Only one week remains before the Floyd, Skeren and Kelly LLP 3rd Annual Employment Law Conference, which will feature keynote speaker Phyllis W. Cheng, Director of the California Department of Fair Employment and Housing (DFEH). The conference will be held on May 9, 2013 at the Disneyland Hotel.
This is an all-day event, designed for employers, supervisors, managers, claims adjusters, risk managers, and any other professionals associated with human resources and employment law. The conference will focus on the latest employment law cases, most recent legislation, and provide helpful practical guidance related to numerous workplace topics, including: the new California disability regulations (which impact an employer’s policies and procedures on reasonable accommodation, the interactive process and medical certifications); an overview of important OSHA workplace requirements; a review of 10 critical steps an employer can take to stay out of court and avoid costly and time consuming employment related lawsuits; a workers’ compensation case law and legislative update; helpful guidance on preventing workers’ compensation fraud; a review of the new comprehensive pregnancy disability regulations now in effect; and, an update on the evolving role of social media in the workplace.
Cost of attendance is $120.00
Discounted room rates at the Disneyland Hotel and discounted Disneyland tickets are available for attendees and their guests. Upon registration this information will be provided to you.
Please visit www.fskhrtraining.com for more details and online registration. You can also contact Christina Bardelli by phone (818) 854-3239 or, email christina.bardelli@fsklaw.com ...
This is an all-day event, designed for employers, supervisors, managers, claims adjusters, risk managers, and any other professionals associated with human resources and employment law. The conference will focus on the latest employment law cases, most recent legislation, and provide helpful practical guidance related to numerous workplace topics, including: the new California disability regulations (which impact an employer’s policies and procedures on reasonable accommodation, the interactive process and medical certifications); an overview of important OSHA workplace requirements; a review of 10 critical steps an employer can take to stay out of court and avoid costly and time consuming employment related lawsuits; a workers’ compensation case law and legislative update; helpful guidance on preventing workers’ compensation fraud; a review of the new comprehensive pregnancy disability regulations now in effect; and, an update on the evolving role of social media in the workplace.
Cost of attendance is $120.00
Discounted room rates at the Disneyland Hotel and discounted Disneyland tickets are available for attendees and their guests. Upon registration this information will be provided to you.
Please visit www.fskhrtraining.com for more details and online registration. You can also contact Christina Bardelli by phone (818) 854-3239 or, email christina.bardelli@fsklaw.com ...
After claiming for three years she damaged her hand desperately enough she was unable to even drive, a field worker pleaded guilty Tuesday to making false statements that allowed her to reap the benefits of workers’ compensation.
According to the story in the Salinas Californian, video surveillance capturing Ema Pantoja, 52, of Greenfield, performing activities inconsistent with her testimony provided the fodder necessary for the Monterey County District Attorney’s Office to file charges for insurance fraud, according to a release.
In January 2007, Pantoja alleged she sustained an injury to her left wrist and elbow while working in the fields owned by Scheid Vineyards. Although she received medical treatment and returned to work, by May 2007 Pantoja told an investigator she was unable to do anything with her lefthand, a premise she repeated to multiple doctors.
On May 7, 2008, Pantoja testified at a hearing about her physical limitations. She continued to receive medical treatment until May 2010.
Although Pantoja stated she couldn’t even drive and was forced to wear a wrist brace at all times, she was caught on tape performing impossible activities if her injury were true, according to the release.
She will be sentenced by Judge Larry Hayes on June 27. Insurance fraud as a felony carries a maximum penalty of five years in the California Department of Corrections and a fune of up to $150,000 or double the fraud amount. In addition, she may be on the hook for restitution which can include attorney’s fees and the cost of investigation ...
According to the story in the Salinas Californian, video surveillance capturing Ema Pantoja, 52, of Greenfield, performing activities inconsistent with her testimony provided the fodder necessary for the Monterey County District Attorney’s Office to file charges for insurance fraud, according to a release.
In January 2007, Pantoja alleged she sustained an injury to her left wrist and elbow while working in the fields owned by Scheid Vineyards. Although she received medical treatment and returned to work, by May 2007 Pantoja told an investigator she was unable to do anything with her lefthand, a premise she repeated to multiple doctors.
On May 7, 2008, Pantoja testified at a hearing about her physical limitations. She continued to receive medical treatment until May 2010.
Although Pantoja stated she couldn’t even drive and was forced to wear a wrist brace at all times, she was caught on tape performing impossible activities if her injury were true, according to the release.
She will be sentenced by Judge Larry Hayes on June 27. Insurance fraud as a felony carries a maximum penalty of five years in the California Department of Corrections and a fune of up to $150,000 or double the fraud amount. In addition, she may be on the hook for restitution which can include attorney’s fees and the cost of investigation ...
Workers’ Memorial Day takes place annually around the world, an international day of remembrance and action for workers killed, injured or made ill on the job. The observance is held each year on April 28, the day Congress passed the Occupational Safety and Health Act in 1970. Workers’ Memorial Day is an opportunity to highlight the preventable nature of most workplace accidents and to promote campaigns in the fight for improvements in workplace safety and health.
"While we pause this day to remember those who died simply by trying to earn a living, we must honor their memories by continuing to make workplace safety a priority," said DIR Director Christine Baker. "We will focus our efforts and resources on identifying and targeting the most serious safety violators, and we will continue working closely with model employers who are making safety a part of their workplace culture."
California has a long history of improving workplace safety and continues to lead the nation in protective safety standards. Cal/OSHA was established by the Occupational Safety and Health Act of 1973 to enforce effective standards, assist and encourage employers to maintain safe and healthful working conditions, and to provide for enforcement, research, information, education and training in the field of occupational safety and health.
Cal/OSHA last year launched a statewide Confined Space Initiative after seven workers died in 2011 due to confined space hazards in various industries. This ongoing initiative includes outreach and enforcement to educate employers and workers about these hazards. Cal/OSHA issued a Confined Space Hazard Alert to help employers and employees identify confined space hazards and take immediate steps to train and protect workers and have emergency procedures on site. Cal/OSHA has also posted extensive resources on confined space hazard materials online.
Cal/OSHA was the first in the nation to adopt an Injury and Illness Prevention Program (IIPP) standard in 1991, to ensure that all employers have effective safety and health programs tailored to their specific workplaces.
Cal/OSHA was also the first in the nation to enact a standard and comprehensive program to prevent workers from suffering heat illness and death working in high heat outdoors. Cal/OSHA’s program has been effective in preventing many heat-related illnesses and deaths to farmworkers, construction workers, landscapers, and others through enforcement, education and outreach, media and partnerships with business and labor organizations to educate employers and workers about the risks of heat illness and simple steps necessary to prevent illness and death. Cal/OSHA has posted extensive resources on heat illness prevention on its website ...
"While we pause this day to remember those who died simply by trying to earn a living, we must honor their memories by continuing to make workplace safety a priority," said DIR Director Christine Baker. "We will focus our efforts and resources on identifying and targeting the most serious safety violators, and we will continue working closely with model employers who are making safety a part of their workplace culture."
California has a long history of improving workplace safety and continues to lead the nation in protective safety standards. Cal/OSHA was established by the Occupational Safety and Health Act of 1973 to enforce effective standards, assist and encourage employers to maintain safe and healthful working conditions, and to provide for enforcement, research, information, education and training in the field of occupational safety and health.
Cal/OSHA last year launched a statewide Confined Space Initiative after seven workers died in 2011 due to confined space hazards in various industries. This ongoing initiative includes outreach and enforcement to educate employers and workers about these hazards. Cal/OSHA issued a Confined Space Hazard Alert to help employers and employees identify confined space hazards and take immediate steps to train and protect workers and have emergency procedures on site. Cal/OSHA has also posted extensive resources on confined space hazard materials online.
Cal/OSHA was the first in the nation to adopt an Injury and Illness Prevention Program (IIPP) standard in 1991, to ensure that all employers have effective safety and health programs tailored to their specific workplaces.
Cal/OSHA was also the first in the nation to enact a standard and comprehensive program to prevent workers from suffering heat illness and death working in high heat outdoors. Cal/OSHA’s program has been effective in preventing many heat-related illnesses and deaths to farmworkers, construction workers, landscapers, and others through enforcement, education and outreach, media and partnerships with business and labor organizations to educate employers and workers about the risks of heat illness and simple steps necessary to prevent illness and death. Cal/OSHA has posted extensive resources on heat illness prevention on its website ...
Federal authorities have taken disciplinary action against a Las Vegas hospital cited for improperly sending newly released psychiatric patients by bus to neighboring California and other states in a practice called "patient dumping." According to the story in Reuters Health, the Rawson-Neal Psychiatric Hospital was warned it was in violation of Medicare rules governing the discharge of patients and could lose critical funding under the federal healthcare insurance program if it failed to correct the problem. The notice came in a letter on Friday from the Centers for Medicare and Medicaid Services, an agency under the U.S. Health and Human Services Department, to the Southern Nevada Adult Mental Health Services agency, which is licensed to run the hospital for the state.
The letter said a March compliance survey, which remains confidential, "reported serious deficiencies" in discharge planning and governance. Rawson-Neal has until May 6 to furnish a plan to remedy the problems or face further actions to terminate its Medicare provider agreement, the letter said. Rufus Arther, a Medicaid operations branch chief for Nevada and California, said he was unable to quantify the exact amount of money at stake for Rawson-Neal.
Dr Tracey Green, Nevada's top state health officer, estimated less than 10 percent of the hospital's billings come from Medicare and none from Medicaid. Most of the hospital's funding comes from the state, she said. "We are 100 percent confident that we will get the plan of corrections implemented and there will be no loss of federal funds," she said. The hospital has tightened discharge policies to ensure patients released to other states have appropriate after-care treatment plans, Green said. She also said all psychiatric patients would from now on be chaperoned when the state pays to put them on Greyhound buses, planes or trains.
The hospital has faced increasing scrutiny since the Sacramento Bee newspaper documented in an investigative series that began last month that Rawson-Neal gave one-way Greyhound Bus tickets to up to 1,500 patients for destinations in California and 46 other states in the past five years. Some of those patients - how many remains the subject of multiple investigations - were put on buses without sufficient food, medicine or plans for housing and continued medical treatment. The Bee's expose grew from its story about one particular discharge, that of James Flavy Coy Brown, 48, who was put in a taxi to a Greyhound Bus station with a ticket for a 15-hour ride to Sacramento in February and a three-day supply of pills to treat his schizophrenia, depression and anxiety. Staff at a Sacramento homeless shelter described him as arriving frightened and disoriented, without money or medication, though Brown eventually was reunited with a daughter from the East Coast who had not heard from him for years.
A state review of the matter led to discipline against two employees, and Nevada health and human services spokeswoman Mary Woods said earlier this week that an ongoing probe has uncovered violations of hospital policy in four or five discharges. While vowing to fully investigate the issue, Nevada Governor Brian Sandoval and state health officials have denied that illegal, out-of-state busing of patients is rampant or that the state condones or practices patient-dumping
Local officials in San Francisco and Los Angeles have said they are looking into the matter. The Bee found one-third of the patients given bus tickets went to California, the bulk of them arriving in Los Angeles, while 36 ended up in San Francisco ...
The letter said a March compliance survey, which remains confidential, "reported serious deficiencies" in discharge planning and governance. Rawson-Neal has until May 6 to furnish a plan to remedy the problems or face further actions to terminate its Medicare provider agreement, the letter said. Rufus Arther, a Medicaid operations branch chief for Nevada and California, said he was unable to quantify the exact amount of money at stake for Rawson-Neal.
Dr Tracey Green, Nevada's top state health officer, estimated less than 10 percent of the hospital's billings come from Medicare and none from Medicaid. Most of the hospital's funding comes from the state, she said. "We are 100 percent confident that we will get the plan of corrections implemented and there will be no loss of federal funds," she said. The hospital has tightened discharge policies to ensure patients released to other states have appropriate after-care treatment plans, Green said. She also said all psychiatric patients would from now on be chaperoned when the state pays to put them on Greyhound buses, planes or trains.
The hospital has faced increasing scrutiny since the Sacramento Bee newspaper documented in an investigative series that began last month that Rawson-Neal gave one-way Greyhound Bus tickets to up to 1,500 patients for destinations in California and 46 other states in the past five years. Some of those patients - how many remains the subject of multiple investigations - were put on buses without sufficient food, medicine or plans for housing and continued medical treatment. The Bee's expose grew from its story about one particular discharge, that of James Flavy Coy Brown, 48, who was put in a taxi to a Greyhound Bus station with a ticket for a 15-hour ride to Sacramento in February and a three-day supply of pills to treat his schizophrenia, depression and anxiety. Staff at a Sacramento homeless shelter described him as arriving frightened and disoriented, without money or medication, though Brown eventually was reunited with a daughter from the East Coast who had not heard from him for years.
A state review of the matter led to discipline against two employees, and Nevada health and human services spokeswoman Mary Woods said earlier this week that an ongoing probe has uncovered violations of hospital policy in four or five discharges. While vowing to fully investigate the issue, Nevada Governor Brian Sandoval and state health officials have denied that illegal, out-of-state busing of patients is rampant or that the state condones or practices patient-dumping
Local officials in San Francisco and Los Angeles have said they are looking into the matter. The Bee found one-third of the patients given bus tickets went to California, the bulk of them arriving in Los Angeles, while 36 ended up in San Francisco ...
A federal jury in Los Angeles found an Anaheim physician and two others guilty last week for their roles in a $1.5-million Medicare fraud scheme involving power wheelchairs.
According to the story in Reuters Health, federal prosecutors said at trial that Godwin Onyeabor, 49, an officer at Fendih Medical Supply Inc. in San Bernardino, paid kickbacks to physician Sri J. Wijegunaratne, 58, and another healthcare professional, Heidi Morishita, 48, for fraudulent prescriptions for durable medical equipment.
Officials said that as a result of this scheme, which ran from 2007 to 2012, those prescriptions were used to bill Medicare $1.5 million for false and fraudulent claims. Medicare paid nearly $1 million on these claims.
Several Medicare patients testified at trial that they were lured to medical clinics with the promise of free items such as vitamins and juice, only to get power wheelchairs they didn't need.
Onyeabor, Wijegunaratne and Morishita face up to 10 years in prison and a $250,000 fine for each count they were found guilty on, prosecutors said.
The case was investigated by the FBI and the Los Angeles regional office for the U.S. Department of Health and Human Services' inspector general.
The Obama administration has tried to crack down on fraud and abuse in Medicare in hopes of recovering some of the estimated $60 billion lost annually in the federal program. The government's enforcement efforts have taken on added importance at a time of rising entitlement spending and mounting federal debt ...
According to the story in Reuters Health, federal prosecutors said at trial that Godwin Onyeabor, 49, an officer at Fendih Medical Supply Inc. in San Bernardino, paid kickbacks to physician Sri J. Wijegunaratne, 58, and another healthcare professional, Heidi Morishita, 48, for fraudulent prescriptions for durable medical equipment.
Officials said that as a result of this scheme, which ran from 2007 to 2012, those prescriptions were used to bill Medicare $1.5 million for false and fraudulent claims. Medicare paid nearly $1 million on these claims.
Several Medicare patients testified at trial that they were lured to medical clinics with the promise of free items such as vitamins and juice, only to get power wheelchairs they didn't need.
Onyeabor, Wijegunaratne and Morishita face up to 10 years in prison and a $250,000 fine for each count they were found guilty on, prosecutors said.
The case was investigated by the FBI and the Los Angeles regional office for the U.S. Department of Health and Human Services' inspector general.
The Obama administration has tried to crack down on fraud and abuse in Medicare in hopes of recovering some of the estimated $60 billion lost annually in the federal program. The government's enforcement efforts have taken on added importance at a time of rising entitlement spending and mounting federal debt ...
CompWest Insurance has signed an agreement with Phoenix Risk Management Insurance Services, to write California health care workers' compensation insurance program for specific classes in the health care industry.
Under the terms of the accord, CompWest will combine its underwriting, specialized loss control and integrated claim management services with Phoenix Risk Management's significant experience in this particular segment to minimize injuries and reduce long-term insurance costs for policyholders.
The team will provide service-oriented, long-term, stable market for the growing health care industry for customers and retail agents.Targetting California operations with an annual premium between $75,000 and $500,000, the program aims a variety of classifications such as residential care for children, nursing homes, convalescent homes or hospitals and rest homes, physicians' offices, residential care for elderly or adults and residential care for the developmentally disabled.
CompWest Insurance is part of the Accident Fund Holdings, which is a workers' compensation insurance holding company conducting business through four operating units in the US - Accident Fund Cos., located in Lansing, Mich.; United Heartland, located in New Berlin, Wisc.; CompWest, located in San Francisco; and Third Coast Underwriters, located in Chicago. Accident Fund Holdings, Inc. is one of the largest privately held monoline workers’ compensation carriers in the country and is rated "A-" (Excellent) by A.M. Best. It is a wholly-owned subsidiary of Blue Cross Blue Shield of Michigan ...
Under the terms of the accord, CompWest will combine its underwriting, specialized loss control and integrated claim management services with Phoenix Risk Management's significant experience in this particular segment to minimize injuries and reduce long-term insurance costs for policyholders.
The team will provide service-oriented, long-term, stable market for the growing health care industry for customers and retail agents.Targetting California operations with an annual premium between $75,000 and $500,000, the program aims a variety of classifications such as residential care for children, nursing homes, convalescent homes or hospitals and rest homes, physicians' offices, residential care for elderly or adults and residential care for the developmentally disabled.
CompWest Insurance is part of the Accident Fund Holdings, which is a workers' compensation insurance holding company conducting business through four operating units in the US - Accident Fund Cos., located in Lansing, Mich.; United Heartland, located in New Berlin, Wisc.; CompWest, located in San Francisco; and Third Coast Underwriters, located in Chicago. Accident Fund Holdings, Inc. is one of the largest privately held monoline workers’ compensation carriers in the country and is rated "A-" (Excellent) by A.M. Best. It is a wholly-owned subsidiary of Blue Cross Blue Shield of Michigan ...
Maria Elana Mendez settled her claims against Le Chef Bakery and Pacific Compensation Insurance by a compromise and release in 2010.
On April 30, 2012, Dr. Fatolomi filed a medical-legal lien claim and concurrently filed a DOR requesting a lien conference. A lien conference was held on June 14, 2012 and continued to July 20, 2012. (before SB 863 became law) The parties filed a pretrial conference statement, and the case was scheduled for a December 12, 2012 trial, which was continued to January 3, 2013.
Dr. Fatolomi did not pay a lien activation fee prior to the January 3, 2013 lien trial. The WCJ concluded that, under WCAB Rule 10582, Dr. Fatolomi’s filing of a DOR "activated" his lien and that the intent of section 4903.06 is that, beginning January 1, 2013, a lien claimant must pay an activation fee whenever it uses the WCAB to collect on its lien, regardless of whether the first appearance in 2013 is at a lien conference or lien trial. Therefore, the WCJ dismissed Dr. Fatolomi’s lien with prejudice for failure to pay the fee.
Dr. Fatolomi filed a petition for reconsideration contending that Labor Code section 4903.06 does not require payment of a lien activation fee prior to a lien trial and, therefore, his lien should not have been dismissed. The WCAB in a significant panel decision agreed and reversed the dismissal in the case of Maria Elana Mendez vs Le Chef Bakery and Pacific Compensation Insurance.
Payment of a lien activation fee was not required with a DOR filed prior to January 1, 2013 or at a lien conference held prior to January 1, 2013. This is because section 4903.06 was not effective until that date. Therefore, Dr. Fatolomi was not required to pay a lien activation fee based on his April 30, 2012 DOR or based on the June 14 or July 20, 2012 lien conferences. However, because section 4903.06 applies to all cases that were not final as of its January 1, 2013 effective date (Stats. 2012, ch. 363, § 84), the WCAB emphasized that if Dr. Fatolomi’s pre-2013 DOR had triggered a lien conference (rather than a lien trial) in 2013, he would have been required to pay the activation fee prior to the lien conference. Under the WCAB Rules, there is a clear and unambiguous distinction between a "lien conference" and a "lien trial."
The panel concluded that a lien claimant is not required to pay a lien activation fee prior to a 2013 lien trial where: (1) the declaration of readiness (DOR) is filed prior to January 1, 2013; (2) the lien conference takes place prior to January 1, 2013; and (3) the lien trial takes place in 2013, without any intervening 2013 lien conference.
However the panel observed that section 4903.06(a)(5) provides: any lien filed pursuant to subdivision (b) of Section 4903 prior to January 1, 2013, and any cost that was filed as a lien prior to January 1, 2013, for which the filing fee or lien activation fee has not been paid by January 1, 2014, is dismissed by operation of law. Therefore, if a lien subject to the lien activation fee is not resolved or withdrawn by January 1, 2014, the lien activation fee must be paid by that date, or the lien will be dismissed by operation of law ...
On April 30, 2012, Dr. Fatolomi filed a medical-legal lien claim and concurrently filed a DOR requesting a lien conference. A lien conference was held on June 14, 2012 and continued to July 20, 2012. (before SB 863 became law) The parties filed a pretrial conference statement, and the case was scheduled for a December 12, 2012 trial, which was continued to January 3, 2013.
Dr. Fatolomi did not pay a lien activation fee prior to the January 3, 2013 lien trial. The WCJ concluded that, under WCAB Rule 10582, Dr. Fatolomi’s filing of a DOR "activated" his lien and that the intent of section 4903.06 is that, beginning January 1, 2013, a lien claimant must pay an activation fee whenever it uses the WCAB to collect on its lien, regardless of whether the first appearance in 2013 is at a lien conference or lien trial. Therefore, the WCJ dismissed Dr. Fatolomi’s lien with prejudice for failure to pay the fee.
Dr. Fatolomi filed a petition for reconsideration contending that Labor Code section 4903.06 does not require payment of a lien activation fee prior to a lien trial and, therefore, his lien should not have been dismissed. The WCAB in a significant panel decision agreed and reversed the dismissal in the case of Maria Elana Mendez vs Le Chef Bakery and Pacific Compensation Insurance.
Payment of a lien activation fee was not required with a DOR filed prior to January 1, 2013 or at a lien conference held prior to January 1, 2013. This is because section 4903.06 was not effective until that date. Therefore, Dr. Fatolomi was not required to pay a lien activation fee based on his April 30, 2012 DOR or based on the June 14 or July 20, 2012 lien conferences. However, because section 4903.06 applies to all cases that were not final as of its January 1, 2013 effective date (Stats. 2012, ch. 363, § 84), the WCAB emphasized that if Dr. Fatolomi’s pre-2013 DOR had triggered a lien conference (rather than a lien trial) in 2013, he would have been required to pay the activation fee prior to the lien conference. Under the WCAB Rules, there is a clear and unambiguous distinction between a "lien conference" and a "lien trial."
The panel concluded that a lien claimant is not required to pay a lien activation fee prior to a 2013 lien trial where: (1) the declaration of readiness (DOR) is filed prior to January 1, 2013; (2) the lien conference takes place prior to January 1, 2013; and (3) the lien trial takes place in 2013, without any intervening 2013 lien conference.
However the panel observed that section 4903.06(a)(5) provides: any lien filed pursuant to subdivision (b) of Section 4903 prior to January 1, 2013, and any cost that was filed as a lien prior to January 1, 2013, for which the filing fee or lien activation fee has not been paid by January 1, 2014, is dismissed by operation of law. Therefore, if a lien subject to the lien activation fee is not resolved or withdrawn by January 1, 2014, the lien activation fee must be paid by that date, or the lien will be dismissed by operation of law ...
Early this month an Appeals Board significant panel decision held that where a lien claim falls within the lien activation fee requirements of Labor Code section 4903.06: (1) the lien activation fee must be paid prior to the commencement of a lien conference, which is the time that the conference is scheduled to begin, not the time when the case is actually called; (2) if the lien claimant fails to pay the lien activation fee prior to the commencement of a lien conference and/or fails to provide proof of payment at the conference, its lien must be dismissed with prejudice; (3) a breach of a defendant’s duty to serve required documents or to engage in settlement negotiations does not excuse a lien claimant’s obligation to pay the lien activation fee; and (4) a notice of intention is not required prior to dismissing a lien with prejudice for failure to pay the lien activation fee or failure to present proof of payment of the lien activation fee at a lien conference.
The facts of the case showed that a lien conference was set for January 9, 2013, at 8:30 a.m. and one of the lien claimants, Orthomed, did not appear at the conference. Because Orthomed did not submit proof of prior timely payment of the lien activation fee, and because the WCJ reviewed the record and determined that the lien activation fee had not in fact been paid, the WCJ dismissed Orthomed’s lien with prejudice, without first issuing a notice of intention. The WCAB sustained the dismissal in a case classified as a significant panel decision.
Significant panel decisions are not binding precedent. Their intent is to augment the body of binding appellate court and en banc decisions. A panel decision will be deemed significant if: (1) it involves an issue of general interest to the workers’ compensation community; and (2) all Appeals Board members review the decision and agree that it is significant. (Elliott v. Workers’ Comp. Appeals Bd. (2010) 182 Cal.App.4th 355, 361, fn. 3 [75 Cal.Comp.Cases 81]; Larch v. Workers’ Comp. Appeals Bd. (1999) 64 Cal.Comp.Cases 1098, 1099-1100 (writ den.).)
To ensure uniform application of the law concerning payment of the lien activation fee and consequences for failure to do so, the Appeals Board voted to grant reconsideration of the April 5 significant panel decision on Board motion (Lab. Code, § 5911; see also §§ 5900(b), 5906, 5315) and the Chairwoman of the Appeals Board, upon a majority vote of its members, reassigned this case to the Appeals Board as a whole for an en banc decision. (Lab. Code, § 115.)
Thus the WCAB sitting en banc rescinded the April 5, 2013 significant panel decision and issue a new en banc decision, Eliezer Figueroa v B.C. Doering Co., Employers Compensation Insurance Co that essentially reiterated the prior result. Now that the decision is en banc, it is binding authority in all trial level cases ...
The facts of the case showed that a lien conference was set for January 9, 2013, at 8:30 a.m. and one of the lien claimants, Orthomed, did not appear at the conference. Because Orthomed did not submit proof of prior timely payment of the lien activation fee, and because the WCJ reviewed the record and determined that the lien activation fee had not in fact been paid, the WCJ dismissed Orthomed’s lien with prejudice, without first issuing a notice of intention. The WCAB sustained the dismissal in a case classified as a significant panel decision.
Significant panel decisions are not binding precedent. Their intent is to augment the body of binding appellate court and en banc decisions. A panel decision will be deemed significant if: (1) it involves an issue of general interest to the workers’ compensation community; and (2) all Appeals Board members review the decision and agree that it is significant. (Elliott v. Workers’ Comp. Appeals Bd. (2010) 182 Cal.App.4th 355, 361, fn. 3 [75 Cal.Comp.Cases 81]; Larch v. Workers’ Comp. Appeals Bd. (1999) 64 Cal.Comp.Cases 1098, 1099-1100 (writ den.).)
To ensure uniform application of the law concerning payment of the lien activation fee and consequences for failure to do so, the Appeals Board voted to grant reconsideration of the April 5 significant panel decision on Board motion (Lab. Code, § 5911; see also §§ 5900(b), 5906, 5315) and the Chairwoman of the Appeals Board, upon a majority vote of its members, reassigned this case to the Appeals Board as a whole for an en banc decision. (Lab. Code, § 115.)
Thus the WCAB sitting en banc rescinded the April 5, 2013 significant panel decision and issue a new en banc decision, Eliezer Figueroa v B.C. Doering Co., Employers Compensation Insurance Co that essentially reiterated the prior result. Now that the decision is en banc, it is binding authority in all trial level cases ...
The Los Angeles Times reports that a full-court press by professional sports leagues to limit the ability of out-of-state players to file for workers' compensation benefits in California scored big in a crucial first vote by state lawmakers.
A bill, backed by the owners of 16 California teams, including basketball's Los Angeles Lakers, baseball's Dodgers, hockey's Kings and soccer's Galaxy, passed out of the Assembly Insurance Committee with a unanimous 11-0 tally over objections from players and labor unions. The measure now heads to the full Assembly for debate and a vote. "Why should California be the workers' compensation forum for every professional athlete in America?" asked committee Chairman Henry T. Perea (D-Fresno), the author of the bill, AB 1309.
At issue is team owners' contentions that out-of-state athletes, who may have played only a few games in California, are taking advantage of a peculiarity in the Golden State's workers' compensation law. The alleged loophole allows often long-retired pros to get benefits for so-called cumulative trauma injuries acquired over years of pounding on football and soccer fields, basketball courts, baseball diamonds and hockey rinks. California has become a magnet for such claims that are not linked to a specific injury, such as a torn tendon or broken bone, caused by a specific incident during a game or practice, bill supporters said. What's more, many of the claims are filed years after a player retires because of California workers' compensation judges' liberal interpretation of the statute of limitations.
"This is about closing a loophole that out-of-state players are using to cash in on generous benefits that California provides," testified Andrew Govenar, a lobbyist for the National Football League.
Claims filed in California workers' compensation courts by athletes from teams outside California have grown exponentially since the mid-2000s and are clogging up some local dockets and putting pressure on insurance companies to raise rates on all types of employers, Govenar argued. A study commissioned by the professional sports leagues estimated that the out-of-state players' claims could cause a 1.3% rise in California employers' workers' compensation premiums across the board, Govenar said. Although the bill targets one - albeit glamorous - class of workers, some labor leaders fear it could set a dangerous precedent. The worry is that it could be extended to truck drivers, salespeople and others whose jobs take them to California and other states.
"There is a slippery slope of who is going to be next," said Angie Wei, legislative director for the California Labor Federation. Players for pro sports said their claims have no effect on California taxpayers since claims are paid by team owners or their insurance companies. They noted that all sports except baseball have caps on athletes' salaries that include the pro-rata cost of an individual's workers' compensation coverage.
Chad Brown, who spent 15 seasons with the Pittsburgh Steelers, New England Patriots and Seattle Seahawks before retiring from the NFL in 2007, stressed that he paid more than $100,000 in state income taxes for the games he played in California during his career. Doctors have diagnosed him with a 74% disability because of his cumulative trauma injuries, said Brown, who currently has a workers' comp claim pending. "All I'm asking is for this committee to consider allowing professional sports workers a forum to be heard for workers' compensation claims," he said.
But California should not be penalized because it offers richer workers' compensation benefits than other states," Assemblywoman Kristin Olsen (R-Modesto) said. "I don't think California should be the catch-all for deficiencies in other states," she said. "That's neither wise nor affordable." ...
A bill, backed by the owners of 16 California teams, including basketball's Los Angeles Lakers, baseball's Dodgers, hockey's Kings and soccer's Galaxy, passed out of the Assembly Insurance Committee with a unanimous 11-0 tally over objections from players and labor unions. The measure now heads to the full Assembly for debate and a vote. "Why should California be the workers' compensation forum for every professional athlete in America?" asked committee Chairman Henry T. Perea (D-Fresno), the author of the bill, AB 1309.
At issue is team owners' contentions that out-of-state athletes, who may have played only a few games in California, are taking advantage of a peculiarity in the Golden State's workers' compensation law. The alleged loophole allows often long-retired pros to get benefits for so-called cumulative trauma injuries acquired over years of pounding on football and soccer fields, basketball courts, baseball diamonds and hockey rinks. California has become a magnet for such claims that are not linked to a specific injury, such as a torn tendon or broken bone, caused by a specific incident during a game or practice, bill supporters said. What's more, many of the claims are filed years after a player retires because of California workers' compensation judges' liberal interpretation of the statute of limitations.
"This is about closing a loophole that out-of-state players are using to cash in on generous benefits that California provides," testified Andrew Govenar, a lobbyist for the National Football League.
Claims filed in California workers' compensation courts by athletes from teams outside California have grown exponentially since the mid-2000s and are clogging up some local dockets and putting pressure on insurance companies to raise rates on all types of employers, Govenar argued. A study commissioned by the professional sports leagues estimated that the out-of-state players' claims could cause a 1.3% rise in California employers' workers' compensation premiums across the board, Govenar said. Although the bill targets one - albeit glamorous - class of workers, some labor leaders fear it could set a dangerous precedent. The worry is that it could be extended to truck drivers, salespeople and others whose jobs take them to California and other states.
"There is a slippery slope of who is going to be next," said Angie Wei, legislative director for the California Labor Federation. Players for pro sports said their claims have no effect on California taxpayers since claims are paid by team owners or their insurance companies. They noted that all sports except baseball have caps on athletes' salaries that include the pro-rata cost of an individual's workers' compensation coverage.
Chad Brown, who spent 15 seasons with the Pittsburgh Steelers, New England Patriots and Seattle Seahawks before retiring from the NFL in 2007, stressed that he paid more than $100,000 in state income taxes for the games he played in California during his career. Doctors have diagnosed him with a 74% disability because of his cumulative trauma injuries, said Brown, who currently has a workers' comp claim pending. "All I'm asking is for this committee to consider allowing professional sports workers a forum to be heard for workers' compensation claims," he said.
But California should not be penalized because it offers richer workers' compensation benefits than other states," Assemblywoman Kristin Olsen (R-Modesto) said. "I don't think California should be the catch-all for deficiencies in other states," she said. "That's neither wise nor affordable." ...
A WCRI study summarized by Property Casualty 360 says that substantial workers-compensation rule changes in California are likely to affect the price and utilization of medical care to injured workers by most types of providers. The study by the Workers Compensation Research Institute is meant to provide a baseline for monitoring the impact of California reforms in S.B. 863, passed last August on the last day of the California legislative session.
In general, the new legislation seeks to increase benefits to workers, especially those on long-term disability, by 30 percent-- paying for it by imposing certain reforms. According to WCRI, the potential impact from the measure could include, among other things, an increase in prices paid for primary care and a decrease in prices paid for specialty services. Other possibilities include a decrease in payments for ambulatory surgical care services, changes in utilization of different types of services, lower medical legal expenses, faster dispute resolution, and more timely medical treatment.
The WCRI report examines the state medical reimbursement and treatment prior to its reform legislation and compares the state to 16 other states. Prices paid for most types of professional services - which cover office visits, physical medicine, major and minor radiology, and major surgeries - were less than the others studied, anywhere from 54 to 14 percent lower. This was primarily due to lower fee schedule rates in California.
However, utilization of non hospital services, such as chiropractors and physical therapists, was higher in California. Non hospital office visits for a claim of more than seven days of lost time and 36 months of experience in 2008 averaged 13 per claim in California compared to 8 in the median state.
"Some system participants suggest that some providers might have billed more complex office visits in order to compensate for substantially lower fee schedule rates," says the report.
The costs of medical care for injured workers in California grew rapidly from 2005 to 2010, WCRI reports. This growth followed a decrease of more than 30 percent from 2002 to 2004 due to the previous round of regulatory changes in the California workers’ compensation system. The report says the growth in utilization of non hospital care and hospital outpatient and/or ambulatory surgical center costs may reflect the combined impact of changes in regulation and participant behaviors ...
In general, the new legislation seeks to increase benefits to workers, especially those on long-term disability, by 30 percent-- paying for it by imposing certain reforms. According to WCRI, the potential impact from the measure could include, among other things, an increase in prices paid for primary care and a decrease in prices paid for specialty services. Other possibilities include a decrease in payments for ambulatory surgical care services, changes in utilization of different types of services, lower medical legal expenses, faster dispute resolution, and more timely medical treatment.
The WCRI report examines the state medical reimbursement and treatment prior to its reform legislation and compares the state to 16 other states. Prices paid for most types of professional services - which cover office visits, physical medicine, major and minor radiology, and major surgeries - were less than the others studied, anywhere from 54 to 14 percent lower. This was primarily due to lower fee schedule rates in California.
However, utilization of non hospital services, such as chiropractors and physical therapists, was higher in California. Non hospital office visits for a claim of more than seven days of lost time and 36 months of experience in 2008 averaged 13 per claim in California compared to 8 in the median state.
"Some system participants suggest that some providers might have billed more complex office visits in order to compensate for substantially lower fee schedule rates," says the report.
The costs of medical care for injured workers in California grew rapidly from 2005 to 2010, WCRI reports. This growth followed a decrease of more than 30 percent from 2002 to 2004 due to the previous round of regulatory changes in the California workers’ compensation system. The report says the growth in utilization of non hospital care and hospital outpatient and/or ambulatory surgical center costs may reflect the combined impact of changes in regulation and participant behaviors ...
Reuters Health reports that the U.S. government filed a civil fraud lawsuit against Novartis AG on Tuesday, accusing a unit of the Swiss drug maker of causing the Medicare and Medicaid programs to pay tens of millions of dollars in reimbursements based on fraudulent, kickback-tainted claims. U.S. Attorney Preet Bharara in Manhattan said Novartis Pharmaceuticals Corp had since 2005 induced at least 20 pharmacies to switch thousands of kidney transplant patients to its immunosuppressant drug Myfortic from competitors' drugs, in exchange for kickbacks disguised as rebates and discounts. He said Novartis tried to conceal the scheme by omitting the agreements from rebate and discount contracts with pharmacies.
In one alleged case, Novartis offered a Los Angeles pharmacist a "bonus" rebate of 5 percent of that pharmacist's annual Myfortic sales, or several hundred thousand dollars, to switch as many as 1,000 patients to Myfortic. "Novartis co-opted the independence of certain pharmacists and turned them into salespeople," Bharara said in a statement.
The lawsuit was filed in U.S. District Court in Manhattan, and seeks civil penalties and triple damages from Novartis for violating the federal False Claims Act.
Novartis disputes the claims and will defend itself, spokeswoman Julie Masow said in an email. Novartis is "committed to high standards of ethical business conduct and regulatory compliance in the sale and marketing of our products," Masow said.
Myfortic net sales totaled $579 million in 2012, up 12 percent from a year earlier, according to Novartis' annual report. The Novartis Pharmaceuticals unit has offices in East Hanover, New Jersey.
In his announcement, Bharara called Novartis a "repeat offender," referring to a settlement of health care fraud charges based on kickbacks less than three years ago. Novartis in September of 2010 agreed to pay $422.5 million to resolve criminal and civil liability over its marketing of several drugs, including the epilepsy drug Trileptal.
The company violated a federal anti-kickback statute, "choosing instead to put sales growth and profits before its duty to comply with federal law," according to the new complaint. The federal anti-kickback statute prohibits paying people to buy drugs or services that Medicare, Medicaid or other federal healthcare programs cover, according to the complaint.
The scheme has been highly lucrative for Novartis, according to the complaint, resulting in "rapid, sometimes exponential growth in Myfortic sales." A pharmacy in Arkansas, for example, increased its annual sales of the drug to more than $1 million from $100,000 over four years, according to the complaint.
The lawsuit also claims a Novartis account manager admitted the kickback scheme generates "an ongoing stream of revenue" for Novartis "as long as the patient is still living and using (Myfortic)." These types of cases "are one of the highest priorities of the FBI's health care fraud program," FBI Assistant Director Ronald Hosko said in a statement. The case is U.S. v. Novartis Pharmaceuticals Corp, U.S. District Court, Southern District of New York, No. 11-08196 ...
In one alleged case, Novartis offered a Los Angeles pharmacist a "bonus" rebate of 5 percent of that pharmacist's annual Myfortic sales, or several hundred thousand dollars, to switch as many as 1,000 patients to Myfortic. "Novartis co-opted the independence of certain pharmacists and turned them into salespeople," Bharara said in a statement.
The lawsuit was filed in U.S. District Court in Manhattan, and seeks civil penalties and triple damages from Novartis for violating the federal False Claims Act.
Novartis disputes the claims and will defend itself, spokeswoman Julie Masow said in an email. Novartis is "committed to high standards of ethical business conduct and regulatory compliance in the sale and marketing of our products," Masow said.
Myfortic net sales totaled $579 million in 2012, up 12 percent from a year earlier, according to Novartis' annual report. The Novartis Pharmaceuticals unit has offices in East Hanover, New Jersey.
In his announcement, Bharara called Novartis a "repeat offender," referring to a settlement of health care fraud charges based on kickbacks less than three years ago. Novartis in September of 2010 agreed to pay $422.5 million to resolve criminal and civil liability over its marketing of several drugs, including the epilepsy drug Trileptal.
The company violated a federal anti-kickback statute, "choosing instead to put sales growth and profits before its duty to comply with federal law," according to the new complaint. The federal anti-kickback statute prohibits paying people to buy drugs or services that Medicare, Medicaid or other federal healthcare programs cover, according to the complaint.
The scheme has been highly lucrative for Novartis, according to the complaint, resulting in "rapid, sometimes exponential growth in Myfortic sales." A pharmacy in Arkansas, for example, increased its annual sales of the drug to more than $1 million from $100,000 over four years, according to the complaint.
The lawsuit also claims a Novartis account manager admitted the kickback scheme generates "an ongoing stream of revenue" for Novartis "as long as the patient is still living and using (Myfortic)." These types of cases "are one of the highest priorities of the FBI's health care fraud program," FBI Assistant Director Ronald Hosko said in a statement. The case is U.S. v. Novartis Pharmaceuticals Corp, U.S. District Court, Southern District of New York, No. 11-08196 ...
The DIR Office of Self Insured Plans proposes to amend sections 15201, 15210, 15210.1, 15475, 15477, 15481, 15484, 15496 and 15497 and to adopt new section 15209 of Subchapter 2, Chapter 8, Division 1, Title 8, California Code of Regulations to implement amendments to the California Labor Code regarding the administration of Self Insurance Plans pursuant to SB 863 These regulations were amended and adopted on an emergency basis effective January 1, 2013, and are currently in effect in a substantially similar form to these final proposed regulations.
Labor Code section 3700 requires every employer in California, except the State, to secure the payment of workers’ compensation either by being insured against liability to pay compensation by one or more insurers duly authorized to write workers’ compensation insurance in this state, or by securing from the Department of Industrial Relations a certificate of consent to self-insure.
Among other things, SB 863, which took effect on January 1, 2013, amended Labor Code section 3701 to change the manner in which security deposits are calculated. Section 3701, subdivision (c), as amended, requires that the calculation of a self-insurer’s projected losses and expenses upon which the security deposit is based "be reflected in a written actuarial report that projects ultimate liabilities of the private self-insured employer at the expected actuarial confidence level, to ensure that all claims and associated costs are recognized. The written actuarial report shall be prepared by an actuary meeting the qualifications prescribed by the Director in regulation."
The regulations proposed in this rulemaking action would permanently: define the content of the annual actuarial reports required by Labor Code section 3701, subdivision (c); prescribe the qualifications for the actuaries who may prepare those required annual actuarial reports; and bring the requirements for self-insurers’ security deposits into conformity with Labor Code section 3701, subdivision (c) as amended by SB 863.
Any interested person may submit written comments relevant to the proposed regulatory action to the Department. Submit comments to Jon Wroten, Chief Office of Self Insurance Plans, 2265 Watt Avenue, Suite 1, Sacramento, CA 95825. The written comment period closes at 5:00 p.m. on Monday, June 10, 2013 ...
Labor Code section 3700 requires every employer in California, except the State, to secure the payment of workers’ compensation either by being insured against liability to pay compensation by one or more insurers duly authorized to write workers’ compensation insurance in this state, or by securing from the Department of Industrial Relations a certificate of consent to self-insure.
Among other things, SB 863, which took effect on January 1, 2013, amended Labor Code section 3701 to change the manner in which security deposits are calculated. Section 3701, subdivision (c), as amended, requires that the calculation of a self-insurer’s projected losses and expenses upon which the security deposit is based "be reflected in a written actuarial report that projects ultimate liabilities of the private self-insured employer at the expected actuarial confidence level, to ensure that all claims and associated costs are recognized. The written actuarial report shall be prepared by an actuary meeting the qualifications prescribed by the Director in regulation."
The regulations proposed in this rulemaking action would permanently: define the content of the annual actuarial reports required by Labor Code section 3701, subdivision (c); prescribe the qualifications for the actuaries who may prepare those required annual actuarial reports; and bring the requirements for self-insurers’ security deposits into conformity with Labor Code section 3701, subdivision (c) as amended by SB 863.
Any interested person may submit written comments relevant to the proposed regulatory action to the Department. Submit comments to Jon Wroten, Chief Office of Self Insurance Plans, 2265 Watt Avenue, Suite 1, Sacramento, CA 95825. The written comment period closes at 5:00 p.m. on Monday, June 10, 2013 ...
Michael Brooks started working as a supervising probation officer at the County of Sacramento’s juvenile hall in 2007, and was apprised of a pending lawsuit alleging use of excessive force by the officers there. He observed problems he believed bordered on violation of protocols and felt that the Security Emergency Response Team (SERT), which he supervised, resisted and undermined his authority and supervision.
In November 2007, Brooks counseled two of the SERT officers as a result of an incident with a ward. Brooks informed his supervisor that the SERT officers resisted his instructions concerning restraining and movement of wards. Later Assistant Chief Deputy John O’Brien met with Brooks and gave him a memo entitled "Admonition and Notice of Internal Affairs Investigation." The memo advised Brooks of the allegations by Ron Parker, a SERT member, which formed the basis of the internal affairs investigation. The memo directed Brooks to refrain from any supervisory duties which involve Ron Parker, refrain from abusive and or indiscreet language toward Ron Parker, and refrain from any other actions that could reasonably be construed as an attempt to intimidate or threaten Ron Parker. Brooks believed that these directives were unreasonable when it was his job to supervise Ron Parker. Brooks believed that with these directives he would not be able to intervene in an emergency.
Brooks asked to be reassigned or placed on administrative leave pending completion of the investigation. His requests were denied. Brooks did not feel that the Chiefs listened to his concerns or provided a reasonable alternative. However, the employer allowed Brooks to change his shifts to reduce contact with Ron Parker. Brooks went to work on January 2, 2008 and saw that Ron Parker was scheduled to work. Brooks was too upset to work and filed a workers' compensation psychiatric injury claim which the employer denied. The defense of the claim involved the "good faith personnel action" defense.
Psychiatrist Ann E. Allen, M.D., acted as the agreed medical evaluator. Dr. Allen reported that his disorder was caused by (1) Parker’s complaint, (2) the internal affairs investigation, and (3) Brooks’s feelings that his supervisors were not supporting him. Based upon her report, the WJC found an industrial injury. Ultimately the WCAB affirmed the WCJ’s decision, with one dissenting commissioner, The employer appealed, and the Court of Appeal reversed the finding of injury in the published decision of County of Sacramento v WCAB, Michael Brooks.
The Court of Appeal agreed that Dr. Allen’s reports and testimony did not constitute substantial evidence. Labor Code section 3208.3 was enacted as part of the Margolin-Greene Workers’ Compensation Reform Act of 1989. It is part of the Legislature’s response to increased public concern about the high cost of workers’ compensation coverage, limited benefits for injured workers, suspected fraud and widespread abuses in the system, and particularly the proliferation of workers’ compensation cases with claims for psychiatric injuries. The Legislature’s expressed intent in enacting Labor Code section 3208.3 was to establish a new and higher threshold for compensability for psychiatric injury. To further this more restrictive policy, subdivision (h) provides: "No compensation under this division shall be paid by an employer for a psychiatric injury if the injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action."
A personnel action has been defined as conduct attributable to management in managing its business, including such things as reviewing, criticizing, demoting, transferring, or disciplining an employee. An employer’s disciplinary actions short of termination may be considered personnel actions even if they are harsh and if the actions were not so clearly out of proportion to the employee’s deficiencies so that no reasonable manager could have imposed such discipline.
The reports of Dr. Allen, when "taken as a whole, were so confusing and changing that Dr. Allen’s opinion cannot be deemed support for the Board’s conclusion that personnel actions were not a substantial cause of Brooks’s injury. Therefore, the Board’s award must be annulled." ...
In November 2007, Brooks counseled two of the SERT officers as a result of an incident with a ward. Brooks informed his supervisor that the SERT officers resisted his instructions concerning restraining and movement of wards. Later Assistant Chief Deputy John O’Brien met with Brooks and gave him a memo entitled "Admonition and Notice of Internal Affairs Investigation." The memo advised Brooks of the allegations by Ron Parker, a SERT member, which formed the basis of the internal affairs investigation. The memo directed Brooks to refrain from any supervisory duties which involve Ron Parker, refrain from abusive and or indiscreet language toward Ron Parker, and refrain from any other actions that could reasonably be construed as an attempt to intimidate or threaten Ron Parker. Brooks believed that these directives were unreasonable when it was his job to supervise Ron Parker. Brooks believed that with these directives he would not be able to intervene in an emergency.
Brooks asked to be reassigned or placed on administrative leave pending completion of the investigation. His requests were denied. Brooks did not feel that the Chiefs listened to his concerns or provided a reasonable alternative. However, the employer allowed Brooks to change his shifts to reduce contact with Ron Parker. Brooks went to work on January 2, 2008 and saw that Ron Parker was scheduled to work. Brooks was too upset to work and filed a workers' compensation psychiatric injury claim which the employer denied. The defense of the claim involved the "good faith personnel action" defense.
Psychiatrist Ann E. Allen, M.D., acted as the agreed medical evaluator. Dr. Allen reported that his disorder was caused by (1) Parker’s complaint, (2) the internal affairs investigation, and (3) Brooks’s feelings that his supervisors were not supporting him. Based upon her report, the WJC found an industrial injury. Ultimately the WCAB affirmed the WCJ’s decision, with one dissenting commissioner, The employer appealed, and the Court of Appeal reversed the finding of injury in the published decision of County of Sacramento v WCAB, Michael Brooks.
The Court of Appeal agreed that Dr. Allen’s reports and testimony did not constitute substantial evidence. Labor Code section 3208.3 was enacted as part of the Margolin-Greene Workers’ Compensation Reform Act of 1989. It is part of the Legislature’s response to increased public concern about the high cost of workers’ compensation coverage, limited benefits for injured workers, suspected fraud and widespread abuses in the system, and particularly the proliferation of workers’ compensation cases with claims for psychiatric injuries. The Legislature’s expressed intent in enacting Labor Code section 3208.3 was to establish a new and higher threshold for compensability for psychiatric injury. To further this more restrictive policy, subdivision (h) provides: "No compensation under this division shall be paid by an employer for a psychiatric injury if the injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action."
A personnel action has been defined as conduct attributable to management in managing its business, including such things as reviewing, criticizing, demoting, transferring, or disciplining an employee. An employer’s disciplinary actions short of termination may be considered personnel actions even if they are harsh and if the actions were not so clearly out of proportion to the employee’s deficiencies so that no reasonable manager could have imposed such discipline.
The reports of Dr. Allen, when "taken as a whole, were so confusing and changing that Dr. Allen’s opinion cannot be deemed support for the Board’s conclusion that personnel actions were not a substantial cause of Brooks’s injury. Therefore, the Board’s award must be annulled." ...
Federal officials announced that a former owner of a Los Angeles-area medical equipment supply company pleaded guilty Monday to conspiring with others to defraud Medicare.
Tigran Aklyan, 37, of Van Nuys, California, pleaded guilty before U.S. District Judge Michael W. Fitzgerald in the Central District of California to one count of conspiracy to commit health care fraud.
According to court documents, Aklyan was the owner and president of Las Tunas Medical Equipment Inc., a durable medical equipment (DME) supply company located in San Gabriel, California. Aklyan admitted that from approximately October 2007 through May 2009, he conspired with others to commit health care fraud through the operation of Las Tunas by providing medically unnecessary power wheelchairs and other DME to Medicare beneficiaries and submitting false and fraudulent claims to Medicare. Aklyan admitted that he paid the owners and operators of fraudulent medical clinics to provide him with prescriptions and supporting medical documentation for the power wheelchairs and DME that he billed to Medicare. Aklyan admitted knowing that the prescriptions and medical documents that the clinics produced were fraudulent, yet he certified to Medicare with the submission of each claim that the DME was medically necessary. Aklyan also admitted that he knew it was illegal for him to pay for prescriptions, but he did so anyway.
From approximately December 17, 2007 through February 20, 2009, Aklyan, through Las Tunas, submitted approximately $910,377 in fraudulent claims to Medicare for power wheelchairs and related services, and Medicare paid Las Tunas approximately $653,461 on those claims.
At sentencing, scheduled for August 5, 2013, Aklyan faces a maximum penalty of 10 years in prison and a $250,000 fine.
The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov ...
Tigran Aklyan, 37, of Van Nuys, California, pleaded guilty before U.S. District Judge Michael W. Fitzgerald in the Central District of California to one count of conspiracy to commit health care fraud.
According to court documents, Aklyan was the owner and president of Las Tunas Medical Equipment Inc., a durable medical equipment (DME) supply company located in San Gabriel, California. Aklyan admitted that from approximately October 2007 through May 2009, he conspired with others to commit health care fraud through the operation of Las Tunas by providing medically unnecessary power wheelchairs and other DME to Medicare beneficiaries and submitting false and fraudulent claims to Medicare. Aklyan admitted that he paid the owners and operators of fraudulent medical clinics to provide him with prescriptions and supporting medical documentation for the power wheelchairs and DME that he billed to Medicare. Aklyan admitted knowing that the prescriptions and medical documents that the clinics produced were fraudulent, yet he certified to Medicare with the submission of each claim that the DME was medically necessary. Aklyan also admitted that he knew it was illegal for him to pay for prescriptions, but he did so anyway.
From approximately December 17, 2007 through February 20, 2009, Aklyan, through Las Tunas, submitted approximately $910,377 in fraudulent claims to Medicare for power wheelchairs and related services, and Medicare paid Las Tunas approximately $653,461 on those claims.
At sentencing, scheduled for August 5, 2013, Aklyan faces a maximum penalty of 10 years in prison and a $250,000 fine.
The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov ...
The Division of Workers’ Compensation April 19 Newsline issued the following warning to claims administrators.
The DWC has received complaints regarding claims administrators who do not accept electronic bills from medical providers. The DWC Audit Unit has begun investigating claims administrators to determine if they accept electronic transmissions of medical bills.
Provisions relating to electronic medical bills became effective Oct. 18, 2012. By statute, claims administrators are required to accept electronic bills and may develop their own capacity to accept e-bills or may contract with a vendor to perform the function. Participation in e-billing is optional for medical providers.
Claims administrators who do not comply with the e-billing regulations will be subject to assessment, including civil penalties. The electronic billing rules are available on the DWC website. Claims administrators seeking assistance in implementing electronic medical bill processing may wish to consult one or more of the service providers who have elected to be listed on the DWC website. Other companies not listed may be equally capable of providing electronic bill processing services or products ...
The DWC has received complaints regarding claims administrators who do not accept electronic bills from medical providers. The DWC Audit Unit has begun investigating claims administrators to determine if they accept electronic transmissions of medical bills.
Provisions relating to electronic medical bills became effective Oct. 18, 2012. By statute, claims administrators are required to accept electronic bills and may develop their own capacity to accept e-bills or may contract with a vendor to perform the function. Participation in e-billing is optional for medical providers.
Claims administrators who do not comply with the e-billing regulations will be subject to assessment, including civil penalties. The electronic billing rules are available on the DWC website. Claims administrators seeking assistance in implementing electronic medical bill processing may wish to consult one or more of the service providers who have elected to be listed on the DWC website. Other companies not listed may be equally capable of providing electronic bill processing services or products ...
Former Orange County Sheriff Mike Carona, who is serving a 66-month term in federal prison for public corruption, has settled two workers' compensation cases against Orange County for more than $37,000 over injuries he suffered on duty, according to state records reviewed by the Orange County Register.
The Orange County Register says that Carona, 57, agreed through his attorney to accept $22,165 as compensation for lower back, hip and leg injuries he suffered in a car crash Dec. 5, 2005
The claim stems from a car accident on Dec. 5, 2006. Carona was a passenger in an unmarked department vehicle that rear-ended another car causing an injury to his lower back.The driver of the car was an investigator from what was formerly known as the dignitary protection unit, which regularly provided security and transportation for Carona. The investigator picked up Carona at his home because Carona had a full schedule that day, and when they were traveling near Chapman Avenue and Earlham Street in Orange about 8 a.m.,traffic suddenly stopped and they rear-ended the car in front of them.
Carona’s driver and the driver of the other car were not injured. But Carona filed a workers’ compensation claim for his back pain at the time, and it was accepted. Since then, Carona has received medical treatment through the claim.Then Carona filed an application for adjudication of claim.
Carona resigned from office after nine years in January 2008 to focus on his federal public corruption trial. He was convicted in 2009 of federal witness tampering and sentenced to 66 months in prison. He was acquitted on five other charges, including conspiracy, three charges of mail fraud and one additional count of witness tampering. He was ultimately convicted and sentenced to 5 1/2 years in prison and a fine of $125,000.
A doctor examined Carona before he reported to a Colorado prison in January 2011 and determined he suffered permanent injuries on the job.
Last year, the U.S. Supreme Court declined to review Carona's appeal. Carona had argued prosecutors breached an ethical rule when they had an assistant sheriff secretly record him in 2007, and that he was charged under the wrong federal statute ...
The Orange County Register says that Carona, 57, agreed through his attorney to accept $22,165 as compensation for lower back, hip and leg injuries he suffered in a car crash Dec. 5, 2005
The claim stems from a car accident on Dec. 5, 2006. Carona was a passenger in an unmarked department vehicle that rear-ended another car causing an injury to his lower back.The driver of the car was an investigator from what was formerly known as the dignitary protection unit, which regularly provided security and transportation for Carona. The investigator picked up Carona at his home because Carona had a full schedule that day, and when they were traveling near Chapman Avenue and Earlham Street in Orange about 8 a.m.,traffic suddenly stopped and they rear-ended the car in front of them.
Carona’s driver and the driver of the other car were not injured. But Carona filed a workers’ compensation claim for his back pain at the time, and it was accepted. Since then, Carona has received medical treatment through the claim.Then Carona filed an application for adjudication of claim.
Carona resigned from office after nine years in January 2008 to focus on his federal public corruption trial. He was convicted in 2009 of federal witness tampering and sentenced to 66 months in prison. He was acquitted on five other charges, including conspiracy, three charges of mail fraud and one additional count of witness tampering. He was ultimately convicted and sentenced to 5 1/2 years in prison and a fine of $125,000.
A doctor examined Carona before he reported to a Colorado prison in January 2011 and determined he suffered permanent injuries on the job.
Last year, the U.S. Supreme Court declined to review Carona's appeal. Carona had argued prosecutors breached an ethical rule when they had an assistant sheriff secretly record him in 2007, and that he was charged under the wrong federal statute ...
City Controller Wendy Greuel issued her latest audit, raising serious concerns about the City's Worker's Compensation Salary Continuation Program for employees injured on the job. Her audit finds potential savings of up to $5.2 million annually by bringing the City's non-sworn employee payment program in line with other jurisdictions in the State of California.
Greuel called on the responsible departments and City leaders to act immediately to protect taxpayer resources and reduce t he benefits to a level comparable with others throughout the State. The State Rate for temporary disability is two thirds of an employee's take-home pay not to exceed $1 ,067 per week, while Los Angeles pays an employee's full salary for the first 52 weeks. As all disability pay is tax-exempt by law, the City's policy creates the potential for earning more than 100% of salary and, in some instances, employees earn more while on disability leave than while working.
"I am deeply concerned by the findings of this audit. While it is critical to support our injured employees, Los Angeles absolutely cannot afford to leave $5 million a year on the table that could go towards keeping our children safe and our roads paved," said Greuel.
Greuel’s audit found that Injury on Duty (IOD) payments have increased dramatically each of the last four years, from $12.6 million in 2009 to over $19 million in 2012. According to the audit, this increase is most likely a result of employees receiving payments for a longer period of time, rather than an increase in the number of employees receiving payments.
The audit also evaluated system controls to prevent overpayments. A test sampling of payment data identified $127,000 in overpayments due primarily to departments' failure to terminate salary continuation payments following the 52 week period and a failure to communicate between two independent systems.
"I am pleased that the Personnel Dept is working closely with my Office to enhance oversight and improve communications and controls for Workers Compensation" Greuel said.
Controller Greuel has conducted more than 80 audits and and claims she uncovered more than $160 million that the City has lost to wasteful spending, fraudulent activity, and abuse of city resources ...
Greuel called on the responsible departments and City leaders to act immediately to protect taxpayer resources and reduce t he benefits to a level comparable with others throughout the State. The State Rate for temporary disability is two thirds of an employee's take-home pay not to exceed $1 ,067 per week, while Los Angeles pays an employee's full salary for the first 52 weeks. As all disability pay is tax-exempt by law, the City's policy creates the potential for earning more than 100% of salary and, in some instances, employees earn more while on disability leave than while working.
"I am deeply concerned by the findings of this audit. While it is critical to support our injured employees, Los Angeles absolutely cannot afford to leave $5 million a year on the table that could go towards keeping our children safe and our roads paved," said Greuel.
Greuel’s audit found that Injury on Duty (IOD) payments have increased dramatically each of the last four years, from $12.6 million in 2009 to over $19 million in 2012. According to the audit, this increase is most likely a result of employees receiving payments for a longer period of time, rather than an increase in the number of employees receiving payments.
The audit also evaluated system controls to prevent overpayments. A test sampling of payment data identified $127,000 in overpayments due primarily to departments' failure to terminate salary continuation payments following the 52 week period and a failure to communicate between two independent systems.
"I am pleased that the Personnel Dept is working closely with my Office to enhance oversight and improve communications and controls for Workers Compensation" Greuel said.
Controller Greuel has conducted more than 80 audits and and claims she uncovered more than $160 million that the City has lost to wasteful spending, fraudulent activity, and abuse of city resources ...
The Palm Desert Patch reports that a father and son are accused of more than $1 million in workers' compensation insurance fraud. Indio resident Jesse Garcia Contreras, 57, and his son, 32-year-old Carlos Contreras of Bermuda Dunes, have each pleaded not guilty to six felony counts of workers' compensation insurance fraud. They both face up to 19 years and eight months in prison if convicted, according to John Hall of the Riverside County District Attorney's Office.
Jesse Contreras is president and CEO of Thousand Palms-based Sunshine Landscape and Carlos Contreras is the company's accounting director. Sunshine Landscaping contracts with many homeowner's associations and businesses in the Coachella Valley, according to Hall and the company's website.
An 18-month investigation showed that the Contrerases allegedly defrauded the State Compensation Insurance Fund and insurance companies out of about $1.45 million from January 2008 to March 2012, Hall said.
"The defendants intentionally misclassified dozens of employees as having jobs that were less dangerous than they actually were. They classified more than 40 tree trimmers as landscapers, therefore having to pay far less in workers' compensation insurance premiums," Hall alleged.
He said the case was investigated by the Inland Empire Premium Fraud task force because of a complaint of possible fraud filed by Zenith Insurance Company with both the California Department of Insurance and the Riverside County District Attorney's Office.
"By cheating insurance companies out of their rightful premiums, this type of criminal conduct causes there to be an uneven playing field for those businesses which are doing things the right and legal way," District Attorney Paul Zellerbach said. "Crimes like this also cause an increase in insurance premiums for those businesses which are following the law. It is this office's responsibility to make sure that businesses operate under the same rules and guidelines to ensure that there is a fair marketplace." ...
Jesse Contreras is president and CEO of Thousand Palms-based Sunshine Landscape and Carlos Contreras is the company's accounting director. Sunshine Landscaping contracts with many homeowner's associations and businesses in the Coachella Valley, according to Hall and the company's website.
An 18-month investigation showed that the Contrerases allegedly defrauded the State Compensation Insurance Fund and insurance companies out of about $1.45 million from January 2008 to March 2012, Hall said.
"The defendants intentionally misclassified dozens of employees as having jobs that were less dangerous than they actually were. They classified more than 40 tree trimmers as landscapers, therefore having to pay far less in workers' compensation insurance premiums," Hall alleged.
He said the case was investigated by the Inland Empire Premium Fraud task force because of a complaint of possible fraud filed by Zenith Insurance Company with both the California Department of Insurance and the Riverside County District Attorney's Office.
"By cheating insurance companies out of their rightful premiums, this type of criminal conduct causes there to be an uneven playing field for those businesses which are doing things the right and legal way," District Attorney Paul Zellerbach said. "Crimes like this also cause an increase in insurance premiums for those businesses which are following the law. It is this office's responsibility to make sure that businesses operate under the same rules and guidelines to ensure that there is a fair marketplace." ...
Amgen Inc., a California-based biotechnology company, has agreed to pay the United States $24.9 million to settle allegations that it violated the False Claims Act. Amgen develops, manufactures, and sells pharmaceutical products, including products sold under the trade name Aranesp.
The settlement resolves allegations that Amgen paid kickbacks to long-term care pharmacy providers Omnicare Inc., PharMerica Corporation and Kindred Healthcare Inc. in return for implementing "therapeutic interchange" programs that were designed to switch Medicare and Medicaid beneficiaries from a competitor drug to Aranesp. The government alleged that the kickbacks took the form of performance-based rebates that were tied to market-share or volume thresholds. The government further alleged that, as part of the therapeutic interchange program, Amgen distributed materials to consultant pharmacists and nursing home staff encouraging the use of Aranesp for patients who did not have anemia associated with chronic renal failure.
"We will continue to pursue pharmaceutical companies that pay kickbacks to long-term care pharmacy providers to influence drug prescribing decisions," said Stuart F. Delery, Acting Assistant Attorney General for the Justice Department’s Civil Division. "Patients in skilled nursing facilities deserve care that is free of improper financial influences."
"By this agreement we are making important strides in holding drug manufacturers accountable for fraudulent and abusive practices not only in South Carolina but nationwide," said William Nettles, U.S. Attorney for the District of South Carolina. "I am proud of the tireless work of this office to investigate this case across the country."
This civil settlement resolves a lawsuit filed under the qui tam, or whistleblower, provision of the False Claims Act, which allows private citizens with knowledge of false claims to bring civil actions on behalf of the United States and share in any recovery. The False Claims Act suit was filed in the U.S. District Court for the District of South Carolina, and is captioned United States ex rel. Kurnik v. Amgen Inc., et al.
Acting Assistant Attorney General Delery noted that the settlement with Amgen, Inc. was the result of a coordinated effort among the Civil Division, the U.S. Attorney’s Office for the District of South Carolina, and the U.S. Department of Health and Human Services, Office of Inspector General.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14.2 billion.
The claims settled by this agreement are allegations only; there has been no determination of liability ...
The settlement resolves allegations that Amgen paid kickbacks to long-term care pharmacy providers Omnicare Inc., PharMerica Corporation and Kindred Healthcare Inc. in return for implementing "therapeutic interchange" programs that were designed to switch Medicare and Medicaid beneficiaries from a competitor drug to Aranesp. The government alleged that the kickbacks took the form of performance-based rebates that were tied to market-share or volume thresholds. The government further alleged that, as part of the therapeutic interchange program, Amgen distributed materials to consultant pharmacists and nursing home staff encouraging the use of Aranesp for patients who did not have anemia associated with chronic renal failure.
"We will continue to pursue pharmaceutical companies that pay kickbacks to long-term care pharmacy providers to influence drug prescribing decisions," said Stuart F. Delery, Acting Assistant Attorney General for the Justice Department’s Civil Division. "Patients in skilled nursing facilities deserve care that is free of improper financial influences."
"By this agreement we are making important strides in holding drug manufacturers accountable for fraudulent and abusive practices not only in South Carolina but nationwide," said William Nettles, U.S. Attorney for the District of South Carolina. "I am proud of the tireless work of this office to investigate this case across the country."
This civil settlement resolves a lawsuit filed under the qui tam, or whistleblower, provision of the False Claims Act, which allows private citizens with knowledge of false claims to bring civil actions on behalf of the United States and share in any recovery. The False Claims Act suit was filed in the U.S. District Court for the District of South Carolina, and is captioned United States ex rel. Kurnik v. Amgen Inc., et al.
Acting Assistant Attorney General Delery noted that the settlement with Amgen, Inc. was the result of a coordinated effort among the Civil Division, the U.S. Attorney’s Office for the District of South Carolina, and the U.S. Department of Health and Human Services, Office of Inspector General.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14.2 billion.
The claims settled by this agreement are allegations only; there has been no determination of liability ...
A new California Workers' Compensation Institute (CWCI) "Injury Scorecard" on job injury claims identified as "other injuries, poisonings and toxic effects" finds that these claims often involve non-specific or ill-defined diagnoses; are more likely than other claims to involve attorneys and permanent disability payments; take longer to close; result in above average loss payments; and a disproportionate share of them (32.5%) are filed by Los Angeles County residents. CWCI compiled data for the Score Card from 169,287 open and closed claims for 2001-11 injuries in which the primary diagnosis fell into the "other injury, poisoning and toxic effect" category. As of January 2012, medical and indemnity benefit payments on those claims totaled nearly $3.1 billion.
The Score Card shows that during the 11-year span of the study, "other injury, poisoning and toxic effect cases accounted for 7.7% of California's workers' compensation claims, but 10.1% of workers' compensation loss payments, as more than 1 out of every 5 of these injuries resulted in a permanent disability payment (vs. 1 in 6 injury claims overall), nearly 2/3 of the lost-time claims in this category involved an attorney (vs. less than half of all lost-time claims), and PD claims in this category took longer to close than other PD claims.
Notably, during the pre-reform era of 2001-03, average paid losses on other injury, poisoning and toxic effect claims were below the average for all claims, but unlike other types of injury claims, loss payments on these claims never declined following the 2002-2004 workers' compensation reforms, and have remained above average since 2004. For example, the Score Card shows average loss payments at 36 months post injury on AY 2001-03 other injury, poisoning and toxic effect indemnity claims totaled $26,512 ($12,891 medical + $13,622 indemnity), or 8.9% less than the average for all indemnity claims. But, while average 36-month losses for all indemnity claims fell 13.9% in the 3 years after the reforms, average payments on indemnity claims in this category rose 17% to $31,015; then continued up for 3 more years, rising 30.7% to $40,547 ($23,801 medical + $16,746 indemnity) for AY 2007-09 claims - 38.8% above the average for all indemnity claims from the same era.
Aside from tracking average paid losses for 2001 through 2009 other injury, poisoning and toxic effect claims at 12-, 24- and 36-months post injury, the CWCI Score Card provides a profile of claimants in this injury category, as well as claim distributions by industry sector, the claimants' county of residence, and cause and nature of injury. Several exhibits also compare other injury, poisoning and toxic effect claim results to those for all California workers' compensation claims (these include exhibits showing the percentage of claims with PD payments within 3 years of injury; attorney involvement data; claim closure data; prescription drug distributions; breakdowns of medical development by Fee Schedule Section at 12 and 24 months post injury; notice and treatment time lags; and medical network utilization rates).
In addition to the Score Card on "other injury, poisoning and toxic effect" claims, recent Score Cards have examined medical back problems with and without spinal cord or root involvement; shoulder, arm, knee and leg sprains; head and spinal injuries without spinal cord involvement; and carpal tunnel syndrome. Injury Score Cards and summary Bulletins are available to CWCI members and subscribers who log on to www.cwci.org ...
The Score Card shows that during the 11-year span of the study, "other injury, poisoning and toxic effect cases accounted for 7.7% of California's workers' compensation claims, but 10.1% of workers' compensation loss payments, as more than 1 out of every 5 of these injuries resulted in a permanent disability payment (vs. 1 in 6 injury claims overall), nearly 2/3 of the lost-time claims in this category involved an attorney (vs. less than half of all lost-time claims), and PD claims in this category took longer to close than other PD claims.
Notably, during the pre-reform era of 2001-03, average paid losses on other injury, poisoning and toxic effect claims were below the average for all claims, but unlike other types of injury claims, loss payments on these claims never declined following the 2002-2004 workers' compensation reforms, and have remained above average since 2004. For example, the Score Card shows average loss payments at 36 months post injury on AY 2001-03 other injury, poisoning and toxic effect indemnity claims totaled $26,512 ($12,891 medical + $13,622 indemnity), or 8.9% less than the average for all indemnity claims. But, while average 36-month losses for all indemnity claims fell 13.9% in the 3 years after the reforms, average payments on indemnity claims in this category rose 17% to $31,015; then continued up for 3 more years, rising 30.7% to $40,547 ($23,801 medical + $16,746 indemnity) for AY 2007-09 claims - 38.8% above the average for all indemnity claims from the same era.
Aside from tracking average paid losses for 2001 through 2009 other injury, poisoning and toxic effect claims at 12-, 24- and 36-months post injury, the CWCI Score Card provides a profile of claimants in this injury category, as well as claim distributions by industry sector, the claimants' county of residence, and cause and nature of injury. Several exhibits also compare other injury, poisoning and toxic effect claim results to those for all California workers' compensation claims (these include exhibits showing the percentage of claims with PD payments within 3 years of injury; attorney involvement data; claim closure data; prescription drug distributions; breakdowns of medical development by Fee Schedule Section at 12 and 24 months post injury; notice and treatment time lags; and medical network utilization rates).
In addition to the Score Card on "other injury, poisoning and toxic effect" claims, recent Score Cards have examined medical back problems with and without spinal cord or root involvement; shoulder, arm, knee and leg sprains; head and spinal injuries without spinal cord involvement; and carpal tunnel syndrome. Injury Score Cards and summary Bulletins are available to CWCI members and subscribers who log on to www.cwci.org ...
