Category: Daily News

Gregg Rader sustained industrial injury to the psyche and in the form of emotional stress while employed by Ticketmaster Corporation. On November 19, 2011, a WCJ approved the parties’ Stipulations with Request for Award and awarded 100 percent permanent and total disability. Applicant’s attorney requested a fee of $39,444.71, based on applicant’s life expectancy. The WCJ approved the attorney fee request and ordered that the amount of attorney fees be commuted from weekly indemnity payments by uniform weekly reduction. Accordingly, while applicant’s nominal weekly permanent disability rate was $336.00, defendant reduced each payment by $50.40, yielding a net weekly payment of $285.60.

Applicant filed a Petition Amend the Award, and argued that the amount commuted from his permanent disability award has been fully satisfied, and that his weekly permanent disability indemnity should return to the nominal rate of $336.00 without reduction for additional attorney fees. Applicant’s calculations begin with the gross amount of attorney’s fees of $39,444.71, divided by the weekly commutation amount of $50.40. Applicant adds the resulting 782.63 weeks to the initial date of payment of June 6, 2008, resulting in the date of June 5, 2023 as “the date when the commutation of attorneys fees stops.”

Applicant further contends that he is entitled to statutory interest per Labor Code § 5800 on any sums improperly withheld and to penalties pursuant to section 5814 and attorney’s fees pursuant to section 5814.5 for defendant’s unreasonable delay in the payment of the disputed benefits.

Defendant’s Answer responds that applicant’s Award is silent as to the end date of commutation and any inference otherwise is improper. SCIF further contends that the WCAB lacks jurisdiction to alter or amend the Award at this juncture pursuant to section 5804.

The WCJ found that the Workers’ Compensation Appeals Board (WCAB) lacks jurisdiction to amend the applicant’s prior Award of permanent disability, and that applicant has not proven that additional indemnity payments are due beyond what is specified in the Award.

The WCAB granted reconsideration in the Significant Panel Decision of Gregg Rader v Ticketmaster -ADJ7138762 (January 2026) and substitute new Findings of Fact that the WCAB retains ongoing jurisdiction over the award of attorney’s fees pursuant to section 5803, and that because defendant has taken credit from applicant’s weekly payment of permanent indemnity in an amount equivalent to the dollar amount of commuted attorney’s fees, applicant is thereafter entitled to the full amount of his award without further reduction for attorney’s fees.

The panel noted that WCAB maintains exclusive jurisdiction pursuant to the California Constitution and Labor Code § 5300 to adjudicate workers’ compensation disputes.” (Dennis v. State of California (2020) 85 Cal.Comp.Cases 28 [2020 Cal. Wrk. Comp. LEXIS 1] (Appeals Board en banc).) The Appeals Board has continuing jurisdiction over all its orders, decisions, and awards made and entered. (Lab. Code, § 5803.) The Appeals Board may rescind, alter, or amend any order, decision, or award, for good cause.

However, section 5804 provides that “[n]o award of compensation shall be rescinded, altered, or amended after five years from the date of the injury.” As explained by our Supreme Court, the WCAB “is empowered with continuing jurisdictional authority over all of its orders, decisions and awards … However, this power is not unlimited … The WCAB’s authority under section 5803 to enforce its awards, including ancillary proceedings involving commutation, penalty assessment and the like, is not to be confused with its limited jurisdiction to alter prior awards by benefit augmentation at a later date. The latter action is subject to the provisions of sections 5410 and 5804.” (Nickelsberg v. Workers’ Comp. Appeals Bd. (1991) 54 Cal.3d 288, 297 [56 Cal.Comp.Cases 476].)

Thus, in contrast to the limitations imposed by the statute on the Appeals Board to augment previously awarded benefits or to set aside an entire award, the Appeals Board continues to have jurisdiction after five years to enforce its awards. (Barnes v. Workers’ Comp. Appeals Bd. (2000) 23 Cal.4th 679, 687 [65 Cal.Comp.Cases 780].) That is, the WCAB’s jurisdiction to enforce an award extends beyond section 5804’s five-year limitations period because an order ascertaining and fixing the exact amount of liability does not rescind, alter or amend any prior award in violation of section 5804. (Id.)

In Garcia v. Industrial Acci. Com. (1958) 162 Cal.App.2d 761, the Court of Appeal concluded that the “award of compensation to the employee is not altered or amended within the intended meaning of sections 5803 and 5804 by the allowance of the attorneys’ lien after the five- year period.” (Id. at p. 767.)

In Garcia, new attorneys substituted in more than five years after the date of injury to assist the injured worker in resisting a petition to reopen the case by defendant Subsequent Injuries Fund (now Subsequent Injuries Benefits Trust Fund). (Id. at pp. 762-763.) The Garcia court reasoned, “[t]he imposition of the attorneys’ lien after the five-year period would only amount to a reallocation or redistribution of the funds to be paid under the original award of compensation, i.e., the award of compensation is the same, only its payments are ultimately redirected by the imposition of a charge upon the award as security for the reasonable fee allowed 5 by the commission for legal services performed on behalf of the employee by his attorneys.” (Id. at p. 767, italics added.) Thus, the court determined that the underlying award of compensation remained the same even if a lien for attorney’s fees was allowed. (Id. at p. 767.)

Pursuant to the above authorities, the Appeals Board retains the jurisdiction under section 5803 to make collateral changes to an award so long as the merits of the basic decision determining the worker’s right to benefits are not altered, and the amount of benefits remains unchanged.

The panel concluded that the lateral commutation of attorney’s fees from an award of lifetime benefits is limited to the specified amount of attorney’s fees approved by the WCJ or the Appeals Board in the first instance. Once defendant has deducted an aggregate amount commensurate with the specified commuted attorney’s fees, no further deduction from applicant’s weekly indemnity payment is appropriate or permissible.”

An Orange County Superior Court judge was federally charged on January 7 with defrauding California’s workers’ compensation program. Israel Claustro, 50, was charged via information with one count of mail fraud, a crime that carries a statutory maximum sentence of 20 years in federal prison. Claustro signed a plea agreement in which he agreed to plead guilty to the felony charge. Claustro is expected to make his initial appearance on January 12 in United States District Court in Santa Ana.

Claustro has agreed to resign from his position as an Orange County Superior Court judge.

According to the plea agreement, Claustro – who was an Orange County prosecutor at the time of the fraud – operated Liberty Medical Group Inc., a Rancho Cucamonga-based medical corporation, despite being neither a physician nor a medical professional as required under California law.

One of Liberty’s employees was Dr. Kevin Tien Do, 60, of Pasadena, a physician who had served a one-year federal prison sentence after being convicted in 2003 of felony health care fraud. Because of this conviction, in October 2018, Do was suspended from participating in the California’s workers’ compensation program. Claustro was aware of Do’s prior criminal conviction and suspension from California’s workers’ compensation program.

According to the plea agreement, Claustro admitted that he defrauded California’s Subsequent Injuries Benefits Trust Fund (SIBTF), a special fund administered by California’s workers’ compensation program to provide additional compensation to injured workers who already had a disability or impairment at the time of a subsequent injury.

Specifically, Claustro paid Do more than $300,000 for preparing medical evaluations, medical record reviews, and med-legal reports after Do’s suspension. Claustro caused Liberty to mail these reports to California’s SIBTF, concealing that they were prepared by Do by listing other doctors’ names on the billing forms and reports. Based on these fraudulent submitted reports, Liberty received hundreds of thousands of dollars from SIBTF.

The loss amount from Claustro’s participation in this scheme is approximately $38,670 – the amount SIBTF paid to Liberty based on reports Claustro knew Do had drafted after his suspension from SIBTF.

In connection with this scheme, Do pleaded guilty in January 2025 to one count of conspiracy to commit mail fraud and one count of subscribing to a false tax return. Do is expected to be sentenced in the coming months.

“Judge Claustro violated the law for his personal financial benefit,” said First Assistant United States Attorney Bill Essayli. “We will not hesitate to prosecute anyone – judges included – who defraud public benefits intended to help those in need.”

The FBI, IRS Criminal Investigation, and the California Department of Insurance are investigating this matter.Former Special Assistant United States Attorney Stephanie Orrick of the Orange County Office prosecuted this case.

Stanley Ellicott has been sentenced to a term of three years in State Prison after pleading guilty and being convicted of seven felony counts of public corruption in connection to a complex scheme that defrauded the city of San Francisco of more than $627,000 directly from the Department of Human Resources’ Division of Workers’ Compensation, and another case where he aided and abetted public corruption.  Ellicott was remanded into custody and is currently in San Francisco County Jail, awaiting transfer to the California Department of Corrections and Rehabilitation’s custody in State Prison.

Ellicott pled guilty and was convicted of two counts of misappropriation of public moneys, grand theft, financial conflict of interest, presentation of fraudulent claim, money laundering, and aiding and abetting a financial conflict of interest in a government contract. His guilty plea and conviction settled two fraud cases he was facing.

Ellicott was born and raised in Maine. He earned a Bachelor of Arts degree from Wheaton College and a Master of Public Policy from the University of California, Berkeley’s Goldman School of Public Policy. Prior to his roles with the City and County of San Francisco, where he began working on and off in 2012, Ellicott was employed as an associate analyst at Moody’s.

Over a four-and-a-half-year period from May of 2019 to January of 2024, Ellicott stole $627,118.86 from the City, where he previously served as the Assistant Director of Finance and Technology for the Human Resources Department, Workers’ Compensation Division. One of his responsibilities was to oversee “the financial integrity of the Workers’ Compensation Division.”

Ellicott enlisted a friend to register a fake business in Illinois called “IAG Services” and open a bank account for the business, which she gave full control of to Ellicott.  Ellicott then added this fake business as a vendor in the workers’ compensation system and over time billed more than 600 actual City workers’ compensation claims with charges for auditing services.

Department archives show no evidence any auditing services were ever performed.  Because the City is self-insured for workers’ compensation purposes, payments to doctors, employees, and vendors related to workers’ compensation claims come directly from the City’s coffers.

All the City payments to “IAG Services” were deposited into the account set up by Ellicott’s friend, then the money was systematically transferred into Ellicott’s personal checking accounts in a pattern to appear like they were payroll payments. In total, he transferred more than $488,000 from IAG’s account into accounts belonging to him.

The website for the Illinois business “IAG Services” created in Oakland – where Ellicott lives – and IAG emails sent to Ellicott’s work address that appear to be created by him. On several occasions, Ellicott emailed his subordinates and directed them to process payments to IAG that he had approved, enlisting their unknowing and unwitting assistance in his fraud.

Ellicott also pled guilty to and was convicted in a separate case for his role in a scheme to misappropriate grant funds awarded through the City’s Community Challenge Grant Program.

The cases against Ellicott were prosecuted by Assistant District Attorney Erin Loback, with assistance from District Attorney Investigator Mike Reilly, paralegal Chloe Mosqueda and the entire Public Integrity Task Force.

Investigators were able to locate and freeze all of the stolen funds before he was arrested. The stolen $627,118.86 back to the City’s Worker’s Compensation Fund.”

Anthony Romero began his career with the Kern County Fire Department in October 1999 as a fireman. Over the years, he received positive performance reviews, earned certifications in fire prevention and code enforcement, and advanced through the ranks, becoming an engineer in 2009 and a captain in 2019.

In January 2020, Romero discovered that fire extinguishers on the county’s fire engines were being improperly serviced, which he believed posed a safety hazard and violated various laws and regulations. He reported these concerns verbally to his battalion chief and in writing to the deputy chief, who forwarded the complaint to the fire marshal. Shortly after, Romero received a text from the assistant fire marshal banning him from working in the fire marshal’s office or in fire prevention roles. Romero alleged this ban was retaliatory, but his internal complaints were dismissed, with the county citing “unauthorized overtime” as the reason.

In April 2020, he filed an internal relations complaint with the county’s Human Resources office, which was denied in July 2020. He escalated the issue to the Kern County Civil Service Commission in the fall of 2020 but withdrew it after assurances from the fire chief that it would be handled internally. Tensions escalated in January 2022 when Romero was notified of an investigation into possible misconduct, leading to his placement on administrative leave four months later. On October 4, 2022, the county terminated his employment, citing violations of civil service and fire department rules. Romero then filed a claim under the Government Claims Act on March 24, 2023, which the county rejected on May 8, 2023.

In September 2023, Romero sued the County of Kern in superior court, alleging wrongful termination in retaliation for his whistleblower activities in violation of Labor Code sections 1102.5, 6310, and 98.6. He filed a first amended complaint the following month, reiterating these three causes of action. After answering the complaint, the county moved for judgment on the pleadings, arguing that Romero failed to exhaust internal administrative remedies under Ordinance Code section 3.04.080 and related civil service rules, which require appealing dismissals to the Civil Service Commission.

The trial court ruled that Romero’s lawsuit was jurisdictionally barred because he failed to exhaust administrative remedies by appealing his termination to the Kern County Civil Service Commission under Ordinance 3.04.080 and rule 1700 et seq. It accepted the county’s argument that these procedures for challenging dismissals applied to Romero’s claims, regardless of their whistleblower retaliation basis.

The Court of Appeal reversed the judgment in the published case of Romero v County of Kern -F088325 (December 2025) concluding Romero was not required to exhaust the county’s internal remedies because they did not apply to or adequately address whistleblower retaliation claims.

The appellate court examined the exhaustion doctrine, noting that administrative remedies must be exhausted as a jurisdictional prerequisite where provided by statute or internal rules, as established in cases like Abelleira v. District Court of Appeal (1941) 17 Cal.2d 280 and Campbell v. Regents of University of California (2005) 35 Cal.4th 311. However, exceptions apply if remedies are unavailable, inadequate, or outside the agency’s jurisdiction, as in Lloyd v. County of Los Angeles (2009) 172 Cal.App.4th 320, where whistleblower claims fell outside discrimination-focused rules.

The court analyzed Kern County’s ordinances and rules. It agreed rule 1810 et seq. (for discrimination and harassment) did not apply to whistleblower retaliation. Focusing on Ordinance 3.04.080 and rule 1700 et seq. (for dismissals), it found these provided procedures for challenging disciplinary actions but lacked “clearly defined machinery” for submitting, evaluating, and resolving whistleblower retaliation complaints specifically. The rules required the commission to address only the appointing authority’s stated grounds for dismissal, not alternative claims like retaliation. Arguments were limited to rule violations, and the commission was not obligated to investigate or make findings on retaliation. This contrasted with explicit procedures for discrimination claims and cases like Campbell, where specific whistleblower policies existed.

The court distinguished the county’s position: while an employee might raise retaliation defensively, the commission was not required to address it, failing to promote exhaustion’s purposes like factual development or judicial economy. It cited precedents where optional or non-mandatory processes do not trigger exhaustion (e.g., City of Coachella v. Riverside County Airport Land Use Com. (1989) 210 Cal.App.3d 1277.

Alberto Mendoza began working as a Ventura County Deputy Sheriff in 2012, assigned to the Todd Road Jail Facility. In December 2014, he suffered a back injury after slipping on stairs, causing lower back discomfort. In May 2015, he sustained another back injury when an inmate kicked him in the right waist area during a subdue attempt. An MRI in May 2015 revealed degenerative disc disease at the L5-S1 level, a disc herniation abutting the right S1 nerve root, and extrusion of nucleus pulposus material also affecting the nerve root.

Mendoza was evaluated by several doctors. Dr. Robert Fields, the Qualified Medical Evaluator in his workers’ compensation case, recommended referral to a spine specialist and noted a high likelihood of needing surgery. Dr. Brian Grossman, an orthopedic surgeon, initially suggested physical therapy and an epidural injection but later concluded Mendoza had reached maximal medical improvement without surgery, though he discussed microscopic discectomy as an option; Mendoza declined, citing colleagues’ negative experiences. Dr. Sam Bakshian, his treating physician, reported worsening symptoms post-injection and requested authorization for a hemilaminectomy microdiscectomy at L5-S1, which the County authorized, but Mendoza refused due to fears and concerns about outcomes.

Subsequent MRIs in December 2015 and June 2017 showed progression of discopathy. Dr. Fields reevaluated Mendoza in 2016, urging surgery with a 90% chance of good to excellent results, allowing potential return to work. Mendoza continued to decline. By 2017, Dr. Bakshian recommended a more extensive laminoforaminotomy discectomy due to scar formation and annular tearing, but this was denied via utilization review for lack of objective evidence. Dr. Richard Rosenberg evaluated Mendoza in 2018 and 2019, opining he no longer needed surgery, had lost less than 5% lifting capacity, and could return to most deputy duties with accommodations, recommending a home exercise program and work hardening; Mendoza stopped the exercises due to pain and declined work hardening.

Mendoza testified at an administrative hearing that he refused surgery because his urinary incontinence resolved and he believed his body was improving, though he reported constant pain. The County presented evidence from radiologist Dr. Stephen Rothman that the 2017 MRI showed no nerve compression, and testimony that accommodations were possible. A supplemental report from Dr. Bakshian in 2020 agreed the disc extrusion resolved but noted significant disc height loss and dysfunction, now requiring decompression, neurolysis, and possibly fusion.

In May 2016, Mendoza applied for service-connected disability retirement benefits with the Ventura County Employees’ Retirement Association (VCERA). The County challenged the application, leading to an administrative hearing before a VCERA hearing officer in December 2019. The hearing officer issued proposed findings in October 2020, recommending denial because Mendoza unreasonably refused surgery with a high success probability (90% per Dr. Fields), stopped his home exercise program, and declined work hardening, potentially worsening his condition. The Board adopted this decision, denying benefits.

Mendoza then petitioned the Ventura County Superior Court for a writ of administrative mandate under Code of Civil Procedure section 1094.5, challenging the Board’s denial as an abuse of discretion and unsupported by evidence.

The trial court denied Mendoza’s writ petition, exercising independent judgment and upholding the Board’s findings. The court held Mendoza’s delay worsened his condition, making his disability self-inflicted rather than service-connected. Substantial evidence, including uncontradicted medical opinions, supported this, and Mendoza failed to meet his burden.

The Court of Appeal affirmed the trial court’s denial, in the published opinion of Mendoza v. Bd. of Retirement of the Ventura County Employee’s Retirement Association  -B327347 (December 2025). It reasoned that allowing benefits despite unreasonable refusal would undermine the doctrine’s purpose: preventing employees from relying on unfounded fears to reject treatment and claim disability.

The appellate court reviewed for substantial evidence supporting the trial court’s findings, given Mendoza’s vested right to benefits required independent judgment. It presumed the administrative findings correct, with Mendoza bearing the burden to show otherwise. The court applied the doctrine of avoidable consequences, which denies benefits if disability is caused, continued, or aggravated by unreasonable refusal of treatment with inconsiderable risk relative to injury severity.

The court found substantial evidence for the unreasonable refusal: recommendations from three doctors (Bakshian, Fields, Grossman), Dr. Fields’ 90% success opinion outweighing risks, and Mendoza’s fears based on anecdotal information. It noted conflicts in Dr. Bakshian’s testimony but deemed them insufficient to compel reversal. The court also upheld findings on refusal of work hardening and home exercises, and forfeiture of Mendoza’s sufficiency claim for omitting favorable evidence in his brief. It reasoned that allowing benefits despite unreasonable refusal would undermine the doctrine’s purpose: preventing employees from relying on unfounded fears to reject treatment and claim disability.