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Employee Waiver of Meal Breaks for 6 Hour Shifts are Valid

In 2014, La Kimba Bradsbery and Cheri Brakensiek filed a putative class action against their former employer, Vicar Operating, Inc.,alleging claims on behalf of “[a]ll individuals who worked for [Vicar] in California as a veterinary assistant, veterinary technician, surgery technician, kennel technician, client service representative, or similar position” in the four years before the complaint was filed.

Plaintiffs alleged Vicar failed to provide them with the meal periods required by section 512 and IWC Wage Order Nos. 4-2001 (Wage Order No. 4) and 5-2001 (Wage Order No. 5).

In April 2009, Plaintiffs each signed a written meal period waiver with Vicar. The waiver stated: “I hereby voluntarily waive my right to a meal break when my shift is 6 hours or less. I understand that I am entitled to take an unpaid 30-minute meal break within my first five hours of work; however, I am voluntarily waiving that meal break. I understand that I can revoke this waiver at any time by giving written revocation to my manager.”

Vicar moved for summary adjudication regarding the validity of this waiver under section 512 and the wage orders. Vicar argued the prospective meal period waiver was valid because “neither the Labor Code nor the wage orders specify what form the waiver must take, or when or how it may be obtained.”

Plaintiffs opposed, arguing prospective waivers were prohibited under Wage Order Nos. 4 and 5 (together, the “wage orders”), an opinion letter from the Division of Labor Standards Enforcement (DLSE) interpreting an agricultural wage order, and Brinker Restaurant Corp. v. Superior Court (2012) 53 Cal.4th 1004. Plaintiffs further argued employees could waive a meal period for a given shift only after they were scheduled to work that shift.

The trial court agreed with defendants and determined the waivers were valid and ruled for Vicar.The Court of Appeal affirmed in the published case of Bradsbery v. Vicar Operating, Inc. – B322799 (April 2025).

At issue in this case is the meaning of the phrase “waived by mutual consent” of the employer and employee in section 512 and the two wage orders, and whether that meaning prohibits the prospective written waivers Vicar had its employees sign.

The Court of Appeal noted that the text of section 512 and the text of the wage orders are all silent regarding the timing (prospective or as-accrued) and form (written or oral) of a meal period waiver for shifts between five and six hours. The text also does not define “waived” or “waiver.” The meal period waiver provisions at issue here in section 512 and section 11(A) of the wage orders do not require a written waiver (let alone in mandatory language).

The administrative history of the wage orders reflects the IWC has not viewed prospective written waivers as negatively as Plaintiffs suggest. The waiver of off-duty meal periods in a prospective written agreement instituted in 1976 was at the request of employees on wage boards and was seen by the IWC as protecting employees and employers. Similarly, in promulgating the waiver provisions for health care employees working eight-hour shifts in 1993, the IWC characterized the use of waivers as a ‘protective condition[]” for employers and employees.’ “

In short, we believe it is reasonable to infer the Legislature and IWC wanted to be more protective of employees who worked longer shifts and for that reason spelled out in detail what is required to waive a right to a meal break for shifts over eight hours for health care employees and over 12 hours for all other covered employees. But it does not follow that when employees work fewer hours, here between five and six hours, that there was also an intent to prohibit a prospective written waiver.”

Plaintiffs relied heavily on their reading of Brinker. In their view, Brinker, supra, 53 Cal.4th 1004, interpreted the same meal period waiver provisions at issue in this case and supports their reading of the statute and wage orders. In Brinker, the California Supreme Court considered, as relevant here, “(1) the nature of an employer’s duty to provide employees with meal periods; and (2) the timing requirements applicable to the provision of meal periods.”

However “Brinker did not address the requirements for the waiver of rest breaks. (See Brinker, at p. 1033.) For these reasons, we do not find Plaintiffs’ reading of this passage from Brinker persuasive.”

PAGA One Year Statute of Limitations Applies to Penalties

Corbin Williams worked as an insurance adjuster for Alacrity Solutions Group, LLC starting in 2014. While employed, Williams “typically” worked 84-hour weeks – that is, 12 hours a day, seven days a week. He was an hourly employee. As a result, he was entitled to overtime pay whenever he worked more than eight hours in a day or 40 hours in a workweek, and was also entitled to overtime pay whenever he worked a seventh consecutive day.

But defendant did not pay Williams any overtime pay. As a result, defendant violated the Labor Code by not paying Williams all the wages he was owed and by issuing Williams inaccurate wage statements. (§§ 201- 203, 510 et seq., 226, 1174, 1174.5.

Williams’s employment with defendant ended in January 2022.It was not until March 7, 2023 – more than a year after his employment ended – that Williams provided written notice to California’s Labor & Workforce Development Agency (the Agency) of his intent to pursue a PAGA action for defendant’s Labor Code violations.

A few days later, on March 10, 2023, Williams sued defendant. In the operative first amended complaint, Williams asserted a single claim under PAGA seeking civil penalties “on behalf of the State of California and other current and former employees” – but, critically, not on his own behalf – for the alleged overtime and wage statement violations occurring in the “one year prior” to the written notice Williams filed with the Agency on March 7, 2023.

Defendant demurred to the complaint, arguing Williams failed to state a cause of action because (1) his PAGA action was barred by the one-year statute of limitations, and (2) he lacked standing to assert a PAGA action.

In his opposition, Williams effectively conceded that any individual claim he might assert under PAGA was “barred by the statute of limitations,” but maintained that this untimeliness was irrelevant because the PAGA action he alleged sought only to recover civil penalties on behalf of other aggrieved employees and the State.

The trial court issued an order sustaining the demurrer without leave to amend. The Court of Appeal affirmed in the Published case of Williams v. Alacrity Solutions Grp. – B335445 (April 2025).

The Private Attorneys General Act (PAGA) (Lab. Code, § 2698 et seq.) authorizes an “aggrieved employee” to step into the shoes of the State of California and sue for civil penalties premised on certain violations of the Labor Code “on behalf of himself or herself and other current or former employees.”

In this case, a former employee was barred by the statute of limitations from suing his former employer for civil penalties on his own behalf under PAGA. (Code Civ. Proc., § 340, subd. (a) [one-year limitations period].) So the former employee sued solely to recover penalties “on behalf of . . . other current and former employees.”

Is this allowed? The Court of Appeal held it is not. To be a PAGA plaintiff (under the statutes in effect prior to July 1, 2024), a private individual must, among other things, seek to recover civil penalties on his own behalf for that violation (Leeper v. Shipt, Inc. (2024) 107 Cal.App.5th 1001, 1008-1010 (Leeper), review granted Feb. 18, 2025), and must establish that this so-called “individual claim” is timely as to at least one Labor Code violation (Arce v. The Ensign Group, Inc. (2023) 96 Cal.App.5th 622, 630 (Arce); LaCour v. Marshalls of California, LLC (2023) 94 Cal.App.5th 1172, 1184- 1185 (LaCour); Hutcheson v. Superior Court (2022) 74 Cal.App.5th 932, 939 (Hutcheson); Esparza v. Safeway, Inc. (2019) 36 Cal.App.5th 42, 59 (Esparza); Brown v. Ralphs Grocery Co. (2018) 28 Cal.App.5th 824, 839 (Brown)).

“Because the employee in this case has not and cannot satisfy these requirements, the trial court properly sustained a demurrer to the PAGA action without leave to amend.”

SCOTUS Shifts Burden of Proof to Employers in ERISA Litigation

In Cunningham et al. v. Cornell University et al., the plaintiffs, a class of over 30,000 current and former Cornell University employees enrolled in two 403(b) retirement plans, alleged violations of the Employee Retirement Income Security Act of 1974 (ERISA). The plaintiffs, led by Casey Cunningham, claimed that Cornell University and its fiduciaries breached their fiduciary duties under ERISA by mismanaging the retirement plans, which held nearly $3.4 billion in net assets.

They alleged Cornell engaged in prohibited transactions – (ERISA § 1106(a)(1)(C)) – by paying excessive fees to the plans’ service providers, specifically Teachers Insurance and Annuity Association of America (TIAA-CREF) and Fidelity Investments, for record keeping and investment management services. These payments were alleged to violate ERISA’s prohibition on transactions between the plan and a “party in interest” (e.g., service providers), as the fees were deemed unreasonable and not justified by the services provided.

The plaintiffs argued that merely alleging a transaction with a party in interest was sufficient to state a claim under ERISA § 1106(a)(1)(C), and that exemptions under § 1108(b)(2) (allowing reasonable and necessary services) were affirmative defenses that Cornell had to prove.

Cornell University, along with its appointed fiduciaries, denied the allegations and argued that the plaintiffs failed to meet the legal threshold for their claims.

Cornell maintained that the plaintiffs’ allegations were insufficient to state a claim under ERISA § 1106(a)(1)(C). They argued that plaintiffs needed to plead specific facts showing that the transactions were unnecessary or involved unreasonable compensation, not just that a transaction occurred with a party in interest.

The university contended that ERISA § 1106(a) must be read in conjunction with § 1108 exemptions, which permit reasonable and necessary transactions (e.g., for recordkeeping services). Cornell argued that these exemptions are integral to the claim’s elements, not merely affirmative defenses.

They asserted that the recordkeeping services provided by TIAA-CREF and Fidelity were standard, necessary for plan operations, and that the fees were not excessive when viewed in the context of the services’ quality and market st

The lawsuit was filed in 2016 in the U.S. District Court for the Southern District of New York, which dismissed the prohibited transaction claims and granted summary judgment to Cornell on most fiduciary duty claims, finding that the plaintiffs failed to show loss or provide sufficient evidence of imprudence.

The Second Circuit affirmed in 2023, holding that plaintiffs must plead that the transactions were unnecessary or involved unreasonable compensation to survive a motion to dismiss, effectively incorporating § 1108 exemptions into the pleading requirements for § 1106(a) claims.

The Supreme Court granted certiorari to resolve a circuit split on the pleading standard for prohibited transaction claims, with the plaintiffs arguing that the Second Circuit’s approach improperly shifted the burden to them to negate exemptions, while Cornell defended the ruling as necessary to prevent baseless lawsuits.

On April 17, 2025, the Supreme Court unanimously reversed the Second Circuit (U.S. Supreme Court, No. 23-1007, decided April 17, 2025), holding that to state a claim under ERISA § 1106(a)(1)(C), plaintiffs need only allege the elements of the provision itself (i.e., a transaction with a party in interest) without addressing potential § 1108 exemptions. The Court clarified that § 1108 exemptions are affirmative defenses, which defendants must raise and prove. The case was remanded for further proceedings consistent with this ruling.

$1M Verdict Against LAPD for FEHA Violations Affirmed

Vincent Albano joined the Los Angeles Police Department in 1997. He developed chronic fatigue syndrome caused by a Coxsackie B4 virus in 2003, leading to severe fatigue, insomnia, and body aches. In 2004, he took medical leave, returned with restrictions for “desk duties/low stress” and “day shifts only,” and was assigned to the detectives’ desk at Harbor Division, where he worked from 2004 to 2018 with positive performance reviews.

In 2018, despite plans to transition Albano to the Property Disposition Coordinator role, which suited his medical restrictions, the LAPD reassigned him to a night shift patrol desk position, violating his restrictions. This decision followed a meeting with Teresa Chin, who inquired about his condition but did not discuss accommodations or inform him of the reassignment. The new captain, Greg McManus, reportedly believed Albano was faking his illness and eliminated the detectives’ desk position.

No further interactive process occurred to address Albano’s restrictions or explore alternative accommodations, despite his long-standing medical documentation and prior engagement with the department.

The reassignment exacerbated Albano’s symptoms, causing severe hypertension, chronic fatigue flare-ups, and emotional distress, leading to medical leave in December 2018. Feeling targeted and unable to work night shifts, Albano retired in June 2019 after 21.5 years of service, incurring financial hardship due to a reduced pension and medical subsidy.

He filed a lawsuit in 2020, alleging FEHA violations. At trial, the jury rejected the failure-to-accommodate claim but found the City liable for failing to engage in the interactive process, awarding Albano $700,000 in past noneconomic damages and $300,000 in future noneconomic damages for physical pain, emotional distress, and loss of identity.

The City’s motion for a new trial was denied, and the Court of Appeal affirmed the judgment, finding substantial evidence supported the jury’s verdict and damages award in the unpublished case of Albano v. City of Los Angeles – B329165 (April 2025).

On appeal, the City of Los Angeles raised two primary arguments challenging the jury’s verdict and damages award in Vincent Albano’s case.

The City contended that substantial evidence did not support the jury’s finding that it failed to engage in the interactive process under the Fair Employment and Housing Act (FEHA). Specifically, the City argued that Albano failed to initiate the interactive process after learning of his reassignment to the night shift patrol desk position in December 2018, asserting that he bore the burden of reinitiating the process. Albano’s medical leave starting December 11, 2018, halted the interactive process because LAPD policy prohibited engaging in the process until he returned to work.

It also argued that Albano could not prevail because he failed to identify a reasonable accommodation that would have been available during the interactive process. The jury’s verdict was inconsistent, as the finding that the City failed to engage in the interactive process could not be reconciled with the jury’s finding that the City did not fail to provide a reasonable accommodation. (Note: This argument was referenced in the trial court motion but not developed in the City’s opening brief on appeal, leading the court to consider it abandoned or forfeited.)

In its second primary argument the City claimed that the jury’s award of $700,000 in past noneconomic damages and $300,000 in future noneconomic damages was excessive and not supported by substantial evidence.

The Court of Appeal rejected these arguments, finding substantial evidence supported both the jury’s finding of liability for failing to engage in the interactive process and the damages award, and that the award did not shock the conscience or suggest passion, prejudice, or corruption by the jury.

Major TPA Faces Challenge by Excess Carrier After $34.5M Verdict

Braulio Ruvalcaba was employed by Santa Cruz City Schools as a custodian. In 2016, he suffered a back injury on the job. Keenan & Associates was the District’s workers’ compensation claims administrator.He returned to work with basic accommodations and was able to perform essential job duties for nine months. However on January 9, 2018 the District terminated his employment.

On March 30, 2020, Ruvalcaba filed his First Amended in Complaint Santa Cruz Superior Court (19-CV-00488) against Santa Cruz City Schools and Keenan and Associates alleging (1) disability discrimination under California Government Code (“Gov. Code”) § 12940(a); (2) failure to accommodate under Gov. Code § 12940(m); (3) failure to engage in a good-faith interactive process under Gov. Code § 12940(n); (4) failure to prevent discrimination under Gov. Code § 12940(k) (against the District only); and (5) wrongful termination in violation of public policy.

The plaintiff alleged that Keenan provided misleading information to the District, leading to the mistaken belief that Ruvalcaba was too injured to continue working. Specifically Keenan allegedly instructed the District to disregard medical information not provided by Keenan itself. And Keenan allegedly withheld medical reports that would have shown Ruvalcaba’s ability to perform his job, even without accommodations. This conduct was claimed to have aided, abetted, incited, coerced, or compelled the District’s failure to accommodate and wrongful termination.

According to media information, Keenan conceded that it failed to transmit accurate medical information to the District, it claimed these were innocent mistakes and oversights rather than intentional efforts to discriminate against plaintiff or get him fired. Keenan claimed that the District was solely responsible for the decision to terminate plaintiff and its refusal to rehire him, and that it was not appropriate for the District to blame Keenan for those decisions.

The jury trial lasted 17 days. They returned verdicts against Keenan on May 23 and May 24, 2022. The verdict against Keenan totaled $6,908,000 for compensatory itemized damages related to emotional distress and $27,600,000 in punitive damages.The total verdict amounted to $34,508,000 against Keenan, with the District also liable for portions of the noneconomic damages.

AP Keenan is a division of Assured Partners, Inc., the eleventh largest insurance broker in the United States and a company with more than $1.6 billion in annual revenues according to its own website. Ironshore Indemnity issued Excess Financial Institutions Professional Liability policy to Assured Partners, for the policy period October 1, 2019 to October 1, 2020. It followed Insurance Agents and Brokers Professional Liability Policy issued by Allied World Insurance Company (“Allied”), for the policy period October 1, 2019 to October 1, 2020, with limits of $15,000,000. The MAIC Policy provides excess coverage over the followed policy with an aggregate limit in the amount of $10,000,000 excess of $15,000,000. The Ironshore Indemnity Policy provides an aggregate limit of $10,000,000 excess of the total $25,000,000 limits of the Followed Policy and the MAIC Policy.

Ironshore is a subsidiary of Liberty Mutual Insurance Company. Its lawsuit Ironshore Indemnity, Inc. v. Keenan & Associates (Case No. 2:25-cv-03310) was filed on April 15, 2025 in the United States District Court for the Central District of California, and it is a declaratory judgment action asking the court to determine whether it has a duty to defend or indemnify Keenan for the Ruvalcaba judgment.

Ironshore asserts that California Insurance Code Section 533, prohibits insurers from covering losses caused by an insured’s willful acts. The lawsuit points to the Ruvalcaba jury’s findings and answers to questions required for the verdict. And Ironshore claims these findings support that Keenan intentionally conspired with the school district and acted with “willful, malicious, and oppressive” conduct. Ironshore asserts that both the compensatory and punitive damages fell outside its policy’s coverage. The company also noted that its policy followed the terms of the Allied World policy, which excluded amounts uninsurable under applicable law, further reinforcing its stance.

The Ruvalcaba case, and its aftermath, is highly significant to the California workers’ compensation industry. The California Labor Code section 3762, along with related regulations and privacy laws, impose specific restrictions on the release of medical reports by a workers’ compensation claims administrator to the employer involved in the claim. However, these restrictions are nuanced and depend on the context, the purpose of the disclosure, and compliance with privacy laws such as the California Confidentiality of Medical Information Act (CMIA) and federal regulations like the Health Insurance Portability and Accountability Act (HIPAA).

Specifically the claims administrator is authorized to release “Medical information regarding the injury for which workers’ compensation is claimed that is necessary for the employer to have in order for the employer to modify the employee’s work duties.” Otherwise they “are prohibited from disclosing or causing to be disclosed to an employer, any medical information, as defined in Section 56.05 of the Civil Code, about an employee who has filed a workers’ compensation claim.”

In light of the above, some may argue that fine line exists between the juxtaposition of what a claims administrator must release to avoid liability such as what happened in the Ruvalcaba case, or legal liability for disclosing what might be argued as protected medical information that should not have been disclosed. And there seems to be little guidance on use on a case by case basis, especially in cases that contain perhaps hundreds of pages of narrative medical information.

39 State AGs Ask Congress to End PBM Pharmacy Ownership

The California Attorney General along with 38 attorneys generals, which includes those representing United States territories and the District of Columbia, urge Congress to pass an act prohibiting pharmacy benefit managers, their parent companies or affiliates from owning or operating pharmacies, according to an April 14 letter to Congress.

According to this letter, “PBMs have overtaken the market and now wield outsized power to reap massive profits at the expense of consumers. The rise of PBMs as middlemen in the prescription drug market has resulted in patients facing fewer choices, lower quality care, and higher prices.3 PBMs’ use of affiliated pharmacies—pharmacies owned by either the PBM itself or the PBM’s parent company—has exacerbated the problem of manipulated prices and unavailability of certain prescription medications.”

Over the past few decades, horizontal consolidation and vertical integration have transformed PBMs from useful administrative service providers into market-dominating behemoths that control the industry. The three largest PBMs process 80% of the nation’s prescriptions and bring in 70% of the specialty drug revenue. Furthermore, these same PBMs, along with the next largest three, are vertically integrated both upstream and down. Each of the top six PBMs operate their own affiliated pharmacies, while five of the top six are also a part of parent conglomerates that operate insurance companies and health care clinics.”

The PBMs then use their place as middlemen to exert this power in ways that harm independent pharmacies, forcing these small businesses to accept contractual terms that are ‘confusing, unfair, arbitrary, and harmful.’ PBMs’ position further allows and incentivizes them to provide their affiliated pharmacies with more favorable contract terms, steer consumers away from independent pharmacies to their own affiliated pharmacies, and otherwise engage in tactics aimed at forcing their competition out of business. Over the course of the last decade, approximately ten percent of rural independent pharmacies in the United States have closed.”

“The control of the pharmaceutical ecosystem by PBMs has resulted in decreased access, affordability, and choice for many Americans seeking prescription healthcare. Congressional action is warranted to restore a free market and protect consumers and small businesses.”

As self-designated middlemen, PBMs should not be permitted to own or operate affiliated pharmacies. Further, they should not be able to skirt such a prohibition by having a parent company or other affiliated healthcare conglomerate own a pharmacy. PBMs should be prohibited from having direct ownership ties to the parties they purport to be bridging. This requirement would allow pharmacies to compete on fair terms and create a market that is more accessible to consumers.”

Studies Show Surgeons Continue to Leave Materials in Patients

A Hearst Newspapers investigation, published on April 16, 2025, revealed that surgeons across the United States have inadvertently left surgical materials – such as sponges, wires, needles, drill bits, instruments, and broken tool fragments – inside patients’ bodies over the past decade. The full article is available on Hearst Newspapers’ platforms, such as the San Francisco Chronicle or Houston Chronicle

These incidents, known as retained surgical items (RSIs) or “never events,” are rare but can have severe consequences, including infections, organ damage, additional surgeries, and, in extreme cases, death. The investigation, conducted by reporters Emilie Munson and Leila Merrill, highlights the persistence of these medical errors despite protocols designed to prevent them, such as mandatory counting of surgical items and the use of radiopaque sponges visible on X-rays.

While exact numbers vary due to underreporting, studies cited in related sources estimate RSIs occur in approximately 1 in every 5,500 surgical procedures, with around 1,500 cases annually in the U.S. The Hearst investigation emphasizes that these incidents often require additional surgeries, extend hospital stays, and cause significant patient harm, such as infections, abscesses, or organ damage. For example, retained sponges, which account for 48% to 69% of RSIs, can lead to “gossypiboma,” where the body forms a mass around the foreign object, causing pain or complications like fistulas or bowel obstructions.

The investigation notes a range of items left behind, including:

– – Surgical sponges and gauze (most common, often used in large quantities during procedures).
– – Needles, wires, and drill bits.
– – Surgical instruments like clamps or retractors.
– – Broken fragments of tools, such as catheter tips or parts of wire cutters.These items are typically left in the abdomen, pelvis, or chest, but cases have been reported in vaginas, spinal canals, and even brains

The investigation points to human error as a primary cause, often due to:

– – Inaccurate manual counting of surgical items, which can be disrupted by complex procedures, shift changes, or distractions.
– – Poor communication among surgical teams.
– – Complacency or overconfidence in counts reported as correct, even when items are missing.
– – Inadequate documentation or failure to follow protocols like the World Health Organization’s surgical safety checklist.

The investigation references specific cases to illustrate the human toll:

– – A 2021 case where a woman suffered for 18 months after a plastic wound retractor (the size of a dinner plate) was left inside her abdomen following a C-section. An abdominal CT scan eventually
– – A 2018 case in Japan where a woman experienced abdominal bloating for six years due to two gauze sponges left during a C-section, which had adhered to her connective tissue and colon
– – A California man who suffered infections and septic shock from two retained surgical clamps, leading to a stroke.

The investigation underscores systemic challenges, including:

– – Underreporting of RSIs due to inconsistent definitions, varying reporting requirements, and fear of litigation.
– – Limitations of manual counting processes, which are prone to error in high-stress, complex surgeries, especially those involving obese patients or trauma cases requiring numerous instruments
– – Resistance to adopting new technologies, such as RFID-tagged sponges or barcode systems, due to cost or integration challenges, despite their potential to reduce errors.
– – RSIs lead to significant costs for hospitals, with a single case potentially costing up to $600,000 due to corrective surgeries and legal fees. Malpractice claims are common, with a 2003 study noting an average of $52,000 in compensation and legal expenses per case.

Hospitals employ several strategies to prevent RSIs, including:

– – Surgical teams count sponges, instruments, and other items before and after procedures. However, studies show that counts are often recorded as correct even when items are left behind.
– – Sponges and some instruments are embedded with X-ray-detectable materials to aid identification if left inside a patient.
– – The WHO surgical safety checklist and National Safety Standards for Invasive Procedures aim to standardize safety checks, but compliance varies.
– – Systems like ORLocate’s Surgical Counting and Detection System use RFID or barcode technology to track items more accurately, but adoption is not widespread.

Despite these measures, the investigation notes that errors persist due to the complexity of surgical environments, staff fatigue, and organizational pressures, such as high workloads or frequent staff changes during procedures.

The Hearst investigation aligns with prior studies and reports highlighting RSIs as a persistent patient safety issue. For instance, a 2008 study at the Mayo Clinic found RSIs in 1 in 5,500 surgeries, with most counts incorrectly reported as accurate. A 2017 article from the National Center for Biotechnology Information (NCBI) notes that RSIs can be life-threatening, often requiring further operations. The investigation also reflects Hearst Newspapers’ history of award-winning investigative journalism, as seen in their Polk Awards for reporting by the San Antonio Express-News and San Francisco Chronicle.

Discover Magazine on RSIs discusses real-world cases, such as the 2021 C-section retractor case and the 2018 Japanese gauze case, with broader implications. Washington Post on Never Events Reports 4,857 objects left in patients over two decades, with insights into malpractice claims and systemic issues. Times Union on New York Cases details specific RSI incidents, including a surgical sponge missed during a hysterectomy due to incorrect counting. PSNet on RSI Epidemiology offers data from California’s reporting system (2007–2011), noting 58% of RSI cases involved sponges or towels. Minnesota Department of Health reports 270 retained objects since 2003, emphasizing sponges and clamps as common items.

Misdated VA PACT Act Disability Decisions Cost Millions

The PACT Act (Promise to Address Comprehensive Toxics Act of 2022) is a landmark law that expands VA health care and benefits for veterans exposed to toxic substances, such as burn pits, Agent Orange, and radiation. Signed into law on August 10, 2022, it is considered one of the largest expansions of veteran benefits in U.S. history.

However a sampling of disability claims filed under the 2022 PACT Act found that roughly one-quarter listed incorrect start dates, resulting in improper payouts of about $6.8 million to some veterans and shortchanging an estimated 2,300 others, the Department of Veterans Affairs’ internal watchdog found.

In a report released this month, the Veterans Affairs Officer of Inspector General concluded that the legislation’s complexity, along with inadequate guidance from the Veterans Benefits Administration, led claims adjudicators to assign the wrong “effective date” to an estimated 26,000 claims, resulting in overpayment by the government in the first year of the legislation.

An estimated 2,300 additional claims had erroneous dates — including some that should have been made retroactive to a date before the law was signed, increasing compensation for veterans — but the watchdog agency said it “could not determine their monetary impact” on any affected veterans.

According to the VA, it has received 2.44 million PACT Act-related claims since the law went into effect. It has adjudicated 2.14 million claims and approved 1.59 million and, as of May 2024, had awarded $5.7 billion in related benefits to veterans or survivors. The VA OIG estimated that the VA will have made an estimated $20.4 million in improper payments in the first three years of the law, representing about 0.36% of payouts.

Some veterans who had diagnosed conditions covered by the PACT Act prior to its passage were eligible for retroactive benefits back to their date of diagnosis. After Aug. 10, 2023, any approvals under the act would have the date of application as a start date for benefits or, in the case of intentions filed before that date, to Aug. 10, 2022.

The complexity of determining the correct start date led the VA OIG to review claims for accuracy.

To figure out whether the VA was assigning effective dates correctly, the watchdog examined a statistical sampling of 100 claims filed in the law’s first year. Based on that analysis, the OIG estimated that the VBA assigned an incorrect effective date to roughly 26,100 of 131,000 claims, and it found it likely that an additional 2,300 should have been assigned a date that may have awarded veterans and their families more money.

“Errors that had the potential to affect veterans’ compensation benefits payments occurred when claims processors decided claims before taking all the necessary steps, such as gathering additional evidence, to determine whether a more advantageous effective date applied,” wrote Larry Reinkemeyer, the VA’s assistant inspector general for audits and evaluations, in the report. “As a result, some veterans did not receive their correct benefit payments.”

The OIG found that mistakes were made because claims processors were not adequately prepared to determine correct effective dates. The team added that the automated tools created to provide assistance in determining a date “were unreliable.” The team also noted that claims processors had made the VBA aware of the complexities, and the administration had taken steps to include updated training and conduct reviews to ensure accuracy.

WCAB Denied Commutation of 76% PD Award to Pay Bills

Chester Taylor worked as a kosher food manager/inmate laborer for State of California, Department of Corrections Inmate Claims when he sustained an industrial injury to his bilateral arms on January 20, 2017.

The injury was resolved through a Stipulated Findings & Award on April 6, 2024, which provided him with a 76% permanent disability rating. The defendant, State Compensation Insurance Fund (SCIF), paid permanent disability benefits at a weekly rate of $160.00, totaling $49,406.39 through December 13, 2024.

Mr. Taylor filed a petition to commute his remaining permanent disability benefits into a lump sum, covering the period from December 13, 2024, for the remainder of his life expectancy.

At trial, he testified that his monthly income (from Social Security, workers’ compensation, and SNAP benefits) totaled $2,428.00, while his expenses (rent, food, medical copays, and dental expenses) amounted to $1,251.00. He claimed to be in arrears by $300.00 to $600.00 per month, borrowing approximately $600.00 per week from his daughter. However, he provided no documentary evidence to substantiate these figures.

The presiding Workers’ Compensation Administrative Law Judge (PWCJ) denied Mr. Taylor’s petition, finding that he failed to meet the burden of proof under Labor Code § 5100(a). The lack of documentary evidence supporting his financial claims and the unclear calculations of his expenses were critical factors.

The WCAB denied reconsideration in the panel decision of Chester Taylor vs. State of California, Department of Corrections Inmate Claims – ADJ13319691 (April 2025).

Under Labor Code § 5100(a), commutation of benefits is allowed if it is “necessary for the protection of the person entitled thereto, or for the best interest of the applicant.” Additionally, § 5100(b) requires that commutation must avoid inequity and not cause undue expense or hardship to the applicant.

The Workers’ Compensation Appeals Board (WCAB) has discretion to grant or deny commutation, and the applicant bears the burden of proving the necessity of commutation. (Hulse v. Workers’ Comp. Appeals Bd. (1976) 63 Cal.App.3d 221, 226 [41 Cal.Comp.Cases 691].)

The PWCJ also noted that commuting the benefits could potentially cause undue hardship, as Mr. Taylor’s current income, including permanent disability payments, was insufficient to cover his expenses. Commuting the benefits would reduce or eliminate this income stream, potentially exacerbating his financial difficulties.

The WCAB, in its Opinion and Order dated April 8, 2025, adopted and incorporated the PWCJ’s report and denied the Petition for Reconsideration, affirming the PWCJ’sdenial of commutation.

The WCAB noted that Mr. Taylor remains free to file a new petition for commutation if he can provide adequate evidence meeting the requirements of Labor Code § 5100(a) and (b).

Insurance Agent and Son Charged With $1.4M Commission Fraud

The California Department of Insurance announced that five individuals, including former insurance agents, have been charged in a large-scale insurance fraud scheme involving misrepresented life insurance policies that resulted in fraudulent commissions totaling over $1.4 million.

Daniel Jon Carpenter, 62, of Morgan Hill, was arraigned on felony charges of insurance fraud, grand theft, and identity theft. Carpenter, a former insurance agent, allegedly orchestrated the fraudulent scheme alongside four co-defendants.

– – Natorae Marie Wettstein, 56, of Rancho Mirage, was arraigned on felony charges of insurance fraud and grand theft.
– – Blake John Carpenter, 27, of San Jose, the son of Daniel Jon Carpenter, was arraigned on felony charges of insurance fraud and grand theft.
– – Noah Maxwell Kuh, 26, of San Jose, was arraigned on a felony charge of insurance fraud.
– – Alejandro Carlos, 25, of Gilroy, remains a fugitive at large and is wanted on felony charges of insurance fraud and grand theft.

The Department of Insurance launched its investigation after receiving a complaint from a consumer alleging forgery and insurance fraud linked to life insurance policies sold by Daniel Carpenter.

The investigation revealed that Carpenter, in conjunction with Wettstein, Blake Carpenter, Carlos, and Kuh, misrepresented life insurance policy terms to California consumers while falsifying agent information on policy applications submitted to multiple insurance companies. This deceptive scheme allowed them to collect unearned commissions from four insurance carriers between 2017 and 2023.

In total, the defendants fraudulently obtained over $1.4 million in commissions by manipulating over $2 million in insurance premiums from 28 California consumers. The California Department of Insurance has successfully assisted in recovering over $2 million for the affected victims.

Carpenter, Wettstein, Blake Carpenter, and Kuh are scheduled to return to court on April 25, 2025. Anyone with information on Carlos’ whereabouts is asked to contact the Department at 707-751-2000. The Santa Clara County District Attorney’s Office is prosecuting the case.

According to Santa Clara County Superior Court records one client, Alex Lowry, sued Carpenter and Wettstein in 2021, alleging Carpenter forged his signature to purchase two $7.5 million life insurance policies, with Wettstein listed as the agent due to Carpenter’s lack of authorization.

Wettstein claimed Lowry was repaid $190,000 in premiums and knowingly held the policies, while Carpenter denied the allegations but offered to settle. Lowry dropped the case in August 2024 for unclear reasons.