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Category: Daily News

Former Police Officer to Serve 6 Months for Comp Fraud

A former Costa Mesa Police Department officer was sentenced to six months in county jail for committing insurance fraud by presenting a false insurance claim and making false material statements related to the claim.

On Sept. 23, 2014, Ryan Patrick Natividad, 32, Corona, who was employed as a CMPD officer at the time of the crime, reported a work-related injury to CMPD.

Natividad falsely claimed that earlier in the day, he struck his hand against a brick wall near the CMPD jail while transporting an arrestee for booking. The defendant claimed that the arrestee stumbled into the wall, prompting him to use his hand to prevent the arrestee from striking the wall. He was subsequently directed by CMPD to seek immediate medical attention.

Natividad listed a jail employee as a witness to the incident in his injury paperwork.

The employee reviewed the jail surveillance camera footage, determined that the incident the defendant reported never occurred, and brought the video footage to his supervisor’s attention.

The video was submitted with Natividad’s workers’ compensation insurance claim to the City of Costa Mesa.

The City of Costa Mesa, the city’s insurance company AdminSure, and a private investigation firm hired by AdminSure investigated Natividad’s workers’ compensation insurance claim and reported the fraud to the Orange County District Attorney’s Office, who investigated this case.

He was found guilty of one felony count each of Insurance fraud Making a fraudulent statement after a jury trial on Feb. 16, 2017.

He was now sentenced to six months in county jail, tree years formal probation and ordered to pay restitution.

Deputy District Attorney Noor Hasan of the Insurance Fraud Unit prosecuted this case.

Cal/OSHA and Chevron Settle Safety Citation Appeal

Cal/OSHA and Chevron have reached a settlement agreement for a comprehensive plan that will improve safety at the Chevron Richmond refinery and for surrounding communities.

The agreement resolves Chevron’s appeal of citations issued by Cal/OSHA on January 30, 2013, following an investigation into a fire that occurred at the Richmond refinery on August 6, 2012. Cal/OSHA cited Chevron for 17 workplace safety and health violations, including six serious and nine willful in nature.

On August 6, 2012, a large fire erupted at the refinery at about 6:15 PM. Flames were seen issuing from at least two of the refinery’s towers. Contra Costa Health Services responded by notifying residents shelter in place. BART shut down local service. Initial reports estimated that 11,000 people sought treatment at area hospitals, and later reports placed the number above 15,000 people. Six employees that were present at the scene of the fire suffered varying degrees of injury.

Cal/OSHA immediately launched an investigation into the fire and the leak repair procedures throughout the refinery, and found that Chevron did not follow the recommendations of its own inspectors and metallurgical scientists to replace the corroded pipe that ultimately ruptured and caused the fire. They also found that Chevron did not follow its own emergency shutdown procedures when the leak was identified, and did not protect its employees and employees of Brand Scaffolding who were working at the leak site. There were also violations in Chevron’s overall implementation of its own “process safety management” (PSM) procedures, required by Cal/OSHA of all refineries. Chevron appealed the Cal/OSHA citations.

In 2013, the company pleaded no contest to six charges in connection with the fire, and agreed to pay $2 million in fines and restitution. The charges were filed by the California Attorney General’s Office and the Contra Costa District Attorney’s Office, including failing to correct deficiencies in equipment and failing to require the use of certain equipment to protect employees from potential harm.

The negotiated Cal/OSHA settlement requires Chevron to institute the following extraordinary measures to ensure process safety at the Richmond refinery:

– Replace all carbon steel piping that transports corrosive liquids with chrome-alloy piping, which has better corrosion resistance, at an estimated cost of $15 million.
– Develop and implement criteria and procedures, at an estimated cost of $5 million, to monitor equipment to alert operators when equipment should be replaced.
– Provide specialized, hands-on training on incident command situational awareness and hazard recognition for all Chevron Fire Department personnel at the Richmond refinery with rank of lieutenant and above. The training will include at least three hours of instruction and focus on emergency response.
– Provide at least eight hours of in-person training on process safety management for operators at the refinery beyond the training that is already provided.
– Continue its collaboration with the United Steelworkers in order to meet the training requirements imposed by the new refinery safety regulation pending approval by the OAL.
– Donate $200,000, in addition to any monies already donated in 2016, to the Regional Occupational Program in Richmond, a job-readiness course offered by the Contra Costa County Office of Education in partnership with Chevron to help prepare students for jobs in the petrochemical and related industries.
– Pay the citation penalties originally proposed by Cal/OSHA in January 2013 ($782,700), plus an additional $227,300.

Cal/OSHA agrees to withdraw nine of the 17 violations cited. The withdrawn citations include four willful-serious category violations, three serious and two general in nature. It will amend five of the remaining eight violations cited,

Retailer to Pay $7.6 M Restitution – or Serve 17 Years

A two-year investigation led by the Tax Recovery and Criminal Enforcement (TRaCE) Task Force, with assistance from the Department of Insurance, ended with a Southern California clothing retailer pleading guilty on four counts of sales tax evasion, filing false state tax returns, failure to pay taxes on employee wages, workers’ compensation fraud, and admitting to two special enhancements: white collar crime and excessive taking.

Jeong Hwan Kim, 59, of Los Angeles County, entered the plea in Los Angeles County Superior Court, Norwalk Branch, on July 18, 2017. Kim owned and operated more than 50 retail clothing stores in Los Angeles, Orange, San Diego, and Ventura counties.

From 2010 through 2016, the TRaCE investigation revealed Kim failed to report more than $29 million in sales, more than $39 million in taxable income, more than $8 million in wages, and evaded payment of $5.7 million in sales, income, and payroll tax. Kim also failed to report more than $7 million in wages to his insurance carriers, and evaded payment of more than $350,000 in workers’ compensation insurance.

Kim’s plea agreement states that he must pay more than $7.6 million in restitution for tax and associated costs, and serve two years in county jail. If he fails to pay full restitution within six months, he will receive a 17-year prison sentence.

The California Attorney General’s Office prosecuted the case in coordination with the California Department of Justice, California Department of Tax and Fee Administration, Department of Insurance, Employment Development Department, and Franchise Tax Board.

USC Medical School Dean Parties with Prostitutes and Drugs

In USC’s lecture halls, labs and executive offices, Dr. Carmen Anthony Puliafito was a towering figure. The dean of the Keck School of Medicine was a renowned eye surgeon whose skill in the operating room was matched by a gift for attracting money and talent to the university. But, there was another side to the Harvard-educated physician – uncovered by a Los Angeles Times investigation.

During his tenure as the medical school dean, a Los Angles Times investigation claims Puliafito kept company with a circle of criminals and drug users who said he used methamphetamine and other drugs with them. Puliafito, 66, and these much younger acquaintances captured their exploits in photos and videos. The Times reviewed dozens of the images.

Shot in 2015 and 2016, they show Puliafito and the others partying in hotel rooms, cars, apartments and the dean’s office at USC. In one video, a tuxedo-clad Puliafito displays an orange pill on his tongue and says into the camera, “Thought I’d take an ecstasy before the ball.” Then he swallows the pill. In another, Puliafito uses a butane torch to heat a large glass pipe outfitted for methamphetamine use. He inhales and then unleashes a thick plume of white smoke. Seated next to him on a sofa, a young woman smokes heroin from a piece of heated foil.

As dean, Puliafito oversaw hundreds of medical students, thousands of professors and clinicians, and research grants totaling more than $200 million. He was a key fundraiser for USC, bringing in more than $1 billion in donations, by his estimation. It was a tip about an incident in a Pasadena hotel that led The Times to discover Puliafito’s other life.

Puliafito resigned his $1.1-million-a-year post in March 2016, in the middle of the spring term, three weeks after a 21-year-old woman allegedly overdosed in the former dean’s hotel room. After he stepped down as dean, USC kept Puliafito on the medical school faculty, and he continued to accept new patients at campus eye clinics, according to Keck’s website.

Sarah Warren, was allegedly the woman who overdosed in the Pasadena hotel room. She told the Times she met Puliafito in early 2015 while working as a prostitute. She said they were constant companions for more than a year and a half, and that Puliafito used drugs with her and sometimes brought her and other members of their circle to the USC campus after hours to party.

Just before 5 p.m. on March 4, 2016, an employee of the Hotel Constance, an upscale Colorado Boulevard landmark, called 911 to report that a guest had suffered an apparent overdose. The hotel employee transferred a Fire Department dispatcher to a third-floor room. A man answered, identified himself as a doctor and said his companion’s condition was not serious, according to a recording of the call. “My girlfriend here had a bunch of drinks and she’s sleeping,” he told the dispatcher. Asked whether the woman had taken anything else, he replied, “I think just the alcohol.”

After she awoke in the hospital six hours later, Puliafito picked her up, and “we went back to the hotel and got another room and continued the party,” she said.

Initially, a Pasadena Police department spokeswoman said there was no report, apart from a call-for-service log. After The Times made repeated requests for additional information, the department acknowledged that an officer at the scene should have prepared a report. The officer was ordered to do so in June 2016 – three months after the incident. In the report, Puliafito is identified as a witness to the overdose and a “friend” of the victim. The rest of the document is heavily redacted. The department also released an evidence report that shows officers seized a little over a gram of methamphetamine from the hotel room. The name of the drug’s “owner” is redacted, and the Pasadena address listed as that person’s residence does not exist.

Under state law, illegal possession of methamphetamine could be charged as a misdemeanor. Asked why no one was charged, Pasadena police spokeswoman Tracey Ibarra said officers would have had to determine who was “responsible” for the drugs. She declined to answer questions about the extent of the officers’ investigation. Warren said they never interviewed her.

But, a recording made the night before the overdose shows Puliafito and Warren in a room at the hotel. Warren asks him to help her crush methamphetamine in preparation for doing a “hot rail,” a method of snorting the drug. “Absolutely,” Puliafito replies. Warren is later shown bending over a tray with several lines of white powder.

USC’s medicine department climbed from #38 to #31 on on U.S. News & World Report’s rankings during Puliafito’s tenure as dean. The doctor had secured millions of dollars in donations for the school.

USC fundraising galas can be glittering affairs with movie stars and billionaire donors rubbing elbows in Beverly Hills ballrooms. Puliafito glided confidently through these events, posing for photos with Gwyneth Paltrow and Pierce Brosnan and chatting up tech mogul Larry Ellison and mega-developer Rick Caruso.

California Medical Board records show his license is current and that no disciplinary charges are pending. Methamphetamine is classified as a Schedule II drug under the Controlled Substance Act. A case can be made for discipline of a physician who abuses a controlled substance. Despite an abundance of physical and other evidence available publicly for more than a year, the Medical Board has not taken any action that can be discovered on its website.

The evidence seems to be hidden in plain sight.

Broker Faces 16 Years for MSA Embezzlement

Tom Fallon, 63, of Long Beach, is being arraigned Monday, July 24 in Superior Court in Long Beach on multiple felony charges including theft by embezzlement and money laundering. Fallon’s daughter, Christina Fallon, 28, also of Long Beach, is scheduled to surrender herself at the Long Beach Police Department on Monday, July 24 and is facing the same felony charges.

According to investigators with the California Department of Insurance Investigation Division, Tom Fallon and his daughter allegedly embezzled $273,954 from injured workers who trusted him to invest settlement funds from workplace accidents with his company Fortis Financial Insurance Services, Inc., and then diverted their funds to his own accounts for his personal use.

“The Fallons’ alleged theft from injured workers is particularly egregious,” said Insurance Commissioner Dave Jones. “By stealing from injured workers who depend on the funds for future care, the Fallons may have left many victims without the resources they need for medical treatment.”

Evidence revealed Tom Fallon suggested two victims who received a $273,974 settlement from a work-related traffic collision deposit their accident settlement funds with him in what’s known as a Workers’ Compensation Set Aside Arrangement, which would provide investment management for their settlement.

In December 2014, the victims received an interest payment check from Tom Fallon that bounced for non-sufficient funds, which raised their suspicions that something was wrong. The victims filed a request for assistance with the California Department of Insurance Consumer Services Division, which led to a criminal investigation that uncovered the alleged crime and revealed Fallon embezzled over $250,000 from the victims and used the funds for his personal expenses and business ventures, including Big Daddy’s Cigar lounge in Naples.

The Los Angeles County District Attorney’s Office filed a criminal complaint against Tom and Christina Fallon on July 14, 2017, charging two counts of Theft by Embezzlement PC 504 and 487(a), and 15 counts of Money Laundering PC 186.10 including PC 186.11(a) (3) white collar crime enhancements. If convicted of all charges, the defendants face a maximum sentence of more than 16 years in state prison.

Superseding Indictment Filed Against Ronald Grusd M.D.

A Superseding Indictment was filed against Beverly Hills radiologist Ronald Grusd M.D. by federal prosecutors on July 11. His prosecution is part of the aftermath of Operation Backlash.

The Superseding Indictment contains forty five counts against the Defendants, the Original Indictment contained only eight. The Superseding Indictment now charges violations of federal health care law under the health care fraud statutes. In the Original Indictment, the counts were based on violations of state health care law and brought into the federal sphere by the Travel Act. The Superseding Indictment now charges violations of money laundering, not included in the Original Indictment and now includes allegations of conspiring with Fermin Iglesias, Carlos Arguello, Julian Garcia, and Jonathan Pena, not included in the Original Indictment.

Operation Backlash, has been an extensive FBI-led undercover investigation that revealed a widespread workers’ compensation kickback scheme, including attorneys, doctors and medical providers who referred patients for health services in exchange for money. Operation Backlash was first announced in November 2015 when the initial round of federal indictments was handed down. San Diego chiropractor Steven J. Rigler and San Diego workers’ compensation attorney Sean O’Keefe previously pleaded guilty to federal charges.

Grusd’s practice, California Imaging Network Medical Group, has clinics in San Diego, Los Angeles, Beverly Hills, Fresno, Rialto, Santa Ana, Studio City, Bakersfield, Calexico, East Los Angeles, Lancaster, Victorville and Visalia.

Trial in the case pending against Grusd was set for June 6, 2017. On March 31, 2017, Defendants Grusd, California Imaging Network Medical Group, and Willows Consulting Company rejected a plea offer in this case.

On April 7, his attorneys moved for a continuance, claiming that they did not have sufficient time to prepare his defense. Last December they say they were provided with digital discovery documents by the prosecutors which were placed on a 2 terabyte drive that can hold millions of documents and recordings.

It would appear that the newly filed indictment would provide the defense attorneys with details about the evidence they will face including specific events, dates, times and places.

For example, on page 12 of the 29 page Indictment prosecutors introduce the topic of “Overt Acts” with paragraph 22. The list of Overt Acts is lengthy, specific and detailed, referring at times to emails, presumably contained on the discovery hard drive, and to specific meetings between Grusd and alleged co-conspirators.

Paragraph 22(s) is illustrative of many of the allegations he will face. “In or about March 2015, in a meeting at GRUSD’s Beverly Hills office, GRUSD suggested that it would be “cleaner,” or words to that effect, to pay Jonathan Pena a flat monthly fee instead of per item referred.” These allegations, if true, directly implicate Grusd in the operation of the enterprise.

There are so many specific allegations in the Superseding Indictment, such as the above, as to statistically make a conviction more probable than not. Prosecutors do not need to convince a jury that all of them are true, just some of them, or maybe even just one of them. One “Overt Act” alone may be enough to support conviction of a crime.

The Superseding Indictment also seeks the forfeiture of Grusd’s title to, and interest in an amount of proceeds not less than $206,330.56 in real property located at 14655 Mulholland Drive, Los Angeles, CA 90077, and all appurtenances affixed thereto. Prosecutors filed a Lis Pendens which creates a lien on this real property.

Arraignment is set on the new indictment for 7/27/2017 02:00 PM in Courtroom 2B before Magistrate Judge Jan M. Adler. On that date Grusd’s attorneys intend to ask the Court for a continuance for the start of trial currently scheduled to begin on October 10, 2017 in order to allow them time to prepare a defense to the Superseding Indictment.

Tom Cruise Film Litigation Raises Industry Safety Questions

American Made is an upcoming biographical crime film starring Tom Cruise. The film is based on the life of Barry Seal, a former TWA pilot who became a drug smuggler in the 1980s and was recruited later on by the DEA to provide intelligence. It is set to be released on September 29, 2017.

A twin-engine Piper Smith Aerostar 600, had been ferrying three pilots who were working on a film: Alan Purwin, 51, one of Hollywood’s most sought-after helicopter stunt operators; Carlos Berl, 58, a well-qualified airman who knew how to navigate the red tape of the plane import-export business; and Georgia native Jimmy Lee Garland, 55, who could fly and repair just about anything. The flight took off after a long day of filming underway for weeks in the hills in northeast Colombia, near the border with Panama. This early-evening flight  was supposed to be a short taxi ride home. Instead it crashed in foggy and cloudy conditions in the Ciolombian mountains. The only person to survive the crash was Garland, who suffered injuries to his legs, arms, face and chest

Relatives of Purwin sued the movie’s production companies – including Imagine Entertainment and Cross Creek Pictures – as well as the estate of Berl. Their suit alleges that Berl was piloting the plane at the time of the crash even though he lacked the skills to do so.

Berl’s estate countersued, claiming Berl informed producers and other parties related to the film that he had insufficient experience to fly the aircraft. The estate also alleges that the flight wasn’t safely planned, prepared or supervised.

Great American Insurance contends in its complaint filed in a Los Angles federal court that its policy covering the plane doesn’t require it to defend the defendants in the two suits.

Great American initially indemnified the production companies under a $50 million general coverage policy. The company claims that the flight in question, as well as other flights conducted during the course of production, may have been performed illegally. The insurer said the policy was issued to parties including Heliblack, the Van Nuys company that owned and operated the plane; Purwin; Frederic North, another pilot who worked on the movie; and S&S Aviation, a Georgia company hired to provide aircraft inspection, repair, maintenance and other services, for the film.

The accident is the latest in a series of deadly tragedies that have occurred on film sets.

A helicopter crash on the set of a French reality TV show in Argentina earlier this year claimed 10 lives. Another helicopter crash in Acton for a Discovery Channel TV show killed three people in 2013. It was the worst film set accident since the 1982 “Twilight Zone: The Movie” copter crash near Santa Clarita that killed actor Vic Morrow and two children.

Last year, 27-year-old camera assistant Sarah Jones was killed and seven others were injured when a freight train hit the crew filming “Midnight Rider,” a movie about the life of rocker Gregg Allman. In a case that became a rallying cry for film set safety, the film’s director, Randall Miller, pleaded guilty to involuntary manslaughter and was given a two-year prison sentence, the first of its kind in Hollywood history.

A Los Angeles Times report in March found a sharp rise in catastrophic injuries on film sets in recent years. There were 20 deaths in the U.S. related to motion picture and television production for the five years that ended in December 2014, double the number of fatalities during the previous five-year period.

Drugmakers Profit by Premature Drug Expiration Dates

Hospitals and pharmacies are required to toss expired drugs, no matter how expensive or vital. The idea that drugs expire on specified dates goes back at least a half-century, when the FDA began requiring manufacturers to add this information to the label. Meanwhile the FDA has long known that many remain safe and potent for years longer.

Federal and state laws prohibit pharmacists from dispensing expired drugs and The Joint Commission, which accredits thousands of health care organizations, requires facilities to remove expired medication from their supply. Outdated drugs are shunted to shelves in the back of the pharmacy and marked with a sign that says: “Do Not Dispense.” The piles grow for weeks until they are hauled away by a third-party company that has them destroyed. And then the bins fill again.

Though the government requires pharmacies to throw away expired drugs, it doesn’t always follow these instructions itself. Instead, for more than 30 years, it has pulled some medicines and tested their quality. The story on ProPublica claims that the federal government has stockpiled massive stashes of medication for decades, antidotes and vaccines in secure locations throughout the country. The drugs are worth tens of billions of dollars and would provide a first line of defense in case of a large-scale emergency.

The federal agencies that stockpile drugs – including the military, the Centers for Disease Control and Prevention and the Department of Veterans Affairs – have long realized the savings in revisiting expiration dates.

In 1986, the Air Force, hoping to save on replacement costs, asked the FDA if certain drugs’ expiration dates could be extended. In response, the FDA and Defense Department created the Shelf Life Extension Program. The program authorizes governmental stockpiling and use of expired drugs.

FDA’s Office of Regulatory Affairs (ORA) Field Science Laboratories centrally manages the program, including interacting with DoD and coordinating laboratory work. The FDA Center for Drug Evaluation and Research (CDER) Division of Product Quality Research analyzes the data and makes decisions regarding shelf life extensions.

Each year, drugs from the stockpiles are selected based on their value and pending expiration and analyzed in batches to determine whether their end dates could be safely extended. For several decades, the program has found that the actual shelf life of many drugs is well beyond the original expiration dates.

A 2006 study of 122 drugs tested by the program showed that two-thirds of the expired medications were stable every time a lot was tested. Each of them had their expiration dates extended, on average, by more than four years, according to research published in the Journal of Pharmaceutical Sciences.

The billion dollar question asks why it is this research has not extended to the private sector? Pharmacists and researchers say there is no economic “win” for drug companies to investigate further. They ring up more sales when medications are tossed as “expired” by hospitals, retail pharmacies and consumers despite retaining their safety and effectiveness.

Some medical providers have pushed for a changed approach to drug expiration dates – with no success. In 2000, the American Medical Association, foretelling the current prescription drug crisis, adopted a resolution urging action. The shelf life of many drugs, it wrote, seems to be “considerably longer” than their expiration dates, leading to “unnecessary waste, higher pharmaceutical costs, and possibly reduced access to necessary drugs for some patients.”

No one remembers the details of the AMA resolution – just that the effort fell flat. “Nothing happened, but we tried,” says rheumatologist Roy Altman, now 80, who helped write the AMA report.  Experts estimate such squandering eats up about $765 billion a year – as much as a quarter of all the country’s health care spending.

Fraud Defense Firms Expect Nationwide Growth

The focus of white-collar defense at private law firms shifts depending on the enforcement priorities of federal prosecutors. Without prosecutors to bring cases, there’s no need to hire lawyers to defend against them.

And things seem to be looking up for medical fraud defense lawyers. At the American Health Lawyers Association, membership in the fraud and abuse practice group has grown 8 percent over the last five years, to 2,341 attorneys.

And Chicago may be the place for new fraud defense lawyers to hang their shingle.

The Chicago U.S. Attorney’s Office is creating a new unit to prosecute health care fraud, a move that tantalizes the city’s white-collar defense lawyers with the promise of more work.

Assistant U.S. Attorney Heather McShain will lead the team of five prosecutors, and Assistant U.S. Attorney Stephen Chahn Lee will serve as the unit’s Senior Counsel.

“What the (U.S. Attorney’s Office) is doing is putting folks on notice that it’s a big deal,” said Deborah Gersh, co-chair of the health care practice at Ropes & Gray. “I do think there’s going to be greater emphasis on firms building out their health care and government enforcement combined practice. We’ve been doing that for years – in other cities and would expect to see that here as well.”  The firm boasts of more than 60 attorneys in offices across the United States represent virtually every sector of the global health care industry,

The new unit “sends a message,” that health care fraud remains a priority for the office, said Nancy DePodesta, a partner at Arnstein & Lehr and former assistant U.S. attorney. Since 2015, the Chicago firm has brought on four attorneys, including her, who have experience either with False Claims Act cases or with representing doctors before the Illinois Department of Financial & Professional Regulation.

Lisa Noller, chair of the white-collar defense practice at Foley & Lardner, said responding to government enforcement in health care fraud cases is a “booming business” for her. It’s the result of better coordination between three government agencies – the DOJ, Centers for Medicare & Medicaid Services, and U.S. Department of Health & Human Services – combined with prosecutors who’ve devoted their careers to this area of law.

Whether the new DOJ Chicago unit will translate into new work for white-collar lawyers fluent in health care will depend on the resources it receives, said Noller, who was an assistant U.S. attorney before joining Foley seven years ago. It will also depend on the complexity of the cases prosecutors pursue, and the size and finances of the defendants they charge.

This report published in Crain’s Chicago Business is consistent with a common and not necessarily apocryphal lawyer joke that portrays a solo practitioner starved for business in a small town until a second lawyer arrives – and then they both prosper.

CIGA Covers Defunct Excess Carrier Claim

CSAC Excess Insurance Authority is a joint powers authority formed to cover the workers’ compensation obligations of its member counties through a combination of risk retention and excess insurance. It had secured retention ($500,000) with a now defunct insurer – the Protective National Insurance Company of Omaha.

On behalf of member Fresno County and member Mendocino County, CSAC paid workers’ compensation benefits for an employee injury. The total amount of payments in each of the two cases exceeded the $500,000 retention. Claims were made for the payments to the excess carrier, Protective National, but a Nebraska court filed a declaration of insolvency with respect to Protective in February 2004. Thus, Protective forwarded CSAC’s claims to the California Insurance Guarantee Association (CIGA) for payment.

CIGA is a statutory nonprofit unincorporated association to which insurance companies must belong as a condition of doing business in California. Its primary objective is to pay “covered claims” arising from the failure of an insolvent insurer to meet its obligations under its policies.CIGA assesses the costs of covering an insolvent’s obligations against its membership, which in turn recovers this cost through premium surcharges on policies; this spreads the costs of insolvency across the entirety of the insurance market

CIGA denied the claims essentially asserting that these were not “covered claims” within the meaning of a growing body of law embellishing the definition of what is, and is not a “covered claim.”.

CSAC sought a declaration from the Superior Court that its payments for two of its members in excess of the agreed retention are within the statutory definition of unpaid “covered claims” that CIGA has an obligation to reimburse. The trial court issued a ruling in favor of CSAC that CIGA had breached its statutory duty to reimburse CSAC for the excess workers’ compensation coverage due under the Protective policy.

CIGA appealed. The Court of Appeal affirmed the ruling in the unpublished case of CSAC Excess Insurance Authority v California Insurance Guarantee Association.

On appeal, CIGA contends that Protective did not “incur” an “obligation” to indemnify until the retention limits were reached, which did not occur until after the drop-dead date for presenting claims to CIGA specified in Insurance Code section 1063.1(c)(1)(D) and thus were not “covered claims.” The Court of Appeal rejected this argument and concluded that the obligation for excess insurance is incurred on the date of injury, not on the date of the exhaustion of the retention.

CIGA also contends that even if the Mendocino and Fresno workers’ compensation payments were covered excess claims within the meaning of section 1063.1(c), they “ceased to be” once the liquidator ended Protective’s existence and cut off any further claims against it. The Court of Appeal found no authority for this contention and concluded that a liquidation termination order does not extinguish CIGA’s obligations under California law.