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WCAB Rules Deposing an Attorney Requires “Extremely Good Cause”

A Findings of Fact, Award & Order dated October 22, 2021 concluded that Terri Scott suffered 100% permanent disability as a result of injuries caused by her employment as a peace officer by the City of Los Angeles. On November 15, 2021 the City of Los Angeles filed a Petition for Reconsideration of that Order.

While the case was pending at the Reconsideration Unit, on December 30, 2021, the City of Los Angeles filed a motion and a DOR to quash the deposition of Bryant Yip, deputy city attorney, scheduled for January 7. Yip alleged “bad faith, frivolous and harassing actions and tactics in setting deposition of opposing counsel” and conditioning “withdrawal of the [deposition] subpoena on withdrawal of defendant’s petition for reconsideration.”

Reconsideration of the 100% award was denied on January 12, 2022.

On January 10, 2022, Ms. Falter, an attorney for officer Scott, filed her petition for sanction essentially accusing Mr. Yip of making false material statements in his petition for reconsideration. Ms. Falter averred that Mr. Yip “[wa]s lying threw [sic] his teeth” with the “nten[tion] to disenfranchise a dedicated and decorated police officer from her rightful workers’ compensation benefits under the law.”

On January 18, 2022, the WCJ issued his notice of intention to impose sanctions and costs against applicant’s attorneys Asvar Law, PC, Christopher Asvar and Theresia Falter. On February 8, Falter filed a verified declaration objecting to imposition of sanctions for various reasons.

On February 11, 2022 the WCJ ordered applicant’s attorneys, Asvar Law, Christopher Asvar and Theresia Falterthem to jointly and severally pay (1) sanctions to the general fund of $1,500.00; and (2) costs to defendant of $6,800.00.

Applicant attorneys petition for reconsideration of this sanction order was granted, and the matter remanded to further develop the record in the WCAB panel decision of Terri Scott v City of Los Angeles – ADJ9671636 (June, 2022).

Applicant’s attorneys argue that they are entitled to depose defendant’s attorney and to a determination of the merits of their petition against defendant’s attorney before the WCJ may determine this issue of whether sanctions should be imposed against them.

Ordinarily a party may take the deposition of any person. (Code Civ. Proc. § 2025.010). However, “[d]epositions of opposing counsel are presumptively improper, severely restricted, and require “extremely” good cause – a high standard.” (Carehouse Convalescent Hospital v. Superior Court (2006) 143 Cal.App.4th 1558, 1562.)

The WCAB panel noted that the “circumstances under which opposing counsel may be deposed are limited to where (1) no other means exist to obtain the information than to depose the opposing counsel; (2) the information sought is relevant and not privileged; and (3) the information is crucial to the preparation of the case. (Spectra-Physics, Inc. v. Superior Court (1988) 198 Cal.App.3d 1487, 1496; Carehouse, supra, 143 Cal.App.4th at p. 1563.).”

The panel went on to note that “the pleadings posture in this case is that defendant’s attorney sought sanctions against applicant’s attorneys before applicant’s attorneys made any attempt, much less a successful one, to establish their alleged entitlement to depose him.”

“But since the merits of applicant’s disability claim as well as defendant’s petition for reconsideration of the findings thereon have been determined in applicant’s favor, we are unable to discern what, if any, issue pending in applicant’s case could be ripe for discovery, much less how defendant’s attorney could be in possession of information crucial to the issue which would only be discoverable through deposition.

Thus the panel “conclude[d] applicant’s attorneys’ argument that that they should be allowed to depose defendant’s attorney and have their sanctions petition determined before sanctions may be imposed against them lack merit.

However, instead of issuing the NOI and determining the sanctions issue based upon applicant’s attorneys’ written response, the WCAB panel said that “the WCJ should have obtained a pretrial conference statement from the parties on the sanctions issues, held a pretrial conference at which the specific issues and stipulations on the petitions could be framed, and held a hearing thereon”.

“Because the NOI’s allegations originated with defendant’s attorney and concerned conduct outside of court which the WCJ did not observe, it did not fully apprise applicant’s attorneys of the evidence against them or provide a meaningful opportunity for them to offer evidence against sanctions”. (See also, e.g., Cal. Code Regs., tit. 8, former § 10561(a)(b) now § 10421(a)(b); see also Cal. Code Regs., tit. 8, former § 10349 now § 10832 (authorizing the WCJ to imposes sanctions and costs on the court’s own motion through the notice of intention procedure) [Emphasis added.].)

Accordingly, the WCAB granted reconsideration and rescinded the Order, and the matter was returned to the trial level for further proceedings consistent with this decision.

Inexpensive Ibuprofen Most “Heavily Used Drug” in Comp Claims

New data from the California Workers’ Compensation Institute (CWCI) shows the types of drugs used to treat injured workers in California, and the distribution of payments for those medications, has shifted dramatically over the past decade, with opioids becoming far less prevalent and anti-inflammatory drugs (NSAIDs) accounting for an increasing share of the prescriptions and the total drug spend within the workers’ comp system.

The results show that NSAIDs, often used as non-narcotic alternatives to treat pain, surpassed opioids to become the top workers’ comp drug group in 2016, and in 2021 they increased to a record 34.0% of the prescriptions dispensed to injured workers in California.

The distribution of prescriptions by drug ingredient revealed that most of the growth in NSAIDs over the past decade has been due to the increased use of inexpensive ibuprofen, which increased from 27.0% of all anti-inflammatories in 2012 to 41.2% of the NSAIDs dispensed in 2021.

As a result, ibuprofen is now the most heavily used drug in workers’ compensation, accounting for 14.1% of all prescriptions dispensed last year, ranking well ahead of another NSAID, naproxen, which ranked second, accounting for 8.3% of the prescriptions dispensed to injured workers.

Meanwhile opioids’ share of the workers’ comp prescriptions continued to decline, falling to 10.2% last year, though most of the decline in opioid use within the past decade occurred between 2012 and 2019, as opioid’s share of the prescriptions has been relatively stable over the past 3 years, only edging down slightly from 11.7% to 10.2%.

As in 2020, anticonvulsants, dermatologicals, and antidepressants rounded out the top five most prescribed drug groups in 2021. Like NSAIDs, anticonvulsants and dermatologicals are often used to treat pain, and their share of the workers’ comp prescriptions has risen over the past decade, while antidepressants’ share, which ranged between 5.2% and 6.6% from 2012 through 2019, climbed to a record 8.0% in 2021 – the second year of the pandemic.

On the other hand, musculoskeletal drugs have fallen from 10.6% of all workers’ comp prescriptions in 2016 to 6.0% of the prescriptions last year, a drop that followed the state’s implementation of a workers’ comp formulary in 2017. The formulary made most prescriptions for musculoskeletal drugs subject to utilization review, with limited exceptions where they are allowed as special fill or perioperative drugs.

Ranking the top therapeutic drug groups based on total payments the CWCI analysts found that the top 10 groups combined for 77.9% of the total drug spend in 2021, down from 80.2% in 2012, when opioids consumed 26.2% of the prescription dollars (vs. 5.8% last year) and ulcer drugs accounted for 10.3% (vs. 6.3% in 2021).

With opioid payments down, NSAID’s share of the prescription dollars jumped from 13.4% in 2012 to 25.0% in 2021, dermatological drugs jumped from 12.9% to 17.2%, and anticonvulsants’ share rose from 4.9% to 8.6%.

The 2021 data also show that several other drug groups (psychotherapeutic and neurological drugs, anticoagulants, and antidiabetic drugs) that a decade ago each represented only 0.3% of the prescription dollars are now among the 10 most expensive drug groups, each accounting for between 2.6% and 2.9% of the total payments. Thus, combined payments for these drugs, which a decade ago represented only 0.9% of the prescription drug costs, accounted for 8.1% of the total drug spend in 2021.

Although ibuprofen and naproxen accounted for almost two-thirds of all NSAIDs dispensed last year, average payments for these drugs were $12 and $47 respectively, so they were relatively inexpensive.

However, the Institute found that as in 2020, two low-volume, high-priced NSAIDs, fenoprofen calcium and ketoprofen, made NSAIDs the most expensive drug category. In a March 2021 study, CWCI noted that under the formulary, both these drugs are exempt from prospective utilization review and because they are not listed in the national Medicaid database, neither has a Federal Upper Limit, which would serve as a price control in California workers’ comp. Instead, they are reimbursed at 85% of the average wholesale price, which is based on manufacturer pricing.

Insurance Commissioner Lara Leads in Primary Election Battle

California voters have cast their primary ballot for the leader for the state agency that wields significant power over home, auto and other insurance policies purchased by millions of consumers.

Nine candidates are vying to be California insurance commissioner, a regulator with the authority to approve or reject rate increases and investigate fraud. The top two finishers in the June 7 primary will face off in the November general election.

Incumbent Ricardo Lara, a Democrat from Los Angeles, is looking to hold on to his seat amid a fierce challenge from a Democratic opponent, San Rafael Assemblymember Marc Levine.

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

While much of the attention in the race has been centered on jabs between Lara and Levine, seven other contenders are also running for the post.

Two of the lesser-known challengers are Democrats, Dr. Vinson Eugene Allen and paralegal Jasper Jackson. They are joined by two Republicans – businessman and former California Public Utilities Commission president Greg Conlon and cybersecurity equipment manufacturer Robert Howell – and two minor-party candidates: Veronika Fimbres, a nurse and Green Party member, and teacher Nathalie Hrizi from the Peace and Freedom Party.

Healthcare advocate Robert Molnar, who once worked for former Insurance Commissioner Steve Poizner, is on the ballot as a “no party preference” candidate.

A day after the election, unofficial results have been published by the California Secretary of State.

Ricardo Lara has 37% of the vote. with Republican Robert Howell in second place with 17.8%. Levine is in third place with 16.8%, followed by Greg Conlon at 16.5%. The remaining candidates are under 5% of the vote each.

Howell “pledged to not take insurance company political donations.”  He personally owns and operates an electronics firm in the Silicon Valley, and boasts that he is not an insurance agent or politician, and is proud to be a “Regan Republican.”  He will likely proceed to the November election where he will challenge Ricardo Lara for the Insurance Commissioner position.

Troy Slaten, a newly appointed Workers’ Compensation Judge who works at the Van Nuys District Office of the WCAB, ran for a Los Angeles County Superior Court judicial position, competing with four other candidates.

Unofficial results show Abby Baron in the lead of that race with 29.73% of the vote, and Anna Slotky Reitano in second place with 24.64%. WCJ Slaten will not likely move to the November election as he has 11.27% of the vote.

He also unsuccessfully competed for a Los Angeles County Superior Court position in 2020. He was a former deputy district attorney and was supported by unions, firefighters and law enforcement during his campaigns.

Congress Passes Improved Care for Federal Workers Compensation

The Improving Access to Workers’ Compensation for Injured Federal Workers Act (H.R. 6087), was passed in the House of Representatives on a strong bipartisan basis.

Reps. Courtney and Walberg introduced H.R. 6087 in December 2021 to amend the existing Federal Employees Compensation Act, or FECA – the workers’ compensation program for the vast majority of U.S. federal employees – to allow injured workers to receive treatment for work related injuries from state-licensed Physician Assistants (PAs) and Nurse Practitioners (NPs).

PAs and NPs are increasingly taking on the role of primary care providers for many patients, but current law prohibits federal workers from being treated by PAs and NPs for worker compensation cases, even in states that allow PAs and NPs to practice independently.

Courtney and Walberg’s bipartisan bill earned the support of organizations representing both health care providers and federal employees nationwide, like the American Association of Nurse Practitioners (AANP), the American Association of Physician Assistants (AAPA), the National Treasury Employees Union (NTEU), and the National Postal Mail Handlers Union (NPMHU).

The bill would make a simple but important correction to FECA, enabling PAs and NPs to be compensated for care through the program, expanding access to health care for federal workers and providing a boost to the health of America’s labor force. The Improving Access to Workers’ Compensation for Injured Federal Workers Act was passed by the House by a vote of 325-83.

The federal government is the largest employer in the nation, and FECA provides federal employees with work-related disability and medical benefits, as well as survivors benefits to the families of employees killed on the job.

In 2021, the American Rescue Plan Act (H.R. 1319) created a presumption of FECA eligibility for cases of COVID-19, an important piece of the puzzle in ensuring that a large swath of America’s workers would be covered, cared for, and able to return work in the event they contracted COVID-19.

However, although many federal employees rely on PAs and NPs as their primary care providers, current law prohibits them from being reimbursed for caring for FECA patients within their state scope of practice, and from providing medical evidence to support a FECA benefit claim.

However, in California the bill seems to have triggered a turf war with the California Medical Association.

On June 6 it published an “URGENT!” message on It’s website claiming “Congress is rushing to push through a bill that recklessly expands scope of practice at the federal level.

It went on to claim that “If passed, this bill would allow nurse practitioners and physician assistants to diagnose, prescribe, treat, and certify an injury and extent of disability for purposes of compensating federal workers under the Federal Employees’ Compensation Act. To take this function away from physicians who have the proper education, training, and expertise to make these evaluations is a threat to the practice of medicine and quite simply, unacceptable.”

And the American Medical Association also voiced opposition. “H.R. 6087 effectively removes physicians from the care team and sets up our federal workers for suboptimal health outcomes and increased costs,” AMA CEO James Madara wrote in a letter to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy, urging them to oppose the bill.

The proposed law will now move to the Senate, and if passed will need the approval of President Biden.

SCOTUS Exempts Airline Cargo Loaders from Mandatory Arbitration

A U.S. Supreme Court decision in favor of an employee, in a closely watched employment law case involving arbitration clauses in employment contracts, was a divergence from the Court’s tendency in recent years to favor arbitration. Instead of a company or industry wide exemption for mandatory arbitration, courts must instead use a fact-specific test focused on actual job duties of employees.

Southwest Airlines moves a lot of cargo. In 2019, Southwest carried the baggage of over 162 million passengers to domestic and international destinations. To move that cargo, Southwest employs “ramp agents, who physically load and unload baggage, airmail, and freight. It also employs “ramp supervisors,” who train and supervise teams of ramp agents. Frequently, ramp supervisors step in to load and unload cargo alongside ramp agents.

Latrice Saxon, was a ramp supervisor for Southwest Airlines at Chicago Midway International Airport.. Saxon came to believe that Southwest was failing to pay proper overtime wages to ramp supervisors, and she brought a putative class action against Southwest under the Fair Labor Standards Act of 1938.

Because Saxon’s employment contract required her to arbitrate wage disputes individually, Southwest sought to enforce its arbitration agreement and moved to dismiss.

In response, Saxon claimed that ramp supervisors were a “class of workers engaged in foreign or interstate commerce” and therefore exempt from the Federal Arbitration Act’s coverage. 9 U. S. C. §1.

The District Court disagreed, holding that only those involved in “actual transportation,” and not those who merely handle goods, fell within §1’s exemption.

The United States Court of Appeals, Seventh Circuit. reversed. It held that “[t]he act of loading cargo onto a vehicle to be transported interstate is itself commerce, as that term was understood at the time of the [FAA’s] enactment in 1925.- 993 F. 3d 492, 494. The Seventh Circuit’s decision conflicted with an earlier decision of the Fifth Circuit. See Eastus v. ISS Facility Services, Inc., 960 F. 3d 207 (2020).

The U.S. Supreme Court agreed to hear the case to resolve the disagreement. It held in a unanimous 8-0 decision in Southwest v Saxon – 21-309 (June 2022) that Saxon belongs to a “class of workers engaged in foreign or interstate commerce” to which §1’s exemption applies. However, the Supreme Court rejected the contention that all airline workers are exempt from the FAA and instead used a fact-specific test focused on actual job duties.

The parties dispute how to define the relevant “class of workers.” Saxon argues that because air transportation “as an industry” is engaged in interstate commerce, “airline employees” constitute a “‘class of workers’” covered by §1.

Southwest, by contrast, maintains that §1 “exempts classes of workers based on their conduct, not their employer’s,” and the relevant class therefore includes only those airline employees who are actually engaged in interstate commerce in their day-to-day work.

The Court of Appeals rejected Saxon’s industry wide approach, as did the U.S. Supreme Court.

The FAA speaks of “workers,”not “employees” or “servants.” The word “workers” directs the interpreter’s attention to “the performance of work.” Thus Saxon belongs to a class of workers who physically load and unload cargo on and off airplanes on a frequent basis.

The parties dispute whether that class of airplane cargo loaders is “engaged in foreign or interstate commerce” under §1. The Supreme Court held that it was.

To be “engaged” in something means to be “occupied,” “employed,” or “involved” in it. “Commerce,” meanwhile, includes, among other things, “the transportation of . . . goods, both by land and by sea.” Airplane cargo loaders are such a class.

Taken together, these canons showed that §1 exempted only contracts with transportation workers, rather than all employees, from the FAA.

Major Employers Pledge to Reduce Injuries 25% by 2025

Kicking off National Safety Month, and one year after announcing a historic partnership with Amazon, the National Safety Council unveiled the first-of-its-kind MSD Pledge to reduce the most common workplace injury, musculoskeletal disorders (MSDs). During the inaugural Workplace Safety Summit: Business Action to Prevent Musculoskeletal Injuries, more than 15 of the nation’s leading organizations joined this effort and signed the pledge to improve workplace safety, reduce MSD risk, and enhance all workers’ well-being.

MSDs – such as tendinitis, back strains and sprains, and carpal tunnel syndrome – impact nearly a quarter of the world’s population and are the leading cause of worker disability, early retirement, and limitations to gainful employment. The MSD Pledge seeks to create safer outcomes for millions of workers worldwide by reducing these injuries by 25% by 2025. By making critical changes, employers will also build more equitable workplaces for frontline workers and communities of color, which are two groups disproportionately impacted by MSDs.

Along with Amazon and NSC, founding pledge members include Alcon Research, LLC; Ansell Inteliforz; Amentum; American Industrial Hygiene Association; AMP; Benchmark ESG; Cummins Inc.; Human Balance and Stability Systems, LLC; John Deere; MEGA InTech; Meteorite; Tenneco; United Airlines; and VelocityEHS.

Organizations signing the MSD Pledge promise to:

– – Reduce risks by analyzing the causes of MSD injuries across operations and investing in solutions and practices that reduce risks to workers.
– – Innovate and collaborate by leveraging best practices and sharing learnings and countermeasures to expand upon innovations to improve safety practices.
– – Build an organizational culture that values safety by promoting a workplace where safety excellence, transparency, and accurate reporting are equally valued, and where everyone, at every level of the organization, is accountable for the safety and health of workers.
– – Commit to a significant reduction of MSD injuries by creating safer outcomes for millions of workers worldwide and reducing MSD risk and subsequent injuries by 25% by 2025.

In addition to accessing free resources and sharing safety innovations to help reduce MSD risks, MSD Pledge members will participate in the MSD Solutions Index, an annual company index that analyzes the benefits of the pledge over time.

The index will aggregate data on risk reduction strategies, workplace safety culture, and innovation and collaboration, while also identifying areas for targeted action and uncovering trends to inform future approaches. MSD Pledge members benefit from free events, training and coaching opportunities from the Council’s team of ergonomics experts, as well as opportunities to share best practices and lessons learned with one another. Participation in the MSD Pledge is free and open to any employer that is committed to identifying and reducing risks of MSD injuries and creating a culture of safety at work.

The MSD Pledge was developed at the MSD Solutions Lab, a ground breaking initiative established as part of the NSC and Amazon partnership to solve this omnipresent safety challenge. Led by NSC, the pledge is one of several initiatives launching in 2022 to achieve the program goal of preventing MSDs before they start, including:

– – Advisory Council: NSC has named the founding members of the advisory council for this ground breaking program. Composed of volunteers, these experts in safety, health, ergonomics and innovation support and inform the program’s work by engaging in, researching, solving, and amplifying MSD prevention efforts.
– – MSD 2025 Pioneering Research: Support comprehensive research efforts, including utilizing natural language processing, case studies, reports, and expansive systematic reviews and meta-analyses to explore current and future MSD prevention-related strategies. The research findings will be available to all industries to explore and glean insights.
– – Innovation Challenges: Individuals and organizations alike will have the opportunity to develop and share cutting-edge solutions to prevent and eliminate workplace-related MSDs. During this competition, prizes and grants will be awarded to honor innovation and help fund these solutions.
– – Small Business and University Grants: Provide grants to small businesses, universities, and students to fund research and innovation that help companies of all sizes achieve impact.

To learn more about the MSD Pledge, the MSD Solutions Lab, and the risks associated with MSDs, visit nsc.org/msd.

SDPD Officers File Shooting Range Lead Poisoning WC Claims

NBC7 San Diego reports that Seven San Diego Police Department officers have filed worker’s compensation claims after blood testing showed elevated lead levels in their bodies, and the Police Chief has shut down an outdoor gun range believed to be the cause.The range is located on Federal Boulevard, just north of state Route 94 and west of Interstate 805 in the Fairmount Park neighborhood.

About a month ago, the city ordered air sample tests at the range after officers raised concerns. It’s not unusual to find higher levels of lead at firing ranges, but those tests showed lead concentrations more than 10 times greater than the OSHA standard for acceptable air levels.

Every year, sworn SDPD officers are required to pass firearm proficiency training at that range for their service weapons and off-duty weapons. That’s a minimum of three sessions per gun.

The officers who work there have gray dust in their nose and ears at the end of the day from working there for 10 hours doing department shoots,” Wilson said. “And they’ve been subjected to lead dust for over a year now.”

A little more than a year ago, the city installed a Vortex Total Containment Trap as part of an ongoing renovation project. As bullets enter a chamber, they are funneled into a compartment that can be removed and emptied. Before that installation, bullets were fired through targets into dirt berms.

NBC 7 Investigates discovered the range was cited for violations relating to lead prior to the renovation. That happened during a routine inspection of the range in February of 2020. Five violations were discovered at that time, having to do with proper handling and disposal of hazardous waste.

– – Violation 1: Failed to make a proper waste determination
– – Violation 2: Failed to properly dispose of hazardous waste at an authorized facility.
– – Violation 3: Failed to maintain &/or operate facility to minimize the possibility of a fire, explosion, or any unplanned sudden or non-sudden release of hazardous waste or hazardous waste constituents.
– – Violation 4: Initial &/or annual employee training not conducted in safety procedures for a hazardous material release or threatened release &/or employee training records not available or not maintained for 3 years.
– – Violation 5: Failed to report &/or update the required inventory information for hazardous waste(s) generated at the facility in CERS.

The police union says the firearms instructors who work at the range now suffer from chronic headaches and joint pain, and that all seven officers recently tested for lead exposure and reported blood lead levels in the teens. NBC 7 Investigates asked to see those test results, but the officers declined to share their medical information.

Doctors say no level of lead in your blood is considered safe. Cal/OSHA requires that employers immediately remove workers who test at or above 50 micrograms of lead per deciliter of blood. The California Department of Public Health considers any level over five “dangerous.”

That’s why lead dust is especially concerning at gun ranges. Yet, the city chose not to install that dust collection unit, a piece of safety equipment that would added $184,000 to the city’s $17.8 million range renovation project.

When NBC7 asked the city why the collector wasn’t installed, they said it’s because it was optional. The manufacturer confirmed to NBC 7 Investigates some customers choose not to install them at outdoor ranges.

Fixing lead issues at the range is a priority now. Mayor Todd Gloria’s office didn’t make him available for an on-camera interview, but sent a statement:

Since the range is now closed, the department is advising officers to use other police agencies or private ranges to practice.

Telehealth Declines Nationally for Second Straight Month

In March 2022, telehealth utilization, as measured by telehealth’s share of all medical claim lines, fell nationally for the second straight month, according to FAIR Health’s Monthly Telehealth Regional Tracker.

Following a drop of 9.3 percent in February, telehealth utilization decreased 6.1 percent in March, declining from 4.9 percent of all medical claim lines in February to 4.6 percent in March.

Telehealth utilization also decreased in February in every US census region (Midwest, Northeast, South and West), with the greatest decrease (8.1 percent) in the South, followed closely by the West (7.8 percent). The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid.

The drop in telehealth utilization was likely due to continuing reduction in the reported number and severity of COVID-19 infections, which may have led more patients to return to in-person healthcare services. Data published by the Centers for Disease Control and Prevention show that the number of reported cases of COVID-19 continued to fall in March.

The rankings of the top five telehealth diagnoses did not change nationally in March 2022, but there were some changes at the regional level. In the Northeast, acute respiratory diseases and infections rose from fifth place to second place in the rankings. In the South, encounter for examination fell off the list and urinary tract infections rejoined the list (in fifth place) for the first time since December 2021. In all regions and nationally, mental health conditions remained the top-ranking telehealth diagnosis.

The rankings of the top five telehealth specialties did not change nationally or in most regions in March 2022. But in the Midwest, psychiatrist and primary care nonphysician switched places, with the former rising to fourth place in March and the latter dropping to fifth place. In all regions and nationally, for the second month in a row, social worker remained the top-ranking telehealth specialty.

In March 2022, the rankings of the top five telehealth procedure codes did not change nationally or in any region. The number one telehealth procedure code nationally and in every region remained CPT®2 90837, one-hour psychotherapy.

For March 2022, the Telehealth Cost Corner spotlighted the cost of CPT 97803, therapy procedure reassessment for nutrition management, each 15 minutes. Nationally, the median charge amount for this service when rendered via telehealth was $49.97, and the median allowed amount was $31.58.3

California Loses 263,000 People and $17.8 B Taxable Income in 2020

Worker’s compensation premium is based upon employment income, and rising income equates to more premium dollars on average. It might therefore be reasonable to track employment income trends across various states as a leading indicator of workers’ compensation premium market conditions.

And using that metric, California does not look favorable in terms of employment income growth.

Every year, states across the country compete with each other for people and their wealth as millions of Americans move between states. The stakes are large. A growing population for the winners means an increasing tax base, economic growth and investment. For the biggest losers, it means more difficulties in paying down debts, higher taxes and fewer investments for the future.

The nation’s most-recent winners of migration from other states are Florida and Idaho according to the latest migration data released by the IRS. Florida, the nation’s perennial winner, gained the most people and income overall in 2020, while Idaho gained the most of both on a percentage basis.

On the other end of the competition are states that have become perennial losers. States like California, New York, Illinois and New Jersey once again experienced some of the nation’s biggest losses of both residents and their money.

Those findings are based on a Wirepoints’ analysis of the latest 2020 domestic migration data provided by the Internal Revenue Service. The IRS reviews tax returns annually to track when and where people move. It also aggregates the ages, income brackets and adjusted gross incomes of filers.

Florida attracted over $41.1 billion in Adjusted Gross Income (AGI) from 624,000 new residents (tax filers and their dependents) that moved into Florida in 2020. On the flip side, Florida lost $17.4 billion in AGI from 457,000 people who left. Overall, Florida came out ahead with 167,000 net new people and $23.7 billion in net new taxable income.

That’s a total gain of about 3.3 percent of the state’s total 2019 AGI ($711 billion).

Texas was the runner up with a net income gain of $6.3 billion, followed by Arizona with $4.8 billion. North and South Carolina rounded out the top five with net gains of $3.8 billion and $3.6 billion, respectively.

On the losing side, New York suffered the worst outflow of money of any state in 2020. The Empire State lost a net $19.5 billion in income, or 2.5 percent of its 2019 AGI, while a net of nearly 250,000 residents moved out.

California was next, losing a net $17.8 billion and 263,000 people. Illinois was third with a net loss of $8.5 billion and 101,000 people. Massachusetts and New Jersey were in 4th and 5th place, with $2.6 and $2.3 billion in income losses, respectively.

The problem with chronic outflows, like in the case of New York, is that one year’s losses don’t only affect the tax base the year they leave, but they also hurt all subsequent years. The losses pile up on top of each other, year after year. And when a state loses income to other states for 21 straight years, the numbers add up.

In 2020 alone, New York would have had nearly $123 billion more in AGI to tax had it not been for the state’s string of yearly migration losses. And when the state’s AGI losses are accumulated from 2000 to 2020, it totals $1.0 trillion in cumulative lost income that could have been taxed over the entire period.

The opposite is true for migration winners like Florida. Gains in people and income pile on top of each other each year, building an ever-growing tax base. In 2020 alone, the state’s tax base was some $197 billion higher due to the 20-year string of positive income gains from net in-migration.

Even though Florida doesn’t tax incomes, Wirepoints also added up Florida’s cumulative AGI to make an apples-to-apples comparison with New York. When the Sunshine State’s AGI gains are accumulated from 2000 to 2020, it totals $1.6 trillion in income that could have been taxed over the entire period.

Illinois, one of the nation’s other big losers, shows just how damaging being an “exit” state can be – especially when a state starts to lose its wealthier residents and and they are only partially replaced by people who make less. The Illinoisans who fled in 2020 earned, on average, $30,600 more than the residents Illinois gained from other states. That’s the biggest gap since at least 2000, based on Wirepoints’ analysis of the IRS data.

Based on a percentage of total income, Illinois ranked 2nd-worst nationally for income losses in 2020. Illinois lost 1.9 percent of its 2019 AGI. New York and Alaska ranked 1st and 3rd, with losses of 2.5 percent and 1.3 percent of their 2019 total incomes, respectively.

In contrast, Idaho was the nation’s big winner on a percentage basis in 2020, gaining 4.2 percent of its 2019 AGI base. The nation’s top five were rounded out by Wyoming, Montana, Florida and South Carolina.

California Last in 2022 Best and Worst Business Climate CEO Survey

In what’s become an annual rite of spring for its Best & Worst States for Business survey of CEOs, Texas and Florida held on to their No. 1 and No. 2 spots this year, continuing their long-running lock on the top of the rankings.

Based on polling of nearly 700 CEOs and business owners from every U.S. state, conducted in January and February 2022, the Lone Star State placed No. 1 again, as it has every year since Chief Executive began the compiling the list in 2001. Their combination of a fast-growth population and a low-tax, low-regulation business climate is proven catnip for companies.

It’s a position that seems unlikely to change, even as Governor Greg Abbott has stressed some corporate sensibilities in recent weeks by snarling supply chains with an order for state inspection of commercial trucks coming from Mexico, looking to stop the flow of illegal immigrants and drugs. Abbott also has assumed a high profile in the growing national controversy over new abortion restrictions that began with a law in Texas.

The state’s faltering electrical grid resulted in a similar tsunami of criticism – even worse in business circles, including a rare knuckle-rap from new Austin resident Elon Musk in early 2021—but that did little to chill the state’s reputation or ranking among CEOs.

Meanwhile, Florida has solidified its hold on the No. 2 position in the Chief Executive rankings with a consistently business-friendly approach under Governor Ron DeSantis that crested during the past couple of years with his hands-off approach to Covid shutdowns.

Texas has enjoyed an era of stunning growth based on a broadening of its economy to automobile production, digital-technology development and shared services as well as the traditional base in oil, gas and refining. And last fall, Samsung announced its investment of $17.1 billion to construct a microchip factory outside Austin.

Similarly, Florida and Tennessee (holding at No. 3) have welcomed continuing streams of new corporate investments, such as Ford’s recent multi-billion-dollar commitment to Tennessee to build electric vehicles there.

Arizona climbed six spots this year, to No. 4 in the ranking, thanks in part to the most laissez-faire pandemic-shutdown policies in the West. “There’s a big spread across the Sun Belt from Raleigh to Charlotte to Tampa and Jacksonville, and the big metro areas of Texas, on to Phoenix that are all in various respects growing fast,” said Cullum Clark, director of the Bush Institute-SMU Economic Growth Initiative. “It’s a distinctive model.”

States at the bottom of the list continued to suffer from reputations for high taxes, regulation and costs of living, with Washington at No. 46, followed by New Jersey, Illinois, New York and California, all unchanged in their rankings from previous years.

Despite some of the nation’s top talent pools and education systems, it will take a true revolution in their tax and regulatory structures to gain ground with CEOs -and move up from the basement.