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Governor Newsom has signed AB-336. Current law does not require the Contractors State License Board (CSLB) to publicly post which of three workers’ compensation classifications their licensee contractors are in. According to the bill author, this lack of transparency incentivizes intentional misclassification by unscrupulous contractors so they can purchase workers’ compensation insurance that is not appropriate for the kind of work that their employees do. This could provide these bad actors with a competitive advantage over contractors who play by the rules. This new law requires all contractor licensees to report to the CLSB their workers’ compensation classification code as a condition of licensure. It also requires CSLB to post each licensee contractor’s classification code on its website. This will ensure that licensee contractors provide their employees with the proper level of workers’ compensation insurance, and create a level playing field for contractors that no longer rewards bad actors. Classification codes for specific occupations, industries, or businesses are assigned by WCIRB and approved by the Insurance Commissioner. Insurance companies have an option to create their own classification system and submit it to CDI for approval, but typically use the WCIRB’s classifications. Insurance companies do, however, assign a specific rate to each classification code, subject to approval by the Insurance Commissioner. The classification codes and related rates are used to calculate the base rate of the workers’ compensation insurance premium. Insurance companies are currently required to provide CSLB with specific information about an applicant’s or licensee’s workers’ compensation insurance policy, including the name, license number, policy number, dates that coverage is scheduled to commence and lapse, and cancellation date if applicable. This information is available on CSLB’s website. The law provides that the board is not required to verify or investigate the accuracy of the licensee’s classification codes and would prohibit the board from being held liable for any misreported classification codes. The law will require the board, when it updates the public license detail on its internet website for an active renewal, to include the classification codes certified by the licensee. The provisions of this new law are operative on July 1, 2024. Because the bill would expand the scope of a crime under the Contractors State License Law and expand the crime of perjury. AB 2894 (Cooper) of 2022 was substantially similar to this bill. Held on the Senate Appropriations Committee Suspense File.This new law was sponsored by the District Council of Iron Workers of California ...
/ 2023 News, Daily News
Gabriella Santibanez, 59, and her sister Lisa Hazard, 55, both of Temecula, were sentenced Monday to 15 months in prison and ordered to pay over $7.5 million in restitution for health care fraud. According to court documents, between Dec, 1, 2015, and Dec, 1, 2020, Santibanez and Hazard ran a mobile phlebotomy company, PhlebXpress Inc. (NPI ) that provided phlebotomy and other medical collection services at patients’ homes and long-term care facilities in Sacramento and elsewhere. Santibanez and Hazard agreed to bill Medicare for services provided that were not reimbursable by Medicare. Santibanez and Hazard also agreed to bill Medicare for overstated mileage that PhlebXpress phlebotomists traveled. On average, Santibanez and Hazard caused false billing to Medicare of over 140 miles for each patient seen by PhlebXpress. Santibanez and Hazard caused a loss to Medicare of at least $7.5 million based on false billing by PhlebXpress. In November 2020, due to "credible allegations of fraud" at PhlebXpress, Medicare instituted a payment suspension for PhlebXpress under which Medicare ceased paying PhlebXpress for the services it continued to bill Medicare. According to court documents, between July 1, 2021, and Dec. 31, 2021, Santibanez and Hazard agreed to circumvent the payment suspension by representing to Medicare that services provided to Medicare patients were done by another company, Phlebotomy Solutions, when they were in fact being provided by PhlebXpress through its contractors and employees from PhlebXpress’s offices. Through Phlebotomy Solutions, Santibanez and Hazard agreed to bill Medicare for a non-reimbursable service, misrepresenting that it was for another reimbursable service and overstating the mileage traveled by phlebotomists in order to receive additional money from Medicare. For example, in September 2021, Phlebotomy Solutions billed Medicare for 124.6 miles of travel by a phlebotomist when in fact the phlebotomist travelled 1.4 miles. Santibanez and Hazard caused a loss to Medicare of at least $50,000 based on false billing by Phlebotomy Solutions. This case was the product of an investigation by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services Office of Inspector General. Assistant U.S. Attorney Lee Bickley prosecuted the case ...
/ 2023 News, Daily News
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released its Quarterly Experience Report. This report is an update on California statewide insurer experience valued as of June 30, 2023. The report on balance is essentially good news for California Employers. Highlights of the report include: Written premium in 2022 is 14% higher than 2021 and almost at the pre-pandemic level. The increase is being driven by higher employee wage levels and the economic recovery. Written premium through the second quarter of 2023 of $8.5 billion is 4.1% higher than the same period in 2022. The average charged rate for the first six months of 2023 continues to decrease; it is 3% lower than 2022 and the lowest in decades. In the September 1, 2023 Pure Premium Rate Filing, the WCIRB proposed an average 0.3% increase in advisory pure premium rates. In the FilingDecision, the Insurance Commissioner approved an average 2.6% decrease in advisory pure premium rates. After five consecutive increases, the projected loss ratio, including the cost of COVID-19 claims, dropped 3 points in accident year 2022. The lower combined ratio in 2022 is driven by a significant increase in premium due to higher payrolls and very modest changes in claim frequency and severity. Indemnity claims had been settling more quickly through the first quarter of 2020, primarily driven by the reforms of Senate Bill No. 863 (SB 863) and Senate Bill No. 1160 (SB 1160). Average claim closing rates declined sharply beginning in the second quarter of 2020 due to the pandemic. Average claim closing rates have steadily increased in 2022 and 2023, but remain below the pre-pandemic level. Projected total indemnity claim severity for 2022 is 4% higher than 2021 and 16% above 2016. The average severity in 2022 is the highest it has been in more than a decade, since before the SB 863 reforms. Pharmaceutical costs per claim decreased by 86% from 2012 through 2022. After increasing during the early pandemic period in 2020, average pharmaceutical costs per claim reverted to the pre-pandemic trend in 2021 and declined another 12% in 2022. For more information, please download the full report with greater detail and graphs and other data ...
/ 2023 News, Daily News
The California Department of Insurance announced two settlement agreements with Go Maps, Inc. and its insurance underwriter, Topa Insurance Company, after an investigation into complaints that consumer claims were mishandled for more than two dozen drivers. As part of the agreement, Go Maps agreed to surrender its insurance license, pay a $150,000 fine, pay $50,000 in cost reimbursement, and provide the Department all the information necessary to ensure statutory requirements are fulfilled in regards to existing policyholders. Topa was fined $2,108,000, and agreed to ensure it has permanent access to all policies managed by any future general agents, certify all general agents and entities hired by general agents are properly licensed, and not to seek any money from consumers who may have been undercharged as a result of rating mistakes in the Go Maps/Topa program. Go Maps is an "insurtech" company that used an app-based marketing platform to sell and transact its insurance business for Topa. Insurtech companies and insurance companies that use them to market and manage their products must follow California consumer protection laws and have the insurance expertise and licensed individuals in place to properly transact insurance in this state. In 2019, Go Maps entered into an agreement with Topa to perform all the functions necessary for the sale, service, management, and claims handling of Topa’s private passenger automobile policies that were sold to the public through the Go Maps app. At one point, the Go Maps/Topa program had more than 10,000 California customers representing the vast majority of its approximately 12,000 policies nationwide. In June 2022, the Department announced it was taking action against Go Maps and Topa in order to protect the public from further harm caused by the companies’ repeatedly violating various consumer protection laws relating to insurance claims. Go Maps’ and Topa’s failures to follow California’s consumer protection rules forced drivers to pay for rental car expenses and other costs while their insurance claims were delayed. Among other violations Go Maps and/or Topa: - - Failed to pay claims within 30 days after the coverage was determined or a settlement was reached. For one consumer, the companies missed the deadline by 52 days. The average delay was more than 24 days beyond the legal 30-day claims payment deadline. - - Failed to acknowledge claims, provide necessary forms or instructions, or begin investigations within the statutory 15-day requirement. For one consumer, the companies missed the deadline by 30 days. The average delay was more than 8 days beyond the legal 15-day requirement. - - Failed to respond to consumers’ inquiries about their claims within 15 days. For one consumer, the companies missed the deadline by 25 days. The average delay was more than 11 days beyond the legal 15-day requirement. - - Failed to deny or accept claims within 40 days. For one consumer, the companies missed the deadline by 66 days. The average delay was more than 25 days beyond the legal 40-days deadline. - - Hired an unlicensed insurance adjusting firm to adjust claims. "These settlements represent an important victory for California consumers as we hold all companies accountable and ensure that they comply with our strong consumer protection laws," the Insurance Commissioner said. "While we encourage new products and innovation in our marketplace, our top priority is protecting policyholders and making sure insurance companies deliver on their promises." ...
/ 2023 News, Daily News
Investing in technology to reduce workplace musculoskeletal disorders, or MSDs, is demonstrated to improve both worker wellbeing and an organization's bottom line, but initial research findings from the National Safety Council suggest employers may not have the access and knowledge they need to effectively assess and implement these risk-reducing technologies. Recognizing this challenge and the importance of broader adoption of proven safety solutions, the Council released a white paper, Emerging Technologies for the Prevention of Musculoskeletal Disorders, to help employers navigate the evolving technology marketplace. "Advancements in technology and automation have decreased workplace hazards to an extent undreamt of only a few years ago, but these rapid changes and a lack of clear standards for MSD-focused innovations can create uncertainty among organizations looking to adopt these tools," said Sarah Ischer, MSD Solutions Lab program lead at NSC. "This white paper aims to bridge the gap between solution providers and adopters so that all organizations, regardless of their size or industry, can understand technology solutions available to minimize MSD risks and create safer outcomes for their workers." Published through its MSD Solutions Lab, a groundbreaking initiative established in 2021 with funding from Amazon, the report was developed in partnership with Safetytech Accelerator and builds on the Council's commitment to reducing MSDs worldwide through innovation and pioneering research. Specifically, the paper references nearly two dozen academic publications to assess the benefits of the most common emerging safety technologies: computer vision, wearable sensors, exoskeletons, autonomous and semi-autonomous materials handling equipment, digital twins, and extended reality. The MSD Solutions Lab also interviewed executives from a range of sectors, including agriculture, logistics and manufacturing, to better understand industry-specific MSD concerns and highlight successful applications of emerging technology. Notable findings from the report include: - - Computer vision may be a helpful tool for large organizations, so they can more effectively aggregate and analyze ergonomic risks across an enterprise. - - In instances where implementing engineering controls is not financially feasible, workers may benefit from the use of wearable sensors, which can provide real-time haptic feedback to reduce back injuries caused by poor posture, over-reaching and improper lifting. - - To reduce MSD risk caused by manual materials handling, organizations may consider adopting passive exoskeletons, which have shown to reduce muscle activity by up to 40% and, in one case study, decreased worker fatigue by 45% and boosted organization output by nearly 10%. - - While Industry 4.0, characterized by the widespread use of computerization, big data and AI in the workplace, is still ongoing, the next phase of advancement - Industry 5.0 - has already begun, prompting employers to dedicate a greater emphasis on harmonizing human ingenuity and automation in the workplace. "The marketplace for MSD risk management is enormous, and it's increasingly becoming more accessible as innovators continue to push the boundaries of safety technology. Building awareness of these resources is a critical next step in the effort to solve the biggest workplace safety challenges, and we are proud to help advance this cause through our ongoing work with the MSD Solutions Lab," said Dr. Maurizio Pilu, Managing Director of Safetytech Accelerator. MSDs - such as tendinitis, back strains and sprains, and carpal tunnel syndrome - are the leading cause of worker disability, involuntary retirement and limitations to gainful employment. This white paper is one of several initiatives underway by the MSD Solutions Lab to solve this pervasive safety issue, including an advisory council, additional pioneering research, innovation challenges and grant program. "Every workplace is unique, but today's employers can agree ongoing strides in technology are redefining and improving the ways in which organizations are able to respond to complex issues facing their business," said Carla Gunnin, director of Global Governance and External Affairs for Workplace Health and Safety at Amazon. "We are proud to support the Council's work in this area and know regardless of what industry or sector an organization belongs, this emerging safety technology research is an invaluable resource for any employer looking to advance healthier, safer workplaces." To learn more about the MSD Solutions Lab and the risks associated with MSDs, visit nsc.org/msd, or sign up to attend the world's largest annual gathering of safety professionals at the 2023 NSC Safety Congress & Expo in New Orleans, October 20-26. To register, visit congress.nsc.org ...
/ 2023 News, Daily News
The California Governor signed Senate Bill 428 on September 30, 2023. The new law expands the circumstances under which employers can seek civil restraining orders on behalf of their employees for harassment. Under the new law, harassment is defined as "a knowing and willful course of conduct directed at a specific person that seriously alarms, annoys, or harasses the person, and that serves no legitimate purpose. The course of conduct must be that which would cause a reasonable person to suffer substantial emotional distress, and must actually cause substantial emotional distress." To obtain a restraining order for harassment, a declaration must be filed that establishes: - - that an employee has suffered harassment by the respondent; - - that great or irreparable harm would result to an employee; - - that the course of conduct at issue served no legitimate purpose; and - - that the issuance of the order is not prohibited by speech or other activities protected by any other law as defined in the law. The problem with the current law, from the point of view of the author and sponsor of the bill, is that the employer was powerless to obtain a restraining order for an employee until the situation reaches the point of including unlawful violence or a credible threat of violence. Even when a co-worker, a customer, or some other third party is harassing an employee in extreme ways therefore, the employer may try other measures to protect the employee, but a civil restraining order is not one of the employer’s available tools unless and until the harasser becomes or threatens to become violent. An example of this problem was illustrated by our August 2022 report on the California Court of Appeal published case in Technology Credit Union v Rafat 82 Cal. App. 5th 314 (August 17, 2022). The Court of Appeal reversed a Santa Clara County Superior Court restraining order under existing law against Matthew Mehdi Rafat. In doing so, the Opinion said "Rafat’s conduct on March 24 was indisputably rude, impatient, aggressive, and derogatory. Further, he had a history of using aggressive language, including making offensive remarks." However it went on to say "However, while he appeared angry and frustrated during the March 24 incident and its aftermath, there was not sufficient evidence produced by TCU linking any of Rafat’s statements or conduct to any implied threat of violence." Perhaps the new law will assist employers who want a restraining order against behavior such as what occurred in the case of Mr. Rafat. Newsom also signed Senate Bill (SB) 553, which will require employers to establish, implement, and maintain an effective workplace violence prevention plan (WVPP) effective January 1, 2025. The employer will also be required to record information in a violent incident log for every workplace violence incident, and to provide effective training to employees on the workplace violence prevention plan, along with other requirements specified in the new law. And at the federal level, on September 29, 2023, the Equal Employment Opportunity Commission (EEOC) issued Proposed Enforcement Guidance on Harassment in the Workplace. In Proposing this new Guidance, the EEOC said "harassment remains a serious workplace problem. Between the beginning of fiscal year (FY) 2018 and the end of FY 2022, thirty-five percent of the charges of employment discrimination received by the Equal Employment Opportunity Commission included an allegation of harassment based on race, sex, disability, or another protected characteristic. The actual cases behind these numbers reveal that many people still experience harassment that may be unlawful." The Proposed Enforcement Guidance on Harassment in the Workplace is part of the EEOC's Fiscal Years 2024 - 2028 Strategic Enforcement Plan. The purpose of the EEOC’s Strategic Enforcement Plan (SEP) is to focus and coordinate the agency’s work over a multiple fiscal year period to have a sustained impact in advancing equal employment opportunity. The agency’s first Strategic Enforcement Plan adopted for FY 2013-2016 established subject matter priorities and strategies to integrate the EEOC’s private, public, and federal sector activities. In adopting the FY 2017-2021 SEP, the Commission reaffirmed its subject matter priorities with some modifications and additions. In its Fiscal Years 2024 - 2028 Strategic Enforcement Plan the EEOC says it "will focus on harassment, retaliation, job segregation, labor trafficking, discriminatory pay, disparate working conditions, and other policies and practices that impact particularly vulnerable workers and persons from underserved communities." It seem clear that once the Proposed Guidance on Harassment in the Workplace becomes final, and other measures and policies under Fiscal Years 2024 - 2028 Strategic Enforcement Plan are announced, SB 428 may assist employers in obtaining restraining orders against persons who are outside their facilities. Unfortunately SB 428 does not take effect until January 1, 2025 ...
/ 2023 News, Daily News
Governor Newsom vetoed Senate Bill 799 on Saturday, legislation that would have allowed workers to collect unemployment pay while on strike after two weeks, disappointing union leaders who had hoped to capitalize on a wave of high-profile walkouts during the state's "hot labor summer" this year. SB 799 would have also codified case law that employees who left work due to a lockout by their employer, even if it was in anticipation of a trade dispute, are eligible for UI benefits. Newsom said in a veto message that he rejected giving California unemployment checks to strikers because it would have cost too much. He said the "UI financing structure has not been updated since 1984, which has made the UI Trust Fund vulnerable to insolvency. Any expansion of eligibility for UI benefits could increase California's outstanding federal UI debt projected to be nearly $20 billion by the end of the year and could jeopardize California's Benefit Cost Ratio add-on waiver application, significantly increasing taxes on employers." "Furthermore, the state is responsible for the interest payments on the federal UI loan and to date has paid $362.7 million in interest with another $302 million due this month. Now is not the time to increase costs or incur this sizable debt." The Governor also rejected SB 686, which would have extended workplace safety protections to domestic workers, such as housekeepers and nannies. In his veto message he said "new laws in this area must recognize that private households and families cannot be regulated in the exact same manner as traditional businesses." "SB 686 as written would make private household employers immediately subject to the full set of existing workplace safety and health regulations governing businesses in the state, starting January 1, 2025." "These obligations range from the requirement to establish an effective Injury and Illness Prevention Program to providing an eyewash station if household workers use chemicals like bleach, to implementing a Hazard Communication Program." "Additionally, the current penalty scheme was meant for businesses and not private individuals. For a domestic employer covered by SB 686, these penalties could be up to $15,000 per violation depending on the circumstances." ...
/ 2023 News, Daily News
Mesa Pharmacy, Mesa Pharmacy, Inc., and Mesa Pharmacy Irvine are admitted to be the same entities. Mesa Pharmacy has been in the workers' compensation system as a lien claimant who provided compounded pharmaceuticals for many years. A trial was convened as part of the Special Adjudication Unit to determine the whether John Garbino - who previously plead guilty to Medicare fraud - exercised control of Mesa Pharmacy sufficient to subject them to the stays under Labor Code §4615 and §139.21. Some of the testimony produced at this trial was summarized by the WCJ as follows: Mytu Do, aka Julie Do, and Benny Leo Birch, aka Ben Birch, met as she was a house flipper and he contracted as her landscaper. Ben Birch has a Federal conviction for Bankruptcy Fraud. At some point they came up with the idea of opening a pharmacy, Pharmacy Development Corporation (PDC), which was the top corporation and all the Mesa iterations were under that umbrella. Ben Birch was the only one who put up any capital for the venture. They formed Mesa in 2005 or 2006, approximately two to three years after Mytu Do's son, Andrew Do, had graduated from pharmacy school. and he was made the Mesa Pharmacist in Charge. Although Andrew Do testified that he "formed" the corporation, he had no knowledge of if there was a board or who was on the board, how much money they did or did not make, who actually ran the day to day operations, whether there was stock issued and how he ultimately wound up with Praxsyn stock. He testified at one point that he was the president of Mesa, but then contradicted himself later indicating that this title was "only on paper," he could not recall ever attending a meeting, seeing a profit or loss statement or doing more than signing checks. Ultimately Andrew Do Ultimately took the Fifth when asked to testify as to whether he ever signed a contract with Trestles Pain Specialists, LLC (TPS) to market the products that he prepared as a pharmacist. According to Ben Birch, Mesa was introduced to the owners of PAWS Airline in 2013, which had gone "belly up." Neither Ben Birch, Andrew Do nor Mytu Do were involved in the merger of PAWS and Mesa to become Praxsyn. They just knew they got stock out of the deal. Despite still being "president" of Mesa, Andrew Do did not participate in any of the merger negotiations, did not sign the merger contract. In 2012 Mesa and a company owned by Garbino, Trestles Pain Specialists, LLC (TPS) entered into their first contracts with each other. None of the other Mesa players were aware of this business arrangement until the contracts were signed. John Edward Garbino plead guilty to a Federal Felony of Healthcare fraud in the fall 2017. Garbino/TPS had contractual business relationships with Ray Riley and David Fish. David Fish was convicted, as part of Premier Medical Management, of Workers’ Compensation kick-back schemes and permanently suspended from participating in the California Workers’ Compensation System. As part of the TPS agreement, Mesa was filling prescriptions through TPS contracts for Andrew Robert Jarminski and Craig Chanin, both of whom were charged with involvement in the Workers’ Compensation kick- back scheme as part of the First Choice and Landmark Medical schemes. This was in addition to Mesa’s already established relationship with Robert Villapania, DC as a referral source for prescriptions. This is the same Villapania who was charged in People of the State of California v. Robert Julian Villapania (Case no. 16CF1360) and who is listed by the DIR on the criminally charged providers list. Mesa could not handle the amount of business that TPS was bringing in. They needed financing to expand, and that was rectified by obtaining financing through parties such as Javlin III. Garbino discussed Mesa’s business with Javlin and other financers. Andrew Do, although allegedly Mesa’s president, was not involved in any of these meetings. This funding revitalized the Mesa/TPS agreement. Mesa’s sales "exploded" in 2014 as a result of the agreement. Garbino testified that TPS brought in most, if not all, of the sales for Mesa during their relationship. According to Garbino, he, Riley and Fish had a great deal of input into Mesa’s business strategy. Garbino confirmed that he was listed as an officer of Mesa on Exhibit O, but he claimed he didn’t know how his name got there. Andrew Do testified, then immediately recanted, that Mr. Garbino told him what ingredients should be used in the prescriptions. Mr. Garbino admitted, then immediately recanted, that he had discussions with Mr. Do regarding the compounds and formularies. Garbino did confirm during trial that, as he had testified in his deposition, he had a lot of influence on Mesa - "about one-hundred-million dollars" worth. In 2014 Garbino became aware that Mesa listed him as an officer in filings with the Arizona Pharmacy Board. PAWS and Mesa merged to become Praxsyn. Garbino was on the board of directors of Praxsyn for about eight months, and it was his testimony that he thought Mesa, PAWS and Praxsyn were all the same, and Mesa business was discussed at the Praxsyn Board Meetings. Garbino testified that he had voting rights in Mesa. Garbino had voting rights in Praxsyn of which Mesa was a wholly owned subsidiary. The ALJ requested that Mesa produce its Board of Director’s Meeting Minutes. Mesa was either unwilling or unable to do so. The court was therefore entitled to, and did, form an adverse inference that those documents contained material adverse to the position of Mesa. The WCJ found that John Garbino exercised de facto control of Mesa under Labor Code section 139.21, subdivision (a)(3) (section 139.21(a)(3)). The the Findings of Fact was affirmed except it was amended to add an additional exhibit in the case of Melvin Garcia Galdames v Vinyl Technology Inc., -SAU9997873 (September 2023) After review of the record, based upon that evidence the WCAB panel found that Praxsyn Corporation was not merely a separate parent corporation to Mesa Pharmacy, but rather, that Mesa Pharmacy was the alter ego of Praxsyn Corporation, i.e., that they were one and the same. The panel also found that as a director of Praxsyn Corporation, Garbino "controlled" Mesa Pharmacy under Labor Code section 139.21, subdivision (a)(3) as an "officer or director." ...
/ 2023 News, Daily News
The Center for Medicare & Medicaid Innovation (CMMI) was created by the Affordable Care Act (ACA) in 2010. It conducts pilot programs, known as models, that test new ways to deliver and pay for health care in Medicare, Medicaid, and the Children’s Health Insurance Program, with the goal of identifying approaches that reduce spending or improve the quality of care. In this new report, the Congressional Budget Office presents findings from its analysis of CMMI’s activities during the first decade of operation and uses those findings to update its projections of CMMI’s effects on federal spending. The report explains changes to CBO’s analytic method based on those findings and discusses the agency’s revised approach to estimating the effects of legislative proposals that would change CMMI’s models or operations. CBO previously estimated that CMMI’s activities would reduce net federal spending but now estimates that they increased that spending during the first 10 years of the center’s operation and will continue to do so in its second decade.CBO currently estimates that CMMI’s activities increased direct spending by $5.4 billion, or 0.1 percent of net spending on Medicare, between 2011 and 2020.1 Specifically, CMMI spent $7.9 billion to operate models, and those models reduced spending on health care benefits by $2.6 billion. The estimates reflect CBO’s review of published evaluations of 49 models initiated over CMMI’s first decade as well as corresponding historical budget data. By contrast, in 2010, when the ACA was enacted, CBO projected that CMMI would produce net savings over the 2010-2019 period. Extending that earlier approach to the 2011-2020 period, which spans the first full decade of CMMI’s operation, yields an estimated net reduction of $2.8 billion in federal spending, or 0.05 percent of net spending on Medicare during those years. That estimate reflects a projection that CMMI’s models would lower spending on benefits by $10.3 billion, more than offsetting the $7.5 billion that CMMI would spend to operate those models. Looking ahead, CBO currently projects that CMMI’s activities will increase net federal spending by $1.3 billion, or 0.01 percent of net spending on Medicare, over the center’s second decade, which extends from 2021 to 2030. If CBO used its 2010 approach instead, it would estimate net savings of $77.5 billion, or 0.8 percent of net spending on Medicare, in the second decade of the center’s operation. The difference between CBO’s current projections for the second decade and projections using its 2010 approach largely reflects an update in the agency’s expectation about the rate at which CMMI will identify and expand models that reduce spending. For the period spanned by CBO’s current baseline projections, 2024 to 2033, CBO projects that CMMI will increase net federal spending by less than $50 million.3 CBO’s current projections for CMMI’s second decade draw on the net increases in spending that occurred during the center’s first decade of operations and also reflect the expected accumulation of savings in the second decade from both previously and newly certified models. CBO’s findings about the budgetary effects of CMMI’s activities over the first decade and its updated projections are subject to considerable uncertainty. In estimating the budgetary effects of legislation that would change CMMI, CBO evaluates each proposal individually. In general, legislative proposals fall into one of three categories: changes to specific models, modifications to the parameters within which CMMI operates, and repeal of CMMI’s statutory authority and rescissions of the agency’s funding. CBO’s estimates reflect its overall view of CMMI’s effects on federal spending for both administrative operations and benefits. CBO will continue to monitor CMMI’s activities and will refine its approach as new information becomes available ...
/ 2023 News, Daily News
In May 2020, foreshadowing this appeal, the Attorney General of California, joined by city attorneys of the cities of Los Angeles, San Diego, and San Francisco, brought a civil action on behalf of the People of the State of California that alleged Uber and Lyft violated the Unfair Competition Law (Bus. & Prof. Code, § 17200 et seq.) (UCL) by misclassifying their California ride-share and delivery drivers as independent contractors rather than employees, thus depriving them of wages and benefits associated with employee status. The People sought, and the trial court entered, a preliminary injunction prohibiting Uber and Lyft from misclassifying their drivers as independent contractors in violation of Assembly Bill 5. The Court of Appeal affirmed in an October 2020 opinion (People v. Uber Technologies, Inc., 56 Cal.App.5th 266) . Following the passage of Proposition 22, which altered the standards for determining whether app-based drivers are independent contractors (Bus. & Prof. Code, § 7451), the People and Uber and Lyft stipulated to dissolve the preliminary injunction, which had been stayed since it was entered. The People’s operative first amended and supplemental complaint clarifies that the People seek injunctive relief to the extent Proposition 22 is unconstitutional or otherwise invalid. In August 2020, the Labor Commissioner filed separate actions against Uber and Lyft, pursuant to her enforcement authority under the Labor Code. (E.g., Lab. Code, §§ 61, 90.5, 95, 98.3, subd. (b).) The Labor Commissioner alleges Uber and Lyft have misclassified drivers as independent contractors and have thus violated certain Labor Code provisions and wage orders. The Labor Commissioner seeks injunctive relief, civil penalties payable to the state, and unpaid wages and other amounts alleged to be due to Uber’s and Lyft’s drivers, such as unreimbursed business expenses. The People’s action and the Labor Commissioner’s actions were coordinated (along with other cases not involved in this appeal) as part of Uber Technologies Wage and Hour Cases. Uber and Lyft filed motions to compel arbitration in the People’s action; and filed similar motions in the Labor Commissioner’s actions, to the extent they seek remedies that Uber and Lyft characterize as "driver-specific" or "individualized" relief, such as restitution under the UCL and unpaid wages under the Labor Code. In their motions, Uber and Lyft relied on arbitration agreements they entered into with drivers. The trial court denied the motion, and the Court of Appeal affirmed in the published case of In re Uber Technologies Wage and Hour Cases -A166355 (October 2023). Uber and Lyft contend the arbitration agreements they entered into with their drivers require that portions of the civil enforcement actions brought by the People and the Labor Commissioner be compelled to arbitration. The trial court correctly concluded there is no basis to compel arbitration here because the People and the Labor Commissioner are not parties to the arbitration agreements Uber and Lyft entered into with their drivers. Uber and Lyft contend arbitration nevertheless should be compelled on the basis of either (1) federal preemption or (2) equitable estoppel. The Court of Appeal disagreed. The United States Supreme Court has emphasized that, while the FAA embodies a strong federal policy in favor of enforcing parties’ agreements to arbitrate, that policy is founded on the parties’ consent, and there is no policy in favor of requiring arbitration of disputes the parties have not agreed to arbitrate. (Viking River Cruises, Inc. v. Moriana (2022) 596 U.S. __, __ [142 S.Ct. 1906, 1918]. "We reject Uber’s and Lyft’s suggestion that the People and the Labor Commissioner should be bound because they allegedly are mere proxies for Uber’s and Lyft’s drivers." ... "The relevant statutory schemes expressly authorize the People and the Labor Commissioner to bring the claims (and seek the relief) at issue here. (Bus. & Prof. Code, §§ , , ). "The order denying Uber’s and Lyft’s motions to compel arbitration of, and to stay, the People’s and the Labor Commissioner’s actions is affirmed." ...
/ 2023 News, Daily News
A federal grand jury has charged a doctor who operated clinics in Westminster and Garden Grove with defrauding a COVID-19 program for uninsured patients by submitting more than a quarter billion dollars in claims - ultimately receiving about $150 million in payments - for services not covered under the program or simply not provided. Anthony Hao Dinh, 64, of Newport Coast - a licensed doctor of osteopathy who was an ear, nose and throat specialist, as well as a facial plastic surgeon - was charged in an 18-count indictment with defrauding the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program. Dinh was initially charged in this case in a criminal complaint filed April 10. The new indictment this month significantly expands the case by increasing the total amount of fraudulent claims allegedly submitted to HRSA, adding money laundering charges and further allegations about other schemes to defraud pandemic relief programs, and charging Dinh with obstructing the government’s investigation into improper health care billing. The indictment charges Dinh with 12 counts of wire fraud, five counts of money laundering (with two of those charges alleging the transfer of more than $11 million to personal stock trading accounts) and one count of obstructing justice. Dinh, who is free on a $7 million bond, is scheduled to be arraigned on the indictment on October 30 in United States District Court in Santa Ana. This is the largest fraud scheme in the nation targeting the HRSA COVID-19 Uninsured Program uncovered at this time. Two other defendants charged with Dinh in April also face new charges: - - Hanna ("Hang") Trinh Dinh, 65, of Lake Forest, who is Dinh’s sister, has agreed to plead guilty to conspiracy to commit wire fraud and admitted helping submit fraudulent Paycheck Protection Program (PPP) and Economic Injury Disaster Loan (EIDL) applications that sought more than $260,000 in COVID relief funds; and - - Matthew Hoang Ho, 66, of Melbourne, Florida, was charged on May 2 in a grand jury indictment with conspiracy to commit wire fraud, wire fraud and money laundering in relation to the PPP and EIDL applications, and he is scheduled to go on trial on February 6, 2024. In relation to the fraud against HRSA, over the course of about nine months - from July 2020 to March 2021 - Dinh allegedly submitted fraudulent claims for the treatment of patients who were insured, services that were not rendered, and services that were not medically necessary. As a result of these false and fraudulent claims, HRSA made payments to defendant Dinh, through [his medical] practices, in the approximate amount of $150 million. The Uninsured Program was designed to prevent the further spread of the pandemic by providing access to uninsured patients for testing and treatment. The Uninsured Program was also designed to provide financial support to health care providers fighting the COVID-19 pandemic by reimbursing them for services provided to uninsured individuals. In relation to the PPP and EIDL program, the indictment alleges that Dinh submitted, or caused to be submitted, approximately 65 fraudulent loan applications that sought nearly $8 million and caused the programs to disburse approximately $2.8 million in funds. An indictment contains allegations that a defendant has committed a crime. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law. If he were to be convicted in this case, Dinh would face up to 20 years in prison for the wire fraud and three of the money laundering charges, up to 10 years for two of the money laundering charges, and up to 20 years for the obstruction of justice charge that alleges he submitted false patient records in response to a grand jury subpoena ...
/ 2023 News, Daily News
The California Workers Compensation Insurance Rating Bureau has released its COVID-19 in California Workers’ Compensation 2023 Update. Key highlights from the report are as follows: Through July, a total of nearly 324,000 COVID-19 claims have been reported to the Division of Workers’ Compensation. Self-insured employers have reported more than half of the COVID-19 claims, whereas self-insured employer claims make up about one-third of non-COVID-19 claims. More than half of 2022 claims were reported in January during the Omicron surge, after which there was a notable and rapid decline to around 2% of claims. During the first few months of the pandemic, COVID-19 claims accounted for nearly one in every seven indemnity claims in California. In December 2020, amid the peak of the initial winter surge, nearly one-third of all indemnity claims were attributed to COVID-19. Subsequently, following the vaccine rollout and a significant decline in spring 2021, the proportion of COVID-19 claims began to increase again, with the emergence of the Delta variant and the Omicron variant. This surge peaked in January 2022, with one-third of reported indemnity claims stemming from COVID-19. Throughout the pandemic, the healthcare sector consistently had the highest proportion of indemnity claims related to COVID-19 within the insured sector. Public administration, which includes some first responders, also saw a significant number of COVID-19 claims. The share of indemnity claims related to COVID-19 has decreased across all industries. Through 2021, Manufacturing held the second highest share of COVID-19 claims among sectors. However, as the economy rebounded late in 2021 and during 2022, the second highest share of claims were from the Accommodation and Food Services sector. Workers between the ages of 16 and 39 accounted for over half of all COVID-19 claims, a slightly higher proportion than that seen among all indemnity claims for younger workers. Throughout the pandemic, 80% of all COVID-19 death claims have been incurred by workers aged 50 years or older in contrast to less than one-third of all indemnity claims in this age group. For AY 2022, approximately 70% of incurred losses on COVID-19 claims have originated from Temporary Disability (TD) only claims compared to less than half of the incurred losses on non-COVID-19 claims. A quarter of incurred losses on COVID-19 claims in AY 2022 are on death and PD claims. This marks a significant decrease from AY 2021 when half of the incurred losses on COVID-19 claims at first report (18 months) were related to death and PD claims. Nearly all indemnity-only claims from AY 2022 have an incurred value below $5,000. While the incurred loss distribution for non-COVID-19 claims remained similar to that of AY 2021, a higher proportion of COVID-19 claims have less than $1,000 of incurred losses. In prior AYs, the shares of COVID-19 claims exceeding $500,000 were several times greater than that of non-COVID-19 indemnity claims. In AY 2022, the shares are similar, indicating a reduced filing of large COVID-19 claims in 2022. Denial rates on COVID-19 claims have been higher than on non-COVID-19 claims, as on average, only about 8% of non-COVID-19 claims are denied and this has continued throughout the pandemic. Many COVID-19 claims are denied due to the lack of a positive test result for a COVID-19 infection. Generally, denial rates have been higher during the period Senate Bill No. 1159 has been in effect, with its less expansive presumption of compensability than early in the pandemic, when the Governor’s Executive Order was in effect. Virtually all COVID-19 indemnity-only claims close quickly, as they typically involve only short durations of TD with nearly all claims closed by 18 months. COVID-19 claims with both indemnity and medical on average close more quickly than non-COVID indemnity claims as more have relatively small incurred values and have shorter TD durations. Both indemnity and medical COVID-19 paid losses have developed less since year-end 2022 than non-COVID-19 claims paid losses. This lower paid loss development of COVID-19 claims has occurred because many AY 2022 COVID-19 claims close quickly and with shorter TD duration than non-COVID-19 claims ...
/ 2023 News, Daily News
The Labor Commissioner’s Office (LCO) has cited five Kern County Wingstop restaurants and their owner, Clinton Lewis, $3,161,606 for wage theft violations affecting 551 workers. The LCO opened its investigation in November 2020 after receiving a Report of Labor Law Violation for one of the locations. The investigation revealed that, between 2019 and 2022, five Wingstop locations were each operating as separate corporate entities, although Lewis owned and operated each of them and shared employees between the multiple locations. Treating each location as a separate employer, Lewis paid the workers the lower minimum wage for small employers with 25 or fewer employees. LCO determined that legally, Lewis’s restaurants were a single employer at the five locations, and the workers should have been paid the higher minimum wage for employers with 26 or more employees. Workers scheduled to work at more than one Wingstop in one day were denied overtime pay when they worked more than eight hours in a workday or 40 hours in a workweek. Lewis avoided paying missed meal break premiums to workers when scheduling them to work at more than one location. The employees also lost out on getting paid for off-the-clock work for their time traveling from one worksite to another during the workday. The LCO’s Bureau of Field Enforcement issued citations to Hot Wing Holdings Group, Inc., The Northwest Bakersfield Wing Company Inc., The East Bakersfield Wing Company Inc., The Bakersfield Wing Company, Inc., The Southeast Bakersfield Wing Company Inc., and Clinton Lewis dba Wingstop, located in Kern County. The five corporate entities and Lewis, as an individual, are each jointly and severally liable for $190,741 in minimum wage violations, $4,323 for contract wages, $57,312 for overtime, $87,656 for meal premiums, $238,569 for liquidated damages, and $1,307,980 for waiting time penalties for a total of $1,886,581. The citations also include interest on those penalties totaling $77,124, all of which are payable to the 551 employees. The five corporate entities and Lewis, as an individual, are also jointly and severally liable for civil penalties totaling $1,197,900. Enforcement investigations typically include a payroll audit of the previous three years to determine minimum wage, overtime, and other labor law violations, and to calculate payments owed and penalties due. When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid minimum wages plus interest ...
/ 2023 News, Daily News
In July 2016 Anel Perez filed a civil complaint against Galt Joint Union Elementary School District. which alleged that she was acting as a volunteer for the spelling bee held at River Oaks Elementary School, which is owned or in the possession of the Galt Joint Union Elementary School District. The complaint alleges that on December 4, 2015, while attending the event, she fell off the school’s auditorium stage and down an adjacent stairway, causing catastrophic injury to her. The School District filed an answer to the compliant in November 2016, but the affirmative defenses in this initial answer did not include anything regarding the availability of workers’ compensation coverage. In late 2018, the District filed a successful motion for leave to amend its answer to the complaint which added an affirmative defense of the workers' compensation exclusive remedy. The litigation was bifurcated, and Phase 1 involved only the applicability of the exclusive remedy defense, and would address if a resolution adopted under Labor Code section 3364.5 applied to the School District, such that Perez’s sole and exclusive remedy would be workers’ compensation. Dr. Karen Schauer, who testified that she was the superintendent of the "Galt Joint Union Elementary School District." . Schauer’s testimony and the evidence she presented touched on three key issues: the 1968 adoption of a resolution pursuant to Labor Code section 3364.5 by the governing board of the "Galt Joint Union School District," the names by which the district identifies itself, and her use of school principals as her designees. Plaintiff testified she had two children who attended River Oaks Elementary at the time of the accident, and she was a frequent volunteer at the school. She was vice president of the PTA. Plaintiff testified that the PTA president asked her to volunteer at the bee the day before the event. Plaintiff agreed that during the time of the spelling bee and before her fall, she "understood that [she] w[as] under the direction and control of Ms. Yount who was in essence running the spelling bee." Lois Yount has worked for "Galt Joint Union Elementary School District" for 20 years. She used to work as a school administrator at River Oaks Elementary. As a school administrator, she would oversee every aspect of the school, including student safety and staff safety, day-to-day happenings, and school functions. She would serve as a leader of instruction, maintenance, and operation. Her direct supervisor, with whom she would communicate on an on-going basis, was the district superintendent. After conclusion of the Phase 1 trial, the court entered judgment in favor of the District on the ground that a resolution passed under Labor Code section 3364.5 in 1968 by the "Governing Board of Galt Joint Union School District of Sacramento and San Joaquin Counties" for the "Galt Joint Union School District" converted plaintiff’s status to that of an employee under the Act, rendering workers’ compensation the sole and exclusive remedy to compensate plaintiff for her injuries. The Court of Appeal affirmed the trial court in the published case of Perez v. Galt Joint Union Elementary School District -C092691 (September 2023). Generally, a person "performing voluntary service[s] for a public agency . . . who does not receive remuneration for the services" is excluded from the definition of "employee" under the Workers Compensation Act. (Lab. Code, § 3352, subd. (a)(9).) However, under certain circumstances, usually upon the governing board’s adoption of a resolution, volunteers of statutorily identified organizations can be deemed employees under the Act. (See, e.g., Lab. Code, §§ 3361.5-3364.7.) One such exception to the exclusion of volunteers from the definition is contained in Labor Code section 3364.5, and applies "upon the adoption of a resolution of the governing board of the school district" to "person[s] authorized by the governing board of a school district or the county superintendent of schools to perform volunteer services for the school district" who are injured "while engaged in the performance of any service under the direction and control of the governing board of the school district or the county superintendent." (Lab. Code, § 3364.5.) In response to the plaintiff's arguments against application of § 3364.5 the Court of Appeal concluded: (1) that so long as a resolution has been passed at some point by the governing board of a district and not later rescinded, Labor Code section 3364.5 does not require that district board members and staff be aware of the statute at the time a volunteer is injured in order for it to apply; (2) district board members do not need to know about and authorize a specific volunteer’s involvement in a specific activity for the exception to apply; and (3) district board members do not need to directly control and direct a volunteer’s actions for the exception to apply. "The broad purpose of Labor Code section 3364.5, reflected in the legislative history, reinforces our decision that the statute does not apply just in the narrow circumstances and to the narrow class of volunteers to which plaintiff’s reading would have us apply the statute." ...
/ 2023 News, Daily News
The U.S. Department of Labor announced that its Occupational Safety and Health Administration awarded approximately $12.7 million in grants to 100 non-profit organizations across the nation to support education and training to help workers and employers recognize serious workplace hazards, employ injury prevention and understand workers’ rights and employers’ responsibilities under federal law. Funded through the Susan Harwood Training Grant Program, the grants are being awarded in three categories, namely Targeted Topic Training, Training and Educational Materials Development and Capacity Building grants. "The award of Susan Harwood Training Grants remind us of Dr. Harwood’s important contributions to making our nation’s workplaces safer and healthier for countless U.S. workers," said Acting Secretary of Labor Julie Su. "Dr. Harwood’s dedication to educating workers and employers continues to inspire those of us at the Department of Labor and those whose organizations will use these grants to help save lives." The program’s name and purpose reflect the legacy of the former director of OSHA’s Office of Risk Assessment. In 17 years with OSHA, the late Dr. Harwood was instrumental in developing federal standards that today protect people from workplace hazards, including asbestos, benzene, bloodborne pathogens, cotton dust, formaldehyde and lead. "These grants are one of our most effective resources for providing training and education to hard-to-reach workers in high-hazard industries. More than a third of the awardees will be conducting training in the south, improving our training footprint in an area with a large, underserved workforce," said Assistant Secretary for Occupational Safety and Health Doug Parker. "Training should be a key part of ensuring vulnerable workers are in safe and healthy environments and that they feel safe at work." OSHA awards grants to non-profit organizations, including community and faith-based groups, employer associations, labor unions, joint labor-management associations, Native American tribes and local and state-sponsored colleges and universities. Target trainees include small-business employers and underserved vulnerable workers in high-hazard industries. Many of the recipients of fiscal year 2023 Susan Harwood Training Grants will provide training and education in their regions and across the nation. Several of them are in California such as the University of California San Diego ($159,946), Port of San Diego Ship Repair Association ($81,016), Asian Immigrant Women Advocates in Oakland ($55,000), National Day Laborer Organizing Network in Pasadena ($160,000), and Community Services & Employment Training Inc. in Visalia ($160,000), The complete list of Grant Recipients is available online ...
/ 2023 News, Daily News
The California Flats Solar Project is a large solar power plant built on part of a former cattle ranch in the southeastern corner of Monterey County. Granite Construction was involved as a subcontractor in the construction of this project. The Monterey County Planning Department required the primary project contractor to prepare and implement a worker training program about Valley fever before any grading activity. Consistent with these requirements, the owner of the project site created a Valley fever fact sheet, a Valley fever training program, and a Valley fever management plan for the project. The project general contractor, in turn, created a safety plan that identified Valley fever as a potential risk and described methods for mitigating this risk. Granite Construction also discussed Valley fever in safety instructions to its employees. In May 2017, Cal/OSHA began an inspection of the project worksite, which ultimately centered on the potential exposure of Granite Construction’s employees to Coccidioides, the fungus which causes Valley fever. During their site visits, Cal/OSHA staff did not wear respiratory protection to prevent their own potential exposure to Coccidioides. Nor did they test the site for Coccidioides, though staff assumed that tests were available to determine the presence of the fungus. No evidence in the record shows that any Granite Construction employee contracted Valley fever. Nor does any testimony show that any person who visited the worksite contracted Valley fever. Cal/OSHA issued a citation to Granite Construction for allegedly violating three regulations. It alleged Granite Construction violated one regulation because it required its employees to wear masks without first providing a medical evaluation to determine their fitness to wear them. And it alleged the company violated two other regulations because it exposed its employees to dust containing a harmful fungus - namely, Coccidioides, the fungus that causes Valley fever - and failed to implement adequate measures to limit this exposure. After Granite Construction disputed these allegations, an ALJ rejected the Division’s claims. The ALJ reasoned that no credible evidence showed that Granite Construction required its employees to wear masks and no reliable evidence showed that Coccidioides was present at the worksite. But after the Cal/OSHA petitioned for reconsideration, the Occupational Safety and Health Appeals Board reversed on these issues and ruled for Cal/OSHA. The trial court later denied Granite Construction’s petition for writ of administrative mandate seeking to set aside the Board’s decision. On appeal from the trial court, the Court of Appeal reversed in the published case of Granite Construction Co. v. Occupational Safety and Health Appeals Bd. - C096704 (September 2023). It agreed with Granite Construction’s claim that insufficient evidence shows its employees were exposed to Coccidioides. But it ejected its additional claim that it allowed (rather than required) its employees to wear masks, finding sufficient evidence supports the Board’s contrary ruling on this point. Granite Construction challenged the Board’s finding that it violated California Code of Regulations, title 8, section 5144(a)(1) - a finding that was largely premised on the Board’s conclusion that the company exposed its employees to Coccidioides because no evidence showed Coccidioides was present at the worksite. Over the years, the Board has discussed two competing standards for evaluating whether an employee has been exposed to an atmospheric contaminant within the meaning of this regulation. It established the first standard - the “harmful exposure” standard - decades ago. Under this standard, the Division must show “ ‘[a]n exposure to dusts, fumes, mists, vapors, or gases . . . [o]f such a nature by inhalation as to result in, or have a probability to result in, injury, illness, disease, impairment, or loss of function.’ ” The Board has since suggested that an alternative standard - the “zone of danger” standard - might be more appropriate in evaluating alleged violations of section 5144(a)(1). Under this alternative standard, the Division must show either that the employees have been or are in the zone of danger or ‘that it is reasonably predictable by operational necessity or otherwise, including inadvertence, that employees have been, are, or will be in the zone of danger. To date, the Division has yet to decide which of these two standards - the “harmful exposure” standard or the “zone of danger” standard - is the appropriate one in cases involving alleged violations of section 5144(a)(1). It has instead, in each case it has considered these standards, found it unnecessary to decide between the two standards because it concluded that both favor the same result. In its decision here, the Board noted that the “harmful exposure” standard is the one it has applied in past decisions involving section 5144(a)(1). But at the same time, it noted it might have reason to “overrule” this approach and apply the “zone of danger” standard - which it characterized as its “typical exposure analysis.” The Court of Appeal concluded that under either standard, the Board’s finding that employees were exposed to dusts containing Coccidioides lacks evidentiary support. "Here, however, nothing we have found in the record shows that any part of the worksite “present[ed] [a] danger to employees.” The CDC, to be sure, has said Coccidioides is endemic in California. But that does not mean that the fungus is present everywhere in the state (or for that matter, everywhere in Monterey County) - which even Division staff conceded." "The Department of Industrial Relations, moreover, has indicated that Monterey County and seven other counties have relatively high rates of Valley fever, with rates over 10 per 100,000 people. But that does not mean that Coccidioides was present (or even likely present) at the worksite here. Nor does it even show a meaningful probability that the fungus was present." And although Monterey County and even Granite Construction demonstrated concerns about Valley fever and took steps to limit potential exposure, that too does not show that Coccidioides was actually present. All this evidence instead only shows, with no degree of certainty, that the worksite might have presented a danger to employees because Coccidioides might have been present in the soil. That, however, is insufficient to support the Board’s finding that the worksite was in fact a zone of danger." ...
/ 2023 News, Daily News
More than three years into the pandemic, millions of people claim to have suffered from Long COVID. For those who have claimed workers' compensation benefits, Long COVID cases are the most costly. According to a new study, there soon may be scientific methods to confirm their condition. According to a report by NBC News,scientists may have found clear differences in the blood of people with Long COVID — a key first step in the development of a test to diagnose the illness. Researchers from Yale School of Medicine and the Icahn School of Medicine at Mount Sinai, with contributions from Stanford University, were able to identify a range of biomarkers and predict with 94% accuracy who had long COVID. The research is among the first to prove that "Long COVID is, in fact, a biological illness," said David Putrino, principal investigator of the new study and a professor of rehabilitation and human performance at the Icahn School of Medicine at Mount Sinai in New York. Post-acute infection syndromes (PAIS) may develop after acute viral disease. Infection with SARS-CoV-2 can result in the development of a PAIS known as “Long COVID.” Individuals with Long COVID frequently report unremitting fatigue, post-exertional malaise, and a variety of cognitive and autonomic dysfunctions, however, the biological processes associated with the development and persistence of these symptoms are unclear. In the new study published this month in Nature, 273 individuals with or without Long COVID were enrolled in a cross-sectional study that included multi-dimensional immune phenotyping and unbiased machine learning methods to identify biological features associated with Long COVID. Several differences in the blood of people with Long COVID stood out from the other groups. The activity of immune system cells called T cells and B cells — which help fight off germs — was "irregular" in Long COVID patients, Putrino.said. He also said that one of the strongest findings was that Long COVID patients tended to have significantly lower levels of a hormone called cortisol. "It was one of the findings that most definitively separated the folks with Long COVID from the people without Long COVID," Putrino said. The finding likely signals that the brain is having trouble regulating hormones. The research team plans to dig deeper into the role cortisol may play in Long COVID in future studies. A major function of the hormone is to make people feel alert and awake. Low cortisol could help explain why many people with Long COVID experience profound fatigue, he said. Meanwhile simply boosting a person's cortisol levels in an attempt to "fix" the problem is not yet recommended. Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive COVID-19 Center in Chicago, called the findings "important." He was not involved with the new research. "This will need to be investigated with more research, but at least it's something because, quite frankly, right now we don't have any blood tests" either to diagnose Long COVID or help doctors understand why it's occurring, he said ...
/ 2023 News, Daily News
A new California Workers’ Compensation Institute study finds that average paid losses on California workers’ compensation lost-time claims fell immediately after legislative reforms (SB 863) took effect a decade ago, but then gradually increased up until the pandemic hit. Currently, average paid losses on claims at all valuation points within 60 months of injury are above their post-reform lows, with only the most developed data on older claims -- 72-month data on accident year (AY) 2016 claims -- still showing declines in loss payments in the wake of the 2012 reforms. Using data from CWCI’s Claims Monitoring Application on nearly 570,000 indemnity claims for injuries that occurred during the 10-year span ending in December 2022, the study tracks average paid losses at 6, 12, 24, 36, 48, 60 and 72 months post injury, breaking out the results by accident year to identify growth trends. In addition to average total losses, the study notes the average medical and indemnity payments at each level of development and compares the loss payments for claims from 5 key industry sectors and from different regions of the state. Average total paid losses within the first year of injury fell immediately after the 2012 reforms took effect but bottomed out in AY 2014 and started to trend up in AY 2015, continuing to increase through AY 2020. Average 24-month loss payments bottomed out in AY 2016, then trended up through AY 2019, the latest year for which 24-month data are available. For the first time in 7 years, the 6- and 12-month average paid losses fell slightly in AY 2021 (the second year of the pandemic) while the 6-month payments on AY 2022 claims edged up slightly, so average total losses in the initial months after injury have changed little since the pandemic began. Unlike the 6-, 12- and 24-month data, there are no COVID claims in the 36-, 48-, 60- and 72-month results as data at those levels of development is not available beyond AY 2019 and the pandemic began in AY 2020. More developed data on older claims show average total losses declined through AY 2016, but beginning with AY 2017 claims, paid losses at 36, 48, and 60 months began to rise, so the 72-month trendline, which now runs through AY 2016, is the only one that is still declining from the post-SB 863 level. A review of average 24-month paid medical losses shows they declined from AY 2013 through AY 2016, but between AY 2017 and AY 2020 they jumped by 16.6%, which helped fuel the increase in the 24-month total loss trend. Much of that increase occurred in AY 2019 (+4.5%) and AY 2020 (+6.2%), and notably, 24-month data on claims from both those years included payments for medical services delivered during the pandemic. Temporary disability comprises most of the indemnity paid in the first 2 years after a job injury, and despite some year-to-year fluctuations, the average indemnity paid at 6 months increased 40.6% from AY 2013 to AY 2022, the average indemnity paid at 12 months rose 27.7% from AY 2013 to AY 2021; and the average indemnity paid at 24 months fluctuated from AY 2013 to AY 2017 but increased for AY 2018, AY 2019, and AY 2020 claims, resulting in a 22.7% net increase between AY 2013 and AY 2020. In the first few years after SB 863 took effect, the 36-month trendline for indemnity payments tracked with those at the shorter development periods, first fluctuating in a narrow range then gradually trending up to a peak in AY 2019. Average indemnity payments at the longer-term valuations, which are more affected by PD, were flatter, with a net increase of 3.4% in the 48-month payments from AY 2013 to AY 2018; a net decrease of 1.3% in the 60-month payments from AY 2013 to AY 2017; and a net decrease of 1.8% in the 72-month payments between AY 2013 and AY 2016. The Institute study also examines differences in 24-month total loss trends for AY 2013 to AY 2022 indemnity claims from 5 industry sectors (construction; health care; clerical; food service; and agriculture); and for claims from injured workers living in 7 distinct regions of the state (San Diego, the Inland Empire/Orange County; Los Angeles County; the Central Coast; the Central Valley, the Bay Area, and the North Counties/Sierras), as well as for claims from out-of-state workers. CWCI has published its study in a Research Update report, “California Workers’ Compensation Claims Monitoring: Medical & Indemnity Development, AY 2013 – AY 2022.” ...
/ 2023 News, Daily News
The 3M earplug litigation represents the largest mass tort in U.S. history. There have been more than 300,000 claims in which veterans accuse 3M and Aearo Technologies, a company acquired by 3M in 2008, of producing faulty earplugs that failed to protect their hearing from noise damage when they received them from the U.S. military. 3M manufactured, marketed and sold its Combat Arms Earplugs, Version 2 (CAEv2) from 1999 to 2015,with an alleged design defect which hampered their effectiveness. 3M announced that it has reached an agreement with the court-appointed negotiating plaintiffs' counsel to resolve the Combat Arms Earplug litigation against Aearo Technologies (Aearo) and 3M. The settlement comes after 3M failed to move the lawsuits into bankruptcy court in hope of limiting its liability. Under the agreement, 3M will contribute a total amount of $6.0 billion between 2023 and 2029, which is structured under the agreement to include $5.0 billion in cash and $1.0 billion in 3M common stock. “This settlement is a tremendous outcome for veterans of Iraq and Afghanistan who put their lives on the line for our freedom,” said Duane Sarmiento, the Veterans of Foreign Wars (VFW) national commander. “For those who came home with hearing damage due to 3M’s faulty earplugs, this is not only compensation, it’s a statement that their sacrifices won’t be ignored.” Last summer, Aearo Technologies filed for bankruptcy as a separate company, accepting responsibility for all the liability claims. The move was intended to give Aearo leverage in bankruptcy court to reach a settlement with the plaintiffs. 3M said it would pay for any settlement Aearo reached. U.S. Bankruptcy Court Judge Jeffrey Graham in Indianapolis dismissed Aearo’s bankruptcy filing in June. The judge said Aearo did not qualify for bankruptcy protections as a distressed company since it had 3M’s promise to pay for a settlement. Aearo plans to appeal the ruling, as reported in The Wall Street Journal. In February, VFW filed an Amicus Curiae brief to the Seventh Circuit Court of Appeals in support of claimants seeking relief from 3M for defective ear protection. 3M had tried to shift the blame to its subsidiary Aearo Technologies, who it said was responsible for the defective earplugs and who had filed Chapter 11 bankruptcy, to avoid paying claimants. The bankruptcy appeal is being held in abeyance pending finalization of the settlement. This agreement, reached through the mediation process that 3M has previously disclosed, is structured to promote participation by claimants and is intended to resolve all claims associated with the Combat Arms Earplug products. The agreement includes all claims in the multi-district litigation in Florida and in the coordinated state court action in Minnesota, as well as potential future claims. The Florida and Minnesota courts are entering orders to support implementation of the agreement. 3M also added to its announcement that this "agreement is not an admission of liability. The products at issue in this litigation are safe and effective when used properly. 3M is prepared to continue to defend itself in the litigation if certain agreed terms of the settlement agreement are not fulfilled." Aearo and 3M are actively engaged in insurance recovery activities to offset a portion of the settlement payments, and Aearo initiated insurance recovery litigation against its carriers in June related to the litigation. According to Fox Business News, the settlement amount is significantly less than the $10 billion to $15 billion that some analysts predicted the case would cost the company. Still, the settlement will impact financial results. 3M will record a $4.2 million pre-tax charge in the third quarter, which "represents the $5.3 billion pre-tax present value of contributions under the agreement net of 3M's existing accrual of approximately $1.1 billion related to this matter," the company detailed. More information about the settlement is available at 3m-earplugsettlement.com ...
/ 2023 News, Daily News
National Nurses United, with nearly 225,000 members nationwide, is the largest union and professional association of registered nurses in U.S. history. In 2009, California Nurses Association/National Nurses Organizing Committee played a lead role in bringing state nursing associations across the nation together into one national organization, National Nurses United (NNU). At its founding convention, NNU adopted a call for action to counter what it called “the national assault by the healthcare industry on patient care conditions and standards for nurses,” and to promote a unified vision of collective action for nurses. This legislative year, nurses across California were instrumental in the introduction of A.B. 1156, authored by Assemblymember Mia Bonta (D-Oakland) and sponsored by California Nurses Association (CNA). The organization held a press conference about the proposed law on April 5 at the Kaiser Permanente Oakland Medical Center. This bill would define “injury,” for a hospital employee who provides direct patient care in an acute care hospital, to include infectious diseases, cancer, musculoskeletal injuries, post-traumatic stress disorder, and respiratory diseases. The bill would include the 2019 novel coronavirus disease (COVID-19) from SARS-CoV-2 and its variants, among other conditions, in the definitions of infectious and respiratory diseases. The bill would create rebuttable presumptions that these injuries that develop or manifest in a hospital employee who provides direct patient care in an acute care hospital arose out of and in the course of the employment. The bill would extend these presumptions for specified time periods after the hospital employee’s termination of employment. Fortunately for California employers, A.B. 1156 was last found In the Assembly Insurance Committee as of March 2023. It failed deadline the deadline to move from policy committee to fiscal committee as of April 28, 2023. Thus the measure did not proceed to be passed by the Legislature in the current session, but technically is still alive for 2024 consideration. The California Chamber of Commerce, and a number of other business organizations opposed A.B. 1156. It pointed out that in 2019, SB 567 (Caballero) included presumptions for a very similar, more narrow list of illnesses and injuries. The Senate Committee on Labor, Public Employment and Retirement issued an analysis concluding that there was no evidence supporting the need for this presumption. It also warned that “the creation of presumptive injuries is an exceptional deviation that uncomfortably exists within the space of the normal operation of the California workers’ compensation system,” and to not limit them “would essentially consume and undermine the entire system”. Two of the most recent iterations of this bill, SB 893 (Caballero) and SB 567 (Caballero) received 0 and 1 Aye votes in committee, respectively. SB 213 (Cortese) did not receive a motion in Assembly Insurance last year. In 2014, AB 2616 (Skinner), the only version to make it to the Governor’s desk, was vetoed by Governor Edmund G. Brown, Jr. In his veto message he stated, “This bill would create a first of its kind private employer workers' compensation presumption for a specific staph infection -- methicillin-resistant Staphylococcus aureus (MRSA) -- for certain hospital employees. California's no-fault system of worker's compensation insurance requires that claims must be ‘liberally construed’ to extend benefits to injured workers whenever possible. The determination that an illness is work-related should be decided by the rules of that system and on the specific facts of each employee's situation. While I am aware that statutory presumptions have steadily expanded for certain public employees, I am not inclined to further this trend or to introduce it into the private sector.” ...
/ 2023 News, Daily News