Menu Close

Category: Daily News

CWCI Study Shows Medical Treatment Patterns Have Stabilized

A new California Workers Compensation Institute study finds treatment patterns for California workers’ comp professional medical services have stabilized in recent years, with only minor changes in the utilization rates and volume of services rendered to injured workers within the first two years for indemnity claims with 2014 through 2019 initial treatment dates, and within the first six months for indemnity claims with 2018 through 2021 initial treatment dates.

The study uses data from CWCI’s Industry Research Information System (IRIS) database to analyze professional medical services from non-COVID indemnity claims to determine the percent of claims that involved a major surgery within two years of the initial treatment date. The authors then calculated the percent of claims with and without major surgery from each of the initial treatment years that utilized Evaluation and Management (E? Physical Medicine; Advanced Imaging; Mental Health; and Injection services.

Among the key findings:

– – Since 2014, the percentage of indemnity claims involving a major surgery in the first 2 years has declined 1 percentage point per year, falling from 28% of the 2014 claims to 23% of the 2019 claims.
– – Across the 6-year span of the study, surgical claims averaged about 7 to 9 more E&M visits in the first 2 years than claims without major surgery.
– – The share of claims that had Physical Medicine services in the first 24 months showed little change, even after the pandemic was declared. Claims with major surgery have consistently averaged about 26 Physical Medicine visits in the first 2 years, more than twice the average for claims without major surgery.
– – Use of Advanced Imaging in the initial 24 months was also fairly stable across the 6 initial treatment years, ranging from 40 to 42% of the claims without major surgery and from 61 to 64% of the surgical claims.
– – Only 5 to 6% of the claims without major surgery and 6 to 7% of the surgical claims received Mental Health services in the first 24 months of treatment, with almost no change in the prevalence of these services among claims in which initial treatment was rendered in 2018 and 2019.
– – Though the percentage of claims with Mental Health services showed little change after the pandemic was declared, the average number of Mental Health visits within 24 months increased in the 2 most recent years.
– – About half of all claims with surgery had Injections compared to 17 to 18% of claims without major surgery.
– – The 6-month data on claims with 2018 to 2021 initial service dates showed pandemic-related disruptions to medical service delivery had little impact on the prevalence or volume of early treatment provided.

The full study provides a detailed look at California workers’ compensation professional medical service utilization trends for initial treatment years 2014 through 2021, including graphics and additional analyses. CWCI has published the study in a Research Update Report, “Patterns in the Provision of Professional Medical Services in California Workers’ Compensation.”

Court Affirms $8.2M Restitution Calculation in Premium Fraud Case

Alfredo Ayala and Juan Luis Ayala owned farm labor contracting businesses and shared business offices and office staff.

The Grand Jury of Tulare County returned an indictment charging them with workers’ compensation insurance and tax fraud by underreporting their payroll amounts.

Alfredo and Juan stipulated to a factual basis for their pleas based on police reports and grand jury proceedings, and Alfredo pleaded no contest to workers’ compensation insurance fraud and tax fraud, Juan to tax fraud, and both agreed to pay restitution to the Employment Development Department (EDD), and requested a restitution hearing to determine restitution owed to their workers’ compensation insurance companies.

After a hearing, the trial court awarded a total of $8,170,326 in restitution to the insurance companies measured by the amount of lost premiums caused by defendants’ false payroll reporting.

Defendants argue on appeal that the trial court erred in calculating restitution because (1) the prosecutor failed to present evidence that defendants’ criminal conduct caused payment of lowered premium amounts to the insurers and, even if the evidence was sufficient, that (2) the trial court should have calculated the premium owed on only the unreported payroll amount and the unreported payroll amount should have been calculated based upon only the voided payroll check amounts reflected in defendants’ computers.

The prosecutors responded that defendants “Harvey” waivers established they fraudulently underreported their businesses’ payroll to the insurers and the trial court properly determined the insurers’ economic losses by calculating the premiums that should have been paid to the insurers based upon the corrected payroll amounts. A “Harvey” waiver permits the sentencing court to consider the facts underlying dismissed counts and enhancements when determining the appropriate disposition for the offense or offenses of which the defendant stands convicted. (People v. Munoz (2007) 155 Cal.App.4th 160, 167.)

The Court of Appeal concluded that the trial court did not abuse its discretion in calculating $8,170,326 in restitution in this case and affirmed the judgments, but it vacated an erroneous $250 presentence investigation report fee imposed by the trial court in the unpublished case of People v Ayala -F083941 (March 2023).

The insurance companies involved in this case obtained records that the district attorney’s office had seized from defendants’ businesses and used them to conduct fraud audits. Representatives from each carrier testified at the restitution hearing. Daniel Harold was an IT technician who worked for JA Contracting, and testified for the Defendant. At the conclusion the trial court ordered a total of $8,170,326 in restitution to SCIF, SeaBright, Ullico, Liberty Mutual and Meadowbrook.

The trial court did not abuse its discretion in ordering defendants to pay restitution to their workers’ compensation insurance companies. California crime victims have a constitutional and statutory right to receive full restitution for economic losses suffered as a result of a defendant’s criminal conduct. (Cal. Const., art. I, § 28, subd. (b)(13); Pen. Code, § 1202.4, subds. (a)(1), (3)(B), (f).)

Defendants’ pleas of no contest and accompanying Harvey waivers establish that defendants intentionally and falsely underreported their monthly payroll to the insurers to pay lower premiums. Furthermore, the willful underpayment of insurance premiums constitutes an economic loss under section 1202.4.

Section 1203.1 “gives trial courts broad discretion to impose probation conditions to foster rehabilitation and to protect public safety.” (People v. Anderson (2010) 50 Cal.4th 19, 26.)

The methodology adopted by the trial court appears rational and did not produce an arbitrary result. (See Giordano, supra, 42 Cal.4th at p. 665.) Therefore, the court of appeal presumed the judgments are correct, and to set them aside defendants must affirmatively show error. (Id. at p. 666.)

At the conclusion of an exhaustive review of the evidence presented by each carrier, the Opinion concluded that “To the extent the scope and nature of defendants’ misconduct precludes an exact determination of the insurers’ losses, the equities favor the insurers as far as calculating the amount of restitution that is due. (See Prosser (2007) 157 Cal.App.4th 682, 691; People v. Baker, supra, 126 Cal.App.4th at p. 469.) After reviewing all the relevant considerations, we are satisfied there is a factual and rational basis for the trial court’s restitution order. No abuse of discretion or other ground for reversal has been shown.”

O.C. Pharmacy Director Sentenced to 9½ Years for Kickback Scheme

A Florida man who once was the director of operations at a now-shuttered Irvine pharmacy was sentenced to 114 months in federal prison for his role in a scheme in which kickbacks were paid for prescriptions for “compounded” medications – a scam that cost Tricare, the United States military’s health care plan, more than $3 million in losses.

Marcus Orlando Armstrong, 56, of Miami, was sentenced by United States District Judge Otis D. Wright II, who also ordered Armstrong to pay $3,070,091 in restitution.

Armstrong pleaded guilty in October 2022 to two counts of paying illegal kickbacks for health care referrals.

Armstrong was the director of operations for the now-defunct Irvine Wellness Pharmacy, which made compounded medications. Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.

In mid-2014, Armstrong agreed to pay a physician, identified in court documents as “N.G.,” kickbacks in exchange for prescriptions bearing N.G.’s name and credentials. Armstrong intended that Irvine Wellness Pharmacy would fill the prescriptions and Tricare would pay to reimburse them. Armstrong further intended to receive a portion of the reimbursements and then, out of those funds, Armstrong intended to pay kickbacks to N.G.

In February 2015, Armstrong wrote two checks – one for $16,418 and the other for approximately $10,000 – to N.G. that were noted as being for “marketing.” In fact, the checks were illegal kickback payments to N.G. in exchange for prescriptions that were not medically necessary.

A co-defendant, Sandy Mai Trang Nguyen, 42, of Irvine, was found guilty by a jury in November 2022 of 21 counts of health care fraud and one count of obstruction of a federal audit. Nguyen was the pharmacist-in-charge at Irvine Wellness Pharmacy.

According to evidence presented at Nguyen’s trial, from late 2014 to May 2015, Nguyen and others under her supervision filled approximately 1,150 compounded prescriptions for pain, scarring and migraines that Tricare reimbursed for tens of thousands of dollars per prescription. Nearly all the prescriptions were sent to the pharmacy by so-called marketers who were paid kickbacks of nearly half of the Tricare reimbursements paid to the pharmacy.

The beneficiaries were solicited to provide their Tricare insurance information for medications they did not seek out or need, and most were never examined by a physician. The prescriptions were electronically sent from marketers or telemedicine businesses and submitted by the pharmacy for reimbursement even though Tricare rules excluded reimbursements for claims based on telemedicine visits and would not, in any event, have been authorized had Tricare known the prescriptions originated based upon the payment of kickbacks.

Nguyen’s sentencing hearing is scheduled for April 3.

Co-defendants Leslie Andre Ezidore, 53, of West Los Angeles, and Alexander Michael Semenik, 51, of Las Vegas, have pleaded guilty to felony charges in this case and await sentencing.

National Firefighters Union Battles Cancer Causing Protective Gear

The International Association of Fire Fighters is a labor union representing paid full-time firefighters and emergency medical services personnel in the United States and Canada. The IAFF was formed in 1918 and is affiliated with the AFL-CIO in the United States and the Canadian Labour Congress in Canada. It represents more than 334,000 fire fighters across the United States and Canada.

The National Fire Protection Association (NFPA) is a global self-funded nonprofit organization, established in 1896, devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards.

In what it calls “the next step in its fight to combat fire fighter cancer”, the International Association of Fire Fighters filed suit March 16 against the National Fire Protection Association (NFPA) for its role in imposing a testing standard that effectively requires the use of toxic forever chemicals known as PFAS, in fire fighter protective gear,

Section No. 8.62, a provision in NFPA Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting (Standard 1971), requires certain components of fire fighter bunker gear to pass the Ultraviolet Light Degradation Test. The test requires turnout gear to be exposed to UV light for 40 hours without degradation. The only substance that can pass the test for that long is PFAS.

A June 2020 study of bunker gear by researchers at the University of Notre Dame analyzed 30 new and used bunker jackets and pants originally marketed, distributed, and sold in 2008. 2014, and 2017, by six bunker gear makers, and found high levels of PFAS in bunker gear worn, used, or handled by fire fighters.

IAFF General President Edward Kelly said however that: “Even when presented with independent science on the health and safety risks, the NFPA has refused to help save our lives,

The complaint, International Association of Fire Fighters v. National Fire Protection Association, Inc., seeks to hold the NFPA liable for not removing the dangerous test from its Standard 1971.

On March 6, 2023, President Joseph R. Biden, speaking to fire fighters in Washington, pledged, ,..We’re going after toxic exposure to PFAS, so-called ‘forever chemicals’ that for years have been in your gear, your equipment … that you depend on to be able to do your job.”

PFASs are human-made chemicals first invented in the 1930s. As of 2021, PFASs are defined as fluorinated substances that, with a few noted exceptions, any chemical with at least a perfluorinated methyl group or a perfluorinated methylene group is a PFAS.

PFAS are known as °’forever chemicals,” and per the Stockholm Convention on Persistent Organic Pollutants (to which the U S is a signatory) are defined as: Persistent- because they do not break down through organic processes or in the environment; Transboundary – as they migrate through surface and ground water, as well as in the atmosphere and through wildlife; and Bio-accumulative – as they concentrate within our bodies and are passed to the fetus within the womb and though breast milk. Exposure to PFAs in humans can occur through inhalation, ingestion and dermal contact. The two most widely known and studied PFAS are PFOA and PFOS.

According to the OECD, at least 4,730 distinct PFASs are known, which contain at least three perfluorinated carbon atoms. The United States Environmental Protection Agency (EPA) toxicity database, DSSTox, lists 14,735 unique PFAS chemical compounds. PubChem lists approximately 6 million.

Many PFASs were used in the mid-20th century in products and on materials due to their enhanced water-resistant properties, such as within Teflon or aqueous film forming foam. Only since the start of the 21st century has the environmental impact and toxicity to human and mammalian life been studied in depth. PFASs are commonly described as persistent organic pollutants because they remain in the environment for long periods of time, and are also known as “forever chemicals”.

Certain PFASs are no longer manufactured in the United States, as a result of phase-outs including the PFOA Stewardship Program (2010-2015), in which eight major chemical manufacturers agreed to eliminate the use of PFOA and PFOA-related chemicals in their products and as emissions from their facilities. Although PFOA and PFOS are no longer manufactured in the United States, they are still produced internationally and are imported into the US in consumer goods such as carpet, leather and apparel, textiles, paper and packaging, coatings, rubber and plastics.

An estimated 26,000 U.S. sites are contaminated with PFASs. At least six million Americans are estimated to have drinking water containing PFASs above the safe limit published prior to 2022 by the U.S. Environmental Protection Agency (EPA).

In 2021 California banned PFASs for use in food packaging and from infant and children’s products and also required PFAS cookware in the state to carry a warning label. In 2021, Maine became the first U.S. state to ban these compounds in all products by 2030, except for instances deemed “currently unavoidable.”

Much of the bunker gear worn by fire fighters is made by Lion who is is the fifth largest manufacturer of bunker gear in the United States. W. L. Gore & Associates markets these products. Neither of them are named as defendants in the complaint, but both are discussed as opposing efforts by the IAFF to change the NFPA standard mandating PFAS in bunker gear.

Plaintiffs allege that NFPA, Lion, Gore and others entered into agreements before an after adoption Section No. 8.62 of Standard 1971 which they claim to be an actionable “civil conspiracy” for which they seek “judgment in its favor against Defendant NFP A for compensatory damages in an amount to be determined by a jury, injunctive relief requiring NFPA to immediately rescind Section No. 8.62 of NFPA 1971, together with prejudgment interest, post-judgment interest, costs and expenses, attorneys’ fees and costs , and such other relief as this Court deems just and equitable.”

Floyd Skeren Annual Employment Law Conference Set for June 30th

Floyd Skeren Manukian Langevin and Fisher Phillips are pleased to partner and present the 2023 Annual Employment Law Conference on June 30th, 2023, at the Disneyland Hotel in Anaheim from 7:45 am until 6:00 pm PDT.

Kevin Kish, Director of the California Civil Rights Department, and experienced workplace law attorneys will deliver a one-day comprehensive program that will address the hottest issues that impact California businesses. The conference will feature keynote speakers, and timely topics in employment law, workers’ compensation, and HR.

Conference sessions include:

Morning Sessions

– – Kevin Kish, Director of the California Civil Rights Department.
– – 2023 Employment Law Update – Presented by Bernadette M. O’Brien, Esq., SPHR, Partner at Floyd Skeren Manukian Langevin, LLP, and Alden J. Parker, Esq., Sacramento Regional Partner at Fisher & Phillips, LLP.

Afternoon Breakout Session One:

– – Workers’ Compensation and Leaves of Absence – Presented by John B. Floyd, Esq., Senior Partner at Floyd Skeren Manukian Langevin, Eric E. Ostling, Esq., Partner at Floyd Skeren Manukian Langevin, LLP, and Tim Simmen, Esq., Attorney at Floyd Skeren Manukian Langevin, LLP
– – Wage & Hour and PAGA Claims – Presented by Alden J. Parker, Esq., Sacramento Regional Partner at Fisher & Phillips, LLP.
– – Terminations and Investigations – Presented by Amanda A. Manukian, Esq., Senior Partner at Floyd Skeren Manukian Langevin, LLP, Daniel R. Brown, Esq., Partner at Floyd Skeren Manukian Langevin, LLP, and Kyle R. Uebelhardt, Esq., Partner at Floyd Skeren Manukian Langevin, LLP.

Afternoon Breakout Session Two:

– – Preventing Workplace Violence – Presented by Fisher & Phillips, LLP.
– – Workers’ Compensation Psyche Claims – Presented by John M. Langevin, Esq., Senior Partner at Floyd Skeren Manukian Langevin, LLP
– – Cal OSHA Employer Rights And Strategies For Responding to OSHA Complaints – Presented by Fisher & Phillips, LLP.
– – Key Strategies for Defending WC Complex Litigation – Presented by Michael G. McConville, Esq., Partner at Floyd Skeren Manukian Langevin, LLP, and Carey A. Guynes, Esq., Partner at Floyd Skeren Manukian Langevin, LLP.
– – Workplace Dispute Resolution & Sexual Harassment Investigations – Presented by Bernadette M. O’Brien, Esq., SPHR, Partner at Floyd Skeren Manukian Langevin, LLP, and Alden J. Parker, Esq., Sacramento Regional Partner at Fisher & Phillips, LLP

And more..

The day will end with a cocktail reception where attendees can connect with conference presenters.

Registration is now open. Date: June 30, 2023 – Price: – Early Bird (until March 31, 2023): $275.00 – General Entry Fee (after March 31, 2023): $325.00.

MCLE credit will be given for attorneys who attend this event.  Rene Thomas Folse is the MCLE sponsor for this event. His California State Bar sponsor number is 11240. He has sole responsibility for the content of this course.

We hope you can join us!

Covid Misinformation Law Entangled in Conflicting Lawsuits

Gov. Gavin Newsom may have been prescient when he acknowledged free speech concerns as he signed California’s covid misinformation bill last fall. In a message to lawmakers, the governor warned of “the chilling effect other potential laws may have” on the ability of doctors to speak frankly with patients but expressed confidence that the one he was signing did not cross that line.

California’s covid misinformation law, which took effect Jan. 1, is being challenged by vaccine skeptics and civil liberties groups. Among those suing to get the law declared unconstitutional is a group founded by Robert F. Kennedy Jr., who has questioned the science and safety of vaccines for years.

According to Kaiser Health news. the law – meant to discipline doctors who give patients false information about covid-19 – is now in legal limbo after two federal judges issued conflicting rulings in recent lawsuits that say it violates free speech and is too vague for doctors to know what it bars them from telling patients.

In two of the lawsuits, Senior U.S. District Judge William Shubb in Sacramento issued a temporary halt on enforcing the law, but it applies only to the plaintiffs in those cases. Shubb said the law was “unconstitutionally vague,” in part because it “fails to provide a person of ordinary intelligence fair notice of what is prohibited.” His ruling last month clashed with one handed down in Santa Ana in December; in that case, U.S. District Judge Fred Slaughter refused to halt the law and said it was “likely to promote the health and safety of California covid-19 patients.”

Plaintiffs in the Santa Ana case, two doctors who have sometimes diverged from public health guidelines, appealed Slaughter’s ruling allowing the law to stand. The case has been combined in the 9th U.S. Circuit Court of Appeals with another case in which a San Diego judge declined to rule on a similar request to temporarily halt the law.

But doubts about the law are not confined to those who have battled the scientific mainstream.

Dr. Leana Wen, a health policy professor at George Washington University who previously served as president of Planned Parenthood and as Baltimore’s health commissioner, wrote in an op-ed a few weeks before Newsom signed the law that it would exert “a chilling effect on medical practice, with widespread repercussions that could paradoxically worsen patient care.”

The Northern California affiliate of the American Civil Liberties Union has weighed in against the law on free speech grounds, though the national organization has affirmed the constitutionality of covid vaccine mandates.

If doctors are scared of losing their licenses for giving advice that they think is helpful and appropriate, but they don’t quite know what the law means, they will be less likely to speak openly and frankly with their patients,” said Hannah Kieschnick, an attorney with the ACLU of Northern California.

The law establishes that doctors who give false information about covid to patients are engaging in unprofessional conduct, which could subject them to discipline by the Medical Board of California or the Osteopathic Medical Board of California.

But the law lacks such specifics, defining misinformation only as “false information that is contradicted by contemporary scientific consensus contrary to the standard of care.”

Michelle Mello, a professor of law and health policy at Stanford University, said the wording is confusing. “On a matter like covid, science is changing all the time, so what does it mean to say there is scientific consensus?” she asked. “To me, there are lots of examples of statements that clearly, with no vagueness involved, meet the definition of the kind of conduct that the legislature was going after. The problem is that there are all kinds of other hypothetical things that people can say that don’t clearly violate it.”

Dr. Christine Cassel, a professor of medicine at the University of California-San Francisco, said she expects the law to be applied only in the most flagrant cases. “I trust scientists enough to know where there’s a legitimate dispute,” she said.

Cassel’s view mirrors Newsom’s rationale for signing the legislation despite his awareness of potential free speech concerns. “I am confident,” he wrote in his message to lawmakers, “that discussing emerging ideas or treatments including the subsequent risks and benefits does not constitute misinformation or disinformation under this bill’s criteria.”

CSLB Stings Show Abundance of Unlicensed and Uninsured Contractors

42 year old Adan Contreras Rivas, an unlicensed contractor from Modesto, was on the Contractors State License Board “Most Wanted” list and served a previous prison sentence for contracting without a license.

He was sentenced last week to seven years and eight months in prison after a conviction on charges of defrauding and stealing from customers.

Rivas was the target of a sting operation conducted in October by the Contra Costa District Attorney’s Office and the California Department of Insurance. He was again arrested in November after posing as a licensed landscaping contractor and stealing thousands of dollars from customers, the news release said.

Rivas was previously sent to prison for several convictions including grand theft, theft from a senior citizen and contracting without a license in Santa Clara County.

And the Contractors State License Board continues regular sting operations in cities statewide, and there seems to be an abundance of violators who have no license, and no workers’ compensation insurance.

On March 8 the Contractors State License Board (CSLB) announced it had cited unlicensed individuals in San Diego County who placed bids as high as $20,000 for residential contracting work.

In February, CSLB’s Statewide Investigative Fraud Team (SWIFT) partnered with the California Department of Insurance and the San Diego County Sheriff’s Department and went undercover to catch unlicensed contractors in Ramona. Of those invited, 11 came to the site and placed high bids without having the proper license to back up their workmanship.

The bids ranged from $4,500 for tree removal to as much as $20,000 for concrete – all above the legal $500 threshold for contracting without a license. In California, contracting without a license is a misdemeanor and punishable by a fine of up to $15,000.

A Notice to Appear in criminal court was issued to these individuals at the sting site while one individual was referred to the San Diego County District Attorney for misdemeanor prosecution for placing a construction bid after leaving the property.

All 11 suspects could face additional administrative or criminal charges for placing illegal advertisements for construction services without having the required license. Licensed contractors are required to include their license number on all business-related materials (such as advertisements, vehicles, and business cards).

Three individuals also asked for an excessive down payment ahead of starting the work. Contractors can only ask for 10% or $1,000, whichever is less. This is a misdemeanor that could result in charges of up to $5,000, or up to a one-year county jail sentence, or both the fine and imprisonment.

Three individuals were issued an order to cease all work requiring employees until a workers’ compensation insurance policy is obtained. CSLB investigators can halt jobsite activity when any person, with or without a contractor license, does not have workers’ compensation insurance coverage for employees. Failure to comply with a stop order can result in misdemeanor charges and penalties, including 60 days in jail and/or up to $10,000 in fines.

Penalties for not carrying workers’ compensation insurance can be severe. For a first- time offense, suspects could be sentenced to one year in county jail and/or pay a fine of up to $10,000. They may also be fined $1,000 per employee on the payroll at that time – up to $100,000. There are additional penalties if an injured worker files a workers’ compensation claim, and the employer doesn’t have the proper insurance. That employee can also file a civil action against the employer.

Insurance Carrier Resolves Policy Dispute Class Action for $6.2M

General Insurance Company (GEICO) insurance policies require payment of actual cash value (“ACV”) upon the total loss of a covered auto and define ACV as the “replacement cost” of the auto, less depreciation.

A consolidated class action was filed in the United States District Court, Northern District of California, against GEICO alleging that it breached the terms of private passenger auto insurance policies issued to Plaintiffs, and similarly situated insureds, by failing to properly include or calculate sales tax (as to leased vehicles) and regulatory fees (as to all vehicles).

Plaintiffs argue that (1) the insurance policies require Defendant to include sales tax on the cost to purchase a replacement vehicle when paying leased-vehicle claims; and (2) under Cal. Ins. Code § 2695.8(b)(1), registration fees for the “remaining term of the loss vehicle’s current registration” should be calculated on an end-of-month (rather than, as Defendant contends, a beginning-of-month) basis or, alternatively, on a daily (not monthly) basis.

Over the course of two years, the parties engaged in motion practice, extensive production and review of documents and class-wide data, and multiple depositions, including the depositions of corporate representatives, class representatives, and expert witnesses.

After multiple mediation sessions the parties reached a settlement. The Court granted preliminary approval of the settlement on July 28, 2022, and final approval on March 15, 2023.

Approval of a class settlement is appropriate when plaintiffs must overcome significant barriers to make their case. The Court found in this case that the amount offered in settlement is reasonable in light of the substantial risk that Plaintiffs would face in litigating the case. According to Plaintiffs, litigation of these claims through trial presents significant challenges to prevailing on the merits since no California court, state or federal, has held that insureds who leased a vehicle are entitled, upon a total-loss determination, to full payment of sales tax.

They cite to unfavorable decisions regarding Defendant’s policy language, including three federal courts of appeal that have considered similar claims and ruled in favor of the insurers.

Although the Court expressed concerns at the preliminary approval stage regarding the claims-made structure of this settlement, the actual monetary benefit to the class has turned out to be substantial, even if less than anticipated. Defendant has conducted a preliminary audit of submitted claims, and the actual estimated cash benefit for the class is $6,200,000.

The settlement recovery is particularly compelling for the Sales Tax Class, where each class member will receive 100% of the sales tax (and thus 100% of the potential recovery). On average, class members with valid claims will receive more than $2,000. Plaintiffs estimate a total payout to the Sales Tax Class of approximately $5,800,000.

For the Regulatory Fees class, each class member will receive $6.88, which represents 50% of the potential recovery. Plaintiffs estimate a total payout to the Regulatory Fees Class of approximately $402,824.

The amount offered in the settlement is another factor that weighs in favor of approval. Based on the facts in the record and the parties’ arguments at the final fairness hearing, the Court found that the settlement amount falls “within the range of reasonableness” in light of the risks and costs of litigation.

Nurses Across the State Protest Working Conditions

A union representing 18,000 health care workers at Dignity Health plans a series of protests and “informational picketing” outside 26 of the company’s California hospitals and outpatient centers starting today until March 31.

Over the course of two weeks, thousands of healthcare workers will protest and picket throughout March at 26 Dignity Health facilities across California. Dignity Health workers say they are chronically understaffed in just about every department, putting patients and caregivers at risk.

We are so short-staffed, we only have time to see the sickest of the sick,” said Andrea Tuma, a respiratory therapist at Dignity’s Mercy Medical Center in Redding. “Those with chronic, non-urgent needs have to wait, usually until those needs become urgent. We end the day feeling like we didn’t do enough when we did everything we could.”

In a report published last year by SEIU-United Healthcare Workers West (SEIU-UHW), 77% of Dignity Health workers surveyed described their working conditions as ‘severely’ or ‘somewhat’ understaffed.

SEIU-UHW represents approximately 18,000 Dignity Health workers statewide. Caregivers joining the protests represent a variety of job classes, including respiratory therapists, nursing assistants, emergency medical technicians, dietitians, laboratory assistants, social workers, environmental services/housekeeping, and many other frontline staff. They are calling on their employer to listen to and work with healthcare workers to address the staffing crisis through ongoing contract negotiations.

Dignity Health is part of one of the largest not-for-profit health systems in the country, CommonSpirit Health, which earned over $5.4 billion in profits in fiscal year 2021.

The union and company have been negotiating a new labor contract since Jan. 26. Their current five-year contract expires April 30.

In communications with members, SEIU-UHW slammed the company for offering annual raises of 3% as consumer prices soared 6.5% last year. The union said the Dignity should have offered at least 6%.

Dignity Health shared the following statement with Becker’s Hospital Review: “We recognize and respect the right of our employees to participate in informational picketing events. These events are related to ongoing contract negotiations between Dignity Health and SEIU-UHW. The safety of our caregivers and patients is our highest priority. Hospital operations are not impacted by these events.”

Also, registered nurses at UCSD Health Jacobs Medical Center in La Jolla are holding a rally on Thursday, March 16, outside the emergency room entrance to demand that University of California (UC) management end the unsafe practice of placing patients on gurneys in hallways and other areas that are not properly equipped or staffed for patient care, announced California Nurses Association/National Nurses United (CNA/NNU). The nurses are deeply concerned about eroding patient care conditions and the lack of patient privacy and dignity.

No Liability For Off Worksite, Weekend Sexual Misconduct Between Friends

Hanin Atalla and Erik Lund met in the “early fall” of 2017, during her last year of pharmacy school, when she did a six-week “business administrative rotation with Rite Aid.” The rotation entailed Atalla “shadow[ing]” Lund. Lund was Atalla’s “preceptor” for the rotation. Atalla did six other rotations besides the Rite Aid rotation as part of her pharmacy school requirements. When Atalla’s rotation with Rite Aid ended, Atalla celebrated at a dinner with Lund and his wife. Atalla stayed in close touch with Lund thereafter.

Starting from the time Atalla did her six-week rotation with Lund, she and Lund developed a social relationship. Over time, they became close friends. They were friends before Atalla started working at Rite Aid. Atalla also viewed Lund as a mentor.

Atalla and her husband celebrated a Friendsgiving at the home of Lund and his wife in 2017. Atalla and Lund texted frequently; they joked with one another in texts; they texted about personal matters; they texted about a wide range of things; and they sent multimedia messages to one another as well. They would go out to lunch together.

Atalla’s friendship with Lund continued after Atalla began working at Rite Aid in March 2018. They continued to text frequently about all kinds of things, including travel and vacations, exercise, weight loss, food, restaurants, getting together for meals, religious observances, family and relatives, their respective spouses, pets, social media, drinking and alcohol, birthdays, fashion, and work issues. They exchanged hundreds of texts. They would go out for coffee and meet up for lunch. In December 2018, Lund and his wife joined Atalla and her husband (and another couple) for dinner to celebrate Atalla’s birthday.

One month after Atalla and Lund dined together in celebration of her birthday, they engaged in their final text exchange, also on their personal cell phones. On January 4, 2019, a Friday night, Lund texted Atalla a “Live Photo” of him engaging in a sexual act by himself while he was drunk. The next morning, Lund texted Atalla, “Wanted to apologize I was embarrassing drunk last night.”

On Sunday, January 6, 2019, Atalla called her training pharmacist and said she was not feeling well and would not be able to work that week. On January 10, 2019, Atalla’s counsel, John Waterman sent a letter to Rite Aid asserting a claim of sexual harassment. Atalla’s counsel also advised that Atalla “will not be returning to work at Rite Aid.” Atalla’s counsel said he had already obtained a right-to-sue letter and would be filing a complaint that coming Monday, January 15, 2019.

Rite Aid interviewed Lund who admitted what he had done, and investigated whether there were any other complaints of sexual harassment against Lund; the investigation revealed none.

Rite Aid made the decision to terminate Lund on Monday, January 14, 2019. That same day, their counsel emailed a letter to Atalla’s counsel advising of Lund’s termination and assuring them, “Ms. Atalla remains an active employee in our system, and she is welcome to return to work.”

Rite aid concluded that Atalla had no intention of returning to work at Rite Aid and, rather, had decided to resign and pursue litigation. Accordingly, on January 21, 2019, Atalla’s status in Rite Aid’s system was changed to “resignation with the possibility of re-hire.” On January 22, 2019, Rite Aid sent Atalla a separation notice, along with her vacation payout.

Atalla filed a sexual harassment, failure to prevent sexual harassment, wrongful constructive termination, discrimination, and retaliation action against her former employer, Rite Aid Corporation and Thrifty Payless, Inc., dba Rite Aid.

The Rite Aid defendants brought a summary judgment motion. Rite Aid attached over 500 pages filled with text messages (along with images and photographs) exchanged between Atalla and Lund.

The trial court granted summary judgment noting that the “question is whether the harassment arose from a completely private relationship unconnected with the employment. I think defendants have met their burden of showing that this is the case. The Court of Appeal affirmed in the published case of Atalla v. Rite Aid Corporation -F082794 (March 2023).

The underlying goal of FEHA in this context is to provide effective measures to prevent workplace  harassment. (State Dept. of Health Services v. Superior Court (2003) 31 Cal.4th 1026, at pp. 1046-1047.)  “‘Under the FEHA … there is a need to determine whether sexual conduct that occurs off the worksite or after working hours constitutes an “unlawful employment practice” within the ambit of the act.’ “ (Myers v. Trendwest Resorts, Inc. (2007) 148 Cal.App.4th 1403, 1422, quoting § 12940 (italics added).)”

We affirm the trial court’s conclusion that Atalla has not raised a triable issue of material fact with respect to the required showing that Lund was acting in the capacity of a supervisor in the text exchange in which he sent the inappropriate texts. Rather, as the trial court found, Lund and Atalla had ‘an extensive texting relationship’ and their January 4, 2019 late-night text exchange, which ‘occurred outside the workplace and outside of work hours,’ was ‘spawned from a personal exchange that arose from a friendship between [them].’ Summary judgment is therefore proper as to Atalla’s sexual harassment claims.”