myMatrixx Chief Clinical Officer, Phil Walls, was joined by Marcos Iglesias MD, Chief Medical Director of the Travelers and Constitution State Services to discuss the interaction between behavioral health and chronic pain management in workers’ compensation.
The presentation, Navigating the Intersection of Pain Management and Psychotropic Drugs, was held as part of the National Workers’ Compensation and Disability Conference’s (NWCDC) ongoing Digital Sessions Series.
During the panel, the two experts examined the types of psychotropic drugs that claims professionals most commonly encounter, including those used off-label, and effective strategies for managing safety and cost considerations.
Mental health is a growing concern that requires more attention - only 40% of the 39 million adults in the United States who experience a mental health event actually receive treatment.
In workers’ compensation, where so many injured workers deal with chronic pain, treated and untreated mental health conditions are associated with high claim costs over long periods of time.
According to Walls and Dr. Iglesias, certain drug combinations, such as opioids and benzodiazepines, require particular attention from both a patient safety and cost standpoint.
Another key topic in the presentation was off-label drug use. According to research, 73% of medications prescribed for an off-label use, such as using a drug for longer than indicated or to treat a different condition, had poor or no scientific support.
You can view the presentation in full and download slides on the NWCDC website ...
The presentation, Navigating the Intersection of Pain Management and Psychotropic Drugs, was held as part of the National Workers’ Compensation and Disability Conference’s (NWCDC) ongoing Digital Sessions Series.
During the panel, the two experts examined the types of psychotropic drugs that claims professionals most commonly encounter, including those used off-label, and effective strategies for managing safety and cost considerations.
Mental health is a growing concern that requires more attention - only 40% of the 39 million adults in the United States who experience a mental health event actually receive treatment.
In workers’ compensation, where so many injured workers deal with chronic pain, treated and untreated mental health conditions are associated with high claim costs over long periods of time.
According to Walls and Dr. Iglesias, certain drug combinations, such as opioids and benzodiazepines, require particular attention from both a patient safety and cost standpoint.
Another key topic in the presentation was off-label drug use. According to research, 73% of medications prescribed for an off-label use, such as using a drug for longer than indicated or to treat a different condition, had poor or no scientific support.
You can view the presentation in full and download slides on the NWCDC website ...
The Department of Industrial Relations and its California Labor Commissioner's Office has launched a web-based tool in English and Spanish that offers key information on the new 2021 COVID-19 Supplemental Paid Sick Leave law, Senate Bill No. 95, signed by Governor Newsom on March 19.
"The 2021 Supplemental Paid Sick Leave law provides workers up to 80 hours of paid sick leave if they or a family member are unable to work or telework due to COVID-19, including for vaccine-related reasons," said Labor Commissioner Lilia García-Brower. "We designed this tool so workers and their employers can get information on workers' paid sick leave options."
The law, which went into effect on March 29 and is retroactive to January 1, 2021, requires that California workers are provided up to two weeks of supplemental paid sick leave if they are affected by COVID-19. Among the key updates in the new legislation, leave time now also applies to attending a COVID-19 vaccine appointment and recovering from symptoms related to the vaccine. The new law is in effect until September 30, 2021. Small businesses employing 25 or fewer workers are exempt from the law but may offer supplemental paid sick leave and receive a federal tax credit, if eligible.
The navigator tool, available in English and Spanish, helps workers and employers confirm if they are eligible for COVID-19 supplemental paid sick leave by answering short simple questions on the impact COVID-19 is having on an employee's ability to work. Workers and employers need not provide a name or other personal details to determine eligibility. In addition, Supplemental Paid Sick Leave FAQs are posted online in English and Spanish.
In the FAQs, workers can find information on:
- - Required circumstances for taking COVID-19 leave
- - How to request paid sick leave from your employer
- - Where to file a claim if you were not paid for leave
- - What rights you have as a covered employee
Employers can find information on:
- - When must employers pay COVID-19 sick leave
- - Calculating leave time for full-time and part-time employees
- - Requirements for informing employees about the new law
- - How to calculate and list paid leave on pay stubs
The law also includes unique provisions for firefighters. The law defines what constitutes an "active" firefighter and it identifies the member firefighter agencies covered under SB 95.
Employees may also be eligible for workers' compensation benefits if they believe their COVID-19 illness is work-related. In that instance, workers should tell their employers about their work-related illness as soon as possible and file a workers' compensation claim, which pays for medical treatment and partial wages during recovery. For support, please contact the Division of Workers' Compensation's Information and Assistance Unit or call 1- 909-383-4341.
Workers whose employers refuse to provide paid sick leave or COVID-19 supplemental paid sick leave as required by law, or prevent workers from accessing paid sick hours, are encouraged to call the Labor Commissioner's Office at 833-LCO-INFO (833-526-4636) to file a wage claim.
The Department of Industrial Relations' Division of Labor Standards Enforcement, or the California Labor Commissioner's Office, combats wage theft and unfair competition by investigating allegations of illegal and unfair business practices. Californians can follow the Labor Commissioner on Facebook and Twitter ...
"The 2021 Supplemental Paid Sick Leave law provides workers up to 80 hours of paid sick leave if they or a family member are unable to work or telework due to COVID-19, including for vaccine-related reasons," said Labor Commissioner Lilia García-Brower. "We designed this tool so workers and their employers can get information on workers' paid sick leave options."
The law, which went into effect on March 29 and is retroactive to January 1, 2021, requires that California workers are provided up to two weeks of supplemental paid sick leave if they are affected by COVID-19. Among the key updates in the new legislation, leave time now also applies to attending a COVID-19 vaccine appointment and recovering from symptoms related to the vaccine. The new law is in effect until September 30, 2021. Small businesses employing 25 or fewer workers are exempt from the law but may offer supplemental paid sick leave and receive a federal tax credit, if eligible.
The navigator tool, available in English and Spanish, helps workers and employers confirm if they are eligible for COVID-19 supplemental paid sick leave by answering short simple questions on the impact COVID-19 is having on an employee's ability to work. Workers and employers need not provide a name or other personal details to determine eligibility. In addition, Supplemental Paid Sick Leave FAQs are posted online in English and Spanish.
In the FAQs, workers can find information on:
- - Required circumstances for taking COVID-19 leave
- - How to request paid sick leave from your employer
- - Where to file a claim if you were not paid for leave
- - What rights you have as a covered employee
Employers can find information on:
- - When must employers pay COVID-19 sick leave
- - Calculating leave time for full-time and part-time employees
- - Requirements for informing employees about the new law
- - How to calculate and list paid leave on pay stubs
The law also includes unique provisions for firefighters. The law defines what constitutes an "active" firefighter and it identifies the member firefighter agencies covered under SB 95.
Employees may also be eligible for workers' compensation benefits if they believe their COVID-19 illness is work-related. In that instance, workers should tell their employers about their work-related illness as soon as possible and file a workers' compensation claim, which pays for medical treatment and partial wages during recovery. For support, please contact the Division of Workers' Compensation's Information and Assistance Unit or call 1- 909-383-4341.
Workers whose employers refuse to provide paid sick leave or COVID-19 supplemental paid sick leave as required by law, or prevent workers from accessing paid sick hours, are encouraged to call the Labor Commissioner's Office at 833-LCO-INFO (833-526-4636) to file a wage claim.
The Department of Industrial Relations' Division of Labor Standards Enforcement, or the California Labor Commissioner's Office, combats wage theft and unfair competition by investigating allegations of illegal and unfair business practices. Californians can follow the Labor Commissioner on Facebook and Twitter ...
A Reuters analysis shows that new cases of COVID-19 in the United States fell 16% last week to about 409,000, the biggest percentage drop in weekly new cases since February, according to a Reuters analysis of state and county data.
Deaths from COVID-19 fell 4% to 4,972 in the week ended April 25, dropping below 5,000 for the first time since October.
Michigan still led the states in new cases per capita, though new infections fell 29% last week compared to the previous seven days. New cases also fell by over 20% in New Jersey and Pennsylvania, the states with the next highest rates of infection based on population. (Graphic with state-by-state details) tmsnrt.rs/2WTOZDR
New infections are still rising on a weekly basis in 12 out of 50 states, down from 30 states last month. The states with the biggest percentage increases are Tennessee, Oregon and Arizona.
As of Sunday, 43% of the U.S. population has received at least one dose of a COVID-19 vaccine, and 29% was fully vaccinated, according to the Centers for Disease Control and Prevention.
Nationally, the pace of vaccinations fell 14% from the previous week to an average of 2.7 million shots per day.
The average number of COVID-19 patients in hospitals across the country held steady at about 41,000, according to the Reuters analysis ...
Deaths from COVID-19 fell 4% to 4,972 in the week ended April 25, dropping below 5,000 for the first time since October.
Michigan still led the states in new cases per capita, though new infections fell 29% last week compared to the previous seven days. New cases also fell by over 20% in New Jersey and Pennsylvania, the states with the next highest rates of infection based on population. (Graphic with state-by-state details) tmsnrt.rs/2WTOZDR
New infections are still rising on a weekly basis in 12 out of 50 states, down from 30 states last month. The states with the biggest percentage increases are Tennessee, Oregon and Arizona.
As of Sunday, 43% of the U.S. population has received at least one dose of a COVID-19 vaccine, and 29% was fully vaccinated, according to the Centers for Disease Control and Prevention.
Nationally, the pace of vaccinations fell 14% from the previous week to an average of 2.7 million shots per day.
The average number of COVID-19 patients in hospitals across the country held steady at about 41,000, according to the Reuters analysis ...
The FDA has cleared two Brainlab AG surgical robots: the Loop-X Mobile Imaging Robot and the Cirq Robotic Alignment Module, a robotic surgical system for spine procedures. The clearances follow CE mark approvals last summer.
Claiming the "first fully robotic intraoperative imaging device on the market," the company said the Loop-X's independently moving imaging source and detector panels, "enable flexible patient positioning and non-isocentric imaging which reduces the amount of radiation exposure and increases the variety of indications which can be treated." The mobile imaging robot can be controlled wirelessly with a touchscreen tablet.
The Cirq Robotic Alignment Module, according to December 2020 FDA clearance documents, is intended to be an intraoperative image guided localization system "to support the surgeon to achieve pre-planned trajectories with surgical instruments." The indications for use of the CIRQ module for spinal use "is the treatment of diseases where the placement of spinal screws is indicated."
The company says the module is capable of "fine tuning the alignment to a pre-planned trajectory and freeing up surgeons’ hands, enabling them to focus on the patient’s anatomy." The module has already been used by surgeons at Royal London Hospital for cases ranging from lumbar fusions to complex deformity and cervical fractures.
According to the FDA documents, the module is connected to the Surgical BaseSystem from Germany-based Medineering GmbH and aligns instruments to a pre-planned trajectory during surgical procedures using the Cirq Robotic Application Software together with the Brainlab IGS Spinal software applications.
Infrared passive marker-based tracking provided by the optical tracking camera unit of the navigation platform is used to determine the instrument’s and patient’s position. The relation between the patient and the reference attached to the patient is realized with a manual or automatic registration (manually or automatically).
The device is manually pre-aligned to the region of interest by opening the brakes of the Surgical Base System using its "7 degrees of freedom." The tracking information is used to automatically fine align a tracked guide attached to the Cirq Robotic Alignment Module to "achieve a pre-planned trajectory" controlled by the application software. After finishing the alignment, the device remains in this position and the surgeon "can use surgical instruments through the provided guide to perform the surgical steps intended without losing the trajectory."
Brainlab was founded in 1989, employs more than 1,500 people in 20 offices and is present in over 5,600 hospitals in 116 countries ...
Claiming the "first fully robotic intraoperative imaging device on the market," the company said the Loop-X's independently moving imaging source and detector panels, "enable flexible patient positioning and non-isocentric imaging which reduces the amount of radiation exposure and increases the variety of indications which can be treated." The mobile imaging robot can be controlled wirelessly with a touchscreen tablet.
The Cirq Robotic Alignment Module, according to December 2020 FDA clearance documents, is intended to be an intraoperative image guided localization system "to support the surgeon to achieve pre-planned trajectories with surgical instruments." The indications for use of the CIRQ module for spinal use "is the treatment of diseases where the placement of spinal screws is indicated."
The company says the module is capable of "fine tuning the alignment to a pre-planned trajectory and freeing up surgeons’ hands, enabling them to focus on the patient’s anatomy." The module has already been used by surgeons at Royal London Hospital for cases ranging from lumbar fusions to complex deformity and cervical fractures.
According to the FDA documents, the module is connected to the Surgical BaseSystem from Germany-based Medineering GmbH and aligns instruments to a pre-planned trajectory during surgical procedures using the Cirq Robotic Application Software together with the Brainlab IGS Spinal software applications.
Infrared passive marker-based tracking provided by the optical tracking camera unit of the navigation platform is used to determine the instrument’s and patient’s position. The relation between the patient and the reference attached to the patient is realized with a manual or automatic registration (manually or automatically).
The device is manually pre-aligned to the region of interest by opening the brakes of the Surgical Base System using its "7 degrees of freedom." The tracking information is used to automatically fine align a tracked guide attached to the Cirq Robotic Alignment Module to "achieve a pre-planned trajectory" controlled by the application software. After finishing the alignment, the device remains in this position and the surgeon "can use surgical instruments through the provided guide to perform the surgical steps intended without losing the trajectory."
Brainlab was founded in 1989, employs more than 1,500 people in 20 offices and is present in over 5,600 hospitals in 116 countries ...
Precision medicine aims to create specialized treatment regimens that are tailored to each individual’s unique genetics, environment, and lifestyle.
In his 2015 State of the Union address, President Obama announced that he was launching the Precision Medicine Initiative - a bold new research effort to revolutionize how we improve health and treat disease.
Most medical treatments have been designed for the "average patient." As a result of this "one-size-fits-all" approach, treatments can be very successful for some patients but not for others.
Precision Medicine, on the other hand, is an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles. It gives medical professionals the resources they need to target the specific treatments of the illnesses we encounter, further develops our scientific and medical research, and keeps our families healthier.
Today, there are numerous clinical applications of precision medicine that are expected to continue to shape how medicine and research are conducted for years to come. Precision medicine has been particularly successful in targeting various aspects of DNA in the treatment of various diseases, particularly cancer.
Patients with breast, lung, and colorectal cancers, as well as melanomas and leukemias, for instance, routinely undergo molecular testing as part of patient care, enabling physicians to select treatments that improve chances of survival and reduce exposure to adverse effects.
Precision methods are relatively unexplored in trauma patients. New research is being looked at for precision methods to treat patients with large extremity wounds, nonunions, and fractures associated with polytrauma.
Precision-based clinical decision tools are being validated to optimize timing for open wound definitive closure. Early patient-specific biomarkers to stratify nonunion risk within 1 week of fracture are being explored. Patient-specific data to stage timing of major fracture interventions in multiply injured patients are being interrogated ...
In his 2015 State of the Union address, President Obama announced that he was launching the Precision Medicine Initiative - a bold new research effort to revolutionize how we improve health and treat disease.
Most medical treatments have been designed for the "average patient." As a result of this "one-size-fits-all" approach, treatments can be very successful for some patients but not for others.
Precision Medicine, on the other hand, is an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles. It gives medical professionals the resources they need to target the specific treatments of the illnesses we encounter, further develops our scientific and medical research, and keeps our families healthier.
Today, there are numerous clinical applications of precision medicine that are expected to continue to shape how medicine and research are conducted for years to come. Precision medicine has been particularly successful in targeting various aspects of DNA in the treatment of various diseases, particularly cancer.
Patients with breast, lung, and colorectal cancers, as well as melanomas and leukemias, for instance, routinely undergo molecular testing as part of patient care, enabling physicians to select treatments that improve chances of survival and reduce exposure to adverse effects.
Precision methods are relatively unexplored in trauma patients. New research is being looked at for precision methods to treat patients with large extremity wounds, nonunions, and fractures associated with polytrauma.
Precision-based clinical decision tools are being validated to optimize timing for open wound definitive closure. Early patient-specific biomarkers to stratify nonunion risk within 1 week of fracture are being explored. Patient-specific data to stage timing of major fracture interventions in multiply injured patients are being interrogated ...
Last month, the California Department of Fair Employment and Housing provided guidance that gave California employers the green light to make vaccinations a mandatory requirement for return to work, with some exceptions.
The next step is to see what employers will follow this guidance and require vaccinations for return to work.
For more than a year, state university campuses across California have been largely empty and students and professors have been forced to adapt to an online college experience. But the CSU and UC systems have their eyes set on reopening this fall, announcing Thursday they will require Covid-19 vaccines for students and faculty in order to return to campus.
The California State University and the University of California’s vaccination requirements affect more than a million students and faculty across the Golden State.
While ideally the requirement would begin with the fall 2021 term, students and faculty won’t be required to get the jab until the U.S. Food and Drug Administration formally approves one or more of the vaccines on the market for general use. The FDA issued emergency-use authorization for the Pfizer and Moderna Covid vaccines this past December, but the vaccines could receive full approval later this year. Use of the Johnson & Johnson vaccine has been paused pending investigation over reports of rare blood clots.
Immunization requirements are nothing new for California colleges, but students and faculty who return to school in the fall will be in classrooms, libraries, gyms and labs for the first time in a world with Covid-19.
CSU Chancellor Joseph Castro called the approach "the most comprehensive and consequential university plan for Covid-19 vaccines in the country."
UC President Michael Drake, a medical doctor, said in a statement, "Receiving a vaccine for the virus that causes Covid-19 is a key step people can take to protect themselves, their friends and family, and our campus communities while helping bring the pandemic to an end."
While terms of the university system vaccine plan have yet to be finalized, officials announced the plan now to give students, faculty and staff time to prepare. Students will need to update their vaccination records or provide an approved exception or medical exemption before they enroll for their fall semester. University officials say if students are unable to find a vaccination provider on their own, their student health centers might be able to help.
The CSU system boasts over 485,000 students across 20 campuses. The UC system has 10 campuses with over 280,000 students and roughly 227,000 faculty and staff.
News of the university vaccine plan comes as California has one of the lowest case rates in the country.
As of Thursday, roughly 43% of all Californians 16 years and older have received at least one vaccine dose ...
The next step is to see what employers will follow this guidance and require vaccinations for return to work.
For more than a year, state university campuses across California have been largely empty and students and professors have been forced to adapt to an online college experience. But the CSU and UC systems have their eyes set on reopening this fall, announcing Thursday they will require Covid-19 vaccines for students and faculty in order to return to campus.
The California State University and the University of California’s vaccination requirements affect more than a million students and faculty across the Golden State.
While ideally the requirement would begin with the fall 2021 term, students and faculty won’t be required to get the jab until the U.S. Food and Drug Administration formally approves one or more of the vaccines on the market for general use. The FDA issued emergency-use authorization for the Pfizer and Moderna Covid vaccines this past December, but the vaccines could receive full approval later this year. Use of the Johnson & Johnson vaccine has been paused pending investigation over reports of rare blood clots.
Immunization requirements are nothing new for California colleges, but students and faculty who return to school in the fall will be in classrooms, libraries, gyms and labs for the first time in a world with Covid-19.
CSU Chancellor Joseph Castro called the approach "the most comprehensive and consequential university plan for Covid-19 vaccines in the country."
UC President Michael Drake, a medical doctor, said in a statement, "Receiving a vaccine for the virus that causes Covid-19 is a key step people can take to protect themselves, their friends and family, and our campus communities while helping bring the pandemic to an end."
While terms of the university system vaccine plan have yet to be finalized, officials announced the plan now to give students, faculty and staff time to prepare. Students will need to update their vaccination records or provide an approved exception or medical exemption before they enroll for their fall semester. University officials say if students are unable to find a vaccination provider on their own, their student health centers might be able to help.
The CSU system boasts over 485,000 students across 20 campuses. The UC system has 10 campuses with over 280,000 students and roughly 227,000 faculty and staff.
News of the university vaccine plan comes as California has one of the lowest case rates in the country.
As of Thursday, roughly 43% of all Californians 16 years and older have received at least one vaccine dose ...
Cal/OSHA has cited Sierra Pacific Industries $108,300 for workplace safety and health violations after one of its employees was fatally injured when a pipeline on an air compressor exploded.
On September 17, an employee working for Sierra Pacific Industries in Lincoln was setting up a Quincy 300 Compressor when a pipeline on the air compressor exploded. Pieces of the pipeline hit two employees nearby, injuring one and killing another
.
"Working on equipment attached to pressure vessels such as air compressors requires special precautions," said Cal/OSHA Deputy Chief Debra Lee. “Employers must identify and evaluate potential hazards before assigning employees to perform work on this hazardous machinery and equipment."
Cal/OSHA cited Sierra Pacific Industries $108,300 for nine violations, including three serious accident-related, three serious, and three general in nature. The serious accident-related violations were cited for the employer’s failure to:
- - Test the discharge piping prior to operating the Quincy 300 compressor and ensure proper connection
- - Ensure a pressure relieving safety device was installed in the line between the compressor and block valve
- - Ensure all pressure piping for the compressor was designed and fit in accordance with good engineering practice.
The serious violations were cited for the employer’s failure to ensure the energy within the pipeline system was controlled to prevent release during repair, and failure to ensure group lockout/tagout procedures were utilized and employees worked under supervision of a qualified person. The other citations were issued for violations related to uncertified employees welding, failure to establish hazardous energy control procedures and operating equipmentt under conditions of stress.
A serious violation is cited when there is a realistic possibility that death or serious harm could result from the actual hazard created by the violation. Violations are classified as accident-related when the injury, illness or fatality is caused by the violation. Cal/OSHA has extensive information on lock out / tag out requirements online.
Cal/OSHA’s Pressure Vessel Unit is responsible under Labor Code sections 7620-7771 for the permitting and inspection of boilers and tanks, including air compressors. All employers in California are required to have an effective written injury and illness prevention program, and a safety program to identify, assess and control hazards in the workplace. Cal/OSHA has online tools and publications to guide employers on how to establish an effective safety program ...
On September 17, an employee working for Sierra Pacific Industries in Lincoln was setting up a Quincy 300 Compressor when a pipeline on the air compressor exploded. Pieces of the pipeline hit two employees nearby, injuring one and killing another
.
"Working on equipment attached to pressure vessels such as air compressors requires special precautions," said Cal/OSHA Deputy Chief Debra Lee. “Employers must identify and evaluate potential hazards before assigning employees to perform work on this hazardous machinery and equipment."
Cal/OSHA cited Sierra Pacific Industries $108,300 for nine violations, including three serious accident-related, three serious, and three general in nature. The serious accident-related violations were cited for the employer’s failure to:
- - Test the discharge piping prior to operating the Quincy 300 compressor and ensure proper connection
- - Ensure a pressure relieving safety device was installed in the line between the compressor and block valve
- - Ensure all pressure piping for the compressor was designed and fit in accordance with good engineering practice.
The serious violations were cited for the employer’s failure to ensure the energy within the pipeline system was controlled to prevent release during repair, and failure to ensure group lockout/tagout procedures were utilized and employees worked under supervision of a qualified person. The other citations were issued for violations related to uncertified employees welding, failure to establish hazardous energy control procedures and operating equipmentt under conditions of stress.
A serious violation is cited when there is a realistic possibility that death or serious harm could result from the actual hazard created by the violation. Violations are classified as accident-related when the injury, illness or fatality is caused by the violation. Cal/OSHA has extensive information on lock out / tag out requirements online.
Cal/OSHA’s Pressure Vessel Unit is responsible under Labor Code sections 7620-7771 for the permitting and inspection of boilers and tanks, including air compressors. All employers in California are required to have an effective written injury and illness prevention program, and a safety program to identify, assess and control hazards in the workplace. Cal/OSHA has online tools and publications to guide employers on how to establish an effective safety program ...
Mitchell International, Inc., headquartered in San Diego, California, delivers smart technology solutions that simplify and accelerate claims handling and repair processes, driving more accurate, consistent and cost-effective resolutions.
The company announced the results of a survey of workers' compensation professionals in the U.S., revealing how the COVID-19 pandemic has influenced technology usage in the industry.
The survey results show that the industry has rapidly increased its technology adoption in the last year, with more than 50% of respondents saying they adopted telemedicine during the pandemic. Forty percent of participants said changes and pressures related to the COVID-19 pandemic are the main driving factors for the increased pace of technology adoption in the industry today.
Looking ahead, the majority of respondents overwhelmingly believe that telemedicine (35%) and predictive analytics (35%) are the technologies that will have the biggest impact on the industry within the next 5-10 years, followed next by mobile coming in at a distant third place (8.5%). Respondents believe the most valuable applications of telemedicine - driven largely by a rising need for remote healthcare - will be for provider visits (54%). They also reported that they foresee predictive analytics being used best for claim triage, severity or reserving (35%).
In a similar survey conducted by Mitchell in 2020 before the COVID-19 pandemic began, respondents foresaw telemedicine as having the most significant influence on the industry (32%), but reported artificial intelligence (30%) as the second potential most impactful technology and ranked predictive analytics (20%) in third place.
"The workers' compensation industry has greatly benefitted from technology innovation in recent years, but the need to enable the continuity of care has brought explosive growth in new technology adoption as a result of COVID-19," said Shahin Hatamian, senior vice president of product management at Mitchell. "The past year has only reinforced the trends our annual surveys have tracked in recent years, highlighting the rising importance of technologies that can automate manual processes and enable faster and smarter decision making."
Mitchell's survey also uncovered the biggest claims challenges experienced by workers' compensation industry professionals. Almost one-quarter (22%) of participants ranked adapting to challenges from the COVID-19 pandemic as the top obstacle their organization is facing today, followed by workflow efficiency (19%) and cost pressures (18%). Other hurdles reported include return-to-work time, employee turnover, IT budget, keeping up with regulatory changes, and pharmaceutical management.
"As companies continue to focus on stabilizing and improving their businesses in the coming years, they will be seeking workflow efficiencies and determining ways to lower costs, to help injured employees return to the workforce even quicker," said Hatamian. "We foresee a continued focus on automation, analytics and workflows to maximize care and improve outcomes."
Mitchell surveyed nearly 100 workers' compensation professionals at a range of companies, including insurance carriers, third-party administrators, public entities, brokers, and managed care and risk management organizations ...
The company announced the results of a survey of workers' compensation professionals in the U.S., revealing how the COVID-19 pandemic has influenced technology usage in the industry.
The survey results show that the industry has rapidly increased its technology adoption in the last year, with more than 50% of respondents saying they adopted telemedicine during the pandemic. Forty percent of participants said changes and pressures related to the COVID-19 pandemic are the main driving factors for the increased pace of technology adoption in the industry today.
Looking ahead, the majority of respondents overwhelmingly believe that telemedicine (35%) and predictive analytics (35%) are the technologies that will have the biggest impact on the industry within the next 5-10 years, followed next by mobile coming in at a distant third place (8.5%). Respondents believe the most valuable applications of telemedicine - driven largely by a rising need for remote healthcare - will be for provider visits (54%). They also reported that they foresee predictive analytics being used best for claim triage, severity or reserving (35%).
In a similar survey conducted by Mitchell in 2020 before the COVID-19 pandemic began, respondents foresaw telemedicine as having the most significant influence on the industry (32%), but reported artificial intelligence (30%) as the second potential most impactful technology and ranked predictive analytics (20%) in third place.
"The workers' compensation industry has greatly benefitted from technology innovation in recent years, but the need to enable the continuity of care has brought explosive growth in new technology adoption as a result of COVID-19," said Shahin Hatamian, senior vice president of product management at Mitchell. "The past year has only reinforced the trends our annual surveys have tracked in recent years, highlighting the rising importance of technologies that can automate manual processes and enable faster and smarter decision making."
Mitchell's survey also uncovered the biggest claims challenges experienced by workers' compensation industry professionals. Almost one-quarter (22%) of participants ranked adapting to challenges from the COVID-19 pandemic as the top obstacle their organization is facing today, followed by workflow efficiency (19%) and cost pressures (18%). Other hurdles reported include return-to-work time, employee turnover, IT budget, keeping up with regulatory changes, and pharmaceutical management.
"As companies continue to focus on stabilizing and improving their businesses in the coming years, they will be seeking workflow efficiencies and determining ways to lower costs, to help injured employees return to the workforce even quicker," said Hatamian. "We foresee a continued focus on automation, analytics and workflows to maximize care and improve outcomes."
Mitchell surveyed nearly 100 workers' compensation professionals at a range of companies, including insurance carriers, third-party administrators, public entities, brokers, and managed care and risk management organizations ...
A new Covid-19 therapy has completed its phase two human trial and the results are promising.
Molnupiravir was developed at Emory University by the university's drug innovation company, Drug Innovation Ventures at Emory (DRIVE). It was then acquired by Miami-based company Ridgeback Biotherapeutics, who later partnered with Merck & Co. to develop the drug further.
A review of the progress of further development of molnupiravir by Forbes concludes that the experimental phase of the development effort shows a "new hope for prevention and treatment of Covid-19 and other dangerous viruses."
Merck and Ridgeback Biotherapeutics, LP announced preliminary results from Ridgeback’s Phase 2a randomized, double-blind, placebo-controlled trial to evaluate the safety, tolerability, and efficacy to eliminate SARS-CoV-2 viral RNA of molnupiravir, an investigational oral antiviral agent.
Of 202 treated participants, no safety signals have been identified and of the 4 serious adverse events reported, none were considered to be study drug related.
In addition to the ongoing clinical studies, Merck has conducted a comprehensive nonclinical program to characterize the safety profile of molnupiravir.
"We are very pleased to share our initial Phase 2 infectivity data at this important conference, which remains at the forefront for critical clinical scientific information in infectious diseases," shared Dr. Wendy Painter, Chief Medical Officer of Ridgeback Biotherapeutics. "At a time where there is unmet need for antiviral treatments against SARS-CoV-2, we are encouraged by these preliminary data."
"The secondary objective findings in this study, of a quicker decrease in infectious virus among individuals with early COVID-19 treated with molnupiravir, are promising and if supported by additional studies, could have important public health implications, particularly as the SARS-CoV-2 virus continues to spread and evolve globally," noted Dr. William Fischer, lead investigator of the study and Associate Professor of Medicine, Division of Pulmonary Diseases and Critical Care Medicine at the University of North Carolina School of Medicine.
"We continue to make progress in our Phase 2/3 clinical programs evaluating molnupiravir in both outpatient and hospital settings and plan to provide updates when appropriate," said Dr. Roy Baynes, senior vice president and head of global clinical development, chief medical officer, Merck Research Laboratories.
Molnupiravir is an investigational, orally-bioavailable form of a potent ribonucleoside analog that inhibits the replication of multiple RNA viruses including SARS-CoV-2, the causative agent of COVID-19.
In addition to its reduction of Covid-19 transmission, Molnupiravir is likely to be useful against influenza, ebola, and a large swath of other viruses as well. Its development appears to be a major advancement in virus control and should be active against Covid-19 variants and variants of other viruses.
However, we caution Molnupiravir should be administered in conjunction with other therapies to avoid viruses rapidly developing resistance, which all these viruses are well-equipped to do ...
Molnupiravir was developed at Emory University by the university's drug innovation company, Drug Innovation Ventures at Emory (DRIVE). It was then acquired by Miami-based company Ridgeback Biotherapeutics, who later partnered with Merck & Co. to develop the drug further.
A review of the progress of further development of molnupiravir by Forbes concludes that the experimental phase of the development effort shows a "new hope for prevention and treatment of Covid-19 and other dangerous viruses."
Merck and Ridgeback Biotherapeutics, LP announced preliminary results from Ridgeback’s Phase 2a randomized, double-blind, placebo-controlled trial to evaluate the safety, tolerability, and efficacy to eliminate SARS-CoV-2 viral RNA of molnupiravir, an investigational oral antiviral agent.
Of 202 treated participants, no safety signals have been identified and of the 4 serious adverse events reported, none were considered to be study drug related.
In addition to the ongoing clinical studies, Merck has conducted a comprehensive nonclinical program to characterize the safety profile of molnupiravir.
"We are very pleased to share our initial Phase 2 infectivity data at this important conference, which remains at the forefront for critical clinical scientific information in infectious diseases," shared Dr. Wendy Painter, Chief Medical Officer of Ridgeback Biotherapeutics. "At a time where there is unmet need for antiviral treatments against SARS-CoV-2, we are encouraged by these preliminary data."
"The secondary objective findings in this study, of a quicker decrease in infectious virus among individuals with early COVID-19 treated with molnupiravir, are promising and if supported by additional studies, could have important public health implications, particularly as the SARS-CoV-2 virus continues to spread and evolve globally," noted Dr. William Fischer, lead investigator of the study and Associate Professor of Medicine, Division of Pulmonary Diseases and Critical Care Medicine at the University of North Carolina School of Medicine.
"We continue to make progress in our Phase 2/3 clinical programs evaluating molnupiravir in both outpatient and hospital settings and plan to provide updates when appropriate," said Dr. Roy Baynes, senior vice president and head of global clinical development, chief medical officer, Merck Research Laboratories.
Molnupiravir is an investigational, orally-bioavailable form of a potent ribonucleoside analog that inhibits the replication of multiple RNA viruses including SARS-CoV-2, the causative agent of COVID-19.
In addition to its reduction of Covid-19 transmission, Molnupiravir is likely to be useful against influenza, ebola, and a large swath of other viruses as well. Its development appears to be a major advancement in virus control and should be active against Covid-19 variants and variants of other viruses.
However, we caution Molnupiravir should be administered in conjunction with other therapies to avoid viruses rapidly developing resistance, which all these viruses are well-equipped to do ...
The American Property Casualty Insurance Association (APCIA) was formed on January 1, 2019, following the merger of the American Insurance Association (AIA) and the Property Casualty Insurers Association of America (PCI). Together these organizations trace their history back to the founding of the National Board of Fire Underwriters in 1866.
APCIA members represent all sizes, structures, and regions - protecting families, communities, and businesses in the U.S. and across the globe.
H.R. 1996, the SAFE Banking Act generally prohibits a federal banking regulator from penalizing a depository institution for providing banking services to a legitimate cannabis-related business. Prohibited penalties include terminating or limiting the deposit insurance or share insurance of a depository institution solely because the institution provides financial services to a legitimate cannabis-related business and prohibiting or otherwise discouraging a depository institution from offering financial services to such a business.
The Association released the following statement commending the House of Representatives for passing H.R. 1996, the SAFE Banking Act.
The legislation will prevent federal prosecution of and civil liability for insurance agents, brokers, and carriers, as well as their officers, directors, or employees when engaging in the business of insurance in states that have legalized cannabis in some form.
The following statement may be attributed to Nat Wienecke, APCIA’s senior vice president of federal government relations:
"APCIA commends the House for providing greater certainty surrounding the insurance marketplace for cannabis-related legal businesses and consumers adhering to state laws. This legislation addresses the legal uncertainty created by the dueling state and federal treatment of cannabis. While marijuana is illegal under the federal law, thirty-six states and the District of Columbia have legalized some form of marijuana."
"We applaud Representatives Perlmutter, Stivers, Velazquez, and Davidson for their steadfast leadership. We encourage the Senate to take up and pass the SAFE Banking Act, as soon as possible."
The Bill passed the House of Representatives with bipartisan support. It now moves to the Senate for its consideration ...
APCIA members represent all sizes, structures, and regions - protecting families, communities, and businesses in the U.S. and across the globe.
H.R. 1996, the SAFE Banking Act generally prohibits a federal banking regulator from penalizing a depository institution for providing banking services to a legitimate cannabis-related business. Prohibited penalties include terminating or limiting the deposit insurance or share insurance of a depository institution solely because the institution provides financial services to a legitimate cannabis-related business and prohibiting or otherwise discouraging a depository institution from offering financial services to such a business.
The Association released the following statement commending the House of Representatives for passing H.R. 1996, the SAFE Banking Act.
The legislation will prevent federal prosecution of and civil liability for insurance agents, brokers, and carriers, as well as their officers, directors, or employees when engaging in the business of insurance in states that have legalized cannabis in some form.
The following statement may be attributed to Nat Wienecke, APCIA’s senior vice president of federal government relations:
"APCIA commends the House for providing greater certainty surrounding the insurance marketplace for cannabis-related legal businesses and consumers adhering to state laws. This legislation addresses the legal uncertainty created by the dueling state and federal treatment of cannabis. While marijuana is illegal under the federal law, thirty-six states and the District of Columbia have legalized some form of marijuana."
"We applaud Representatives Perlmutter, Stivers, Velazquez, and Davidson for their steadfast leadership. We encourage the Senate to take up and pass the SAFE Banking Act, as soon as possible."
The Bill passed the House of Representatives with bipartisan support. It now moves to the Senate for its consideration ...
RIMS, the risk management society®, is a global not-for-profit committed to advancing the practice of risk management throughout the world.
David Lupinsky, Vice President of Digital Health and Innovation, CorVel, will be co-presenter of a session exploring the impact of AI and telehealth at RIMS LIVE 2021.
"Disruption: How Big Data, AI and Telehealth Are Transforming Claims Management," led by Lupinsky and Stacey Caldwell, Corporate Claims Manager, BBSI, will chronicle the journey that is transforming care for injured workers, producing better outcomes at less cost and improving the patient’s experience.
The educational session is scheduled for Monday, April 26 at 4:30PM EDT but will remain available to all attendees for 60 days after the conference.
Although telehealth was already in use for workers’ compensation, the pandemic pushed its evolution forward to quickly and permanently make virtual end-to-end care possible - and even preferable - for rapid, safe recovery.
"We started several years ago by connecting with the injured worker via telehealth so we could immediately determine the best course of care, saving time off work and getting the right level of care for the injury," said Lupinsky.
"Now, we can provide remote physician visits, home pharmacy delivery, in-home tele-rehab, instruction for DME equipment operation, and mental health therapy with the case manager, the medical team and the patient all connected digitally. Patients love this approach. They are more engaged, and we’ve found that it costs less and produces superior outcomes."
Lupinsky will also address the use of digital monitoring in prevention, as well as applying artificial intelligence and machine learning to proactively identify potential or emerging problems for immediate intervention. Caldwell will present case studies showing the effectiveness of virtual end-to-end care ...
David Lupinsky, Vice President of Digital Health and Innovation, CorVel, will be co-presenter of a session exploring the impact of AI and telehealth at RIMS LIVE 2021.
"Disruption: How Big Data, AI and Telehealth Are Transforming Claims Management," led by Lupinsky and Stacey Caldwell, Corporate Claims Manager, BBSI, will chronicle the journey that is transforming care for injured workers, producing better outcomes at less cost and improving the patient’s experience.
The educational session is scheduled for Monday, April 26 at 4:30PM EDT but will remain available to all attendees for 60 days after the conference.
Although telehealth was already in use for workers’ compensation, the pandemic pushed its evolution forward to quickly and permanently make virtual end-to-end care possible - and even preferable - for rapid, safe recovery.
"We started several years ago by connecting with the injured worker via telehealth so we could immediately determine the best course of care, saving time off work and getting the right level of care for the injury," said Lupinsky.
"Now, we can provide remote physician visits, home pharmacy delivery, in-home tele-rehab, instruction for DME equipment operation, and mental health therapy with the case manager, the medical team and the patient all connected digitally. Patients love this approach. They are more engaged, and we’ve found that it costs less and produces superior outcomes."
Lupinsky will also address the use of digital monitoring in prevention, as well as applying artificial intelligence and machine learning to proactively identify potential or emerging problems for immediate intervention. Caldwell will present case studies showing the effectiveness of virtual end-to-end care ...
What happens when the enhancement is in more demand than the original product? That was the quandary faced a few years ago by entrepreneurs operating an insurance agency. And, like all good entrepreneurs, they followed the money, right into a whole new business.
Dino Carbone, executive vice president for sales and marketing at SmartPay Solutions LLC, tells the story published by Hartford Business Journal, of the firm’s inception.
He and his partners had set out to make it easier for clients to pay their insurance bills. Their pay-as-you-go software was a hit. Soon, clients wanted to buy the software as well as the insurance. The partners hung a "for sale" sign on the agency and set up shop in the emerging field of insurtech.
In 2013, Connecticut Innovations became an investor. In 2014, a Series A round closed with $1.4 million, including investments from Tennant Capital Partners and Stonehenge Growth Capital. But in 2015, the partners changed course and took the firm private again. Robert Conerly, who had joined the firm as CFO, was named CEO. Dino Carbone
Today, SmartPay has more than 10,000 businesses on its platform. There, payroll information is massaged against the client’s workers’ compensation insurance needs. SmartPay shops more than 30 carriers, including many of the best-known firms, for the best rates and coverage matches.
But the element that sets SmartPay apart from competitors is that its software can make changes in 24 to 48 hours, as staffing levels change.
And during a pandemic, that ability is an asset. Keeping pace with ever-changing workers’ comp rates has been a selling point for SmartPay. But times change. Carbone leaves no doubt the pandemic has been a boon for SmartPay’s business.
Through furloughs and layoffs, Paycheck Protection Program-funded rehiring and false starts at reopening, clients always had their workers’ comp coverage right. No gaps in coverage. No over or under payments.
The underlying software logic makes it applicable to any insurance situation where coverage is based on variables like headcount or pay rate.
And Carbone says major expansion is ahead, as quickly as the staff of 24 can manage it. First up is a new website, to be launched within weeks. Then it’s on to new lines of coverage.
Carbone says SmartPay is on course to double its revenue. He’s cautious about dropping names and numbers but says about $14 billion in payroll data crosses the platform. He also said Liberty Mutual is one of the large firms offering workers’ comp insurance through SmartPay’s platform and his firm has done "a lot" of work with The Hartford.
Carbone says SmartPay works with "thousands" of independent insurance agents.
He sees the firm’s main competitors as large national payroll providers, which are moving into the bill payment space. And that’s part of SmartPay’s pitch to recruit smaller payroll providers to its team.
SmartPay lets payroll providers add workers’ comp pay-as-you-go as a service, improving their competitive position as well as SmartPay’s ...
Dino Carbone, executive vice president for sales and marketing at SmartPay Solutions LLC, tells the story published by Hartford Business Journal, of the firm’s inception.
He and his partners had set out to make it easier for clients to pay their insurance bills. Their pay-as-you-go software was a hit. Soon, clients wanted to buy the software as well as the insurance. The partners hung a "for sale" sign on the agency and set up shop in the emerging field of insurtech.
In 2013, Connecticut Innovations became an investor. In 2014, a Series A round closed with $1.4 million, including investments from Tennant Capital Partners and Stonehenge Growth Capital. But in 2015, the partners changed course and took the firm private again. Robert Conerly, who had joined the firm as CFO, was named CEO. Dino Carbone
Today, SmartPay has more than 10,000 businesses on its platform. There, payroll information is massaged against the client’s workers’ compensation insurance needs. SmartPay shops more than 30 carriers, including many of the best-known firms, for the best rates and coverage matches.
But the element that sets SmartPay apart from competitors is that its software can make changes in 24 to 48 hours, as staffing levels change.
And during a pandemic, that ability is an asset. Keeping pace with ever-changing workers’ comp rates has been a selling point for SmartPay. But times change. Carbone leaves no doubt the pandemic has been a boon for SmartPay’s business.
Through furloughs and layoffs, Paycheck Protection Program-funded rehiring and false starts at reopening, clients always had their workers’ comp coverage right. No gaps in coverage. No over or under payments.
The underlying software logic makes it applicable to any insurance situation where coverage is based on variables like headcount or pay rate.
And Carbone says major expansion is ahead, as quickly as the staff of 24 can manage it. First up is a new website, to be launched within weeks. Then it’s on to new lines of coverage.
Carbone says SmartPay is on course to double its revenue. He’s cautious about dropping names and numbers but says about $14 billion in payroll data crosses the platform. He also said Liberty Mutual is one of the large firms offering workers’ comp insurance through SmartPay’s platform and his firm has done "a lot" of work with The Hartford.
Carbone says SmartPay works with "thousands" of independent insurance agents.
He sees the firm’s main competitors as large national payroll providers, which are moving into the bill payment space. And that’s part of SmartPay’s pitch to recruit smaller payroll providers to its team.
SmartPay lets payroll providers add workers’ comp pay-as-you-go as a service, improving their competitive position as well as SmartPay’s ...
Former EDD employee, 44 year old Andrea M. Gervais, who lives in Roseville, pleaded guilty to theft of government money in a scheme involving 97 fraudulent Pandemic Unemployment Assistance (PUA) claims in the names of persons other than her own.
The investigation began when federal agents discovered that someone had filed a PUA claim using the identity of Sen. Dianne Feinstein, a sitting U.S. senator, for approximately $21,000. This fraudulent claim was processed for payment, and Gervais received an EDD debit card in the senator’s name.
Agents further discovered that Bank of America ATM cameras captured Gervais on multiple occasions withdrawing cash from at least seven of the EDD debit cards, and at least one captured transaction showed Gervais using the debit card issued to the senator.
According to court documents, at least 10 of 97 fraudulent PUA claims were processed for payment, and nearly $200,000 in unemployment insurance and PUA benefits were paid out to Gervais’s Roseville address in the form of Bank of America debit cards. The potential value of all fraudulent 97 claims associated with the scheme exceeded $2 million.
This case is the product of an investigation by the U.S. Department of Labor - Office of the Inspector General, the Federal Bureau of Investigation, and the California Employment Development Department - Investigation Division. Special Assistant U.S. Attorney Robert J. Artuz is prosecuting the case.
Gervais remains on pretrial release as she awaits sentencing. She is scheduled to be sentenced by U.S. District Judge Kimberly J. Mueller on Aug. 9.
She faces a maximum statutory penalty of 10 years in prison and a $250,000 fine ...
The investigation began when federal agents discovered that someone had filed a PUA claim using the identity of Sen. Dianne Feinstein, a sitting U.S. senator, for approximately $21,000. This fraudulent claim was processed for payment, and Gervais received an EDD debit card in the senator’s name.
Agents further discovered that Bank of America ATM cameras captured Gervais on multiple occasions withdrawing cash from at least seven of the EDD debit cards, and at least one captured transaction showed Gervais using the debit card issued to the senator.
According to court documents, at least 10 of 97 fraudulent PUA claims were processed for payment, and nearly $200,000 in unemployment insurance and PUA benefits were paid out to Gervais’s Roseville address in the form of Bank of America debit cards. The potential value of all fraudulent 97 claims associated with the scheme exceeded $2 million.
This case is the product of an investigation by the U.S. Department of Labor - Office of the Inspector General, the Federal Bureau of Investigation, and the California Employment Development Department - Investigation Division. Special Assistant U.S. Attorney Robert J. Artuz is prosecuting the case.
Gervais remains on pretrial release as she awaits sentencing. She is scheduled to be sentenced by U.S. District Judge Kimberly J. Mueller on Aug. 9.
She faces a maximum statutory penalty of 10 years in prison and a $250,000 fine ...
Farm labor company owners and siblings Elias Perez, 40, of Greenfield, and Alejandra Perez, 37, of Soledad, were arraigned on over 20 felony counts of insurance and tax fraud after allegedly underreporting payroll by over $17 million resulting in a loss of over $1.42 million to their insurance companies.
The Department of Insurance discovered the alleged fraud after learning that an injured employee was treated out of a garage by an unlicensed professional.
The Perezes are owners of farm labor contracting companies in Greenfield called PFL Contracting Inc., Future Ag Management, Inc. (FAM) and Future Harvesters and Packers, Inc., (FHP), which primarily hire farm labor employees to harvest crops.
An investigation found on June 28, 2016, an employee of one of the Perezes’ businesses, FAM, sustained a work-related injury to their back when they tripped and fell while harvesting crops. The Perezes along with a FAM supervisor allegedly did not provide the injured employee with the required professional medical treatment. For two weeks, the FAM supervisor took the injured worker to seek treatment from an unlicensed professional who operated a business out of their garage.
More than two weeks after the employee’s injury, Elias Perez filed a workers’ compensation claim with their insurance company and stated the employee’s injury occurred on July 7, 2016.
FAM and FHP obtained workers’ compensation policies from two different insurance companies. A comparison of records from the insurance companies and the California Employment Development Department (EDD) showed large discrepancies in the payroll reported by the Perezes. From July 2014 to August 2017, they reported to EDD that FAM and FHP paid $28,521,347 in wages while reporting only $23,246,922 to their insurance companies for the same time period.
Investigators served bank search warrants and conducted a thorough review and audit of the payroll checks, which determined that FAM and FHP from July 2014 to August 2017 actually paid over $41 million in wages. They allegedly underreported over $17 million in wages, which resulted in approximately $1.42 million in premium owed to their insurance companies.
In addition, the Perezes underreported PFL, FAM and FHP’s wages by approximately $12.8 million to EDD resulting in potentially $1.28 million in unpaid taxes.
FAM also maintained a workers’ compensation policy with another insurance company for the Perezes’ farm labor contracting operation in Arizona. Records obtained from that insurance company and the Arizona Department of Economic Security indicated additional discrepancies in their reporting and was included in this audit and investigation.
Elias Perez was charged with five felony counts and Alejandra Perez was charged with 21 felony counts. Both were arraigned in Monterey County Superior Court.
The Monterey County District Attorney’s Office is prosecuting this case ...
The Department of Insurance discovered the alleged fraud after learning that an injured employee was treated out of a garage by an unlicensed professional.
The Perezes are owners of farm labor contracting companies in Greenfield called PFL Contracting Inc., Future Ag Management, Inc. (FAM) and Future Harvesters and Packers, Inc., (FHP), which primarily hire farm labor employees to harvest crops.
An investigation found on June 28, 2016, an employee of one of the Perezes’ businesses, FAM, sustained a work-related injury to their back when they tripped and fell while harvesting crops. The Perezes along with a FAM supervisor allegedly did not provide the injured employee with the required professional medical treatment. For two weeks, the FAM supervisor took the injured worker to seek treatment from an unlicensed professional who operated a business out of their garage.
More than two weeks after the employee’s injury, Elias Perez filed a workers’ compensation claim with their insurance company and stated the employee’s injury occurred on July 7, 2016.
FAM and FHP obtained workers’ compensation policies from two different insurance companies. A comparison of records from the insurance companies and the California Employment Development Department (EDD) showed large discrepancies in the payroll reported by the Perezes. From July 2014 to August 2017, they reported to EDD that FAM and FHP paid $28,521,347 in wages while reporting only $23,246,922 to their insurance companies for the same time period.
Investigators served bank search warrants and conducted a thorough review and audit of the payroll checks, which determined that FAM and FHP from July 2014 to August 2017 actually paid over $41 million in wages. They allegedly underreported over $17 million in wages, which resulted in approximately $1.42 million in premium owed to their insurance companies.
In addition, the Perezes underreported PFL, FAM and FHP’s wages by approximately $12.8 million to EDD resulting in potentially $1.28 million in unpaid taxes.
FAM also maintained a workers’ compensation policy with another insurance company for the Perezes’ farm labor contracting operation in Arizona. Records obtained from that insurance company and the Arizona Department of Economic Security indicated additional discrepancies in their reporting and was included in this audit and investigation.
Elias Perez was charged with five felony counts and Alejandra Perez was charged with 21 felony counts. Both were arraigned in Monterey County Superior Court.
The Monterey County District Attorney’s Office is prosecuting this case ...
41 year old Ahmad Zaki Noori, who lives in Sacramento, was arraigned on two felony counts of workers’ compensation insurance fraud, after allegedly misrepresenting symptoms following a work-related injury, in order to receive $21,000 in undeserved benefits.
On July 16, 2019, Noori, while working as a welder, sustained a head injury and contusions on multiple parts of his body.
Following his injury, a workers’ compensation claim was filed with his employer’s insurance company and Noori began receiving workers’ compensation benefits. He presented himself as someone with severe amnesia and as someone who had difficulty performing daily functions of living, like speaking, walking or driving.
An investigation by the California Department of Insurance found Noori misrepresented his symptoms to medical professionals and those handling his claim.
Undercover surveillance showed Noori speaking, walking, and driving - all functions he claimed not to be able to do as a result of the injury. The surveillance also showed him performing duties at an automobile dismantling yard, like loading items onto a flatbed trailer and changing a spare tire.
In addition, two of his former co-workers reported they saw him out and about acting normally. One co-worker reported seeing Noori inside a retail store and that he was walking unassisted, laughing, and speaking on the phone. The second co-worker reported seeing Noori at another retail store and that he drove a vehicle into the parking lot, exited the vehicle and was able to walk with no walking aids.
After watching the video surveillance, his doctor reported the actions Noori was performing in the video were drastically different than the actions he was performing during his office visits. The doctor also reported that Noori showed no evidence of neurocognitive or orthopedic deficits during the entirety of this claim period.
Due to Noori’s misrepresentations, he received $21,000 in undeserved workers’ compensation payments and his employers’ insurance company lost an additional $80,679 in medical, legal and investigation costs.
Noori was arrested at his residence on April 13, 2021. He is scheduled to return to court on May 20, 2021.
This case is being prosecuted by the Sacramento County District Attorney’s Office ...
On July 16, 2019, Noori, while working as a welder, sustained a head injury and contusions on multiple parts of his body.
Following his injury, a workers’ compensation claim was filed with his employer’s insurance company and Noori began receiving workers’ compensation benefits. He presented himself as someone with severe amnesia and as someone who had difficulty performing daily functions of living, like speaking, walking or driving.
An investigation by the California Department of Insurance found Noori misrepresented his symptoms to medical professionals and those handling his claim.
Undercover surveillance showed Noori speaking, walking, and driving - all functions he claimed not to be able to do as a result of the injury. The surveillance also showed him performing duties at an automobile dismantling yard, like loading items onto a flatbed trailer and changing a spare tire.
In addition, two of his former co-workers reported they saw him out and about acting normally. One co-worker reported seeing Noori inside a retail store and that he was walking unassisted, laughing, and speaking on the phone. The second co-worker reported seeing Noori at another retail store and that he drove a vehicle into the parking lot, exited the vehicle and was able to walk with no walking aids.
After watching the video surveillance, his doctor reported the actions Noori was performing in the video were drastically different than the actions he was performing during his office visits. The doctor also reported that Noori showed no evidence of neurocognitive or orthopedic deficits during the entirety of this claim period.
Due to Noori’s misrepresentations, he received $21,000 in undeserved workers’ compensation payments and his employers’ insurance company lost an additional $80,679 in medical, legal and investigation costs.
Noori was arrested at his residence on April 13, 2021. He is scheduled to return to court on May 20, 2021.
This case is being prosecuted by the Sacramento County District Attorney’s Office ...
After patiently waiting for COVID-19 vaccine guidance in California, employers now have some clarification from California’s Department of Fair Employment and Housing (DFEH). As somewhat expected, the DFEH’s guidance issued early this month aligns with the EEOC’s Guidance issued in December 2020.
The firm of Fisher Phillips has commented on the top five takeaways for employers about COVID-19 vaccines according to the DFEH’s recent guidance regarding COVID-19 vaccines:
1. An employer may require employees to receive COVID-19 vaccines.
Consistent with the EEOC’s guidance, the DFEH states that, with certain exceptions, employers may require at-will employees to receive vaccines issued under the FDA’s Emergency Use Authorization (EUA) procedures.
2. If an employer requires vaccination against COVID-19 in its workforce, the employer must reasonably accommodate employees with disabilities or with sincerely held religious beliefs or practices.
Even if an employer may mandate vaccines amongst its employees, it does not mean you have free reign to require the vaccine for all workers. In accordance with the guidance from the EEOC, the DFEH states that if an employee objects to vaccination on the basis of disability or sincerely held religious belief or practice, you must engage in the interactive process to identify options for reasonable accommodations that do not cause undue hardship.
3. An employer is not legally required by the FEHA to reasonably accommodate all employees who refuse the vaccine.
The DFEH says that if an employee does not have a reason based on a disability or sincerely held religious belief for not being inoculated with a vaccine issued under the EUA procedures, you are not legally required to reasonably accommodate the employee.
The DFEH goes on to state that you are permitted to enforce reasonable disciplinary policies and practices if you are not retaliating against any employee for engaging in protected activity, such as opposing practices prohibited by FEHA.
4. If an employer administers a COVID-19 vaccination program, an employer may ask employees for medical information relevant to vaccination.
The DFEH indicates that you may ask for medical information, such as whether an employee is experiencing COVID-19 symptoms or a pre-vaccination screening questionnaire, so long as the inquiry is "job-related and consistent with business necessity."
5. An employer may require its employees to provide proof of vaccination.
The DFEH specifies that simply asking employees or applicants for proof of vaccination is not a disability-related inquiry, or religious creed-related inquiry, or a medical examination.
Despite the wording of this Guidance, the five takaways require caution and guidance before implementation. The DFEH material should be read in its entirety ...
The firm of Fisher Phillips has commented on the top five takeaways for employers about COVID-19 vaccines according to the DFEH’s recent guidance regarding COVID-19 vaccines:
1. An employer may require employees to receive COVID-19 vaccines.
Consistent with the EEOC’s guidance, the DFEH states that, with certain exceptions, employers may require at-will employees to receive vaccines issued under the FDA’s Emergency Use Authorization (EUA) procedures.
2. If an employer requires vaccination against COVID-19 in its workforce, the employer must reasonably accommodate employees with disabilities or with sincerely held religious beliefs or practices.
Even if an employer may mandate vaccines amongst its employees, it does not mean you have free reign to require the vaccine for all workers. In accordance with the guidance from the EEOC, the DFEH states that if an employee objects to vaccination on the basis of disability or sincerely held religious belief or practice, you must engage in the interactive process to identify options for reasonable accommodations that do not cause undue hardship.
3. An employer is not legally required by the FEHA to reasonably accommodate all employees who refuse the vaccine.
The DFEH says that if an employee does not have a reason based on a disability or sincerely held religious belief for not being inoculated with a vaccine issued under the EUA procedures, you are not legally required to reasonably accommodate the employee.
The DFEH goes on to state that you are permitted to enforce reasonable disciplinary policies and practices if you are not retaliating against any employee for engaging in protected activity, such as opposing practices prohibited by FEHA.
4. If an employer administers a COVID-19 vaccination program, an employer may ask employees for medical information relevant to vaccination.
The DFEH indicates that you may ask for medical information, such as whether an employee is experiencing COVID-19 symptoms or a pre-vaccination screening questionnaire, so long as the inquiry is "job-related and consistent with business necessity."
5. An employer may require its employees to provide proof of vaccination.
The DFEH specifies that simply asking employees or applicants for proof of vaccination is not a disability-related inquiry, or religious creed-related inquiry, or a medical examination.
Despite the wording of this Guidance, the five takaways require caution and guidance before implementation. The DFEH material should be read in its entirety ...
Marion Piggee, Jr., 68, of Los Angeles, was arraigned on seven counts of insurance fraud after an investigation by the California Department of Insurance revealed he was allegedly underreporting employee payroll by nearly $6 million in order to fraudulently reduce his business’s workers’ compensation insurance premium by over $1 million.
On November 28, 2016, the State Compensation Insurance Fund (SCIF) filed a suspected fraudulent claim with the Department of Insurance alleging potential insurance fraud. SCIF reported that Piggee, as owner of Center for Behavioral Change, an adult residential care facility, allegedly underreported employee payroll in order to reduce the proper rate of insurance premiums owed to SCIF.
A routine audit for the policy period of November 1, 2014, to November 1, 2015, found that Center for Behavioral Change reported one employee and payroll wages of $8,035. However, the audit revealed wages to be $881,593 for the same policy year. It also showed Piggee’s business had obtained workers’ compensation insurance for one facility, but failed to disclose they had also acquired eight other facilities.
The investigation found that Piggee had allegedly been underreporting company payroll from November 2009 through May 2016. The investigation also revealed Center for Behavioral Change had 60 employees, despite their reporting of only one employee. The business underreported payroll by $5,982,410, which resulted in a premium loss to SCIF of $1,017,937.
Piggee was arraigned at the Los Angeles Superior Court on April 6, 2021.
This case is being prosecuted by the Los Angeles County District Attorney’s Office ...
On November 28, 2016, the State Compensation Insurance Fund (SCIF) filed a suspected fraudulent claim with the Department of Insurance alleging potential insurance fraud. SCIF reported that Piggee, as owner of Center for Behavioral Change, an adult residential care facility, allegedly underreported employee payroll in order to reduce the proper rate of insurance premiums owed to SCIF.
A routine audit for the policy period of November 1, 2014, to November 1, 2015, found that Center for Behavioral Change reported one employee and payroll wages of $8,035. However, the audit revealed wages to be $881,593 for the same policy year. It also showed Piggee’s business had obtained workers’ compensation insurance for one facility, but failed to disclose they had also acquired eight other facilities.
The investigation found that Piggee had allegedly been underreporting company payroll from November 2009 through May 2016. The investigation also revealed Center for Behavioral Change had 60 employees, despite their reporting of only one employee. The business underreported payroll by $5,982,410, which resulted in a premium loss to SCIF of $1,017,937.
Piggee was arraigned at the Los Angeles Superior Court on April 6, 2021.
This case is being prosecuted by the Los Angeles County District Attorney’s Office ...
Chiropractor Joserodel Zavala Candelario, an Irvine resident, was sentenced in federal court to 36 months in federal custody for his participation in two huge health care fraud schemes, one involving the California Worker's Compensation system, and for concealing income he received from those multi-million dollar schemes.
He was the owner of Candelario Chiropractic, a Professional Corporation, and R.I.S.E. Medical Center, a Professional Corporation, dba R.I.S.E. Wellness Center, which operated at multiple locations in the Southern District of California, including at 5030 Bonita Road, Suite B, in Bonita and at 3231 Waring Road, Suite N, in Oceanside.
Candelario pleaded guilty on January 21, 2020 to a three-count superseding information, charging Conspiracy in violation of 18 U.S.C. § 371, Conspiracy to Commit Health Care Fraud in violation of 18 U.S.C. § 1349, and False Statement on Tax Return in violation of 26 U.S.C. § 7206(1).
In addition, between March 2012 and November 2015, Candelario carried on an unlawful cross-referral scheme, in which he would receive new Workers’ Compensation patients for RISE Wellness. In return for new patients, Candelario agreed to meet a quota for the "value" of ancillary services and DME he was expected to prescribe for each patient sent to him by co-conspirators, with a "value" -- such as $30-$50 per MRI referral -- set by those conspirators.
As part of the scheme, Candelario, who could function as a WC primary care provider, dictated the same treatment plan for all WC patients, regardless of their individual medical needs, so he could fraudulently bill WC insurers.
Candelario admitted that he violated his duty of honest services to his patients. He received approximately 529 new WC patients as a result of the scheme, and he submitted approximately $6,605,364 in bills to insurers for services rendered to those patients. Of those billed amounts, he was paid $771,000 by WC insurers
Separately, he has been charged and has pleaded guilty in San Diego Superior Court case SCD281328 to Concealing an Event Affecting an Insurance Claim, in a violation of California Penal Code 550(b)(3).
Candelario carried out a scheme to defraud Medicare and TRICARE out of millions of dollars by using physical therapy codes to bill for supposed physical therapy services performed on patients by individuals who were not licensed to provide physical therapy, including chiropractors, massage therapists, physical therapy aides, and an acupuncturist.
Candelario and his co-conspirators told patients that RISE Wellness offered an "integrated" approach to wellness, to convince patients to accept physical therapy, acupuncture, chiropractic, and diagnostic services at RISE Wellness, in order to fraudulently bill for non-covered services provided by unauthorized individuals, and collect as much money as possible from health care benefit programs.
Once patients came in the door, the defendant pushed his staff to conduct diagnostic tests on every patient, regardless of medical necessity, to increase billing and payment, and he also demanded that staff meet quotas for the minimum number of diagnostic tests, and recommendations for durable medical equipment, or DME, massages and other services, regardless of whether specific patients needed the items and services.
He also imposed quotas for the minimum number of patients with specific types of insurance coverage at RISE Wellness, e.g., "60 Tricare patients per day," regardless of whether those patients needed treatments.
For example, on June 6, 2014, Candelario instructed a staff member, "I need you to do 5 axonii [diagnostic tests] a day no matter what for now on." The following month, on July 7, 2014, Candelario texted, "OK team you are receiving 2 new diagnostic testing devices this month. I need 20 patients to be tested on each one this month no matter What [sic]."
To increase billing and payment, the defendant pushed the schedulers to cram in as many as 50 patients per day for each provider. He complained when staff fell short of this goal, noting, on June 11, 2015, certain "front desk issues" including: "No[one] has called any patients to fill empty slots in provider schedules or grab patients in lobbies to put into provider schedules."
If a patient failed to show up for an appointment, Candelario directed staff to bill the health care benefit program for the visit, even though no visit had occurred and no service had been provided. For example, on March 9, 2015, Candelario wrote, about late reimbursements, that "the only solution is to start billing the missed appointments like i asked following the system."
It was part of the scheme that, using the mean and manners described above, and others, the co-conspirators submitted and caused to be submitted at least $7,260,327.20 in false and fraudulent bills to TRICARE and Medicare. Of those fraudulent bills, TRICARE paid a total of $3,450,596.43 and Medicare paid $37,843.04.
Candelario failed to pay his fair share of taxes on the funds he fraudulently took, resulting in $505,000 in tax losses just for tax year 2013.
...
He was the owner of Candelario Chiropractic, a Professional Corporation, and R.I.S.E. Medical Center, a Professional Corporation, dba R.I.S.E. Wellness Center, which operated at multiple locations in the Southern District of California, including at 5030 Bonita Road, Suite B, in Bonita and at 3231 Waring Road, Suite N, in Oceanside.
Candelario pleaded guilty on January 21, 2020 to a three-count superseding information, charging Conspiracy in violation of 18 U.S.C. § 371, Conspiracy to Commit Health Care Fraud in violation of 18 U.S.C. § 1349, and False Statement on Tax Return in violation of 26 U.S.C. § 7206(1).
In addition, between March 2012 and November 2015, Candelario carried on an unlawful cross-referral scheme, in which he would receive new Workers’ Compensation patients for RISE Wellness. In return for new patients, Candelario agreed to meet a quota for the "value" of ancillary services and DME he was expected to prescribe for each patient sent to him by co-conspirators, with a "value" -- such as $30-$50 per MRI referral -- set by those conspirators.
As part of the scheme, Candelario, who could function as a WC primary care provider, dictated the same treatment plan for all WC patients, regardless of their individual medical needs, so he could fraudulently bill WC insurers.
Candelario admitted that he violated his duty of honest services to his patients. He received approximately 529 new WC patients as a result of the scheme, and he submitted approximately $6,605,364 in bills to insurers for services rendered to those patients. Of those billed amounts, he was paid $771,000 by WC insurers
Separately, he has been charged and has pleaded guilty in San Diego Superior Court case SCD281328 to Concealing an Event Affecting an Insurance Claim, in a violation of California Penal Code 550(b)(3).
Candelario carried out a scheme to defraud Medicare and TRICARE out of millions of dollars by using physical therapy codes to bill for supposed physical therapy services performed on patients by individuals who were not licensed to provide physical therapy, including chiropractors, massage therapists, physical therapy aides, and an acupuncturist.
Candelario and his co-conspirators told patients that RISE Wellness offered an "integrated" approach to wellness, to convince patients to accept physical therapy, acupuncture, chiropractic, and diagnostic services at RISE Wellness, in order to fraudulently bill for non-covered services provided by unauthorized individuals, and collect as much money as possible from health care benefit programs.
Once patients came in the door, the defendant pushed his staff to conduct diagnostic tests on every patient, regardless of medical necessity, to increase billing and payment, and he also demanded that staff meet quotas for the minimum number of diagnostic tests, and recommendations for durable medical equipment, or DME, massages and other services, regardless of whether specific patients needed the items and services.
He also imposed quotas for the minimum number of patients with specific types of insurance coverage at RISE Wellness, e.g., "60 Tricare patients per day," regardless of whether those patients needed treatments.
For example, on June 6, 2014, Candelario instructed a staff member, "I need you to do 5 axonii [diagnostic tests] a day no matter what for now on." The following month, on July 7, 2014, Candelario texted, "OK team you are receiving 2 new diagnostic testing devices this month. I need 20 patients to be tested on each one this month no matter What [sic]."
To increase billing and payment, the defendant pushed the schedulers to cram in as many as 50 patients per day for each provider. He complained when staff fell short of this goal, noting, on June 11, 2015, certain "front desk issues" including: "No[one] has called any patients to fill empty slots in provider schedules or grab patients in lobbies to put into provider schedules."
If a patient failed to show up for an appointment, Candelario directed staff to bill the health care benefit program for the visit, even though no visit had occurred and no service had been provided. For example, on March 9, 2015, Candelario wrote, about late reimbursements, that "the only solution is to start billing the missed appointments like i asked following the system."
It was part of the scheme that, using the mean and manners described above, and others, the co-conspirators submitted and caused to be submitted at least $7,260,327.20 in false and fraudulent bills to TRICARE and Medicare. Of those fraudulent bills, TRICARE paid a total of $3,450,596.43 and Medicare paid $37,843.04.
Candelario failed to pay his fair share of taxes on the funds he fraudulently took, resulting in $505,000 in tax losses just for tax year 2013.
...
The Division of Workers’ Compensation announced its Eureka satellite office will close the physical location at 409 K St. on July 1, 2021 and its operations will remain online.
By most accounts, the virtualization of matters proceeding through the litigation process has been a positive experience for the industry. Additionally, depositions have been successfully taken online. And some medical evaluations have been by telehealth.
The Eureka satellite office has conducted operations virtually since the COVID-19 pandemic began in 2020.
All Eureka matters will continue to be heard either by phone or video even after COVID-19 restrictions ease.
As of July 1, all filings that are sent by U.S. Mail should be directed to the Santa Rosa district office.
It is not known if this is a precursor to the "new normal," or just the destiny for one of the smaller and remote offices of the statewide system. Over the next few months, the virtual evolution, if there will be one, will likely become more transparent ...
By most accounts, the virtualization of matters proceeding through the litigation process has been a positive experience for the industry. Additionally, depositions have been successfully taken online. And some medical evaluations have been by telehealth.
The Eureka satellite office has conducted operations virtually since the COVID-19 pandemic began in 2020.
All Eureka matters will continue to be heard either by phone or video even after COVID-19 restrictions ease.
As of July 1, all filings that are sent by U.S. Mail should be directed to the Santa Rosa district office.
It is not known if this is a precursor to the "new normal," or just the destiny for one of the smaller and remote offices of the statewide system. Over the next few months, the virtual evolution, if there will be one, will likely become more transparent ...
In this time of uncertainty, one thing is for sure: the workplace of the future will look different than it does today. For some companies, offering telecommuting continues to be a viable option. At the other end of the spectrum, some employers will likely continue to require high physical proximity working environments for the foreseeable future.
NCCI conducted interviews with several industry professionals to better understand what the future workplace might look like and how new challenges are being addressed.
In speaking with interviewees, NCCI consistently heard that employers have taken similar measures and developed multifaceted risk mitigation strategies, such as:
- - Working remotely when possible
- - Applying social distancing
- - Conducting health/symptom screenings
- - Cleaning and disinfecting
- - Implementing workspace layout changes
- - Limiting visitors
Some employers were able to move to a full telecommuting model within a very short time, while others used what might be called a "hybrid" approach; that is, implementing safety controls for jobs that must be performed onsite, while encouraging telecommuting for employees who can effectively perform their jobs from home.
Employers are looking for ways to reduce travel and human-to-human contact, which may impact workplace congestion, shift work, group training, overnight travel, and the use of cleaning chemicals and tools/equipment. New technologies are enabling more physical distancing to address infectious disease prevention.
Examples include virtual meetings and training sessions, as well as touchless transactions, touchless printing, and wearable technology that supports contact tracing and signaling to prevent close physical proximity.
Insurance companies have many interactions with their customers in various ways, which are critical in this time. Insurers’ roles involve exposure assessment, claims mitigation, loss prevention, audits, etc. Insurers indicated that they are taking similar proactive approaches and have already started to develop new evaluation methods to address physical proximity exposures, while simultaneously providing education and services to their customers.
Examples include using telesurveys and virtual visits for analysis, loss prevention, and audit services to cut back on in-person activity. One insurer noted that policyholders have expanded the duties of their employees to an all-hands-on-deck approach due to workforce cutbacks ...
NCCI conducted interviews with several industry professionals to better understand what the future workplace might look like and how new challenges are being addressed.
In speaking with interviewees, NCCI consistently heard that employers have taken similar measures and developed multifaceted risk mitigation strategies, such as:
- - Working remotely when possible
- - Applying social distancing
- - Conducting health/symptom screenings
- - Cleaning and disinfecting
- - Implementing workspace layout changes
- - Limiting visitors
Some employers were able to move to a full telecommuting model within a very short time, while others used what might be called a "hybrid" approach; that is, implementing safety controls for jobs that must be performed onsite, while encouraging telecommuting for employees who can effectively perform their jobs from home.
Employers are looking for ways to reduce travel and human-to-human contact, which may impact workplace congestion, shift work, group training, overnight travel, and the use of cleaning chemicals and tools/equipment. New technologies are enabling more physical distancing to address infectious disease prevention.
Examples include virtual meetings and training sessions, as well as touchless transactions, touchless printing, and wearable technology that supports contact tracing and signaling to prevent close physical proximity.
Insurance companies have many interactions with their customers in various ways, which are critical in this time. Insurers’ roles involve exposure assessment, claims mitigation, loss prevention, audits, etc. Insurers indicated that they are taking similar proactive approaches and have already started to develop new evaluation methods to address physical proximity exposures, while simultaneously providing education and services to their customers.
Examples include using telesurveys and virtual visits for analysis, loss prevention, and audit services to cut back on in-person activity. One insurer noted that policyholders have expanded the duties of their employees to an all-hands-on-deck approach due to workforce cutbacks ...
