Category: Daily News

Lario Melendrez worked for Ameron International Corporation in Pasadena for 24 years and was exposed to asbestos while manufacturing pipe products for the company. He died in 2011 of asbestos-related mesothelioma. His wife and children filed a wrongful death lawsuit against Ameron and argued that Mr. Melendrez was exposed to asbestos at work and through waste or scrap pipe that Ameron permitted him to take home for personal projects, such as making flower pots and part of a patio. Ameron argued that workers comp was the exclusive remedy for Mr. Melendrez’s family.

The Superior Court agreed with the employer and granted summary judgment finding that Mr. Melendrez’s death was work-related and the exclusive remedy applied. The family appealed, and the court of appeal sustained the dismissal in the published case of Melendrez v Ameron International Corporation.

The appeals court agreed that although a triable issue of fact exists whether Melendrez’s exposure to asbestos at home arose out of and in the course of his employment with Ameron, that issue is not material to the viability of Ameron’s defense of workers’ compensation exclusivity. “It is undisputed that Melendrez’s exposure to asbestos in his employment with Ameron substantially contributed to his mesothelioma. Therefore, under the contributing cause standard applicable in workers’ compensation law, his mesothelioma is covered by workers’ compensation, and his separate exposure at home does not create a separate injury outside workers’ compensation coverage. Thus, plaintiffs’ lawsuit is barred by workers’ compensation exclusivity.”

The court also upheld an award of $80,719 to be paid by Mr. Melendrez’s family to Ameron for costs and fees as a result of their rejection of a CCP 998 offer to allow judgment in the lower court trial.

A federal grand jury indicted 54 year old Oakland resident Daniel Rush for taking illegal payments as a union employee, honest services fraud, attempted extortion, and money laundering. According to the indictment, Rush is alleged to have used his position as a union organizer with the United Food and Commercial Workers (UFCW) to obtain money and other things of value over a five year period.

Rush was an organizing coordinator of the medical cannabis division of the UFCW. The indictment further charges Rush with taking kickbacks from Marc Terbeek, an Oakland workers compensation attorney, in exchange for arranging for the attorney to represent clients in worker’s compensation matters. Rush was an officer and director of an advocacy organization for the working poor. Rush directed the organization’s referral of worker’s compensation clients to the attorney. In exchange, the attorney provided Rush with a credit card on which Rush charged thousands of dollars of personal expenses which ultimately were paid by the attorney.

Rush also is charged with attempted extortion. Rush was a member of the Berkeley Medical Cannabis Commission, which is a commission of the City of Berkeley organized to facilitate the appropriate licensing and regulation of medical marijuana in the city. Rush demanded a well-compensated job from a prospective medical marijuana dispensary in exchange for his influence as a member of the commission.

In addition, the indictment alleges that Rush engaged in a conspiracy to commit money laundering and financial structuring, as well as substantive money laundering. The indictment and FBI agent’s affidavit filed in the case explain that Rush took a loan totaling $600,000 in cash from a person engaged in the marijuana business. Rush and the attorney engaged in a series of structuring transactions designed to obscure the origin of the money. Over the ensuing years, Rush required the attorney to fund interest payments on the loan and, when Rush ultimately was not able to repay the loan, he offered favorable union benefits in exchange for forgiveness of the loan.

The case is being prosecuted by the Special Prosecutions and National Security Unit of the U.S. Attorney’s Office in San Francisco and investigated by the FBI.

Joann Matute claimed cumulative industrial injury to her psyche, fibromyalgia, carpal tunnel syndrome, allergies and rheumatoid arthritis while employed as a teacher for the Los Angeles Unified School District. She was awarded 37% permanent disability and future medical treatment for rheumatoid arthritis, fibromyalgia and psychiatric injuries.

On July 7, 2014, Pamela Stitt, M.D. issued a prescription for 24-hour home health care services. On August 23, 2014, defendant served applicant with a letter finding that the requested services were not medically necessary. On September 4, 2014, applicant filed a request for IMR. On November 6, 2014, Maximus Federal Services, Inc., issued a Final Determination Letter upholding the UR denial. On December 10, 2014, applicant filed an appeal of the IMR determination. December 10 was 34 days after the November 6, 2014 date of the Final Determination Letter.

The WCJ found that a five day extension for service by mail pursuant to Code of Civil Procedure [C.C.P.] section 1013(a) did not apply to applicant’s IMR appeal and issued the Findings and Order dismissing the IMR appeal as untimely. The WCAB in the case of Matute v LAUSD reversed and held that:

(1) The term “mailing” contained in section 4610.6(h) is equivalent to and means “service by mail” and (2) The 30-day period to file a timely appeal from an IMR determination under section 4610.6(h) is extended by five days pursuant to the provisions of section 5316 and C.C.P. section 1013(a).

There is no specific mention of “service” in section 4610.6(h). Thus, the issue presented is whether the “mailing” of the written IMR determination to the employee or employer is equivalent to and means service by mail. WCAB Rule 10957.1(c) specifically mentions “service by mail” as the trigger for responding to an IMR determination. This rule reflects the intended meaning of “mailing” in light of the relevant case law. The 30-day period to file an appeal of an IMR determination pursuant to section 4610.6(h) is extended by five days pursuant to the provisions of section 5316 and C.C.P. section 1013(a).

SB 863 placed limits on the ability to claim permanent disability for psychiatric injury, sleep disorder or sexual disorder, if it is the result of a physical injury. Before the new law, these claims were referred to as AMA Guides “add-on” cases. A recent case may answer questions about the use of a PQME with a specialty in those areas in add-on cases.

Shari Hernandez, a bank teller for Fremont Bank, claims to have sustained a specific injury to her knee, and cumulative trauma injury to her left leg and foot. Both Applications were amended to include claim of injury to psyche, stomach and internal organs.

The parties later decided to utilize Joel Renbaum, M.D., as an orthopedic AME. Applicant petitioned for assignment of an additional panel in psychiatry, and an Order to that effect was issued by a WCJ. It is from this Order that Defendant petitioned for removal.

Defendant relied on Labor Code Section 4660.l(c)(l), which it quotes as follows: “‘there shall be no increases in impairment ratings for sleep dysfunction, sexual dysfunction or psychiatric disorder, or any combination thereof arising out of a compensable physical injury’ for injuries occurring on or after 1/1/13.” Defendant goes on, “Therefore, a medical legal evaluation in the specialty of psychiatry is inappropriate.”

The WCAB denied removal in the case of Hernandez v. Fremont Bank. The WCJ pointed out that the second sentence of 4660. l(c)(l), states, “Nothing in this section shall limit the ability of an injured employee to obtain treatment for sleep dysfunction, sexual dysfunction, or psychiatric disorder, if any, that are a consequence of an industrial injury.”

The appropriate procedure to resolve a dispute over injury is to utilize the panel Qualified Medical Evaluator mechanism (or agree to an AME). The fact that compensation for a permanent psychiatric impairment is not available to this injured worker does not deprive her of her potential right to medical care or, for that matter, temporary disability indemnity on a psychiatric basis.

Los Angeles County District Attorney Jackie Lacey announced that two criminal Grand Jury indictments were unsealed charging an orthopedic surgeon, his personal attorney and a cadre of assistants with operating one of the largest insurance fraud scams in state history.

Dr. Munir Uwaydah, his personal lawyer and his former office manager were among the 15 named in two indictments totaling 132 felony counts. Uwaydah was arrested in Germany and is awaiting extradition back to the United States.

The vast conspiracy outlined in the overt acts included fraudulently billing of more than $150 million to insurance companies including workers’ compensation claims, and paying attorneys and marketers up to $10,000 a month each for illegal patient referrals, known as “capping.” But the most serious charges outlined in the indictment involve Uwaydah and his staff deceiving nearly two dozen patients into having surgeries thinking they would be done by Uwaydah. In fact, the surgical procedures were performed by a physician’s assistant who never attended medical school, prosecutors said.

The physician’s assistant operated on patients while they were under general anesthesia and without Uwaydah present in the operating room, the indictment alleges. Prosecutors said in addition all 21 patients sustained lasting scars and many required additional surgeries and suffered physical and psychological trauma as a result of their experience in Uwaydah’s clinics.

A total of 102 people testified during two separate Grand Jury proceedings, one in February and the second in August. The 57-count indictment, BA425397, charges Uwaydah and 10 other defendants with one count each of conspiracy; 32 counts each of insurance fraud; 18 counts each of aggravated mayhem; and three counts each of capping or unlawful client referrals. Uwaydah, the physician’s assistant and three others are charged with three additional counts of aggravated mayhem involving patients. The 57-count indictment alleges all the surgeries were billed to insurance companies as if Uwaydah had performed the surgeries. As part of the fraud, the indictment alleges MRI and insurance authorization reports were routinely altered to justify surgeries, and some surgeries were performed with no medical justification.

In the 75-count indictment, BA435339, Uwaydah’s personal lawyer and three others are charged as coconspirators. Charges include conspiracy to commit insurance fraud, money laundering, illegal patient referrals and filing false tax returns. His personal attorney also is charged with one count of aggravated mayhem for her role in the alleged fraudulent surgery of a patient. If convicted, Uwaydah and 11 others face up to life in state prison.

In case BA425397, a 57-count indictment returned on Feb. 25, the 11 defendants are: Munir Uwaydah (dob 4/1/66): Alleged mastermind of fraud and owner of Frontline Medical. Awaiting extradition from Germany – Paul Turley (dob 11/12/62) of Granada Hills: A chiropractor and Uwaydah’s business partner – Maria Turley (dob 3/4/67) of Granada Hills: Uwaydah’s director of surgery and Paul Turley’s wife – Marisa Schermbeck-Nelson (dob 11/29/76) of Redondo Beach: Uwaydah’s personal assistant – Peter Nelson (dob 8/1/71) of Redondo Beach: Uwaydah’s physician assistant and Marisa Schermbeck-Nelson’s husband – David Johnson (dob 11/7/34) of Corona: Doctor who worked for Frontline – Leticia Alvarez Lemus (dob 2/9/77) of Corona: Office manager for Frontline – Jeff Stevens (dob 4/4/51) of Playa Del Rey: Uwaydah’s business associate – Wendee Luke (dob 7/2/74) of Brea: Uwaydah’s office manager for several of his companies – Kelly Park (dob 10/10/65) of Thousand Oaks: Uwaydah’s office manager and personal assistant; – Ron Case (dob 4/11/76) of Camarillo: Billing manager for Frontline.

In BA435339, a 75-count indictment returned on Aug. 26, the four defendants are: Tatiana Torres Arnold (dob 1/6/70) of Encino: Uwaydah’s personal attorney who held various positions for Uwaydah’s companies – Terry Luke (dob 1/23/45) of Brea: Held various positions for Uwaydah’s companies and defendant Wendee Luke’s father – Tony Folgar (dob 11/24/57) of Sylmar: Paralegal for a law firm and Yolanda Groscost (dob 7/16/66) of Fountain Valley: Owner of YDG Marketing, a marketing firm.