RAND Corporation recently released a new Perspectives Report that examines policymakers’ initial efforts and reasoning around enabling access to workers’ compensation benefits for employees who are required to work outside their homes during the COVID-19 pandemic. They briefly assess the potential impacts of continuing to expand such access on workers, employers, and insurers. And finally, they pose further questions that policymakers and others may want to consider when evaluating past policies and crafting new ones to meet future public health emergencies. The coronavirus disease 2019 (COVID-19) pandemic has posed incredible challenges to the U.S. workforce. Although many businesses have transitioned employees from on-site work to telework, frontline employees in certain sectors deemed "essential" (e.g., hospitals and other health care facilities, public safety agencies such as police and fire departments, critical infrastructure such as electric and water utilities, or the food supply chain) must continue to work on-site. Depending on the specific public health restrictions in place, many "nonessential" businesses have also operated in a manner that requires employees to work on-site and, in some instances, to have extensive contact with customers, vendors, and suppliers. As of July 31, 2021, 36 states, the District of Columbia, and Puerto Rico have either implemented or are considering changes to make it easier for some classes of workers who contract COVID-19 while working outside the home to obtain benefits. In a majority of states that have expanded workers’ compensation presumptions, the presumption takes effect upon either a positive COVID-19 test result or physician’s diagnosis. In Mississippi, North Dakota, and Washington, the presumption takes effect once a worker is ordered to quarantine by an employer because of suspected COVID-19 exposure. Workers’ compensation actuaries in a majority of states have adopted regulations excluding COVID-19 from experience rating. NCCI proposed a rule change omitting COVID-19 claims from experience rating calculations. To date, 34 out of the 36 states (excepting Alaska and Nebraska) within NCCI have approved the rule change. Additionally, all states not covered by NCCI have approved similar rule changes. The COVID-19 pandemic has, so far, not had dramatic impacts on the profitability of the workers’ compensation insurance market. Far from the dire predictions at the start of the public health emergency, many employees who have contracted COVID-19 have recovered relatively quickly, without the need for long-term, costly medical care or time off from work. And although numerous laws and regulations have been enacted across many states, many of the COVID-19 claims have not ultimately met the requirements for compensability. Additionally, some observers have noted that overall claims frequency in 2020 declined in many states. A study by the Workers’ Compensation Research Institute found that in the second quarter of 2020, “the volume of non–COVID-19 WC [workers’ compensation] claims . . . [dropped] by at least 30 percent in the vast majority of the states and by as much as 50 percent in Massachusetts” (Fomenko and Ruser, 2021, p. 8). The biggest risk that insurers now face is the unknown long-term health implications for people who have recovered from a serious COVID-19 infection. Patients admitted to intensive care units are generally at greater risk of long-term adverse health outcomes. Some experts also anticipate that "in addition to claims for occupational exposure to COVID-19, an influx of posttraumatic stress and mental health claims could also be on the way" (Marsh, 2020, p. 5). It will take decades to fully understand what, if any, serious long-term side effects patients who have recovered from COVID-19 will face. Insurers face uncertain risk around tail costs, which include the potential for latent claims filed for lifetime medical, permanent disability, or death benefits. The RAND Researchers conclude by saying "The effects of the COVID-19 pandemic on the U.S. business and labor market will last far beyond an official declaration that the pandemic has ended." ...

The Omicron BA.2 sub-variant, also dubbed "stealth Omicron," has been detected in at least 40 countries worldwide. Labs in countries including Denmark and Norway have reported that the sub-variant has been gaining ground, accounting for nearly half of all COVID cases in the former as of January 20, marking a sharp increase in recent weeks. In a press release issued last Friday, the U.K.'s Health Security Agency (HSA) said that the Omicron variant sub-lineage known as BA.2 has been designated a variant under investigation by the Agency. The Agency went on to report that In total, 40 countries have uploaded 8,040 BA.2 sequences to GISAID since 17 November 2021. At this point it is not possible to determine where the sublineage may have originated. The first sequences were submitted from the Philippines, and most samples have been uploaded from Denmark (6,411). Other countries that have uploaded more than 100 samples are India (530), Sweden (181), and Singapore (127). Dr Meera Chand, COVID-19 Incident Director at UKHSA, said "It is the nature of viruses to evolve and mutate, so it’s to be expected that we will continue to see new variants emerge as the pandemic goes on. Our continued genomic surveillance allows us to detect them and assess whether they are significant." A press release from Denmark's Statens Serum Institut (SSI) infectious disease research institution last week stated that the subvariant BA.2 accounted for 20% of all covid-19-cases in Denmark in December. And other countries also experience an increase in BA.2 cases: E.g. Great Britain, Norway and Sweden One notable aspect of BA.2 is that it lacks a genetic characteristic that scientists had used to identify Omicron cases previously -giving credence to its "stealth Omicron" monicker. However, Cornelius Roemer, a computational biologist at the University of Basel in Switzerland, posted to Twitter that BA.2 is still detectable on PCR tests and branded news reports to the contrary as "totally wrong." "Depending on the PCR test used it may not look like BA.1 (the other Omicron). But it will still give a positive result," he added ...

Insurance Commissioner Ricardo Lara has been under fire since 2019, when news media reported questionable campaign contributions from associates of Applied Underwriters, while Applied was under investigation by the CDI, and seeking approval of the sale of the company.. At that time, Lara reported $31,000 in contributions from Stephen Acunto and his wife, Carole. Acunto is president of CINN Group, a New York publishing and financial services firm. Acunto, who also has served as a spokesman for Applied Underwriters. The donations came on April 30 2019, one month before Applied Underwriters alerted the California Department of Insurance that the company was in the process of being sold. Although news media discontinued following the story, Consumer Watchdog pursued the investigation with Freedom of Information Act requests. And the lawsuit provided evidence this month that Lara and top lieutenant Bryant Henley communicated with two former lawmakers representing a workers’ compensation insurer at the heart of a pay-to-play scandal. A new declaration from former legislator-turned-lobbyist Rusty Areias confirms that Commissioner Lara and Special Counsel Bryant Henley were in contact with Mr. Areias and former Assembly Speaker Fabian Nunez, Lara’s friend and political mentor. Nunez and Areias have emerged as central figures in the scandal following a lawsuit filed by Fabian Nunez’s former lobbying firm to collect a $2 million "success fee" from Applied Underwriters related to the sale of the company. The payment was to be made in exchange for Nunez and Areias’s successful efforts to protect a $60 million deposit. The declaration of Mr. Areias was filed in Los Angeles Superior Court with a motion seeking to compel the Department to produce 200 internal communications regarding Consumer Watchdog’s public records requests. This Motion is scheduled for April 27, 2022 at 9:30 a.m. Department 86 of the Los Angeles Superior Court ...

Insurance Commissioner Ricardo Lara has been under fire since 2019, when news media reported questionable campaign contributions from associates of Applied Underwriters, while Applied was under investigation by the CDI, and seeking approval of the sale of the company.. Lara reported accepting more than $50,000 in donations from insurance company executives and their apparent spouses, according to a 2019 San Diego Union-Tribune analysis of campaign funding data. At that time, Lara reported $31,000 in contributions from Stephen Acunto and his wife, Carole. Acunto is president of CINN Group, a New York publishing and financial services firm. Acunto, who also has served as a spokesman for Applied Underwriters. The donations from the Acuntos to Lara came on April 30 2019, one month before Applied Underwriters alerted the California Department of Insurance that the company was in the process of being sold. Although most news media discontinued following the story, Consumer Watchdog pursued the investigation with Freedom of Information Act requests. The requests were follow up by a Public Records Act lawsuit, brought by attorneys for Consumer Watchdog was filed in early 2020. Consumer Watchdog is a non-profit public interest organization. And the lawsuit provided evidence this month that Lara and top lieutenant Bryant Henley communicated with two former lawmakers representing a workers’ compensation insurer at the heart of a pay-to-play scandal. The communications occurred while a high-profile merger and other regulatory matters involving the insurer were pending before the California Department of Insurance. A new declaration from former legislator-turned-lobbyist Rusty Areias confirms that Commissioner Lara and Special Counsel Bryant Henley were in contact with Mr. Areias and former Assembly Speaker Fabian Nunez, Lara’s friend and political mentor. The declaration states that Areias and Nunez identified themselves as representing Applied Underwriters, the workers’ compensation insurer that directed tens of thousands of dollars in campaign donations to Lara’s 2022 re-election campaign. The communications occurred around the time Henley intervened in at least four proceedings on Commissioner Lara’s behalf to benefit Applied Underwriters. When the scandal became public in mid-2019, Lara returned the campaign contributions, stating "I believe in transparency..... I believe effective public service demands constant adherence to the highest ethical standards." Despite Commissioner Lara’s pledge of "transparency," Consumer Watchdog says the the Department of Insurance failed to search for, let alone produce, records of meetings and communications with individuals "representing" the workers’ compensation insurer, including Nunez and Areias. According to Mr. Areias’s declaration, submitted under penalty of perjury, Nunez and Areias began communicating with Commissioner Lara and Bryant Henley as early as February 2019. Yet, not a single record of meetings or phone calls between Nunez and Areias and Lara and Henley or other Department staff has been disclosed - no phone records, no calendar entries, no emails or text messages. Nunez and Areias have emerged as central figures in the scandal following a lawsuit filed by Fabian Nunez’s former lobbying firm to collect a $2 million "success fee" from Applied Underwriters related to the sale of the company. The payment was to be made in exchange for Nunez and Areias’s successful efforts to protect a $60 million deposit. The declaration of Mr. Areias was filed in Los Angeles Superior Court with a motion seeking to compel the Department to produce 200 internal communications regarding Consumer Watchdog’s public records requests. Consumer Watchdog expects that "these communications likely reflect the Department’s decision to withhold key information from the public." This Motion is scheduled for April 27, 2022 at 9:30 a.m. Department 86 of the Los Angeles Superior Court ...

Judy Hein (DOB 07/04/49), of Rhinelander, Wisconsin, pled guilty to two counts of felony workers’ compensation insurance fraud. Cal Roofing Inc was founded in 2007. From 2013 through 2017, Hein was a co-owner of Cal Roofing Inc. located in Simi Valley. During that time, Hein underreported the true amount of company payroll by over $3 million to her workers’ compensation insurance company, State Fund. Hein’s fraud caused State Fund to lose $1.6 million in premium payments. At the time of her guilty plea, Hein paid $600,000 in partial restitution to State Fund. Hein is scheduled to be sentenced on February 23, 2022, at 9:00 a.m. in courtroom 23 of the Ventura County Superior Court. This case was investigated the California Department of Insurance Fraud Division and prosecuted by the District Attorney’s Office Workers’ Compensation Insurance Fraud Unit ...

In a first-of-its kind study, Ametros found that over 34,000 claims per year were denied to Medicare beneficiaries’ post-settlement because Workers’ Compensation Medicare Set Aside (WCMSA) funds were responsible for the payments. Following settlement resolution of a workers’ compensation claim, the MSA may only be used to "...pay for medical treatment or prescription drugs related to [the underlying] claim, and only if the expense is for a treatment or prescription Medicare would cover. This is true even if you are not yet a Medicare beneficiary... " See Self-Administration Toolkit for WCMSAs, v1.3, Sec. 4 & WCMSA Reference Guide, Sec. 17.3 An MSA administrator is responsible for accurate record keeping of payments made from the account. On an annual basis, within 30 days from the anniversary of the settlement, the administrator reports attestation information to CMS. This attestation is a "statement that payments from the WCMSA account were made for Medicare-covered medical expenses and Medicare- covered prescription drug expenses related to the work- related injury, illness, or disease." (WCMSA Reference Guide, v3.5, Sec. 17.5). An attestation is also reported in instances where an annuitized MSA has been temporarily depleted prior to annual re-funding of the account as well as when an account is permanently exhausted. Id. The Centers for Medicare and Medicaid Services (CMS) has long warned that it requires WCMSA funds to be used appropriately before Medicare benefits will pay for injury-related treatment. CMS’s WCMSA Reference Guide states in Section 17.3 "Medicare will deny all [workers’ compensation] injury-related claims until the WCMSA administrator can demonstrate appropriate use equal to the full amount of the WCMSA." Despite this, many in the industry have questioned whether Medicare ever denies claims. Ametros decided to find out. Collaborating with ResDac researchers, Ametros analyzed Medicare Part B claim data from 2018-2020 and has published "A Study of CMS Policy on Treatment Denials for Injured Workers with a Medicare Set Aside." Examining a random sample of five percent of the Medicare beneficiary population over a three-year period, researchers estimated Medicare denied 35,980 WCMSA claims in 2018, 36,060 in 2019, and 30,720 in 2020 because the individual’s WCMSA account should have paid the claims. The report provides a state-by-state chart of denial breakdowns along with definitions and explanations of the Medicare Secondary Payer and MSA terms, how CMS tracks MSAs, and MSA post-settlement administration and compliance obligations. Almost a third of all denials were in California, which has a robust workers’ compensation claim volume. Less populated states like Indiana, Colorado, and Maryland also had a substantial amount of denied claims. The data shows a robust tracking system is in place for Medicare to identify and deny payment when an individual with an MSA submits a claim and they have properly attested to exhausting their funds. The report concludes by saying "it’s evident that individuals who choose to self-administer risk being denied future treatments and services by Medicare because they have not properly complied with Medicare’s guidelines. This includes setting up their account incorrectly or not using their MSA settlement funds appropriately." Ametros will present the study’s findings in a February 15 webinar hosted by John Kane, Shawn Deane, and Jayson Gallant starting at 1 p.m. EST. Register here ...

San Diego’s Balboa Pharmacy has paid $105,000 to resolve allegations that it illegally dispensed opioids and other dangerous drugs to its patients, according to a settlement agreement signed by Balboa Pharmacy and the United States. The Controlled Substances Act states that pharmacists have a responsibility to only fill prescriptions that are written for a legitimate medical purpose while acting in the usual course of professional practice. The United States alleged that Balboa Pharmacy failed to meet its responsibility when it filled opioid prescriptions without resolving, or often even attempting to resolve "red flags" that the prescriptions raised. "Red flags" are indications that a prescription may be invalid. According to the settlement agreement, Balboa Pharmacy filled prescriptions without resolving the following commonly known red flags: - - large quantities of opioids well above guidelines for treating patients, which sometimes exceeded a daily Morphine Milligram Equivalent of 100; - - dangerous combinations of drugs, including duplicative therapy; opioids and benzodiazepines (e.g., Valium, Xanax); and opioids, benzodiazepines, and muscle relaxants (e.g., Soma), a combination that is colloquially referred to by drug abusers as the “trinity” because of the rapid euphoric effects of this combination of drugs; - - patients who received prescriptions from multiple prescribers, which sometimes were for the same types of controlled substances or for dangerous combinations of drugs; and - - filling prescriptions for patients early, which includes filling a patient’s prescription before the patient’s earlier prescription for the same drug ran out. In addition to the settlement agreement, the DEA and Balboa Pharmacy entered into a Memorandum of Agreement in October 2021 in which Balboa Pharmacy agreed to, among other things, develop policies and procedures and training that address the identification and resolution of "red flags." The investigation exemplifies the Department of Justice’s willingness to investigate pharmacies that may be filling dangerous prescriptions without first confirming the legitimacy of each prescription. "This investigation is a reminder that all pharmacies have a responsibility to ensure that prescriptions are issued for a legitimate medical purpose," said DEA Special Agent in Charge Shelly S. Howe. "Failure to do so allows prescriptions to become subject to abuse and diversion, fueling the ongoing opioid epidemic. DEA will continue to hold pharmacies, such as Balboa Pharmacy, accountable." ...

The Division of Workers’ Compensation announces its emergency regulation for Medical-Legal Evaluations became effective on January 18, 2022 and will expire on July 19, 2022. There are two possible 90 day extensions (in accordance with Government Code section 11346.1(h)). The emergency regulations can be found on the DWC website. The regulation allows a QME or AME to complete a medical-legal evaluation through telehealth when a hands on physical examination is not necessary and all of the following conditions are met: - - There is a medical issue in dispute which involves whether or not the injury is AOE/COE (Arising Out of Employment / Course of Employment), or the physician is asked to address the termination of an injured worker’s indemnity benefit payments or address a dispute regarding work restrictions; and - - There is agreement in writing to the telehealth evaluation by the injured worker, the carrier or employer, and the QME. Agreement to the telehealth evaluation cannot be unreasonably denied. If a party to the action believes that agreement to the telehealth evaluation has been unreasonably denied under this section, they may file an objection with the Worker’s Compensation Appeals Board, along with a Declaration of Readiness to Proceed to set the matter for a hearing; - - The telehealth evaluation conducted by means of a virtual meeting is consistent with appropriate and ethical medical practices, as determined by the QME and the relevant medical licensing board; and - - The QME attests in writing that the evaluation does not require an in person physical exam. During the time this regulation is in effect, section 34(b) of title 8 of the California Code of Regulations is suspended, and for purposes of QME telehealth evaluations conducted under this regulation, the medical office listed on the panel selection form for the QME shall be deemed the site of the telehealth evaluation. For all other telehealth evaluations conducted under this regulation, the medical office of the physician that is within a reasonable geographic distance from the injured worker’s residence shall be deemed the site of the telehealth evaluation ...

And there might be some good news for California, and California claims administrators. While California continues to see disturbing rises in COVID-19 hospitalizations and deaths, The Los Angeles Times reports that there are some early signs the unprecedented Omicron wave is slowing. The shift is uneven across the state, but the numbers suggest California could be reaching a crest in the latest surge. States on the East Coast that were hit earlier by the Omicron wave have already started to see a sustained decline in infections. California has recorded more than 7 million coronavirus cases as of this week. The tally, recorded in the state’s databases late Monday, comes one week after it recorded its 6 millionth coronavirus case. There have never been as many Californians simultaneously infected in the history of the 2-year-old pandemic. According to data released Wednesday that reflect numbers through Tuesday, California was averaging 103,000 cases a day for the most recent seven-day period, slightly below the prior week’s rate of 107,000; the week before, the state was reporting 60,000 cases a day. California’s case rate fluctuated between 114,000 and 115,000 in the last few days - the highest rates of the pandemic. Some of the state’s most populous regions may be starting to see a leveling in case rates. Southern California recorded 69,000 new cases a day over the most recent seven-day period, a slight reduction from the 75,000 recorded from a week earlier. The week before, the region tallied 43,000 cases a day. Los Angeles County posted a record number of coronavirus cases last week, nearly 42,000 a day. But based on numbers released through Wednesday afternoon, the county is now averaging about 37,000 cases a day. The greater San Francisco Bay Area is now averaging about 18,000 coronavirus cases a day, a rate that has fluctuated between 18,000 and 22,000 for roughly a week and a half. In Santa Clara County, coronavirus levels in wastewater started declining about 1 1/2 weeks ago. Officials expect the dip will presage a sustained decline in coronavirus cases. The Greater Sacramento area recorded about 5,400 cases a day for the most recent weekly period. The capital region has been fluctuating between 5,000 and 6,000 cases a day for the last week and a half. In the Greater San Joaquin Valley, a region that generally lags behind trends in Southern California and the Bay Area, cases are still going up. The area tallied 9,300 cases a day over the last week, higher than the 7,100 cases a day for the prior week; the week before that, the region recorded 3,200 cases a day. In rural Northern California, about 720 cases a day were reported in the last week, nearly even with 710 reported the week before, but more than double the roughly 350 cases a day the sparsely populated region reported the prior week. The rate at which California’s coronavirus tests are coming back positive has also started to decline. For the seven-day period that ended Jan. 10, California hit a record positive test rate of 23.1%. Since then, the rate fell to 21.1% for the seven-day period that ended Sunday. The rate is still very high; by comparison, in early December, it was around 2% ...

A continuing crush of patients in the South Bay became so severe Tuesday that the San Diego region’s two main medical facilities declared internal disasters, a term used to indicate that conditions have worsened to the point where patient care may be affected. According to the report in the San Diego Union Tribune, Chris Van Gorder, chief executive officer of Scripps Health, said that the emergency department at Scripps Mercy Hospital Chula Vista had 73 patients mid-afternoon filling its 24 emergency beds and 23 more inside tents in the parking lot. Twenty more were in beds set up in emergency room hallways with additional spaces taken in areas traditionally used for recovery from surgical procedures or medical imaging. He added in an email just after 9 p.m. that Scripps was able "to move some patients" and exit disaster status "for now." While such a cascade did not appear to be underway, a second facility - Sharp Chula Vista Medical Center - experienced similar levels of stress Tuesday, declaring the same internal disaster status. The largest hospital serving the South Bay, Sharp Chula Vista had 30 of its 48 emergency beds occupied by patients waiting to be admitted to the main hospital, which was already full. As of 7 p.m., 116 of the medical center’s 349 total beds were filled with patients fighting COVID-19. Statewide, California continues to struggle with large numbers of its residents testing positive. According to the Los Angeles Times, California recently hit the 7 million case mark, just one week after hitting 6 million, a record pandemic pace. When the number of emergency patients exceeds an individual hospital’s resources, facilities traditionally turn to diversion, a system that allows them to significantly reduce ambulance deliveries, providing a few hours for harried staff to catch up. But that option was taken off the table last week when the county’s emergency medical services director temporarily suspended self-directed diversion for all hospitals through Jan. 27. The move came as a way of coping with the fact that high patient volume was regularly forcing a large percentage of the region’s hospitals to simultaneously go on bypass. Declaring an internal disaster is, in some significant sense, hospitals telling the region’s emergency medical services system that despite a ban on bypass, they can’t handle the volume and are closing their doors to additional ambulance patients. Dr. Eric McDonald, the county’s chief medical officer, said Tuesday afternoon that duty officers who run the local emergency medical services system were working to help alleviate the disaster conditions at the two South Bay locations. The situation countywide, he added, did not appear to be as impacted as it was Tuesday in the South Bay. Scripps said Tuesday afternoon that it has shifted some patients out of Chula Vista to other hospitals it operates across San Diego County. Transfers as far north at Tri-City Medical Center in Oceanside, Van Gorder said, were occurring. Tri-City confirmed in a short statement Tuesday evening that it recently requested and received "some staffing support to address the challenging environment caused by elevated demand for services and workforce limitations during the current surge." Tri-City did not provide the total number of supplemental staff that the state sent to supplement its Oceanside workforce. McDonald said the number was about 50 ...

The California Workers’ Compensation Institute has announced that registration is open for its 58th Annual Meeting. It is planned as a live event on Tuesday, March 8 from 9:00 a.m. to 3:00 p.m. at the Lesher Center for the Arts in Walnut Creek, California. For those who are unable to attend the live event, there will be an "Encore" broadcast with live Q&A on Thursday, March 10th at 9:00 a.m. The theme of this year’s meeting will be "Are We There Yet?" an acknowledgement and analysis of our industry’s dual state of mind after almost two years of working through the worldwide pandemic and the anticipation of returning to "normal." CWCI staff and guest speakers will examine both the current environment as well as the issues, challenges, and opportunities facing the California workers’ compensation community as we move toward and into the post-pandemic environment. The meeting will include the following: - - Dr. Mark Schniepp, Director of the California Economic Forecast, will examine the impact that COVID-19 continues to have on the California and the U.S. economies, the "great resignation," and the economic outlook for the year ahead. - - CWCI’s Rena David and Alex Swedlow will present a 3-part Research Update on COVID-19’s continuing impact on California workers’ compensation, changes in medical-legal utilization and reimbursement under the new medical-legal fee schedule, and injured worker access to medical care. - - Industry advocates Jason Schmelzer and Jeremy Merz will discuss the 2022 legislative and regulatory environment. - - Veteran defense attorney Michael Marks will wrap up the meeting, revisiting the theme of "Are We There Yet?" by reviewing how our current system operates, examining how well it fulfills the original workers’ compensation grand bargain, and providing his insights on what is left to accomplish and whether or not we can ever "get there." CWCI’s 58th Annual Meeting is free to CWCI member company employees, regulators, and the press; $325 for all others. The live meeting will begin with a Continental breakfast at 8:00 a.m., and will also include a luncheon from noon to 1:00 p.m. All those planning to attend the March 8 live event or the March 10 Encore broadcast must preregister. To register and get information on the Lesher Center, the meeting agenda, and hotel options, go to conferences.html. If you have questions, please call CWCI at 510-251-9470 or email pmedrano@cwci.org. CWCI and the Lesher Center will abide by all COVID-19 public health directives from Contra Costa County’s Health Director. Currently those directives include masking requirements and proof of full vaccination, with medical and religious exemptions allowed if specified criteria detailed on the Lesher Center Website are met. Please note that these criteria are subject to change so please check the website before attending the live event ...

The CWCI reports that California workers’ compensation COVID-19 claim volume continues to track with the state’s fluctuating COVID infection trends. The latest monthly count of COVID workers’ comp claims jumped 172% in December to the second highest level of the year, as the Omicron variant spread rapidly across the state CWCI’s latest projection also shows that the December total could ultimately increase to 12,438 cases once claims that are yet to be filed or still under investigation are added to the count. The January 10 update to CWCI’s COVID-19/non-COVID-19 Interactive Claim Application, shows that since the pandemic was declared in March 2020, there have been 181,770 COVID claims reported to the DWC. The monthly COVID claim count fell to a 5-month low in November, then reversed course in December as the Omicron variant led to a wave of coronavirus cases throughout the state. Although additional claims with November and December injury dates are still being reported, the current count of 8,292 COVID claims for December represents a one-month increase of 172% and is already above the peak level reached in August during last summer’s Delta surge. The spike in claim volume at the end of the year pushed the total number of COVID claims reported to the DWC for 2021 to 63,034, which translates to 10.0% of all 2021 work injury and illness claims reported to the state. That was significantly better than the 118,995 COVID claims reported for 2020, prior to the availability of COVID vaccines, when COVID cases accounted for 17.9% of all California workers’ compensation claims reported to the state. With the Omicron surge at the end of 2021, however, COVID claims as a percent of all California workers’ compensation claims more than tripled from 6.6% in November to 20.5% in December ­- the highest percentage since January 2021. The latest report also notes a total of 1,284 COVID death claims since the pandemic began, with 955 of those having 2020 injury dates and 329 having 2021 injury dates, so COVID death claims accounted for well over half (54.5%) of the 1,752 work-related death claims reported to the DWC for 2020 and 39.4% of the 836 death claims reported thus far for 2021. The new data also show that while COVID claims were most prevalent among health care workers in the first year of the pandemic, accounting for nearly a third (32.5%) of 2020 COVID claims, with the introduction of vaccines and increased safety procedures that percentage dropped to 22.5% in 2021. Meanwhile, public safety/government workers’ share of the COVID claims jumped from 16.7% in 2020 to 24.7% in 2021, as their share grew steadily as the year progressed, climbing from 20.7% of the COVID claims in the first quarter to 30.8% of the COVID claims in the fourth quarter. As a result, the public safety/government sector surpassed the health care to become the #1 sector for California workers’ compensation COVID claims in 2021 ...

A retired San Jose Police officer with a side security business was convicted of $1.13 million in insurance fraud, $18 million in money laundering to cover it up, tax evasion, and worker exploitation. The former officer owned the business without the knowledge of the SJPD. Robert Foster, 48, of Morgan Hill, pleaded no contest to a series of felony fraud charges and will be sentenced to three years in county jail and two years of mandatory supervision. Foster will repay $1.13 million to Everest National Insurance and the Employment Development Department. There will also be a general order of restitution. Foster owns Atlas Private Security (now Genesis Private Security) with his wife, Mikaila Foster, 46, who also pleaded no contest to a variety of related fraud charges. She will be sentenced to one year in county jail and five years of probation. Robert Foster will be sentenced on February 25th at 1:30 p.m. in department 26 in the Hall of Justice in San Jose. Mikaila Foster will also be sentenced in department 26 on April 29th at 1:30 p.m. The six-month investigation was spearheaded by the Santa Clara County District Attorney’s Office Bureau of Investigation in close collaboration with the California Department of Insurance, Employment Development Department, Department of Justice, and the Department of Labor. The Fosters illegally reduced their insurance premiums and taxes by reporting false and inaccurate payroll, underreporting headcount, paying employees off-the-books, and underreporting employee injuries. The Fosters failed to pay employees overtime and dissuaded those employees from accurately reporting on-the-job injuries and wage-theft violations. In one instance, an "off-the-books" security guard suffered severe injuries during a crash while driving an Atlas security vehicle. Robert Foster responded to the guard’s $1 million medical bill by telling the insurance company that the guard was not an Atlas employee. Investigators found records showing that the guard was driving an Atlas vehicle and wearing an Atlas uniform at the time of the collision. The probe also uncovered that the Fosters allegedly hid millions of dollars of payroll through a complex subcontractor masking scheme. Employees were paid by a different security company, which had no knowledge of the employees’ hours, wages, or schedules. Instead, the other company simply moved money from the Fosters’ firm to the employees so that the Fosters could avoid paying their fair share of taxes, workers’ compensation insurance, and overtime wages ...

Federal OSHA recently enacted a vaccine mandate for much of the Nation’s work force. The mandate, which employers must enforce, applies to roughly 84 million workers, covering virtually all employers with at least 100 employees. Many States, businesses, and nonprofit organizations challenged OSHA’s rule in Courts of Appeals across the country. The litigation efforts to stop the mandate ultimately ended up in the US Supreme court which heard oral arguments on the issues, and published a ruling in the case of National Federation of Independent Businesses v OSHA. The 6-3 majority of Justices ruled against the OSHA imposed vaccine mandate finding that "Applicants are likely to succeed on the merits of their claim that the Secretary lacked authority to impose the mandate. Administrative agencies are creatures of statute. They accordingly possess only the authority that Congress has provided. The Secretary has ordered 84 million Americans to either obtain a COVID-19 vaccine or undergo weekly medical testing at their own expense. This is no 'everyday exercise of federal power.' " The dissenting opinion said that OSHA’s mandate is comparable to a fire or sanitation regulation imposed by the agency. But the majority responded that "a vaccine mandate is strikingly unlike the workplace regulations that OSHA has typically imposed. A vaccination, after all, 'cannot be undone at the end of the workday.' " "We expect Congress to speak clearly when authorizing an agency to exercise powers of vast economic and political significance." And the opinion added that "Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly," Requiring the vaccination of 84 million Americans, selected simply because they work for employers with more than 100 employees, certainly falls in the latter category." President Biden responded to the ruling by saying "I am disappointed that the Supreme Court has chosen to block common-sense life-saving requirements for employees at large businesses that were grounded squarely in both science and the law," And he concluded by saying that "The Court has ruled that my administration cannot use the authority granted to it by Congress to require this measure, but that does not stop me from using my voice as President to advocate for employers to do the right thing to protect Americans’ health and economy," However in the companion case of Biden v Missouri, the 5-4 majority approved the HHS/CMS omnibus rule mandating that medical facilities nationwide order their employees, volunteers, contractors, and other workers to receive a COVID-19 vaccine. The majority reasoned that "COVID-19 is a highly contagious,dangerous, and - especially for Medicare and Medicaid patients - deadly disease. The Secretary of Health and Human Services determined that a COVID-19 vaccine mandate will substantially reduce the likelihood that healthcare workers will contract the virus and transmit it to their patients." They concluded that the HHS/CMS rule "thus fits neatly within the language of the statute. After all, ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm." ...

The Employment Development Department just announced that it suspended account activity for approximately 27,000 suspicious medical provider registrants and 345,000 claims associated with those providers or other suspicious activity. While the majority of these providers and claims were likely fraud attempts, the Department has partnered with state regulators and medical provider organizations to coordinate the verification process to clear any legitimate claims as quickly as possible. This is EDD’s top priority. That includes working to contact all claimants who have had their claim held up in this identity theft scam. Purported medical providers must complete further identity verification with ID.me to potentially certify any disability claims. These personalized requests for medical provider verification through ID.me only come from an official EDD email address ending in @edd.ca.gov. Medical providers who receive emails with information about how to verify identity through ID.me should carefully confirm the sender’s @edd.ca.gov email address. Scammers attempt to impersonate government agencies in an attempt to trick people into clicking fake links. Such scam efforts are unfortunately common and slow verification and payment for legitimate claimants and providers. Californians should safeguard financial and personal information online and elsewhere and remain vigilant to guard against identity theft. Those who receive communications from EDD regarding a medical provider online account being created in the DI system, or an application for public benefits (such as disability or unemployment insurance) and believe someone filed the claim falsely, should file a fraud report by visiting Ask EDD and selecting the Report Fraud category to complete the Fraud Reporting Form. Identity theft victims may also want to file an identity theft report with the Federal Trade Commission (FTC). EDD continues to enhance and update information on the Help Fight Fraud webpage. EDD took action in recent weeks to clamp down on a new disability insurance (DI) identity theft scam involving suspected organized criminal elements filing false DI claims using stolen credentials of individuals and medical or health providers. Disability insurance claimants have continued to receive payments if they were not associated with the recent scam attempts ...

In June 2014, while Atkinson Construction LP’s employees were erecting "falsework" near the I-405/I-605 interchange in Seal Beach for a new freeway bridge, an accident occurred, which seriously injured one of it’s employees. Specifically, a forklift attempting to position a long steel beam atop two vertical falsework structures, known as "bents," accidentally hit another beam, causing that beam and another to overturn and fall off the bents. Each of the steel beams weighed approximately 60,000 pounds. As the beams collapsed Ramon Torres, an employee standing on one of the bents fell nearly 30 feet to the ground. Torres suffered serious physical injuries from the fall. After an investigation, the Division cited Atkinson for violating a construction safety order - section 1709, subdivision (b)(1) - that requires beams to be "braced laterally and progressively" to prevent overturning. Atkinson appealed the citation, but the Occupational Safety and Health Appeals Board denied the appeal. It then filed a petition for a writ of administrative mandate in the superior court which also was denied. Atkinson appealed the denial of its writ petition, arguing that (1) the cited safety order does not apply because another, more specific, safety order governs falsework operations; and that (2) it complied with the more specific safety order. The Court of Appeal was not persuaded by these arguments, and affirmed the citation in the unpublished case of Atkinson Construction LP v. DIR Division of Occupational Safety and Health. Atkinson requested the court of appeal to review the regulatory history of section 1709, subdivision (b)(1). However the court found no basis for doing so. The language clearly states that "[t]russes and beams shall be braced laterally and progressively during construction to prevent buckling or overturning." (§ 1709, subd. (b)(1).) There is no ambiguity in the text to justify an inquiry into its regulatory history. Despite the safety order’s plain language, Atkinson argues that section 1709 does not apply to falsework operations. It contends that falsework is a "separate and distinct" type of construction, with its own specific safety order (section 1717), and therefore the absence of any reference to falsework in section 1709 necessarily implies that it applies only to nonfalsework construction. Prior Board decisions establish that more than one safety order may apply to a particular set of facts, even when the construction involves falsework. Here, section 1709 is part of the specific industry safety orders promulgated for the construction industry. Such construction safety orders establish minimum safety standards that apply to any employment "in connection with the construction, alteration, painting, repairing, construction maintenance, renovation, removal, or wrecking of any fixed structure or its parts." Thus, Atkinson’s falsework operations were covered by the construction safety orders, including section 1709 ...

The Santa Clara County Superior Court announced Wednesday that it is closing public counters and restricting courthouse entry through the end of the month because of staffing absences driven by the rapidly spreading omicron variant of COVID-19, joining other Bay Area courts that have also been limiting public access. The decision to decrease the public’s access to South Bay court facilities is effective through Jan. 31, by which point officials plan to reevaluate whether to rescind or modify the restrictions. This marks at least the third large-scale order in Santa Clara County to restrict court availability. Courthouses across the state were largely shuttered in the first few months of the pandemic and began widely installing teleconference and videoconference lines to maintain some level of court access. Mercury News reports that the order echoes past restriction orders, limiting courthouse access to people directly involved in a court hearing; those submitting an in-person pleading; family-court petitioners seeking protective orders regarding domestic violence, gun violence, civil harassment, workplace and school violence, elder abuse, and juvenile dependency; and those seeking emergency orders for eviction and child-safety matters. "Our court is experiencing a significant number of employee absences, creating staffing shortages across all departments of the court," Presiding Judge Theodore Zayner said in a statement. "We are hopeful that these circumstances are transitory and will frequently reexamine conditions as we continue to serve the public through the pandemic and the current omicron variant surge." In San Mateo County, court officials have shifted many non-criminal hearings from in-person to Zoom, and have consolidated preliminary hearings to court facilities in Redwood City. Both San Mateo and Contra Costa counties have obtained emergency authorization from the state’s Judicial Council - which governs Superior Court operations in California - to postpone jury selection panels and trials that were set to start in January by as many as 30 days. In Alameda County, the court has temporarily decreased telephone and in-person access to clerk’s offices to "allow the court to mitigate the ongoing surge in COVID cases brought about as a result of the rapid spread of the Omicron variant," according to a court statement. The court will continue to monitor the situation and make additional changes as circumstances warrant. The Alameda County court has also obtained authorization to postpone jury trials set to start in January and also to treat most of January as a holiday when it comes to many court filing deadlines. But it has also revived an emergency order, which was highly criticized as a due process violation when it was implemented in the first few months of the pandemic, to extend the allowable arraignment deadline for someone arrested and in jail custody from 48 hours to as many as seven days ...

UC San Diego Health, the academic health system of the University of California, San Diego, has paid $2.98 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary genetic testing reimbursed by Medicare, the Justice Department announced today. The settlement resolves allegations that, from December 2015 to October 2019, UC San Diego Health ordered and submitted referrals for medically unnecessary genetic testing performed by CQuentia Arkansas Labs, CQuentia NGS, and Total Diagnostic II (collectively "the CQuentia labs"). The government alleged that this conduct led to the submission of false claims for payment to Medicare for unnecessary genetic testing. UC San Diego Health did not admit any liability as part of the settlement, which allowed the provider to continue to focus on patient care, said UC San Diego Health spokesperson Jacqueline Carr. "Working at the forefront of patient care sometimes involves the use of new technologies from emerging companies. When UC San Diego Health learned that the Department of Justice had concerns about one of our technology providers, we fully cooperated and promptly resolved the matter," Carr said in a statement. "The DOJ’s settlement announcement alleges that our doctors ordered tests from a company that then allegedly made false claims about those orders." "UC San Diego Health remains committed to integrating the leading best practices and technology into our research, teaching and patient care missions, in accordance with the highest standards of ethical conduct and all applicable laws and regulations," Carr added. Tennessee-based C Quentia has since apparently gone out of business.as it's Website simply states "C Quentia has been closed" and tells previous customers how to obtain medical records. The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Southern District of California, with assistance from the U.S. Department of Health & Human Services Office of Inspector General and the FBI. "Ordering unnecessary genetic tests creates a drain on vital government-funded health care programs like Medicare," said U.S. Attorney Randy Grossman. "This settlement is another example of this office’s commitment to work with our law enforcement partners to hold medical providers accountable when their conduct leads to taxpayers bearing the cost of improper billing practices." Grossman thanked the prosecution team and investigators for their excellent work on this case. "Hospitals are the gatekeepers for medical care and are expected to ensure that all services performed at their direction, including genetic tests, are medically appropriate," said Acting Assistant Attorney General Brian M. Boynton for the Justice Department’s Civil Division. "The department will continue to pursue those who undermine the integrity of federal health care programs and waste taxpayer dollars." This matter was handled by Nicholas C. Perros of the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorneys Joseph Price and Joseph Purcell of the U.S. Attorney’s Office for the Southern District of California. The claims resolved by the settlement are allegations only, and there has been no determination of liability ...

The Division of Workers’ Compensation announced that as of January 12, 2022, all hearings will be heard virtually. Until further notice, DWC will telephonically hear all trials, lien trials, expedited hearings, and special adjudication unit (SAU) trials. In addition, mandatory settlement conferences, priority conferences, status conferences, SAU conferences, and lien conferences will continue to be held on the individually assigned judges’ conference lines as announced in Newslines issued on April 3, April 28, May 28, August 12, September 9, 2020, and Sept. 1, 2021. The division acknowledges that due to the recent surge in COVID-19 cases, a pause of in-person hearings is necessary at this time. The pause will continue through the end of the month and will be reevaluated at that time. DWC hearing notices will not change but parties should be aware that as of January 12, 2022, if a trial, expedited hearing, lien trial or SAU trial is set at a district office, all parties should call the judges’ assigned conference line and not appear in person. The judges’ assigned conference lines may be found on the DWC webpage. All division offices will remain open during this time. If a party to a DWC hearing has a question on a specific case, they may contact the DWC call center at (909) 383-4522 ...

California’s courts would see a sizable funding boost as part of Governor Gavin Newsom’s $4.9 billion judicial branch budget package that reflects a commitment to cybersecurity and other tech investments. According to the report by Courthouse News, the proposal includes $34.7 million for electronic filing, digitizing records and updating case management software in fiscal year 2022-23, with plans to increase that amount to $40.3 million in fiscal year 2025-26. It also devotes $33.2 million for better access to remote proceedings each year for two years, with $1.6 million in ongoing funding thereafter. "These resources will be used to provide a publicly accessible audio stream for every courthouse in the state," Newsom said. Cybersecurity and remote technology have taken center stage as courts moved proceedings online during the Covid-19 pandemic, a change made all the more permanent with the passage of Assembly Bill 716 last year. AB 716 requires courts to provide streaming audio or a public call-in line when courthouses close for public health reasons. Discussing budget priorities with reporters in December, Judicial Council administrative director Martin Hoshino said "There's a big year coming up for the trial courts. In this window in time we see the courts are still dealing with pandemic impacts, trying to safety operate and having some limited operational capacities. At the same time they have to groove and balance two modes of operation, which are in-person and remote stuff that people have pivoted to during the pandemic. We're pushing hard for funds to be able to support so we can find our way through that in this particular year," The budget proposal also provides funding for other online services, like $2.6 million in 2022-23 and $1.7 million ongoing for electronic filing systems for domestic and gun violence restraining orders. Newsom also assigned $15 million in general fund dollars to "timely and accurate data collection" from trial and appellate courts, saying, "This investment will enhance the ability of all three branches of government to assess court programs and resource needs." Criminal fines and accompanying administrative fees have historically been a leading source of court funding for the courts - adding $1 billion in revenue in 2020-21. But with the support of Chief Justice Tani Cantil-Sakauye, Newsom and his predecessor Jerry Brown have sought to eliminate what they see as undue burdens on the poor. Other funds include $42.6 million in 2022-23 and $42.3 million ongoing to hire 23 state court judges, funding for new courthouses in Fresno, Santa Clarita, Fairfield, Quincy, and San Luis Obispo, as well as three projects already approved by the council — a new courthouse in Mendocino County and renovations to juvenile facilities in San Bernardino and Butte counties. Newsom's proposal drew an initial positive reaction from the chief justice on Monday. "I welcome the governor’s continuing commitment to sustainable funding in his budget proposal for the judicial branch. He clearly recognizes how important equal access to justice is for all Californians," she said in a statement. "We look forward to working on this landmark budget proposal with his administration and the Legislature in the next few months as the budget becomes finalized." ...