Reuters Health reports that Swedish researchers have devised a blood test that could better diagnose sports-related brain injuries and prevent American football, rugby and ice hockey players returning to the field in danger.
In findings from a study of ice hockey players, the researchers said their method can show just an hour after a head injury how severe the concussion is, whether there is a risk of long-term symptoms, and when the player can return to the sport. "In ice hockey and other contact sports, repeated concussions are common, where the brain has not finished healing after the first blow," said Henrik Zetterberg of the Sahlgrenska Academy at the University of Gothenburg, who led the study. "This kind of injury is particularly dangerous, but there have not been any methods for monitoring how a concussion in an athlete heals."
Litigation, much of it based upon studies of former American football players and boxers, suggests repeated head knocks such as in contact sports can cause chronic traumatic encephalopathy, a brain condition that can lead to loss of cognitive function, dementia, aggression and depression. While mild concussions don't generally cause loss of consciousness, they can induce other symptoms such as dizziness, nausea, trouble concentrating, memory problems and headaches. Severe concussions can cause a loss of consciousness. Most concussions get better in days or weeks, but some patients can suffer symptoms more than a year after injury.
The National Football League in the United States agreed in August to pay $765 million to settle a lawsuit brought by thousands of former players, many suffering from dementia and health problems. They accused the league of hiding the dangers of brain injury while profiting from the sport's violence. Many of these players have also filed workers' compensation claims in Califoria.
"Concussions are a growing international problem," said Zetterberg. "The stakes for the individual athlete are high, and the list of players forced to quit with life-long injury is getting ever longer."
Zetterberg's team examined all the players in the Swedish Hockey League and found that between September and December of the 2012/2013 season alone, 35 of 288 players had had a concussion. In three cases, it was so severe that the player was knocked unconscious. For the study, which was published on Thursday in the journal JAMA Neurology, the players who had a concussion were asked to provide repeated blood samples, initially directly after the concussion and then also during the following days. The results were compared with the pre-season samples from two full teams, and the scientists found that having raised levels of a nerve cell protein called tau in the blood was a marker of concussion. By measuring tau levels in regular tests, the researchers could say how severe the concussion was just one hour after the injury, and could predict with a high level of certainty which players would have long-term symptoms and needed to rest longer.
Yelverton Tegner, a researcher at Lulea University of Technology and a team doctor for the Swedish national women's football team, who also worked on the study, said the ultimate aim was "to have a working kit that can be used for diagnostics in hospitals, and perhaps also at rink-side or in stadiums", for use immediately after a player is concussed. Zetterberg said the same test could also be used in general emergency medical care to diagnose brain damage from concussions, regardless of how they happened ...
In findings from a study of ice hockey players, the researchers said their method can show just an hour after a head injury how severe the concussion is, whether there is a risk of long-term symptoms, and when the player can return to the sport. "In ice hockey and other contact sports, repeated concussions are common, where the brain has not finished healing after the first blow," said Henrik Zetterberg of the Sahlgrenska Academy at the University of Gothenburg, who led the study. "This kind of injury is particularly dangerous, but there have not been any methods for monitoring how a concussion in an athlete heals."
Litigation, much of it based upon studies of former American football players and boxers, suggests repeated head knocks such as in contact sports can cause chronic traumatic encephalopathy, a brain condition that can lead to loss of cognitive function, dementia, aggression and depression. While mild concussions don't generally cause loss of consciousness, they can induce other symptoms such as dizziness, nausea, trouble concentrating, memory problems and headaches. Severe concussions can cause a loss of consciousness. Most concussions get better in days or weeks, but some patients can suffer symptoms more than a year after injury.
The National Football League in the United States agreed in August to pay $765 million to settle a lawsuit brought by thousands of former players, many suffering from dementia and health problems. They accused the league of hiding the dangers of brain injury while profiting from the sport's violence. Many of these players have also filed workers' compensation claims in Califoria.
"Concussions are a growing international problem," said Zetterberg. "The stakes for the individual athlete are high, and the list of players forced to quit with life-long injury is getting ever longer."
Zetterberg's team examined all the players in the Swedish Hockey League and found that between September and December of the 2012/2013 season alone, 35 of 288 players had had a concussion. In three cases, it was so severe that the player was knocked unconscious. For the study, which was published on Thursday in the journal JAMA Neurology, the players who had a concussion were asked to provide repeated blood samples, initially directly after the concussion and then also during the following days. The results were compared with the pre-season samples from two full teams, and the scientists found that having raised levels of a nerve cell protein called tau in the blood was a marker of concussion. By measuring tau levels in regular tests, the researchers could say how severe the concussion was just one hour after the injury, and could predict with a high level of certainty which players would have long-term symptoms and needed to rest longer.
Yelverton Tegner, a researcher at Lulea University of Technology and a team doctor for the Swedish national women's football team, who also worked on the study, said the ultimate aim was "to have a working kit that can be used for diagnostics in hospitals, and perhaps also at rink-side or in stadiums", for use immediately after a player is concussed. Zetterberg said the same test could also be used in general emergency medical care to diagnose brain damage from concussions, regardless of how they happened ...
Plaintiffs Mark Tanner Construction, Inc. (Tanner), and Mt. Lincoln Construction, Inc. (Mt. Lincoln), are both general contractors located in Truckee. CAP is a self-insured workers compensation program for the construction industry. Compensation Risk Managers of California, LLC (CRM) administered a self-insured workers compensation program for contractors, Contractors Access Program of California (CAP). The Department of Industrial Relations granted CAP a Certificate of Consent to Self-Insure in 2004. CRM administers CAP and contracted with Diversified to market CAP. Diversified Risk Insurance Brokers (Diversified), later acquired by defendant HUB International Insurance Services, Inc. (HUB), marketed and sold CAP to plaintiffs Mark Tanner Construction, Inc., and Mt. Lincoln Construction, Inc.
California contractors were able to fulfill their obligation to obtain workers compensation insurance by joining CAP. Membership in CAP required an agreement to be jointly and severally liable for the workers compensation liability of all other members for that year of membership. Approximately 250 employers became members of CAP. Tanner and Mt. Lincoln became a member of CAP in 2006.
On December 31, 2009, CAP was terminated. The Director of the Department revoked CAP’s certificate to self-insure and CAP was placed into conservatorship. CAP’s estimated exposure for unfunded liabilities was over $20 million. In the spring of 2010, members were sent assessments for the anticipated exposure. Tanner was assessed $150,258 and Mt. Lincoln was assessed $42,784. Later that year, CAP defaulted on payment of benefits for its workers compensation liabilities.
Tanner, Mt. Lincoln, and two other companies sued HUB and others for professional negligence and constructive fraud. The first amended complaint (FAC) alleged that CAP was marketed through insurance brokers, including Diversified, as a less expensive and more effective means of handling workers compensation insurance claims. Diversified did not disclose to Tanner or Mt. Lincoln its exclusive broker relationship with CRM. Diversified allegedly did not inform plaintiffs of the following facts concerning the financial stability of CAP: (1) beginning in 2006, CAP incurred losses of over $28 million and then over $60 million; (2) CRM was involved in a multimillion-dollar lawsuit in New York over similar self-insured insurance programs; (3) CAP’s security bond was not renewed after 2008 and plaintiffs were unprotected if claims exceeded reserves; and (4) at least five other self-insured insurance programs administered by CRM in California had failed. The FAC alleged "[t]his information provided sufficient notice that agent brokers should investigate the proverbial health" of the self-insured workers compensation programs.
While a defense motion for summary judgment was pending, plaintiffs obtained a copy of a Regional Field Consultant Agreement (Agreement) between CRM and Diversified that had not been provided to plaintiffs in discovery. Plaintiffs believed the Agreement "significantly alter[ed] the legal landscape in this action." They argued the Agreement established that rather than acting as broker for them, Diversified instead was acting as the broker for CAP. Further, Plaintiffs argued that the Agreement revealed Diversified was part of a joint venture with CRM. These relationships had not been disclosed to plaintiffs. Plaintiffs moved for leave to file a second amended complaint to add new allegations and new causes of action arising from legal relationships revealed by the Agreement. They also moved to continue the hearing on the summary judgment motion to permit additional discovery pursuant to Code of Civil Procedure section 437c, subdivision (h). The trial court denied both motions, finding the Agreement was not the "silver bullet" that plaintiffs claimed. The trial court granted HUB’s motion for summary judgment. Plaintiffs appeal from the ensuing judgment. Plaintiffs contend the trial court abused its discretion in denying both the motion to amend the complaint and the motion to continue the summary judgment hearing.
The Court of Appeal sustained the dismissal in the partially published opinion of Mark Tanner Construction v. HUB International Insurance Services.
The trial court found that HUB was entitled to summary judgment on the professional negligence claim because insurance brokers had no duty to investigate the financial condition of the insurer, and "no facts were presented demonstrating that Defendants knew or should have known of the financial condition of CAP." As to the claim for constructive fraud, the trial court found a duty to disclose arose in an arm’s length business transaction only if there was a fiduciary relationship, and "Plaintiffs have failed to demonstrate a triable issue of material fact demonstrating that Defendants have a fiduciary relationship." "Apparently distracted by what they perceive to be an egregious discovery violation, plaintiffs fail [on appeal] to adequately challenge either the legal bases or the factual findings of the trial court’s rulings." The trial court denied plaintiffs’ request for a continuance. It found plaintiffs were dilatory in initiating discovery and that because the Agreement added little to the case, additional discovery based on this agreement was not necessary ...
California contractors were able to fulfill their obligation to obtain workers compensation insurance by joining CAP. Membership in CAP required an agreement to be jointly and severally liable for the workers compensation liability of all other members for that year of membership. Approximately 250 employers became members of CAP. Tanner and Mt. Lincoln became a member of CAP in 2006.
On December 31, 2009, CAP was terminated. The Director of the Department revoked CAP’s certificate to self-insure and CAP was placed into conservatorship. CAP’s estimated exposure for unfunded liabilities was over $20 million. In the spring of 2010, members were sent assessments for the anticipated exposure. Tanner was assessed $150,258 and Mt. Lincoln was assessed $42,784. Later that year, CAP defaulted on payment of benefits for its workers compensation liabilities.
Tanner, Mt. Lincoln, and two other companies sued HUB and others for professional negligence and constructive fraud. The first amended complaint (FAC) alleged that CAP was marketed through insurance brokers, including Diversified, as a less expensive and more effective means of handling workers compensation insurance claims. Diversified did not disclose to Tanner or Mt. Lincoln its exclusive broker relationship with CRM. Diversified allegedly did not inform plaintiffs of the following facts concerning the financial stability of CAP: (1) beginning in 2006, CAP incurred losses of over $28 million and then over $60 million; (2) CRM was involved in a multimillion-dollar lawsuit in New York over similar self-insured insurance programs; (3) CAP’s security bond was not renewed after 2008 and plaintiffs were unprotected if claims exceeded reserves; and (4) at least five other self-insured insurance programs administered by CRM in California had failed. The FAC alleged "[t]his information provided sufficient notice that agent brokers should investigate the proverbial health" of the self-insured workers compensation programs.
While a defense motion for summary judgment was pending, plaintiffs obtained a copy of a Regional Field Consultant Agreement (Agreement) between CRM and Diversified that had not been provided to plaintiffs in discovery. Plaintiffs believed the Agreement "significantly alter[ed] the legal landscape in this action." They argued the Agreement established that rather than acting as broker for them, Diversified instead was acting as the broker for CAP. Further, Plaintiffs argued that the Agreement revealed Diversified was part of a joint venture with CRM. These relationships had not been disclosed to plaintiffs. Plaintiffs moved for leave to file a second amended complaint to add new allegations and new causes of action arising from legal relationships revealed by the Agreement. They also moved to continue the hearing on the summary judgment motion to permit additional discovery pursuant to Code of Civil Procedure section 437c, subdivision (h). The trial court denied both motions, finding the Agreement was not the "silver bullet" that plaintiffs claimed. The trial court granted HUB’s motion for summary judgment. Plaintiffs appeal from the ensuing judgment. Plaintiffs contend the trial court abused its discretion in denying both the motion to amend the complaint and the motion to continue the summary judgment hearing.
The Court of Appeal sustained the dismissal in the partially published opinion of Mark Tanner Construction v. HUB International Insurance Services.
The trial court found that HUB was entitled to summary judgment on the professional negligence claim because insurance brokers had no duty to investigate the financial condition of the insurer, and "no facts were presented demonstrating that Defendants knew or should have known of the financial condition of CAP." As to the claim for constructive fraud, the trial court found a duty to disclose arose in an arm’s length business transaction only if there was a fiduciary relationship, and "Plaintiffs have failed to demonstrate a triable issue of material fact demonstrating that Defendants have a fiduciary relationship." "Apparently distracted by what they perceive to be an egregious discovery violation, plaintiffs fail [on appeal] to adequately challenge either the legal bases or the factual findings of the trial court’s rulings." The trial court denied plaintiffs’ request for a continuance. It found plaintiffs were dilatory in initiating discovery and that because the Agreement added little to the case, additional discovery based on this agreement was not necessary ...
An article in Reuters Health predicts changes on the horizon in the word of medicine that will have far reaching consequences for third party payers who reserve files for future medical care. "We are at an inflection point," said Dr. Francis Collins, who now directs the National Institutes of Health. In a telephone interview, he said he never expected an "overnight, dramatic impact" from sequencing the human genome, in part because of cost. But recently, a combination of lower-cost sequencing technology and a growing list of wins in narrow corners of medicine are starting to show that genomic medicine is on the verge of delivering on at least some of the early claims.
Recent advances in sequencing have been "pretty stunning" and genomics is "just on the threshold" of delivering results, Craig Venter, the pioneer in the field, told Reuters. Although much is left to be learned about the genome, scientists believe knowing a person's genetic code will lead to highly personalized treatments for cancer, better predictions for diseases in babies and help unlock the puzzle of mysterious genetic diseases that currently go undiagnosed and untreated. Venter is staking his latest entrepreneurial venture on that expectation. Earlier this week, he announced formation of a new company, Human Longevity Inc., to undertake a massive project: sequencing 40,000 human genomes a year in a search for new therapies to preserve health and fight off diseases, including cancer, heart disease and Alzheimer's. To do that, Human Longevity will use two HiSeq X Ten machines and has an option to buy three more. The sequencers, made by Illumina Inc., can map a single genome for as little as $1,000. Venter's new company, Human Longevity, has picked cancer as its first sequencing target. Working with the University of -California, San Diego, the company plans to sequence the genomes, as well as the tumors, of every cancer patient treated at UCSD's Moores Cancer Center.
Collins' government-funded Human Genome Project spent $3 billion and took 13 years to sequence the human genome. Breaching the $1,000 genome could prove to be a watershed. At that cost, said Illumina Chief Executive Jay Flatley, ambitious projects like Venter's are economically feasible and clinical results more achievable. "We've still only scratched the surface of what the genome holds," he said. "What we need to do now is get hundreds of thousands to millions of genomes in databases with clinical information," he added.
Advances in sequencing equipment and the advent of next-generation sequencing has transformed the work Dr. Elizabeth McNally does as director of the Cardiovascular Genetics Clinic at the University of Chicago. In seven short years, she said, her group has gone from testing just one gene at a time to testing 60 to 70 genes and she is moving quickly into whole genome sequencing. Although McNally uses panels of 70 to 80 genes in her clinic, she has started experimenting with whole genomes. With the reduced cost of gene mapping, whole gene sequencing is a potentially cheaper, more powerful tool. The reduced cost of mapping is cutting the cost of research, too -- another factor that could speed clinical outcomes. McNally's team recently published a paper in the journal Bioinformatics in which she used Beagle, a supercomputer housed at Argonne National Laboratory, to analyze 240 full genomes in about two days. Such an endeavor normally takes months. "That dramatically decreases the cost associated with analysis because we sped up the time," said McNally.
Dr. Jay Shendure, associate professor of Genome Sciences at the University of Washington in Seattle, said the impact of gene sequencing is beginning to emerge in specific areas -- after a startup period that was longer and narrower than expected. "I do think there are these corners of medicine, which are important ones, that may happen relatively quickly," he said. A key example is the use of a pregnant woman's blood to see if her fetus may have trisomies -- chromosomal abnormalities associated with Down syndrome and other disorders. "Almost overnight, sequencing is in the process of taking over as the primary means of screening for trisomies in at-risk populations, and maybe eventually to everyone," Shendure said. The clinical results are promising. A trial of Illumina's test published last week in the New England Journal of Medicine found about 3.6 percent of standard tests for trisomies had false positive results, compared with 0.3 percent with Illumina's verifi test. That means fewer women would need to go through invasive follow-up diagnostic tests using amniocentesis or chorionic villus sampling, both of which can cause miscarriages. If the tests become routine practice, Goldman Sachs analyst Issac Ro estimates the market could reach $6 billion a year ...
Recent advances in sequencing have been "pretty stunning" and genomics is "just on the threshold" of delivering results, Craig Venter, the pioneer in the field, told Reuters. Although much is left to be learned about the genome, scientists believe knowing a person's genetic code will lead to highly personalized treatments for cancer, better predictions for diseases in babies and help unlock the puzzle of mysterious genetic diseases that currently go undiagnosed and untreated. Venter is staking his latest entrepreneurial venture on that expectation. Earlier this week, he announced formation of a new company, Human Longevity Inc., to undertake a massive project: sequencing 40,000 human genomes a year in a search for new therapies to preserve health and fight off diseases, including cancer, heart disease and Alzheimer's. To do that, Human Longevity will use two HiSeq X Ten machines and has an option to buy three more. The sequencers, made by Illumina Inc., can map a single genome for as little as $1,000. Venter's new company, Human Longevity, has picked cancer as its first sequencing target. Working with the University of -California, San Diego, the company plans to sequence the genomes, as well as the tumors, of every cancer patient treated at UCSD's Moores Cancer Center.
Collins' government-funded Human Genome Project spent $3 billion and took 13 years to sequence the human genome. Breaching the $1,000 genome could prove to be a watershed. At that cost, said Illumina Chief Executive Jay Flatley, ambitious projects like Venter's are economically feasible and clinical results more achievable. "We've still only scratched the surface of what the genome holds," he said. "What we need to do now is get hundreds of thousands to millions of genomes in databases with clinical information," he added.
Advances in sequencing equipment and the advent of next-generation sequencing has transformed the work Dr. Elizabeth McNally does as director of the Cardiovascular Genetics Clinic at the University of Chicago. In seven short years, she said, her group has gone from testing just one gene at a time to testing 60 to 70 genes and she is moving quickly into whole genome sequencing. Although McNally uses panels of 70 to 80 genes in her clinic, she has started experimenting with whole genomes. With the reduced cost of gene mapping, whole gene sequencing is a potentially cheaper, more powerful tool. The reduced cost of mapping is cutting the cost of research, too -- another factor that could speed clinical outcomes. McNally's team recently published a paper in the journal Bioinformatics in which she used Beagle, a supercomputer housed at Argonne National Laboratory, to analyze 240 full genomes in about two days. Such an endeavor normally takes months. "That dramatically decreases the cost associated with analysis because we sped up the time," said McNally.
Dr. Jay Shendure, associate professor of Genome Sciences at the University of Washington in Seattle, said the impact of gene sequencing is beginning to emerge in specific areas -- after a startup period that was longer and narrower than expected. "I do think there are these corners of medicine, which are important ones, that may happen relatively quickly," he said. A key example is the use of a pregnant woman's blood to see if her fetus may have trisomies -- chromosomal abnormalities associated with Down syndrome and other disorders. "Almost overnight, sequencing is in the process of taking over as the primary means of screening for trisomies in at-risk populations, and maybe eventually to everyone," Shendure said. The clinical results are promising. A trial of Illumina's test published last week in the New England Journal of Medicine found about 3.6 percent of standard tests for trisomies had false positive results, compared with 0.3 percent with Illumina's verifi test. That means fewer women would need to go through invasive follow-up diagnostic tests using amniocentesis or chorionic villus sampling, both of which can cause miscarriages. If the tests become routine practice, Goldman Sachs analyst Issac Ro estimates the market could reach $6 billion a year ...
California’s sweeping SB 863 workers’ compensation reform is working for the most part, but some of the savings may not materialize thanks to pressure on the system, according to Dave Bellusci, executive vice president, chief operating officer and chief actuary at the Workers’ Compensation Rating Bureau.
According to the report in the Insurance Journal, Bellusci was speaking recently on the state’s workers’ comp system at the Golden Gate Chapter of the Chartered Property Casualty Underwriters Society during the group’s "All Industry Day." The group held their daylong conference at the Delancey Street Conference Center. Also addressing the large group of insurance professionals at the conference was Alex Swedlow, president and chief executive officer of the California Workers’ Compensation Institute. Both men talked about the state’s workers’ comp reform law, Senate Bill 863, passed at the end of 2012 and implemented last year.
Among the host of changes the bill made was to establish an independent medical review process. IMR takes the process of reviewing cases that were elevated from utilization review away from a process that included judges and other members of the workers’ comp community and puts it in the hands of doctors. The IMR process was projected to produce a savings of $400 million related to administrative costs. However, that was assuming that between 50,000 and 60,000 disputes would make it to IMR each year. But many more cases have been going to IMR, according to Bellusci. By WCIRB’s estimates more than 14,000 IMR cases are being brought each month, putting the system on pace for more than 170,000 cases for the year. "We think the administrative costs are probably not going to materialize if they stay at this level," Bellusci said.
According to Swedlow, other than that, the new system seems to be working as intended. Based on the medical treatment utilization schedule or other guidelines, 75 percent of all treatment requests are being approved at the initial level without further review, according to Swedlow. Out of the one-fourth of cases that get elevated for further review, slightly more than 23 percent of the time that treatment is either modified or denied, he said. When it’s all added up, that means less than 5 percent of requests are either modified or denied, Swedlow said.
One trouble spot for Swedlow in both the new and the old systems is that pharmacy costs continue to dominate. According to Swedlow, 43 percent of utilization reviews are over pharmacy spending and more the one-third of IMRs are for pharmacy. Much of the pharmacy spending in workers’ comp comes from physicians prescribing opioids, Swedlow said. According to him, 30 percent of the pharmacy spending goes to Schedule II and Schedule II opioids. Nearly half the Schedule II opioids, like morphine and oxycodone, are being prescribed for minor injuries, Swedlow said, adding that the opioid problem has become worse across the U.S. each year. "This is truly an national epidemic," he said.
Another epidemic that continues to impact workers’ comp is obesity, which may become a bigger problem for the system he said. Swedlow fears that a decision in June 2012 by the American Medical Association House of Delegates reclassifying obesity as "a disease state" may elevate the cases of injured workers who are obese. With obesity reclassified as a disease, medical providers may feel a greater responsibility to counsel obese patients about their weight, or if treatment for a compensable injury causes significant weight gain, Swedlow said. "We feel thanks to AMA obesity may move from being treated as a comorbidity to a compensable injury," Swedlow said ...
According to the report in the Insurance Journal, Bellusci was speaking recently on the state’s workers’ comp system at the Golden Gate Chapter of the Chartered Property Casualty Underwriters Society during the group’s "All Industry Day." The group held their daylong conference at the Delancey Street Conference Center. Also addressing the large group of insurance professionals at the conference was Alex Swedlow, president and chief executive officer of the California Workers’ Compensation Institute. Both men talked about the state’s workers’ comp reform law, Senate Bill 863, passed at the end of 2012 and implemented last year.
Among the host of changes the bill made was to establish an independent medical review process. IMR takes the process of reviewing cases that were elevated from utilization review away from a process that included judges and other members of the workers’ comp community and puts it in the hands of doctors. The IMR process was projected to produce a savings of $400 million related to administrative costs. However, that was assuming that between 50,000 and 60,000 disputes would make it to IMR each year. But many more cases have been going to IMR, according to Bellusci. By WCIRB’s estimates more than 14,000 IMR cases are being brought each month, putting the system on pace for more than 170,000 cases for the year. "We think the administrative costs are probably not going to materialize if they stay at this level," Bellusci said.
According to Swedlow, other than that, the new system seems to be working as intended. Based on the medical treatment utilization schedule or other guidelines, 75 percent of all treatment requests are being approved at the initial level without further review, according to Swedlow. Out of the one-fourth of cases that get elevated for further review, slightly more than 23 percent of the time that treatment is either modified or denied, he said. When it’s all added up, that means less than 5 percent of requests are either modified or denied, Swedlow said.
One trouble spot for Swedlow in both the new and the old systems is that pharmacy costs continue to dominate. According to Swedlow, 43 percent of utilization reviews are over pharmacy spending and more the one-third of IMRs are for pharmacy. Much of the pharmacy spending in workers’ comp comes from physicians prescribing opioids, Swedlow said. According to him, 30 percent of the pharmacy spending goes to Schedule II and Schedule II opioids. Nearly half the Schedule II opioids, like morphine and oxycodone, are being prescribed for minor injuries, Swedlow said, adding that the opioid problem has become worse across the U.S. each year. "This is truly an national epidemic," he said.
Another epidemic that continues to impact workers’ comp is obesity, which may become a bigger problem for the system he said. Swedlow fears that a decision in June 2012 by the American Medical Association House of Delegates reclassifying obesity as "a disease state" may elevate the cases of injured workers who are obese. With obesity reclassified as a disease, medical providers may feel a greater responsibility to counsel obese patients about their weight, or if treatment for a compensable injury causes significant weight gain, Swedlow said. "We feel thanks to AMA obesity may move from being treated as a comorbidity to a compensable injury," Swedlow said ...
Governor Edmund G. Brown, Jr. has appointed Sheryl Chalupa as Chair of the State Compensation Insurance Fund Board of Directors effective immediately. Chalupa succeeds Larry Mulryan who has served on State Fund’s Board since 2009 and as Chair for the past three years. Mulryan will remain a member of the Board and chair of the Governance Committee. She was appointed by Governor Arnold Schwarzenegger to State Fund’s Board of Directors in 2007, re-appointed by Governor Edmund G. Brown in January 2014, and named Chair in March 2014.
Since 2001, Chalupa has been President and CEO of Goodwill Industries of South Central California overseeing the non-profit corporation’s work in Kern, King, and Southern Tulare counties. Chalupa also served as Executive Director of Girl Scouts-Joshua Tree Council between 1994 and 2001. A native of California, Chalupa is active in her local community. She served as Chair of the Greater Bakersfield Chamber of Commerce in 2011; currently serves on the boards of the California State University, Bakersfield Foundation and the Westside Energy Services and Education Center (WESTEC); and is an active member of the Bakersfield Rotary Club.
Chalupa received both her bachelor’s degree in Political Science and her Masters of Public Administration from the California State University, Bakersfield. She holds a Certificate in Nonprofit Management from Case Western Reserve University in Cleveland, is a Certified Executive with Goodwill Industries International, and is a Governance Fellow with the National Association of Corporate Directors.
State Fund insures more than 130,000 California businesses. In 2013, State Fund wrote over $1.1 billion dollars in premium, making it one of the largest workers’ compensation insurers in the nation.
"I am honored to serve as chair and appreciate the confidence Governor Brown has demonstrated in me and this organization," said Chalupa. "State Fund’s Board is focused on building a competitive company with a resourceful, creative workforce that provides fair prices and excellent service, creates stability in the market, and delivers significant value to California employers and injured workers." ...
Since 2001, Chalupa has been President and CEO of Goodwill Industries of South Central California overseeing the non-profit corporation’s work in Kern, King, and Southern Tulare counties. Chalupa also served as Executive Director of Girl Scouts-Joshua Tree Council between 1994 and 2001. A native of California, Chalupa is active in her local community. She served as Chair of the Greater Bakersfield Chamber of Commerce in 2011; currently serves on the boards of the California State University, Bakersfield Foundation and the Westside Energy Services and Education Center (WESTEC); and is an active member of the Bakersfield Rotary Club.
Chalupa received both her bachelor’s degree in Political Science and her Masters of Public Administration from the California State University, Bakersfield. She holds a Certificate in Nonprofit Management from Case Western Reserve University in Cleveland, is a Certified Executive with Goodwill Industries International, and is a Governance Fellow with the National Association of Corporate Directors.
State Fund insures more than 130,000 California businesses. In 2013, State Fund wrote over $1.1 billion dollars in premium, making it one of the largest workers’ compensation insurers in the nation.
"I am honored to serve as chair and appreciate the confidence Governor Brown has demonstrated in me and this organization," said Chalupa. "State Fund’s Board is focused on building a competitive company with a resourceful, creative workforce that provides fair prices and excellent service, creates stability in the market, and delivers significant value to California employers and injured workers." ...
Each year the California Chamber of Commerce releases a list of "job killer" bills to identify legislation that will decimate economic and job growth in California. The CalChamber will track the bills throughout the rest of the legislative session and work to educate legislators about the serious consequences these bills will have on the state.
A number of California Chamber of Commerce-opposed "job killer" bills first identified in 2013 on labor law topics appear to be dead for this year after missing legislative deadlines or being amended.
SB 626 (Beall; D-San Jose) would have resulted in dramatic workers’ compensation cost increases for employers. The bill was pulled from the January 15 hearing agenda for the Senate Labor and Industrial Relations Committee at the author’s request, therefore missing the January 17 legislative deadline for a 2013 bill to pass from policy committee to fiscal committee in the house in which it was introduced. SB 626 would have resulted in employers paying nearly $1 billion in benefit increases to injured workers without an expectation that the increases will be fully offset by system savings.The bill would have distorted the entire balance of the 2012 workers’ compensation reform deal, SB 863 (De León; D-Los Angeles; Chapter 363), that provides injured workers with needed benefit increases, but offsets these increased costs by closing certain loopholes and making California’s workers’ compensation system operate more efficiently with fewer disputes and litigation.
AB 1164 (Lowenthal; D-Long Beach) would have created a dangerous and unfair precedent in the wage-and-hour arena by allowing an employee who claims a wage violation to assert a lien on an employer’s real or personal property, or even a third party’s real or personal property, before any trial or administrative hearing has been held to determine if any wages are actually owed by the employer. AB 1164 was placed on the Assembly Inactive File on January 30, thereby missing the January 31 deadline to pass the house in which it was introduced in 2013.
SB 761 (DeSaulnier; D-Concord) Expansion of Paid Family Leave Program - Would have transformed the paid family leave program from a wage replacement program into a new protected leave of absence that will burden small and large businesses by allowing an employee to file litigation for any alleged retaliation or discrimination as a result of their intent, request, or use of the paid family leave program. The bill has been amended to deal with a different subject.
And now the Chamber has started the "job killer" bills list for 2014. Thus far there is nothing on the horizon of concern for California employers. The stagnation or removal of the holdover legislation from last year has cleared the deck for this years fight ...
A number of California Chamber of Commerce-opposed "job killer" bills first identified in 2013 on labor law topics appear to be dead for this year after missing legislative deadlines or being amended.
SB 626 (Beall; D-San Jose) would have resulted in dramatic workers’ compensation cost increases for employers. The bill was pulled from the January 15 hearing agenda for the Senate Labor and Industrial Relations Committee at the author’s request, therefore missing the January 17 legislative deadline for a 2013 bill to pass from policy committee to fiscal committee in the house in which it was introduced. SB 626 would have resulted in employers paying nearly $1 billion in benefit increases to injured workers without an expectation that the increases will be fully offset by system savings.The bill would have distorted the entire balance of the 2012 workers’ compensation reform deal, SB 863 (De León; D-Los Angeles; Chapter 363), that provides injured workers with needed benefit increases, but offsets these increased costs by closing certain loopholes and making California’s workers’ compensation system operate more efficiently with fewer disputes and litigation.
AB 1164 (Lowenthal; D-Long Beach) would have created a dangerous and unfair precedent in the wage-and-hour arena by allowing an employee who claims a wage violation to assert a lien on an employer’s real or personal property, or even a third party’s real or personal property, before any trial or administrative hearing has been held to determine if any wages are actually owed by the employer. AB 1164 was placed on the Assembly Inactive File on January 30, thereby missing the January 31 deadline to pass the house in which it was introduced in 2013.
SB 761 (DeSaulnier; D-Concord) Expansion of Paid Family Leave Program - Would have transformed the paid family leave program from a wage replacement program into a new protected leave of absence that will burden small and large businesses by allowing an employee to file litigation for any alleged retaliation or discrimination as a result of their intent, request, or use of the paid family leave program. The bill has been amended to deal with a different subject.
And now the Chamber has started the "job killer" bills list for 2014. Thus far there is nothing on the horizon of concern for California employers. The stagnation or removal of the holdover legislation from last year has cleared the deck for this years fight ...
Three days before the Oscars, the Los Angeles film czar and a think tank delivered some damning news to Tinseltown: Hollywood's status as the home of American film and television production is threatened because places like New York are offering better financial incentives to studios. The study of employment and production data released on Thursday by the Milken Institute, an economic think tank and summarized in a story by Reuters, says California has lost tens of thousands of entertainment jobs to New York and other U.S. states in the past decade, and film and television productions with them. While it may be one of the best years for high-quality film in recent memory, with nine strong films nominated for the best picture Oscar, just one of the nine was filmed in California.
Ken Ziffren, a veteran California attorney recently appointed as Hollywood's film czar by the mayor of Los Angeles, said the report showed Hollywood was in a "bad spiral," both in terms of jobs and productions leaving California. Ziffren repeated a call for an expanded California film and tax credit, as did the Milken report - an issue that is politically controversial. Proponents say it is vital to keep middle-class jobs and film production in the state. Opponents say wealthy Hollywood studios don't need another tax break and question whether further financial incentives will produce a net gain in jobs and revenue.
The report by the Milken Institute, headquartered in Santa Monica, California, but with a national and international perspective, said California lost 16,137 film and TV industry jobs between 2004 and 2012, based on U.S. Labor Department statistics. During the same period, the report said, New York state gained 10,675 entertainment jobs. "California is losing film and television productions to New York and other states," the report said. "The data shows that other states are being more effective in using their incentives to bring in new productions and create jobs." The report said the loss of jobs was particularly troublesome because it represented the exodus of middle-class wage earners with high pay, an average of $98,500 per person, and businesses that thrive on the movie industry such as caterers.
California has a tax-credit program, but essentially only productions with budgets of $75 million or less qualify for the rebate of 20 percent to 25 percent. Proponents of legislation under consideration in California want the incentives to cover big-budget movies, as well as television pilots and dramas.
New York offers tax credits of between 30 percent and 35 percent and allocates more money - $420 million annually - out of its budget to give incentives to film and television production there, roughly four times what is awarded in California. Other states such as Louisiana, Texas and New Mexico have also drawn jobs and production from California in recent years through tax credits.
The Milken report says that production in California hit its peak in 2004, when 128 films were made there, while 50 were filmed in New York. In 2012, other states offering incentives were involved in 142 films, compared with 104 in California. Of the nine movies nominated for best picture Oscar on Sunday, only "Her," the science fiction romantic drama starring Joaquin Phoenix and Scarlett Johansson, was made in California. It had a relatively low budget of $25 million.
The key question for California is how much the state is willing to spend to preserve high-paying jobs and to give Californians who are still officially listed as working in the industry and residing in the state a chance to remain local. The economic impact of the incentives has been examined by sources such as UCLA and the Los Angeles Economic Development Corporation and questioned in turn by the California Legislative Analyst’s Office ...
Ken Ziffren, a veteran California attorney recently appointed as Hollywood's film czar by the mayor of Los Angeles, said the report showed Hollywood was in a "bad spiral," both in terms of jobs and productions leaving California. Ziffren repeated a call for an expanded California film and tax credit, as did the Milken report - an issue that is politically controversial. Proponents say it is vital to keep middle-class jobs and film production in the state. Opponents say wealthy Hollywood studios don't need another tax break and question whether further financial incentives will produce a net gain in jobs and revenue.
The report by the Milken Institute, headquartered in Santa Monica, California, but with a national and international perspective, said California lost 16,137 film and TV industry jobs between 2004 and 2012, based on U.S. Labor Department statistics. During the same period, the report said, New York state gained 10,675 entertainment jobs. "California is losing film and television productions to New York and other states," the report said. "The data shows that other states are being more effective in using their incentives to bring in new productions and create jobs." The report said the loss of jobs was particularly troublesome because it represented the exodus of middle-class wage earners with high pay, an average of $98,500 per person, and businesses that thrive on the movie industry such as caterers.
California has a tax-credit program, but essentially only productions with budgets of $75 million or less qualify for the rebate of 20 percent to 25 percent. Proponents of legislation under consideration in California want the incentives to cover big-budget movies, as well as television pilots and dramas.
New York offers tax credits of between 30 percent and 35 percent and allocates more money - $420 million annually - out of its budget to give incentives to film and television production there, roughly four times what is awarded in California. Other states such as Louisiana, Texas and New Mexico have also drawn jobs and production from California in recent years through tax credits.
The Milken report says that production in California hit its peak in 2004, when 128 films were made there, while 50 were filmed in New York. In 2012, other states offering incentives were involved in 142 films, compared with 104 in California. Of the nine movies nominated for best picture Oscar on Sunday, only "Her," the science fiction romantic drama starring Joaquin Phoenix and Scarlett Johansson, was made in California. It had a relatively low budget of $25 million.
The key question for California is how much the state is willing to spend to preserve high-paying jobs and to give Californians who are still officially listed as working in the industry and residing in the state a chance to remain local. The economic impact of the incentives has been examined by sources such as UCLA and the Los Angeles Economic Development Corporation and questioned in turn by the California Legislative Analyst’s Office ...
A federal investigation into kickbacks allegedly paid by Tenet Healthcare Corp. marks the latest fraud inquiry involving the Dallas-based hospital giant over the last decade. Although not directly related to the current investigation, the company has a number of hospitals in California including many in Southern California. The report in the Dallas News comes as Tenet has tried to reshape its image and operations since 2006, when it reached a $900 million settlement, one of the largest ever, with the U.S. Justice Department to resolve fraud accusations.
The new investigation alleges that four Tenet hospitals in Georgia and South Carolina made improper payments in return for patient referrals. Both investigations also were triggered by whistle-blower lawsuits filed under the U.S. False Claims Act, leading federal authorities to intervene as plaintiffs. The FBI said in its release that the hospitals paid kickbacks to obstetric clinics serving "undocumented Hispanic women." The money was in exchange for providing labor and delivery services to the patients. The hospitals then falsely billed Medicaid for reimbursements tied to the procedures, the statement said. Anti-kickback laws are designed to prevent financial incentives from interfering with caregivers’ medical judgment.
Tenet officials said in their own statement that transactions with the clinics were proper. They would "vigorously defend against the allegations," the statement said. The agreements with the clinics provided "substantial benefits to women in under served Hispanic communities," Tenet said. "By ensuring that pregnant women received prenatal care and appropriate treatment during birth, these programs increased the likelihood of a safe birth and a healthy baby while reducing the overall cost to state Medicaid programs."
Federal authorities, however, used sharp language to stress the seriousness of the allegations. "Schemes such as this one corrupt the health care system and take advantage of vulnerable patients," Stuart F. Delery, assistant attorney general for the Justice Department’s civil division, said in the news release. "My office has made the investigation of health care fraud a priority," said Michael J. Moore, the U.S. attorney for the Middle District of Georgia. "In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need."
Tenet operates in 12 states including several hospitals in California such as Los Alamitos Medical Center, Placentia-Linda Hospital, San Ramon Regional Medical Center, Sierra Vista Regional Medical Center in San Luis Obispo, Twin Cities Community Hospital inTempleton and others.Tenet owned Memorial Medical Center of New Orleans in 2005, when 45 bodies were found after the Hurricane Katrina floods. The corporation paid $25 million to settle a suit that accused it of being ill-prepared for the disaster. Tenet denied wrongdoing, saying poor levees and government rescue efforts were to blame. Other Tenet facilities were investigated in the early 2000s on improper billing. Tenet struck its 2006 deal with the government to settle some of the improper billing allegations as well as kickback accusations.
Tenet Healthcare Corporation agreed in August 2013 to pay $54 million to resolve government accusations that doctors at Redding Medical center in Northern California conducted unnecessary heart procedures and operations on hundreds of patients. The settlement was the largest in a case involving what is known as medical necessity fraud, or billing government health programs for tests and treatments that the patient's condition did not require. The settlement preempts any civil and criminal charges by the Justice Department against Tenet, its hospital division and the hospital itself, which did not admit wrongdoing. Nevertheless, in settling, Tenet signaled it would rather pay a record fine than argue in court that there was a medical reason for the patients to undergo the procedures or operations. The scandal and subsequent federal investigation are described in the book Coronary: A True Story of Medicine Gone Awry by author Stephen Klaidman ...
The new investigation alleges that four Tenet hospitals in Georgia and South Carolina made improper payments in return for patient referrals. Both investigations also were triggered by whistle-blower lawsuits filed under the U.S. False Claims Act, leading federal authorities to intervene as plaintiffs. The FBI said in its release that the hospitals paid kickbacks to obstetric clinics serving "undocumented Hispanic women." The money was in exchange for providing labor and delivery services to the patients. The hospitals then falsely billed Medicaid for reimbursements tied to the procedures, the statement said. Anti-kickback laws are designed to prevent financial incentives from interfering with caregivers’ medical judgment.
Tenet officials said in their own statement that transactions with the clinics were proper. They would "vigorously defend against the allegations," the statement said. The agreements with the clinics provided "substantial benefits to women in under served Hispanic communities," Tenet said. "By ensuring that pregnant women received prenatal care and appropriate treatment during birth, these programs increased the likelihood of a safe birth and a healthy baby while reducing the overall cost to state Medicaid programs."
Federal authorities, however, used sharp language to stress the seriousness of the allegations. "Schemes such as this one corrupt the health care system and take advantage of vulnerable patients," Stuart F. Delery, assistant attorney general for the Justice Department’s civil division, said in the news release. "My office has made the investigation of health care fraud a priority," said Michael J. Moore, the U.S. attorney for the Middle District of Georgia. "In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need."
Tenet operates in 12 states including several hospitals in California such as Los Alamitos Medical Center, Placentia-Linda Hospital, San Ramon Regional Medical Center, Sierra Vista Regional Medical Center in San Luis Obispo, Twin Cities Community Hospital inTempleton and others.Tenet owned Memorial Medical Center of New Orleans in 2005, when 45 bodies were found after the Hurricane Katrina floods. The corporation paid $25 million to settle a suit that accused it of being ill-prepared for the disaster. Tenet denied wrongdoing, saying poor levees and government rescue efforts were to blame. Other Tenet facilities were investigated in the early 2000s on improper billing. Tenet struck its 2006 deal with the government to settle some of the improper billing allegations as well as kickback accusations.
Tenet Healthcare Corporation agreed in August 2013 to pay $54 million to resolve government accusations that doctors at Redding Medical center in Northern California conducted unnecessary heart procedures and operations on hundreds of patients. The settlement was the largest in a case involving what is known as medical necessity fraud, or billing government health programs for tests and treatments that the patient's condition did not require. The settlement preempts any civil and criminal charges by the Justice Department against Tenet, its hospital division and the hospital itself, which did not admit wrongdoing. Nevertheless, in settling, Tenet signaled it would rather pay a record fine than argue in court that there was a medical reason for the patients to undergo the procedures or operations. The scandal and subsequent federal investigation are described in the book Coronary: A True Story of Medicine Gone Awry by author Stephen Klaidman ...
Travelers Cos. Inc. was the largest workers compensation insurer in the nation last year, overtaking Liberty Mutual Holding Co. Inc. for the top spot, according to market share data released this week by the National Association of Insurance Commissioners.
Travelers had $4.14 billion in direct written workers comp premiums in 2013, or roughly 8% of the national workers comp market share, according to NAIC. Liberty Mutual had $3.6 billion in direct written comp premiums last year, or roughly 6.97% of the market share. The report includes tentative data that will be updated through the end of March, Washington-based NAIC said in a statement Monday.
Finalized NAIC data from last year showed that Liberty Mutual had $4.18 billion in direct written workers comp premiums in 2012, or 8.69% of the national workers comp market share that year. Travelers was in second place with $3.8 billion in workers comp premiums in 2012, or 7.91% of the national comp market. The next-largest workers comp insurers have remained largely unchanged, NAIC data shows. Hartford Financial Services Group Inc. remained in third place with $3.34 billion in direct written comp premiums in 2013, up 1.8% from $3.28 billion in 2012. American International Group Inc. remained in fourth place with $2.84 billion in workers comp premiums last year, down 3.5% from $2.95 billion in 2012. Swiss-based Zurich Insurance Group Ltd. stayed in fifth place with $2.53 billion in comp premiums last year, down 8.5% from $2.77 billion in premiums for 2012.
The NAIC's report, along with data for other property/casualty lines, is available here ...
Travelers had $4.14 billion in direct written workers comp premiums in 2013, or roughly 8% of the national workers comp market share, according to NAIC. Liberty Mutual had $3.6 billion in direct written comp premiums last year, or roughly 6.97% of the market share. The report includes tentative data that will be updated through the end of March, Washington-based NAIC said in a statement Monday.
Finalized NAIC data from last year showed that Liberty Mutual had $4.18 billion in direct written workers comp premiums in 2012, or 8.69% of the national workers comp market share that year. Travelers was in second place with $3.8 billion in workers comp premiums in 2012, or 7.91% of the national comp market. The next-largest workers comp insurers have remained largely unchanged, NAIC data shows. Hartford Financial Services Group Inc. remained in third place with $3.34 billion in direct written comp premiums in 2013, up 1.8% from $3.28 billion in 2012. American International Group Inc. remained in fourth place with $2.84 billion in workers comp premiums last year, down 3.5% from $2.95 billion in 2012. Swiss-based Zurich Insurance Group Ltd. stayed in fifth place with $2.53 billion in comp premiums last year, down 8.5% from $2.77 billion in premiums for 2012.
The NAIC's report, along with data for other property/casualty lines, is available here ...
Carlos Razo claimed that while employed as a driver by Las Posas Country Club during the period May 7, 2011 through May 7, 2012, he sustained a cumulative trauma (CT) injury to his psyche, sleep disorder, head, eyes, back, digestive system, hernia, knee, hands and head. After the employer denied the claim, a dispute arose over the panel QME selection process.
At trial the parties stipulated to the facts of the QME process. In the field of internal medicine, an original panel of QMEs initially issued on October 18, 2012. A replacement panel was ordered on November 30, 2012. The replacement panel issued on January 3, 2013. On January 11, 2013, defendant exercised its right to strike a member of the panel. On January 24, 2013, defendant designated one of the other panel members to be the QME. On January 15, 2013, applicant exercised his right to strike a member of the panel. In the field of orthopedics, an original panel of QMEs initially issued on October 18, 2012. A replacement panel was ordered on November 13, 2012. The replacement panel issued on January 3, 2013. On January 11. 2013, defendant exercised its right to strike a member of the panel. On January 14, 2013, defendant designated one of the other panel members to be the QME. On January 15, 2013, applicant exercised his right to strike a member of the panel. The parties further stipulated that all dates with respect to the issuance of the QME panels reflect the dates that were written on the panel forms sent to the parties, and not the receipt dates.
The dispute was submitted on the issues of whether applicant timely exercised the right to strike a member of the panel pursuant to Labor Code section 4062.2(c), and "whether that code section in its 2012 version or ... in its 2013 version is applicable[.]" In the May 28, 2013 Findings and Order, the WCJ found that applicant timely exercised his right to strike members from replacement QME internal medicine and orthopedic panels assigned on January 3, 2013. The WCJ applied former section 4062.2(c). In his Opinion on Decision, the WCJ explained that to make a timely strike, applicant had 10 days after assignment of the QME panel on January 3, 2013 plus "three working days," i.e., until January 16, 2013. Since applicant made his strike on January 15, 2013, it was timely.
The WCAB agreed with the WCJ that applicant's strike was timely in the panel decision of Razo v Las Posas Country Club. However, it disagreed that former section 4062.2 applies. Instead,it applied section 4062.2 as amended by SB 863.
SB 863 became effective January 1, 2013. However, section 84 of SB 863 states: "This act shall apply to all pending matters, regardless of date of injury, unless otherwise specified in this act, but shall not be a basis to rescind, alter, amend, or reopen any final award of workers' compensation benefits." (Stats. 2012, ch 363, § 84.). Because section 4062.2 governs the panel QME process, it is a procedural statute. Therefore, its application in this case is prospective, not retroactive.
The WCAB also held that pursuant to the discussion of Code of Civil Procedure (CCP) I 013 in Messele v.Pitco Foods, Inc. (2011) 76 Cal.Comp.Cases 956 (Appeals Board en bane) ("Messe/e"), that section 4062.2(c) allows a party ten days from the Administrative Director's assignment of a QME panel, plus five days for U.S. mail, to strike a name from the QME panel. In Messe/e, the Board held that when the first written AME proposal is ''made" by mail or by any method other than personal service, the period for seeking agreement on an AME under former Labor Code section 4062.2(b) is extended five calendar days if the physical address of the party being served with the first written proposal is within California. Thus it construed the phrase in amended section 4062.Z(c), "assignment of the panel by the Administrative Director," to mean not only assignment but also service of the names of the panel QMEs on the parties by U.S. mail.
The panel was aware that in Alvarado v. Workers' Comp. Appeals Bd. (2007) 72 Cal.Comp.Cases 1142 (writ den.) the Board panel found CCP section 1013 inapplicable to extend the time for a party to strike a physician's name from a QME panel because the operative trigger for the time period was not service, but assignment of the panel. The Board stated that "the time limits prescribed by Labor Code § 4062.2(c) run from the date of assignment of the three-member panel, not from service of the panel." (72 Cal.Comp.Cases at p. 1145.). Alvarado is distinguishable because it involved application of former section 4062.2. which gave the parties a right to strike a name from the panel "within three working days of gaining the right to do so[.]" The statute now provides that each party has 10 days from assignment of the panel and, as construed here, an additional five calendar days for service of the assignment by U.S. mail ...
At trial the parties stipulated to the facts of the QME process. In the field of internal medicine, an original panel of QMEs initially issued on October 18, 2012. A replacement panel was ordered on November 30, 2012. The replacement panel issued on January 3, 2013. On January 11, 2013, defendant exercised its right to strike a member of the panel. On January 24, 2013, defendant designated one of the other panel members to be the QME. On January 15, 2013, applicant exercised his right to strike a member of the panel. In the field of orthopedics, an original panel of QMEs initially issued on October 18, 2012. A replacement panel was ordered on November 13, 2012. The replacement panel issued on January 3, 2013. On January 11. 2013, defendant exercised its right to strike a member of the panel. On January 14, 2013, defendant designated one of the other panel members to be the QME. On January 15, 2013, applicant exercised his right to strike a member of the panel. The parties further stipulated that all dates with respect to the issuance of the QME panels reflect the dates that were written on the panel forms sent to the parties, and not the receipt dates.
The dispute was submitted on the issues of whether applicant timely exercised the right to strike a member of the panel pursuant to Labor Code section 4062.2(c), and "whether that code section in its 2012 version or ... in its 2013 version is applicable[.]" In the May 28, 2013 Findings and Order, the WCJ found that applicant timely exercised his right to strike members from replacement QME internal medicine and orthopedic panels assigned on January 3, 2013. The WCJ applied former section 4062.2(c). In his Opinion on Decision, the WCJ explained that to make a timely strike, applicant had 10 days after assignment of the QME panel on January 3, 2013 plus "three working days," i.e., until January 16, 2013. Since applicant made his strike on January 15, 2013, it was timely.
The WCAB agreed with the WCJ that applicant's strike was timely in the panel decision of Razo v Las Posas Country Club. However, it disagreed that former section 4062.2 applies. Instead,it applied section 4062.2 as amended by SB 863.
SB 863 became effective January 1, 2013. However, section 84 of SB 863 states: "This act shall apply to all pending matters, regardless of date of injury, unless otherwise specified in this act, but shall not be a basis to rescind, alter, amend, or reopen any final award of workers' compensation benefits." (Stats. 2012, ch 363, § 84.). Because section 4062.2 governs the panel QME process, it is a procedural statute. Therefore, its application in this case is prospective, not retroactive.
The WCAB also held that pursuant to the discussion of Code of Civil Procedure (CCP) I 013 in Messele v.Pitco Foods, Inc. (2011) 76 Cal.Comp.Cases 956 (Appeals Board en bane) ("Messe/e"), that section 4062.2(c) allows a party ten days from the Administrative Director's assignment of a QME panel, plus five days for U.S. mail, to strike a name from the QME panel. In Messe/e, the Board held that when the first written AME proposal is ''made" by mail or by any method other than personal service, the period for seeking agreement on an AME under former Labor Code section 4062.2(b) is extended five calendar days if the physical address of the party being served with the first written proposal is within California. Thus it construed the phrase in amended section 4062.Z(c), "assignment of the panel by the Administrative Director," to mean not only assignment but also service of the names of the panel QMEs on the parties by U.S. mail.
The panel was aware that in Alvarado v. Workers' Comp. Appeals Bd. (2007) 72 Cal.Comp.Cases 1142 (writ den.) the Board panel found CCP section 1013 inapplicable to extend the time for a party to strike a physician's name from a QME panel because the operative trigger for the time period was not service, but assignment of the panel. The Board stated that "the time limits prescribed by Labor Code § 4062.2(c) run from the date of assignment of the three-member panel, not from service of the panel." (72 Cal.Comp.Cases at p. 1145.). Alvarado is distinguishable because it involved application of former section 4062.2. which gave the parties a right to strike a name from the panel "within three working days of gaining the right to do so[.]" The statute now provides that each party has 10 days from assignment of the panel and, as construed here, an additional five calendar days for service of the assignment by U.S. mail ...
Alyce Leticia Biggs, 44, of Lake Arrowhead was sentenced last week to 11 years in state prison for committing workers’ compensation insurance fraud, tax fraud and grand theft.
In 2010, Biggs was convicted of workers’ compensation insurance fraud, tax fraud, and grand theft. At that time, she was placed on probation and ordered to serve a year in custody. After her custody time was completed and while on probation, Biggs, a bookkeeper, continued to steal from at least two of her clients.
"Biggs would take bank deposits from the victims that consisted of cash and checks, and, on the way to the bank would pocket the cash, and only deposit the checks," said Deputy District Attorney Michael Chiriatti, Jr., who prosecuted the case.
According to Chiriatti, Biggs’ criminal activity continued for at least three years. As a result, she was rearrested, her probation was revoked, and a new criminal case was filed.
On Jan. 17, 2014, Biggs pleaded guilty to six new counts of grand theft, admitted a white collar crime enhancement, and admitted that she was in violation of her prior grant of probation. She also agreed at that time to serve 11 years in state prison, and pay back the victims all of the money she took from them. At the sentencing hearing, victim Vicki Center told the Court, "This whole event has been tragic to me." When asked if she had anything she would like to tell the Court or the victims, Biggs stated she did not ...
In 2010, Biggs was convicted of workers’ compensation insurance fraud, tax fraud, and grand theft. At that time, she was placed on probation and ordered to serve a year in custody. After her custody time was completed and while on probation, Biggs, a bookkeeper, continued to steal from at least two of her clients.
"Biggs would take bank deposits from the victims that consisted of cash and checks, and, on the way to the bank would pocket the cash, and only deposit the checks," said Deputy District Attorney Michael Chiriatti, Jr., who prosecuted the case.
According to Chiriatti, Biggs’ criminal activity continued for at least three years. As a result, she was rearrested, her probation was revoked, and a new criminal case was filed.
On Jan. 17, 2014, Biggs pleaded guilty to six new counts of grand theft, admitted a white collar crime enhancement, and admitted that she was in violation of her prior grant of probation. She also agreed at that time to serve 11 years in state prison, and pay back the victims all of the money she took from them. At the sentencing hearing, victim Vicki Center told the Court, "This whole event has been tragic to me." When asked if she had anything she would like to tell the Court or the victims, Biggs stated she did not ...
Appellant Chris Fopiano sued applicant attorneys Leonard Stern and Steven Barry for legal malpractice arising out of their representation of Fopiano in a workers’ compensation case. He claimed they improperly waived his right to seek reasonable disability accommodations from his employer. The trial court sustained the attorneys’ demurrer without leave to amend on the ground that the action was time-barred. Fopiano appealed, and the Court of Appeal reversed the dismissal and reinstated the case in the unpublished opinion of Fopiano v. Stern.
Fopiano suffered pulmonary injuries while working for his employer, Eastern Municipal Water District (EMWD). In July 2008, he hired attorneys Stern and Barry to represent him in a workers’ compensation case against EMWD. In January 2011, in the course of their representation of Fopiano, he alleges they waived his right to seek reasonable accommodations for his disability, although Fopiano had never discussed this with respondents, and did not know he possessed such a right. Additionally, Stern allegedly advised Fopiano that if he did not request early retirement, his employer could force him to retire. On March 14, 2011, Fopiano accepted an award of $69,813.62 for his permanent disability and voluntarily retired.
Soon thereafter, on March 25, 2011, Fopiano filed a pre-complaint questionnaire with California’s Department of Fair Employment and Housing (DFEH) to institute a disability discrimination complaint against EMWD. EMWD was afforded an opportunity to respond and denied Fopiano’s allegations of disability discrimination. EMWD asserted that Fopiano was not offered reasonable accommodations for his disability because respondents waived his right to seek reasonable accommodations and indicated to EMWD that Fopiano would instead retire.
Fopiano sued his comp attorneys on May 24, 2012, alleging they committed legal malpractice by waiving his right to seek reasonable accommodations from EMWD that would have allowed him to continue working. His attorneys demurred, arguing the allegations were insufficient to state a cause of action because they failed to allege when Fopiano learned of the attorneys’ wrongful conduct. The trial court sustained the demurrer to an amended complaint without leave to amend, finding Fopiano’s claim was time-barred because the fact that he filed a DFEH pre-complaint questionnaire demonstrated he knew of his attorneys’ malpractice at least by March 2011, which was more than one year before he filed his complaint. Fopiano timely appealed from the resulting judgment of dismissal.
The Court of Appeal reversed. The limitations period for legal malpractice is set forth in Code of Civil Procedure section 340.6, which states, in relevant part: "An action against an attorney for a wrongful act or omission, other than for actual fraud, arising in the performance of professional services shall be commenced within one year after the plaintiff discovers, or through the use of reasonable diligence should have discovered, the facts constituting the wrongful act or omission, or four years from the date of the wrongful act or omission, whichever occurs first. . . ."
The allegations in the second amended complaint did not show Fopiano’s claim was time-barred. Fopiano’s complaint alleged Stern erroneously counseled Fopiano to retire and negligently waived his right to seek reasonable accommodations for his disability. DFEH allegedly informed Fopiano in October 2011 of correspondence between respondents and EMWD in which respondents effected this waiver. Fopiano filed his complaint less than a year later, in May 2012. Assuming these allegations are true,Fopiano discovered respondents’ wrongful conduct within the one-year limitations period ...
Fopiano suffered pulmonary injuries while working for his employer, Eastern Municipal Water District (EMWD). In July 2008, he hired attorneys Stern and Barry to represent him in a workers’ compensation case against EMWD. In January 2011, in the course of their representation of Fopiano, he alleges they waived his right to seek reasonable accommodations for his disability, although Fopiano had never discussed this with respondents, and did not know he possessed such a right. Additionally, Stern allegedly advised Fopiano that if he did not request early retirement, his employer could force him to retire. On March 14, 2011, Fopiano accepted an award of $69,813.62 for his permanent disability and voluntarily retired.
Soon thereafter, on March 25, 2011, Fopiano filed a pre-complaint questionnaire with California’s Department of Fair Employment and Housing (DFEH) to institute a disability discrimination complaint against EMWD. EMWD was afforded an opportunity to respond and denied Fopiano’s allegations of disability discrimination. EMWD asserted that Fopiano was not offered reasonable accommodations for his disability because respondents waived his right to seek reasonable accommodations and indicated to EMWD that Fopiano would instead retire.
Fopiano sued his comp attorneys on May 24, 2012, alleging they committed legal malpractice by waiving his right to seek reasonable accommodations from EMWD that would have allowed him to continue working. His attorneys demurred, arguing the allegations were insufficient to state a cause of action because they failed to allege when Fopiano learned of the attorneys’ wrongful conduct. The trial court sustained the demurrer to an amended complaint without leave to amend, finding Fopiano’s claim was time-barred because the fact that he filed a DFEH pre-complaint questionnaire demonstrated he knew of his attorneys’ malpractice at least by March 2011, which was more than one year before he filed his complaint. Fopiano timely appealed from the resulting judgment of dismissal.
The Court of Appeal reversed. The limitations period for legal malpractice is set forth in Code of Civil Procedure section 340.6, which states, in relevant part: "An action against an attorney for a wrongful act or omission, other than for actual fraud, arising in the performance of professional services shall be commenced within one year after the plaintiff discovers, or through the use of reasonable diligence should have discovered, the facts constituting the wrongful act or omission, or four years from the date of the wrongful act or omission, whichever occurs first. . . ."
The allegations in the second amended complaint did not show Fopiano’s claim was time-barred. Fopiano’s complaint alleged Stern erroneously counseled Fopiano to retire and negligently waived his right to seek reasonable accommodations for his disability. DFEH allegedly informed Fopiano in October 2011 of correspondence between respondents and EMWD in which respondents effected this waiver. Fopiano filed his complaint less than a year later, in May 2012. Assuming these allegations are true,Fopiano discovered respondents’ wrongful conduct within the one-year limitations period ...
The Commission on Health and Safety and Workers’ Compensation (CHSWC) examines the health and safety and workers’ compensation systems in California and makes recommendations to improve their operation. At the request of the Executive Branch, the Legislature and the Commission, CHSWC conducts research, releases public reports, presents findings, and provides information on the health and safety and workers’ compensation systems. Accordingly, CHSWC has now published its 352 page 2013 Annual Report.
CHSWC is again this year recommending the integration of workers' compensation medical care with general medical care insurance. The Report notes that health costs have been rising more quickly than inflation and wages. These costs create financial challenges for employers, especially those in industries with already high workers’ compensation costs. Furthermore, group health care and workers’ compensation medical care are typically delivered through separate provider systems, resulting in unnecessary, duplicative and contraindicated treatment and inefficient administration. Suggestions have been made to integrate workers’ compensation medical care with the general medical care provided to patients by group health insurers in order to improve the quality and coordination of care, lower overall medical expenditure, reduce administrative costs, and derive other efficiencies in care. Research also supports the contention that an integrated 24-hour care system could potentially provide medical cost savings, as well as shorten the duration of disability for workers.
Nonetheless, CHSWC determined that SB 863 has indeed resulted in some medical cost savings. In 2012, based on a California Workers' Compensation Institute analysis, the WCIRB estimated an approximate $20,000 per claim reduction on claims involving spinal implant hardware due to the SB 863 provisions related to duplicate reimbursement for spinal implant hardware. Preliminary WCIRB data suggests savings of more than $15,000 per claim on affected spinal surgery claims in 2013. In 2012, the WCIRB estimated that the revised fee schedule for ambulatory surgery center (ASC) facility fees required by SB 863 would reduce those fees by approximately 25 percent. Preliminary WCIRB data for 2013 services suggest a 26 percent reduction in ASC fees.
The cost of the total medical benefit decreased by 23 percent from 2003 to 2007, and then increased by 35 percent from 2007 to 2012. Payments to physicians decreased by 42 percent from 2003 to 2009, and then increased 20.5 percent from 2009 to 2012. Pharmacy costs peaked in 2004, declined by 27 percent from 2004 to 2007, and then increased overall by 26 percent from 2007 to 2012. Hospital costs declined by 39 percent from 2003 to 2006, increased overall by 37 percent from 2006 to 2011, and then decreased by 18 percent from 2011 to 2012. Direct payments to patients averaged $226 million from 2003 to 2005, increased sharply 4 times from 2005 to 2006, and then more than doubled from 2006 to 2012. Expenditures on medical cost-containment programs in 2005 were less than a half of what they were in 2003, increased 4 times from 2005 to 2010, and then decreased by 29 percent from 2010 to 2012.
CHSWC complains about the high cost of medical legal examinations. Medical-legal evaluation costs peaked in 2008 at $289 million (an increase of 58 percent from 2003), decreased by 19 percent from 2008 to 2009, and then gradually went back to 2008 level from 2009 to 2012. The average number of psychiatric evaluations per claim in California increased by 19 percent from 0.062 in 2002 to 0.074 in 2010. Psychiatric evaluations are nearly always billed under the ML-104 code that is the most expensive. The average cost of a psychiatric evaluation more than doubled from $1,528 in 2002 to $3,719 in 2010. It was an increase of 13 percent from $3,302 in 2010. The Southern region produces over 60 percent of all psychiatric evaluations in California and has the biggest impact on both the frequency and cost of medical-legal evaluations statewide.The complexity of impairment rating under the AMA Guides, new rules for apportionment, and the criteria for medical treatment decisions under the Medical Treatment Utilization Schedule are among the reasons cited for rising costs per exam. Thus, the Report recommends that a study of the operation and potential improvements of the QME system ...
CHSWC is again this year recommending the integration of workers' compensation medical care with general medical care insurance. The Report notes that health costs have been rising more quickly than inflation and wages. These costs create financial challenges for employers, especially those in industries with already high workers’ compensation costs. Furthermore, group health care and workers’ compensation medical care are typically delivered through separate provider systems, resulting in unnecessary, duplicative and contraindicated treatment and inefficient administration. Suggestions have been made to integrate workers’ compensation medical care with the general medical care provided to patients by group health insurers in order to improve the quality and coordination of care, lower overall medical expenditure, reduce administrative costs, and derive other efficiencies in care. Research also supports the contention that an integrated 24-hour care system could potentially provide medical cost savings, as well as shorten the duration of disability for workers.
Nonetheless, CHSWC determined that SB 863 has indeed resulted in some medical cost savings. In 2012, based on a California Workers' Compensation Institute analysis, the WCIRB estimated an approximate $20,000 per claim reduction on claims involving spinal implant hardware due to the SB 863 provisions related to duplicate reimbursement for spinal implant hardware. Preliminary WCIRB data suggests savings of more than $15,000 per claim on affected spinal surgery claims in 2013. In 2012, the WCIRB estimated that the revised fee schedule for ambulatory surgery center (ASC) facility fees required by SB 863 would reduce those fees by approximately 25 percent. Preliminary WCIRB data for 2013 services suggest a 26 percent reduction in ASC fees.
The cost of the total medical benefit decreased by 23 percent from 2003 to 2007, and then increased by 35 percent from 2007 to 2012. Payments to physicians decreased by 42 percent from 2003 to 2009, and then increased 20.5 percent from 2009 to 2012. Pharmacy costs peaked in 2004, declined by 27 percent from 2004 to 2007, and then increased overall by 26 percent from 2007 to 2012. Hospital costs declined by 39 percent from 2003 to 2006, increased overall by 37 percent from 2006 to 2011, and then decreased by 18 percent from 2011 to 2012. Direct payments to patients averaged $226 million from 2003 to 2005, increased sharply 4 times from 2005 to 2006, and then more than doubled from 2006 to 2012. Expenditures on medical cost-containment programs in 2005 were less than a half of what they were in 2003, increased 4 times from 2005 to 2010, and then decreased by 29 percent from 2010 to 2012.
CHSWC complains about the high cost of medical legal examinations. Medical-legal evaluation costs peaked in 2008 at $289 million (an increase of 58 percent from 2003), decreased by 19 percent from 2008 to 2009, and then gradually went back to 2008 level from 2009 to 2012. The average number of psychiatric evaluations per claim in California increased by 19 percent from 0.062 in 2002 to 0.074 in 2010. Psychiatric evaluations are nearly always billed under the ML-104 code that is the most expensive. The average cost of a psychiatric evaluation more than doubled from $1,528 in 2002 to $3,719 in 2010. It was an increase of 13 percent from $3,302 in 2010. The Southern region produces over 60 percent of all psychiatric evaluations in California and has the biggest impact on both the frequency and cost of medical-legal evaluations statewide.The complexity of impairment rating under the AMA Guides, new rules for apportionment, and the criteria for medical treatment decisions under the Medical Treatment Utilization Schedule are among the reasons cited for rising costs per exam. Thus, the Report recommends that a study of the operation and potential improvements of the QME system ...
In 2009, Ismael Navarro filed an application and claim form alleging a cumulative injury from February 9, 2008 to February 9, 2009 to his back and ear and was evaluated by panel QME J. Yogaratnam, M.D., Then in 2010, applicant filed applications for adjudication with claim forms alleging a specific injury of June 1, 2010 to his back, lower extremities and legs and a specific injury of August 31, 2010 to his back and left leg.
In 2012, defendant petitioned to compel an evaluation of applicant’s two subsequent claims of injury by original panel QME Dr. Yogaratnam, but it did not seek to have applicant reevaluated regarding his previous claim of cumulative injury. Applicant objected. The WCJ found that applicant was entitled to a new panel QME in his specific injury cases and that QME Rule 35.5(e) that seems to require an applicant to return to the original QME did not apply.
Defendant filed a Petition for Removal contending that Rule 35.5(e) applies and because Rule 35.5(e) applies, applicant must return to original panel QME Dr. Yogaratnam. The WCAB in the En Banc decision of Ismael Navarro v.City of Montebello, administered by Corvel Corporation disagreed with defendant and affirmed the order for a new panel.
The WCAB reviewed the Labor Code provisions for the use of a QME and concluded "we see no provision in the Labor Code that requires an employee to return to the same evaluator for a subsequent claim of injury. And, we see no provision that distinguishes between procedures for evaluation of claims of injury based on the same or different body parts".Thus the Labor Code does not require an employee to return to the same evaluator for a subsequent claim of injury.
"Rule 35.5(e) appears to impose an unwarranted limitation on the Labor Code, particularly sections 4060(a), (c), and (d), 4062.1, 4062.2, 4062.2(a), 4062.3(j), 4062.3(k), 4064(a), and 4067. Thus, Rule 35.5(e) appears to be invalid to the extent that it imposes an additional requirement that an employee return to the same evaluator when a new injury or illness is claimed that involves the same body parts and the same parties." Applicant’s two claims of specific injury were reported after the original evaluation but before a subsequent evaluation by a new evaluator. Thus, under sections 4062.3(j) and section 4064(a), it appears that applicant is entitled to be evaluated by one new evaluator for his two subsequent claims of injury.
The WCAB therefore indicated its intent to rule that "The requirement in Rule 35.5(e) that an employee return to the same evaluator when a new injury or illness is claimed involving the same parties and the same type of body parts is inconsistent with the Labor Code and that this requirement is therefore invalid." The Petition for Removal was granted, and the parties were given 20 days notice of this intended ruling and an opportunity to respond.
In the event that this case becomes a final ruling, this will be the second QME rule to be declared invalid. In 2010, the En Banc decision of Amelia Mendoza v. Huntington Hospital, Permissibly Self-Insured; and Sedwick Claims Management Services, Inc. declared rule 30 to be invalid. The Appeals Board held in that case that: (1) California Code of Regulations, title 8, section 30(d)(3) (Administrative Director Rule 30(d)(3)), which states that when a claim has been entirely denied by the defendant only the employee may request a panel of Qualified Medical Evaluators, is invalid because it conflicts with Labor Code sections 4060(c) and 4062.2 and exceeds the scope of section 5402(b); (2) the time limits of section 4062(a) for objecting to a treating physician’s medical determination do not apply when the injury has been entirely denied by the defendant; and (3) section 4062.2 does not establish timelines for initiating or completing the process for obtaining a medical-legal report on compensability ...
In 2012, defendant petitioned to compel an evaluation of applicant’s two subsequent claims of injury by original panel QME Dr. Yogaratnam, but it did not seek to have applicant reevaluated regarding his previous claim of cumulative injury. Applicant objected. The WCJ found that applicant was entitled to a new panel QME in his specific injury cases and that QME Rule 35.5(e) that seems to require an applicant to return to the original QME did not apply.
Defendant filed a Petition for Removal contending that Rule 35.5(e) applies and because Rule 35.5(e) applies, applicant must return to original panel QME Dr. Yogaratnam. The WCAB in the En Banc decision of Ismael Navarro v.City of Montebello, administered by Corvel Corporation disagreed with defendant and affirmed the order for a new panel.
The WCAB reviewed the Labor Code provisions for the use of a QME and concluded "we see no provision in the Labor Code that requires an employee to return to the same evaluator for a subsequent claim of injury. And, we see no provision that distinguishes between procedures for evaluation of claims of injury based on the same or different body parts".Thus the Labor Code does not require an employee to return to the same evaluator for a subsequent claim of injury.
"Rule 35.5(e) appears to impose an unwarranted limitation on the Labor Code, particularly sections 4060(a), (c), and (d), 4062.1, 4062.2, 4062.2(a), 4062.3(j), 4062.3(k), 4064(a), and 4067. Thus, Rule 35.5(e) appears to be invalid to the extent that it imposes an additional requirement that an employee return to the same evaluator when a new injury or illness is claimed that involves the same body parts and the same parties." Applicant’s two claims of specific injury were reported after the original evaluation but before a subsequent evaluation by a new evaluator. Thus, under sections 4062.3(j) and section 4064(a), it appears that applicant is entitled to be evaluated by one new evaluator for his two subsequent claims of injury.
The WCAB therefore indicated its intent to rule that "The requirement in Rule 35.5(e) that an employee return to the same evaluator when a new injury or illness is claimed involving the same parties and the same type of body parts is inconsistent with the Labor Code and that this requirement is therefore invalid." The Petition for Removal was granted, and the parties were given 20 days notice of this intended ruling and an opportunity to respond.
In the event that this case becomes a final ruling, this will be the second QME rule to be declared invalid. In 2010, the En Banc decision of Amelia Mendoza v. Huntington Hospital, Permissibly Self-Insured; and Sedwick Claims Management Services, Inc. declared rule 30 to be invalid. The Appeals Board held in that case that: (1) California Code of Regulations, title 8, section 30(d)(3) (Administrative Director Rule 30(d)(3)), which states that when a claim has been entirely denied by the defendant only the employee may request a panel of Qualified Medical Evaluators, is invalid because it conflicts with Labor Code sections 4060(c) and 4062.2 and exceeds the scope of section 5402(b); (2) the time limits of section 4062(a) for objecting to a treating physician’s medical determination do not apply when the injury has been entirely denied by the defendant; and (3) section 4062.2 does not establish timelines for initiating or completing the process for obtaining a medical-legal report on compensability ...
In 2003 and 2004, Jose Dubon sustained industrial injuries to his spine and other body parts while employed by World Restoration, Inc., Applicant’s primary treating physician for both injuries has been Mark W. Brown, M.D. His consulting orthopedic surgeon has been Albert Simpkins, Jr., M.D. The agreed medical evaluator (AME) in orthopedics has been Israel Rottermann, M.D.
In a report dated July 1, 2013, Dr. Simpkins requested authorization to perform an anterior and posterior fusion from L4 through S1 with decompression. On July 19, 2013, Bunch CareSolutions, SCIF’s UR agent, sent Dr. Simpkins a letter denying authorization for surgery as not medically necessary. The letter was based on the July 19, 2013 report of SCIF’s UR physician, Donald A. deGrange, M.D., a board certified orthopedic surgeon. Dr. Simpkins invoked Bunch CareSolutions’s internal UR appeal process. On August 2, 2013, a second UR denial was issued based on the report of board certified orthopedic surgeon Kevin Mark Deitel, M.D. In all significant respects, this report was identical to that of Dr. deGrange.
On August 12, 2013, applicant signed an application for IMR. On August 14, 2013, applicant filed a declaration of readiness (DOR) for an expedited hearing regarding his entitlement to spinal surgery. In the DOR, applicant contended that defendant’s UR denial was defective because, among other reasons, there was insufficient record review.
In her Opinion on Decision, the WCJ observed that: (1) Dr. deGrange did not identify the 18 pages of additional medical records he reviewed, in violation of section 4610(g)(4) and AD Rule 9792.9.1(e)(5)(D) (Cal. Code Regs., tit. 8, § 9792.9.1(e)(5)(D); see also § 9792.9(l)(3));5 and (2) there was " wealth of medical records"that Dr. deGrange did not review, including all reports of Dr. Brown, the reports of Dr. Simpkins (other than the July 1, 2013 report), the AME report of Dr. Rottermann, and the discogram report of Dr. Lowenstein. The WCJ said that Dr. deGrange’s failure to review all of the relevant medical records "was a critical error" because "The determination [of medical necessity] is made in part based upon the severity of pain, duration of pain, radiculopathy as well as a review as to whether conservative care had been undertaken." The WCJ added that a UR physician "is compelled by ACOEM to look at objective testing performed coupled with subjective complaints, history of radiculopathy, and history of conservative care" and that "a complete review of applicant’s medical condition and prior treatment "is especially important when utilizing ACOEM Guidelines in determining whether treatment should be authorized." Despite the procedural defects with defendant’s UR that the WCJ identified, she concluded that any alleged procedural defects must be resolved through IMR. The WCJ further concluded that the WCAB cannot allow the surgery recommended by Dr. Simpkins because the issue of medical necessity must be determined by IMR.
The WCAB in the en banc decision of Jose Dubon v. World Restoration, Inc.; and State Compensation Insurance Fund agreed that the UR was inadequate but disagreed with the solution.
In reviewing the UR decision the sole focus of the IMR physician is the medical necessity of the proposed treatment. (Lab. Code, §§ 4610.5(c)(2), (c)(3), (k), 4610.6(a), (c), (e).) Because the role of an IMR physician is limited to assessing medical necessity, disputes over whether a UR decision is timely and/or procedurally proper must be resolved solely by the WCAB. (Lab. Code, § 4604 ["[c]ontroversies between employer and employee arising under this chapter shall be determined by the appeals board, upon the request of either party, except as otherwise provided by Section 4610.5" (italics added)].) Judicial scrutiny of the procedural validity of a UR decision is of particular importance since SB 863 amended the Labor Code to bar an injured worker from renewing a treatment request for 12 months absent a documented material change in circumstances. (Lab. Code, § 4610(g)(6).) Furthermore, requiring strict compliance with mandatory time limits and other regulations governing UR will ensure the integrity of the UR process and the decisions rendered. This result will be beneficial to the workers’ compensation system as a whole.
But, not all procedural violations of section 4610 or the AD’s Rules render a UR decision invalid. Instead, a UR decision is invalid only if it suffers from material procedural defects that undermine the integrity of the UR decision. A UR decision is invalid if it suffers from material procedural defects that undermine the integrity of the UR decision. If, however, there are only minor technical or immaterial defects, a defendant’s UR determination remains fully subject to the IMR process.
If a UR decision is invalid because its integrity was undermined due to the defendant’s failure to provide the UR physician with adequate medical records or because the UR physician failed to consider them, there is no valid UR determination and no basis for the employee to invoke IMR. Although both the defendant and employee may submit medical records and reports to the IMR organization (Lab. Code, § 4610.5(l)(1), (f)(3); see also Cal. Code Regs., tit. 8, § 9792.10.5(a)(1), (f)(3), (h)(1)), a defendant may not use this as a vehicle to cure defects in its UR process if the UR decision has been found invalid. The need for a UR physician to be provided with and review sufficient medical records to determine the medical necessity of a treatment request and to disclose what those records are goes to the very core of a UR decision. Where there is no valid UR decision subject to IMR, the issue of medical necessity must be determined by the WCAB ...
In a report dated July 1, 2013, Dr. Simpkins requested authorization to perform an anterior and posterior fusion from L4 through S1 with decompression. On July 19, 2013, Bunch CareSolutions, SCIF’s UR agent, sent Dr. Simpkins a letter denying authorization for surgery as not medically necessary. The letter was based on the July 19, 2013 report of SCIF’s UR physician, Donald A. deGrange, M.D., a board certified orthopedic surgeon. Dr. Simpkins invoked Bunch CareSolutions’s internal UR appeal process. On August 2, 2013, a second UR denial was issued based on the report of board certified orthopedic surgeon Kevin Mark Deitel, M.D. In all significant respects, this report was identical to that of Dr. deGrange.
On August 12, 2013, applicant signed an application for IMR. On August 14, 2013, applicant filed a declaration of readiness (DOR) for an expedited hearing regarding his entitlement to spinal surgery. In the DOR, applicant contended that defendant’s UR denial was defective because, among other reasons, there was insufficient record review.
In her Opinion on Decision, the WCJ observed that: (1) Dr. deGrange did not identify the 18 pages of additional medical records he reviewed, in violation of section 4610(g)(4) and AD Rule 9792.9.1(e)(5)(D) (Cal. Code Regs., tit. 8, § 9792.9.1(e)(5)(D); see also § 9792.9(l)(3));5 and (2) there was " wealth of medical records"that Dr. deGrange did not review, including all reports of Dr. Brown, the reports of Dr. Simpkins (other than the July 1, 2013 report), the AME report of Dr. Rottermann, and the discogram report of Dr. Lowenstein. The WCJ said that Dr. deGrange’s failure to review all of the relevant medical records "was a critical error" because "The determination [of medical necessity] is made in part based upon the severity of pain, duration of pain, radiculopathy as well as a review as to whether conservative care had been undertaken." The WCJ added that a UR physician "is compelled by ACOEM to look at objective testing performed coupled with subjective complaints, history of radiculopathy, and history of conservative care" and that "a complete review of applicant’s medical condition and prior treatment "is especially important when utilizing ACOEM Guidelines in determining whether treatment should be authorized." Despite the procedural defects with defendant’s UR that the WCJ identified, she concluded that any alleged procedural defects must be resolved through IMR. The WCJ further concluded that the WCAB cannot allow the surgery recommended by Dr. Simpkins because the issue of medical necessity must be determined by IMR.
The WCAB in the en banc decision of Jose Dubon v. World Restoration, Inc.; and State Compensation Insurance Fund agreed that the UR was inadequate but disagreed with the solution.
In reviewing the UR decision the sole focus of the IMR physician is the medical necessity of the proposed treatment. (Lab. Code, §§ 4610.5(c)(2), (c)(3), (k), 4610.6(a), (c), (e).) Because the role of an IMR physician is limited to assessing medical necessity, disputes over whether a UR decision is timely and/or procedurally proper must be resolved solely by the WCAB. (Lab. Code, § 4604 ["[c]ontroversies between employer and employee arising under this chapter shall be determined by the appeals board, upon the request of either party, except as otherwise provided by Section 4610.5" (italics added)].) Judicial scrutiny of the procedural validity of a UR decision is of particular importance since SB 863 amended the Labor Code to bar an injured worker from renewing a treatment request for 12 months absent a documented material change in circumstances. (Lab. Code, § 4610(g)(6).) Furthermore, requiring strict compliance with mandatory time limits and other regulations governing UR will ensure the integrity of the UR process and the decisions rendered. This result will be beneficial to the workers’ compensation system as a whole.
But, not all procedural violations of section 4610 or the AD’s Rules render a UR decision invalid. Instead, a UR decision is invalid only if it suffers from material procedural defects that undermine the integrity of the UR decision. A UR decision is invalid if it suffers from material procedural defects that undermine the integrity of the UR decision. If, however, there are only minor technical or immaterial defects, a defendant’s UR determination remains fully subject to the IMR process.
If a UR decision is invalid because its integrity was undermined due to the defendant’s failure to provide the UR physician with adequate medical records or because the UR physician failed to consider them, there is no valid UR determination and no basis for the employee to invoke IMR. Although both the defendant and employee may submit medical records and reports to the IMR organization (Lab. Code, § 4610.5(l)(1), (f)(3); see also Cal. Code Regs., tit. 8, § 9792.10.5(a)(1), (f)(3), (h)(1)), a defendant may not use this as a vehicle to cure defects in its UR process if the UR decision has been found invalid. The need for a UR physician to be provided with and review sufficient medical records to determine the medical necessity of a treatment request and to disclose what those records are goes to the very core of a UR decision. Where there is no valid UR decision subject to IMR, the issue of medical necessity must be determined by the WCAB ...
Solus Industrial Innovations LLC makes plastics at an Orange County manufacturing facility. Solus had moved some production to Rancho Santa Margarita, Calif., from Aston, Pa., in 2007 and was in a hurry to begin production. The company purchased a water heater for $541.66 from a Lowe’s home improvement store to avoid the cost and permitting requirements of a proper installation. Use of an industrial water heater would have required permits and the installation of a natural gas line, and it would have delayed the start of the Rancho Santa Margarita extrusion of plastic components for conveyor chains and sprockets. In March 2009, that water heater exploded, killing two workers instantly in what district attorney refers to as an "untimely and horrific death."
Solus former plant manager Carl E. Richardson and former maintenance supervisor Roy Faulkinbury were responsible for removal of an automatic safety shut-off protection and installation of a temperature control device to force the heater to operate above its capacity. The heater had leaked often and blown a safety valve but was kept in service. On March 19, 2009 the water heater exploded killing two an injuring a third employee. The tank pierced the 30-foot-high roof and landed about 25 feet from its original location. The blast hurled other equipment and materials against the concrete-block walls causing extensive damage and effectively destroying the facility, which never resumed operations.
The two pleaded guilty on Feb. 14 to two felony violations of California Labor Code section 6425, subdivision (a). They agreed to collectively pay $450,000 to families of the victims and individually do 250 hours of community service. (See People v. Faulkinbury, (Super. Ct. Orange County, 2012, No. 12CF0698).) No party challenged the district attorney’s standing to bring these or other appropriate criminal prosecutions.
The district attorney’s office also filed a civil lawsuit against Solus, Emerson and subsidiary Emerson Power Transmission Corp. The complaint contains four causes of action, all based on the same worker health and safety standards placed at issue in the administrative proceedings. The third cause of action alleges that Solus’s failure to comply with workplace safety standards amounts to an unlawful, unfair and fraudulent business practice under Business and Professions Code section 17200, and the district attorney requests imposition of civil penalties as a consequence of that practice, in the amount of up to $2,500 per day, per employee, for the period from November 29, 2007 through March 19, 2009. The fourth cause of action alleges Solus made numerous false and misleading representations concerning its commitment to workplace safety and its compliance with all applicable workplace safety standards, and as a result of those false and misleading statements, Solus was allegedly able to retain employees and customers in violation of Business and Professions Code section 17500. Again, the district attorney requests imposition of civil penalties as a consequence of this alleged misconduct, in the amount of up to $2,500 per day, per employee, for the period from November 29, 2007 through March 19, 2009.
Solus demurred to these two causes of action, contending they were preempted under Fed/OSHA, because a prosecutor’s pursuit of civil penalties under the UCL is not part of California’s workplace safety plan approved by the Secretary. The trial court disagreed, and overruled the demurrer to the district attorney’s two causes of action based on violations of the UCL. The Court of Appeal reversed in the published opinion of Solus Industrial Innovations LLC v The Superior Court of Orange County.
Under the supremacy clause of the United States Constitution (art. VI, cl. 2), Congress has the power to preempt state law concerning matters that lie within the authority of Congress. On the matter of workplace safety regulation, the federal government’s intent to preempt is clear: However, "Congress expressly saved two areas from federal pre-emption. . . . [T]he Act does not ‘supersede or in any manner affect any workmen’s compensation law [and] the Act does not ‘prevent any State agency or court from asserting jurisdiction under State law over any occupational safety or health issue with respect to which no [federal] standard is in effect.’" Moreover, Congress also gave states the option of side-stepping federal preemption entirely, by allowing any state which "desires to assume responsibility for development and enforcement therein of occupational safety and health standards relating to any occupational safety or health issue [to] submit a State plan for the development of such standards and their enforcement."
After a review of the facts and law on preemption, the Court of Appeal concluded that state regulation of workplace safety standards is explicitly preempted by federal law under the OSH Act, and that consequently California is entitled to exercise its regulatory power only in accordance with the terms of its federally approved workplace safety plan. Thus the district attorney cannot presently rely on the UCL to provide an additional means of penalizing an employer for its violation of workplace safety standards ...
Solus former plant manager Carl E. Richardson and former maintenance supervisor Roy Faulkinbury were responsible for removal of an automatic safety shut-off protection and installation of a temperature control device to force the heater to operate above its capacity. The heater had leaked often and blown a safety valve but was kept in service. On March 19, 2009 the water heater exploded killing two an injuring a third employee. The tank pierced the 30-foot-high roof and landed about 25 feet from its original location. The blast hurled other equipment and materials against the concrete-block walls causing extensive damage and effectively destroying the facility, which never resumed operations.
The two pleaded guilty on Feb. 14 to two felony violations of California Labor Code section 6425, subdivision (a). They agreed to collectively pay $450,000 to families of the victims and individually do 250 hours of community service. (See People v. Faulkinbury, (Super. Ct. Orange County, 2012, No. 12CF0698).) No party challenged the district attorney’s standing to bring these or other appropriate criminal prosecutions.
The district attorney’s office also filed a civil lawsuit against Solus, Emerson and subsidiary Emerson Power Transmission Corp. The complaint contains four causes of action, all based on the same worker health and safety standards placed at issue in the administrative proceedings. The third cause of action alleges that Solus’s failure to comply with workplace safety standards amounts to an unlawful, unfair and fraudulent business practice under Business and Professions Code section 17200, and the district attorney requests imposition of civil penalties as a consequence of that practice, in the amount of up to $2,500 per day, per employee, for the period from November 29, 2007 through March 19, 2009. The fourth cause of action alleges Solus made numerous false and misleading representations concerning its commitment to workplace safety and its compliance with all applicable workplace safety standards, and as a result of those false and misleading statements, Solus was allegedly able to retain employees and customers in violation of Business and Professions Code section 17500. Again, the district attorney requests imposition of civil penalties as a consequence of this alleged misconduct, in the amount of up to $2,500 per day, per employee, for the period from November 29, 2007 through March 19, 2009.
Solus demurred to these two causes of action, contending they were preempted under Fed/OSHA, because a prosecutor’s pursuit of civil penalties under the UCL is not part of California’s workplace safety plan approved by the Secretary. The trial court disagreed, and overruled the demurrer to the district attorney’s two causes of action based on violations of the UCL. The Court of Appeal reversed in the published opinion of Solus Industrial Innovations LLC v The Superior Court of Orange County.
Under the supremacy clause of the United States Constitution (art. VI, cl. 2), Congress has the power to preempt state law concerning matters that lie within the authority of Congress. On the matter of workplace safety regulation, the federal government’s intent to preempt is clear: However, "Congress expressly saved two areas from federal pre-emption. . . . [T]he Act does not ‘supersede or in any manner affect any workmen’s compensation law [and] the Act does not ‘prevent any State agency or court from asserting jurisdiction under State law over any occupational safety or health issue with respect to which no [federal] standard is in effect.’" Moreover, Congress also gave states the option of side-stepping federal preemption entirely, by allowing any state which "desires to assume responsibility for development and enforcement therein of occupational safety and health standards relating to any occupational safety or health issue [to] submit a State plan for the development of such standards and their enforcement."
After a review of the facts and law on preemption, the Court of Appeal concluded that state regulation of workplace safety standards is explicitly preempted by federal law under the OSH Act, and that consequently California is entitled to exercise its regulatory power only in accordance with the terms of its federally approved workplace safety plan. Thus the district attorney cannot presently rely on the UCL to provide an additional means of penalizing an employer for its violation of workplace safety standards ...
Average facility fee payments to ambulatory surgery centers (ASCs) have declined 26% per episode and 28% per procedure since fee schedule changes mandated by SB 863 were adopted last year according to a new study by the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) and the California Workers’ Compensation Institute (CWCI). The results of this study are consistent with the WCIRB’s initial projection of a 25% reduction in ASC costs that was part of the January 1, 2013 Pure Premium Rate Filing.
The CWCI/WCIRB joint study measured average amounts billed and paid for workers’ compensation outpatient surgery services rendered in the year preceding the adoption of the revised fee schedule (2012) and in the first 6 months after the revised fee schedule took effect (January through June of 2013). Payment results were measured both on a per procedure basis using CWCI data, and a per episode basis using WCIRB data. In addition, the authors looked for changes in a number of factors that can affect the total amounts paid to ASCs. Among the findings of the report are:
The CWCI/WCIRB joint study measured average amounts billed and paid for workers’ compensation outpatient surgery services rendered in the year preceding the adoption of the revised fee schedule (2012) and in the first 6 months after the revised fee schedule took effect (January through June of 2013). Payment results were measured both on a per procedure basis using CWCI data, and a per episode basis using WCIRB data. In addition, the authors looked for changes in a number of factors that can affect the total amounts paid to ASCs. Among the findings of the report are:
- The average amount paid per ASC procedure following the implementation of the revised ASC fee schedule declined 28%.
- The average amount paid for ASC services per episode declined 26%.
- Although billings increased and negotiated discounts eroded, the net paid amounts for ASC services were not materially affected.
- Both ASCs and hospital outpatient departments showed declines in the proportion of outpatient facility fees paying for additional services associated with the primary paid procedure.
- The proportion of ASC payments attributable to services not subject to the fee schedule change increased, but remained relatively small.
- The data indicate no change in the mix of services or the percentage of episodes occurring in outpatient hospital settings and ASCs.
An injured worker, or someone she or he designates, may request independent medical review (IMR) if utilization review (UR) denies or modifies a requested medical treatment for an accepted claim. The claims administrator must send the injured worker a notice of the UR denial along with a partially completed IMR request form. To request IMR, the worker must submit the signed application for IMR and mail the original signed Application for Independent Medical Review and a copy of the utilization review denial of treatment within 30 days of receiving the utilization denial:
To date, when an IMR application is received without a copy of the UR denial, a reminder letter is sent to the worker requesting the UR denial and allowing an additional 15 days to comply with this requirement.
As of March 1, 2014, a revised IMR application must be sent by the claims administrator to the injured worker. The revised form now clearly advises that the copy of the UR denial must be included with the IMR application. Therefore, beginning April 1, 2014, DWC will cease issuing reminder letters if the UR denial is not included with the submittal of an IMR application and will instead advise the worker that the IMR application is ineligible.
Similarly, when a provider submits a request for independent bill review (IBR), the provider is required to include and index the following documents:
These changes are being made in an effort to better serve the public by streamlining the process and focusing efforts on issuing determinations in a timely manner ...
To date, when an IMR application is received without a copy of the UR denial, a reminder letter is sent to the worker requesting the UR denial and allowing an additional 15 days to comply with this requirement.
As of March 1, 2014, a revised IMR application must be sent by the claims administrator to the injured worker. The revised form now clearly advises that the copy of the UR denial must be included with the IMR application. Therefore, beginning April 1, 2014, DWC will cease issuing reminder letters if the UR denial is not included with the submittal of an IMR application and will instead advise the worker that the IMR application is ineligible.
Similarly, when a provider submits a request for independent bill review (IBR), the provider is required to include and index the following documents:
- The original billing itemization and original supporting documentation
- The explanation of review provided in response to the original billing
- The request for second bill review and original documentation supporting second review
- The explanation of review provided in response to the second bill request
- If applicable, the relevant contract provisions for reimbursement rates.
These changes are being made in an effort to better serve the public by streamlining the process and focusing efforts on issuing determinations in a timely manner ...
On the heels of a massive corruption scheme involving state Sen. Ronald Calderon and a former hospital executive, two whistleblowers are speaking out to NBC4's I-Team, for the first time, about what they said was insurance fraud, involving counterfeit medical hardware, which ran rampant under that hospital executive's command. "The red flags started immediately," said Mark Sersansie of Orange County, who was hired as a sales representative for a man he said worked for Michael Drobot, the former owner of Pacific Hospital of Long Beach.
Sersansie is one of two plaintiffs in a civil lawsuit, which was originally filed in Sacramento in May 2012, but was recently transferred to Los Angeles County. The suit alleges doctors were recruited to push workers comp patients to have spinal surgeries done at certain hospitals that overcharged for operations and medical devices, which in many cases were counterfeit, according to the suit. According to Sersansie, Drobot and his co-conspirators bullied their employees to keep quiet about their scheme. "These guys are absolute thugs," said Sersansie. "They tried different ways to intimidate me and my family. We had instances where they actually came to my home, three of them and threatened me."
According to the suit, the scheme involved an elaborate web of conspirators that included Pacific Hospital of Long Beach, which is now closed, Tri-City Medical Group, whose former CEO has since been investigated and removed and medical hardware distributors and doctor whom collected on illegal kick-backs. Justin Berger, Sersansie's attorney, showed NBC4 an invoice -- an exhibit in the suit -- which totals $24,000. "These are bribes to get these surgeons to do surgeries at this hospital with this particular hardware," said Berger. "Much of this hardware, if not all of it, we believe is counterfeit."
Bill Reynolds, an insurance fraud investigator and the other whistleblower named in the suit, said this scheme bilked the state's workers compensation system out of millions and put thousands at risk. "Initially, we were looking at 500 to a thousand (surgeries)," said Reynolds. "But we have obtained records now that could (show) 10-15,000 surgeries nationally."
Drobot, who the suit alleges is a key player in the scheme, has entered a plea agreement in the sweeping corruption scandal involving state senator Ron Calderon. A statement sent to NBC4 by Drobot's lawyer team said he has agreed to assist the government in its "expanding operations." "We thought Drobot would be the last person to plead guilty," said Sersansie. "We thought he would go down with a fight because he had the financing and resources to do it, because he was the big bully. When we found out he pled guilty for reasons that he pled guilty. It was a bit of vindication."
Tri-City Medical Center is under new management. In a statement to NBC4, hospital officials stated the allegations are "without merit" and that they would "vigorously defend the false claims made in the lawsuit." NBC4 learned late Tuesday, the U.S. Attorney's office contacted Berger, inquiring about the lawsuit ...
Sersansie is one of two plaintiffs in a civil lawsuit, which was originally filed in Sacramento in May 2012, but was recently transferred to Los Angeles County. The suit alleges doctors were recruited to push workers comp patients to have spinal surgeries done at certain hospitals that overcharged for operations and medical devices, which in many cases were counterfeit, according to the suit. According to Sersansie, Drobot and his co-conspirators bullied their employees to keep quiet about their scheme. "These guys are absolute thugs," said Sersansie. "They tried different ways to intimidate me and my family. We had instances where they actually came to my home, three of them and threatened me."
According to the suit, the scheme involved an elaborate web of conspirators that included Pacific Hospital of Long Beach, which is now closed, Tri-City Medical Group, whose former CEO has since been investigated and removed and medical hardware distributors and doctor whom collected on illegal kick-backs. Justin Berger, Sersansie's attorney, showed NBC4 an invoice -- an exhibit in the suit -- which totals $24,000. "These are bribes to get these surgeons to do surgeries at this hospital with this particular hardware," said Berger. "Much of this hardware, if not all of it, we believe is counterfeit."
Bill Reynolds, an insurance fraud investigator and the other whistleblower named in the suit, said this scheme bilked the state's workers compensation system out of millions and put thousands at risk. "Initially, we were looking at 500 to a thousand (surgeries)," said Reynolds. "But we have obtained records now that could (show) 10-15,000 surgeries nationally."
Drobot, who the suit alleges is a key player in the scheme, has entered a plea agreement in the sweeping corruption scandal involving state senator Ron Calderon. A statement sent to NBC4 by Drobot's lawyer team said he has agreed to assist the government in its "expanding operations." "We thought Drobot would be the last person to plead guilty," said Sersansie. "We thought he would go down with a fight because he had the financing and resources to do it, because he was the big bully. When we found out he pled guilty for reasons that he pled guilty. It was a bit of vindication."
Tri-City Medical Center is under new management. In a statement to NBC4, hospital officials stated the allegations are "without merit" and that they would "vigorously defend the false claims made in the lawsuit." NBC4 learned late Tuesday, the U.S. Attorney's office contacted Berger, inquiring about the lawsuit ...
Ron Calderon, a Democrat and a member of a California political dynasty that goes back several decades, turned himself in to federal authorities to face two dozen counts of bribery, fraud, money laundering and conspiracy involving workers compensation legislation. He appeared in court Monday, handcuffed and shackled in his street clothes at a brief hearing at the US District Court in Los Angeles, where he was ordered freed on $50,000 bond after surrendering his passport and agreeing not to leave the United States. The 56-year-old lawmaker was also ordered to return to court in March.
The Los Angeles Times reports that a Calderon political dynasty has spanned three decades, based upon a family infused into the blue-collar neighborhoods east of Los Angeles where the Calderon surname has appeared on local ballots for two generations. The Calderons have flourished in the sometimes ruthless environs of the California Assembly and Senate, where four family members have served in the carpeted chambers: brothers Charles, Ronald and Tom, and Charles' son. They've cut reputations for raising campaign cash and reigning over the Legislature's powerful "juice committees," those overseeing banking, insurance and other industries that have the cash to bankroll political campaigns. They use their political muscle to help one another, squeezing political opponents, pushing legislation backed by supporters and even orchestrating a brazen leadership coup attempt.
Federal officials remain mum on the focus of the investigation, but the inquiry appears to be as far-reaching as the family's influence, and may involve more than the current indictment. FBI agents questioned officials from cities served by the Central Basin Municipal Water District, a regional water wholesaler in Los Angeles County that has paid Tom Calderon more than $750,000 in consulting fees since 2004. A Los Angeles County grand jury subpoenaed several lawmakers as part of the probe, including a former aide to Ronald Calderon. The federal investigation has done little to dampen the Calderons' political aspirations.
Ronald Calderon, who will be termed out of the Senate next year, has opened campaign accounts to raise money for possible runs for state controller and an Assembly seat in the future. Tom Calderon maintains a fund to run for his brother's Senate post. Ian Calderon is running for reelection in the Assembly; and his father, Charles, is collecting donations for a campaign for secretary of state. Until May, Tom Calderon controlled a political action committee whose biggest contributions came from large insurance companies. It paid for outings at golf resorts and for private plane travel, campaign finance reports show. Calderon family members have opened 54 political accounts since 1986 and have taken in at least $15 million in contributions since 2000. Slightly more than half a million dollars of the money in the family members' political accounts was passed from brother to brother, father to son, uncle to nephew. An additional $463,000 went to pay the Calderon brothers, wives and children as staff during that time; $110,000 went to Tom Calderon and his firm, Calderon Group.
A related story by the Los Angeles Times last December claims that the funds also paid more than $1 million to golf resorts in Las Vegas, Hawaii and other locations; $220,000 on steak dinners, $4,000 for cigars and $325 for false eyelashes. The last item was reported as an "appreciation" gift from Charles Calderon to his sister-in-law, serving as a campaign consultant. Ronald Calderon's political bounty has paid for high-priced stogies, VIP tickets to Las Vegas boxing matches and Lakers playoff games, his campaign filings show. It has also financed rounds of golf at Pebble Beach, skybox tickets to a Britney Spears concert and a $1,320 spa bill during his "Birthday Bash" fundraiser at the Grand Pacific Palisades Resort near San Diego.
Diversity PAC has raised $1.2 million from interests that lobby the Legislature. Donors included AT & T, cigarette maker Philip Morris USA, Sempra Energy, the Assn. of California Life and Health Insurance Companies, the Pharmaceutical Research and Manufacturers of America (PhRMA), Eli Lilly and Co., Walgreens, Blue Shield and the payday loan firm Check Into Cash. Tom Calderon was the group's founding principal officer, in 2005. He called it Latino PAC, and its mission was "to elect Latino candidates," according to filings with the secretary of state. The fund later became Diversity PAC, and its purpose evolved into support for moderate Democrats, those involved said.
As part of its fundraising, the PAC took big donors by private jet and limousine to top-rated golf courses, including Pebble Beach, the Bandon Dunes Golf Resort in Oregon and the American Club Resort in Wisconsin. Diversity PAC has paid more than $100,000 to Bandon Dunes over the years for fundraisers, not counting the cost of the flights. The PAC has spent $43,000 on fundraising events at the La Quinta Resort and Club near Palm Springs, which boasts on its website of having 41 pools, 23 tennis courts, seven restaurants and five golf courses ...
The Los Angeles Times reports that a Calderon political dynasty has spanned three decades, based upon a family infused into the blue-collar neighborhoods east of Los Angeles where the Calderon surname has appeared on local ballots for two generations. The Calderons have flourished in the sometimes ruthless environs of the California Assembly and Senate, where four family members have served in the carpeted chambers: brothers Charles, Ronald and Tom, and Charles' son. They've cut reputations for raising campaign cash and reigning over the Legislature's powerful "juice committees," those overseeing banking, insurance and other industries that have the cash to bankroll political campaigns. They use their political muscle to help one another, squeezing political opponents, pushing legislation backed by supporters and even orchestrating a brazen leadership coup attempt.
Federal officials remain mum on the focus of the investigation, but the inquiry appears to be as far-reaching as the family's influence, and may involve more than the current indictment. FBI agents questioned officials from cities served by the Central Basin Municipal Water District, a regional water wholesaler in Los Angeles County that has paid Tom Calderon more than $750,000 in consulting fees since 2004. A Los Angeles County grand jury subpoenaed several lawmakers as part of the probe, including a former aide to Ronald Calderon. The federal investigation has done little to dampen the Calderons' political aspirations.
Ronald Calderon, who will be termed out of the Senate next year, has opened campaign accounts to raise money for possible runs for state controller and an Assembly seat in the future. Tom Calderon maintains a fund to run for his brother's Senate post. Ian Calderon is running for reelection in the Assembly; and his father, Charles, is collecting donations for a campaign for secretary of state. Until May, Tom Calderon controlled a political action committee whose biggest contributions came from large insurance companies. It paid for outings at golf resorts and for private plane travel, campaign finance reports show. Calderon family members have opened 54 political accounts since 1986 and have taken in at least $15 million in contributions since 2000. Slightly more than half a million dollars of the money in the family members' political accounts was passed from brother to brother, father to son, uncle to nephew. An additional $463,000 went to pay the Calderon brothers, wives and children as staff during that time; $110,000 went to Tom Calderon and his firm, Calderon Group.
A related story by the Los Angeles Times last December claims that the funds also paid more than $1 million to golf resorts in Las Vegas, Hawaii and other locations; $220,000 on steak dinners, $4,000 for cigars and $325 for false eyelashes. The last item was reported as an "appreciation" gift from Charles Calderon to his sister-in-law, serving as a campaign consultant. Ronald Calderon's political bounty has paid for high-priced stogies, VIP tickets to Las Vegas boxing matches and Lakers playoff games, his campaign filings show. It has also financed rounds of golf at Pebble Beach, skybox tickets to a Britney Spears concert and a $1,320 spa bill during his "Birthday Bash" fundraiser at the Grand Pacific Palisades Resort near San Diego.
Diversity PAC has raised $1.2 million from interests that lobby the Legislature. Donors included AT & T, cigarette maker Philip Morris USA, Sempra Energy, the Assn. of California Life and Health Insurance Companies, the Pharmaceutical Research and Manufacturers of America (PhRMA), Eli Lilly and Co., Walgreens, Blue Shield and the payday loan firm Check Into Cash. Tom Calderon was the group's founding principal officer, in 2005. He called it Latino PAC, and its mission was "to elect Latino candidates," according to filings with the secretary of state. The fund later became Diversity PAC, and its purpose evolved into support for moderate Democrats, those involved said.
As part of its fundraising, the PAC took big donors by private jet and limousine to top-rated golf courses, including Pebble Beach, the Bandon Dunes Golf Resort in Oregon and the American Club Resort in Wisconsin. Diversity PAC has paid more than $100,000 to Bandon Dunes over the years for fundraisers, not counting the cost of the flights. The PAC has spent $43,000 on fundraising events at the La Quinta Resort and Club near Palm Springs, which boasts on its website of having 41 pools, 23 tennis courts, seven restaurants and five golf courses ...
