Author: WorkCompAcademy

This month, at Uber’s annual product event, GO-GET, Uber Health announced Uber Caregiver, a new solution designed specifically for caregivers and their loved ones. For the first time, beginning this summer, care-receivers will have the ability to add a caregiver to their Uber profile, empowering them to request and monitor rides and deliveries, as well as apply the care-receiver’s eligible health benefits to pay. The solution is designed to help patients maximize their ancillary healthcare benefits and to improve the care experience for caregivers and care-receivers alike.

More than one in five Americans – 53 million people – are caregivers. A growing subset of these caregivers are adults who care for their aging parents while raising their own children, holding a job, and balancing other household and family duties. Caregiving is demanding work, with responsibilities ranging from medication management, to assistance with daily activities, to administrative tasks like scheduling appointments, grocery shopping, and meal planning. About half of caregivers say the role has increased their emotional stress, and 39% say that they’re rarely or never relaxed. The logistical responsibilities of calling a health plan to determine benefit eligibility, deciding how to pay for an appointment or delivery, and submitting expenses for reimbursement add another layer of stress and complexity to the role. This can also contribute to financial strain; the average caregiver spends about $7,000 annually out of pocket.

Uber Caregiver is designed to relieve this logistical burden and provide peace of mind. It aims to transform the historically fragmented, complicated, and time-consuming process of navigating ancillary benefits with a one-stop shop for caregivers to understand and act on benefit information on behalf of their loved one. Soon, care-receivers can invite caregivers directly in the Uber app. Where eligible, caregivers will be able to view a loved one’s ancillary healthcare benefits, coordinate services like transportation to a medical appointment or grocery delivery, and help the care-receiver pay in-app using their health benefit cards. By leveraging Uber’s mobility and merchant networks, Uber Health can help meet caregivers and patients where they are.

Benefits include:

– – Care at the tap of a button: Beginning this summer, caregivers will be able to quickly and easily coordinate benefits like rides and grocery delivery on behalf of family members in an app they already know and love, receiving real-time updates along the way.
– – Enhanced visibility into ancillary healthcare benefits: As plans come on board to Uber Caregiver, caregivers will have information about their loved one’s benefit eligibility – for example, how many more rides will be covered or how much of a monthly grocery benefit remains – available in the Uber and Uber Eats apps. This will empower caregivers to coordinate services and deliveries without worrying about what will or won’t be covered.
– – Reduced financial burden: Almost 80% of caregivers pay for some care-receiver expenses out of pocket. The new offering will allow care-receivers to give caregivers permission to pay for services with their loved one’s eligible health benefits to reduce financial strain.

This is the beginning of Uber Health’s efforts to address caregivers’ pain points. In the coming months, the organization will begin working with Medicare Advantage, Medicaid, and commercial plans to provide enhanced support to caregivers in the United States.

Caregivers will have the ability to coordinate transportation on behalf of a loved one on the Uber app beginning this summer. Additional capabilities will roll out later this year.

On April 10, 2024, the WCAB issued an En Banc Order of Consolidation and Notice of Intent to Impose Sanctions of up to $2,500.00 against Susan Garrett in eight (8) instances where it appeared that she filed petitions for reconsideration with willful intent to disrupt or delay the proceedings of the Workers’ Compensation Appeals Board or with an improper motive, or where it appeared that such actions were indisputably without merit (up to $20,000.00 total).

It also issued a notice of intent to impose sanctions of up to $2,500.00 against Lance Garrett in eight (8) instances where it appeared that he filed petitions for reconsideration with willful intent to disrupt or delay the proceedings of the Workers’ Compensation Appeals Board or with an improper motive, or where it appeared that such actions were indisputably without merit (up to $20,000.00 total).

Lastly, it issued a notice of intent to award reasonable expenses, including attorney’s fees and costs, associated with the petitions for reconsideration filed in each of these matters. It deferred the amount of such costs to the trial level.

Following the Notice of Intent Susan Garrett filed a verified response arguing that her decision to file petitions for reconsideration in lieu of petitions for removal was based upon non-frivolous arguments. She argued, without citation, that pleading for reconsideration in the alternative “has long been general pleading practice in various workers’ compensation community practice reference materials.”

Susan Garrett further argued that the maximum sanction was not proportional to the conduct committed. She describes the effect of her conduct as creating “inconvenient situations.” She argued that it was not her intent to delay proceedings of the Appeals Board, but instead it was unavoidable due to chronic health conditions experienced by her and by Lance Garrett. Alternatively, she argued that her non-appearances were due to trials being set on notice, which caused calendar conflicts.

The response of Lance Garrett essentially restated the arguments contained in the Response of Susan Garrett, often verbatim. Neither response addresses the issue of costs and/or attorney’s fees.

After a review of the record and the Responses, the En Banc WCAB panel made its final ruling in the consolidated cases of Alfredo Ledezma, et al. vs. Kareem Cart Commissary and Mfg.;State Compensation Insurance Fund, et al. (May 2024)

The WCAB sitting En Banc wrote: “Generally, there are two responses when faced with the possibility of imposition of sanctions: 1) a person can admit that the conduct was wrong, acknowledge the harm done, evidence an understanding of why the conduct was wrong, and assure the court that it will not happen again; or 2) a person can argue that the conduct was not in bad faith and/or frivolous.”

“The responses of both Susan Garrett and Lance Garrett argue that their conduct was not frivolous or in bad faith.”

“Instead, Susan Garrett and Lance Garrett’s responses trivialize the act of filing multiple frivolous petitions for reconsideration as an ‘inconvenience.’ However, their conduct here goes far beyond inconvenience. The filing of frivolous petitions for reconsideration significantly hampers the work of the Appeals Board. Each petition costs significant time and resources and delays the issuance of other decisions pending at the Appeals Board. More significantly, it delays a determination of applicant’s benefits in each of the cases at bar.”

After issuing a notice of intent on April 10, 2024, and having received and reviewed the responses of Susan Garrett and Lance Garrett, on May 16, 2024, the Appeals Board issued an En Banc Order imposing sanctions and costs in eight cases collectively of $20,000.00 against attorney Susan Garrett (CA BAR #195580) in eight (8) instances where she filed petitions for reconsideration with willful intent to disrupt or delay the proceedings of the Workers’ Compensation Appeals Board or with an improper motive, or where it appeared that such actions were indisputably without merit.

The Appeals Board issued a second order imposing costs and sanctions collectively of $20,000.00 against hearing representative Lance Garrett in eight (8) instances where he filed petitions for reconsideration with willful intent to disrupt or delay the proceedings of the Workers’ Compensation Appeals Board or with an improper motive, or where it appeared that such actions were indisputably without merit.

In the En Banc order imposing sanctions and costs, the Appeals Board found that filing a petition for reconsideration to halt trial level proceedings in order to obtain a de facto continuance is bad faith and/or frivolous conduct, which is sanctionable. The Appeals Board found that the responses of Susan Garrett and Lance Garrett did not warrant a reduction in sanctions as they failed to take responsibility for their conduct, acknowledge the seriousness of their conduct, and demonstrate genuine remorse.

The Appeals Board deferred the amount of reasonable expenses, including attorneys’ fees and costs, and returned the matter to Presiding Judge Robert Rassp to conduct a hearing on that issue.

Heigo Kubar, 84, of Fresno, was arraigned on three felony counts of workers’ compensation fraud, after a Central Valley Workers’ Compensation Fraud Task Force investigation discovered he allegedly underreported over $2 million in payroll to illegally save on workers’ compensation insurance for his trucking company. The investigation began after an employee was found deceased in a company owned semi-truck.

Kubar is the former owner of TKJ Trucking. Following an unfortunate incident where a TKJ Trucking employee was found deceased in company owned semi-truck, Kubar’s insurance company became suspicious and began an investigation.

The insurance company found that leading up to the death of this employee, Kubar had classified the employee as a company salesperson, not a truck driver. Twenty-five days after the death, TKJ Trucking amended the employee’s job classification to truck driver.

An investigation, led by the Fresno County District Attorney’s Office, found the deceased employee had been working for TKJ Trucking as a truck driver for approximately 15 years. At the time of their death, the cost to insure a sales person was approximately $1 for every $100 in payroll, but the cost to insure a truck driver was approximately $20 for every $100 in payroll.

An audit by the California Department of Insurance, as part of the task force investigation, revealed that between December 1, 2018 to December 1, 2021, TKJ Trucking had workers’ compensation insurance coverage and reported $875,591 in employee payroll, however, the company actually had $3,233,899 in payroll. Kubar underreported payroll by $2,358,307, resulting in insurance premiums of $480,093 owed to Kubar’s insurance company.

The Central Valley Workers’ Compensation Fraud Task Force is an inter-agency anti-fraud partnership with members from the California Department of Insurance, the Fresno County District Attorney’s Office, the Tulare County District Attorney’s Office, the Kings County District Attorney’s Office, the Kern County District Attorney’s Office, the Merced County District Attorney’s Office, the Madera County District Attorney’s Office, the San Luis Obispo County District Attorney’s Office, the California Employment Development Department, and the California Franchise Tax Board.

This case is being prosecuted by the Fresno County District Attorney’s Office. Kubar is scheduled to appear in court next on August 14, 2024.

The performance of the workers compensation system remains strong according to the 2023 metrics that the National Council on Compensation Insurance (NCCI) released today.

Workers compensation premium increased 1% in 2023. Private carriers produced their 10th consecutive year of underwriting profitability with a Calendar Year 2023 combined ratio of 86. It is the 7th consecutive year with a combined ratio below 90 for the workers compensation insurance market.

“The overall numbers for workers compensation show a financially healthy system,” said Donna Glenn, Chief Actuary, NCCI. “To maintain the health of the system, NCCI continues to look beyond the headline numbers to understand the intricacies of the system and identify risks that may impact our future. We are relentless in our commitment to being The Source You Trust.”

“The workers compensation system has unique features that have differentiated us from other commercial lines in terms of overall performance during the past several years,” said NCCI President and CEO Bill Donnell. “However, there are key questions ahead related to issues such as frequency change and medical cost inflation.”

Key Insights

– – Workers compensation premium increased 1% in 2023.
– – The Calendar Year 2023 combined ratio for workers compensation is 86%, a sign of underwriting profitability for the system.
– – Workers compensation’s Accident Year 2023 combined ratio is 98% with prior years continuing to experience downward reserve development.
– – The workers compensation reserve redundancy grew to $18 billion.
– – Lost-time claim frequency declined by 8% in the past year, which is more than two times the size of the long-term average decline.
– – Severity changes were considered moderate for 2023 with increases of 2% for medical claim severity and 5% for indemnity claim severity.

Related may be downloaded using these links:

– – 2024 State of the Line Report (PDF)
– – 2024 State of the Line Guide (HTML)
– – 2024 State of the Line Insights (PDF)

A San Joaquin County District Attorney’s Office investigator is on paid leave amid allegations of fraud.

According to a news release from the district attorney’s office, potential fraud was flagged after an audit of the 2024 Auto Insurance Fraud Grant Application.

The district attorney’s office says the audit found an investigator within the office was allegedly falsifying timesheet information to justify the office’s receipt of grant funds.

The investigator told them they had done it at the ‘urging’ of the prior district attorney’s office administration.

District Attorney Ron Freitas began auditing the Auto Insurance Fraud Grant Program in 2017 and asked the San Joaquin County Auditor’s Office to conduct its own audit, too.

“We pledge to cooperate fully with the California Department of Insurance, the Office of the Attorney General and the San Joaquin County Auditor’s Office, to ascertain any wrongdoing, and return any monies that were fraudulently received by this Office via the Auto Insurance Fraud Grant Program,” said Freitas.

“As soon as the alleged fraud was uncovered, we notified the California Department of Insurance, along with the Office of the Attorney General, in order to help correct the wrong that was committed and ensure that our Office is run with the highest ethical standards.”

The Auto Insurance Fraud Grant Program would give money to district attorney’s offices across the state to cover attorney’s fees, investigators, paralegals and other costs as it related to investigating and prosecuting auto insurance fraud.