Workers' compensation premium fraud can range from misclassifying a few workers into safer jobs than what they actually perform, falsely reporting employees as independent contractors, or setting up dummy companies to "hide" employees to keep payroll, and in turn, workers' compensation premiums artificially low.
In yet another case of alleged premium fraud, Felipe Saurez Barocio, 63, of Atwater, owner of Agriculture Services, Inc., and his daughter, Angelita Barocio-Negrete, 33, of Merced, were arraigned on multiple felony counts of insurance fraud. Prosecutors say the company allegedly underreported employee payroll by $11 million in order to fraudulently reduce the business’s premium for workers’ compensation insurance by over $2.5 million.
The California Department of Insurance said that the alleged fraud potentially left employed farm workers without insurance coverage and at financial risk.
State Compensation Insurance Fund filed a suspected fraudulent claim with the California Department of Insurance alleging potential insurance fraud last October.
SCIF reported that Barocio, as owner of a farm labor contracting business, allegedly under reported employee payroll in order to reduce the proper rate of insurance premiums owed to SCIF.
An investigation by the California Department of Insurance revealed that between 2015 and 2019, Barocio and his daughter, who worked as the office manager, provided SCIF with fabricated quarterly employee payroll reports.
The Department discovered a missing $11 million in payroll when they compared the quarterly reports submitted to SCIF to the quarterly reports submitted to the Employment Development Department.
This underreporting of employee payroll resulted in a total loss of $2,582,142 in insurance premiums.
Barocio and his daughter, Barocio-Negrete, will return to court on October 27, 2020. The Merced County District Attorney’s Office is prosecuting this case.
"When businesses illegally underreport payroll and employees they create an unfair advantage that places legitimate businesses at a competitive disadvantage," said Insurance Commissioner Ricardo Lara.
"We all pay the price for insurance fraud through increased costs for services and higher premiums." ...
In yet another case of alleged premium fraud, Felipe Saurez Barocio, 63, of Atwater, owner of Agriculture Services, Inc., and his daughter, Angelita Barocio-Negrete, 33, of Merced, were arraigned on multiple felony counts of insurance fraud. Prosecutors say the company allegedly underreported employee payroll by $11 million in order to fraudulently reduce the business’s premium for workers’ compensation insurance by over $2.5 million.
The California Department of Insurance said that the alleged fraud potentially left employed farm workers without insurance coverage and at financial risk.
State Compensation Insurance Fund filed a suspected fraudulent claim with the California Department of Insurance alleging potential insurance fraud last October.
SCIF reported that Barocio, as owner of a farm labor contracting business, allegedly under reported employee payroll in order to reduce the proper rate of insurance premiums owed to SCIF.
An investigation by the California Department of Insurance revealed that between 2015 and 2019, Barocio and his daughter, who worked as the office manager, provided SCIF with fabricated quarterly employee payroll reports.
The Department discovered a missing $11 million in payroll when they compared the quarterly reports submitted to SCIF to the quarterly reports submitted to the Employment Development Department.
This underreporting of employee payroll resulted in a total loss of $2,582,142 in insurance premiums.
Barocio and his daughter, Barocio-Negrete, will return to court on October 27, 2020. The Merced County District Attorney’s Office is prosecuting this case.
"When businesses illegally underreport payroll and employees they create an unfair advantage that places legitimate businesses at a competitive disadvantage," said Insurance Commissioner Ricardo Lara.
"We all pay the price for insurance fraud through increased costs for services and higher premiums." ...
The Los Angeles County District Attorney’s Office announced that a Los Angeles County sheriff’s deputy has been arrested and charged with workers’ compensation fraud.
47 year old Kevin Adams, who lives in Covina, faces one count of workers’ compensation insurance fraud in Superior Court case BA489895.
His arraignment is scheduled for January 11, 2021 at the Foltz Criminal Justice Center, in department 30.
Adams was assigned to the Twin Towers Correctional Facility, Custody Services Division.
The terse announcement by the district attorney's office simply says that he is accused of filing a false workplace injury claim for which he was receiving disability benefits. The alleged fraud began in 2015.
Inmate records show he was arrested around 9 a.m. Monday and released a short time later after being cited.
Adams faces a possible maximum sentence of five years in county jail if convicted as charged.
The case remains under investigation by the Los Angeles County Sheriff’s Department, Internal Criminal Investigations Bureau ...
47 year old Kevin Adams, who lives in Covina, faces one count of workers’ compensation insurance fraud in Superior Court case BA489895.
His arraignment is scheduled for January 11, 2021 at the Foltz Criminal Justice Center, in department 30.
Adams was assigned to the Twin Towers Correctional Facility, Custody Services Division.
The terse announcement by the district attorney's office simply says that he is accused of filing a false workplace injury claim for which he was receiving disability benefits. The alleged fraud began in 2015.
Inmate records show he was arrested around 9 a.m. Monday and released a short time later after being cited.
Adams faces a possible maximum sentence of five years in county jail if convicted as charged.
The case remains under investigation by the Los Angeles County Sheriff’s Department, Internal Criminal Investigations Bureau ...
Cal/OSHA has issued citations to frozen food manufacturer Overhill Farms Inc. and its temporary employment agency Jobsource North America Inc. with over $200,000 in proposed penalties to each employer for failing to protect hundreds of employees from COVID-19 at two plants in Vernon.
The employers did not take any steps to install barriers or implement procedures to have employees work at least six feet away from each other and they did not investigate any of their employees’ COVID-19 infections, including more than 20 illnesses and, in the case of Overhill Farms, one death.
According to a report in the Los Angeles times, the move followed the first fines announced for coronavirus safety violations last week. Cal/OSHA cited 11 employers in industries that included food processing, retail, agriculture, meatpacking and healthcare, and proposed penalties ranging from $2,025 to $51,190.
On April 28, Cal/OSHA opened inspections with Overhill Farms and Jobsource after receiving complaints of hazards related to COVID-19. The inspections included visits to two facilities in Vernon where Overhill Farms employees and workers from Jobsource manufacture a variety of frozen foods.
Cal/OSHA said it found hundreds of employees were exposed to serious illness from COVID-19 due to the lack of physical distancing procedures among workers including where they clock in and out of their shift, at the cart where they put on gloves and coats, in the break room, on the conveyor line and during packing operations.
At the larger of the two facilities Cal/OSHA said it identified 330 employees of Overhill Farms and 60 employees of Jobsource were exposed to the virus from the lack of physical distancing. At the smaller facility, Cal/OSHA found 80 Overhill Farms workers and 40 employees of Jobsource did packing operations, worked in the marinating area and processed raw poultry without any distancing procedures or protective barriers in place.
Other violations that put workers at risk of exposure to COVID-19 include the failure by both employers to train employees on the hazards presented by the virus and failure to investigate any of the more than 20 COVID-19 illnesses and one death Cal/OSHA uncovered amongst their employees.
The employers did not adequately communicate the COVID-19 hazards to their workforce, and Overhill did not report a COVID-19 fatality to Cal/OSHA.
The COVID-19 related violations cited at both plants include $222,075 in proposed penalties to Overhill Farms and $214,080 in proposed penalties to Jobsource, with an additional $14,450 in proposed penalties for Overhill Farms for non-COVID related violations.
Cal/OSHA also issued citations to both employers from inspections of two accidents in February, after one worker at each of the two facilities was injured when their hands got caught in unguarded conveyor parts. These accident inspections resulted in citations with $103,780 in proposed penalties to Overhill Farms, including for repeat violations due to a similar accident in 2016, and $29,700 in proposed penalties to Jobsource.
Overhill Farms said that it would contest the agency’s "erroneous" allegations, adding that Cal/OSHA has falsely claimed that the company failed to install Plexiglas dividers.
"The health and safety of our employees is our first priority,” the company said in a statement. “Overhill Farms has not only taken steps in line with the constantly evolving federal, state and local guidance, we have gone above and beyond those recommendations as we developed our employee safety procedures."
Officials with Jobsource said they also planned to dispute the citations.
"We take the health and safety of all of our team members very seriously and we believe that we have not done anything that would endanger anyone in our community," the company said in a statement ...
The employers did not take any steps to install barriers or implement procedures to have employees work at least six feet away from each other and they did not investigate any of their employees’ COVID-19 infections, including more than 20 illnesses and, in the case of Overhill Farms, one death.
According to a report in the Los Angeles times, the move followed the first fines announced for coronavirus safety violations last week. Cal/OSHA cited 11 employers in industries that included food processing, retail, agriculture, meatpacking and healthcare, and proposed penalties ranging from $2,025 to $51,190.
On April 28, Cal/OSHA opened inspections with Overhill Farms and Jobsource after receiving complaints of hazards related to COVID-19. The inspections included visits to two facilities in Vernon where Overhill Farms employees and workers from Jobsource manufacture a variety of frozen foods.
Cal/OSHA said it found hundreds of employees were exposed to serious illness from COVID-19 due to the lack of physical distancing procedures among workers including where they clock in and out of their shift, at the cart where they put on gloves and coats, in the break room, on the conveyor line and during packing operations.
At the larger of the two facilities Cal/OSHA said it identified 330 employees of Overhill Farms and 60 employees of Jobsource were exposed to the virus from the lack of physical distancing. At the smaller facility, Cal/OSHA found 80 Overhill Farms workers and 40 employees of Jobsource did packing operations, worked in the marinating area and processed raw poultry without any distancing procedures or protective barriers in place.
Other violations that put workers at risk of exposure to COVID-19 include the failure by both employers to train employees on the hazards presented by the virus and failure to investigate any of the more than 20 COVID-19 illnesses and one death Cal/OSHA uncovered amongst their employees.
The employers did not adequately communicate the COVID-19 hazards to their workforce, and Overhill did not report a COVID-19 fatality to Cal/OSHA.
The COVID-19 related violations cited at both plants include $222,075 in proposed penalties to Overhill Farms and $214,080 in proposed penalties to Jobsource, with an additional $14,450 in proposed penalties for Overhill Farms for non-COVID related violations.
Cal/OSHA also issued citations to both employers from inspections of two accidents in February, after one worker at each of the two facilities was injured when their hands got caught in unguarded conveyor parts. These accident inspections resulted in citations with $103,780 in proposed penalties to Overhill Farms, including for repeat violations due to a similar accident in 2016, and $29,700 in proposed penalties to Jobsource.
Overhill Farms said that it would contest the agency’s "erroneous" allegations, adding that Cal/OSHA has falsely claimed that the company failed to install Plexiglas dividers.
"The health and safety of our employees is our first priority,” the company said in a statement. “Overhill Farms has not only taken steps in line with the constantly evolving federal, state and local guidance, we have gone above and beyond those recommendations as we developed our employee safety procedures."
Officials with Jobsource said they also planned to dispute the citations.
"We take the health and safety of all of our team members very seriously and we believe that we have not done anything that would endanger anyone in our community," the company said in a statement ...
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released the 2019 California Workers’ Compensation Aggregate Medical Payment Trends report comparing medical payment information from 2017 to 2019.
The report is available in the Research section of the WCIRB website.
This report analyzes medical payment and utilization trends by provider type, service locations and service types. The report also includes an analysis on utilization and cost of opioid prescriptions and physical medicine services over time and by region.
Key findings from the report include:
-- Overall medical payments and payments per claim continued to decline in 2019, with pharmaceuticals experiencing continuous sharp declines in medical payments.
-- Physical therapy services experienced the largest increase in the share of medical payments, largely driven by increases in the paid per service.
-- Physical Medicine and Rehabilitation procedures are the fastest growing within all physician services, and use of hematological agents increased more significantly than other therapeutic groups from 2018 to 2019.
-- Urban areas had a higher share of claims involving physical medicine services, while more suburban and rural areas had lower shares.
-- Physician Office remained as the leading Place of Service, accounting for the highest share (55%) of medical payments in 2019. This was mostly driven by its highest share of medical transactions in 2019.
-- Urgent Care Center experienced the largest percentage increase in the share of the medical paid.
-- Paid per transaction increased significantly for Emergency Rooms and Outpatient Hospitals in 2019, yet their transaction shares remained similar to the 2018 level.
-- The share of medical payments for Pharmaceuticals decreased significantly by about 43%, from 6% in 2017 to 3% in 2019.
-- Key drivers of the decrease include legislation and policies intended to restrict inappropriate prescribing, use of CURES database to monitor prescriptions of controlled substances, anti-fraud efforts, and the Drug Formulary.
-- The number of claims involving opioid prescriptions continued to decline significantly.
-- Tulare/Inyo and Bakersfield had the highest share of claims involving opioid prescriptions, while the Silicon Valley area and Los Angeles Basin had the lowest share.
-- The share of total medical transactions for ML104 (the most complex and expensive Medical-Legal evaluation) decreased by 11% in 2019 compared to 2017, while that for -- ML105-106 (testimonies and supplementary evaluations) increased by 4%.
-- The paid per transaction for ML104, ML105-106 and ML100 (missed appointment) continued to increase modestly.
The report was based on WCIRB medical transaction data with transaction dates from January 1, 2017 through December 31, 2019. The medical transaction data does not include: (a) medical payments made directly to injured workers or (b) payments made to any known third-party who may be assigned medical management ...
The report is available in the Research section of the WCIRB website.
This report analyzes medical payment and utilization trends by provider type, service locations and service types. The report also includes an analysis on utilization and cost of opioid prescriptions and physical medicine services over time and by region.
Key findings from the report include:
-- Overall medical payments and payments per claim continued to decline in 2019, with pharmaceuticals experiencing continuous sharp declines in medical payments.
-- Physical therapy services experienced the largest increase in the share of medical payments, largely driven by increases in the paid per service.
-- Physical Medicine and Rehabilitation procedures are the fastest growing within all physician services, and use of hematological agents increased more significantly than other therapeutic groups from 2018 to 2019.
-- Urban areas had a higher share of claims involving physical medicine services, while more suburban and rural areas had lower shares.
-- Physician Office remained as the leading Place of Service, accounting for the highest share (55%) of medical payments in 2019. This was mostly driven by its highest share of medical transactions in 2019.
-- Urgent Care Center experienced the largest percentage increase in the share of the medical paid.
-- Paid per transaction increased significantly for Emergency Rooms and Outpatient Hospitals in 2019, yet their transaction shares remained similar to the 2018 level.
-- The share of medical payments for Pharmaceuticals decreased significantly by about 43%, from 6% in 2017 to 3% in 2019.
-- Key drivers of the decrease include legislation and policies intended to restrict inappropriate prescribing, use of CURES database to monitor prescriptions of controlled substances, anti-fraud efforts, and the Drug Formulary.
-- The number of claims involving opioid prescriptions continued to decline significantly.
-- Tulare/Inyo and Bakersfield had the highest share of claims involving opioid prescriptions, while the Silicon Valley area and Los Angeles Basin had the lowest share.
-- The share of total medical transactions for ML104 (the most complex and expensive Medical-Legal evaluation) decreased by 11% in 2019 compared to 2017, while that for -- ML105-106 (testimonies and supplementary evaluations) increased by 4%.
-- The paid per transaction for ML104, ML105-106 and ML100 (missed appointment) continued to increase modestly.
The report was based on WCIRB medical transaction data with transaction dates from January 1, 2017 through December 31, 2019. The medical transaction data does not include: (a) medical payments made directly to injured workers or (b) payments made to any known third-party who may be assigned medical management ...
According to a story in the Hollywood Reporter, pandemic-related delays on Ben Affleck's latest film Hypnotic have sparked a lawsuit against an insurance company that's refusing to extend the term of coverage without a COVID-19 exception even though the original policy didn't have one.
Hoosegow Productions is suing Chubb National Insurance Company for breach of contract and fraud, among other claims, and is asking a California federal judge for a declaration that Hoosegow is entitled to have the policy’s expiration date extended "in accord with Chubb National’s custom and practice and Chubb National’s express and implied representations" and that the insurer's assertion it has no obligation to extend the coverage and can instead offer a renewal policy containing a COVID-19 exclusion is incorrect.
The film was set to begin principal photography in April, but like countless other Hollywood productions, it was postponed because of the pandemic. Hoosegow reached out to Chubb about an extension and claims it was ignored for two months before the company said the "global Chubb position" was to deny the extension request.
The production company purchased a Film Producers Risk policy for Hypnotic and argues the insurer's long-established policy is that if a production is delayed or disrupted the policy period is extended until the production is completed. But, when Hypnotic was delayed because of the pandemic Hoosegow says Chubb refused to extend the policy and instead offered to "renew" it with more limited coverage.
"Specifically, Chubb National said that the policy would be 'renewed' only with the addition of an exclusion applicable to losses relating to COVID-19, thereby depriving Hoosegow of coverage that it had purchased and that was promised under the existing policy," states the complaint, which is posted in full below.
The policy includes $58 million of production media coverage per occurrence, $58 million of media perils coverage per occurrence and $58 million of declared person coverage per occurrence, according to the complaint. It also provides that Chubb will pay for actual production losses incurred because of the "inability of an essential element or other declared person" to complete their duties, in this case, Affleck and director Robert Rodriguez. According to Hoosegow, the policy term is Oct. 28, 2019, through Oct. 28, 2020, but the end date is merely a formality and the parties understood that coverage would be extended if filming went beyond that date.
"The Policy does not include a virus exclusion, pandemic exclusion, COVID-19 exclusion, or any other similar exclusion," states the complaint. Hoosegow argues that it's custom and practice to extend the expiration date "without any material change or reduction in coverage" and that it was explicitly assured of such in writing by the company's underwriter.
Hoosegow alleges that Chubb is engaging in a "coordinated scheme to wrongfully withhold policy benefits" from its customers across the entertainment industry in an effort to save itself millions of dollars.
A Chubb spokesperson on Thursday sent The Hollywood Reporter this statement: "As a matter of policy Chubb does not comment on pending legal matters." ...
Hoosegow Productions is suing Chubb National Insurance Company for breach of contract and fraud, among other claims, and is asking a California federal judge for a declaration that Hoosegow is entitled to have the policy’s expiration date extended "in accord with Chubb National’s custom and practice and Chubb National’s express and implied representations" and that the insurer's assertion it has no obligation to extend the coverage and can instead offer a renewal policy containing a COVID-19 exclusion is incorrect.
The film was set to begin principal photography in April, but like countless other Hollywood productions, it was postponed because of the pandemic. Hoosegow reached out to Chubb about an extension and claims it was ignored for two months before the company said the "global Chubb position" was to deny the extension request.
The production company purchased a Film Producers Risk policy for Hypnotic and argues the insurer's long-established policy is that if a production is delayed or disrupted the policy period is extended until the production is completed. But, when Hypnotic was delayed because of the pandemic Hoosegow says Chubb refused to extend the policy and instead offered to "renew" it with more limited coverage.
"Specifically, Chubb National said that the policy would be 'renewed' only with the addition of an exclusion applicable to losses relating to COVID-19, thereby depriving Hoosegow of coverage that it had purchased and that was promised under the existing policy," states the complaint, which is posted in full below.
The policy includes $58 million of production media coverage per occurrence, $58 million of media perils coverage per occurrence and $58 million of declared person coverage per occurrence, according to the complaint. It also provides that Chubb will pay for actual production losses incurred because of the "inability of an essential element or other declared person" to complete their duties, in this case, Affleck and director Robert Rodriguez. According to Hoosegow, the policy term is Oct. 28, 2019, through Oct. 28, 2020, but the end date is merely a formality and the parties understood that coverage would be extended if filming went beyond that date.
"The Policy does not include a virus exclusion, pandemic exclusion, COVID-19 exclusion, or any other similar exclusion," states the complaint. Hoosegow argues that it's custom and practice to extend the expiration date "without any material change or reduction in coverage" and that it was explicitly assured of such in writing by the company's underwriter.
Hoosegow alleges that Chubb is engaging in a "coordinated scheme to wrongfully withhold policy benefits" from its customers across the entertainment industry in an effort to save itself millions of dollars.
A Chubb spokesperson on Thursday sent The Hollywood Reporter this statement: "As a matter of policy Chubb does not comment on pending legal matters." ...
Anita Vijay, 50, of Sacramento, pleaded guilty to conspiring to pay and receive illegal kickbacks in exchange for Medicare beneficiary referrals and to soliciting kickbacks in exchange for Medicare beneficiary referrals, United States Attorney McGregor W. Scott announced.
According to court documents, Anita Vijay worked as the Social Services Director at a skilled nursing and assisted living facility in Sacramento. In her role, Vijay assisted Medicare beneficiaries in selecting home health care and hospice agencies following their discharge from the facility.
Vijay used her position to steer Medicare beneficiaries to home health agencies in Folsom and El Dorado Hills and a hospice agency in Folsom. In exchange for the referrals, the agencies’ owners paid her and her husband, Jai Vijay, illegal cash kickbacks.
In her plea agreement, Vijay admitted that the agencies’ owners paid her and her husband kickbacks in exchange for the referral of approximately 60 beneficiaries. Medicare paid the agencies approximately $400,000 for services they purportedly provided to the beneficiaries. Because the agencies obtained the referrals by paying kickbacks, they should not have received any reimbursement from Medicare.
This case is a product of an investigation by the Federal Bureau of Investigation and the Department of Health and Human Services’ Office of Inspector General. Assistant United States Attorney Matthew Thuesen is prosecuting the case.
U.S. District Judge Troy L. Nunley is scheduled to sentence Anita Vijay on December 3, 2020.
She faces maximum statutory penalties of five years in prison for the conspiracy charge and ten years in prison for the kickback charge. Anita Vijay also faces a maximum fine of $250,000 or twice the gross loss or gain.
On February 6, 2020, Jai Vijay pled guilty to conspiracy to pay and receive kickbacks in exchange for Medicare beneficiary referrals ...
According to court documents, Anita Vijay worked as the Social Services Director at a skilled nursing and assisted living facility in Sacramento. In her role, Vijay assisted Medicare beneficiaries in selecting home health care and hospice agencies following their discharge from the facility.
Vijay used her position to steer Medicare beneficiaries to home health agencies in Folsom and El Dorado Hills and a hospice agency in Folsom. In exchange for the referrals, the agencies’ owners paid her and her husband, Jai Vijay, illegal cash kickbacks.
In her plea agreement, Vijay admitted that the agencies’ owners paid her and her husband kickbacks in exchange for the referral of approximately 60 beneficiaries. Medicare paid the agencies approximately $400,000 for services they purportedly provided to the beneficiaries. Because the agencies obtained the referrals by paying kickbacks, they should not have received any reimbursement from Medicare.
This case is a product of an investigation by the Federal Bureau of Investigation and the Department of Health and Human Services’ Office of Inspector General. Assistant United States Attorney Matthew Thuesen is prosecuting the case.
U.S. District Judge Troy L. Nunley is scheduled to sentence Anita Vijay on December 3, 2020.
She faces maximum statutory penalties of five years in prison for the conspiracy charge and ten years in prison for the kickback charge. Anita Vijay also faces a maximum fine of $250,000 or twice the gross loss or gain.
On February 6, 2020, Jai Vijay pled guilty to conspiracy to pay and receive kickbacks in exchange for Medicare beneficiary referrals ...
Citing "a strong suspicion of recent fraud," the state’s Employment Development Department is actively investigating reports of suspicious mailings regarding unemployment benefits that people all over the state have received.
The agency noted that between January and June, 60% of notices requiring additional documents were responded to by legitimate claimants.
But in July, the response rate plunged to 15% and in August, 9%. That indicated "a strong suspicion of recent fraud that will go unpaid since the EDD will not receive the necessary documents on these claims to prove identity," the agency said in a news release.
According to the EDD "Fraud attempts have increased during the pandemic, and individuals are exploiting the very efforts of California to issue unemployment benefit payments as quickly as possible to workers impacted by COVID-19. The EDD’s investigation team is working closely with local, state, and federal partners to expose, stop, and hold offenders accountable. While specific details cannot be shared at this time at the risk of jeopardizing investigations, recent schemes have triggered multiple mail items with different names sent to addresses throughout the state."
One of the scams pointed out by the EDD involve debit cards. "Non-claimants may receive debit cards that have to be activated by the individual named on the card with personal identifying information before benefits can be accessed. The card items can be returned to EDD or Bank of America and will be destroyed."
A large number of the mail items are notices requiring additional identifying documents be provided to the EDD before the claim can be paid. Such notices are part of EDD’s preventative Identity Verification process.
However, "While 60% of such notices requiring additional documents were responded to by legitimate claimants in January through June of this year, the response rate dropped significantly to 15% in July and 9% in August - indicating a strong suspicion of recent fraud that will go unpaid since the EDD will not receive the necessary documents on these claims to prove identity."
It also issued this warning: "Californians should be aware to not provide the multiple mail items they may have received to people who may show up at their door claiming to be collecting materials for EDD. EDD representatives will not come to your home."
The EDD has information posted on its website encouraging people who do receive such mail or see other suspicious activity to report it to EDD right away. It also has information about how to return the multiple mail items to the EDD.
The problems California residents have found with possible fraud are not unique to the state. The FBI in July reported a "spike in fraudulent unemployment insurance claims complaints related to the ongoing COVID-19 pandemic involving the use of stolen personally identifiable information."
It said people from "several states have been victimized by criminal actors impersonating the victims and using the victims’ stolen identities to submit fraudulent unemployment insurance claims online." ...
The agency noted that between January and June, 60% of notices requiring additional documents were responded to by legitimate claimants.
But in July, the response rate plunged to 15% and in August, 9%. That indicated "a strong suspicion of recent fraud that will go unpaid since the EDD will not receive the necessary documents on these claims to prove identity," the agency said in a news release.
According to the EDD "Fraud attempts have increased during the pandemic, and individuals are exploiting the very efforts of California to issue unemployment benefit payments as quickly as possible to workers impacted by COVID-19. The EDD’s investigation team is working closely with local, state, and federal partners to expose, stop, and hold offenders accountable. While specific details cannot be shared at this time at the risk of jeopardizing investigations, recent schemes have triggered multiple mail items with different names sent to addresses throughout the state."
One of the scams pointed out by the EDD involve debit cards. "Non-claimants may receive debit cards that have to be activated by the individual named on the card with personal identifying information before benefits can be accessed. The card items can be returned to EDD or Bank of America and will be destroyed."
A large number of the mail items are notices requiring additional identifying documents be provided to the EDD before the claim can be paid. Such notices are part of EDD’s preventative Identity Verification process.
However, "While 60% of such notices requiring additional documents were responded to by legitimate claimants in January through June of this year, the response rate dropped significantly to 15% in July and 9% in August - indicating a strong suspicion of recent fraud that will go unpaid since the EDD will not receive the necessary documents on these claims to prove identity."
It also issued this warning: "Californians should be aware to not provide the multiple mail items they may have received to people who may show up at their door claiming to be collecting materials for EDD. EDD representatives will not come to your home."
The EDD has information posted on its website encouraging people who do receive such mail or see other suspicious activity to report it to EDD right away. It also has information about how to return the multiple mail items to the EDD.
The problems California residents have found with possible fraud are not unique to the state. The FBI in July reported a "spike in fraudulent unemployment insurance claims complaints related to the ongoing COVID-19 pandemic involving the use of stolen personally identifiable information."
It said people from "several states have been victimized by criminal actors impersonating the victims and using the victims’ stolen identities to submit fraudulent unemployment insurance claims online." ...
The Division of Workers’ Compensation and Workers’ Compensation Appeals Board continue to improve their ability to hold hearings during the COVID-19 pandemic.
The following changes are effective September 14.
DWC will continue to hear all mandatory settlement conferences, priority conferences, status conferences, case-in-chief trials, lien conferences, Special Adjudication Unit (SAU) trials and expedited hearings telephonically via the individually assigned judges’ conference lines as announced in newslines issued on April 3, April 28, May 28 and August 12.
Beginning September 14, DWC will resume holding lien trials. Lien trials will be limited to one per judge per day to start.
Parties will continue to use individually assigned judges’ conference lines on the day of trial. However, judges will have the option of conducting any trial or expedited hearing through the judge’s LifeSize virtual courtroom if needed. If that is required, the judge will provide a link to the parties allowing them to log into the video platform.
Stakeholders should download the software prior to a hearing where a video option may become necessary. Neither DWC nor LifeSize will charge for participants to use the platform.
However, parties will need to have certain system requirements to fully participate in the video option. Parties will also need to have a web camera. Participants without access to a web camera may use a smart phone with the program, although it is not recommended. Additional information on LifeSize and how to use the program may be found on the DWC website.
All parties scheduled for a hearing should continue to call the conference line for the judge in front of whom the case is set, at the designated time listed on the hearing notice. When prompted, the parties should enter the access code assigned to that line. DWC staff will instruct participants as to the procedure to follow during the call.
District offices will not hold in-person hearings.
DWC will not accept walk-in filings, walk-through documents or in-person requests at this time. DWC will only accept electronic filing via EAMS and JET File, and paper filing by U.S. mail.
DWC will accept limited email filings pursuant to WCAB’s en banc decision dated April 6 and its newsline issued on April 23. Email filings are limited to documents that are subject to a statute of limitations that cannot otherwise be efiled, JET filed or filed by U.S. mail.
DWC will continue to accept an electronic signature on any settlement documents, applications, pleadings, petitions or motions that are sent to the district offices or filed in EAMS. For all e-forms, parties should utilize “S signature” as shown in the E-forms Filing Reference Guide and the JET File Business Rules.
Injured workers who are unable to file utilizing the available options or need assistance may contact DWC’s call center at 909-383-4522.
The WCAB office in San Francisco is operating with limited in-office staff. The WCAB commissioners and staff continue to work remotely. All practitioners are encouraged to regularly check the WCAB and DWC websites for updates about the district offices’ and the WCAB’s operations during this period ...
The following changes are effective September 14.
DWC will continue to hear all mandatory settlement conferences, priority conferences, status conferences, case-in-chief trials, lien conferences, Special Adjudication Unit (SAU) trials and expedited hearings telephonically via the individually assigned judges’ conference lines as announced in newslines issued on April 3, April 28, May 28 and August 12.
Beginning September 14, DWC will resume holding lien trials. Lien trials will be limited to one per judge per day to start.
Parties will continue to use individually assigned judges’ conference lines on the day of trial. However, judges will have the option of conducting any trial or expedited hearing through the judge’s LifeSize virtual courtroom if needed. If that is required, the judge will provide a link to the parties allowing them to log into the video platform.
Stakeholders should download the software prior to a hearing where a video option may become necessary. Neither DWC nor LifeSize will charge for participants to use the platform.
However, parties will need to have certain system requirements to fully participate in the video option. Parties will also need to have a web camera. Participants without access to a web camera may use a smart phone with the program, although it is not recommended. Additional information on LifeSize and how to use the program may be found on the DWC website.
All parties scheduled for a hearing should continue to call the conference line for the judge in front of whom the case is set, at the designated time listed on the hearing notice. When prompted, the parties should enter the access code assigned to that line. DWC staff will instruct participants as to the procedure to follow during the call.
District offices will not hold in-person hearings.
DWC will not accept walk-in filings, walk-through documents or in-person requests at this time. DWC will only accept electronic filing via EAMS and JET File, and paper filing by U.S. mail.
DWC will accept limited email filings pursuant to WCAB’s en banc decision dated April 6 and its newsline issued on April 23. Email filings are limited to documents that are subject to a statute of limitations that cannot otherwise be efiled, JET filed or filed by U.S. mail.
DWC will continue to accept an electronic signature on any settlement documents, applications, pleadings, petitions or motions that are sent to the district offices or filed in EAMS. For all e-forms, parties should utilize “S signature” as shown in the E-forms Filing Reference Guide and the JET File Business Rules.
Injured workers who are unable to file utilizing the available options or need assistance may contact DWC’s call center at 909-383-4522.
The WCAB office in San Francisco is operating with limited in-office staff. The WCAB commissioners and staff continue to work remotely. All practitioners are encouraged to regularly check the WCAB and DWC websites for updates about the district offices’ and the WCAB’s operations during this period ...
As an increasing number of workers with injuries are receiving physical therapy, a new study from the Workers Compensation Research Institute finds that for workers with low back pain only injuries, early initiation of PT is associated with lower utilization and costs of medical services and shorter duration of temporary disability.
"This is a comprehensive study that shows a strong association between PT timing and outcomes for workers with low back pain," said WCRI President and CEO John Ruser. "While the study cannot conclude that early PT causes better outcomes, it does suggest that the potential benefits of early PT should be considered when planning care for these injuries."
The study ─The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation? ─ focuses on claims with LBP-only injuries, recognizing that PT is often used as first-line treatment for LBP and other musculoskeletal injuries before considering opioid prescriptions and invasive procedures. Controlling for a rich set of factors that might influence both PT timing and outcomes, the study finds the following:
-- Later timing of PT initiation is associated with longer TD duration. On average, the number of TD weeks per claim was 58 percent longer for those with PT initiated more than 30 days post injury and 24 percent longer for those with PT starting 15 to 30 days post injury, compared with claims with PT within 3 days post injury.
-- Workers whose PT treatment started more than 30 days post injury were 46 and 47 percent more likely to receive opioid prescriptions and MRI, respectively, compared with those who had PT treatment initiated within 3 days of injury. The differences between PT after 30 days post injury and PT within 3 days post injury were 29 percent for pain management injections and 89 percent for low back surgeries.
-- The average payment for all medical services received during the first year of treatment was lower for workers with early PT compared with those with late PT. For example, the average medical cost per claim for workers who had PT more than 30 days post injury was 24 percent higher than for those who had PT within 3 days post injury.
-- Among claims with PT treatment starting more than 30 days post injury, the percentage with attorney involvement was considerably higher (27 percent compared with 13 - 15 percent among those in the early PT groups) and workers received initial medical care much later (on average 18 days compared with 2 - 3 days in the early PT groups).
This study is based on nearly 26,000 LBP-only claims with more than seven days of lost time from 27 states, with injuries from October 1, 2015, through March 31, 2017, and detailed medical transactions up through March 31, 2018. The 27 states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.
The study was authored by Dongchun Wang, Kathryn Mueller, and Randy Lea ...
"This is a comprehensive study that shows a strong association between PT timing and outcomes for workers with low back pain," said WCRI President and CEO John Ruser. "While the study cannot conclude that early PT causes better outcomes, it does suggest that the potential benefits of early PT should be considered when planning care for these injuries."
The study ─The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation? ─ focuses on claims with LBP-only injuries, recognizing that PT is often used as first-line treatment for LBP and other musculoskeletal injuries before considering opioid prescriptions and invasive procedures. Controlling for a rich set of factors that might influence both PT timing and outcomes, the study finds the following:
-- Later timing of PT initiation is associated with longer TD duration. On average, the number of TD weeks per claim was 58 percent longer for those with PT initiated more than 30 days post injury and 24 percent longer for those with PT starting 15 to 30 days post injury, compared with claims with PT within 3 days post injury.
-- Workers whose PT treatment started more than 30 days post injury were 46 and 47 percent more likely to receive opioid prescriptions and MRI, respectively, compared with those who had PT treatment initiated within 3 days of injury. The differences between PT after 30 days post injury and PT within 3 days post injury were 29 percent for pain management injections and 89 percent for low back surgeries.
-- The average payment for all medical services received during the first year of treatment was lower for workers with early PT compared with those with late PT. For example, the average medical cost per claim for workers who had PT more than 30 days post injury was 24 percent higher than for those who had PT within 3 days post injury.
-- Among claims with PT treatment starting more than 30 days post injury, the percentage with attorney involvement was considerably higher (27 percent compared with 13 - 15 percent among those in the early PT groups) and workers received initial medical care much later (on average 18 days compared with 2 - 3 days in the early PT groups).
This study is based on nearly 26,000 LBP-only claims with more than seven days of lost time from 27 states, with injuries from October 1, 2015, through March 31, 2017, and detailed medical transactions up through March 31, 2018. The 27 states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.
The study was authored by Dongchun Wang, Kathryn Mueller, and Randy Lea ...
According to a new public policy report, .AARP finances its operations by overcharging members for health care policies and through its billion-dollar relationship with UnitedHealth Group.
Despite its "non-profit" status, AARP’s profits have been increasing for years largely due to the organization’s practices of marketing of products and services. The report, published by public policy think tank American Commitment, mainly examined AARP’s source of revenue since the passage of The Affordable Care Act in 2010.
AARP reported $1.6 billion of revenue and $246.4 million of profit in 2018, the most recent year in which data was available. In total, AARP received more than $5.3 billion tax free from UnitedHealthGroup from 2007 through 2017.21 Between the year of Obamacare’s passage and 2017, the organization made nearly $4.2 billion in those eight short years.
AARP not only makes money from UnitedHealth- Group - and its members - directly, it does so indirectly as well. The Report claims the organization has established a grantor trust, through which it funnels payments for insurance policies issued by UnitedHealth and other insurers, including MetLife, Genworth, and Aetna.
In the past four years, AARP has been sued three times by its own members over its royalty fee policy, which they argued was deceptive, according to court filings. However, AARP ultimately won each of the cases.
U.S. District Court of Washington D.C. Judge Beryl Howell ruled in favor of AARP in May dismissing the plaintiffs’ class action lawsuit. The plaintiffs, led by AARP member Helen Krukas, argued that the organization misrepresented its Medigap royalty fee structure, according to Forbes.
The plaintiffs specifically argued that AARP was "micromanaging the sale of Medigap and therefore [the 4.95% fee] is not really a royalty fee for its intellectual property. They are a salesman. This is a commission and it’s taxable," Jacobs said.
Howell originally rejected AARP’s motion to dismiss the case in March 2019 giving credence to Krukas’ argument. Krukas "sufficiently and plausibly alleged that the defendants engaged in unfair trade practices - by materially misrepresenting information about the 4.95% charge," Howell wrote.
But, in May Howell ruled that Krukas’ argument misses the mark. She said Krukas failed to prove that AARP has a fiduciary relationship with its members.
Similarly, U.S. District Judge Dean D. Pregerson of Los Angeles dismissed two separate AARP class action lawsuits, Forbes reported. Pregerson ruled against plaintiff Simon Levay in November 2018 and against Jerald Friedman in November 2019.
The second dismissal came after the three-judge panel Ninth Circuit Court of Appeals ruled in favor of the plaintiffs. The panel ruled that AARP "transacts" and "solicits" insurance without a license and engaged in fraud by calling the 4.95% commission a "royalty," according to Forbes.
Pregerson didn’t agree, however, saying the plaintiffs failed to prove they suffered economic harm, Forbes reported
The House Ways and Means Committee investigated AARP in 2011. The investigation pointed out several potential issues with AARP’s structure including its royalty fee practices and concluded with a series of suggestions for the Internal Revenue Service to consider ...
Despite its "non-profit" status, AARP’s profits have been increasing for years largely due to the organization’s practices of marketing of products and services. The report, published by public policy think tank American Commitment, mainly examined AARP’s source of revenue since the passage of The Affordable Care Act in 2010.
AARP reported $1.6 billion of revenue and $246.4 million of profit in 2018, the most recent year in which data was available. In total, AARP received more than $5.3 billion tax free from UnitedHealthGroup from 2007 through 2017.21 Between the year of Obamacare’s passage and 2017, the organization made nearly $4.2 billion in those eight short years.
AARP not only makes money from UnitedHealth- Group - and its members - directly, it does so indirectly as well. The Report claims the organization has established a grantor trust, through which it funnels payments for insurance policies issued by UnitedHealth and other insurers, including MetLife, Genworth, and Aetna.
In the past four years, AARP has been sued three times by its own members over its royalty fee policy, which they argued was deceptive, according to court filings. However, AARP ultimately won each of the cases.
U.S. District Court of Washington D.C. Judge Beryl Howell ruled in favor of AARP in May dismissing the plaintiffs’ class action lawsuit. The plaintiffs, led by AARP member Helen Krukas, argued that the organization misrepresented its Medigap royalty fee structure, according to Forbes.
The plaintiffs specifically argued that AARP was "micromanaging the sale of Medigap and therefore [the 4.95% fee] is not really a royalty fee for its intellectual property. They are a salesman. This is a commission and it’s taxable," Jacobs said.
Howell originally rejected AARP’s motion to dismiss the case in March 2019 giving credence to Krukas’ argument. Krukas "sufficiently and plausibly alleged that the defendants engaged in unfair trade practices - by materially misrepresenting information about the 4.95% charge," Howell wrote.
But, in May Howell ruled that Krukas’ argument misses the mark. She said Krukas failed to prove that AARP has a fiduciary relationship with its members.
Similarly, U.S. District Judge Dean D. Pregerson of Los Angeles dismissed two separate AARP class action lawsuits, Forbes reported. Pregerson ruled against plaintiff Simon Levay in November 2018 and against Jerald Friedman in November 2019.
The second dismissal came after the three-judge panel Ninth Circuit Court of Appeals ruled in favor of the plaintiffs. The panel ruled that AARP "transacts" and "solicits" insurance without a license and engaged in fraud by calling the 4.95% commission a "royalty," according to Forbes.
Pregerson didn’t agree, however, saying the plaintiffs failed to prove they suffered economic harm, Forbes reported
The House Ways and Means Committee investigated AARP in 2011. The investigation pointed out several potential issues with AARP’s structure including its royalty fee practices and concluded with a series of suggestions for the Internal Revenue Service to consider ...
Gov. Gavin Newsom has promptly signed into law, a bill that exempts more occupations from Assembly Bill 5, the controversial law that required most independent contractors to become employees of their clients.
Assembly Bill 5 included exemptions for many politically-connected occupations like real estate agents and doctors, but ensnared many others, drawing particular criticism from musicians, independent truck drivers, franchise business owners and freelance writers.
The amendments in AB 2257 specific to writers, photographers, videographers, editors, and illustrators make changes to AB 5 that further accommodate the needs for those individuals in the industry that operate as their own small business.
The new law establishes an exemption for services provided by a still photographer, photojournalist, videographer, or photo editor, as defined, who works under a written contract that specifies certain terms, subject to prescribed restrictions.
It also establishes an exemption for services provided to a digital content aggregator, as defined, by a still photographer, photojournalist, videographer, or photo editor.
It also establishes an exemption for services provided by a fine artist, freelance writer, translator, editor, content contributor, advisor, narrator, cartographer, producer, copy editor, illustrator, or newspaper cartoonist who works under a written contract that specifies certain terms, subject to prescribed restrictions.
The law creates additional exemptions for various professions and occupations. It exempt from the ABC test people who provide underwriting inspections and other services for the insurance industry, a manufactured housing salesperson, subject to certain obligations, people engaged by an international exchange visitor program, as specified, consulting services, animal services, and competition judges with specialized skills, as specified.
The law would also create exceptions for licensed landscape architects, specialized performers teaching master classes, registered professional foresters, real estate appraisers and home inspectors, and feedback aggregators.
The law revises the conditions pursuant to which business service providers providing services pursuant to contract to another business are exempt.
The law revises the criteria pursuant to which referral agencies and service providers providing services to clients through referral agencies are exempt and would revise applicable definitions.
The law also create an exemption for business-to-business relationships between 2 or more sole proprietors, as specified. The bill would provide that a hiring entity need only satisfy all of the conditions of one of the exemption provisions to qualify for the exemption from the ABC Test.
The new law makes conforming changes to tax law regarding the determination of the status of a worker as either an employee or an independent contractor per the criteria described above.
The new law takes effect immediately as an urgency statute.
...
Assembly Bill 5 included exemptions for many politically-connected occupations like real estate agents and doctors, but ensnared many others, drawing particular criticism from musicians, independent truck drivers, franchise business owners and freelance writers.
The amendments in AB 2257 specific to writers, photographers, videographers, editors, and illustrators make changes to AB 5 that further accommodate the needs for those individuals in the industry that operate as their own small business.
The new law establishes an exemption for services provided by a still photographer, photojournalist, videographer, or photo editor, as defined, who works under a written contract that specifies certain terms, subject to prescribed restrictions.
It also establishes an exemption for services provided to a digital content aggregator, as defined, by a still photographer, photojournalist, videographer, or photo editor.
It also establishes an exemption for services provided by a fine artist, freelance writer, translator, editor, content contributor, advisor, narrator, cartographer, producer, copy editor, illustrator, or newspaper cartoonist who works under a written contract that specifies certain terms, subject to prescribed restrictions.
The law creates additional exemptions for various professions and occupations. It exempt from the ABC test people who provide underwriting inspections and other services for the insurance industry, a manufactured housing salesperson, subject to certain obligations, people engaged by an international exchange visitor program, as specified, consulting services, animal services, and competition judges with specialized skills, as specified.
The law would also create exceptions for licensed landscape architects, specialized performers teaching master classes, registered professional foresters, real estate appraisers and home inspectors, and feedback aggregators.
The law revises the conditions pursuant to which business service providers providing services pursuant to contract to another business are exempt.
The law revises the criteria pursuant to which referral agencies and service providers providing services to clients through referral agencies are exempt and would revise applicable definitions.
The law also create an exemption for business-to-business relationships between 2 or more sole proprietors, as specified. The bill would provide that a hiring entity need only satisfy all of the conditions of one of the exemption provisions to qualify for the exemption from the ABC Test.
The new law makes conforming changes to tax law regarding the determination of the status of a worker as either an employee or an independent contractor per the criteria described above.
The new law takes effect immediately as an urgency statute.
...
A major complaint among Californians affected by the state’s anti-freelancing law, AB5, is that the labor unions wrote it and essentially paid for its passage and that the purpose was to enrich unions by creating millions of new "employees" to "organize."
The bill’s author, Asm. Lorena Gonzalez-Fletcher has admitted that the California Labor Federation sponsored the bill but denies that the unions ensured its passage, saying that its purpose was to provide benefits and a guaranteed minimum wage.
Newsom had up to 30 days to sign AB-2257, the AB-5 walk back, so it’s significant that he signed it only three days after passage. And that the new law was deemed an "urgency statute" so that it take effect immediately.
There’s bad blood between San Francisco Democrats and Los Angeles/San Diego Democrats, and Gonzalez-Fletcher’s already made Gavin Newsom’s life more difficult this year by failing to negotiate clean-up provisions for AB-5, and by publicly battling with Elon Musk, a long-time friend of Newsom and major job creator in the state.
Entering stage left, is Willie Brown, who perhaps put his thumb on the scales of legislation once again. For those not familiar, Willie Brown is not only one of the most powerful politicians to have ever graced the floor of the California State Assembly; he’s been the most powerful Democrat in the state since the 1960s.
At age 86, he still wields considerable power as a "kingmaker" in the state. After serving 32 years in the Assembly, Brown was Mayor of San Francisco for eight years and was succeeded by his protege, Gavin Newsom. Kamala Harris’ political career started when Brown appointed her to a state commission then helped her become the elected District Attorney of San Francisco.
Brown wanted AB2257 signed immediately because, as a weekly columnist for the San Francisco Chronicle, he had hit his 35 story limit under AB-5, and they were prohibited from publishing additional columns until AB2257 was signed.
Brown fumed of the move by Hearst Newspapers' flagship publication. "For 12-plus years, every Sunday, I've written that column in the paper and never taken a vacation. And this is the most important year. This is a campaign year, when there's really a contest."
"I signed the bill, write the damn column!"’ Newsom wrote to Brown in a text message that Brown shared with POLITICO.
Earlier in the day, some of Brown’s powerful friends in politics, including attorney Joe Cotchett, contacted Newsom in an effort to get him to move quickly on the bill to get Brown’s Sunday column back in the paper as soon as possible, sources said.
"If there was a place to picket organized labor, I’d do it today," Brown said. "If there was a place to picket a legislator, I’d do it," he said. As Assembly speaker, "I made sure that special interests, no matter who they were - labor or non labor - did not take advantage of the Legislature," but he said it was clear this time was not the case.
"Those bastards," he added ...
The bill’s author, Asm. Lorena Gonzalez-Fletcher has admitted that the California Labor Federation sponsored the bill but denies that the unions ensured its passage, saying that its purpose was to provide benefits and a guaranteed minimum wage.
Newsom had up to 30 days to sign AB-2257, the AB-5 walk back, so it’s significant that he signed it only three days after passage. And that the new law was deemed an "urgency statute" so that it take effect immediately.
There’s bad blood between San Francisco Democrats and Los Angeles/San Diego Democrats, and Gonzalez-Fletcher’s already made Gavin Newsom’s life more difficult this year by failing to negotiate clean-up provisions for AB-5, and by publicly battling with Elon Musk, a long-time friend of Newsom and major job creator in the state.
Entering stage left, is Willie Brown, who perhaps put his thumb on the scales of legislation once again. For those not familiar, Willie Brown is not only one of the most powerful politicians to have ever graced the floor of the California State Assembly; he’s been the most powerful Democrat in the state since the 1960s.
At age 86, he still wields considerable power as a "kingmaker" in the state. After serving 32 years in the Assembly, Brown was Mayor of San Francisco for eight years and was succeeded by his protege, Gavin Newsom. Kamala Harris’ political career started when Brown appointed her to a state commission then helped her become the elected District Attorney of San Francisco.
Brown wanted AB2257 signed immediately because, as a weekly columnist for the San Francisco Chronicle, he had hit his 35 story limit under AB-5, and they were prohibited from publishing additional columns until AB2257 was signed.
Brown fumed of the move by Hearst Newspapers' flagship publication. "For 12-plus years, every Sunday, I've written that column in the paper and never taken a vacation. And this is the most important year. This is a campaign year, when there's really a contest."
"I signed the bill, write the damn column!"’ Newsom wrote to Brown in a text message that Brown shared with POLITICO.
Earlier in the day, some of Brown’s powerful friends in politics, including attorney Joe Cotchett, contacted Newsom in an effort to get him to move quickly on the bill to get Brown’s Sunday column back in the paper as soon as possible, sources said.
"If there was a place to picket organized labor, I’d do it today," Brown said. "If there was a place to picket a legislator, I’d do it," he said. As Assembly speaker, "I made sure that special interests, no matter who they were - labor or non labor - did not take advantage of the Legislature," but he said it was clear this time was not the case.
"Those bastards," he added ...
The surge in workers compensation "mega claims" of at least $3 million continues as medical treatments and technologies advance, according to a report by Business Insurance about research by ratings bureaus around the country.
While mega claims comprise a statistically small percentage of all workers comp claims, claims are reaching the mega threshold more quickly, primarily because of the associated costs of technological advances in medicine. Experts say that upward trend is likely to continue.
Overall, mega claims account for upwards of $2 billion in workers comp costs each year, according to research compiled by the National Council on Compensation Insurance, California’s Workers Compensation Insurance Ratings Bureau and other states that pooled their data to report on mega claims trends across the country.
The study includes data from 43 states and the District of Columbia. It found that more than 4,500 claims from these states and D.C. incurred losses in excess of $3 million (at 2018 cost levels) from 2001 through 2017. Of those claims, 57% cost between $3 million and $5 million, 33% between $5 million and $10 million, and 10% in excess of $10 million, with mega claim counts for 2017 at a 12-year high, according to the report released on Aug. 25.
While fewer than 50% of mega claims reach the $3 million threshold by 18 months from policy inception, these claims are reaching that number more quickly than in the past, the study found.
The types of claims most likely to develop into mega claims include spinal cord injuries, brain injuries and severe burns. Presumption laws - such as those covering a range of cancers for firefighters or heart conditions for law enforcement officers - can also lead to claims cresting the mega threshold.
Then there are the "massive claims that shouldn’t be that big," said William Zachry, San Carlos, California-based workers compensation consultant and board member of California’s State Compensation Insurance Fund. "We’ve seen an increase in the severity of claims, but not an increase in the severity of the injuries."
These claims, which Mr. Zachry refers to as "jumper claims," are those that cost millions of dollars not due to a severe injury, but such issues as a worker’s lack of coping skills, plaintiffs’ attorneys adding multiple body parts to the claim, repeat surgeries, overprescribing and poor care, leading the worker to believe he or she is disabled.
"If you can identify and intervene very early, it is possible to really change the dynamic, change the outcomes," he said.
...
While mega claims comprise a statistically small percentage of all workers comp claims, claims are reaching the mega threshold more quickly, primarily because of the associated costs of technological advances in medicine. Experts say that upward trend is likely to continue.
Overall, mega claims account for upwards of $2 billion in workers comp costs each year, according to research compiled by the National Council on Compensation Insurance, California’s Workers Compensation Insurance Ratings Bureau and other states that pooled their data to report on mega claims trends across the country.
The study includes data from 43 states and the District of Columbia. It found that more than 4,500 claims from these states and D.C. incurred losses in excess of $3 million (at 2018 cost levels) from 2001 through 2017. Of those claims, 57% cost between $3 million and $5 million, 33% between $5 million and $10 million, and 10% in excess of $10 million, with mega claim counts for 2017 at a 12-year high, according to the report released on Aug. 25.
While fewer than 50% of mega claims reach the $3 million threshold by 18 months from policy inception, these claims are reaching that number more quickly than in the past, the study found.
The types of claims most likely to develop into mega claims include spinal cord injuries, brain injuries and severe burns. Presumption laws - such as those covering a range of cancers for firefighters or heart conditions for law enforcement officers - can also lead to claims cresting the mega threshold.
Then there are the "massive claims that shouldn’t be that big," said William Zachry, San Carlos, California-based workers compensation consultant and board member of California’s State Compensation Insurance Fund. "We’ve seen an increase in the severity of claims, but not an increase in the severity of the injuries."
These claims, which Mr. Zachry refers to as "jumper claims," are those that cost millions of dollars not due to a severe injury, but such issues as a worker’s lack of coping skills, plaintiffs’ attorneys adding multiple body parts to the claim, repeat surgeries, overprescribing and poor care, leading the worker to believe he or she is disabled.
"If you can identify and intervene very early, it is possible to really change the dynamic, change the outcomes," he said.
...
A report in MedPage Today claims that the experience of hospitals with significant surges of severely ill COVID-infected patients has delivered a powerful marketing case for the future of palliative care beyond the current pandemic, experts say.
While studies have shown that palliative care improves quality of life and reduces caregiver burden, not everyone can access it, "partly because we don't have enough clinicians, services, and programs -- especially for people outside of the hospital who are seriously ill but not hospice-eligible," she said.
Enter telemedicine, which can dramatically increase access for people in community settings, at home, in assisted living facilities, in long-term care. One clinician can see 8 to 10 seriously ill patients a day at multiple sites without leaving the office -- exponentially increasing access.
It's not only more efficient for the clinician, it expands access for patients who can get to the clinic only with difficulty because they are homebound, live miles away or constrained by geographical barriers, or depend on public transit.
At the height of the COVID surge in New York City, three large health systems separately recruited and deployed palliative care and other professionals from across the country to serve as back-up volunteers to hospital teams on the ground. They gave debriefings for frontline providers, held family meetings and goals-of-care conversations online, even offered psychological and grief support.
"We have made huge strides toward building palliative care into the healthcare system focused on the broad concept of improving quality of life, recognizing that serious illness can turn one's life upside down," says Ashwin Kotwal, MD, assistant professor of geriatrics at the University of California San Francisco. "It's not just about end-of-life support but addressing physical symptoms throughout the disease trajectory, along with psycho-social and spiritual needs. And communication is a big part of what we do."
Kotwal spent the last year building a tele-palliative care program at the San Francisco VA Medical Center, focusing on patients who were homebound or who lived four hours or more from the clinic. Then COVID came along.
For Michael Fratkin, MD, founder and CEO of Resolution Care Network in Eureka, California, the telemedicine encounter is not just more convenient, it's superior.
"The heart of the matter is the preservation of boundaries in healing relationships. We find that a video visit in real time is substantially better than invading people's homes," he says. "This is such a leveling technology. Something about the framing of the computer screen sets limits and puts us more on the same level. Clients show me only what they want to show me in their homes. It keeps the boundaries clearer."
What happens on these visits for Fratkin's community-based palliative care service, which covers a large rural area: trust-building; goal setting; shared-decision-making; advance care planning; symptom management. Surprisingly, he says, there are greater opportunities for intimacy in this encounter, even though the clinician can't reach out and put a hand on the patient's shoulder.
Of course, the future of telemedicine in palliative care will depend on reimbursement. Currently, temporary emergency Medicare waivers, extended for three months on July 23, have allowed payment for professional telehealth and some telephone visits, including physicians' advance care planning conversations with patients and families. The emergency will end eventually, but at least 20 bills have been introduced in Congress to make some aspects of telemedicine coverage permanent ...
While studies have shown that palliative care improves quality of life and reduces caregiver burden, not everyone can access it, "partly because we don't have enough clinicians, services, and programs -- especially for people outside of the hospital who are seriously ill but not hospice-eligible," she said.
Enter telemedicine, which can dramatically increase access for people in community settings, at home, in assisted living facilities, in long-term care. One clinician can see 8 to 10 seriously ill patients a day at multiple sites without leaving the office -- exponentially increasing access.
It's not only more efficient for the clinician, it expands access for patients who can get to the clinic only with difficulty because they are homebound, live miles away or constrained by geographical barriers, or depend on public transit.
At the height of the COVID surge in New York City, three large health systems separately recruited and deployed palliative care and other professionals from across the country to serve as back-up volunteers to hospital teams on the ground. They gave debriefings for frontline providers, held family meetings and goals-of-care conversations online, even offered psychological and grief support.
"We have made huge strides toward building palliative care into the healthcare system focused on the broad concept of improving quality of life, recognizing that serious illness can turn one's life upside down," says Ashwin Kotwal, MD, assistant professor of geriatrics at the University of California San Francisco. "It's not just about end-of-life support but addressing physical symptoms throughout the disease trajectory, along with psycho-social and spiritual needs. And communication is a big part of what we do."
Kotwal spent the last year building a tele-palliative care program at the San Francisco VA Medical Center, focusing on patients who were homebound or who lived four hours or more from the clinic. Then COVID came along.
For Michael Fratkin, MD, founder and CEO of Resolution Care Network in Eureka, California, the telemedicine encounter is not just more convenient, it's superior.
"The heart of the matter is the preservation of boundaries in healing relationships. We find that a video visit in real time is substantially better than invading people's homes," he says. "This is such a leveling technology. Something about the framing of the computer screen sets limits and puts us more on the same level. Clients show me only what they want to show me in their homes. It keeps the boundaries clearer."
What happens on these visits for Fratkin's community-based palliative care service, which covers a large rural area: trust-building; goal setting; shared-decision-making; advance care planning; symptom management. Surprisingly, he says, there are greater opportunities for intimacy in this encounter, even though the clinician can't reach out and put a hand on the patient's shoulder.
Of course, the future of telemedicine in palliative care will depend on reimbursement. Currently, temporary emergency Medicare waivers, extended for three months on July 23, have allowed payment for professional telehealth and some telephone visits, including physicians' advance care planning conversations with patients and families. The emergency will end eventually, but at least 20 bills have been introduced in Congress to make some aspects of telemedicine coverage permanent ...
57 year old Selina Singh, and 30 year old Kabir Singh, plead guilty to conspiracy to commit insurance premium fraud and related felonies. Both defendants also admitted an aggravated white collar crime enhancement for a loss exceeding $500,000 through a pattern of criminal activity.
The investigation of this case started after an employee severed his thumb while working on a Bara Infoware, Inc. construction jobsite at Fort Hunter Liggett. The injured employee and his site safety supervisor reported to Monterey County District Attorney investigators that Selina Singh directed them to lie about the injury occurring on a Bara Infoware, Inc. jobsite and report it occurred while working for the family’s other company, Federal Solutions Group.
The Monterey County District Attorney’s Office determined the companies were headquartered in San Ramon, California and started a joint investigation with the relevant local and State agencies.
Investigators determined that the defendants obtained government contracts, including construction contracts that required compliance with workers compensation laws.
Defendants then used their companies hire, employ, and pay construction laborers, carpenters, painters, and other workers in order to complete construction work, even as they fraudulently misrepresented the construction payroll to insurance carriers in less dangerous industries such as clerical, and consulting, in order to lower their insurance rates.
Investigators located another injured employee that reported that Kabir Singh asked him not to report his injury and offered to pay his medical expenses instead of reporting the injury to company’s insurance and located a third company, Eagle Solutions, that was used first to move money between Bara Infoware, Inc. and Federal Solutions Group, and then eventually directly to obtain workers compensation policies for non-construction payroll while running construction jobsites.
An audit by a forensic accountant at the Contra Costa District Attorney’s Office concluded that the scheme evaded over $2 million dollars of insurance premiums that law abiding competitors would have had to pay in seven years, in addition to over $200,000 of evaded payroll tax owed to the State of California.
Selina Singh pled guilty to conspiracy to commit insurance fraud, insurance premium fraud, payroll tax fraud, and a white collar crime enhancement. The maximum sentence for those charges is eleven years and eight months.
Kabir Singh pled guilty to conspiracy to commit insurance fraud, insurance premium fraud, and a white collar crime enhancement. The maximum sentence for those charges is eleven years and eight months.
Sentencing is scheduled for November 19 at 1:30 p.m. in Department 31 of the Contra Costa County Superior Court ...
The investigation of this case started after an employee severed his thumb while working on a Bara Infoware, Inc. construction jobsite at Fort Hunter Liggett. The injured employee and his site safety supervisor reported to Monterey County District Attorney investigators that Selina Singh directed them to lie about the injury occurring on a Bara Infoware, Inc. jobsite and report it occurred while working for the family’s other company, Federal Solutions Group.
The Monterey County District Attorney’s Office determined the companies were headquartered in San Ramon, California and started a joint investigation with the relevant local and State agencies.
Investigators determined that the defendants obtained government contracts, including construction contracts that required compliance with workers compensation laws.
Defendants then used their companies hire, employ, and pay construction laborers, carpenters, painters, and other workers in order to complete construction work, even as they fraudulently misrepresented the construction payroll to insurance carriers in less dangerous industries such as clerical, and consulting, in order to lower their insurance rates.
Investigators located another injured employee that reported that Kabir Singh asked him not to report his injury and offered to pay his medical expenses instead of reporting the injury to company’s insurance and located a third company, Eagle Solutions, that was used first to move money between Bara Infoware, Inc. and Federal Solutions Group, and then eventually directly to obtain workers compensation policies for non-construction payroll while running construction jobsites.
An audit by a forensic accountant at the Contra Costa District Attorney’s Office concluded that the scheme evaded over $2 million dollars of insurance premiums that law abiding competitors would have had to pay in seven years, in addition to over $200,000 of evaded payroll tax owed to the State of California.
Selina Singh pled guilty to conspiracy to commit insurance fraud, insurance premium fraud, payroll tax fraud, and a white collar crime enhancement. The maximum sentence for those charges is eleven years and eight months.
Kabir Singh pled guilty to conspiracy to commit insurance fraud, insurance premium fraud, and a white collar crime enhancement. The maximum sentence for those charges is eleven years and eight months.
Sentencing is scheduled for November 19 at 1:30 p.m. in Department 31 of the Contra Costa County Superior Court ...
State Compensation Insurance Fund announced plans to distribute an approximate $75 million dividend to its qualifying policyholders with policies that took effect between January 1 and August 26, 2020.
This dividend equals approximately 10% of the estimated annual premium reported during that period.
State Fund’s Board will consider dividends again for the remainder of the 2020 policy year later this year. While the board cannot guarantee future dividends, this mid-year declaration does not affect the possibility of a future payout for the remainder of the 2020 policy year.
Through July of this year, State Fund reported approximately $700 million in estimated annual premium and approximately $60 million in realized capital gains.
"We’re working hard to support our policyholders in every way we can during this difficult time," said State Fund President and CEO Vern Steiner.
"Due to our strong, stable financial position and the claims outcomes we’ve seen over the past several years, we’re able to return money to policyholders and we want to let them know it’s coming as early as possible. This is money they can count on as they plan for next year amidst so much uncertainty."
State Fund has paid out more than $5 billion in dividends to policyholders over its history - more than any other California workers’ compensation carrier.
Just last year State Fund declared an approximate $160 million dividend for 2019 policyholders.
State Fund policyholders eligible for a 2020 dividend will receive their payments after the expiration date of their individual policies ...
This dividend equals approximately 10% of the estimated annual premium reported during that period.
State Fund’s Board will consider dividends again for the remainder of the 2020 policy year later this year. While the board cannot guarantee future dividends, this mid-year declaration does not affect the possibility of a future payout for the remainder of the 2020 policy year.
Through July of this year, State Fund reported approximately $700 million in estimated annual premium and approximately $60 million in realized capital gains.
"We’re working hard to support our policyholders in every way we can during this difficult time," said State Fund President and CEO Vern Steiner.
"Due to our strong, stable financial position and the claims outcomes we’ve seen over the past several years, we’re able to return money to policyholders and we want to let them know it’s coming as early as possible. This is money they can count on as they plan for next year amidst so much uncertainty."
State Fund has paid out more than $5 billion in dividends to policyholders over its history - more than any other California workers’ compensation carrier.
Just last year State Fund declared an approximate $160 million dividend for 2019 policyholders.
State Fund policyholders eligible for a 2020 dividend will receive their payments after the expiration date of their individual policies ...
The WCIRB published its Quarterly Experience Report as of March 31, 2020.
Written premium for 2019 is 7% below that for 2018 and 12% below the peak in 2016. And premium continues decline in 2020. Written premium for the first quarter of 2020 is 5% below that for the first quarter of 2019.
With the COVID-19 pandemic-related economic slowdown, the WCIRB expects employer payroll and insurer premium to decline sharply for the remainder of 2020 compared to 2019.
And rates have declined as well. The average charged rate for the first quarter of 2020 is 7% below that for 2019 and 39% below the peak in 2014. The January 1, 2020 approved advisory pure premium rates are on average 47% below those for January 1, 2015.
And the loss ratio is increasing. The projected loss ratio for 2019 is 5 points above that for 2018, primarily driven by lower premium rates. These ultimate projections as of March 31, 2020 are generally consistent with those as of recent prior quarters as the trends in downward loss development have moderated through March31, 2020.
Loss development for the remainder of 2020 will likely by impacted by the pandemic and stay-at-home orders.
The projected combined ratio for 2019 is 8 points higher than 2018 and 16 points higher than the low point in 2016 as premium levels have dropped while claim frequency and severity increased moderately.
Despite the recent increase, combined ratios for 2013 through 2019 are below 100% and are the lowest since the 2003 through 2007 period.
The COVID-19 crisis is likely to significantly reduce premium levels in 2020 and may increase overall costs leading to further increases in the combined ratio.
There is however some good news. Indemnity claims have settled quicker over the last several years, largely driven by SB 863 and SB1160 reforms. The ratio for 2019 is consistent with 2018, suggesting claim settlement rates may be plateauing.
Claim activity is expected to slow down in the second quarter of 2020 as a result of the COVID-19 crisis. Indemnity claim frequency increased by 11% from 2009 to 2014, but decreased by 9% from 2014 to 2018. Indemnity claim frequency increased modestly in 2019. Data through the first quarter of 2020 shows relatively flat frequency.
The impact of the COVID-19 crisis on overall 2020 claim frequency is not yet clear. Although many claims arising from exposure to the virus continue to be filed, the slowdown in economic activity is expected to reduce claim filings ...
Written premium for 2019 is 7% below that for 2018 and 12% below the peak in 2016. And premium continues decline in 2020. Written premium for the first quarter of 2020 is 5% below that for the first quarter of 2019.
With the COVID-19 pandemic-related economic slowdown, the WCIRB expects employer payroll and insurer premium to decline sharply for the remainder of 2020 compared to 2019.
And rates have declined as well. The average charged rate for the first quarter of 2020 is 7% below that for 2019 and 39% below the peak in 2014. The January 1, 2020 approved advisory pure premium rates are on average 47% below those for January 1, 2015.
And the loss ratio is increasing. The projected loss ratio for 2019 is 5 points above that for 2018, primarily driven by lower premium rates. These ultimate projections as of March 31, 2020 are generally consistent with those as of recent prior quarters as the trends in downward loss development have moderated through March31, 2020.
Loss development for the remainder of 2020 will likely by impacted by the pandemic and stay-at-home orders.
The projected combined ratio for 2019 is 8 points higher than 2018 and 16 points higher than the low point in 2016 as premium levels have dropped while claim frequency and severity increased moderately.
Despite the recent increase, combined ratios for 2013 through 2019 are below 100% and are the lowest since the 2003 through 2007 period.
The COVID-19 crisis is likely to significantly reduce premium levels in 2020 and may increase overall costs leading to further increases in the combined ratio.
There is however some good news. Indemnity claims have settled quicker over the last several years, largely driven by SB 863 and SB1160 reforms. The ratio for 2019 is consistent with 2018, suggesting claim settlement rates may be plateauing.
Claim activity is expected to slow down in the second quarter of 2020 as a result of the COVID-19 crisis. Indemnity claim frequency increased by 11% from 2009 to 2014, but decreased by 9% from 2014 to 2018. Indemnity claim frequency increased modestly in 2019. Data through the first quarter of 2020 shows relatively flat frequency.
The impact of the COVID-19 crisis on overall 2020 claim frequency is not yet clear. Although many claims arising from exposure to the virus continue to be filed, the slowdown in economic activity is expected to reduce claim filings ...
One would think, in these days of COVID-19, that America’s doctors and patients are as reliant on our hospitals as they’ve ever been, and that they’re going to stay that way. Guess again.
Today, even as the health care system and the economy face strains from the coronavirus and its complications, scores of doctors and patients are avoiding large bureaucratic hospitals and instead flocking toward leaner and meaner models of health care.
Professional providers of all types -- from surgeons to drugstore owners -- are focusing on innovation. Even better, they’re now treating patients as consumers who value quality care at reasonable prices they can know in advance.
Walgreens and VillageMD, for instance, have partnered to open primary-care centers in 500 to 700 drugstores over a five-year period. These centers will provide annual check-ups, walk-in appointments, and many other services. Physician-led teams of four people will treat up to 120 patients per day at these mostly 3,300-square-foot locations.
This model is the latest iteration of a trend called decentralized care, in which patients obtain treatment through telehealth services and outpatient surgery centers and clinics -- rather than by visiting hospitals.
For two decades, the late Harvard Business professor Clayton Christensen predicted that decentralization in health care would follow other industries on this path, such as travel, retail, and financial services. It was only a matter of time, said Christensen, before health care innovators improved access to services and reduced costs.
Two key factors are driving this emerging trend, as a recent Healthline.com article pointed out: 1) urgent-care clinics and expanded pharmacy services are improving the efficiency of health care delivery; and 2) more people, especially older adults, are receiving care at home.
Americans who support this free-market health trend share some of the top reasons for its popularity, including convenience and price transparency.
The media has been reporting on the trend, too. Yahoo Finance, for example, ran a piece this summer about the expected growth of urgent-care centers over the next five years ...
Today, even as the health care system and the economy face strains from the coronavirus and its complications, scores of doctors and patients are avoiding large bureaucratic hospitals and instead flocking toward leaner and meaner models of health care.
Professional providers of all types -- from surgeons to drugstore owners -- are focusing on innovation. Even better, they’re now treating patients as consumers who value quality care at reasonable prices they can know in advance.
Walgreens and VillageMD, for instance, have partnered to open primary-care centers in 500 to 700 drugstores over a five-year period. These centers will provide annual check-ups, walk-in appointments, and many other services. Physician-led teams of four people will treat up to 120 patients per day at these mostly 3,300-square-foot locations.
This model is the latest iteration of a trend called decentralized care, in which patients obtain treatment through telehealth services and outpatient surgery centers and clinics -- rather than by visiting hospitals.
For two decades, the late Harvard Business professor Clayton Christensen predicted that decentralization in health care would follow other industries on this path, such as travel, retail, and financial services. It was only a matter of time, said Christensen, before health care innovators improved access to services and reduced costs.
Two key factors are driving this emerging trend, as a recent Healthline.com article pointed out: 1) urgent-care clinics and expanded pharmacy services are improving the efficiency of health care delivery; and 2) more people, especially older adults, are receiving care at home.
Americans who support this free-market health trend share some of the top reasons for its popularity, including convenience and price transparency.
The media has been reporting on the trend, too. Yahoo Finance, for example, ran a piece this summer about the expected growth of urgent-care centers over the next five years ...
California lawmakers on Monday wrapped up a legislative session largely defined by the pandemic. The bills will next head to Gov. Newsom, who will have until Sept. 30 to sign or veto the measures.
Late Monday night, the Legislature passed SB 1159 which would make it easier for police, firefighters and other essential employees who contract COVID-19 on the job to be covered under the state’s workers’ compensation program by establishing a disputable presumption of compensability.
It was declared an "urgency" measure, which means if signed by the Governor, the law will take effect immediately, instead of on January 1. Additionally, the statute "applies to all pending matters except as otherwise specified, including, but not limited to, pending claims relying on Executive Order N-62-20."
Also going to the Governor is Assembly Bill 3216, a proposal pushed by unions that would create significant labor protections for hotel, janitorial, airport, event center and building maintenance workers. The bill requires employers in those industries to first rehire workers they laid off during a state of emergency, including in cases in which a new owner takes over a business.
The Legislature also passed a budget trailer bill, first made public Friday, that would require food-sector companies, healthcare providers and emergency responders with more than 500 employees to provide two weeks of supplemental paid sick leave for full-time workers who are unable to work after being exposed to the coronavirus or contracting COVID-19. AB 1867, which expires Dec. 31, is similar to an executive order Newsom signed earlier this year.
The Legislature also approved AB 276, which would raise the amount Californians can borrow penalty-free from their employer-sponsored retirement accounts to $100,000 from $50,000 if they have been financially impacted by the pandemic.
Another proposal approved by the Legislature, AB 2537, would require general acute care hospitals to stockpile three months of protective equipment supplies by April 1 or face a fine of up to $25,000.
AB 2043 would require the state's Division of Occupational Safety and Health to compile and publicly report investigations into agricultural workplace conditions related to COVID-19, as well as illnesses from the virus.
Lawmakers approved SB 275 which calls for the state to build a supply of medical equipment. Hospitals and other healthcare employers would be required to assemble a 45-day supply by June 1, 2023. ...
Late Monday night, the Legislature passed SB 1159 which would make it easier for police, firefighters and other essential employees who contract COVID-19 on the job to be covered under the state’s workers’ compensation program by establishing a disputable presumption of compensability.
It was declared an "urgency" measure, which means if signed by the Governor, the law will take effect immediately, instead of on January 1. Additionally, the statute "applies to all pending matters except as otherwise specified, including, but not limited to, pending claims relying on Executive Order N-62-20."
Also going to the Governor is Assembly Bill 3216, a proposal pushed by unions that would create significant labor protections for hotel, janitorial, airport, event center and building maintenance workers. The bill requires employers in those industries to first rehire workers they laid off during a state of emergency, including in cases in which a new owner takes over a business.
The Legislature also passed a budget trailer bill, first made public Friday, that would require food-sector companies, healthcare providers and emergency responders with more than 500 employees to provide two weeks of supplemental paid sick leave for full-time workers who are unable to work after being exposed to the coronavirus or contracting COVID-19. AB 1867, which expires Dec. 31, is similar to an executive order Newsom signed earlier this year.
The Legislature also approved AB 276, which would raise the amount Californians can borrow penalty-free from their employer-sponsored retirement accounts to $100,000 from $50,000 if they have been financially impacted by the pandemic.
Another proposal approved by the Legislature, AB 2537, would require general acute care hospitals to stockpile three months of protective equipment supplies by April 1 or face a fine of up to $25,000.
AB 2043 would require the state's Division of Occupational Safety and Health to compile and publicly report investigations into agricultural workplace conditions related to COVID-19, as well as illnesses from the virus.
Lawmakers approved SB 275 which calls for the state to build a supply of medical equipment. Hospitals and other healthcare employers would be required to assemble a 45-day supply by June 1, 2023. ...
Marivel Santos was employed by Crenshaw Manufacturing, Inc. in January 2017 as a machine operator. She was instructed by her supervisor, Jose Flores, to operate a material-forming machine utilizing a die without any protective guards or cages.
Ordinarily, Santos would have had to use both hands to operate the machine. This time, however, Flores instructed her to operate it "from the side using a bypass button." Using the machine in this manner allowed Santos to operate the machine with her right hand, leaving her left hand free to reach into the machine to "press down the part" being cut.
On January 12, 2017, Santos was operating the machine in this fashion when her left hand was crushed underneath the die, mutilating and severely injuring it. She filed a workers’ compensation claim against Crenshaw.
She also filed a civil action for a sole cause of action against Crenshaw for violation of Labor Code 4558, which allows an action against the employer where the injury is caused by the removal of, or knowing failure to install, a point of operation guard on a power press, known as the "power press" exception to the exclusive remedy of worker's compensation.
The machine in this case was an A3 gap frame press, manufactured in or around 1937 by Niagara Machine & Tool Works. Crenshaw purchased two Niagara A3 gap frame presses, along with other equipment, in late 2013 as part of an asset purchase from another business.
Crenshaw filed a motion for summary judgment, asserting Santos failed to meet the requirements of the power press exception, and argued that Niagara had never designed, provided, installed, or specified any particular guard or barrier to be used with the machine in any given context.
The trial court granted summary judgment in favor of the employer. However the Court of Appeal reversed in the unpublished case of Santos v Crenshaw Manufacturing.
A provision in section 4558 provides that "No liability shall arise under [section 4558] absent proof that the manufacturer designed, installed, required, or otherwise provided by specification for the attachment of the guards and conveyed knowledge of the same to the employer. Proof of conveyance of this information to the employer by the manufacturer may come from any source."
Crenshaw argues that section 4558 requires a manufacturer to convey specific information - in other words, to identify a particular point of operation guard.
However, the Court of Appeal noted that the case law has only established that a high degree of specificity in the manufacturer’s safety directives will suffice under section 4558. But not what is the lowest degree of specificity that would suffice?
When a defendant moves for summary judgment, ‘its declarations and evidence must either establish a complete defense to plaintiff’s action or demonstrate the absence of an essential element of plaintiff’s case. Here this standard was not met, and the summary judgment was reversed ...
Ordinarily, Santos would have had to use both hands to operate the machine. This time, however, Flores instructed her to operate it "from the side using a bypass button." Using the machine in this manner allowed Santos to operate the machine with her right hand, leaving her left hand free to reach into the machine to "press down the part" being cut.
On January 12, 2017, Santos was operating the machine in this fashion when her left hand was crushed underneath the die, mutilating and severely injuring it. She filed a workers’ compensation claim against Crenshaw.
She also filed a civil action for a sole cause of action against Crenshaw for violation of Labor Code 4558, which allows an action against the employer where the injury is caused by the removal of, or knowing failure to install, a point of operation guard on a power press, known as the "power press" exception to the exclusive remedy of worker's compensation.
The machine in this case was an A3 gap frame press, manufactured in or around 1937 by Niagara Machine & Tool Works. Crenshaw purchased two Niagara A3 gap frame presses, along with other equipment, in late 2013 as part of an asset purchase from another business.
Crenshaw filed a motion for summary judgment, asserting Santos failed to meet the requirements of the power press exception, and argued that Niagara had never designed, provided, installed, or specified any particular guard or barrier to be used with the machine in any given context.
The trial court granted summary judgment in favor of the employer. However the Court of Appeal reversed in the unpublished case of Santos v Crenshaw Manufacturing.
A provision in section 4558 provides that "No liability shall arise under [section 4558] absent proof that the manufacturer designed, installed, required, or otherwise provided by specification for the attachment of the guards and conveyed knowledge of the same to the employer. Proof of conveyance of this information to the employer by the manufacturer may come from any source."
Crenshaw argues that section 4558 requires a manufacturer to convey specific information - in other words, to identify a particular point of operation guard.
However, the Court of Appeal noted that the case law has only established that a high degree of specificity in the manufacturer’s safety directives will suffice under section 4558. But not what is the lowest degree of specificity that would suffice?
When a defendant moves for summary judgment, ‘its declarations and evidence must either establish a complete defense to plaintiff’s action or demonstrate the absence of an essential element of plaintiff’s case. Here this standard was not met, and the summary judgment was reversed ...
