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Lashing back at federal officials and Senate colleagues, state Sen. Ron Calderon charged in a federal lawsuit filed last week that authorities leaked an FBI affidavit against him after Calderon refused to participate in a sting operation targeting Senate President Pro Tem Darrell Steinberg and Sen. Kevin de Leon. The filing in Sacramento federal court urges a judge to hold the FBI and U.S. Attorney's Office in Los Angeles in contempt, contending that last month's release of a sealed FBI affidavit "has prejudiced any future grand jury proceeding and irreparably tainted any future court proceedings involving Senator Calderon."

Calderon alleges in the complaint that he "was approached on six separate occasions by high level agents of the Federal Bureau of Investigation and on two occasions by the Assistant United States Attorney for the Central District of California Doug Miller demanding that Senator Calderon participate in a sting operation against Senate President pro Tern Darrel Steinberg. The FBI agents requested that Senator Calderon wear a wire and secretly record his conversations with Senator Steinberg and Senator Kevin de Leon. The FBI was specifically interested in Senator Steinberg's financial activities with Michael Drobot, the former Chief Executive Officer of Pacific Hospital of Long Beach. Senator Calderon refused to continue participating in the FBI's sting operation, and rejected their demands to secretly record conversations with Senator Steinberg and Senator de Leon. Senator Calderon, through the law office of Geragos and Geragos, APC, returned the wire equipment supplied by the FBI to the agents working for United States Attorney's Office for the Central District of California."

According to an article published by McClatchy News, Steinberg said Calderon's filing "is pure fantasy." De Leon declined to comment. His office has previously said he has been told he is not a target of the investigation. Mark Geragos, Calderon's lawyer, said Steinberg's move prompted the latest legal action. Steinberg spokesman Rhys Williams said the Senate leader has been told he is not a subject of the investigation, Geragos said "we have indisputable proof that they were targeting Steinberg." Thom Mrozek, a spokesman for the U.S. Attorney's Office in Los Angeles, declined to comment Wednesday evening.

Late last month, Al Jazeera America posted the FBI affidavit, which alleges that Calderon took $60,000 in bribes from an FBI agent posing as a film studio owner and $28,000 in bribes from Drobot. Drobot's lawyer has called the allegations baseless. Calderon is quoted in that document as saying he was working with Steinberg on legislation to lower the threshold for film tax credits to $750,000 from $1 million. The affidavit also describes de Leon amending one workers' compensation bill at Calderon's request in a way that would have less impact on Drobot's business at Pacific Hospital.

There have been calls for Calderon to resign by Assemblywoman Cristina Garcia, D-Bell Gardens, and other officials in Calderon's east Los Angeles County district. Calderon issued a statement slamming Garcia for "assuming the role of judge and jury," adding that his current problems could befall "anyone in public office." ...
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/ 2013 News, Daily News
Intuit Inc. has signed a definitive agreement to acquire privately held Prestwick Services, a leader in payroll based billing and payment solutions for the workers’ compensation industry. Intuit Inc. creates business and financial management solutions that simplify the business for small businesses, consumers and accounting professionals. Its flagship products and services include QuickBooks®, Quicken® and TurboTax®

Traditional workers’ compensation plans involve large pre-payments based on estimates, with the potential for substantial extra payments at year-end audits. With the acquisition of Prestwick Services and its TRUPAY technology, Intuit will open the platform that enables workers’ compensation insurance premiums to be calculated in real-time, based on actual payroll, and will not require small business owners to switch insurance carriers or agents.

For a small business owner, pay-as-you-go workers’ compensation has several benefits. Premiums are calculated every pay period instead of estimated at the beginning of the year, so payments are adjusted as employee changes occur, virtually eliminating surprise payments at year end audits. Hefty lump sum pre-payments are avoided. And automatic collection of premiums means no extra legwork, fewer late payments and one less thing on the to-do list.

"This transaction furthers our commitment to helping small businesses manage every aspect of their business, so they can be free to focus on doing what they really love," said Ginny Lee, senior vice president and general manager of Intuit’s Employee Management Solutions division. "We are very pleased to be adding a team that brings deep insurance industry experience as well as their robust TRUPAY technology platform. Together, we look forward to providing more benefits to our small businesses customers as we work to bring even more insurance carrier partners onto the platform."

The integration of Prestwick Services means more than one million Intuit payroll customers will have access to flexible payment options from 15 top insurance carriers, without requiring a change to their existing agent-client relationships. When the transaction closes, Prestwick Services’ will become part of Intuit’s Employee Management Solutions Division. The transaction is expected to close during the second quarter of Intuit’s fiscal year 2014, which ends Jan. 31, and is subject to customary closing conditions ...
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/ 2013 News, Daily News
The Office of Administrative Law (OAL) has approved the Division of Workers’ Compensation’s (DWC) final version of the Supplemental Job Displacement Benefit (SJDB) regulations. OAL approved the SJDB regulations on November 8. Two sections have been repealed (10133.51 and 10133.52, which required the Notice of Potential Right to SJDB Benefit), effective immediately. The modifications to the remaining sections are effective on January 1, 2014. The SJDB emergency regulations went into effect on January 1, 2013. The final version of the SJDB regulations includes the following changes from the emergency regulations.
  • Section 10118, the word "Inclusive" was added to the title to clarify the exact time period. "Retraining and Return to Work Unit" was deleted from the heading as that Unit no longer exists within the Division of Workers’ Compensation (DWC). DWC’s address was added for filing a Request for Dispute Resolution. On page 3, the case number field was deleted because case numbers may not be assigned at the time offers are made.
  • Section 10133.31, subdivision (f)(5) was amended to allow injured workers to submit a written invoice for computer equipment to be paid directly to the retailer. The claims administrator may also offer to provide the computer equipment directly to the employee. Subdivision (j) is amended to indicate that computer equipment must be provided to the employee within 45 days of receipt of the Request for Purchase of Computer Equipment.
  • Section 10133.32, the form has been stricken out in its entirety and a new version of the form takes its place. The content on the first two pages of the form were moved to allow for all fillable parts of the form to be on the second page so that the injured worker does not have to photocopy the first page with submission of the second page to the claims administrator. A separate Request for Purchase of Computer Equipment was added to the form. Injured workers can submit either a written bid from a computer retailer or receipts of purchase. Following the purchase, receipts for the computer equipment must be submitted to the claims administrator.
  • Section 10133.34, subdivision (b) was deleted so as not to be duplicative with Section 10133.31.
  • Section 10133.35, "Retraining and Return to Work Unit" was deleted from the heading as the unit no longer exists within DWC. DWC’s address was added for filing a Request for Dispute Resolution. The format of the proof of service was amended.
  • Section 10133.36, the form was amended to conform to the functional capacity assessment of the DWC Form PR-4 which primary treating physicians complete when declaring an injured worker permanent and stationary. A box was added to allow the physician to describe in what ways the impaired activities are limited.
  • Section 10133.53, "Retraining and Return to Work Unit" was deleted from the heading as that Unit no longer exists within DWC. The word "Inclusive" was added to the title to clarify the exact time period. DWC’s address was added for filing a Request for Dispute Resolution.
  • Section 10133.55, "Retraining and Return to Work Unit" was deleted from the heading as that Unit no longer exists within DWC. A reason for filing for dispute resolution on page 3 was clarified to encompass objections to job offers and a reason was deleted as the reimbursement program is no longer in existence. Instructions and a proof of service were added to the form.
  • Section 10133.57, "Retraining and Return to Work Unit" was deleted from the heading as that Unit no longer exists within DWC. An instruction was corrected on page 2 because not all Training Providers have approval numbers and expiration dates. DWC’s address was added for filing a Request for Dispute Resolution. Information about Information and Assistance was added to the form.
  • Section 10133.58, this section was amended to reflect changes to approval of eligible providers.
  • Section 10133.60, subdivision (a)(1) was amended to correctly state the requirements for offers of work set forth in section 10133.34.

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State Compensation Insurance Fund’s Board of Directors has approved a $100 million dividend to qualifying policyholders for the 2013 policy year. The dividend represents approximately 8.6 percent of policyholders’ 2012 estimated annual premium and demonstrates the effectiveness of the business improvements and operational efficiencies implemented by the organization.

"State Fund has made significant progress this year by improving efficiency and establishing a new rate structure to provide fairly-priced workers’ compensation insurance,” commented Larry Mulryan, Board Chair. "We are committed to being a competitive workers' compensation insurance provider that brings value to California employers. Part of that value is the ability to return funds to our policyholders in the form of a dividend."

This action brings total dividends declared since 2011 to $250 million. Since its inception State Fund has paid more than $5 billion in dividends to policyholders - a record unparalleled among all California workers’ compensation insurance carriers ...
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/ 2013 News, Daily News
Angelotti Chiropractic, Mooney and Shamsbod Chiropractic, Christina-Arana and Associates, Joyce Altman Interpreters, Scandoc Imaging and Buena Vista Medical Services filed a lawsuit last July in the United States District Court contesting the constitutionality of certain provisions of SB 863, and seeking to avoid payment of millions of dollars in lien activation fees before the end of 2013. Last week a federal judge issued a preliminary injunction that restrains the DWC from imposing the activation fee not only on these named plaintiffs, but on all other lien claimants state wide. The injunction will continue until further order of court or an order by a higher court as a result of a successful appeal. .

As a result of this inunction, the DWC has made this public announcement.

"In compliance with a ruling issued Tuesday by the U.S. District Court for the Central District of California in the matter of Angelotti Chiropractic, Inc., et al. v. Baker, et al., the Division of Workers’ Compensation will no longer collect lien activation fees as of November 19.

Lien claimants whose liens were subject to the activation fee requirement will not be required to pay the $100 fee in order to appear at a hearing or file a Declaration of Readiness to Proceed (DOR) regarding a lien.

DWC is reconfiguring its computer systems to facilitate the filing of DORs on lien claims. The fee for filing liens remains in effect. Only the lien activation fee is affected by U.S. Judge George H. Wu’s ruling.

Further updates on changes will be posted on the DWC SB 863 pages." ...
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/ 2013 News, Daily News
At its meeting on Friday the State Fund Board of Directors announced that Tom Rowe, CEO and President and Dan Sevilla, CFO will resign from State Fund. The reason was not stated in the website announcement.

It was not immediately know why the men stepped down, and the announcement came as a surprise to some. "Certainly many people were surprised in the room when the board chair made that announcement," said Jennifer Vargen, senior vice president of marketing and communications for State Fund, who was quoted in the Insurance Journal and was quick to point out the board was 'very complimentary' of both men as they made the announcement. Vargen couldn’t say why the decision was made, and she said the board hasn’t made that known. "No reason was given," she said. Pressed about motives for the command change, Vargen replied: "These are voluntary resignations." A call by the Insurance Journal seeking comment has been put into Lawrence Mulryan, the board chair. Rowe and Sevilla couldn’t immediately be reached for comment. Board members contacted for comment by the Insurance Journal were not saying much either. "I can’t really talk about it," said Bill Zacrhy, vice president of risk management for the Safeway supermarket chain. Zacrhy indicated that personnel matters are not something he could speak about.

Several years ago, State Fund’s Board set the organization on a path to transform its operations by improving its transparency, accountability, efficiency, and productivity to ensure a stable and open workers’ compensation insurance market. "The executive team has done an outstanding job laying the foundation for State Fund’s future," said Board Chair Larry Mulryan. "The Board thanks Tom for his vision and leadership and Dan for his outstanding fiscal stewardship. We will continue the transformational work that is well underway."

Rowe and Sevilla will step away from overseeing day-to-day operations immediately but will remain available for advice and consultation until the end of the year. The Board will immediately begin a search for a new CEO and has named Carol Newman, State Fund’s General Counsel, as interim President effective immediately. Newman has been with State Fund since 2008 and has played an integral role in leading State Fund’s transformation. Carol has had a long career in insurance that spans over 30 years, affording her the opportunity to oversee a wide breadth of insurance operations including claims, broker/agency management, human resources and government and industry affairs.

The Board also announced that it has appointed Pete Guastamachio as interim CFO. Guastamachio joined State Fund in 2009 and is State Fund’s Chief Investment Officer. He has more than 30 years experience in the financial world having served as vice president-assistant portfolio manager for Bank of the West. He also served in a variety of positions with Argonaut Insurance.

"The executive team will remain focused on building a competitive company with a resourceful, creative workforce that provides fair prices and excellent service, and creates stability in the market," said Newman. "Our financial position is outstanding. It’s going to take time to fully realize our vision, but it is clear we have made good progress. Most importantly, we, along with the employees of State Fund, are committed to getting it done." ...
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The California Supreme Court agreed with the Court of Appeal, and upheld the admissibility of the reports of non-MPN physicians in support of an applicant's claim in the controversial case of Elayne Valdez v WCAB, and Warehouse Demo Services.

After Elayne Valdez filed a claim for industrial injury, the employer admitted her claim to most of the alleged body parts injured and she was sent for medical treatment to the employer’s MPN, where she was seen by Dr. Nagamoto, who treated her from approximately October 9, 2009 to October 31, 2009. Applicant then began treating with Dr. Nario, a non-MPN physician, upon referral from her attorney.

The WCAB in a split en banc decision ruled that non MPN physician reports are not admissible when the employer has properly complied with MPN regulations. The WCAB reasoned that Labor Code 4616.6 provides: "No additional examinations shall be ordered by the appeals board and no other reports shall be admissible to resolve any controversy arising out of this article" and thus precludes the admissibility of non-MPN medical reports with respect to disputed treatment and diagnosis issues, i.e., "any controversy arising out of this article."

The Court of Appeal reversed and remanded in an unpublished opinion. In ruling that non MPN reports are indeed admissible, the Court of Appeal reasoned that "It does not makes sense, however, to construe section 4616.6 as a general rule of exclusion, barring any use of medical reports other than those generated by MPN physicians. Section 4616.6 states nothing of the sort. If the Legislature intended to exclude all non-MPN medical reports, the Legislature could have said so; it did not."

Before the decision by the California Supreme Court, recently enacted S.B. 863 partially addressed this outcome. Effective 1/1/2013 LC 4605 provides that "Any report prepared by consulting or attending physicians pursuant to this section shall not be the sole basis of an award of compensation. A qualified medical evaluator or authorized treating physician shall address any report procured pursuant to this section and shall indicate whether he or she agrees or disagrees with the findings or opinions stated in the report, and shall identify the bases for this opinion."

The California Supreme Court decision is now the final word on this controversy. It concluded that the "Court of Appeal sensibly limited the scope of section 4616.6 to matters arising during the independent medical review process set out in article 2.3. Reading section 4616.6 broadly to apply to all compensation proceedings is a manifest distortion. As the Court of Appeal noted, the comprehensive medical evaluation process set out in section 4060 et seq. for the purpose of resolving disputes over compensability does not limit the admissibility of medical reports. Section 4062.3, subdivision (a) permits any party to provide the evaluator with '[m]edical and nonmedical records relevant to determination of the medical issue.' Under section 4064, subdivision (d), 'no party is prohibited from obtaining any medical evaluation or consultation at the party’s own expense,' and '[a]ll comprehensive medical evaluations obtained by any party shall be admissible in any proceeding before the appeals board,' except as provided in specified statutes. The Board is, in general, broadly authorized to consider '[r]eports of attending or examining physicians.' (§ 5703, subd. (a).) These provisions do not suggest an overarching legislative intent to limit the Board’s consideration of medical evidence."

It remains unclear how much of a Pandora's box this case has opened. In 2004, as a result of SB 899, medical disputes moved to a resolution system requiring the selection of an evaluator off of a panel of three names provided by the DWC. Prior to the panel QME system, employers complained about the costs of duplicative, redundant and unnecessary medical legal evaluations which could easily reach over $10,000 per claim. The panel QME system reduced the number of medical legal evaluations and some of the gamesmanship that took place in the selection of evaluators.

A literal parsing of the Supreme Court's language in Valdez may have opened the door for the return of the old - select who you want - QME evaluation system, or indeed even the use of non QMEs to evaluate a case whenever an attorney deems it expedient to do so. It is not clear if one side, or if both sides may do so, and it is unclear if done by an applicant, would the employer be required to pay for the evaluation as a medical legal charge even though the employer need not pay for out of network treatment.

It is unlikely that the applicant attorneys will not make as much use of the Valdez decision as possible ...
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Based upon stipulated language, federal judge Wu will issue a preliminary injunction ending the application of the new lien activation fee imposed by SB 863. The order applies to all lien holders, not just the few who were plaintiffs in the federal lawsuit filed last summer. The order reads

"1. Defendants are hereby enjoined and restrained from enforcing the lien activation fee provisions of SB 863, which are codified at Cal. Lab Code § 4903.06, against any workers’ compensation lien holder, including Plaintiffs. Specifically, Defendants shall not:
a. Subject any existing workers’ compensation lien holder to a lien activation fee pursuant to Cal. Lab. Code. § 4903.06(a).
b. Require or collect payment of any activation fee on any existing lien, electronically or otherwise, pursuant to Cal. Lab. Code §§ 4903.06(a)(1) and (a)(3).
c. Require any lien claimant to provide proof of payment of a lien activation fee with any declaration of readiness to proceed, pursuant to Cal. Lab. Code § 4903.06(a)(2).
d. Require any lien claimant to provide proof of payment of a lien activation fee at the time of any lien conference, pursuant to Cal. Lab. Code § 4903.06(a)(4).
e. Dismiss any lien for failure to pay an activation fee by the time of any lien conference, pursuant to Cal. Lab. Code § 4903.06(a)(4).
f. Dismiss any lien for which an activation fee has not been paid prior to January 1, 2014, pursuant to Cal. Lab. Code § 4903.06(a)(5).
g. Enforce any issued emergency regulations or any final regulation implementing any provision of Cal. Lab. Code § 4903.06.
h. Take any other action, whether or not listed above, intended to effectuate or enforce any provision of Cal. Lab. Code § 4903.06.
2. This injunction shall take effect seven days from the date of this order.
3. This injunction shall apply to all Defendants as well as any of Defendants’ officers, agents, servants, employees and attorneys. This injunction shall further apply to any other persons who are in active concert or participation with Defendants or Defendants’ officers, agents, servants, employees and attorneys. Fed. R. Civ. P. 65(d)(2).
4. The Court’s reasons for issuing this injunction are contained in a forthcoming opinion, as well in the transcripts of proceedings held on November 4 and 7, 2013. Fed. R. Civ. P. 65 (d)(1)(A).
5. This injunction shall be in effect until further order of the Court."

The DIR may appeal this decision to the 9th Circuit Court of Appeals, and if unsuccessful to the U.S. Supreme Court. For some time, the 9th U.S. Circuit Court of Appeals has suffered a reputation as being the circuit most at odds with the U.S. Supreme Court. The San Francisco-based court has been perceived as the most liberal in the nation and has frequently been the most reversed among the circuit courts, with one term in the mid-1990s seeing 27 of its 28 decisions reversed or vacated by the high court.

The injunction in this case was based upon federal civil rights law contained in 42 U.S.C. § 1983. The Civil Rights Attorney's Fees Awards Act of 1976 provides that one who prevails in a section 1983 action is entitled to recover attorneys' fees. It is unclear if these lien claimants will claim, or recover attorney fees in addition to the injunction they have obtained. Typically the request for an attorney fee is made after the litigation has become final.

The workers' compensation industry had hoped that hundreds of thousands of dormant liens - with no activation fees paid - would be deemed invalid as a matter of law on January 1, 2014. This would have cleared the system of a longstanding backlog. Unless the 9th Circuit Court of Appeals reverses the injunction, this hoped for outcome of SB. 863 legislation will not be the case this January ...
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The Division of Workers’ Compensation has issued a notice of public hearing to revise the recently adopted resource - based relative value scale (RBRVS) based physician fee schedule. The public hearing has been scheduled for 10 a.m., December 12 , in Room 1 of the Elihu Harris Building, 1515 Clay Street, Oakland, CA 94612. Members of the public may also submit written comment on the regulations until 5 p.m. that day.

The RBRVS base d physician fee schedule regulations (Title 8, Code of Regulations, Sections 9789.12.1, et seq.) were adopted by the Acting Administrative Director, and filed with the Secretary of State on September 24, 2013, and will be effective January 1, 2014. The proposed amendment to the RBRVS based physician fee schedule regulations eliminates use of the Federal Office of Workers’ Compensation Program relative value units set forth in Sections 9789.12.3 and 9789.19.

The notice and text of the regulations can be found on the proposed regulations page

Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all Health maintenance organizations (HMOs). RBRVS assigns procedures performed by a physician or other medical provider a relative value which is adjusted by geographic region (so a procedure performed in Manhattan is worth more than a procedure performed in Dallas). This value is then multiplied by a fixed conversion factor, which changes annually, to determine the amount of payment. RBRVS determines prices based on three separate factors: physician work (54%), practice expense (41%), and malpractice expense (5%). RBRVS was created at Harvard University in their national RBRVS study from December 1985 and published on September 29, 1988.

Physicians bill their services using procedure codes developed by a seventeen member committee known as the CPT Editorial Panel. The AMA nominates eleven of the members while the remaining seats are nominated by the Blue Cross and Blue Shield Association, the Health Insurance Association of America, CMS, and the American Hospital Association. The CPT Committee issues new codes twice each year.

A separate committee, the Specialty Society Relative Value Scale Update Committee (RUC),meets three times a year to set new values, determines the Relative Value Units (RVUs) for each new code, and revalues all existing codes at least once every five years. The RUC has 29 members, 23 of whom are appointed by major national medical societies. The six remaining seats are held by the Chair (an AMA appointee), an AMA representative, a representative from the CPT Editorial Panel, a representative from the American Osteopathic Association, a representative from the Health Care Professions Advisory Committee and a representative from the Practice Expense Review Committee. Anyone who attends its meetings must sign a confidentiality agreement ...
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Doctors are well aware that prescribing powerful painkillers known as opioids carries risks for addiction, misuse and accidental overdose - but at least professional guidelines agree on the precautions they can take, say researchers.

Opium-related drugs, like Oxycontin, Percocet, Percodan and methadone can be very addictive and are usually prescribed for just a week or two for intense short-term pain, though their use for longer-lasting pain is growing. Sales of opiates in the U.S. increased by 300 percent since 1999, according to the Centers for Disease Control and Prevention. Three out of four deaths due to prescription drug overdose involve opioids. And for every death there are ten admissions to treatment centers for addiction. The rapid rise in opioid use over the last ten years left little time to research best practices for giving out long-term prescriptions to treat chronic pain, according to Dr. Teryl Nuckols at the David Geffen School of Medicine at the University of California, Los Angeles.

Many organizations offer guidelines for doctors, but it wasn't clear if they agreed or differed greatly, he told Reuters Health. So he and colleagues set out to review the guidelines published since 2006. Surprisingly, the team found that most of them agreed on key points. "There is widespread agreement about some basic ways of mitigating the risks associated with prescribing opioids for chronic pain," Nuckols said. "Guidelines often differ substantially, even when there is pretty good literature addressing the clinical questions," he said. As an example, he pointed to the question of giving screening mammograms to women ages 40 to 50, where there is much evidence but little agreement.

In their review, Nuckols' group assessed recommendations for doctors that drew on evidence for prescribing the powerful drugs to patients with non-cancer pain that lasts more than three months. According to one study, 18 percent of people with this type of chronic pain use opioids.

Most guidelines recommended that clinicians avoid doses greater than 90 to 200 milligrams of "morphine equivalents" daily and that they have additional knowledge to prescribe methadone. Doctors should also increase dosages slowly and monitor for side effects when first prescribing the drugs, and reduce doses by at least 25 percent to 50 percent when switching opioids. Guidelines agreed, as well, that opioid risk assessment tools, written treatment agreements and urine drug testing can help to manage risks of overdose and misuse Nuckols' team writes in the Annals of Internal Medicine.

More research is needed to determine the quality of these guidelines, the researchers note. And whether they're being followed by doctors is still another question. "Unfortunately, guidelines are not followed as often as they should be," Nuckols said.

Doctors also make decisions based on online literature, lectures, journal articles, advice from other physicians and personal experience, he said. Many of the recommendations pointed out in the review are not routinely used in many, if not most, clinical practices where opioids for chronic pain are prescribed, said Dr. Mel Pohl, medical director of the Las Vegas Recovery Center. He was not involved in the review. Understanding dosing limits, knowing who is at risk of misusing, abusing or becoming addicted to prescribed opioids and what constitutes addiction versus the normal tolerance and dependence are important but nuanced aspects of prescribing these drugs, Martin D. Cheatle said. Cheatle is director of the Pain and Chemical Dependency Program at the Center for Studies of Addiction at Perelman School of Medicine at the University of Pennsylvania in Philadelphia and also not involved in the review.

"Most medical school curriculums are notably lacking courses on pain and addiction," he told Reuters Health. "Since most of pain care is delivered by primary care physicians, who typically have the least amount of training, time and resources to manage these complex cases it is imperative that we disseminate critical and well vetted guidelines for safe opioid prescribing." Educating doctors, especially primary care doctors, is the most important step, Cheatle said ...
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Johnson and Johnson will pay more than $4 billion to settle thousands of lawsuits over its recalled defective hip implants. The tentative plan, which must win court approval, represents one of the largest payouts for product liability claims involving a medical device.The agreement will include those patients who have already been forced to have the device, known as the Articular Surface Replacement, or A.S.R., removed and replaced with another artificial hip, said the lawyers who spoke about the agreement only on the condition of anonymity.

According to the story in the New York Times, each patient would receive about $350,000 on average in compensation, though that figure will vary depending on factors like a patient’s age and medical condition.The precise value of the settlement is unclear because lawyers for patients are still trying to estimate how many of the 12,000 related lawsuits involve patients who had a replacement. Lawyers believe that number may be 7,000 to 8,000 cases.The final cost of the deal to Johnson and Johnson could rise, depending on how many claimants who received the device undergo replacement operations in the future, the lawyers said. Under the plan, patients who have not had a replacement would not receive compensation, the lawyers said.

The A.S.R. hip was sold by DePuy until mid-2010, when the company recalled it amid sharply rising early failure rates. The device, which had a metal ball and a metal cup, sheds metallic debris as it wears, generating particles that have damaged tissue in some patients or caused crippling injuries. DePuy officials have long insisted that they acted appropriately in recalling the device when they did. However, internal company documents disclosed during the trial of a patient lawsuit this year showed that DePuy officials were long aware that the hip had a flawed design and was failing prematurely at a high rate.

Many artificial hips last 15 years or more before they wear out and need to be replaced. But by 2008, data from orthopedic databases outside the United States also showed that the A.S.R. was failing at high rates in patients after just a few years. Internal DePuy projections estimate that it will fail in 40 percent of those patients in five years, a rate eight times higher than for many other hip devices.

The hip was first sold by DePuy in 2003 outside the United States for use in an alternative hip replacement procedure called resurfacing. Two years later, DePuy started selling another version for use here in standard hip replacements that used the same cup component as the resurfacing device. Only the standard version was sold in the United States; both were sold outside the country.About 93,000 patients received an A.S.R., about one-third of them in the United States.

Problems with the design first came to light in Australia and England just a few years after its marketing began. But DePuy officials insisted for years to surgeons who complained about that device that patient problems reflected their surgical technique rather than the implant’s design.

Last year, The New York Times reported that DePuy executives decided in 2009 to phase out the A.S.R. and sell existing inventories weeks after the Food and Drug Administration asked the company for more safety data about the implant.

There remains some potential for claims administrators to seek credit for recoveries received by claimants who received these defective hip replacements as a result of an admitted industrial injury. However, few claim files reflect the product details of surgical implants used in surgeries. This lack of information poses a significant problem for the task of identifying appropriate claims ...
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/ 2013 News, Daily News
The Division of Workers’ Compensation (DWC) has posted a revised version of QME Form 105 as well as helpful instructions for its completion. Parties are required to use the revised Form 105 beginning December 1, 2014. Form 105 is used to request a panel Qualified Medical Evaluator (QME) examination for an unrepresented employee. A Spanish-language version of the form and instructions for its use will be available soon.

In addition to the revised Form 105, instructions for the completion of QME Form 106 (used to request a panel QME for a represented employee) and QME Form 37 (used to request factual correction of an unrepresented panel QME report) have been posted ...
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/ 2013 News, Daily News
Workers' compensation claim frequency among California's private self-insured employers showed almost no change in 2012 as a slight increase in the incidence of medical-only claims was offset by a slight reduction in indemnity claim frequency according to a California Workers' Compensation Institute (CWCI) analysis of data compiled by the state Office of Self-Insurance Plans (OSIP).

OSIP's annual summary of private self-insured data, released October 30, provides the first snapshot of California private, self-insured claims experience for cases reported in 2012, including the total number of covered employees, medical-only and indemnity claim counts, and total paid and incurred losses on those claims through the end of the year. The latest summary reflects the experience of private self-insured employers who covered 2.12 million California employees last year (vs. 2.11 million in the 2011 initial report), and who reported a total of 77,557 claims in 2012 - nearly unchanged from the 77,386 claims noted in the 2011 initial report. That translates to frequency rate of 3.65 claims (2.33 medical-only + 1.32 indemnity) per 100 employees - almost identical to the 2011 rate of 3.66 claims (2.29 medical-only + 1.37 indemnity) per 100 employees. Total wages and salaries for private self-insured employees totaled $83.6 billion last year, up 3.2 percent from 2011.

Though the number of reported private self-insured claims has dwindled over the last decade, and claim frequency has shown little change since 2005, average paid and average incurred losses on private self-insured claims remain above the pre-reform levels recorded a decade ago. The initial results for 2012, however, show that last year was the first time since 2005 that both average paid and average incurred losses per private self-insured claim declined, with all of the year-to year reduction in the average paid and most of the reduction in average incurred due to declining medical losses. With claim severity declining, and almost no change in claim volume, total paid losses for 2012 private self-insured claims at the first report fell to $186.2 million, $6 million less than in the 2011first reports, while first report incurred losses fell by $25 million to $594.6 million.

The Institute also reviewed more developed loss data from private self-insured's 2nd through 5th reports on 1999 to 2011 claims which all indicated that private self-insured claim severity (the average loss per claim) fell sharply following the 2002-04 reforms, but after bottoming out with calendar year 2005 claims, began to increase rapidly. As a result, even though claims volume has declined and claim frequency has been flat, total losses for California private self-insured employers measured at the 24-, 36-, 48-, and 60-month benchmarks have continued to trend up.

OSIP's 2012 summary of private self-insured data, which reports on calendar year data, follows the March release of public self-insured claims data, which is reported on a fiscal year basis. Thus, the data from public self-insured employers now lags the private self-insured data by six months, reflecting claims and losses reported through June 2012 rather than through December. The OSIP annual summaries for both private and public self-insured claims from each of the 10 most recent years are posted online. CWCI members and subscribers may also log on to the Institute's website to view an Institute Bulletin that includes more details and graphics ...
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An Orange County physician who admitted that he illegally prescribed dangerous, addictive painkillers to "patients" he barely examined during meetings that were often held at Starbucks stores was sentenced to over 11 years in federal prison. Alvin Mingczech Yee, 44, of Mission Viejo, was sentenced by United States District Judge Andrew J. Guilford.

Yee was taken into custody in 2011 after a year-long investigation resulted in a grand jury indictment that charges him with illegally prescribing dangerous, addictive opiates to "patients" he barely examined during meetings that cost as much as $600 and were often held at Starbucks stores. Yee was arrested pursuant to a 56-count indictment that charged him with prescribing drugs, such as oxycodone and hydrocodone, outside the usual course of professional practice and without a legitimate medical purpose.

Yee pleaded guilty in April to seven counts of illegal distribution of a controlled substance by a practitioner. Yee specifically admitted that he prescribed drugs, such as oxycodone and alprazolam, "while intentionally acting outside the usual course of professional practice and without a legitimate medical purpose."

According to court documents previously filed in this case, Yee met with numerous "patients," including three undercover operatives, during evening meetings at Starbucks across Orange County, where he wrote prescriptions for drugs best known by brand names such as OxyContin, Vicodin and Xanax. A California Department of Justice database showed that half of the prescriptions written by Yee were for oxycodone, the generic name of OxyContin, and that one-third of his "patients" were no older than 25. According to an affidavit in support of search warrants, Yee met with up to a dozen people every night of the week and provided them with prescriptions in exchange for cash. The affidavit also states that people arrested with large quantities of opiates in Seattle, Phoenix and Detroit said they traveled to Orange County to meet with Yee to obtain prescriptions. An expert hired by the government to review evidence against Yee concluded that his practice was a "front for drug dealing," according to the affidavit.

Yee’s illegal prescriptions contributed to the deaths of two of his patients, according to the U.S. Probation Office, a sentencing memo stated.

The investigation of Yee was conducted by the Drug Enforcement Administration, which received the assistance of the Orange Police Department, the Huntington Beach Police Department and the California Medical Board ...
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Some professional athletes have a history of filing and settling workers' compensation claims against their former teams, and later filing a second claim against the same employer. The language of the standard compromise and release agreement is not exactly air tight. The fear of loopholes inspire many employers attempt to strengthen the pre-printed language with a customized addendum that attempts to more specifically make the settlement binding on not only known, but unknown claims. Some WCJs refuse to approve a settlement with an air tight addendum. The claim of National Football League player Tony Dorsett case is a good example. But in his case, the WCJ decided one settled claim is enough for Mr. Dorsett.

The Los Angeles Times reports that a brain-injury claim by former Tony Dorsett was thrown out by a California workers' compensation panel just months before he was diagnosed with early signs of chronic traumatic encephalopathy, a debilitating condition allegedly linked to repeated blows to the head. Following brain scans and other tests, UCLA researchers informed Dorsett, along with Hall of Fame offensive lineman Joe DeLamielleure and three-time All-Pro defensive lineman Leonard Marshall of their diagnoses a few weeks ago.

The 59-year-old Hall of Fame running back's claim was dismissed in May when a workers' compensation judge ruled that because Dorsett had agreed to an $85,000 settlement for injuries to "multiple orthopaedic body parts" in 1991, he could not file another claim for any subsequent injury. Dorsett appealed that workers' compensation decision, but it was upheld in August. A three-judge panel found that language in the 1991 settlement released the Dallas Cowboys and Denver Broncos from all future claims involving virtually any body part, including the head.

Mel Owens, Dorsett's attorney, said that he was not available to discuss the case, which claimed cumulative head injuries but did not specify CTE. Owens had 45 days to appeal the decision to the California Court of Appeal, but court records indicate no such action has been filed.

Dorsett's diagnosis is the latest high-profile case linking America's richest professional sports league to brain injuries that appear years after players retire. Since 2006, more than 3,500 former NFL athletes have filed workers' compensation claims in California alleging head and brain injuries, The Times found. NFL teams routinely fight such claims, which can cost millions in cash awards and lifetime medical care. The league backed legislation signed last month by Gov. Jerry Brown that will bar many athletes from filing such claims in California.

The Times reports on one athlete with a brain injury claim who had previously won a workers' compensation award in California, however, is Jimmie Giles, a pro-bowl tight end in the 1970s and 1980s with the Tampa Bay Buccaneers, among other teams. In 1991 Giles accepted a $75,000 settlement from five NFL teams for numerous orthopedic injuries to his back, wrist, ankles and knees among other parts - described in a medical report at the time as involving "virtually the entire musculoskeletal system." Among the listed body parts was Giles' head. Roughly five years ago, Giles, who turn 59 on Thursday, began complaining of memory loss and other problems and was eventually diagnosed with initial symptoms of dementia, which is progressing steadily. He filed a brain injury claim in California in 2010 and in late September, a workers' compensation judge dismissed the claim. Like in Dorsett's case, a workers' compensation judge found that boilerplate language in the settlement precluded future injury claims. The document, in part, reads, "employee releases and forever discharges said employer from all claims or causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result of said injury."

Los Angeles attorney Ron Feenberg, who is representing Giles, is appealing the decision according to the Times story. Neither Giles, "the defendants, medical science nor the law knew the existence of a relationship between high velocity bodily impacts and brain injury," Feenberg wrote in the appeal, filed last month. He argues that the case draws strong parallels to asbestos-related claims because it take years for symptoms to surface. In some cases, workers exposed to asbestos had reached workers' compensation settlements for asthma claims only to file asbestosis or mesothelioma claims decades later. The courts ultimately allowed those cases to proceed. "How can you release your right to a claim for a condition that hasn't manifest itself?" Feenberg said. If Giles' appeal is successful, it could open the door to many more claims from athletes who long ago accepted workers' compensation awards only to develop serious brain disease years later.

Another of Feenberg's clients, former Minnesota Viking linebacker Fred McNeill, was diagnosed with symptoms of CTE by the same group of UCLA researchers in January. McNeill has no prior workers' compensation claims and Feenberg said a trial could begin by late January. Still, he worries about how to handle the case. McNeill, 61, has advanced cognitive dysfunction, Feenberg said, and had severe difficulties with memory and basic conversation. "I don't even know if I can put McNeill on a witness stand," Feenberg said ...
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Last August the WCAB denied reconsideration in the case of Frazier v State of California, and approved a lower a rating of permanent impairment based upon language in the AMA Guides 6th Edition. This case would have opened the door to ratings outside of the AMA Guides 5th Edition for the first time.

Edward Frazier, a peace officer with the Department of Corrections, had a presumptive (L.C. 3212.1 0) industrial heart trouble with diagnosed hypertensive heart disease accompanied by mild left ventricular hypertrophy.

The AME, Dr. Ng, provided an analysis that in his opinion that under the American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition,Table 4-2, (Criteria for Rating Permanent Impairment Due To Hypertensive Cardiovascular Disease AMA 5lh edition) would require a finding that he has a 30% Whole Person Impairment. l

However, the AME was of the opinion that this WPI while appropriate is not an accurate representation of the injured worker's impairment. Doctor Ng referred to the new AMA Guides 6th Edition as a "standard text or recent research data" to support his conclusion that 30%WPI was too high. He concluded the writers of this recent publication decided that the 30% WPI was too high for asymptomatic mild ventricular hypertrophy. The 6th edition he states shows that for a gentleman with the same mild left ventricular hypertrophy an impairment of 23% WPI is recommended. He concludes that the authors of the AMA guides sixth edition have recognized the accuracy problem (in the 5th edition) and reduced the whole person impairment to a rating of 24% for left ventricular hypertrophy. By inference it is his clinical judgment this lower WPI is more accurate.

In conclusion the AME chose 24% as the most accurate description of this injured workers impairment. This percentage was a combination of his consideration of the analysis of the writers of the AMA 6th edition, his clinical judgment as well as his analogizing with the Coumadin paragraph 9.6C of the AMA 5th edition which has a lower impairment for asymptomatic conditions with serious health risks.

The 24% impairment after the formal rating resulted in a permanent partial disability of 44% which was awarded by the WCJ.

The WCAB denied reconsideration in the panel decision of Edward Frazier v State of California, CDCR - Correctional Training Facility

However, the panel seems to have had second thoughts. LexisNexis reports that "on its own motion" the WCAB rescinded its prior order, and returned the Frazier case back to the WCJ for a new decision. The second decision concluded that use of the AMA Guides Sixth Edition is contrary to the mandatory language in Labor Code § 4660(b)(1), stating that impairments “shall” be rated utilizing whole person impairments reflected in the AMA Guides Fifth Edition, that there is no support in any case law suggesting that impairment ratings from the AMA Guides Sixth Edition may be used to rate permanent disability even if the physician believes, as did the Agreed Medical Examiner here, that the AMA Guides Sixth Edition more accurately reflects whole person impairment ...
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After hearing oral arguments on Monday, and again on Thursday, federal judge George H. Wu indicated he will sign an order next week implementing his tentative ruling that the retroactive lien activation fee violates the equal protection clause of the U.S. Constitution. The scope of the preliminary injunction has yet to be decided. It may apply to just the named plaintiffs, or to all lien claimants subject to the mandatory lien activation fee. Judge Wu will further consider the scope of the injunction in the next few days, and then the actual order will issue.

Angelotti Chiropractic, Mooney and Shamsbod Chiropractic, Christina-Arana and Associates, Joyce Altman Interpreters, Scandoc Imaging and Buena Vista Medical Services filed a lawsuit last July in the United States District Court contesting the constitutionality of certain provisions of SB 863, and seeking to avoid payment of millions of dollars in lien activation fees before the end of 2013. They may be the only beneficiaries of the injunction, or the injunction may apply to lien claimants who are not a party.

The tentative ruling seemed to agree with the arguments that the retroactive lien filing fee violated the equal protection clause of the US Constitution since it discriminated against one class of smaller lien claimants and in favor of large lien claimants who are exempt from the fee. To state a claim under 42 U.S.C. § 1983 for a violation of the Equal Protection Clause of the Fourteenth Amendment a plaintiff must show that the defendants acted with an intent or purpose to discriminate ’against the plaintiff based upon membership in a protected class. Where the group excluded or discriminated against does not constitute a suspect class a plaintiff may still state a claim, but for equal protection purposes, a governmental policy that purposefully treats groups differently need only be ’rationally related to legitimate legislative goals’ to pass constitutional muster. As with suspect classes, differential treatment impinging on a fundamental right will "draw strict scrutiny" attention under the Equal Protection Clause.

The retroactive $100 lien activation fee at issue in this case specifically does not apply to any lien filed by a health care service plan licensed pursuant to [Cal. Health and Safety Code § 1349], a group disability insurer under a policy issued in this state pursuant to the provisions of [Cal. Ins. Code § 10270.5], a self-insured employee welfare benefit plan, as defined in [Cal. Ins. Code § 10121], that is issued in this state, a Taft-Hartley health and welfare fund, or a publicly funded program providing medical benefits on a nonindustrial basis.

Under the "rational basis" review of the lien activation fee, the Equal Protection Clause is satisfied if: (1) ’there is a plausible policy reason for the classification,’ (2) ’the legislative facts on which the classification is apparently based rationally may have been considered to be true by the governmental decisionmaker,’ and (3) ’the relationship of the classification to its goal is not so attenuated as to render the distinction arbitrary or irrational.

On this issue, the tentative ruling said there "is no question that the legislature has a legitimate legislative goal in its implementation of fees to the extent those fees have a purpose of funding the workers’ compensation adjudicative system and/or deterring lien filings so as to not clog the system. The question is whether a retroactive fee like the activation fee herein involved, that is designed to clear the backlog currently in the system (as well as provide funding for the system) can, while accomplishing those purposes, also discriminate amongst lienholders. If it cannot, then the case for a rational relationship to that (or those) legitimate governmental interest(s) is severely weakened."

Defendants contended that the exempted entities are not major contributors to the backlog. However the ruling noted that "if they are not major contributors to the backlog, and if one of the purposes behind the imposition of fees is to fund the system, why any lienholder whose liens are tied up in the 'backlog' would be exempted is somewhat curious, especially ones who would not be greatly impacted because they are not major contributors to the backlog. The backlog is the backlog, and if clearing it is your purpose, then you attempt to clear it. It. makes little sense to clear only part of it."

The ruling concluded that the court would "grant Plaintiffs’ motion for preliminary injunction, and discuss with the parties the appropriate scope of preliminary injunctive relief." The scope of the injunction will be decided in the next few weeks.

So what does this mean to California employers? Essentially, they have lost a great deal of the employer's "benefit" of SB 863, especially if the injunction will apply to all lien claimants. Lien claim resolution was a major component of the bargained for law. Additionally, a new WCIRB study noted once IMR became effective for all injuries regardless of the accident date starting on July 1, 2013, IMR requests have increased significantly. If the higher volume of August (15,731) and September (14,990) IMR requests are indicative of filing rates for subsequent months, the number of IMRs requested per year would be over three times greater than that projected in the WCIRB's prospective cost estimate, potentially eliminating any savings in administrative costs due to IMR and also potentially negatively impacting medical treatment costs. Employers have yet to learn how litigation over the "catastrophic injury" exception to AMA Guides add-on ratings will be resolved. As a whole, the employer economics of S.B. 863 seems to be getting rapidly eroded ...
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The federal government, the public and the health care industry has had an example of how disastrous mismanaged technology can be with the catastrophic roll out of Obamacare in October. The hindsight of that disaster may prompt some foresight into technology planning for the workers' compensation industry. Top technology initiatives for workers’ compensation insurers include agent portal, business intelligence, and core claims and policy administration implementations, according to a new report on the sector from Novarica, titled "Business and Technology Trends: Workers’ Compensation" Whereas other areas of the enterprise are seeing some investments in enhancements, the report points to these technology initiatives as a competitive necessity.

Novarica went on to detail workers’ comp insurer needs, saying, agent portals continue to be viewed as key elements of acquiring and retaining customers, requiring user-friendly functionality for quoting and new business submissions as well as access to loss run reporting/analysis and support services.

Business intelligence and analytics are viewed as key competitive capabilities if the ability to gather, store and retrieve appropriate data leads to insights. Workers’ comp insurers often have existing capabilities for reporting and analysis in claims and underwriting, but are expanding their business intelligence capabilities to operationalize predictive analytics. It is increasingly common for insurers to use third-party data and multidimensional data in their analyses.

In its overview of core systems priorities, Novarica lists among the key features desired, "Data, data and more data." Beyond that, automated underwriting, more accurately and consistently assessing risk and pricing using business rules and predictive models, and other capabilities enabled by rating engines, workflow management and added functionality for agents are among insurer top priorities for core systems investments.

Core claims systems, which Novarica calls "the most critical core system for workers’ compensation carriers," is another emphasized area of investment. Insurers seek increased operational efficiencies, improved data use, automated reserving and new techniques for identifying fraud, such as predictive analytics and network analysis.

The financial trends for the sector, as outlined by Novarica, reveal the fact that the sector’s woeful combined ratio recovered slightly last year, from 116.6 percent in 2010 to 117.1 percent in 2011, then back down to 116.0 percent in 2012. Another dubious trend currently seen by workers’ comp insurers is an increasing number of questionable and fraudulent claims.

The sector’s redeeming financial trends include nine straight quarters of rate increases, including 9-percent premium growth in 2012.

Lower priority technology initiatives include billing, customer portals, distribution management, document creation and management, rating, underwriting workstations, and specialized components. Technology initiatives in these areas are more about enhancements than competitive necessity, e.g. distribution management initiatives are mostly focused on streamlining onboarding and compliance, according to the report.

While mobility has not become a pervasive technology in the sector, the report notes that mobile devices are making inroads. Most workers’ compensation mobile applications currently focus on loss control, with TPAs offering apps with injury reporting and other claims self-service functionality ...
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/ 2013 News, Daily News
This report was commissioned by the California Department of Industrial Relations to examine the different types of inspections that the California Department of Industrial Relations Division of Occupational Safety and Health (Cal-OSHA) carries out and the roles that they play. It focuses on the three major inspection types in California: programmed (planned) inspections, complaint inspections, and accident investigations.

As is well known, programmed inspections in general industry cite substantially more serious violations (and total violations) than other inspection types do. However, complaint inspections take inspectors to workplaces whose injury rates are higher.

The number of complaint inspections fell sharply after 1992, dropping from 8,000 per year to fewer than 3,000 in recent years. Cal- OSHA (and OSHA) adopted a policy for dealing with "informal" complaints (defined as cases in which the complainant was unwilling to give his or her name) that relied primarily on a letter or fax to the employer rather than on an inspection. The employer was required to respond and to explain what it had done to abate the alleged hazard. One out of five of these fax-letter cases is supposed to be followed up by an inspection. Unfortunately, neither Cal-OSHA nor OSHA maintains records on the number of these faxletter complaints or on the subject of the hazard in its computerized files. In addition, there is no way to identify the inspections that were conducted to verify the employer’s compliance statements. Thus, we have almost no information on either the magnitude of this procedure or on how it is working.

CHSWC noted that one idea behind the original fax-letter procedure was that the agency would check back with the complainant to see whether he or she was satisfied with what the employer had said and done. But Cal-OSHA cannot check back if it lacks contact information. The absence of that information makes it more important to maintain data on the complaints that are handled through the fax-letter procedure. Currently, there is no simple way to track the results of those one in five inspections that are carried out to validate employer compliance. In addition, for regular complaint inspections, Cal-OSHA should maintain information about the subject of the complaints; it could use that information to assess how good workers were at identifying different hazards.

California requires that acute injuries that involve hospitalization for more than 24 hours (except for observation) and amputations must, along with fatalities, be reported to Cal-OSHA within eight hours. Except for cases in which other law enforcement agencies have jurisdiction (assaults and highway crashes), Cal-OSHA is obligated to investigate these injuries. Although most believe that fatalities are well-reported, the quality of reporting of nonfatal cases is less clear. National data suggest that the number of hospitalizations is probably well above the roughly 2,000 cases reported in California. The implication is that there is a great deal of underreporting of hospitalizations, at least in construction.

The CHSWC report concludes that the Department of Industrial Relations needs to develop a system for identifying the hospitalizations (and amputations) that employers are supposed to immediately report to Cal-OSHA.

Earlier studies of federal OSHA inspections showed that the number of serious violations cited per inspections fell by about 50 percent after the first inspection and more slowly thereafter. In California, the fall-off is not as fast and varies by inspection type. However, the results do suggest that it may be useful to put a priority on workplaces that have not had frequent inspections.

The CHSWC report recommends that workplaces in high-injury-rate industries that have not been inspected at all or not for many years should be identified and deserve some priority in programmed inspections ...
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/ 2013 News, Daily News
Claims Administrators often need to make reserves for lifetime medical care of seriously injured claimants. This task becomes more difficult as the pace of new developments in medical science rapidly changes the landscape of available treatment an examiner might expect even a decade from now. For example, a breakthrough in genetics - described as "jaw-dropping" by one Nobel scientist - has created intense excitement among DNA experts around the world who believe the discovery will transform their ability to edit the genomes of all living organisms, including humans.

The Independent reports that for the first time, scientists are able to engineer any part of the human genome with extreme precision using a revolutionary new technique called Crispr, which has been likened to editing the individual letters on any chosen page of an encyclopedia without creating spelling mistakes. The landmark development means it is now possible to make the most accurate and detailed alterations to any specific position on the DNA of the 23 pairs of human chromosomes without introducing unintended mutations or flaws, scientists said.

The technique is so accurate that scientists believe it will soon be used in gene-therapy trials on humans to treat incurable viruses such as HIV or currently untreatable genetic disorders such as Huntington’s disease. It might also be used controversially to correct gene defects in human IVF embryos, scientists said.

"Crispr is absolutely huge. It’s incredibly powerful and it has many applications, from agriculture to potential gene therapy in humans," said Craig Mello of the University of Massachusetts Medical School, who shared the 2006 Nobel Prize for medicine for a previous genetic discovery called RNA interference. "This is really a triumph of basic science and in many ways it’s better than RNA interference. It’s a tremendous breakthrough with huge implications for molecular genetics. It’s a real game-changer," Professor Mello told The Independent.

"If this new technique succeeds in allowing perfectly targeted correction of abnormal genes, eliminating safety concerns, then the exciting prospect is that treatments could be developed and applied to the germline, ridding families and all their descendants of devastating inherited disorders," said Dagan Wells, an IVF scientist at Oxford University.

The Crispr process was first identified as a natural immune defence used by bacteria against invading viruses. Last year, however, scientists led by Jennifer Doudna at the University of California, Berkeley, published a seminal study showing that Crispr can be used to target any region of a genome with extreme precision with the aid of a DNA-cutting enzyme called CAS9. Since then, several teams of scientists showed that the Crispr-CAS9 system used by Professor Doudna could be adapted to work on a range of life forms, from plants and nematode worms to fruit flies and laboratory mice ...
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/ 2013 News, Daily News