Category: Daily News

The presumptions for compensability of a COVID related workers’ compensation claim is predicated on a positive test for the presence of the virus. However, according to the California Attorney General, there are now “fake” testing sites surfacing in California.

“Throughout California, fake testing sites are sprouting up to exploit families and individuals seeking COVID tests. It is important to recognize the signs of sham testing sites to protect both your money and personal information,” said Attorney General Bonta. “I urge Californians to do their part to avoid fake testing sites by utilizing state resources, including the California Department of Public Health’s website, to find a verified COVID-19 testing site.”

It would seem prudent that the investigation of claims should not dig deeper to insure that the test offered by the claimant was not from one of the “fake” sites, and indeed is an authentic test result.

California Attorney General Rob Bonta issued this warning to Californians, so they become beware of fake COVID-19 testing locations and websites.

The alert claims that with an increased demand for COVID-19 testing due to the recent spike in cases, scammers are exploiting vulnerable individuals looking to determine whether they have the COVID-19 virus.

These unverified sites pose as legitimate companies and healthcare clinics offering COVID-19 testing. However, after receiving payment for a COVID-19 test, these fake testing sites oftentimes fail to provide their patients with their test results.

These sites may also ask for a patient’s personal identifiable information with the intention of committing fraud. The alert shared tips on how to avoid testing site scams, as well as how to search and locate legitimate, verified testing sites.

–  People should only get tested at verified COVID-19 testing sites or through medical groups: To find a testing site that is verified to perform COVID-19 testing, use the California Department of Public Health’s test site search tool.

–  Someone may also search for local testing sites through your county’s local public health department. You can find your county’s public health department website at COVID19.CA.GOV’s Hotlines and Local Info web page.

–  Also check with local medical groups to see if they offer testing services within their facility.

Should someone choose to use an unaffiliated testing site, be wary of the following:

– – If a provider insists on documenting nationality or immigration status;
– – If a provider does not offer a notice of privacy practices, or cannot explain how it will use and share personal data; or
– – If a provider insists on accessing a passport or driver’s license when they have other documents that show insurance status.

Identify and avoid “lookalike” websites: Fake testing sites may require a person to sign up online. Beware of fake websites that purposely look identical to those belonging to well-known, trusted organizations and state agencies. Before entering personal information into an online form, always make sure that the website is secure and does not display misspellings or unfamiliar names in the URL.

Be cautious of unsolicited calls regarding testing sites: A legitimate company or health clinic will not call, text, or email anyone without permission. If someone receives an unsolicited message from an individual, they should not provide the caller or sender with any personal information until having confirmed it is coming from a legitimate source. If someone feels pressured to provide personal information, just hang up.

Any of these red flags or tips would be good questions to ask a claimant for purposes of establishing the validity of any COVID test result.

Alec Baldwin’s attorneys argued in a demurrer filed on Monday that the Worker’s Compensation exclusive remedy protects him from a lawsuit stemming from the “Rust” shooting last October.

The filing comes in response to a civil suit filed in Los Angeles Superior Court by Mamie Mitchell, the film’s script supervisor, against Baldwin and other producers and crew members on Nov. 17. Mitchell is represented by Gloria Allred. The “Rust” production had a liability policy with Chubb with a $6 million limit.

Mitchell was standing just a few feet away from Baldwin when he fired the gun and was the first to call 911. She alleges that she suffered pain and ringing in her ears as well as emotional injuries. Apparently her lawyers plead the case as an “assault” by the defendants, hoping to construe Baldwin’s behavior as an intentional tort which may be actionable despite the exclusive remedy.

However the defendants challenge her claim that it was an intentional tort, and that she has any legal right to any monetary recovery

They say “the law is clear that she does not. As Plaintiff obviously recognizes, having cited the New Mexico Supreme Court case Delgado v. Phelps Dodge as the basis for each of the three causes of action in her Complaint, Plaintiff cannot bring a workplace injury claim before this Court based on alleged negligence because Defendants are generally immune from such claims under New Mexico’s worker’s compensation law.“

The New Mexico Supreme Court\’s decision in Delgado overruled the “actual intent test” and created an exception to the exclusivity provisions of the Workers Compensation Act which holds employers legally responsible for on-the-job injuries. The new standard is something less than intentional but more than negligence, purported to set the stage for a deluge of tort claims from injured employees who previously would have been precluded as a matter of law from recovering damages outside of the Act.

However, examination of Delgado and its New Mexico progeny, and comparison with case law in other jurisdictions with rules similar to those articulated by the New Mexico Supreme Court, indicate that while Delgado changed the law, legal scholars at the University of New Mexico say its application is so narrow as to have minimal impact. And that subsequent interpretations of the Delgado exception in New Mexico and other jurisdictions employing a similar standard have defined narrow boundaries and severely limited the scope of its coverage.

The demurrer goes on to argue that “despite Plaintiff’s attempt to label claims as intentional, nothing about Plaintiff’s allegations suggest that any of Defendants intentionally committed harmful conduct under New Mexico law. The underlying accident occurred when Cinematographer Halyna Hutchins (“Ms. Hutchins), Director Joel Souza (“Mr. Souza”), and Mr. Baldwin, among other film crew members, were rehearsing Mr. Baldwin drawing and pointing a prop six-shooter style revolver firearm (“Prop Gun”) for a cowboy-standoff scene.”

Mitchell’s suit alleges that Baldwin should have double-checked the gun and also accuses the producers of cutting corners, leading to unsafe conditions. In their demurrer, Baldwin’s attorneys argue that Mitchell cannot point to any intentional act that led to the shooting.

“Nothing about Plaintiff’s allegations suggest that any of Defendants, including Mr. Baldwin, intended the Prop Gun to be loaded with live ammunition,” they wrote. “Moreover, nothing about Plaintiff’s allegations suggests any of the Defendants knew the Prop Gun contained live ammunition.”

Serge Svetnoy, the gaffer who was also nearby when the shot was fired, filed a separate suit on Nov. 10. The producers have yet to respond to that complaint.

The demurrer will be heard on February 24 at 1:30 in Department 32.

RAND Corporation recently released a new Perspectives Report that examines policymakers’ initial efforts and reasoning around enabling access to workers’ compensation benefits for employees who are required to work outside their homes during the COVID-19 pandemic.

They briefly assess the potential impacts of continuing to expand such access on workers, employers, and insurers. And finally, they pose further questions that policymakers and others may want to consider when evaluating past policies and crafting new ones to meet future public health emergencies.

The coronavirus disease 2019 (COVID-19) pandemic has posed incredible challenges to the U.S. workforce. Although many businesses have transitioned employees from on-site work to telework, frontline employees in certain sectors deemed “essential” (e.g., hospitals and other health care facilities, public safety agencies such as police and fire departments, critical infrastructure such as electric and water utilities, or the food supply chain) must continue to work on-site.

Depending on the specific public health restrictions in place, many “nonessential” businesses have also operated in a manner that requires employees to work on-site and, in some instances, to have extensive contact with customers, vendors, and suppliers.

As of July 31, 2021, 36 states, the District of Columbia, and Puerto Rico have either implemented or are considering changes to make it easier for some classes of workers who contract COVID-19 while working outside the home to obtain benefits.

In a majority of states that have expanded workers’ compensation presumptions, the presumption takes effect upon either a positive COVID-19 test result or physician’s diagnosis. In Mississippi, North Dakota, and Washington, the presumption takes effect once a worker is ordered to quarantine by an employer because of suspected COVID-19 exposure.

Workers’ compensation actuaries in a majority of states have adopted regulations excluding COVID-19 from experience rating. NCCI proposed a rule change omitting COVID-19 claims from experience rating calculations. To date, 34 out of the 36 states (excepting Alaska and Nebraska) within NCCI have approved the rule change. Additionally, all states not covered by NCCI have approved similar rule changes.

The COVID-19 pandemic has, so far, not had dramatic impacts on the profitability of the workers’ compensation insurance market. Far from the dire predictions at the start of the public health emergency, many employees who have contracted COVID-19 have recovered relatively quickly, without the need for long-term, costly medical care or time off from work. And although numerous laws and regulations have been enacted across many states, many of the COVID-19 claims have not ultimately met the requirements for compensability.

Additionally, some observers have noted that overall claims frequency in 2020 declined in many states. A study by the Workers’ Compensation Research Institute found that in the second quarter of 2020, “the volume of non–COVID-19 WC [workers’ compensation] claims . . . [dropped] by at least 30 percent in the vast majority of the states and by as much as 50 percent in Massachusetts” (Fomenko and Ruser, 2021, p. 8).

The biggest risk that insurers now face is the unknown long-term health implications for people who have recovered from a serious COVID-19 infection. Patients admitted to intensive care units are generally at greater risk of long-term adverse health outcomes. Some experts also anticipate that “in addition to claims for occupational exposure to COVID-19, an influx of posttraumatic stress and mental health claims could also be on the way” (Marsh, 2020, p. 5).

It will take decades to fully understand what, if any, serious long-term side effects patients who have recovered from COVID-19 will face. Insurers face uncertain risk around tail costs, which include the potential for latent claims filed for lifetime medical, permanent disability, or death benefits.

The RAND Researchers conclude by saying “The effects of the COVID-19 pandemic on the U.S. business and labor market will last far beyond an official declaration that the pandemic has ended.”

Insurance Commissioner Ricardo Lara has been under fire since 2019, when news media reported questionable campaign contributions from associates of Applied Underwriters, while Applied was under investigation by the CDI, and seeking approval of the sale of the company..

At that time, Lara reported $31,000 in contributions from Stephen Acunto and his wife, Carole. Acunto is president of CINN Group, a New York publishing and financial services firm. Acunto, who also has served as a spokesman for Applied Underwriters. The donations came on April 30 2019, one month before Applied Underwriters alerted the California Department of Insurance that the company was in the process of being sold.

Although news media discontinued following the story, Consumer Watchdog pursued the investigation with Freedom of Information Act requests. And the lawsuit provided evidence this month that Lara and top lieutenant Bryant Henley communicated with two former lawmakers representing a workers’ compensation insurer at the heart of a pay-to-play scandal.

A new declaration from former legislator-turned-lobbyist Rusty Areias confirms that Commissioner Lara and Special Counsel Bryant Henley were in contact with Mr. Areias and former Assembly Speaker Fabian Nunez, Lara’s friend and political mentor. Nunez and Areias have emerged as central figures in the scandal following a lawsuit filed by Fabian Nunez’s former lobbying firm to collect a $2 million “success fee” from Applied Underwriters related to the sale of the company. The payment was to be made in exchange for Nunez and Areias’s successful efforts to protect a $60 million deposit.

The declaration of Mr. Areias was filed in Los Angeles Superior Court with a motion seeking to compel the Department to produce 200 internal communications regarding Consumer Watchdog’s public records requests. This Motion is scheduled for April 27, 2022 at 9:30 a.m. Department 86 of the Los Angeles Superior Court.

Judy Hein (DOB 07/04/49), of Rhinelander, Wisconsin, pled guilty to two counts of felony workers’ compensation insurance fraud.

Cal Roofing Inc was founded in 2007. From 2013 through 2017, Hein was a co-owner of Cal Roofing Inc. located in Simi Valley.

During that time, Hein underreported the true amount of company payroll by over $3 million to her workers’ compensation insurance company, State Fund. Hein’s fraud caused State Fund to lose $1.6 million in premium payments. At the time of her guilty plea, Hein paid $600,000 in partial restitution to State Fund.

Hein is scheduled to be sentenced on February 23, 2022, at 9:00 a.m. in courtroom 23 of the Ventura County Superior Court.

This case was investigated the California Department of Insurance Fraud Division and prosecuted by the District Attorney’s Office Workers’ Compensation Insurance Fraud Unit.