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Ricardo Gonzalez worked at AC Enterprises, a dairy operation in Tipton that was owned and run by Carl Brasil. The night before the accident, Hettinga Transportation, Inc, a company based in Pixley, had delivered the hay by truck to the dairy; Hettinga employees had unloaded and stacked the hay upon delivery. In the early morning hours of April 29, 2017, Gonzalez, as part of his job duties, dislodged bales of hay from this haystack to feed the cows at the dairy. After Gonzalez downed a few bales of hay from the stack other hay bales toppled onto him, causing serious injury. Gonzalez received workers' compensation benefits from Zenith Insurance company, and also filed a civil action against Hettinga for negligence alleging they delivered and negligently stacked hay bales at AC Enterprises. Zenith Insurance Company filed a complaint-in-intervention. The case proceeded to jury trial. When Gonzalez and intervenor rested after presenting their cases in chief, Hettinga moved for nonsuit. The trial court granted Hettinga’s motion for nonsuit as to plaintiffs’ and intervenor’s negligence claims, on grounds that expert witness testimony on the standard of care for stacking hay was required but not presented in plaintiffs’ and intervenor’s cases in chief. Plaintiffs Gonzalez as well as intervenor Zenith Insurance Company,appealed the trial court’s ruling. The judgment of nonsuit was reversed and the matter was remanded for the trial court to conduct a new trial in the unpublished case of Gonzalez v. Hettinga Transportation -F083948 (March 2024). Hettinga’s principal argument is that this case is one of professional negligence, rather than ordinary negligence. More specifically, Hettinga argues this matter implicates a professional standard of care and that expert testimony was required to establish the applicable professional standard of care. The Court of Appeal disagreed. Big bales are massive weighing approximately 1,100 pounds or half a ton per bale. When stacked four-high, the bales comprise 4,000 pounds or two tons of hay. Thus, the question is whether in stacking such bales, a reasonably prudent person would have stacked the bales on their narrower three-foot edges when they could have alternatively stacked them on their flat or wide, four-foot edges, especially as stacking the bales on their four-foot edges would result in a lower, overall stack height of 12 feet while stacking the bales on their three- foot edges would result in an "extreme" overall stack height of 16 feet. The bales also could have been stacked in the typical configuration and Brasil’s preferred configuration, that is, three-bale-high/flat, which would have resulted in a very manageable (by all accounts) overall height of nine fee. Frank Ricardo, Carl Brasil, and Steve Hettinga, all of whom were knowledgeable about stacking hay, indicated that big bales should never be stacked on their narrow, three-foot edges, for reasons of safety and stability, especially when higher stacks were at issue. The Court of Appeal reviewed their testimony, and that of many other witnesses and concluded that the record contains evidence from knowledgeable co-workers which a jury could properly find that Hettinga did not exercise due care in stacking the hay upon delivery to AC Enterprises. Plaintiffs and intervenor presented evidence, in the form of the respective testimony as to the manner in which Hettinga stacked the bales delivered to AC Enterprises on April 28, 2017. "Here, the record taken as a whole, does not indicate that stacking haybales was a highly specialized profession - requiring extensive education and training and involving tasks of great complexity - such that the issue of negligence pertaining to hay stacking would entail a professional standard of care and require expert testimony thereon." Finally, Hettinga argued that plaintiffs and intervenor were required to, but did not, "establish that the medical services Mr. Gonzalez received were 'attributable to the accident, that they were necessary and that the charges for such services were reasonable.' " The jury heard that Gonzalez made a claim for payment of workers compensation benefits, Zenith was the insurer for AC Enterprises, and Zenith paid Gonzalez’s medical bills. The jury was provided with a detailed accounting of the expenses that Zenith had paid and heard testimony that the total amount paid by Zenith was $881,649.56. Under Labor Code section 4600, subdivision (a), Zenith (on behalf of Gonzalez’s employer) is required by law to pay for all medical treatment "that is reasonably required to cure or relieve the injured worker from the effects of the worker’s injury." (Lab. Code, § 4600, subd. (a).) Accordingly, the jury could properly infer that Zenith paid $881,649.56 in medical expenses because it was obligated to do so, so as to ensure Gonzalez received all the reasonably necessary treatment for injuries sustained in the accident at the dairy. "Under these circumstances, a showing of negligence and proximate cause would suffice to establish a claim for reimbursement of workers compensation payments made for Gonzalez’s medical treatment on account of the accident." ...
/ 2024 News, Daily News
Huu Tieu, 61, of Porterville, pleaded guilty Tuesday to three counts of introduction of misbranded drugs into interstate commerce. Tieu was the President and Chief Executive Officer of Golden Sunrise Pharmaceutical Inc. and Golden Sunrise Nutraceutical Inc. Golden Sunrise manufactured, marketed, and sold products that claimed to effectively treat a variety of medical conditions. According to court documents, beginning on March 30, 2020, Tieu began selling a set of herbal mixtures he called the "Emergency D-Virus Plan of Care" as a COVID-19 treatment. The treatment consisted of a box containing various vials of Golden Sunrise drug products, including one called "Imunstem," together with an "Emergency D-Virus Plan of Care" information sheet. Tieu mailed the products to various practitioners, public officials, and other individuals both inside and outside of California. According to court documents, the labeling for the drugs, including the information sheet that accompanied the drugs, was false and misleading and stated that ImunStem and other Golden Sunrise products were "uniquely qualified to treat and modify the course of the virus epidemic in China and other countries." Tieu falsely claimed the products had been the first dietary supplement in the United States to be approved as a prescription medicine by the U.S. Food and Drug Administration (FDA) to treat the COVID-19 virus. In fact, the drugs were not FDA approved, and no Golden Sunrise product had ever been approved by the FDA for any purpose. Tieu is scheduled to be sentenced before U.S. Magistrate Judge Barbara A. McAuliffe on June 12, 2024. Tieu faces a maximum statutory penalty of one year in prison and a $100,000 fine on each of the three counts. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables. This case is the product of an investigation by FDA Office of Criminal Investigations, the U.S. Department of Health and Human Services Office of Inspector General, and the Federal Bureau of Investigation with assistance from the Tulare County District Attorney’s Office. Assistant U.S. Attorneys Jeffrey A. Spivak and Emilia P.E. Morris are prosecuting the case ...
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Alejandro Chavero Velazquez was employed as a tile setter. In 2018, he was working for his employer on a tile project at the residence of a customer. While working at the residence, Velazquez reportedly suffered a dog bite injury by the homeowner’s dog. He was apparently diagnosed with nerve damage and "complex regional pain syndrome" and underwent several surgeries. A workers’ compensation case was opened against his employer and the workers’ compensation carrier, NorGUARD Insurance Company. He also filed a personal injury action against the homeowners. One of the disputed issues in the personal injury action was his claim of complex regional pain syndrome. Employer fault was not raised or litigated in the personal injury action. In May 2020, in the personal injury action, NorGUARD filed a notice of lien in the amount of $89,176.27 relating to workers’ compensation benefits that had been paid to Velazquez. The homeowners had an insurance policy with a $1 million limit. They settled appellant’s personal injury action for the policy limit. The settlement agreement provided that the homeowners’ insurer would pay a portion of the settlement to appellant’s personal injury attorneys and that the amount would not be disbursed by the attorneys until the workers’ compensation lien was resolved. Specifically, the settlement agreement stated that the homeowners’ insurer would pay "$109,587.11 to be held in trust and not disbursed at all until the WC lien is fully resolved by settlement or judicial order payable to the LAMB and FRISCHER Law Firm IOLTA client trust account." Velazquez’s attorney and NorGUARD’s attorney signed the settlement agreement, approving it "as to form and content," in January 2022. NorGUARD and Velazquez were unable to settle the workers’ compensation lien. The parties disagreed regarding the amount by which the lien should be reduced for attorney’s fees and the extent, if any, of employer fault. As a result, NorGUARD filed a civil action against Velazquez for breach of contract, alleging that Velazquez’s "failure to perform under the [settlement agreement] by payment to [respondent] of its workers’ compensation benefits constitutes a material breach of the [settlement agreement] . . . ." Velazquez filed a special motion to strike the breach of contract cause of action under Code of Civil Procedure section 425.16, commonly known as the anti-SLAPP statute, which provides that a cause of action arising from constitutionally protected speech or petitioning activity is subject to a special motion to strike unless the plaintiff establishes a probability of prevailing on the claim. (§ 425.16, subd. (b)(1).) The trial court denied his anti-SLAPP motion. Velazquez appealed,contending that the trial court erred in denying his anti-SLAPP motion and that in any event, the Workers’ Compensation Appeals Board (WCAB) has exclusive jurisdiction over this case because it involves an issue of whether the employer was at fault for appellant’s injury. The Court of Appeal affirmed the trial court’s order in the unpublished case of NorGUARD Insurance Company v. Chavero Velazquez -H050725 (March 2014). The parties disagree whether this breach of contract action involving respondent’s lien may be litigated in the trial court or must be determined in the workers’ compensation forum. Depending on the circumstances, the issue of employer negligence may be adjudicated in court or in the workers’ compensation arena. (See, e.g., Short v. State Compensation Ins. Fund (1975) 52 Cal.App.3d 104, 107.) The Court of Appeal concluded tha Velazquez failed "to persuasively demonstrate that the WCAB has exclusive jurisdiction over the issue of employer negligence in the context of respondent’s breach of contract action. On this point, we find Marrujo v. Hunt (1977) 71 Cal.App.3d 972 (Marrujo) instructive." In the present case, employer fault was not raised in the personal injury action against the homeowners. If the issue had been raised, the employer or carrier could have filed a complaint in intervention to protect a claim for reimbursement. Velazquez contended that the lawsuit was a SLAPP (SLAPP is an acronym for strategic lawsuit against public participation,) because NorGUARD’s breach of contract claim "interfere[d] with [his] efforts in petitioning" the WCAB. The workers’ compensation attorney stated that the "issue of employer fault and how it will affect the lien and credit rights of [Velazquez]" are "currently being litigated" in the workers’ compensation case. It thus appears that "the proceeds of the settlement were subject to [respondent workers’ compensation carrier’s] lien in the amount of the benefits paid by it." "In sum, appellant fails to establish that the trial court is an improper forum for resolving the dispute over respondent’s lien." In opposition to the anti-SLAPP motion, NorGUARD contended that it sought to enforce its subrogation rights under the Labor Code through its breach of contract action and that the action did not infringe upon appellant’s right to free speech or to petition the government. "In this case, although respondent’s breach of contract action was filed after appellant’s petitioning activity in the workers’ compensation arena, and even assuming appellant’s petitioning activity triggered respondent’s breach of contract claim, we determine that respondent’s breach of contract claim did not "aris[e] from" appellant’s petitioning activity (§ 425.16, subd. (b)(1)). Rather, the basis for respondent’s breach of contract claim, as alleged in the complaint, is appellant’s failure to pay." ...
/ 2024 News, Daily News
The California Labor Code Private Attorneys General Act (PAGA) authorizes aggrieved employees to file lawsuits, including class actions, to recover civil penalties on behalf of themselves, other employees, and the State of California for Labor Code violations. Those who intend to pursue PAGA cases must follow the requirements specified in Labor Code Sections 2698 - 2699.5. According to the California Legislative Analyst’s Office, approximately 5,000 PAGA notices are filed annually. Any penalties won under PAGA must be split between the employees (25%) and the state of California (75%). A proposed ballot measure, the "Fair Pay and Employer Accountability Act," if passed, will repeal PAGA and replace it with increased enforcement mechanisms in the hands of the Labor and Workforce Development Agency. The initiative at the center of the brewing major political battle, the Fair Play and Employer Accountability Act, got the green light to be placed on the November 2024 ballot almost two years ago. If passed, the Labor and Workforce Development Agency will enforce labor code violations, focusing on encouraging voluntary compliance over punitive measure and ensure that 100% of the penalties go to workers. Notably, the proposed ballot measure would double potential penalties that could be levied, however, it would remove the threat of an award of attorneys’ fees. In exchange, PAGA - as it exists today, will be repealed. The proposal signifies a landmark development, aiming to maintain employee rights while potentially alleviating the burden of PAGA claims on businesses. The initiative has received endorsements from the California Chamber of Commerce, Western Growers Association, California New Car Dealers Association, the California Restaurant Association and a long list of organizations. The California Chamber of Commerce said, "The California Fair Pay and Employer Accountability Act is an opportunity to reform labor law enforcement to prevent frivolous litigation while ensuring that workers receive the wages they are owed in a timely manner, plus any penalties." The battle in November heats up as two reports released last week offer dueling narratives about whether PAGA helps or hurts workers - marking the opening of a potentially expensive fight over the landmark law. On February 15, the UCLA Labor Center, PowerSwitch Action, and the Center for Popular Democracy released a new report, the first examining the impact of a ballot initiative on workers’ ability to fight workplace abuses, and what the authors claim are the theft of billions in wages from their paychecks and violations of sick leave and workplace safety rules. Labor researchers say that the ballot measure, if approved, would harm employees, particularly people with low-wage jobs, by taking away their ability to file what are essentially class-action suits against employers that allege labor law violations. The ballot measure also would weaken the state’s already strained system for enforcing workplace laws. "Corporations are aiming to buy themselves a ‘get out of jail free card’ for labor abuses," said Minsu Longiaru, Senior Staff Attorney for PowerSwitch Action. "California must stand up for PAGA and send a clear message to big companies that stealing from people’s paychecks has consequences." But the business coalition backing the ballot initiative counters that the labor law has resulted in a proliferation of lawsuits that small businesses and nonprofits have little ability to fight. Workers end up getting less money after a long legal process than if they had filed complaints through state agencies. Backers stress it also offers replacement provisions that would bolster state agency enforcement of workplace rules. "Today’s PAGA system is completely broken and does not work well for employees or employers," said Jennifer Barrera, president and chief executive of the California Chamber of Commerce, in announcing a report released last week by backers of the ballot initiative, called the Fix PAGA coalition. Barrera said that because one employee can sue on behalf of others, it allows lawyers to stack charges and extract high penalties from employers with few barriers because PAGA claims don't require the same type of notification and certification of workers allegedly affected that a class-action suit would require. Barry Jardini, executive director of the California Disability Services Assn., said that members of the trade group, many of which are nonprofits reliant on state or federal funding, are increasingly burdened by PAGA claims. He said 20 out of some 85 members who responded to a recent survey said they dealt with PAGA claims in 2023. Jardini said that disability service businesses have struggled to provide true "responsibility-free" 10-minute rest breaks in accordance with labor laws because often workers "can't just walk away" from clients especially if they are out and about instead of at home. He said employers have looked for creative solutions, such as paying employees extra for working through breaks or tacking on breaks at the beginnings or ends of shifts rather than the middle, but these fixes aren't legal substitutes for rest breaks workers are entitled to. "We run into a bit of a legal rock and a hard place," he said. "We do have a conflict with the law in terms of some of our services. Once that becomes known, it's relatively easy for an attorney to try to solicit a client that works in this industry that is maybe ripe for PAGA claims." Some disagree that there is rampant of abuse of PAGA. The UCLA Labor Center researchers published a report in February 2020 finding no evidence that PAGA unleashed a flood of frivolous litigation, as its detractors complain, and that it had demonstrably enhanced Labor Code compliance among employers ...
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Travis Gober, 45, of Hanford, was sentenced to 19 months in prison for committing health care fraud and aggravated identity theft by submitting more than $1 million in fraudulent claims for sleep studies to Medicare, U.S. Attorney Phillip A. Talbert announced. According to court records, Gober owned the VIP Sleep Center, which operated sleep clinics in Fresno and Tulare Counties. Sleep clinics perform diagnostic sleep studies on patients to identify disorders like sleep apnea and narcolepsy. From October 2019 through September 2021, Gober caused the VIP Sleep Center to submit thousands of claims totaling nearly $1 million to Medicare for sleep studies that were not actually performed on patients. The claims also falsely stated that the patients had been referred for the sleep studies by physicians with whom Gober had previously worked. This was done because Medicare will not pay for a sleep study unless the patient was referred by a physician. Gober committed this fraud, at least in part, to try to payoff financial debts and address other financial difficulties that his brother, Jeremy Gober, had caused the VIP Sleep Center and him to incur without his knowledge or consent. This case is the product of an investigation by the U.S. Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the California Department of Health Care Services. Assistant U.S. Attorney Joseph Barton is prosecuting the case. Travis Gober’s brother, Jeremy Gober, was previously charged with, and has pleaded guilty to, health care fraud and aggravated identity theft related to other sleep clinics in the Central Valley. Jeremy Gober is scheduled to be sentenced on May 20, 2024. In December 2022, A federal grand jury returned an 11-count indictment today against Jeremy Gober, 42, of Hanford, charging him with health care fraud and aggravated identity theft. According to court documents, Jeremy Gober owned and operated the Got Sleep center, which was a sleep clinic in Fresno and Orange County, California. From August 2016 through July 2020, Jeremy Gober caused Got Sleep to bill Medicare and Medi-Cal for thousands of sleep studies, totaling over $8,000,000, that the company did not actually perform on patients. This included sleep studies where the patients had died before the dates on which the studies were purportedly performed ...
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Anthony Duane Bell Sr. and his son, Anthony Duane Bell Jr., were sentenced in federal court to 65 months and 12 months and one day, respectively, for their roles in fraudulently receiving more than $21 million in Medicare payments and lying to cover it up. The pair, along with others, conspired to commit Medicare fraud by billing for medically-unnecessary durable medical equipment such as knee, ankle, shoulder, wrist and back braces. Bell Sr. pleaded guilty to Medicare fraud while Bell Jr. pleaded guilty to making false statements to a federal officer. U.S. District Court Judge William Q. Hayes also ordered Bell Sr. to pay $21,725,604.56 in restitution to Medicare and forfeit $806,375.12 and a luxury house in El Cajon. The forfeited property was purchased using money obtained from the fraud. In arriving at the sentence, Judge Hayes found that Bell Sr. intended to defraud Medicare of over $46 million dollars and received over $21 million dollars. According to court records, the Bells created companies known as Universal Medical Solutions 1 and Universal Medical Solutions 2, which supplied durable medical equipment. In order to find customers for their businesses, the Bells entered into sham agreements with "marketing" companies that, instead of marketing, provided packets of information about Medicare beneficiaries for $125 to $350 each. These packets of information included a Medicare beneficiary’s personal information, medical history, Medicare number, and an audio recording between a call center and the patient, in which the patient supposedly agreed to accept a brace. The packet also included a signed prescription from a doctor, obtained via telemedicine, claiming that the brace was medically necessary for the patient - although in almost all cases the prescription was signed by a physician who had no previous doctor-patient relationship with the patient, was often in another state, and at most had conducted an audio call with the patient. In all cases the doctor had not conducted any kind of physical examination of the patient. The Bells bought thousands of these patient packets, each time indirectly paying the telemedicine doctors through the "marketing" companies. The packets were referred to in the industry as "Doctor’s Orders" or "D.O.s." The Bells purchased the "D.O.s" for a variety of braces, paying the most (up to $350) for a back brace prescription, the type of medical equipment for which Medicare offered the highest reimbursement. The Bells could then, after shipping the brace to the patient, bill Medicare around $1,359.89 for each back brace, through their companies. The Bells also bought other braces, including wrist, knee, and shoulder braces, and billed Medicare at much higher prices than they paid for them. When Bell Jr. was interviewed by the FBI, he lied about his knowledge of the scheme. The case is being prosecuted by Assistant U.S. Attorneys Valerie H. Chu and Christopher M. Alexander of the Southern District of California ...
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A report by National Criminal Justice Association; claimed that Medicare recipients from around the U.S. have said that a company called Pretty in Pink charged their health insurance companies thousands of dollars for urinary catheters that they never ordered or received. Flooded by complaints, the Pretty in Pink Boutique in Franklin, Tenn., a provider of accessories for cancer patients, <a href="https://prettyinpinkboutique.com/how-to-report-insurance-fraud/" target="_blank" >launched a webpage in September to explain</a> that its leaders were dumbfounded. The boutique said another company with the same name was submitting the claims. The complaints are a piece of an alleged fraud scheme whose scale has little precedent in the history of Medicare, an estimated $2 billion, reports the Washington Post. The case involves fraudulent insurance claims submitted by seven companies to the taxpayer-funded health insurance program. Federal officials are investigating the allegedly fraudulent billing for catheters. the companies collectively went from billing just 14 patients for catheters to nearly 406,000. The National Association of ACOs (NAACOS) initially reported these findings to the federal government. The association's allegations came from a review of two billing codes for Medicare claims data from the Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center. They say urinary catheter payments to beneficiaries accounted for $153 million in 2021 before surging to $2.1 billion in 2023. Catheter spending by DMEs increased by 15.5% as false claims were filed around the country. In nearly all 50 states, catheter payment growth has skyrocketed. Over half of U.S. states saw an increase in Medicare fee-for-service DME catheter payments of 500% or more from 2022 to 2023. Yet the majority of payments can be attributed back to just seven companies - three companies in New York and one each in Texas, Florida, Connecticut and Kentucky - NAACOS reported. While the companies used real patients’ information to submit bills, NAACOS found no evidence that the patients wanted the catheters or even received them. "We’ve just never seen anything like this nationally," said Clif Gaus of NAACOS, whose members spotted and reported the billings to federal officials last fall. Gaus’s team estimates that Medicare was wrongly billed $2 billion for the catheters in 2022 and 2023. Urinary catheters were an appealing target for scammers because orders for the low-cost products - small tubes often made with latex or silicone - could escape scrutiny on billing for expensive equipment, surgeries and other high-cost claims. After alerting federal authorities, NAACOS felt they needed to push the envelope when the problem persisted. Last week, major news publications broke the story, though states had begun warning beneficiaries of potential fraud months earlier, and local news outlets had started to uncover elements of the scandal. Now, providers are worried about a broken insurance fraud reporting process and the impacts data breaches have on a national scale. And experts are concerned this could be just the tip of the iceberg.The Office of Inspector General (OIG) for the Department of Health and Human Services has not revealed whether there is an ongoing investigation, citing internal agency policy. NAACOS wants the OIG to pay closer attention to fraud reports it receives from ACOs, and it wants to work with CMS to improve the reporting process, a spokesperson said. Despite the troubles ACOs faced in this ordeal, the association says this is why ACOs are so valuable, as fraud detection is more identifiable. NAACOS is also pushing for improved communication between Medicare administrative contractors. Beyond that, it seeks more provider participation and advocates for extending the alternative payment model incentive. After public reports of a large-scale, year-long Medicare fraud scheme involving catheter billing, leaders from the Energy and Commerce, Ways and Means, and Oversight and Accountability committees, along with GOP Doctors Caucus Co-Chairs, announced on March 6 that they are seeking a briefing from Department of Health and Human Services (HHS) Inspector General (IG) Christi Grimm and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. At the time of their announcement, the estimated amount of the fraud in their headline was reported to be "$3 Billion." This estimate was explained by saying "Public reporting estimates the cost of fraud from this scheme to be at least $2 billion.However, discussions between committee staff and stakeholders suggest the dollar figure may be closer to $3 billion." In a new letter, the lawmakers request briefings from the HHS IG and CMS by March 20, 2024, regarding what steps are being taken to address this reported fraud and prevent its reoccurrence ...
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The Insurance Commissioner announced several appointments to the California Department of Insurance related boards and committees. These appointments include naming Ronald Coleman Baeza as the newest member of the California Life and Health Insurance Guarantee (CLHIGA) Board of Directors, Samantha Tradelius as the newest member of the Curriculum Board,reappointmed members Andrew Chick and Heather Pierce to the California Insurance Guarantee Association (CIGA) Board of Governors, reappointed member Debra Gore-Mann to the California Organized Investment Network (COIN) Advisory Board, reappointed members Linda Akutagawa, Imelda Alejandrino, Annalisa Barrett, and Cecil Plummer to the Insurance Diversity Task Force, and reappointed member Jeremy Smith to the California Workers’ Compensation Insurance Rating Bureau (WCIRB) Governing Committee. CLHIGA consists of all insurance companies licensed to sell life and health insurance, and annuities in California, and it protects certain policyholders against a company’s financial failure. The Board of Directors is responsible for the overall oversight of CLHIGA, which includes approving contracts and reinsurance treaties, authorizing assessments, borrowing money, taking legal actions, and serving on committees that oversee audit and investment functions. The Board consists of up to thirteen member insurers who are selected by the board members and are subject to the approval of the Commissioner.AB 1104 (Chapter 236, Statutes of 2019) added two additional members to the board who represent the public generally and are appointed directly by the Commissioner. The Curriculum Board oversees the development of pre-licensing and continuing education curriculum for agents and brokers to uphold professional standards that protect consumers. This includes a list of preapproved courses of study as well as courses of study for professional designations. This Board also develops standards for providers and instructors who offer courses and other training to licensed agents and brokers. The CIGA Board of Governors oversees the guarantee association’s general operations and management in order to protect policyholders in the event of an insurance company insolvency. Established in 1969 by the Governor and California State Legislature, CIGA comprises all insurance companies admitted to sell homeowners, workers’ compensation, automobile, and other specified property and casualty lines of insurance in California. The California Organized Investment Network (COIN) was established in 1996 within the Department of Insurance to guide insurers on making financially sound investments that yield environmental benefits throughout California and social benefits within the State’s underserved communities. Commissioner Lara has prioritized COIN investments which drive affordable housing, support small businesses, combat climate change, and encourage investors to utilize diverse investment managers more. The COIN Advisory Board provides guidance to the Commissioner and the COIN program to meet its mission and chief priorities. The Insurance Diversity Task Force oversees the Department’s Insurance Diversity Initiative, which encourages insurers to advance diversity of insurance company corporate boards and increase procurement contracts with diverse businesses owned by women, veterans and disabled veterans, members of historically disadvantaged communities, and LGBTQ+ people. Additionally, the Task Force makes recommendations to the Commissioner regarding innovative ways to increase diversity within the insurance industry. Last year, Commissioner Lara introduced the first-ever Insurance Diversity Index, a groundbreaking benchmarking tool for a more inclusive insurance industry. The WCIRB Governing Committee sets policy, oversees WCIRB management, and reviews all issues involving pure premium rates, classifications, rating plans, rating systems, manual rules and policy, and endorsement forms. The WCIRB is a private organization licensed by the Department for the purpose of collecting, analyzing, and compiling rating data, with funding coming from assessments of its insurance company members. All workers’ compensation insurance companies in California are required by law to be members of the WCIRB. The next CLHIGA Board of Directors meeting will be held on May 7, 2024, the next Curriculum Board meeting is July 18, 2024, the next CIGA Board of Governors meeting is May 7 and May 8, 2024, the next COIN Advisory Board meeting is March 14, 2024, the next Insurance Diversity Task Force meeting is March 7, 2024, and the next WCIRB Governing Committee meeting is April 17, 2024. More details are available at: www.insurance.ca.gov/boards. All positions are uncompensated ...
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The California Chamber of Commerce has published a reminder "Mandatory Pamphlet Updates for California Employers." All California employers are required to distribute six pamphlets to employees, and two of them - Unemployment Insurance (UI) and Workers’ Compensation Rights and Benefits - have mandatory updates for 2024. To fulfill their legal obligations, employers must make sure they’re giving the most current pamphlet versions to their employees. And remember, if you have Spanish-speaking employees, you’re required to provide the pamphlet in both English and Spanish. The first revised pamphlet ― the California Unemployment Insurance pamphlet - notifies employees of their right to unemployment insurance benefits when they are terminated, laid off or take a leave of absence. Employers must provide this information to any employee no later than the effective date of the termination. The UI pamphlet: - - Describes California’s UI benefits program; - - Contains information about what makes employees eligible or ineligible for unemployment benefits; - - Provides information on how to apply for UI benefits; and - - Fulfills your legal obligation to distribute UI information to all employees who become terminated, laid off or take a leave of absence (note: It is also a best practice to provide this pamphlet when an employee resigns). The latest Unemployment Insurance pamphlet (DE 2320 and DE 2320S) has "Rev. 67 (1/24)." Second is the Workers’ Compensation pamphlet, which informs of new employees of their rights and obligations regarding workers’ compensation. The Workers’ Compensation pamphlet describes: - - The California’s workers’ compensation benefits program, including the types of benefits available; - - How to predesignate a physician who will provide treatment for work-related injuries; - - What to do if there is a dispute; - - The penalties for making fraudulent claims; and - - What to do if the employee becomes injured at work. The current Workers’ Compensation pamphlet revision date is 2/1/24. CalChamber offers a California Required Pamphlets Kit - in both English and Spanish - which contains 20 each of the six required pamphlets. These six pamphlets can also be ordered separately in packs of 20: Paid Family Leave (PFL), Rights of Victims of Domestic Violence, Sexual Assault and Stalking, Sexual Harassment, State Disability Insurance (SDI), Unemployment Insurance and Workers’ Compensation. Keep in mind, PFL and SDI pamphlets had mandatory changes issued in June 2023 and July 2023, respectively, so make sure you are using the most updated version ...
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Tina Royer was a tenured English professor with the the Los Rios Community College District. For the previous thirteen years, she had worked at the Folsom Lake College campus, and during most of the relevant time period, she was the chair of the English department. Josh Fernandez was an English professor at Folsom Lake College. As department chair, Royer was Fernandez’s supervisor. Royer is Caucasian, Christian, married to a Christian minister, and active in her church, and her Christian background and conservative views are known to her colleagues at Folsom Lake College. Fernandez is Hispanic and is allegedly affiliated with Antifa. In the fall of 2018, Fernandez was up for tenure, and Royer was one of three members of his tenure review committee. During the tenure review process, all three committee members expressed concerns about Fernandez’s conduct on campus. All three members of the tenure review committee initially determined Fernandez did not meet the guidelines for granting tenure. Fernandez, however, had threatened to sue the District for attempting to curtail his activities on campus, and purportedly in response to his threat, Dean Snowden ultimately changed his mind about granting tenure. Royer claimed Dean Snowden and Folsom Lake College President Whitney Yamamura successfully pressured her to vote in favor of granting Fernandez tenure. Although Royer voted in favor of granting tenure, her evaluation included some "less than satisfactory" marks, and Fernandez received a copy of the evaluation. Shortly thereafter, a colleague told Royer that Fernandez was telling other department members he "hated" her "because he received a ‘less than satisfactory’ evaluation" from her. Around March 2019, Royer complained to the District about Fernandez’s conduct and the effect it was having on her physical and mental health, and she asked that his classroom be moved so it was not next to hers. The District declined to move Fernandez’s classroom, and offered to move her classroom instead, but she did not think she should have to move when she had done nothing wrong. She asked to work remotely in order to avoid interactions with Fernandez on campus. The District agreed Controversies escalated, and ultimately Royer sued her employer for six separate violations of the Fair Employment and Housing Act (Gov. Code, § 12900 et seq.) (FEHA) and for invasion of privacy. She claims a coworker subjected her to harassment because of her race and religion, and the District discriminated against her because of her race and religion, retaliated against her for complaining about harassment, failed to prevent harassment, and failed to reasonably accommodate her disability. She also claims that, after she filed a claim pursuant to the Government Claims Act (Gov. Code, § 810 et seq.), the District invaded her privacy by publishing the claim on its Web site without redacting her home address and confidential information about her disability. The District responded to the lawsuit by filing a special motion to strike pursuant to Code of Civil Procedure section 425.16 (the anti-SLAPP statute). The District’s motion was directed at the entirety of the causes of action for harassment and invasion of privacy, and portions of the causes of action for discrimination, retaliation, and failure to prevent harassment. The trial court granted the motion as to the discrimination cause of action and denied it as to the other causes of action. The District appealed, and the Court of Appeal reversed in part and affirmed in part, and remanded the case in the unpublished case of Royer v. Los Rios Community College District -C096484 (March 2024). The District challenges the trial court’s finding that the invasion of privacy claim does not arise out of protected activity under the anti-SLAPP statutes.However when the board met to consider and act on Royer’s claim submitted pursuant to the Government Claims Act, that meeting was an official proceeding authorized by law within the meaning of the anti-SLAPP statute. Royer argues she "is not suing [the District] for publishing her tort claim," but instead is suing "because [it] published her tort claim in full without redacting her confidential information." The trial court appears to have agreed, because it found, "the gravamen of [Royer’s] claim is not the publication of the Tort Claim itself, but the inclusion of her private medical and identifying information unnecessarily." However the trial court thus should have proceeded to the second step and determined whether Royer met her burden of establishing a probability of prevailing. The order denying the anti-SLAPP motion was reversed as to Royer’s first cause of action for harassment because she did not establish a probability of prevailing on that cause of action. The order denying the anti-SLAPP motion as to Royer’s seventh cause of action for invasion of privacy is also reversed because the trial court erred in finding it did not arise out of protected activity, and we remand this case to the trial court to determine whether Royer established a probability of prevailing on the invasion of privacy cause of action ...
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Since 1911, the American Society of Safety Professionals has helped occupational safety and health professionals protect people, property and the environment. The nonprofit society is based in Chicago’s suburbs. Its global membership of over 35,000 professionals develops safety and health management systems that prevent injuries, illnesses and fatalities. ASSP has published the first national voluntary consensus standard addressing heat stress for workers in construction and demolition operations. Hundreds of thousands of workers frequently face outdoor hazards such as high heat and humidity. "This new industry consensus standard is an important development because there is no federal regulation focused on heat stress," said ASSP President Jim Thornton, CSP, CIH, FASSP, FAIHA. "Employers need expert guidance on how to manage heat-related risks. They must have the tools and resources to identify and help prevent work hazards before an incident occurs." ANSI/ASSP A10.50-2024, Heat Stress Management in Construction and Demolition Operations, offers guidance on protecting workers; explains how to acclimate workers to high heat conditions; and provides requirements for training employees and supervisors. The standard contains checklists and flowcharts designed to help companies develop clear and effective heat stress management programs that bridge the regulatory gap. "There are tens of thousands of heat-related illnesses each year linked to construction and demolition sites, and workers have died from exposures to excessive heat," said John Johnson, CSP, chair of the ANSI/ASSP A10 standards committee. "This new standard outlines industry best practices and proven solutions to protect workers who commonly do strenuous jobs in challenging conditions." The A10.50 standard identifies engineering and administrative controls a company can implement to ensure that workers get proper rest, water breaks and shade while still meeting business needs. Recommendations such as medical monitoring and using a buddy system can reduce risks and help prevent heat-related illnesses in many work environments. While the scope of the standard focuses on construction and demolitions, the guidance can be adapted to protect workers performing other outdoor jobs such as tree trimming, farming, road maintenance and pipeline painting. The impacts of heat stress can range from mild symptoms such as heat rash and heat cramps to severe conditions including heat exhaustion and heat stroke, which can be fatal. According to the U.S. Bureau of Labor Statistics, more than 400 work-related deaths have been caused by environmental heat exposure since 2011. The standard includes a detailed emergency response plan if a worker has a severe reaction to excessive heat. The A10.50 subcommittee that wrote the standard consisted of 30 safety and health experts from businesses, trade unions, consulting firms, universities and government agencies. The inclusive process took three years. Voluntary consensus standards provide the latest expert guidance and fill gaps where federal standards don’t exist. Companies rely on them to drive improvement, injury prevention and sustainability. With government regulations being slow to change and often out of date, federal compliance is not sufficient to protect workers. ASSP leads the development of voluntary consensus standards for the workplace. In its last fiscal year, ASSP created, reaffirmed or revised 15 standards, technical reports and guidance documents, engaging 1,400 safety experts who represented 500 organizations. The Society also distributed more than 14,000 copies of standards. The organization encourages companies to join ASSP in spreading awareness of heat-related hazards on National Heat Awareness Day on May 31 and during Extreme Heat Awareness Month in July ...
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A former Antelope Valley physician was sentenced to 37 months in federal prison for illegally dispensing prescriptions for often-abused controlled substances - including opioid-based medications - during telemedicine sessions with "patients" from across the United States. Raphael Tomas Malikian, 39, who resides in Llano and Palmdale, was sentenced also ordered to pay a fine of $20,000. Malikian pleaded guilty in October 2023 to one count of aiding and abetting the acquisition of a controlled substance by fraud and one count of distribution of oxycodone. The Medical Board of California suspended Malikian’s medical license in November 2021. His license expired in November 2022. From at least December 2019 to August 2021, Malikian was a licensed physician in California and, in this role, was authorized by the Drug Enforcement Administration (DEA) to prescribe medication. Malikian also owned and operated Happy Family Medicine, a medical clinic that was advertised as being in a co-working space in the Hollywood, but primarily offered telehealth services via telephone or text message communications. Malikian issued prescriptions for controlled substances to customers without first obtaining the person’s full medical history, conducting a physical examination, requiring medical testing, or utilizing diagnostic tools. Malikian did not verify his customers’ identities before prescribing controlled substances, and he allowed customers to obtain prescriptions in the names of others. He also worked with two co-conspirators, who provided Malikian with false names, addresses, dates of birth, and Malikian issued controlled substance prescriptions accordingly, which the co-conspirators then filled and re-sold on the black market. Many of Malikian’s fraudulent controlled substance prescriptions contained notes on the prescriptions or accompanying documentation that falsely urged pharmacies not to verify such prescriptions because medications were urgently needed and the failure to dispense could be life threatening because of the COVID-19 pandemic. Malikian issued hundreds of false prescriptions for liquid promethazine with codeine during this period - including to people he knew were fictitious patients and which totaled more than 82 liters - and directed them to be sent to various pharmacies across the nation for co-conspirators to obtain. From April to July of 2020, Malikian prescribed to a buyer 702 pills of 10 milligrams oxycodone and 240 milliliters of promethazine with codeine. The customer, in fact, was an undercover law enforcement officer. Malikian issued each prescription to this buyer without conducting proper medical evaluations or verifying the buyer’s identity and was performed outside the scope of professional practice and without a legitimate medical purpose. In addition, from May to July of 2020, Malikian prescribed to a customer - who also was an undercover law enforcement officer - 234 pills of the painkiller Norco, which contained a total of 2,340 milligrams of the opioid hydrocodone, and 180 pills of alprazolam, an anxiety medication sold under the brand name Xanax. Once again, Malikian issued each prescription to this buyer without conducting proper medical evaluations or verifying the buyer’s identity and was performed outside the scope of professional practice and without a legitimate medical purpose. The DEA investigated this matter. The California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse provided substantial assistance.. Assistant United States Attorney Brittney M. Harris of the International Narcotics, Money Laundering, and Racketeering Section prosecuted this case ...
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A new California Workers’ Compensation Institute (CWCI) study shows that almost half of all litigated claims in the LA Basin are cumulative trauma (CT) claims that involve physical or mental injuries that arise over time from repetitive stress, motion, or exposures, rather than from a specific event or accident. The CWCI study, based on a sample of 1.4 million California work injury claims with 2010 to 2022 carrier notice dates, examines the growth of CT claims as a share of litigated claims in the California workers’ compensation system and explores the claim characteristics most associated with CT claims. The study found that statewide, CT claims increased from 29.4% to 37.5% of all litigated claims over the 13-year study period. Regional results showed that over that same period, CT claims’ share of all litigated claims was fairly stable in Northern California and the Central Valley, but increased in 2022, while in Southern California CT claims’ share of the litigated claims increased steadily throughout the period. The sharpest increase was in the Inland Empire/Orange County, where CT claims jumped from 30.2% of the litigated claims in 2010 to 40.6% in 2022, slightly more than the increase in Los Angeles County, where CT claims went from 38.6% to 48.7% of the litigated claims, and San Diego where CT claims increased from 25.0% of the litigated claims to 33.4%. A regression analysis, which controls for the influence of other variables, showed that the differences between the regions were only partially explained by differences in other underlying claim characteristics. Other key findings include: - - Other than regional factors, differences in tenure had the strongest impact on differential CT rates. Employees with less than a year of tenure at the time of injury had a much lower CT rate (26.0%) than more tenured workers, as CT rates increased incrementally as tenure increased, climbing as high as 49.0% among workers with more than 10 years on the job. - - A review of the CT rates across nine major industry sectors showed that CT claims were most prevalent in the manufacturing sector, where they accounted for nearly half (48.8%) of the litigated claims, which was almost twice the proportion noted in the construction sector. The food service sector had the second highest CT rate, with 46.9% of the claims in this sector involving CT injuries, while the agriculture sector had the lowest CT rate (24.2%). Regression results showed that while the type of industry influences CT rates, for most sectors other factors such as region and job tenure play a comparable role. - - Workers under the age of 30 had a somewhat lower CT rate (28.3%) than workers who are over 30, whose CT rates ranged from 35.1% to 38.8%, though more than a third of all CT claims in the study involved injured workers who were under 40. Regression analysis showed that age is not a strong predictor of CT rates compared to other factors. - - CT rates were considerably higher for workers at the lower end of the wage scale, with CT rates of 40.0% for workers making less than $300 per week and 42.1% for those earning $300 to $599 per week. In contrast, workers making more than $900 per week all had similar CT rates, with CT claims representing between 30.0% and 31.7% of their litigated claims. As with age, regression analysis showed that the employee’s average weekly wage is not a strong predictor of CT rates compared to other factors. CWCI’s analysis of CT claims has been published in a Research Note, Cumulative Trauma and Litigated Claims in the California Workers’ Compensation System. The report is available to the public here, and is available to CWCI members and research subscribers who log in to the Research section of the website ...
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In February 2021, a strategically coordinated, six-week nationwide federal law enforcement action announced it has resulted in criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States for their alleged participation in various health care fraud schemes that resulted in approximately $1.4 billion in alleged losses. Two of these 138 defendants were prosecuted in the U.S. District Court for the Southern District of California. Charles Ronald Green Jr. and his wife, Melinda Elizabeth Green, were sentenced to 27 months each for fraudulently billing government healthcare programs more than $125 million for medically unnecessary treatments. According to court filings, the Greens engaged in a scheme to defraud two major federal health care programs: TRICARE, the medical benefits program for military servicemembers and their families, and Medicare, the program that provides benefits to elderly or disabled Americans. Chief U.S. District Judge Dana M. Sabraw also ordered $4.5 million in restitution to TRICARE and $69,915,909.69 to Medicare. Between May 12, 2014, and June 29, 2015, the Greens conspired to submit false and fraudulent claims to TRICARE for expensive and medically unnecessary pain creams, scar creams and multi-vitamins, which were billed through various pharmacies. During this period, the Greens owned or were officers of several companies they used in furtherance of their scheme. The pharmacies paid these companies millions of dollars in illegal kickbacks and other remuneration in exchange for the referral of the false and fraudulent prescriptions for compounded medications to TRICARE beneficiaries. In turn, the Greens and others paid a portion of their profits as kickbacks to so-called "marketing" organizations in exchange for more prescriptions for compounded medications. TRICARE and other payers often reimbursed compounding pharmacies thousands of dollars for a 30-day supply of a compounded pain or scar cream for one beneficiary. In just one example, on May 8, 2015, a false and fraudulent claim was submitted to TRICARE in the amount of $14,178 for Baclofen Powder. In furtherance of the compounding fraud scheme, the Greens and others developed compounded medication formulations for the primary purpose of inflating the amount of money TRICARE would reimburse, and to correspondingly increase the amount of kickbacks and remuneration that affiliated marketers would receive. The Greens’ knowing participation in the compounding fraud scheme resulted in the submission of false and fraudulent claims by one pharmacy in the approximate amount of $8,107,816, of which TRICARE paid at least $6,776,222. Between June 1, 2018, and April 2019, the Greens also conspired to defraud Medicare by submitting false and fraudulent claims for expensive durable medical equipment, or "DME," similarly induced through a system of illegal kickbacks. The Greens and others executed the DME fraud scheme by purchasing "completed doctors’ orders" from various "marketers" for Medicare beneficiaries, which included a prescription signed by a doctor certifying the beneficiary received an exam that met Medicare’s requirements and that the DME was medically necessary. In an attempt to disguise the DME fraud scheme from detection, the Greens and their co-conspirators entered into sham "marketing" and other contracts that concealed the pay-per-order arrangement. For example, on March 14, 2019, Charles Ronald Green prepared and submitted an invoice from the Greens’ company, NHS Pharma, concealing that NHS Pharma was being paid a per-brace kickback for selling completed doctors’ orders, but claimed instead to be charging for a $35,000 "TV Campaign," a quantity of 716 website "Landing Pages," and $6,928.71 for processing hours. In addition to purchasing doctors’ orders in furtherance of making false and fraudulent claims on behalf of DME companies they owned or controlled, in some instances the Greens brokered the doctors’ orders by re-selling them at a markup to other DME companies. The Court set a hearing for May 24, 2024, to resolve additional claims for restitution ...
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CEO Magazine has published it's annual Best & Worst States survey of CEOs this year. Broadly speaking, the trends dictating how states are performing as economic actors these days extend beyond CEO opinion to include foreign companies' increasing embrace of the U.S. market; reshoring and a renaissance in domestic manufacturing; the leveraging of state coffers flush from recent federal largess through tax cuts and other means; the rising value of experienced labor along with the expansion of automation; and the pandemic-era migration from city cores to exurbs and beyond. Texas again places No. 1 this year, as it has annually in the survey since its inception. Florida ranked No. 2 again, extending its own string but also putting unprecedented pressure on Texas for the top spot. Tennessee once again is ranked No. 3 in state business climate by CEOs. North Carolina, at No. 4, and No. 5 Arizona flipped spots this year. No. 6 Indiana is a mainstay as well. Just as CEOs have solidified opinions about the welcoming top states, their assessment of the worst has ossified: No. 47 New Jersey, No. 48 Illinois, No. 49 New York and No. 50 California remain the same as in the 2022 survey. Tech layoffs amounted to an estimated 333,000 just since last year, according to a new study by Boston Consulting Group. California workers certainly have suffered the most. But in between, there are some significant advances in this year’s ranking, especially the rise of Georgia and South Carolina, each up four spots to No. 7 and No. 8 in the Chief Executive list. They’ve joined Florida in the broad advance of the Southeast, especially as a new manufacturing hub. In another related study of small business sentiment, the Freedom Economy Index surveyed a universe of over 80,000 small business owners throughout the United States, fielding the questionnaire from February 6 to 9, 2024, with 840 respondents. The survey has a margin of error of +/-3.0% at the 95% confidence level. The survey compared the individual results for California and Florida, and also Red States and Blue States nationwide. The stark contrasts leave little doubt where small businesses thrive. Only 13% of small businesses in California are happy with their location, which is nearly 40% lower than the national average, according to the February survey of 80,000 small business owners nationwide, a joint project of PublicSquare and RedBalloon. Nationwide, half of respondents say they are happy with their current location and don’t plan on moving. In California, 13% say they are happy in their location, and 67% are either planning a move (10%), considering a move (30%) or they are feeling trapped, wanting to move but can’t afford it (27%). Respondents were asked to identify which factors make them want to relocate, with the ability to choose multiple items, 64.5% of employers list high tax rates, and 59.4% blame anti-business government policies. Again, looking just at California, the Golden State is struggling, as 86.4% say high taxes are driving them away, and 84.9% say the anti-business government is also to blame. But the weather is nice" ...
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The EEO-1 Component 1 report is a mandatory annual data collection that requires all private sector employers with 100 or more employees, and federal contractors with 50 or more employees meeting certain criteria, to submit demographic workforce data to the EEOC. As announced this week,the 2023 EEO-1 Component 1 data collection will open on Tuesday, April 30, 2024. The deadline to file the 2023 EEO-1 Component 1 report is Tuesday, June 4, 2024. The EEOC’s EEO-1 Component 1 online Filer Support Message Center (i.e., filer help desk) will also be available on Tuesday, April 30, 2024, to assist filers with any questions they may have regarding the 2023 collection. All updates about the 2023 EEO-1 Component 1 data collection, including the 2023 EEO-1 Component 1 Instruction Booklet and the 2023 EEO-1 Component 1 Data File Upload Specifications, will be posted to www.eeocdata.org/eeo1 as they become available. The EEOC anticipates posting the 2023 EEO-1 Component 1 Instruction Booklet and the 2023 Data File Upload Specifications by Tuesday, March 19, 2024. Traditionally, EEO-1 reports require employers to pick a payroll end date between October 1, 2023, and December 31, 2023, as your "workforce snapshot period." This which will become the basis of reporting all employees as of that date. New for this reporting cycle, the EEOC has said that you will need to file an EEO-1 report if you reached 100 or more employees during any point of the fourth quarter of 2023. The EEO job categories are: (1.1) Executive/Senior-level officials and managers (1.2) First/Mid-level officials and managers (2) Professionals (3) Technicians (4) Sales workers (5) Administrative support workers (6) Craft workers (7) Operatives (8) Laborers and helpers (9) Service workers Employees must be given an opportunity to self-identify their sex and race/ethnicity, and be provided a statement about the voluntary nature of the inquiry. The race/ethnicity categories are unchanged: - - Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. - - White (Not Hispanic or Latino):A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. - - Black or African American (Not Hispanic or Latino):A person having origins in any of the black racial groups of Africa. - - Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino):A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. - - Asian (Not Hispanic or Latino):A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. - - American Indian or Alaska Native (Not Hispanic or Latino):A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. - - Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races. The EEO-1 reporting system has slowed down significantly as the deadline approached, which makes filing more challenging. Employers might want to allow yourself sufficient time before the deadline so you aren’t scrambling at the last minute with technical challenges. Typically, the EEOC does not provide for extensions. It would be beneficial to file well before the June 4, 2024 deadline. The EEOC has recently made significant updates to the EEO-1 Report. The changes include revised nomenclature for report types, guidelines for remote employees, and the inclusion of non-binary employees. The report now also requires the use of Unique Entity IDs (UEI) for federal contractors instead of DUNS numbers. Employers need to stay updated with these changes and ensure their reporting is in line with the latest guidelines. Employers are encouraged to actively stay informed about EEO-1 reporting updates and reach out to legal counsel for guidance and support in ensuring your compliance with the 2024 requirements ...
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The California Medical Board supervises the medical profession in California by issuing licenses, reviewing the quality of medical practice carried out by physicians and surgeons, approving medical- evaluation programs, and administering the continuing- medical-education program. As part of this responsibility, the Medical Board has a duty to "take action against any licensee who is charged with unprofessional conduct," which includes gross negligence, repeated negligent acts, incompetence, dishonesty, and corruption. California’s Business and Professions Code identifies a wide array of activities that the California legislature has determined constitute unprofessional conduct and can lead to professional discipline. Frustrated by what it saw as an "amplification of misinformation and disinformation related to the COVID-19 pandemic" by licensed medical providers who hold a high degree of public trust, the California Medical Association sponsored a bill aimed at ensuring medical professionals were "held accountable for the information they spread." In the Fall of 2022, after some revisions narrowing its scope, the legislature passed, and Governor Newsom signed into law, AB 2098. As codified, the law provided, in relevant part: (a) It shall constitute unprofessional conduct for a physician and surgeon to disseminate misinformation or disinformation related to COVID-19, including false or misleading information regarding the nature and risks of the virus, its prevention and treatment; and the development, safety, and effectiveness of COVID-19 vaccines. In his signing statement, Newsom acknowledged that he was "concerned about the chilling effect" of legislating doctor-patient conversations. Nontheless he signed the law because it was "narrowly tailored to apply only to those egregious instances in which a licensee is acting with malicious intent or clearly deviating from the required standard of care while interacting directly with a patient under their care." The Liberty Justice Center filed McDonald v. Lawson in the U.S. District Court for the Central District of California, in October 2022 to challenge AB2098. The district court denied a preliminary injunction, holding that AB 2098 was neither an unconstitutional restraint on speech nor impermissibly vague. Drs. McDonald and Barke timely appealed. In Couris v. Lawson, No. 22-55069, Michael Couris, M.D. and Michael Fitzgibbons, M.D. separately sued various California officials and also sought an injunction, but the district court stayed their case pending the 9th Circuit Court of Appeals decision in McDonald. Drs. Couris and Fitzgibbons timely appealed, and the Court of Appeals consolidated the two appeals. In September 2023, the California Legislature passed Senate Bill 815, enacted as 2023 Cal. Stat., ch. 294 (SB 815), which repealed AB 2098. Governor Newsom signed SB 815 on September 30, 2023, and it took effect on January 1, 2024. The 9th Circuit Court of Appeals requested supplemental briefing from the parties on the impact of SB 815 on this consolidated appeal. Relevant here, a "repeal, amendment, or expiration of legislation" gives rise to "a presumption that the action is moot, unless there is a reasonable expectation that the legislative body is likely to enact the same or substantially similar legislation in the future." Bd. of Trs. of Glazing Health & Welfare Tr. v. Chambers, 941 F.3d 1195, 1197 (9th Cir. 2019) (en banc). While a private party’s voluntary cessation of challenged conduct "ordinarily does not suffice to moot a case" because the defendant may be "free to return to his old ways" and resume the conduct, see Friends of the Earth, Inc. v. Laidlaw Env't Servs. (TOC), Inc., 528 U.S. 167, 174, 189 (2000) (citation omitted), the voluntary cessation of challenged conduct by government officials ‘must be treated with more solicitude. Plaintiffs argue that this appeal is not moot because they face the possibility of being disciplined for violations that occurred while AB 2098 was in effect. If true, this could defeat a finding of mootness. As part of California’s response addressing the impact of SB 815, the Executive Director of the Medical Board stated under penalty of perjury that, due to the legislative repeal, the Medical Board’s "employees and agents, including investigators . . . have been instructed not to enforce [AB 2098]" through the repeal effective date and that after AB 2098 is no longer in effect, "the Medical Board will have no legal authority to enforce [AB 2098]." The Executive Director’s sworn statement was made in the context of litigation, and, consequently, the Medical Board may be judicially estopped from assuming a contradictory position on enforcement or pursuing legal action against Plaintiffs at a later date. Thus the 9th Circuit Court of Appeals vacated the judgments and remanded both cases with instructions to dismiss the cases as moot in the published case of McDonald et. al. v. Lawson et. al. -22-56220 (February, 2024) ...
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The Division of Workers’ Compensation (DWC) now offers free online educational courses for the workers’ compensation community, including medical providers, claims administrators, case managers, attorneys and HR managers. The training modules consistent of educational tools on the use of the Medical Treatment Utilization Schedule (MTUS), tips for Qualified Medical Evaluators (QMEs), and Medical Legal Report Writing. All three courses qualify for free education credit for Continuing Medical Education (CME) and QME. Additionally, the training modules for QME and MTUS also qualify for continuing educational credit for MCLE (California State Bar), SHRM (Society for HR Management), CRCC (Commission on Rehabilitation Counselor), CDMS (Certified Disability Management Specialist), IEA (Insurance Education Association), and CCMC (Commission for Case Manager Certification). These courses taken together can earn up to 5.5 hours of educational credits. The Medical Treatment Utilization Scheduled (MTUS) course covers the required use of the MTUS in the California Workers’ Compensation system. The course explains how to access and use the MTUS for the care of injured workers, and how to apply the MTUS to report writing. The course also describes the structure, scope, and application of the MTUS Drug-Formulary. The Qualified Medical Evaluator module discusses requirements of the QME process and goes into depth regarding apportionment and bias in reporting. This course describes how to prepare for a QME evaluation, how to identify key components of a medical-legal report, and discusses the requirements of substantial medical evidence. The Medical Legal Report Writing course offers a comprehensive outline of the essential components of a medical-legal report, identifies key concepts and terminology and includes the option to create a medical-legal report using a fillable outline. Please visit the DWC website to learn more about these valuable training options ...
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On November 25, 2020, Dana Hohenshelt filed a complaint against his former employer Golden State Foods Corp.. She alleged four causes of action: retaliation under the California Fair Employment and Housing Act (FEHA); failure to prevent retaliation under FEHA; violation of Labor Code section 226, subdivision (c), failure to timely provide copies of wage statements; and violation of Labor Code section 1198.5, subdivision (b), failure to timely provide copies of personnel records. Golden State moved to compel arbitration according to the parties’ arbitration agreement. On April 1, 2021, the trial court granted the motion and stayed court proceedings pending binding arbitration. On August 3, 2021, arbitration commenced via Judicial Arbitration and Mediation Services (JAMS). An arbitrator was appointed on August 16, 2021. Per the arbitrator’s fee schedule, "All fees are due and payable in advance of services rendered." On July 29, 2022 JAMS sent an invoice to Golden State for $32,300. On August 29, 2022, JAMS sent another invoice for $11,760. Both invoices were due to be paid within 30 days of their respective due dates; both invoices provide that payment is "due upon receipt." On September 30, 2022, JAMS sent a letter stating: "Pursuant to our fee and cancellation policy, all fees must be paid in full by October 28, 2022, or your [arbitration] hearing may be subject to cancellation." Later that same day, on September 30, 2022, Hohenshelt notified JAMS and the court that because Golden State did not pay within 30 days of the due date, he was "unilaterally elect[ing]" to withdraw his claims from arbitration and to proceed in court pursuant to Code of Civil Procedure section 1281.98, subdivision (b)(1). On October 5, 2022, Golden State confirmed via email to Hohenshelt that "all outstanding fees have been paid in full." On October 6, 2022, Hohenshelt filed a motion to lift the litigation stay pending arbitration. On February 2, 2023, the court denied the motion. It deemed Golden State’s payment timely based on the September 30, 2022 letter providing a new due date of October 28, 2022 for payment. The court held that "the arbitrator seemingly set a new due date of October 28, 2022." The Court of Appeal granted Hohenshelt's petition for writ of mandate and directed the trial court to vacate its order denying the motion to lift the stay of litigation and to enter an order lifting the stay in the published case of Hohenshelt v. Superior Court -B327524 (February 2024). "The trial court’s ruling was inconsistent with statutory mandate as well as recent appellate opinions. First, the trial court’s ruling ignored the clear language of Code of Civil Procedure.section 1281.98, subdivision (a)(2), which expressly provides that "[a]ny extension of time for the due date shall be agreed upon by all parties." Here, there is no evidence that Hohenshelt agreed to any extension. Secondly, the Second District Court of Appeal dealt with this exact same situation in Cvejic v. Skyview Capital, LLC (2023) 92 Cal.App.5th 1073. As did their colleagues in Gallo v. Wood Ranch USA, Inc. (2022) 81 Cal.App.5th 621. "The same logic applies in the case before us. Golden State’s arbitration fees were due to be paid within 30 days of the two invoices." Payment was not paid on time. "Section 1281.98 entitled Hohenshelt to withdraw from the arbitration. Section 1281.98 does not allow for any extension of time for the due date absent an agreement 'by all parties.' " Golden State argues for the first time via its supplemental brief that section 1281.98 is preempted by the Federal Arbitration Act (FAA) (9 U.S.C. § 1 et seq.) and that the Court of Appeal should uphold the trial court’s order to allow the parties to return to arbitration. "The question of whether section 1281.98, as well as sections 1281.97 and 1281.99, are preempted by the FAA was addressed and answered in Gallo and followed thereafter by other courts. (See Suarez v. Superior Court (2024) 99 Cal.App.5th 32, 41-42; Espinoza v. Superior Court (2022) 83 Cal.App.5th 761, 783-784; De Leon v. Juanita’s Foods (2022) 85 Cal.App.5th 740, 753-754.)" However, on this last point, Justice John Shepard Wiley Jr. wrote a dissenting opinion which began by noting "What preempts this statute is the decision to make arbitration the hostage of delay." "Delaying contract performance in bad faith is an odious tactic. Employers pursuing this tactic may deserve sanction. But sanctions like damages, a statutory fine of a motivating magnitude, and attorney fees would amply deter delay. Why abolish the arbitration itself?" "One answer is that California state law disagrees, strongly and persistently, with federal law about whether arbitration is desirable." "By again putting arbitration on the chopping block, this statute invites a seventh reprimand from the Supreme Court of the United States." "Recall the past six. Over and over again, with determined but unavailing persistence, the Supreme Court of the United States has rebuked California state law that continues to find new ways to disfavor arbitration." ...
/ 2024 News, Daily News
With medical benefits representing the single largest cost component for many state workers’ compensation systems, the Workers Compensation Research Institute (WCRI) released a new study today that provides a basic understanding of the cost containment strategies used in all 50 states and 3 federal workers’ compensation programs as of January 1, 2024. The study, Workers’ Compensation Medical Cost Containment: A National Inventory, 2024, includes tables of statutory provisions, administrative rules, and processes used by states, which come from surveys completed by state and federal administrators. One of the most popular tables compares fee schedule allowances for eight of the most common medical procedures (e.g., knee arthroscopy, lumbar surgery) in states that regulate fees. New to the report are more details about fee regulations for paying hospitals and ambulatory surgical centers. The following are among the regulations that the study tracks: - - ;Professional and facility fee regulations covering different providers - - Limitation of some types of medical services - - Choice of initial treating provider and change of provider regulations - - Regulations covering managed care and use of treatment guidelines - - Rules covering timely payments to providers, fines, and dispute resolution "Medical cost containment strategies fall into the categories of price management and utilization management - with a goal of either curbing the cost of a particular service or reducing the number of services provided," said Ramona Tanabe, president and CEO of WCRI. "Cost containment regulatory initiatives usually entail a balancing act of limiting the cost of services and inappropriate or unnecessary treatment without negatively affecting the quality of treatment or access to care for workers." The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand. For more information on this study or to download a copy, visit the WCRI website. Karen Rothkin is the author of the study ...
/ 2024 News, Daily News