public entities with workers’ compensation and employee healthcare insurance, filed a joint lawsuit in the Circuit Court of Cook County against leading opioid manufacturers, distributors, professional associations, and prescribers. It is the first opioid lawsuit brought by insurance risk pools in Illinois.

The Intergovernmental Risk Management Agency (IRMA) and Intergovernmental Personnel Benefit Cooperative (IPBC), seek injunctive relief and financial compensation from defendants to recoup substantial costs resulting from the far-reaching impact of the over-prescription and abuse of opioid medication. IPBC’s costs include vast expenditures on hospitalizations due to overdose, addiction treatment services, and overdose reversal medications, while IRMA has paid millions of dollars in cases involving injured workers who were unnecessarily given long-term opioid prescriptions to treat chronic pain.

The suit alleges opioid manufacturers, including Purdue Pharma, Allergan, and Teva, engaged in aggressive and deceptive marketing campaigns; distributors including AmerisourceBergen, Cardinal Health, and McKesson failed to act as gatekeepers against overprescribing the addictive narcotics; professional organizations including Chicago-based American Academy of Pain Medicine and American Pain Society deceptively promoted the use of opioids for chronic pain management; and suburban Chicago doctors Paul Madison and Joseph Giacchino served as “pill mills,” doling out opioids to anyone who came through the door of their clinic.

The 217 page civil complaint  alleges that the defendants’ plan to flood the Illinois market with opioid medication worked: in 2015, eight million opioid prescriptions were filled in Illinois, the equivalent of 60 prescriptions per 100 people.

The lawsuit is the latest step in a proactive multi-pronged strategy IPBC and IRMA have enacted to address and reduce opioid abuse in their members’ employee communities.

“This lawsuit is about real costs incurred directly as a result of the opioid epidemic. We have seen fully employed, respectable public employees with work injuries who were prescribed opioids unnecessarily and became addicted, ultimately rendering them unable to return to work and costing our members millions,” said IRMA Executive Director Margo Ely. “Opioid abuse and addiction has cost our members through not only lost productivity, but very sad stories of lost careers and lives.”

“As a taxpayer-supported health insurance provider to public entities across Illinois, we have a fiduciary obligation to aggressively seek to recoup the millions of dollars in claim costs that have been wasted due to over-prescription of opioid medications and addiction treatment,” said IPBC Executive Director Dave Cook. “The impact of long-term opioid use and abuse has been significant to our organization financially, and to many of our members who have suffered as a result of defendants’ egregious behavior.”

Founded in 1979, the Intergovernmental Risk Management Agency (IRMA) was the first municipal risk pool in Illinois, and today, provides comprehensive risk management services, including workers’ compensation coverage, for 72 municipal groups in northeastern Illinois.

The Intergovernmental Personnel Benefit Cooperative (IPBC) is a public risk entity pool established in 1979 by Chicago area municipalities to administer some or all of the personnel benefit programs offered by participating members to employees and retirees.

Stephen Hom, a San Francisco police officer, suffered an initial industrial injury to his lumbar spine in 2012 in a prior case. The parties in this prior case settled with Stipulations and Request for a permanent disability Award in the amount of 20% permanent disability based on the findings of Primary Treating Physician Dr. William Campbell, who used using the DRE Metric of the AMA Guides to determine the rating.

In 2013, after his initial injury to his lumbar spine, Officer Hom suffered a second admitted industrial injury to his lumber spine, when he was struck by an oncoming vehicle, while on traffic duty. This second injury is the subject of the current litigated case ADJ10658104.

Dr. David Pang served as the AME in the second case. Dr. Pang utilized the ROM method of the AMA Guides to rate applicant’s current whole person impairment (WPI) at 14%, which rates out to 30% PD.

The primary issue at trial was whether defendant has sustained their burden of proof under LC §4664(b) to allow subtraction of applicant’s prior 20% PD award (calculated using the DRE method) regarding his 2012 injury to his lumbar spine, from his current PD level of 30% (calculated using the ROM method) regarding his 2013 injury to his lumbar spine. WCJ found that “apportionment under LC §4664(b) is not applicable in this case.”

The employer petitioned for reconsideration contending that the WCJ erred by not finding overlap between applicant’s two lumbar spine injuries, The WCJ should have subtracted the 20% Permanent Disability (PD) from the first award, from the 30% PD in the second per the apportionment rule set forth in LC §4664(b). Reconsideration was denied in the panel decision of Hom v City and County of San Francisco.

Labor Code §4664(b) provides, “If the applicant has received a prior award of permanent disability, it shall be conclusively presumed that the prior permanent disability exists at the time of any subsequent industrial injury. This presumption is a presumption affecting the burden of proof.”

Case law has repeatedly held that defendant has a two-prong burden of proof regarding apportionment under LC §4664(b): (1) Defendant must first prove that a prior award to the same body part exists, AND (2) Defendant must also prove that there is “overlap” of permanent disability between the initial and subsequent injury. This legal standard was set forth in the 3rd DCA case of Kopping v. WCAB (2006) 71 Cal Comp Cases 1229.

In Kopping, the DCA provided an extensive analysis of the seemingly contradictory language of LC §4664(b) and came up with the only interpretation that made sense to them, which was that the defendant has a two-prong burden of proof under LC §4664(b). “…The burden of proving overlap is part of the employer’s overall burden of proving apportionment, which was not altered by section 4664(b), except to create the conclusive presumption that flows from proving the existence of a prior permanent disability award.”

The WCAB affirmed this two-prong analysis for defendant’s burden of proof under LC §4664(b) in the panel decision of Laster v. City and County of San Francisco, 2014 Cal. Wrk. Comp. PD LEXIS 201.

In the writ denied case of Contra Costa County Fire Protection v. WCAB, (Minvielle), (2010), the WCAB interpreted the burden of proving “overlap” of disabilities to mean that the defendant must use the same metric to measure PD on both the initial and subsequent injuries.

Unfortunately, Dr. Pang, has not accurately understood the correct legal theory to apply in this case.