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Nearly 150 former workers of an elder-care business in West Hills will be paid more than $8.3 million in a wage theft investigation that found employees were subjected to "oppressive" conditions and paid as little as $2.40 hourly, according to the state Labor Commissioner’s Office.

The Oct. 1 judgment will compensate 148 employees who worked at six Adat Shalom Board & Care locations. It upholds wage-theft citations issued to the business and owner Angelica Reingold in 2018.

The facilities, which have since been re-branded as Land of Peace, are all in West Hills with various addresses on Kittridge Street and Sale Avenue.

Pilipino Workers Center, a nonprofit that helps Filipino workers and their families, referred the case to the California Commissioner’s Office and assisted in identifying employees during the investigation.

The Labor Commissioner’s Office opened its investigation in June 2017 after receiving a report of labor law violations. The investigation uncovered that from July 2014 to July 2017, the caregivers at the six facilities in West Hills were:

- - Paid less than the minimum wage for each hour they worked.
- - Not paid overtime for working 24-hour shifts, six days a week.
- - Not relieved from their duties to take meal or rest breaks.
- - Provided pay stubs that withheld key information such as hourly rate of pay and total number of hours worked.

The live-in caregivers were responsible for monitoring and caring for elderly residents and hospice patients, many of them suffering from Alzheimer’s or dementia. The caregivers were paid fixed amounts ranging from $1,500 to $1,800 per month, or $2.40 to $2.88 per hour.

Aquilina Soriano Versoza, the center’s executive director, said employees at the care facilities could sleep at certain times but were still on call 24 hours a day. "They listened to monitors and had to leave their doors open so they’d be ready to respond," she said. "They had to ask permission to leave if they needed to run to the store."

Residential care workers, leaders from Pilipino Workers Center and other supporters held a press conference Wednesday to announce the Labor Commissioner’s decision. The judgment includes:

- - $1,623,384 for minimum wages owed
- - $1,939,112 for unpaid overtime
- - $2,540,675 in liquidated damages
- - $152,441 for meal period wages owed
- - $2,100,405 in prejudgment interest

Founded in 1997, Pilipino Workers Center (PWC) is a non-profit 501(c)3 that organizes the low-wage Pilipinx community in Southern California to demand better living and working conditions. PWC provides support for human trafficking survivors, immigration services, affordable housing, workforce training, education on workers’ rights, wage theft enforcement, free tax preparation, and a cooperative for homecare workers ...
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/ 2021 News, Daily News
Former NFL wide receiver Kenbrell Thompkins pleaded guilty in a scheme to fraudulently obtain COVID-19 unemployment insurance benefits from the state of California.

According to court records obtained by the Associated Press, Thompkins entered guilty pleas on one count of unauthorized access device fraud and one count of aggravated identity theft in a federal court in Miami on Monday.

According to the plea agreement, Thompkins used stolen identities of Florida residents to apply for COVID-19 unemployment benefits from California.

The state approved the applications and sent $300,000 in benefits in the form of debit cards to South Florida addresses Thompkins set up Around $230,000 of those funds were withdrawn from ATMs across South Florida.

The benefits were part of the Covid Aid, Relief and Economic Security Act passed by the U.S. Congress. The bill's intent was to help people and businesses during the financial downturn caused by the COVID-19 pandemic.

33 year old Thompkins played three seasons in the NFL from 2013-15 with the New York Jets, New England Patriots and Oakland Raiders. According to Spotrac, he earned $1.4 million as an NFL player.

He's scheduled to be sentenced on Jan. 6 and faces a maximum of 12 years in prison.

Thompkins is the latest former professional athlete named in a fraud scheme in recent weeks.

In September, ex-NFL players Clinton Portis, Tamarick Vanover and Robert McCune reportedly pleaded guilty to defrauding a league healthcare plan.

On Oct. 7, 18 ex-NBA players including Terrence Williams and Glen "Big Baby" Davis were charged in an alleged $4 million scheme to defraud the NBA player's health and welfare benefit plan ...
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/ 2021 News, Daily News
The District Court of Central California on Wednesday awarded a former Walmart pharmacist with $27 million in total damages, agreeing that the retail giant routinely denied her work breaks and overtime pay.

According to the report on CourtHouse News, the case was originally filed by former Walmart pharmacist Afrouz Nikmanesh in Orange County Superior Court in 2015, but was later moved to the District Court of Central California.

Nikmanesh said Walmart told her to obtain her immunization certification, which would allow her to provide on-site immunizations to pharmacy patients, but refused to compensate her for the time she spent studying and preparing for the exam. She also claimed that getting the certification increased her workload several times over, but said Walmart refused to provide additional staffing to meet the increased demand.

The ruling includes $40,000 for economic losses; $100,000 for non-economic losses; $60,000 for future non-economic losses; and $27.3 million in punitive damages.

In the original complaint, Nikmanesh claimed she was denied overtime wages along with meal and rest breaks, forced to perform work off the clock studying for and taking the immunization certification exam and given inaccurate wage statements that didn’t account for the hours she actually spent working.

She said Walmart enacted a policy prohibiting its pharmacists from leaving the pharmacy unattended, adding that this made it impossible for her to take her legally mandated meal and rest breaks. Because of a shortage of pharmacists who could cover for her, she said she was effectively forced to work throughout their shifts without pause.

Walmart also committed numerous pharmacy violations and instances of noncompliance with state law, according to the plaintiff, including charging Medicare beneficiaries above the Medi-Cal reimbursement rate for prescriptions and failing to provide eligible patients with a Medicare discount.

She also said Walmart failed to report necessary data to the Controlled Substance Utilization Review and Evaluation System, otherwise known as the CURES program, a database of controlled substance prescriptions dispensed throughout California which requires pharmacists to file weekly reports with the California Department of Justice.

Nikmanesh reported these violations to her supervisors sometime between July 2013 and September 2014 and asked that they investigate and correct the various compliance issues. Walmart responded by firing Nikmanesh in September 2014, which she claims was solely in retaliation for her complaining about their non-compliance with state laws.

The company also failed to reimburse Nikmanesh for business expenses, didn’t give her a bonus that she earned, refused her request to host a health fair promoting the pharmacy, unfairly denied her promotions and gave her a poor performance review shortly after she complained about their illegal practices, according to the lawsuit.

"The Jury of 8 unanimously found that Ms. Nikmanesh’s reporting of Walmart’s overcharging Medicare customers over the age of 65 and persons under the age of 65 with disabilities for their medications and not properly reporting the dispensement of controlled substances to the Department of Justice under the Controlled Substance Utilization Review and Evaluation System program was a substantial motivating reason for Walmart’s decision to retaliate against and discharge her," explained Dayton B. Parcells III, lead attorney for the plaintiff.

Representatives for Walmart were not immediately available for comment ...
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/ 2021 News, Daily News
The purpose of the OSHA Federal Regulation located at 29 CFR 1904 is to require employers to record and report work-related fatalities, injuries, and illnesses.

Section 1904.5(a) states "Basic requirement. You must consider an injury or illness to be work-related if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a pre-existing injury or illness. Work-relatedness is presumed for injuries and illnesses resulting from events or exposures occurring in the work environment, unless an exception in §1904.5(b)(2) specifically applies."

Section 1904.5(b)(1) says What is the "work environment"? OSHA defines the work environment as "the establishment and other locations where one or more employees are working or are present as a condition of their employment. The work environment includes not only physical locations, but also the equipment or materials used by the employee during the course of his or her work."

So are adverse reactions to an employer's mandated COVID-19 vaccine recordable on the OSHA recordkeeping log? Looking further in the regulation are the exceptions. One of them might apply.

1904.5(b)(2) You are not required to record injuries and illnesses if . . . 1904.5(b)(2)(iii)The injury or illness results solely from voluntary participation in a wellness program or in a medical, fitness, or recreational activity such as blood donation, physical examination, flu shot, exercise class, racquetball, or baseball.

However this exception does not seem to apply since a "mandated" COVID vaccination is not "voluntary," one of the conditions of the above exception.

It still might raise an employer's concern, had not this exact question been answered by the OSHA Coronavirus FAQ on this regulation, which reads:

"DOL and OSHA, as well as other federal agencies, are working diligently to encourage COVID-19 vaccinations. OSHA does not wish to have any appearance of discouraging workers from receiving COVID-19 vaccination, and also does not wish to disincentivize employers' vaccination efforts. As a result, OSHA will not enforce 29 CFR 1904's recording requirements to require any employers to record worker side effects from COVID-19 vaccination at least through May 2022. We will reevaluate the agency’s position at that time to determine the best course of action moving forward."

By using the word "any" in the FAQ, the temporary excuse until at least May 2022 it would seem to imply to both voluntary or mandatory COVID-19 vaccination adverse reactions, although the wording of this FAQ could have been more clearly written.

Nonetheless, this sua sponte OSHA decision to forgive a component of regulatory oversight is puzzling and questionable. The stated purpose of OSHA is to regulate workplace safety. President Biden has announced his intent to mandate COVID-19 vaccinations. Yet his agency in charge of monitoring safety does not want to know about any adverse effect of the vaccination. Thus if it ends up in the long run to be unsafe, the documentary trail would then be obscured, in what should be a transparent governmental agency.

Employees across the nation are voicing their concerns about the safety of the COVID-19 vaccination. This clause in the FAQ will no doubt trigger their suspicions, rather than calm them down.
...
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/ 2021 News, Daily News
Courthouse News reports that the U.S. Supreme Court declined an emergency application to stop the enforcement of a Covid-19 vaccine mandate for health care workers in Maine.

Maine Governor Janet Mills, a Democrat, instituted the mandate in late September requiring health care workers to be fully vaccinated by Oct. 29, or risk losing their jobs. Several health care workers challenged the mandate, citing in their complaint beliefs that prevent them from receiving a Covid-19 vaccine because of "the vaccines' connections to aborted fetal cell lines," among other religious reasons.

After a federal district court judge denied the health care workers injunctive relief last week, they quickly filed their emergency application with the U.S. Supreme Court.

But Justice Stephen Breyer denied the application without prejudice Tuesday afternoon.

The Supreme Court has previously used the emergency docket - sometimes called the shadow docket - to reject vaccine mandates challenges from public school teachers in New York and students and employees from Indiana University, but this case marks the first time the court addressed a statewide Covid-19 vaccine mandate.

"We are pleased that the Supreme Court is ready to consider this case if we do not get relief at the First Circuit Court of Appeals or if the lower court does not rule by October 29," Mathew Staver, attorney for the plaintiffs and Liberty Counsel founder and chairman, said in a statement. "As of Monday, our case is now fully briefed at the court of appeals. We look forward to an expedited ruling. There is no question that Gov. Janet Mills cannot nullify federal law and the First Amendment to the U.S. Constitution."

Staver and the plaintiffs did not have to wait long for the First Circuit to weigh in. Shortly after the Supreme Court's denial, a three-judge panel of the First Circuit also ruled against the plaintiffs, rejecting their request for a preliminary injunction.

"While we do not diminish the appellants' liberty of conscience, we cannot find, absent any constitutional or statutory violation, any error in the district court's conclusion that the rule promotes strong public interests and that an injunction would not serve the public interest," U.S. Circuit Judge Sandra Lynch, a Bill Clinton appointee, wrote in the 35-page opinion.

Now, the case is likely headed straight back to the Supreme Court.

According to Maine’s vaccination data, over 85% of all health care workers across the state’s facilities were vaccinated as of September ...
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/ 2021 News, Daily News
A new set of studies released by the Workers Compensation Research Institute (WCRI) examines the factors behind trends in medical payments per claim in state workers’ compensation systems and the impact of legislative and regulatory changes on those costs.

The studies, CompScope Medical Benchmarks, 22nd Edition, examine trends in payments, prices, and utilization of medical care for workers with injuries. They provide analyses of recent cost drivers and trends for policymakers and other system stakeholders, reporting how medical payments per claim and cost components vary over time and from state to state.

"The reports are useful to identify where medical cost and care patterns may be changing and help identify where medical payments per claim or utilization may differ from other states," said Ramona Tanabe, executive vice president and counsel for WCRI. "While the full impact of COVID-19 on state workers’ compensation systems is currently unclear, these studies will be a useful baseline to monitor the effects."

This study examines medical payments, prices, and utilization for various types of services by nonhospital and hospital providers in California and compares them with 17 other states. It also examines how these metrics of medical payments and care have changed, mainly from 2014 to 2019.

Claims with experience through 2020 for injuries up to and including 2019 were analyzed. In some cases, a longer period was used to supply historical context for key metrics. Information from other WCRI studies was also included to provide a more complete picture of the system in California.

California implemented multiple policy changes in recent years. The drug formulary required by Assembly Bill (AB) 1124 became effective in January 2018, and data in this report reflect up to 27 months of experience following the implementation of that policy initiative. AB 1124 and Senate Bill (SB) 1160, two major fraud-fighting measures, were enacted in January 2017. The data in this study reflect up to 39 months of experience after the passage of these bills.
SB 863, a comprehensive reform legislation, went into effect in January 2013. Results in this report reflect the state’s system performance seven years after the implementation of SB 863.

In addition, during the analysis period of this study, California went through multiple medical fee schedule updates for hospital outpatient department and ambulatory surgery center services, and nonhospital professional services. These regulatory changes are also potential factors influencing the results discussed in this report.

The results in the report include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic. The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims.

The studies cover the period from 2014 through 2019, with claims experience through March 2020. The 18 states in the study ― Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin ― represent more than 60 percent of the nation’s workers’ compensation benefit payments. Individual reports are available for every state except Arkansas, Iowa, and Tennessee.

For more information on these studies, visit www.wcrinet.org ...
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/ 2021 News, Daily News
Erika Spence filed an application for adjudication of claim alleging that on July 30, 2017 she sustained industrial injury to her right foot while playing in a basketball tournament with other women from the Los Angeles Police Department called the Menehune Basketball Invitational Tournament held at a facility in the City of La Puente, California and hosted by a private organization.

At the trial on the sole issue of AOE-COE, Spence testified that no one encouraged or pressured her to play on the women's basketball team. There would not be any negative consequences if she did not join the team, nor would there be any promotions or benefits if she did join. Her participation on the team was voluntary. Participating in tournaments was also voluntary.

Defendant presented the testimony of Sergeant Edward Acosta along with an excerpt of the 2017 LAPD Manual Vol. 3, in which Sergeant Acosta testified that, while basketball is on a list of approved activities, the tournament in which applicant was injured did not meet the requirements outlined in the LAPD Manual.

Based on this evidence, the WCJ issued the F&O finding that the applicant’s injury occurred AOE/COE. The LAPD petition for reconsideration was granted, and the WCAB panel found that she did not sustain injury AOE-COE to her right foot in the case of Spence v City of Los Angeles, ADJ 10987859 (10/6/2021)

Labor Code section 3600(a)(9) bars compensation for an injury Where the injury does not arise out of voluntary participation in any off-duty recreational, social, or athletic activity not constituting part of the employee’s work-related duties, except where these activities are a reasonable expectancy of, or are expressly or impliedly required by, the employment.

Pursuant to Ezzy v. Workers’ Comp. Appeals Bd. (1983) 146 Cal.App.3d 252, 260 [48 Cal.Comp.Cases 611].) evaluation of whether an injury is barred under section 3600(a)(9) requires a two-prong test: (1) whether the employee subjectively believes his or her participation in an activity is expected by the employer, and (2) whether that belief is objectively reasonable.

In this case, based on applicant’s testimony, the first prong of Ezzy was not met. That is, applicant did not establish that she subjectively believed that participation in the Menehune Basketball Invitational Tournament was required.

Additionally, the panel noted that note that departments have the ability to limit the scope of potential liability by designating and/or pre-approving athletic activities or fitness regimens (Young v. Workers' Comp. Appeals Bd. (2014) 227 Cal.App.4th 472, 482; citing, Taylor v. Workers' Comp. Appeals Bd. (1988) 199 Cal.App.3d 211.) (Taylor).)

In this case, the LAPD Manual specifically outlined the conditions under which injury resulting from athletic activity will be considered on duty ...
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/ 2021 News, Daily News
The Labor Commissioner’s Office has cited JPI Construction $1.7 million for wage theft violations affecting 265 workers. An investigation found that the San Diego-based company failed to pay workers properly on commercial and residential construction projects, resulting in minimum wage and overtime violations.

The Labor Commissioner’s Office opened an investigation in March 2019 after receiving a report of labor law violations indicating JPI Construction workers were experiencing wage theft because they were only paid for 40 hours a week despite consistently working overtime on mixed-use construction projects in the San Diego and Los Angeles areas. The labor law violations were reported by Carpenters/Contractors Cooperation Committee, a non-profit labor-management organization.

The investigation found that from April 2018 to March 2019, employees doing framing and sheetrock work were paid a flat rate that did not include overtime. This resulted in frequent minimum wage and overtime violations. Investigators interviewed workers and audited the employer’s payroll records to identify violations. The audit uncovered illegally modified timesheets that removed record of the overtime hours the workers should have been paid.

When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid minimum wages plus interest. Waiting time penalties are imposed when the employer intentionally fails to pay all wages due to the employee at the time of separation. This penalty is calculated by taking the employee’s daily rate of pay and multiplying it by the number of days the employee was not paid, up to a maximum of 30 days.

The citations total $1,771,133, with $1,610,527 payable to the workers. The amount owed to workers includes minimum wage and overtime, waiting time penalties for failure to provide full pay on time, and liquidated damages and interest payable to workers for failure to pay minimum wage for all hours worked. The citations include $143,200 in civil penalties payable to the state.

The owners have appealed the citations. Under the appeal procedure, the Labor Commissioner’s Office will hold a hearing before a hearing officer who will affirm, modify or dismiss the citations.

The Labor Commissioner’s Office in 2020 launched an interdisciplinary outreach campaign, "Reaching Every Californian." The campaign amplifies basic protections and builds pathways to affected populations so workers and employers understand legal protections and obligations, and the Labor Commissioner’s enforcement procedures ...
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/ 2021 News, Daily News
Supply chain issues in the United States and particularly the role ports in Los Angeles and Long Beach play, have become a hot topic in the news cycle.

Dwell time for containers at terminals is six days, the wait time for on-dock rail is nearly 12 days and it takes 8.5 days on average for containers on the street to find dock space at warehouses. The situation is so bad that a few weeks ago about 65 container vessels were stacked up along the coast waiting to berth and unload.

In addition to the nationwide labor shortage, ports in California face state-specific challenges.

Last week President Biden announced that the Port of Los Angeles will join the Port of Long Beach in operating 24/7 in an attempt to clear the shipyards of cargo containers and allow the dozens of ships anchored offshore to offload their cargo. That should do the trick, right? Only for people who don’t understand how a supply chain works.

According to the California Trucking Association (CTA), there are more than 70,000 predominantly minority-owned independent truckers operating in California. About 17,000 truckers are registered to bring goods into the Los Angeles and Long Beach ports. Many of those are contractors who own or lease their trucks and don’t receive workers’ compensation or other benefits enjoyed by full-time employees.

Many of these independent contractors are hired by large, well known trucking companies, many of them contract with multiple trucking companies, both large and small. Many of the independent contractors are small businesses themselves and utilize employees and contractors. This business model has existed at California ports for many decades.

However, AB5, enacted in 2019, changes the rules for the California trucking industry model of doing business. It sets as law the ABC test for determining whether a worker is an employee or a true independent contractor. And for trucking, the B prong is viewed as making it difficult to hire independent owner-operators as drivers, because it defines a person engaged in the primary activity of the hiring company - like a trucking company hiring a truck driver - as an employee.

There were two AB5/trucking-related cases on the U.S. Supreme Court docket for this term; on October 5 the Court denied certiorari in the Cal Cartage case, but hasn’t yet ruled on another case brought by the California Trucking Association (CTA).

In that case, a federal judge issued an injunction in January 2020 blocking the implementation of the law in the trucking industry until legal challenges could wind their way through the courts. In April the 9th Circuit Court of Appeals ruled against CTA, but enforcement of that order has been stayed pending SCOTUS’ decision, which means the January 2020 injunction is still in effect.

According to an article by Compliance Navigation Specialists, carriers that have been taking the "wait and see" approach on the law and the court’s process are now facing a near-term reality that the independent contractor system might not be possible and will have to face an increase in costs to hire the drivers.Other carriers have been cutting ties with California as the cost of doing business in the state are greater than the reward and pull out of any California operations to shield themselves from the impact of the AB5 law.

And, depending on how SCOTUS rules on a pending case regarding how California’s AB5 applies to the trucking industry, the problem will only get worse. If owner-operators who contract with larger freight companies must be classified as employees there will likely be a huge contraction in trucking capacity in California ...
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/ 2021 News, Daily News
A Calabasas physician was sentenced to 14 months in federal prison for accepting nearly $800,000 in bribes and kickbacks as part of a conspiracy that unlawfully billed the worker's compensation system for compounded medication prescriptions.

Dr. Amir Friedman, 56, pleaded guilty in October 2019 to one count of conspiracy to commit honest services mail and wire fraud, and to violate the Travel Act, a federal law that - among other things - forbids the use of the U.S. mail for the purpose of aiding bribery.

Friedman, a licensed anesthesiologist, violated the fiduciary duty he owed to his patients by accepting kickbacks and bribes for writing prescriptions for compounded medications for his patients.

Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.

From August 2013 to May 2015, Friedman conspired with New Age Pharmaceuticals Inc., a Beverly Hills-based company, and a marketer - listed in court documents as "Marketer A" - to violate federal law.

According to a related 2016 indictment, Hootan Melamed allegedly operated and was the de facto owner of New Age Pharmaceuticals Inc.. He also had business interests in other pharmacies, including RoxSan Pharmacy Inc., Concierge Compounding Pharmaceuticals, Inc , Alexso, Inc. and Portland Professional Pharmacy, Melamed entered into a plea agreement in 2020, and was sentenced to 6 months in prison on March 29, 2021.

Insurance companies under the California Workers’ Compensation System reimbursed New Age for dispensing prescription drugs and other pharmaceuticals. Marketer A was paid commissions for facilitating the referral of compounded drug prescriptions.

Marketer A provided pre-printed prescription pads for compounded drugs to Friedman and offered Friedman kickbacks and bribes for each prescription he wrote. After Friedman wrote the kickback-tainted prescriptions, New Age dispensed the compounded drugs, billed insurance companies for reimbursement and shipped through the mail the compounded drugs to patients.

In total, Friedman accepted $788,140 in kickbacks and bribes - a sum he received in the form of approximately 28 check payments that represented illicit proceeds from the conspiracy. He admitted in his plea agreement that he was aware that the compounded drugs he prescribed were far more expensive than equivalents.

The FBI investigated this matter. Assistant United States Attorney Poonam G. Kumar of the Major Frauds Section prosecuted this case ...
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/ 2021 News, Daily News
The National Academy of Social Insurance is a non-profit, non-partisan organization made up of the nation’s leading experts on social insurance. Its mission is to advance solutions to challenges facing the nation by increasing public understanding of how social insurance contributes to economic security.

Social insurance encompasses broad-based systems that help workers and their families pool risks to avoid loss of income due to retirement, death, disability, or unemployment, and to ensure access to health care.

The Academy just published its Workers’ Compensation Benefits, Costs, and Coverage - 2019 Data. These data range from benefits, costs, and coverage to Department of Labor data on injuries and fatalities, and data on the overlaps between Social Security disability insurance and the workers’ compensation system. This latest report is issued annually by the National Academy of Social Insurance.

Drawing on data from surveys of workers’ compensation agencies from all 50 states and the District of Columbia, as well as from A.M. Best and the National Council on Compensation Insurance, this is the only report of its kind available free-of-charge for researchers and students, state and federal agencies, workers’ rights and employer advocates, and others.

While overall, total benefits paid rose slightly over the five-year study period from 2015 to 2019, standardized benefits fell, continuing a ten-year trend. Total benefits paid rose 0.4%. Cash benefits increased by 2.0%, but medical benefits declined by 1.1%. Standardized cash and medical benefits fell by 14.0% and 16.7%, respectively, combining for a 15.4% decline in total standardized benefits between 2015 and 2019.

While medical benefits as a share of total benefits have increased in recent decades (with the share attributable to cash benefits shrinking), the national average masks enormous variation across states. In 2019, for example, medical benefits constituted 49.6% of all workers’ compensation benefits paid out, yet they are only 29.8% of benefits in D.C. and 79.1% of benefits paid in Wisconsin.

There are considerable cross-state differences within standardized benefits, where only one state, Hawaii, saw an increase over the study period. Declines ranged from 2.4% in Massachusetts to 30.5% in Tennessee and 33.1% in Oklahoma. Over that period, 24 states observed standardized benefit declines exceeding 15%, and 11 of those states, exceeding 20%.

Total employer costs for workers’ compensation in 2019 were $100.2 billion.

Like benefits, standardized employer costs vary substantially across states from the 15.0% national-average decline over the study period. In Hawaii, standardized costs rose by 1.9%. Decreases in the other states range from 4.5% in Massachusetts to 30.8% in Oklahoma and a massive 40.2% figure in Tennessee. In all, standardized costs declined by more than 15% in 31 states, and by more than 20% in 13 states.

Coverage continued to increase, largely because the labor force has continued to expand, a fairly consistent trend, at very different rates. The only five exceptions are Alaska, Louisiana, North Dakota, West Virginia, and Wyoming. Even in those states, covered wages increased.

In 2019, workers’ compensation covered 144,407,000 jobs across the country, with a total of $8.6 billion in covered wages. Measured by covered jobs, workers’ compensation coverage increased by 3.2% from 2015 to 2017, and by 2.8% in the following two years, for a total increase of 6.2%.

Certain source data are available upon request to Griffin Murphy, gmurphy@nasi.org, or Jay Patel, jpatel@nasi.org ...
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/ 2021 News, Daily News
Mitchell, Genex and Coventry announced the creation of their new parent brand, Enlyte. The three businesses have been moving towards this unification since the merger of Mitchell and Genex in 2018, followed by the acquisition of Coventry in 2020.

Mitchell International, Inc. delivers smart technology solutions and services to the auto insurance, collision repair and workers' compensation markets. Each month, Mitchell processes tens of millions of transactions for more than 300 insurance providers, 20,000 collision repair facilities and 70,000 pharmacies.

Genex serves the top underwriters of workers' compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis.

Coventry Workers' Comp Services offers workers' compensation, provider network and specialty network solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 35 years of industry experience, knowledge, and data analytics.

The announcement said that this new alignment allows the family of businesses to better serve the industry with a holistic point of view and expanded reach, while remaining focused on the individual needs of clients in the Auto Physical Damage, Auto Casualty, Workers' Compensation and Disability spaces.

"We are so pleased to share the exciting work our people have been doing to bring our family of businesses even closer together," said CEO, Alex Sun. "Uniting our teams under Enlyte will make it easier for us to help customers manage costs while delivering quality service with an expansive collection of Mitchell, Genex and Coventry solutions from first-notice-of-loss to recovery."

The new team will be led by Nina Smith, who currently serves as Executive Vice President and General Manager of Mitchell's Casualty Solutions Group.

The changes were shared yesterday with an invite-only audience of Mitchell, Genex and Coventry customers at the 2021 Virtual mPower Conference. Attendees were given a first-look at the new brand, and heard directly from Sun and other leaders about the new organization and the promise of a future united. "Aligning under a single, unified brand, while keeping the greatness of our legacy companies, reminds us that we must continue to deliver on our strategic vision of bringing an ever-expanding set of capabilities that positively impact claims outcomes."

The three businesses have a combined organization of nearly 6,000 associates committed to simplifying and optimizing property, casualty and disability claims processes and services.
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/ 2021 News, Daily News
The California Attorney General announced the filing of criminal charges in Sacramento County Superior Court against Alma Hernandez and Jose Moscoso as a result of a multiagency investigation by the Tax Recovery in the Underground Economy (TRUE) Task Force.

Investigators say the leader of SEIU California and her husband embezzled from a union-run PAC and lied on their taxes for half a decade. Facing multiple felonies, Alma Hernandez resigned her union post Wednesday. SEIU California represents over 700,000 employees in every county of the state.

The California Department of Justice’s Bureau of Investigation began looking into the married couple after an investigation by the Fair Political Practices Commission revealed Hernandez, who was the Executive Director of SEIU California, allegedly embezzled money from an SEIU California-sponsored political action committee (PAC).

The California Franchise Tax Board uncovered alleged underreporting of Hernandez's and Moscoso's income from 2014 to 2019. The Employment Development Department (EDD) also identified that Moscoso’s air duct cleaning business allegedly failed to report employees’ wages from 2017 to 2020.

Hernandez previously served as the treasurer of the Working Families for Solorio for Senate 2014 PAC. The complaint alleges that in October 2014, two checks totaling $11,700 were approved by Hernandez and issued by the PAC’s bank account to Moscoso for services he did not provide.

According to the complaint, Moscoso and Hernandez also allegedly filed false joint income tax returns when they underreported $1,427,874 of income to the FTB for tax years 2014 through 2018. The couple are alleged to owe $143,483 in unpaid income tax.

According to court documents, Moscoso allegedly did not disclose to EDD that he employed multiple individuals to work in his air duct cleaning business, resulting in more than $300,000 in unreported wages. Additionally, from 2017 through 2020, Moscoso allegedly failed to file quarterly reports with EDD and failed to pay more than $16,000 in employment taxes.

It would be reasonable to assume that perhaps workers' compensation premium fraud arose out of the payroll fraud. However, the Attorney General did NOT include workers' compensation premium fraud as a charge. It is not known if it was investigated or ruled out.

Hernandez faces two counts of grand theft, one count of perjury and five counts of filing a false income tax return with intent to evade.

Moscoso is also charged with five counts of filing a false income tax return with intent to evade, one count of failure to file a report with the Employment Development Department, one count of failure to pay unemployment insurance and training tax, one count of failure to pay disability insurance, one count of failure to file employment tax returns with intent to evade paying taxes, and one count of failure to collect and pay personal income tax.

Both Hernandez and Moscoso are charged with a special allegation of aggravated white collar crime with loss over $100,000.

Arraignment has been set for Friday morning in Sacramento County Superior Court ...
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/ 2021 News, Daily News
The Division of Workers’ Compensation has posted the 2020 DWC Audit Unit annual report on its website. The Audit Unit annual report provides information on how claims administrators audited by the DWC performed and includes the Administrative Director’s ranking report for audits conducted in calendar year 2020.

The DWC Audit & Enforcement Unit completed 60 audits, of which 33 were routinely selected for PAR. In addition, another 27 audits were selected, of which three were target audits based on the failure of a prior audit, and 24 audits were based on credible referrals and/or complaints filed with the Audit Unit. The PAR audit subjects consisted of 9 insurance companies, 11 self-administered/self-insured employers, 33 third-party administrators (TPA), and seven insurance companies/third-party administrators that combined claims-adjusting locations.

The DWC Administrative Director’s 2020 Audit Ranking Report lists, in ascending order by performance rating, the administrators audited in calendar year 2020. Congratulations to the following who were ranked among the top 10 administrative entities at the end of this years Audit:

1. RICA & RICC - Republic Indemnity / Calabasas
2. Sedgwick Claims Management Services / Rancho Cordova
3. City of Glendale / Glendale
4. The Traveler's Companies, Inc. / Rancho Cordova
5. Golden State Risk Management Authority / Willows
6. ICW Group / San Diego
7. Matrix Absence Management, Inc. / Santa Clara
8. Athens Administrators / Concord
9. Murphy & Beane, Inc. / Culver City
10. City of Santa Monica / Santa Monica

Twenty-one audit subjects (64%) met or exceeded the PAR 2020 performance standard and therefore had no penalty citations assessed. However, these audit subjects were ordered to pay all unpaid compensation.

Twelve audit subjects (36%) failed to meet or exceed the PAR standard, and their audits expanded into full compliance audits of indemnity claims (FCA stage 1).

Five of them failed to meet or exceed the FCA 2020 performance standard, and their audits expanded into full compliance audits of indemnity claims (FCA stage 2), and samples of denied claims to be audited were added. These audit subjects were assessed administrative penalties for all penalty citations.

The other seven met or exceeded the FCA 2020 performance standard and therefore had penalty citations assessed for unpaid and late payment of indemnity ...
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/ 2021 News, Daily News
Over the past weekend, Southwest Airlines canceled more than 2,000 flights. The mass flight cancellations sparked unsubstantiated claims from some social media users and politicians, including Texas Senator Ted Cruz, that pilots and air traffic controllers had either walked off their jobs or called in sick to protest federal vaccination mandates.

"Joe Biden's illegal vaccine mandate at work!" Cruz tweeted Sunday. "Suddenly, we're short on pilots & air traffic controllers. #ThanksJoe."

Southwest said that bad weather and air traffic control issues were to blame for the cancellations. Southwest, the Southwest Airlines Pilots Association and Federal Aviation Administration have all denied there is any truth to the theories that employee pushback was to blame for the weekend's issues. Both the company and union have not said how many of the airline's employees missed work over the past weekend.

Notwithstanding theories about the massive flight cancellations, this October Southwest Airlines Pilots Association (SWAPA) filed a motion for temporary and preliminary injunctive relief against Southwest's newly announced vaccination mandate in its ongoing lawsuit with Southwest Airlines, initially filed on Aug. 30, and then amended on October 6.

Neither Southwest Airlines or the Southwest Airlines Pilots Association know how many pilots remain unvaccinated against COVID-19, according to union president Casey Murray. The airline told employees last week that they would be required to get the vaccine by December 8, leaving less than two months to enforce the requirement.

The original complaint asserts the airlines are in violation of the Railway Labor Act (RLA), among other things, Sec. 6, which requires the parties to maintain "status quo" until a new agreement is reached. The lawsuit maintains that the carrier can not alter pay rates, rules, and working conditions until a new agreement is reached.

SWAPA alleges that "Most recently, on Oct. 4, 2021, Southwest Airlines unilaterally rolled out a new and non-negotiated COVID vaccine mandate for all employees, including SWAPA. The new vaccine mandate unlawfully imposes new conditions of employment, and the new policy threatens termination of any pilot not fully vaccinated by Dec. 8, 2021. Southwest Airlines’ additional new and unilateral modifications of the parties’ collective bargaining agreement is in clear violation of the RLA."

"The new vaccine mandate unlawfully imposes new conditions of employment and the new policy threatens termination of any pilot not fully vaccinated by December 8, 2021," the Southwest Airlines Pilots Association’s lawyers wrote in their legal filing. "Southwest Airlines’ additional new and unilateral modification of the parties’ collective bargaining agreement is in clear violation of the [Railway Labor Act]."

The amended complaint has two counts. Count I, "Failure to Maintain the Status Quo During the Ongoing ‘Major’ Dispute," and Count II, "Failure to Exert Every Reasonable Effort to Reach Agreement."

In a statement on the union’s website, its leadership stipulates: "We want to be perfectly clear: SWAPA is not anti-vaccination, but we do believe that, under all circumstances, it is our role to represent the health and safety of our Pilots and bring their concerns to the company."

A Southwest spokesperson told The Epoch Times that the firm "disagrees with SWAPA’s claims that any COVID-related changes over the past several months require negotiation" and "remains committed to [it’s] employees’ health and welfare and to working with SWAPA, and our other union partners, as we continue navigating the challenges presented by the ongoing pandemic." ...
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/ 2021 News, Daily News
A Los Angeles County Superior Court judge has dismissed felony fraud and grand theft charges against a Baldwin Park Unified School District employee accused of misrepresenting her COVID-19 symptoms to collect more than $33,000 in workers’ compensation benefits.

Judge Craig Richman cited a lack of evidence in dismissing the case against Stephanie Medrano, who was charged with two felony charges of insurance fraud and one felony charge of grand theft. Deputy District Attorney Melinda Murray supported the judge’s decision at Medrano’s preliminary hearing on Oct. 8.

She was charged with multiple counts of grand theft and insurance fraud after allegedly making misrepresentations following a COVID-19 diagnosis in an attempt to collect over $33,000 in undeserved workers’ compensation insurance benefits.

The California Department of Insurance launched an investigation after receiving a claim of suspected fraud from Medrano’s employer, the Baldwin Park Unified School District, on August 21, 2020.

Investigators claimed Medrano made multiple misrepresentations in order to extend a workers’ compensation insurance claim submitted to her employer after she was diagnosed with COVID-19.

Medrano was reportedly exposed to COVID-19 while in the workplace and subsequently filed a workers’ compensation claim. She told her employer that she self-quarantined from July 6, 2020 to August 3, 2020, and reported she only left her house twice to buy medicine for her mother and sister, who were also diagnosed with COVID-19. Medrano reported her symptoms related to the COVID-19 diagnosis were so severe she was unable to work.

The investigation found that during the time Medrano claimed she was self-quarantining, she was seen shopping at multiple stores for several hours a day and interacting with people from outside her immediate household without face masks.

Further, investigators uncovered that Medrano traveled to Lake Havasu with people who live outside her household just two days after she reported she was still experiencing symptoms to the doctor overseeing her claim.

Judge Richman found no relevance to the fact Medrano went grocery shopping and on a weekend getaway the weekend before she returned to work, said Medrano’s attorney, Warren Ellis. He solely blames the school district, which is self-insured, for the misguided prosecution of his client.

The Pasadena Star reports that the prosecutor, declined to comment Tuesday, as did officials at the California Department of Insurance, which disseminated a press release following Medrano’s arraignment in February, claiming their investigation and Medrano’s subsequent arrest thwarted the potential loss of $33,516 to the school district. Officials at the Baldwin Park Unified School District also did not respond to a request for comment on Tuesday ...
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/ 2021 News, Daily News
Sanjoy Banerjee M.D.provided billings and doctor’s reports concerned medical services to workers' compensation patients through three entities that Banerjee owned and operated from a single location in Wildomar California: (1) Sanjoy Banerjee, M.D., Inc., doing business as Pacific Pain Care Consultants (PPCC); (2) Kensington Diagnostics, LLC (Kensington); and (3) Rochester Imperial Surgical Center, LLC (Rochester).

Banerjee presented billings totaling $157,797.01 to Berkshire Hathaway Homestate Companies payable pursuant to the state’s workers’ compensation system, through Kensington and Rochester, for services that Banerjee provided to patients between 2014 and 2016. BHHC paid less than 10 percent of the $157,797.01 amount billed.

Each doctor’s report included the following attestation near the end of the report: "I have not violated Labor Code section 139.3, and the contents of this report and bill are . . . true and correct to the best of my knowledge. This statement is made under penalty of perjury."

Banerjee was charged with two counts of insurance fraud and three counts of perjury. The charges are based on Banerjee’s alleged violations of Labor Code section 139.3(a), which prohibits physician self referrals to entities where the physician owns a specified financial interest.

According to a BHHC investigator who testified as the only witness at his preliminary hearing, Banerjee was obligated to disclose his financial interests in Kensington and Rochester to BHHC, and BHHC had no business records indicating that Banerjee had made this disclosure.

The superior court denied Banerjee’s motion to dismiss the information as unsupported by reasonable or probable and set a trial on the merits. The Court of Appeal granted his petitions for a writ of prohibition and dismissed the perjury charges, but rejected the petition to the fraud charges (for overbilling) in the published case of Banerjee v. Superior Court.

To date, no published court decision has interpreted Labor Code sections 139.3 or 139.31. The statutes were enacted in 1993 as part of Assembly Bill No. 110, part of a comprehensive package of legislation that reformed the state’s workers’ compensation laws. It was intended to reduce costs and strengthen conflict of interest rules in the workers’ compensation system.

Section 139.3(a) makes it unlawful for a physician to refer a person for specified services "if the physician or his or her immediate family has a financial interes with the person or in, the entity that receives the referral." A violation of section 139.3(a) is a misdemeanor.

Section 139.31(e) provides: "The prohibition of section 139.3 shall not apply to any service for a specific patient that is performed within, or goods that are that are supplied by, a physician’s office, or the office of a group practice. . . ." The Court's interpretation of section 139.31(e) means that the physician’s office exception applies to Banerjee’s financially interested "self-referrals" to his two other legal entities since they are both located in his same Widomar office. Since his alleged violations of section 139.3(a) was the only basis to support the perjury charges, the perjury charges must be dismissed.

The record also supports a strong suspicion that Kensington and Rochester were sham entities, and that Banerjee formed Kensington and Rochester with the specific intent to defraud BHHC through his Kensington and Rochester billings. The Kensington and Rochester billings gave the appearance that the entities were not part of Banerjee’s medical practice but were stand alone, diagnostic testing and surgical centers, operating independently of any physician’s office.

Even though the evidence does not show that Banerjee violated section 139.3(a), the evidence supports a strong suspicion that Banerjee specifically intended to present false and fraudulent claims for health care benefits, in violation of Penal Code section 550, subdivision (a)(6), by billing the workers’ compensation insurer substantially higher amounts through his two other legal entities, between 2014 and 2016, than he previously and customarily billed the insurer for the same services he formerly rendered through his professional corporation and his former group practice.

Thus, the Court granted the writ as to the perjury charges but denied it as to the insurance fraud charges ...
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/ 2021 News, Daily News
The Division of Workers' Compensation has launched an update to the online physician education course, "Evaluating California’s Injured Workers: Qualified Medical Evaluators." This course is strongly recommended for all California Qualified Medical Evaluators. It is available to the public and is especially valuable for attorneys, claims administrators and medical providers participating in the California workers' compensation system.

"Evaluating California's Injured Workers: Qualified Medical Evaluators" is an educational module developed for medical doctors, chiropractors and nurses. QMEs play a critical role in resolving disputes within the workers' compensation system.

The online education will cover:

- - How to prepare for an evaluation and outline the components of a quality report
- - The concept of apportionment and how to apportion to causation of disability
- - What constitutes substantial medical evidence and how it applies to apportionment
- - Potential bias and how to avoid it in your medical-legal reports
- - Administrative regulations to stay in compliance as a QME

This activity has been approved for AMA PRA Category 1 Credit as well as 2 hours of QME continuing education credit.

Access to the physician education module can be found on the DWC website. Also, available on the website is an education module, “Caring for California's Injured Workers: Using California's Medical Treatment Utilization Schedule (MTUS).”

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the California Medical Association (CMA) through the joint providership of the Center for Occupational and Environmental Health (COEH) and State of California Department of Industrial Relations’ Division of Workers’ Compensation. The Center for Occupational and Environmental Health is accredited by the CMA to provide continuing medical education for physicians.

The Center for Occupational and Environmental Health designates this enduring material for a maximum of 2 AMA PRA category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity ...
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/ 2021 News, Daily News
The Los Angeles Times reports that a group of 500 Los Angeles firefighters filed a lawsuit Friday against the city over its requirement that L.A. employees be vaccinated against COVID-19.

The lawsuit, filed in Los Angeles County Superior Court, claims the city’s mandate is a violation of employees’ constitutionally protected autonomous privacy rights.

The lawsuit was filed on behalf of the Firefighters 4 Freedom Foundation, a nonprofit representing 529 members, said Kevin McBride, the group’s attorney.

The firefighters are "pawns in a political chess match, ordered by thirteen politicians on the Los Angeles City Council to inject themselves with an experimental vaccine - over their objections - or lose their jobs," the lawsuit states.

A group of employees in the Los Angeles Police Department also sued last week over the vaccination mandate.

The city of L.A. moved to require city employees to be fully vaccinated against COVID-19 by early October, while granting exemptions to employees with medical conditions or "sincerely held religious beliefs."

More than 460 exemption requests have been submitted by LAFD employees, according to city data - a number equal to 12.5% of the department workforce. However, it is possible that some employees may have turned in multiple requests.

The lawsuit filed Friday claims that the city mandate violates the firefighters’ right to privacy under the California Constitution. It seeks a temporary restraining order prohibiting the city’s vaccination mandate from going into effect until a preliminary injunction hearing and further order of the court.

The lawsuit alleges the city doesn’t have the power to "order forced vaccinations of its employees or residents" and that "the vaccine mandate is both unnecessary and ineffective in protecting the public."

A LAFD spokesman told The Times on Friday that 58.5% of the sworn members have been fully vaccinated and 66% have received at least one dose.

The total number of LAFD employees who have tested positive for COVID-19 is 1,079, according to city data. A total of 1,056 LAFD employees have recovered and returned to duty. Two firefighters have died after contracting COVID-19.

City Atty. Mike Feuer said he was confident the city would prevail. "The U.S. Supreme Court and courts across the country have upheld vaccination mandates by government and they’ve done so because they said the greater good compels it," Feuer said. "The greater good compels this right now." ...
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/ 2021 News, Daily News
In a sweeping expansion of existing law, Fisher Phillips reports that Governor Gavin Newsom signed legislation that broadly prohibits non-disclosure clauses in settlement agreements involving workplace harassment or discrimination on any protected bases, not just sex.

SB 331 - known as the "Silenced No More Act" - takes what state lawmakers believe will be a final stand against employers preventing employees from discussing unlawful acts in the workplace. The new law, which takes effect on January 1, 2022, will nullify and make void provisions within any agreement entered on or after that date that prevent or restrict an employee from disclosing factual information on any type of harassment, discrimination, or retaliation.

SB 331 builds on SB 820, also known as the STAND (Stand Together Against Non-Disclosure) Act, which California passed in 2018 in response to the #MeToo movement. To address what advocates of the movement coined as "secret settlements" used to cover up cases of sexual harassment involving high-profile executives, the STAND Act prohibited the use of confidentiality provisions in settlement agreements for actions including claims based on sex. As such, for several years, the STAND Act has allowed employees to discuss factual information relating to sexual harassment in the workplace.

Primarily, SB 331 amends Code of Civil Procedure Section 1001 (previously enacted by SB 820 in 2018) to expand the prohibition of confidentiality provisions in agreements entered into on or after the effective date for all acts of workplace discrimination or harassment, not only based on sex. For example, this includes acts based on race, religion, color, national origin, ancestry, disability, medical condition, familial status, sex, gender, age and other protected characteristics as described in various subdivisions of Sections 12940 and 12955 of the Government Code.

With its substantial changes, the new law importantly preserves the existing protection against disclosure of the settlement amount. While employees may discuss the underlying facts of the case, employers can still insist on clauses that prevent disclosure of the amount of money paid to settle the claim. Therefore, employers remain somewhat shielded against current and former employees "piggybacking" off a settlement with the aim of seeking a similar payout.

As another slight reprieve, employers may still include non-disparagement clauses or similar provisions in agreements provided there is specific language stating the employee’s right to disclose information about unlawful acts in the workplace. Absent that language, the provision would be against public policy and unenforceable. Certainly, crafting such language to ensure enforceability is best handled by consulting with legal counsel.

For those employees with privacy concerns who wish to protect themselves against public attention, the Silenced No More Act leaves untouched the exception allowing claimants to maintain privacy. Therefore, at the request of the claimant, a settlement agreement may still include a provision that shields the claimant’s identity and all facts that could lead to the discovery of their identity. Consistent with prior law, this exception does not apply if a government agency or public official is a party to the settlement agreement ...
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/ 2021 News, Daily News