The Workers’ Compensation Insurance Rating Bureau of California has released a new report, Medical Characteristics of Cumulative Trauma Claims. In the California workers’ compensation system, CT claims have always been a key cost driver mostly because of the complexity of having injury exposure spanning multiple years, litigation and frictional costs from liens and medical-legal services that are incurred on CT claims. Prior WCIRB research has suggested that as much as 40% of all CT claims are filed on a post-employment or post-termination basis. Post-termination CT claims are filed after the termination of employment, and they tend to be more litigious and involve more frictional costs than regular CT claims. This study analyzes both CT and post-termination CT claims, focusing on the characteristics of medical treatment, primary medical diagnoses and underlying drivers for frictional costs. Some of the key findings include: - - Indemnity claims are the key driver of CT claim costs. Average medical severity on CT indemnity claims starts off lower than non-CT indemnity claims, but eventually grows larger as the claims mature. - - CT indemnity claims have a higher payment share for medical-legal and medical liens services than non-CT claims, mostly driven by significantly higher levels of utilization. - - The share of medical payments for medical liens and medical-legal services on CT claims is on average three times the payment shares of these services on non-CT claims. - - The average paid per medical-legal evaluation is more than 20% higher on CT claims than on non-CT claims. In addition, there areover60% more evaluations on CT claims, which leads to a significantly higher overall medical-legalpaid per claim. - - CT claims are more likely to involve soft tissue injuries and mental/psychiatric conditions. About a third of closed CT claims had a medical diagnosis shift, mostly to soft tissue injuries, by the end of their claim life. - - It takes significantly longer for CT indemnity claims to receive the first medical treatment, mostly due to late reporting and a relatively high share of CT claims starting with liens or medical-legal services as the initial service. - - Post-termination CT claims filed following large layoffs tend to concentrate in the manufacturing and service sectors and in the LA region. Not surprisingly, these claims also are more likely to be reported late. - - Compared to regular CT claims, post-termination CT claims incur lower medical severity through 66 months of development but have a higher share of payments for medical liens, medical-legal and interpreter services. - - CT indemnity claims close consistently more slowly than non-CT indemnity claims, with the largest difference at the first report level (18 months from policy inception) when only 1 in 5 CT indemnity claims are closed compared to almost half of non-CT indemnity claims. The claim population in the analysis is derived from linking WCIRB unit statistical data and WCIRB medical transaction data for accident years 2013 through 2019 ...

A no longer California licensed neurosurgeon was sentenced to 60 months in federal prison for accepting approximately $3.3 million in bribes for performing spinal surgeries at a now-defunct Long Beach hospital whose owner, Michael Drobot, later was imprisoned for committing a massive workers’ compensation system scam. 55 year old Lokesh S. Tantuwaya, who lived in San Diego, was sentenced by United States District Judge Josephine L. Staton, who also ordered him to forfeit his ill-gotten gains of $3.3 million. Tantuwaya pleaded guilty last September to one count of conspiracy to commit honest services mail and wire fraud and to receive illegal payments for health care referrals. He has been in federal custody since May 2021 after he was found to have violated the terms of his pretrial release. Tantuwaya accepted money from Michael Drobot from 2010 to 2013, who owned Pacific Hospital in Long Beach, in exchange for Tantuwaya performing spinal surgeries at that hospital. The bribe amount varied depending on the type of spinal surgery. Pacific Hospital specialized in surgeries, especially spinal and orthopedic procedures. Drobot, who in 2018 was sentenced to 63 months in prison for his crimes in this scheme, conspired with doctors, chiropractors and marketers to pay kickbacks and bribes in return for the referral of thousands of patients to Pacific Hospital for spinal surgeries and other medical services paid for primarily through the California workers’ compensation system. During its final five years, the scheme resulted in the submission of more than $500 million in medical bills for spine surgeries involving kickbacks. In total, Tantuwaya received approximately $3.3 million in illegal payments. “Despite his privileges at San Diego-area hospitals, [Tantuwaya] caused several patients to travel from Imperial County and San Diego County up to Pacific Hospital for spine surgery so that [Tantuwaya] could get his bribes,” prosecutors argued in a sentencing memorandum. “This resulted in numerous patient-victims enduring the physical anguish of multi-hour trips after invasive spinal surgeries, in addition [to] dealing with the mental anguish of now wondering whether they needed a surgery, whether the medical hardware drilled into their bones was legitimate hardware, and whether they should have trusted [Tantuwaya] with their lives.” In April 2013, law enforcement searched Pacific Hospital, which was sold later that year, bringing the kickback scheme to an end. To date, 23 defendants have been convicted for participating in the kickback scheme. The FBI, IRS Criminal Investigation, the United States Postal Service Office of Inspector General, and the California Department of Insurance investigated this matter ...

OSIP's summary of the FY 2021/22 public self-insured data, posted this week, provides an initial snapshot of the volume of claims, total loss payments and total incurred losses for the 12 months ending June 30, 2022. The state compiles the data from workers' compensation reports submitted by hundreds of public self-insured entities, including cities and counties, local fire, school, transit, utility and special districts, and joint powers authorities. The latest summary shows that in FY 2021/22 these employers provided workers' compensation coverage to just over 2 million California public workers whose wages and salaries totaled more than $145 billion. California’s public self-insured workforce increased less than 1% in the 12 months ending June 30, but the total number of public self-insured work injuries and illness claims reported to the state jumped 35%, as the medical-only claim count rose 29.9% while the number of indemnity claims soared by 38.1%. A CWCI analysis of data from the state’s Office of Self-Insurance Plans (OSIP) shows that with claim volume up steeply, total workers' compensation paid losses for cities, counties and other public agencies in California increased by 31.5% to a record $585 million in fiscal year (FY) 2021/22, while total incurred losses (paid plus reserves) rose 19.3% to nearly $1.68 billion. Reviewing OSIP’s initial report data for the past two years, CWCI found that after declining 4.4% in FY 2020/21, the number of public self-insured employees in the state increased 0.9 percent in FY 2021/22, but the number of reported work injury and illness claims among these workers jumped from 107,161 to 144,676 cases – a 35% increase. With the huge surge in claims – many of which were likely COVID-19 claims according to both CWCI data and the state’s survey of occupational injuries and illnesses – public self-insureds' total claim payments at the first report increased by $140 million to $585 million, up 31.5% from the comparable figure for FY 2020/21. That was the eighth consecutive increase in total public self-insured paid losses, but in this case it was fueled by the huge jump in claim volume and not an increase in the average amount paid per claim, as an influx of relatively low-cost claims drove first report average paid losses down from $4,152 in FY 2020/21 to $4,043 in FY 2021/22. A closer look at the first report payment data on public self-insured indemnity claims shows the average indemnity paid per FY 2021/22 lost-time claim was $4,165, which was down from $4,256 the prior year, but the impact of this reduction on the total amount paid was more than offset by the addition of 25,433 indemnity claims. With the surge in lost-time cases, indemnity claims’ share of the public self-insured claims increased from 62.3% to 63.7%, while less expensive medical-only claims decreased from 37.7% to 36.3%. Calculating the public self-insured claim frequency rate to control for changes in the work force, CWCI noted that overall claim frequency increased from 5.3 claims per 100 employees (2.0 medical only + 3.3 indemnity) in FY 2020/21 to 7.2 claims per 100 employees (3.3 medical only + 4.6 indemnity) in FY 2021/22. The incurred loss data (paid losses + reserves for future payments) followed the same pattern as the paid loss data. Comparing first report results from the last two years, CWCI found that public self-insureds’ total incurred losses increased by $271.7 million (19.3%) from $1.41 billion ($733.8 million indemnity + $673.8 million medical) in FY 2020/21 to nearly $1.68 billion ($869.9 million indemnity + $809.5 million medical) in FY 2021/22. With the addition of what appears to have been several thousand relatively low-cost COVID lost-time claims -- the average incurred indemnity per indemnity claim at first report fell 14.2% to $9,987, but with 25,433 more indemnity claims in FY 2021/22 than in FY 2020/2021, public self-insured total incurred losses increased by $271.7 million (+19.3%) compared to a year earlier. In addition to the public self-insured data, OSIP also compiles private self-insured claims data, but it is reported on a calendar year basis, so updated figures from California's private self-insurers will be released this summer ...

Laura Ramos sued her former employer Smile Brands, Inc., for various causes of action pertaining to the termination of her employment. Brands is a dental business, headquartered in Irvine California, with "8,000 dedicated team members at over 650 affiliated dental offices around the United States." Beginning in 2005, Ramos worked as an office manager for Brands at several offices in the Inland Empire. Brands moved to compel arbitration. Brands have a software program, named "SmileU," that they use for human resource documents and employee training. The arbitration agreement was presented as a required document, in a section of SmileU entitled "Courses I Have to Do." Upon opening the arbitration agreement, an employee would have needed to scroll through the entire text of the agreement before checking a box at the bottom of the agreement indicating that the employee consented to the terms of the agreement. The arbitration agreement included an opt-out provision that required an opt-out form be mailed to human resources. In opposing the motion, Ramos asserted, "[T]he Agreement attached to [Brands’ motion] is completely blank, having no date, no timestamp, no signature, no initials, or any other indication it was executed. [Brands] have also attached an excel-type printout [, i.e., the Training Record,] which lists the Agreement as one of several dozen ‘lessons’ that Ms. Ramos supposedly completed. This printout is not credible as there is no signature, date, timestamp or anything establishing its accuracy." In a declaration, Ramos declared that she did not sign the arbitration agreement in 2017, and she would not have signed it had she seen it. Ramos declared that she regularly checked the completed documents and courses list in SmileU, and she never saw an arbitration agreement listed there. Ramos declared that the Training Record, filed by Brands, included other errors. For example, the Training Record reflected Ramos completed courses on days she was not at work. The trial court denied the motion. In its ruling the trial court explained that Phillips’s "declaration does not establish that [Ramos] accessed, reviewed and electronically signed the Arbitration Agreement. [¶] The 'Mutual Arbitration Agreement' produced by Brands does not contain an actual ‘electronic signature’ of [Ramos]. [¶] Nowhere in the Arbitration Agreement is [Ramos] identified by name. [¶] Nor does the document contain an electronic signature bearing her name, or any date to show that it is the precise Arbitration Agreement reviewed or signed by [Ramos]." The Court of Appeal affirmed the trial court in the unpublished case of Ramos v. Smile Brands - E077394 (December 2022). Brands provided an arbitration agreement without a signature and without a checkmark, but Brands also provided a Training Record reflecting that Ramos’s arbitration agreement was "[c]omplete." For the sake of argument, the Court of Appeal presumed, without deciding, that such evidence satisfied Brands’ prima facie burden of proof that there was an arbitration agreement between the two parites. At that point, the burden shifted to Ramos. "In the declaration, Ramos explained that she typically reviews legal documents with her husband and one of her sons, who works in the legal field. In 2012, Brands gave Ramos an arbitration agreement, and she discussed the 2012 arbitration agreement with her husband and son prior to rejecting it. Ramos explained that she would have remembered if she saw the arbitration agreement in 2017 because she had rejected it in 2012 and therefore would have discussed it again with her husband and son. Ramos declared that the first time she saw the 2017 arbitration agreement was when her attorneys showed it to her as part of the instant litigation." "The testimony of a single credible witness may constitute substantial evidence." (Spencer v. Marshall (2008) 168 Cal.App.4th 783, 793.) "Ramos’s declaration is not a conclusory, self-serving statement. Rather, the declaration includes an explanation as to why Ramos is able to credibly assert that she did not see nor sign the 2017 agreement. In sum, we are not persuaded that Ramos’s evidence is insufficient. To the contrary, it is substantial evidence on which the trial court could reasonably rely." "The burden shifted back to Brands to authenticate their evidence of Ramos’s alleged consent." ... "Brands failed to present evidence of who or what created the Training Record and how the Training Record was created or generated." ...

70 year old Francis Okyere, a previously licensed insurance agent in Westlake Village California, was sentenced after pleading no contest to 17 felony counts of identity theft and grand theft by false pretenses. Okyere was sentenced to two years in county jail and to pay restitution in full. The Department began an investigation after receiving a complaint from one of Okyere’s ex-relatives that he had stolen the identities of several people in order to open a new insurance agency. The Department’s investigation confirmed that Okyere stole the identities of four victims, in order to open Cyber Access Insurance Agency. The victims’ identities were also used on small business loan applications to fund the fraudulent agency. The Department’s investigation discovered Okyere had also applied for a series of Small Business Administration and Paycheck Protection Program loans, the federal program to help businesses during the COVID-19 pandemic. The documents related to those loans revealed two of the same stolen victims’ identities had been used to fraudulently secure loan funds in the amount of $38,963. Okyere used the same stolen identities when he applied for forgiveness of one of the loans. Okyere was arrested August 18, 2022. Okyere’s alleged accomplice, Holly Freeman, 40, was also arrested and charged with four counts of felony identity theft for her alleged involvement in the same scheme. This is the second time accusations have been brought against Okyere, who has previously been convicted of grand theft following another Department of Insurance investigation which found he stole $65,456 in insurance premiums from small business owners. The charges in the earlier case arose from an investigation by the Department of Insurance’s Investigation Division, Valencia Regional Office, into multiple complaints filed by clients of Okyere alleging that their insurance policies were canceled despite paying Okyere for the coverage. The investigation revealed that, between July 2015 and September 2016, Okyere misappropriated at least $65,456 in insurance premiums payments from four small business owners and used those funds for his personal benefit. Okyere’s actions left the business owners uninsured against potential liability and workers compensation claims. The Department ordered Okyere to surrender his license in 2019. The second case was prosecuted by the Healthcare Fraud Division of the Los Angeles County District Attorney’s Office ...

In 1983, while he was a medical resident, Dr. Bruce E. Fishman was named in a Michigan federal indictment; and he later pled guilty to a single count of conspiracy to distribute a controlled substance. His medical license was revoked in both California and Michigan. After he applied for California reinstatement in 1989, his license was reinstated. In 2003, Dr. Fishman applied to the Division of Workers’ Compensation to become a QME, and was appointed to be a QME and then reappointed several times thereafter. In 2008, Dr. Fishman entered into a relationship with Green Lien Collections, Inc., a company owned by Patrick Nazemi. In 2011, Nazemi formed Med-Legal Associates Inc., with the intent to provide management services to med-legal providers. Dr. Fishman entered into a management services agreement with them in November 2012. Thereafter the relationship between them "deteriorated." At this point, three relevant separate and independent procedural timelines begin: 1) an arbitration between Fishman and Med-Legal; 2) a Qui Tam action against Fishman filed by Nazemi organizations; and 3) the suspension of his QME status by the DWC presumably prompted by a letter send on behalf of Nazemi organizations. With regard to the first arbitration timeline, after a five-day hearing, in February 2017, the arbitrator issued a final award in favor of Fishman. Med-Legal’s petition to vacate the arbitration award was denied, and judgment was entered in favor of Fishman. Med-Legal appealed, and on March 8, 2019, the Court of Appeal affirmed the judgment. With regard to the third timeline involving the suspension of Dr. Fishman's QME status by the DWC, Dr. Fishman filed a petition for writ of mandate, asking the trial court to set aside the adverse decision. In August 2021, the trial court granted his petition for writ of mandate and set aside the DIR’s suspension order. In so ruling, the trial court found that the DIR "prejudicially abused its discretion by failing to consider all relevant facts in connection with its determination of [Dr. Fishman’s] crime is substantially related to the qualification, functions and duties of a provider of services in the workers’ compensation system. By failing to consider all relevant facts - not just the crime - [the DIR] failed to proceed as required by law." The instant appeal concerns the second timeline on the Insurance Fraud Prevention Act (IFPA) Qui Tam action against Dr. Fishman. On June 16, 2020, Fishman filed a motion for judgment on the pleadings, seeking dismissal of the sole remaining cause of action for violation of the IFPA, which was ultimately granted by the trial court, finding that the sole remaining cause of action was barred by the doctrine collateral estoppel because of the arbitration decision. Attorney fees were awarded to Dr. Fishman in the amount of $197,500. The trial court concluded its IFPA dismissal ruling with the following observations: "Ultimately, one lesson emerges from a review of the history of this case and the many other cases in which the Relator sought damages from Dr. Fishman: persistence is one thing; persecution is another. Unfortunately, this case goes well beyond persistence into the realm of persecution." And further added that "It is time to put this sad and pathetic litigation to an end." The Court of Appeal reversed the unpublished case of State of California v. Fishman - B307407 (December 2022). The Opinion commenced by noting "This appeal is just one slice of contentious litigation...." between Nazemi and his entities and Dr. Fishman. The appeal concerns three issues resulting from the judgment in the underlying qui tam action: (1) The propriety of the trial court’s order granting Fishman’s motion for judgment on the pleadings; (2) Whether the trial court abused its discretion in awarding Fishman attorney fees; and (3) The correctness of the trial court’s order adding Nazemi and GLC Operations as judgment debtors. "Regarding the arbitration decision, there are at least two elements of collateral estoppel not satisfied. First, it is unclear whether the issue in the qui tam proceeding is the same as the one at issue in the arbitration case." Thus for this an other reasons, it was concluded that the trial court erroneously granted Fishman’s motion for judgment on the pleadings. The Court of Appeal concluded the Opinion with this remark, "the appellate record of this appeal and the prior one have the earmarks of malice; it does seem that (1) Nazemi has a personal vendetta against Dr. Fishman, (2) Nazemi is controlling the corporate entities and directing the litigation, and (3) several judicial or quasi-judicial entities that have weighed in on the question of Dr. Fishman’s honesty have determined that, in that particular case, he did not commit fraud. Unfortunately, given the procedural posture of this case and based upon what is presented in this appellate record, we cannot conclude that judgment can be entered at this time." ...

Several Central Coast health care providers have agreed to pay a total of $22.5 million to resolve allegations that they violated federal and California law by causing the submission of false claims to Medi-Cal related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act (ACA). Dignity Health, a not-for-profit health system that owns and operates three hospitals and one clinic in Santa Barbara and San Luis Obispo counties, entered into one agreement with the United States and the California. The second settlement agreement resolves allegations against Twin Cities Community Hospital and Sierra Vista Regional Medical Center, two acute healthcare facility subsidiaries of Tenet Healthcare Corporation operating in San Luis Obispo County. Pursuant to the ACA, beginning in January 2014, Medi-Cal was expanded to cover the previously uninsured "Adult Expansion" population - adults between the ages of 19 and 64 without dependent children with annual incomes up to 133% of the federal poverty level. The federal government fully funded the expansion coverage for the first three years of the program. Under contracts with California’s Department of Health Care Services (DHCS), if a California county organized health system (COHS) did not spend at least 85% of the funds it received for the Adult Expansion population on “allowed medical expenses,” the COHS was required to pay back to the state the difference between 85% and what it actually spent. California, in turn, was required to return that amount to the federal government. The two settlements resolve allegations that Dignity, Twin Cities and Sierra Vista knowingly caused the submission of false claims to Medi-Cal for "Enhanced Services" that Dignity purportedly provided to the Adult Expansion patients of a COHS between February 1, 2015 and June 30, 2016, and that Twin Cities and Sierra Vista purportedly provided to such patients between January 1, 2014 and April 30, 2015. The United States and California alleged that the payments were not "allowed medical expenses" permissible under the contract between DHCS and the COHS; were pre-determined amounts that did not reflect the fair market value of any Enhanced Services provided; and/or the Enhanced Services were duplicative of services already required to be rendered. The United States and California further alleged that the payments were unlawful gifts of public funds in violation of the California Constitution. As a result of its settlement, Dignity will pay $13.5 million to the United States and $1.5 million to the State of California. Twin Cities and Sierra Vista have agreed to pay $6.75 million to the United States and $750,000 to the State of California. The civil settlements include the resolution of claims brought under the qui tam, or whistleblower, provisions of the federal False Claims Act by Julio Bordas, the former medical director of the COHS that contracted with Dignity, Twin Cities and Sierra Vista for the provision of health care services under Medi-Cal. Under the act, a private party can file an action on behalf of the United States and receive a portion of any recovery. Mr. Bordas will receive $3.9 million as his share of the federal recovery. The resolution obtained in this matter was the result of a coordinated effort between the United States Attorney’s Office; the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section; and the California Department of Justice. HHS-OIG and DHCS provided substantial assistance ...

Massachusetts Attorney General Maura Healey announced that retail pharmacy provider Walmart, Inc. has agreed to pay $500,000 after allegedly failing to follow prescription pricing procedures that are in place to keep costs down and prevent overcharges in the workers’ compensation insurance system. This case is part of an ongoing review by the Attorney General’s Office into prescription pricing procedures in the workers’ compensation system. AG Healey has now reached settlements with Walmart, Express Scripts, Optum Rx, Walgreens, Stop & Shop, and United Pharmacy for workers’ compensation drug pricing violations totaling over $16 million. The pricing procedures, required by Massachusetts regulations, ensure that prescription costs will be reviewed against certain regulatory benchmarks. According to the assurance of discontinuance, filed this week in Suffolk Superior Court, Walmart allegedly failed to follow those regulations when applying prices for various injured worker prescriptions from 2016 to the present, at Walmart pharmacy locations in Massachusetts. Under Massachusetts’ Workers’ Compensation system, when employees are hurt on the job, they are entitled to lost wages, compensation for injuries, and payments for certain injury-related expenses. The system sets limits for the cost of prescriptions for injured workers and requires companies to validate prices against certain regulatory benchmarks before processing their charges, such as the Federal Upper Limit for Medicare and the Massachusetts Maximum Allowable Cost. On November 7 the Attorney General announced that Pharmacy Benefits Manager, Express Scripts, Inc., has agreed to pay $3.2 million after allegedly failing to follow prescription pricing procedures. The terms of the AG’s settlement require Express Scripts to implement procedures to prevent overcharges in the workers’ compensation insurance system. The settlement also ensures that Express Scripts will cooperate with the AG’s Office’s monitoring of the company’s future regulatory compliance. Last February the AG announced that Pharmacy benefits manager, Optum Rx, Inc., has agreed to pay $5.8 million after allegedly failing to follow workers’ compensation prescription pricing procedures. The settlement, filed in Suffolk Superior Court, resolves allegations that Optum Rx, in some circumstances, failed to apply various regulatory benchmarks - like the Federal Upper Limit for Medicare and the Massachusetts Maximum Allowable Cost - to its pricing determinations for certain workers’ compensation insurance prescription drug charges. These failures, according to the settlement, allegedly occurred on various injured worker prescriptions filled in Springfield, New Bedford, Boston and Worcester at Walgreens, CVS, and RiteAid locations. In February 2019 the AG announced that Walgreens has entered into two separate settlement agreements to resolve allegations that it overcharged MassHealth for prescriptions. These settlements both arise from qui tam (whistleblower) actions originally filed in the United States District Court for the Southern District of New York under the federal False Claims Act. Walgreens is a national pharmacy chain with over 260 locations in Massachusetts. . These cases were handled by staff from Attorney General Healey’s Insurance and Financial Services Division, including Glenn Kaplan, Dr. Burt Feinberg, and Gia Kim ...

The National Safety Council is America’s leading nonprofit safety advocate - and has been for more than 100 years. As a mission-based organization, it works to eliminate the leading causes of preventable death and injury, focusing our efforts on the workplace, roadway and impairment. Funded by the McElhattan Foundation, its Work to Zero program aims to eliminate workplace fatalities through the use of technology. To learn more about creating a safer workplace interested parties are invited to attend The Future of EHS 2023 Environment, Health & Safety Conference beginning on Jan. 31, 2023 through Feb. 2nd in Long Beach, California. This conference brings together EHS professionals, business leaders, researchers and solutions providers for an open exchange of forward-looking ideas, the latest in safety innovations and best practices. Formerly known as the Campbell Institute Symposium and Work to Zero Summit and Expo, The Future of EHS will continue to provide leading-edge content in a new and engaging format. The National Safety Council also just released a white paper through its Work to Zero initiative: Managing Risks with EHS Software and Mobile Applications. The report builds on the program’s initial 2020 research and outlines how employers can use environment, health and safety software and mobile applications to enhance their safety operations to prevent serious injuries and fatalities on the job. "EHS software and mobile applications are a crucial component of any effective risk management strategy and advancements in these powerful, comprehensive tools have made it easier for organizations of all sizes to access and analyze life-saving insights," said Emily Whitcomb, NSC director of innovation and Work to Zero. "In addition to helping leaders select the best program provider, this report demonstrates how to maximize the benefits of EHS software to help organizations further their unique safety goals and ultimately create safer outcomes for their workers." For this white paper, the Work to Zero initiative analyzed more than a dozen academic and industrial publications as well as conducted interviews with software providers for high-risk industries, such as construction and warehousing, to assess the latest trends and benefits of four distinct EHS software categories: risk management and hazard identification, permit management, incident management and safety auditing. In addition, several case studies were conducted with employers that adopted EHS software to further understand the benefits. Compared to utilizing traditional, spreadsheet-based safety tracking, the Work to Zero initiative found organizations that adopt these modules can gain several advantages in preventing workplace injuries and deaths, including: - - Generating deeper safety insights - In an EHS management system, data is centralized and acquired from a variety of sources across the enterprise, making it easier for employers to track, monitor and evolve safety practices. - - Ensuring compliance with regulations - As a cloud-based system, EHS platforms can help companies stay up to date with regulatory changes and provide custom inspection checklists to ensure workplaces are both safe and lawful. - - Accessing cost-savings - In addition to preventing employee injuries, EHS software tools can mitigate costs associated with employee compensation, recruitment, and illness. - - Streamlining reporting through mobile technology - EHS software systems can be deployed and accessed on remote devices like smartphones and tablets to enable employers to access audits, incident reports and real-time safety alerts. Despite the many benefits of EHS software and mobile applications, the Work to Zero initiative uncovered common barriers to widespread EHS software adoption, including challenges large enterprises face with customizing their EHS packages and the limited availability of comprehensive EHS software for smaller organizations. In addition, a certain level of technical expertise is needed to operate these platforms, which is why training is necessary or it’s important to select a software provider that offers technical support and resources. As with any digital change, educating across all levels of the organization is a critical step in technology deployment ...

The California Insurance Commissioner announced that Essilor Laboratories of America, Inc. has agreed to a $23.8 million settlement in a lawsuit which alleged the company violated the Insurance Frauds Prevention Act. The suit alleged Essilor provided kickbacks and other unlawful incentives to eye care providers that ultimately hurt consumers by unfairly driving them toward more expensive services. Essilor manufactures, markets, and distributes optical lenses and equipment used to produce optical lenses throughout California and the nation. This settlement brings to a close a 2016 whistleblower lawsuit brought against Essilor. After investigating the allegations, the Commissioner filed a complaint in intervention in 2021. The lawsuit alleged that Essilor provided unlawful kickbacks to eye care providers, with an up-front payment of tens of thousands of dollars, or sometimes hundreds of thousands of dollars, in exchange for these providers’ promises to send business to Essilor for a period of anywhere between three to five years. The providers were free to use the up-front payment from Essilor in any manner that they chose so long as they hit the volume requirements pursuant to the agreement. Additionally, the lawsuit alleged Essilor further provided kickbacks to California eye care providers through a program called "PracticeBuilder" where providers were given cash payments for using Essilor lenses and laboratory services. The cash payments through the PracticeBuilder program were done to reward the eye care providers who prescribed and dispensed Essilor’s more expensive lenses and coatings and to use its laboratory services. Unlawful incentives, like those alleged in the lawsuit, are prohibited under the Insurance Frauds Prevention Act as these illegal acts can, and do, influence medical decision making. California laws are in place to protect patients and encourage medical decision makers to act solely in the best interest of their patient. The lawsuit further alleges Essilor knowingly submitted false claims to California private payors, including insurance companies, health care savings plans, and vision benefit organizations. The resolution is the result of a collaborative prosecution between the Commissioner and the whistleblower’s counsel, Baron & Budd, P.C., The Weiser Law Firm, and Keller Grover, LLP. "This settlement is an important victory for consumers and patients who were the targets of corporate greed," said the Insurance Commissioner. "Health insurance fraud causes billions of dollars of premium losses annually, resulting in increased cost to Californians. This settlement sends a strong signal that fraudulent practices that hurt California consumers will not be tolerated and will be prosecuted to the full extent of the law. It also will restore key protections for eyecare patients so they receive care and recommendations that are in their best interest." ...

The California Division of Workers’ Compensation announced that registration for its 30th annual educational conference is now open. The conference will take place in person March 9-10, 2023 at the Oakland Marriott City Center Hotel and March 23-24, 2023 at the Los Angeles Airport Marriott. This annual event is the largest workers’ compensation training in the state and allows claims administrators, attorneys, medical providers, return-to-work specialists, employers, human resources and others to learn firsthand about the most recent developments in the system. Attendees will be interested in learning about current topics from a variety of workers’ compensation experts from DWC, other state and public agencies, and the private sector. The presenters include the Administrative Director, DWC Judges and Senior Staff, and outside experts. The topics this year are expected to include the following: - - DWC Update - - Top Ten Litigation Tips - - QME Med-Legal/Regulations Update - - Rating - Legal Ethics - - Trends in WC Medical Treatment - - Audit Unit - Women in Law and Business - - MTUS/Formulary DWC has applied for continuing educational credits by attorney, rehabilitation counselor, case manager, disability management, human resource and qualified medical examiner certifying organizations among others. Organizations who would like to become sponsors of the DWC conference can do so by going to the IWCF Website. Attendee, exhibitor, and sponsor registration may be found at the DWC Educational Conference Webpage ...

Ramiro Rodriguez claimed injury to the neck, arms, back, shoulders, nervous system, depression and anxiety through February 20, 2003 while employed as a forklift operator by Las Vegas LA Express. The employer denied the claim in its entirety. Julie Goalwin, Ph.D. evaluated applicant as the psychiatric qualified medical evaluator (QME) on June 21, 2003 and served her report on the parties on July 14, 2003. Dr. Goalwin sold the receivables for her evaluation and report of applicant to Angoal Medical Collections on July 1, 2003. Janine Angelotti, D.C. evaluated applicant as the applicant’s chiropractic QME on June 25, 2003. Dr. Angelotti also filed a lien claim in the amount of $2,845 for her evaluation and report on July 21, 2003. Applicant’s claim was dismissed for lack of prosecution on February 3, 2010. The matter proceeded to trial on December 19, 2019 regarding Angoal Medical Collections’ lien for Drs. Goalwin and Angelotti. Several issues were identified as in dispute including laches. The WCJ issued the F&O in which he found that the lien claim was barred by laches. All other issues were found to be moot and were not addressed in the F&O. The WCAB panel granted the lien claimants petition for reconsideration, rescinded the F&O and remanded the case for further proceedings in the case of Ramiro Rodriguez v Las Vegas LA Express - ADJ1424195 (November 2022). In common law legal systems, laches is a lack of diligence and activity in making a legal claim, or moving forward with legal enforcement of a right, particularly in regard to equity. In this case the lien claimant contends on reconsideration that the WCJ erroneously found its lien was barred by laches although defendant did not prove prejudice from the delay in pursuing the lien. "The equitable doctrine of laches applies to proceedings before the Appeals Board. (See Truck Ins. Exchange v. Workers’ Comp. Appeals Bd. (Kwok) (2016) 2 Cal.App.5th 394, 401-402 [81 Cal.Comp.Cases 685] ["The appeals board has broad equitable powers with respect to matters within its jurisdiction. . . . Thus, equitable doctrines such as laches are applicable in workers’ compensation litigation."].) The Appeals Board may apply the doctrine of laches to lien claims. (Kaiser Foundation Hospitals v. Workers’ Comp. Appeals Bd. (Martin) (1985) 39 Cal.3d 57, 68, fn. 11 [50 Cal.Comp.Cases 411] ["a lien claim may be barred by laches if there is unjustifiable delay"]." However "the affirmative defense of laches requires unreasonable delay in bringing suit 'plus either acquiescence in the act about which plaintiff complains or prejudice to the defendant resulting from the delay.' Prejudice is never presumed; rather it must be affirmatively demonstrated by the defendant in order to sustain his burdens of proof and the production of evidence on the issue. Generally speaking, the existence of laches is a question of fact to be determined by the trial court in light of all of the applicable circumstances..." "It is acknowledged that there was a substantial delay between the lien claim’s filing and lien claimant’s pursuit of reimbursement. The WCJ in his Opinion on Decision and Report indicates that prejudice to defendant may be presumed by this delay. However, defendant must show that it was actually prejudiced by the delay." "In this matter, defendant only offered two exhibits at trial to dispute the lien claim: an EAMS lien printout for the case and Elaine Taite’s deposition transcript. No witnesses were offered by defendant. The WCJ presumed that defendant’s file has been destroyed, but there is no evidence in the record to support this presumption. Moreover, defendant has not demonstrated how it was prejudiced by the delay. Consequently, the evidence does not support a finding that the lien is barred by laches." The case was returned to the trial level for further proceedings ...

Andres Gomez was injured while working for the Vons Companies Inc. He was issued two Supplemental Job Displacement Benefit (SJDB) vouchers for two injuries that occurred on January 29, 2007 and March 3, 2007, which were issued on July 17, 2017. $3,163.82 in unused voucher funds were returned to the employer from the program he had chosen and provided the vouchers . Gomez attempted to recover the unused benefit which the employer rejected because these two vouchers expired on July 17, 2019, two years after they were issued, even though there were unused funds left over At trial, Gomez pointed out that that even though the vouchers were issued on July 17, 2017, he did not sign them until October 24, 2018 and that the employer then delayed eight months in releasing the voucher funds, which was done on June 13, 2019. Nonetheless, the WCJ found, that the two Supplemental Job Displacement Benefit (SJDB) vouchers that applicant received expired two years after they were issued, and that Labor Code, section 4658.5 prohibits payment or reimbursement of unused funds after the vouchers expired. Reconsideration was denied in the panel decision of Gomez v the Vons Companies Inc - ADJ504245-ADJ1796774 (November 2022). Gomez contends on reconsideration that the vouchers should not be deemed expired and that instead they should be deemed "used" when he signed the vouchers and selected a retraining program. Section 4658.5(d) provides that a "voucher issued after January 1, 2013, shall expire two years after the date the voucher is furnished to the employee or five years after the date of the injury, whichever is later." (§ 4658.5(d).) "The employee shall not be entitled to payment or reimbursement of any expenses that have not been incurred and submitted with appropriate documentation to the employer prior to the expiration date." (§ 4658.5(d).) "The two vouchers here at issue for injuries dated January 29, 2007 and March 3, 2007 were issued on July 17, 2017. Per section 4658.5(d), these two vouchers expired on July 17, 2019." "Even if, under a liberal interpretation, we toll the expiration date of the two vouchers by eight months, which was a delay that applicant suffered through no fault of his own, the tolled expiration date of the vouchers would be March 17, 2020. The welding school applicant chose for retraining returned $3,163.82 in unused voucher funds to defendant on December 31, 2020, which is after the tolled expiration date of March 17, 2020." "Therefore, even if we take into account the eight-month delay caused by defendant, the vouchers would still have expired by the time they were returned. Section 4658.5(d) is clear that applicant is not entitled to reimbursement of any expenses that have not been incurred and submitted prior to the expiration date. Accordingly, we deny reconsideration." ...

Currently, there are no published studies that compare non-pharmacological, pharmacological and invasive treatments for chronic low back pain in adults and provide summary statistics for benefits and harms. A new systemic multi-center and multi-continent review of both randomized controlled studies and trial registries found that surgeons and the industry are still on the journey to successfully treating chronic non-specific low back pain without radiculopathy. The study, "Benefits and Harms of Treatments for Chronic Non-Specific Low Back Pain Without Radiculopathy: Systematic Review and Meta-analysis," was published online on November 15, 2022 in The Spine Journal. The systematic review and meta-analysis compare the benefits (and harms) of treatments for the management of chronic low back pain without radiculopathy using the Benefit-Harm Scale: level 1 to 7. The team collected data from randomized controlled trials, including trial registries and from electronic databases up until May 23, 2022. The outcome measures included comparison of pain at immediate-term (2 weeks or less) and short-term (greater than 2 weeks to less than or equal to 12 weeks) and serious adverse events using the Benefit-Harm Scale (level 1 to 7). The interventions studied include non-pharmacological (acupuncture, spinal manipulation only), pharmacological, and invasive treatments compared to placebo. Overall, 17,326 records were found. Only three studies provided data on the benefits of interventions and 30 provided data on harms. Studies included interventions of: - - Acupuncture, - - Manipulation, - - Pharmacological therapies, including NSAIDS and opioid analgesics, surgery and - - Epidural corticosteroid injections. The researchers found: - - Acupuncture (standardized mean difference (SMD) -0.51, 95%CI -0.88 to -0.14, n = 1 trial, moderate quality of evidence, benefit rating of 3) and - - Manipulation (SMD -0.39 (96%CI -0.56 to -0.21, n = 2 trials, moderate quality of evidence, benefit rating of 5) effective reduced pain intensity compared to sham - - Other treatments were scored as uncertain due to not being effective, statistical heterogeneity preventing pooling of effect sizes, or the absence of relevant trials. The researchers reported that the harms level warnings were at the lowest for: - - Acupuncture, - - Spinal manipulation, - - NSAIDs, - - Combination ingredient opioids, and steroid injections Harms warnings were higher for single ingredient opioid analgesics and surgery. "There is uncertainty about the benefits and harms of all the interventions reviewed due to the lack of trials conducted in patients with chronic non-specific low back pain without radiculopathy. From the limited trials conducted, non-pharmacological interventions of acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions." "However, more research is needed. There were high harms ratings for opioid and surgery." ...

According to a report in BizJournals, Blue Shield of California is planning a layoff of hundreds of employees across the state next month, the bulk of whom are in the Sacramento region. A notice filed with the California Employment Development Department shows that Blue Shield of California is planning a permanent layoff of 373 employees by Jan. 25. The notice, filed pursuant to the Worker Adjustment and Retraining Notification Act, (WARN) does not give a reason for the layoffs. The planned layoffs include 126 employees at the health insurer’s El Dorado Hills campus and 24 employees at its Rancho Cordova office. "As a nonprofit health plan, Blue Shield of California is driven by its mission to provide access to quality health care that’s sustainably affordable for all. This includes managing administrative costs, operating efficiently, and ensuring we have the right talent, skills, and capabilities in place. In a challenging economy, we have made the tough decision to reduce our staff," the company said in a statement to the Business Journal. According to Business Journal research, Blue Shield has around 1,500 employees working out of its El Dorado Hills campus, making it the second-largest employer in El Dorado County. "The affected employees have been offered assistance, including staying on the job for up to 90 days while searching for a new position and skills training activities with the support of a certified professional career coach," according to the statement from Blue Shield. In August, Blue Shield confirmed that it had sold its El Dorado Hills buildings, at 4201-4207 Town Center Blvd., for $49.3 million, but planned to lease back half of the 244,983-square-foot complex, to better accommodate its new flexible work schedule which allowed employees to work from home part of the time. "As a nonprofit health plan whose mission is to provide Californians access to quality health care that’s sustainably affordable, Blue Shield of California is always looking for ways to operate as efficiently as possible," the company wrote to the Business Journal at the time. "As part of that effort Blue Shield has decided to consolidate some of its office spaces in the state, including El Dorado Hills." Layoffs elsewhere include 62 employees at the company’s headquarters in Oakland, 74 employees in Lodi, 63 across locations in Los Angeles and Orange counties, 16 in Redding, seven in San Diego and one in San Francisco. The positions being eliminated include dozens of different job titles. Blue Shield had $22.9 billion in operating revenue last year, according to its 2021 financial report, a 5% increase over the previous year. After expenses, the company earned net income of $237 million in 2021, which was down from its $680 million in net income in 2020 ...

Patricia Harrison claimed injury to the right shoulder and neck on March 29, 2019 while employed as a child support officer II by Los Angeles County Child Support. The parties stipulated that she had a prior industrial injury on November 30, 2011, which was resolved in March 2019 by Stipulations with Request for Award. This 2011 injury caused 41% permanent disability, 24% of which was attributed to the cervical spine. The parties stipulated at trial to the prior award for applicant’s 2011 injury. The issues at trial included permanent disability, apportionment and the applicability of section 4664 for the prior 2011 award. Exhibits admitted at trial included two reports from applicant’s primary treating physician and three reports from Dr. Halbridge, who was the QME in the 2019 case, were offered as joint exhibits. None of the medical reporting from the prior 2011 injury were provided as evidence at trial. Dr. Halbridge was provided with the reporting of the agreed medical evaluator (AME), Dr. Alexander Angerman, with respect to the 2011 injury. He apportioned 45% of permanent disability with regard to the cervical spine to the prior fall down the stairs at work in 2011. Ten percent (10%) of permanent disability with regard to the cervical spine was apportioned to the natural progression of multilevel cervical spondylosis. The WCJ found that applicant’s injury to the right shoulder and neck had caused 30% permanent disability, and found that 20% of applicant’s disability for the neck was attributable to other factors. The award was affirmed in the panel decision of Harrison v. Los Angeles County Child Support. ADJ12332626 (November 2022). On reconsideration the County of Los Angeles contends that the WCJ’s decision failed to properly address apportionment under Labor Code sections 4663 and 4664. Specifically, they contend that there must be apportionment to applicant’s prior disability award for the neck under section 4664. Alternatively, defendant contends that there must be 45% apportionment to the prior injury under section 4663. The employer holds the burden of proof to show apportionment of permanent disability. To meet this burden, the employer must demonstrate that, based upon reasonable medical probability, there is a legal basis for apportionment. "Apportionment is a factual matter for the appeals board to determine based upon all the evidence." (Gay v. Workers’ Comp. Appeals Bd. (1979) 96 Cal.App.3d 555, 564 [44 Cal.Comp.Cases 817) In order to prove apportionment for a prior permanent disability award is warranted under section 4664, the employer must first prove the existence of the prior permanent disability award. Then, having established by this proof that the permanent disability on which that award was based still exists, the employer must prove the extent of the overlap, if any, between the prior disability and the current disability. The parties stipulated at trial that there was a prior award from March 2019 for applicant’s 2011 injury. This constitutes evidence of the existence of a prior award for the cervical spine. "Overlap is not proven merely by showing that the second injury was to the same body part because the issue of overlap requires a consideration of the factors of disability or work limitations resulting from the two injuries, not merely the body part injured." Defendant contends that although the AME for the 2011 injury rated applicant’s cervical spine impairment using the DRE method and Dr. Halbridge rated the spinal impairment using the ROM method, this is irrelevant per Hom v. City and County of San Francisco (April 15, 2020; ADJ10658104) 2020 Cal. Wrk. Comp. P.D. LEXIS 124 "None of the medical reports from applicant’s 2011 injury were placed in evidence. The evidentiary record in this matter thus does not contain Dr. Angerman’s reporting and we are unable to compare his evaluation of impairment to Dr. Halbridge’s reporting." " In Hom, the AME had expressly opined that apportionment per section 4664 can be applied. In this matter, the QME Dr. Halbridge did not provide any discussion regarding how applicant’s prior permanent disability for the cervical spine overlaps with her current permanent disability for this body part. Consequently, we agree with the WCJ that defendant failed to meet its burden of proof to show overlap and apportionment per section 4664 is not warranted." ...

Beginning in 1986, the State of Oregon has analyzed workers’ compensation premium rates in all U.S. states and the District of Columbia using a methodology that controls for interjurisdictional differences in industry compositions. The index rates are not, strictly speaking, the premium rates paid by employers in that jurisdiction; instead, they represent the degree to which the premium rates differ from one another within the group. This edition of the study analyzes premium rates effective through Jan. 1, 2022. The ten highest Index Rates in the current 2022 Oregon Workers’ Compensation Premium Rate Ranking Report are as follows: 1 (2020 Position 1) - New Jersey - Index Rate = $2.44 2 (2020 Position 5) Hawaii - Index Rate = $2.27 3 (2020 Position 4) California - Index Rate = $2.26 4 (2020 Position 2) New York - Index Rate = $2.15 5 (2020 Position 8) Louisiana - Index Rate = $2.13 6 (2020 Position 3) Vermont - Index Rate = $1.98 7 (2020 Position 26) Wyoming - Index Rate = $1.86 8 (2020 Position 11) Wisconsin - Index Rate = $1.67 9 (2020 Position 16) Maine - Index Rate = $1.67 131 10 (2020 Position 6) Connecticut - Index Rate = $1.64 There are many reasons why premium rates vary among jurisdictions: Insurers’ administrative costs are constrained by regional market forces; taxes and assessments are imposed at different rates and use different bases; and accidents and illnesses occur at varying rates as natural and random processes. This study attempts to measure the degree of this variation with a consistent and objective statistic: the premium index rate. The national median index rate is $1.27 per $100 of payroll. This is its lowest value since the inception of the study in 1986, after peaking in 1994. Since the first study, the range of index rates has narrowed considerably to $1.86 per $100 of payroll, from a high of $2.44 per $100 of payroll in New Jersey to a low of $0.58 per $100 of payroll in North Dakota. However, the number of states within 10 percent of the study median dropped from 21 in 2016, to 14 in 2020 and 2022 ...

The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released Drivers of California Claim Duration report. This report describes duration drivers for California workers' compensation claims, including how claim duration differs regionally across the state. Average indemnity claim duration is significantly higher in California than in other states. It takes 7 years to close 90% of claims in California compared to 3 years for the median state. Longer California claim duration is driven by four Duration Drivers: - - California has a higher share of permanent partial disability (PPD) claims, with more than twice as many PPD claims per 100,000 employees compared to the median state. PPD claims close significantly slower than claims with temporary disability only. - - California has a significantly higher share of cumulative trauma (CT) claims, with a proportion multiples higher than other states. CT claims are more complex, involve more legal disputes, and tend to remain open longer than specific injury claims. - - California has a higher share of claims that involve medical-legal reports. 15% of PPD claims have four or more medical-legal reports and one-half of these claims are still open after 5 years compared to about one-tenth for PPD claims without medical-legal. - - California claim duration differs regionally across the state. Claims in the Los Angeles Basin have longer duration as the region has more PPD and CT claims. But, California claim duration improved significantly following the implementation of Senate Bill No. 863 in 2013. The incremental percent of open indemnity claims closed in the next year is almost 50% higher in 2019 compared to 2012 And claim closing rates declined during the pandemic in 2020 and were relatively flat in 2021. Claim closing rates are beginning to pick up again in 2022 but California remains an outlier compared to other states. It takes longer to report and recognize indemnity claims in California. After one year, 22% of California indemnity claims are unreported which is double the comparison state median. Late reported claims typically close slower and many involve cumulative trauma injury. Permanent partial disability (PPD) claims are more complex, more frequently litigated, and typically have longer duration than claims with only temporary disability benefits. California exhibits a much higher PPD claim frequency compared to other states. The frequency of PPD claims per 100,000 employees in California is 2.5 times the countrywide median. Like PPD claims, claims involving a cumulative trauma (CT) injury are typically more complex, more frequently litigated, and have longer durations than non-CT claims. Compared to other workers’ compensation systems, California’s share of Carpal Tunnel indemnity claims are similar to other states. However, when comparing other cumulative natures of injury, California's share is over five times that for other states at the second report level. These differences may be even larger at later maturities as CT claims are often filed later than non-CT claims. Regional differences within California also drive the longer claim duration in California.Temporary-only claims in the Los Angeles Basin on average close slower than in other parts of the state. Although the closing rates for PPD claims are generally similar across California regions, the Los Angeles Basin has a significantly higher share of PPD claims (56%) compared to its share of temporary-only claims (48%). For more details please download the Drivers of California Claim Duration report from the WCIRB website ...

Labor Code Sections 62.5 and 62.6 authorize the Department of Industrial Relations to assess employers for the costs of the administration of the workers' compensation, health and safety and labor standards enforcement programs. These assessments provide a stable funding source to the support operations of the courts, to ensure safe and healthy working conditions on the job, to ensure the enforcement of labor standards and requirements for workers' compensation coverage. These Labor Code provision require allocation of the six assessment types between insured and self-insured employers in proportion to payroll for the most recent year available. The total amounts of the assessments for all payers for each category for the current assessments are as follows: 1) Workers' Compensation Administration Revolving Fund Assessment (WCARF) - $ 617,034,931 2) Subsequent Injuries Benefits Trust Fund Assessment (SIBTF) - $ 430,900,000 3) Uninsured Employers Benefits Trust Fund Assessment (UEBTF) - $ 49,304,051 4) Occupational Safety and Health Fund Assessment (OSHF) - $ 195,438,707 5) Labor Enforcement and Compliance Fund Assessment (LECF) - $ 187,857,815 6) Workers' Compensation Fraud Account Assessment (FRAUD) - $ 87,842,896 Total cost of these assessments are $1,568,378,400 All workers' compensation insurance policies issued with an inception date during the calendar year 2023 must be assessed to recover amounts advanced on behalf of policyholders. Assessable Premium is the premium the insured is charged after all rating adjustments (experience rating, schedule rating, premium discounts, expense constants, etc.) except for adjustments resulting from the application of deductible plans, retrospective rating or the return of policyholder dividends ...

In 2004, Sean Conway, then an officer for the San Diego Police Department, sustained a work-related back injury resulting in multiple surgeries and spinal fusions. In 2008, Sandra Claussen, a medical review officer employed by San Diego City Employees’ Retirement System (SDCERS), recommended that SDCERS’s board approve Conway’s disability retirement. SDCERS granted Conway permanent disability retirement after finding his injuries had resulted in permanent incapacity from the substantial performance of his duties. Conway and his family moved to Idaho in 2008. The following year, he obtained a job as a jail technician, and later secured a job as a detention specialist at a juvenile detention facility. In 2013, Conway considered applying for a position as a detention deputy in an Idaho county jail that paid $23 per hour, but became concerned that accepting this position might jeopardize his disability pension. That year, he met with Claussen to inquire whether his acceptance of the detention deputy position would jeopardize his disability pension. Claussen told his family that the position was similar to a corrections deputy in the San Diego County Jail system run by the San Diego County Sheriff, and that since the San Diego Police Department did not staff jails, there was no comparable position with the San Diego Police Department so that Conway’s taking the Idaho position would not jeopardize his disability pension. They asked Claussen multiple times to put her assurances in writing, but she declined, telling them, "We don’t do that, but you have nothing to worry about." Conway took the Idaho position. Claussen intentionally concealed her assurances to plaintiffs from SDCERS, which later commenced an administrative action to have Conway’s disability retirement taken away. The Conways did not discover Claussen’s concealment until they deposed her in June 2019. That month, Conway and SDCERS participated in a hearing before a retired judge. The judge ruled in Conway’s favor and recommended his disability retirement continue. In November 2019, the SDCERS board voted to continue his disability retirement. The Conways then sued SDCERS for intentional and negligent representation and concealment, and alleged they "incurred substantial expenses and suffered substantial emotional distress during SDCERS’ efforts to eliminate [Conway’s] disability pension." The the trial court sustained a demurrer to the second amended complaint without leave to amend, ruling that the action was barred by Government Code sections 821.6 and 815.2. The trial court ruling was affirmed in the unpublished case of Conway v. San Diego City Employees’ Retirement System - D079355 (November 2022). Under the Government Claims Act, a public entity is not liable for injury except as otherwise provided by statute. Government Code Section 815.6 is one of these statutes. The intent of the act is not to expand the rights of plaintiffs in suits against governmental entities, but to confine potential governmental liability to rigidly delineated circumstances: immunity is waived only if the various requirements of the act are satisfied. Under 815.6 the government may be liable when (1) a "mandatory duty" is imposed by enactment, (2) the duty was designed to protect against the kind of injury allegedly suffered, and (3) breach of the duty proximately caused injury. The California Constitution’s broadly-worded duties on retirement boards to administer pension systems to assure prompt delivery of services and benefits, or to discharge duties solely in the beneficiaries’ interests and with care, skill, prudence and diligence, are not specific commands to engage in particular advice or disclosures of the sort on which plaintiffs base their claim. And none of the other provisions cited by the Conways suffice to create "mandatory duties" on SDCERS. The lack of a showing of a "mandatory duty" to properly properly advise the Conways about their pension continuation is the missing element for the governmental immunity exception under 815.6 to apply to their claims ...