Kay Marie Gibbs worked as a court reporter for the Humboldt County Superior Court for nearly 40 years, starting in June 1982. She became eligible for enrollment in the California Public Employees' Retirement System (CalPERS) in December 1983, but the county did not enroll her until November 1989 — a gap of roughly six years. When Gibbs began preparing for retirement in 2019, she discovered she would not receive CalPERS service credit for those early years. CalPERS told her it could not adjust her benefits without a certification from the county of her full employment history. What followed was a prolonged and fruitless effort to get the county to produce those records. Gibbs alleged that three individual employees in the county's human resources department lost, destroyed, or failed to search for the requested records. After repeated promises, the county eventually sent CalPERS an incomplete compilation that was missing records for multiple periods spanning from 1982 to 1989. Gibbs attempted to mitigate the damage by purchasing "prior service credit," but she could not do so without the county's certification of her employment history. She alleged she was forced to delay retirement and stood to lose hundreds of thousands of dollars in benefits. Gibbs filed suit asserting four causes of action under Government Code section 815.6, each based on the county's alleged failure to discharge a mandatory statutory duty — specifically, duties to maintain CalPERS-related records, allow inspection of personnel records, timely enroll her in CalPERS, and properly maintain employment information. She also asserted a fifth cause of action for negligence against all defendants. The trial court sustained the county's demurrers to all four statutory causes of action without leave to amend. It allowed Gibbs to amend only the negligence claim. She filed a second amended complaint focused on negligence, but the court sustained the demurrer to that claim as well, concluding that no statutory authority supported the duties Gibbs alleged. The court suggested that "a simple mandamus will suffice" if Gibbs wanted to review withheld records. The First District Court of Appeal largely reversed in the partially published case of Gibbs v. County of Humboldt et al., -A173637 (May 2026). It found the trial court's result "untenable" — that Gibbs, who alleged the county failed to enroll her in CalPERS through no fault of her own, was left without a claim because the county also lost her records through no fault of hers. The court reversed on three of Gibbs's causes of action. It affirmed on only one — the fourth cause of action under Government Code sections 26205 and 26205.1, which the court found authorizes destruction of certain records rather than mandating their retention. On the personnel records claim, the court held that Government Code section 31011 and Labor Code section 1198.5 impose mandatory, nondiscretionary duties on public employers to let employees inspect their personnel records and to maintain those records for at least three years after employment ends. The court rejected the county's argument that the Trial Court Employment Protection and Governance Act (TCEPGA), which transferred court employees from county to court employment effective January 1, 2004, extinguished its obligations. Gibbs was never terminated — she continued the same work — and the Public Employees’ Retirement Law (PERL), Government Code § 20000 et seq., itself, provides that a contracting agency's obligations "continue through the memberships of the respective members." (Gov. Code, § 20164, subd. (a).) The court was guided by Thornburg v. El Centro Regional Medical Center (2006) 143 Cal.App.4th 198, which found a private right of action under similar record-inspection statutes. On the failure to enroll claim, the court held that the PERL imposes a mandatory duty on contracting agencies to timely enroll employees in CalPERS, pointing to sections 20283, 20502, 20281, and 20028. The Supreme Court had already recognized a "duty to enroll employees in CalPERS" in Metropolitan Water Dist. v. Superior Court (2004) 32 Cal.4th 491, 506. Reading the enrollment obligation as discretionary, the court said, would render the statutes' benefits "illusory," citing Henderson v. Newport-Mesa Unified School Dist. (2013) 214 Cal.App.4th 478, 494–495. On the negligence claim, in the unpublished portion of the opinion, the court concluded that Gibbs stated a viable claim against the individual defendants for breaching their duties of care, and the county could be held vicariously liable under Government Code section 815.2. The court rejected the defendants' invocations of discretionary-act immunity (§ 820.2) and the economic loss rule, finding neither applicable. The court also rejected the argument that mandamus was Gibbs's exclusive remedy, distinguishing Crumpler v. Board of Administration (1973) 32 Cal.App.3d 567 and Metropolitan, neither of which held that a writ is the only available path when an employee was wrongfully denied CalPERS enrollment ...

A study published in the journal Science by Stanford Medicine researchers has demonstrated something the orthopedic world has been chasing for decades: the ability to regrow cartilage that has been lost to aging or injury, using a simple injection rather than surgery. If the approach translates from the laboratory to clinical practice — and early signs suggest it may — the implications for workers' compensation claims involving knee and hip injuries would be profound. Osteoarthritis is the single most common joint disease in the United States, affecting roughly one in five adults. It occurs when the cartilage that cushions joints wears away, leading to pain, stiffness, and progressive loss of function. There is currently no drug that can slow or reverse the disease. Every treatment available today — anti-inflammatory medications, corticosteroid injections, physical therapy, viscosupplementation — manages symptoms. When those fail, the endpoint is surgical joint replacement. More than one million Americans undergo knee or hip replacement surgery each year, and workplace injuries are a significant driver of the demand. Workers who sustain knee injuries — meniscus tears, ligament damage, repetitive stress injuries — are at elevated risk for developing osteoarthritis in the affected joint. Roughly half of all people who suffer an ACL tear develop osteoarthritis within 10 to 20 years of the injury, even after successful surgical repair. For workers' compensation, that means an acute knee injury claim can evolve into a decades-long medical management case culminating in joint replacement. The Stanford research offers the first realistic prospect of breaking that cycle. The research team, led by Drs. Helen Blau and Nidhi Bhutani, focused on a protein called 15-PGDH — classified as a "gerozyme," an enzyme whose levels increase as the body ages and which drives the gradual loss of tissue function. Higher levels of 15-PGDH are linked to declining muscle strength, reduced bone repair, and diminished nerve regeneration in older animals. The Stanford team hypothesized that the same protein might be responsible for the cartilage loss that underlies osteoarthritis. They were right. In aged mice, knee cartilage that had naturally thinned and deteriorated — the animal equivalent of age-related osteoarthritis — thickened and regenerated after the mice received injections of a small-molecule drug that blocks 15-PGDH activity. The treated cartilage closely resembled the cartilage of young, healthy animals. The researchers then tested whether the treatment could prevent arthritis after a traumatic injury. They induced ACL-like knee injuries in young mice — the kind of injury that reliably leads to osteoarthritis in both mice and humans — and administered the 15-PGDH inhibitor. Untreated mice developed arthritis within four weeks. Treated mice did not. They avoided cartilage breakdown, moved more normally, and placed more weight on the injured limb. Critically, the treatment also worked in human tissue. When the researchers applied the 15-PGDH inhibitor to human cartilage samples in the laboratory, the cartilage cells responded by shifting their gene expression toward a younger, healthier profile. Previous attempts at cartilage regeneration have relied on stem cell transplantation — harvesting cells from one part of the body, cultivating them, and surgically implanting them into the damaged joint. These procedures are complex, expensive, and have produced inconsistent results. The Stanford approach is fundamentally different: it does not introduce new cells. Instead, it causes the existing cartilage cells — the chondrocytes already present in the joint — to change their behavior. The drug essentially reprograms aged, deteriorating cartilage cells to act like younger, healthier versions of themselves, without requiring stem cells or surgery. The mechanism works through prostaglandin E2, a naturally occurring molecule. While prostaglandin E2 is commonly associated with inflammation and pain, the researchers found that small, controlled increases — achieved by blocking the enzyme that breaks it down — actually promote tissue regeneration rather than inflammation. How close is this to clinical use? Closer than one might expect for a laboratory breakthrough. A version of the 15-PGDH inhibitor has already completed Phase 1 safety testing in humans for a different age-related condition — muscle weakness — and did not raise safety concerns. That existing safety data could significantly accelerate the pathway to human trials for joint applications. The researchers have indicated they are moving toward clinical trials for cartilage regeneration. However, important caveats remain. The current results are in mice and in human tissue samples in the laboratory, not yet in human patients with osteoarthritis. The transition from animal models to human clinical practice is uncertain, and even with fast-tracked development, it would likely be several years before a treatment could reach clinical use. The therapy would also need to demonstrate that regenerated cartilage is durable and functionally equivalent to native cartilage over the long term. Even at this early stage, the research is worth tracking for several reasons. Knee injuries are among the most common and costly workers' comp claims. Any development that could reduce the long-term progression from acute knee injury to osteoarthritis to joint replacement has the potential to significantly alter the lifetime cost trajectory of these claims. Joint replacement surgery, with its associated surgical costs, hospitalization, rehabilitation, temporary disability, and potential complications, is one of the most expensive procedures in the workers' comp system ...

Plaintiff Lawyers are now calling the RICO cases filed in several states, including California, by employers against plaintiff lawfirms for filing alleged exaggerated claims a "Very Dangerous Trend." Ostensibly, this "trend" became of interest recently when Uber Technologies, Inc. filed three racketeering lawsuits recently against lawyers and medical providers for alleged fraudulent insurance claims, with a California lawsuit against Downtown LA Law Group et al.being the third. The the first was filed in New York in 2025 targeting a group of lawyers and medical providers in New York for allegedly exploiting Uber’s state-mandated $1 million rideshare insurance policy to file fraudulent personal injury claims. The scheme allegedly involved directing claimants to pre-selected medical providers who produced fraudulent medical records and bills to inflate settlement demands. The second was filed in South Florida (Uber v. Law Group of South Florida et al., Case No. 25-cv-22635-CMA) and Uber accused the defendants of staging car accidents, manufacturing damages, and pursuing unnecessary medical procedures to exploit insurance policies between 2023 and 2024. Uber Technologies filed another lawsuit in the United States District Court for the Central District of California alleging a fraudulent scheme involving personal injury claims filed against them in California. The complaint alleges that this “scheme begins when Defendants (Igor) Fradkin, Downtown LA Law Group, Emrani, and Law Offices of Jacob Emrani identify individuals with potential personal injury claims against rideshare companies such as Uber.” And goes on to allege “Both firms aggressively pursue clients to sue Uber, as shown in this online advertisement by Emrani” which appears to be screen grab of an advertisement showing Jacob Emrani next to an UBER/Lyft logo above the words “Uber or Lyft Accident?” followed by a banner that reads “Call Jacob.com.” Uber then alleges that a “key repeat participant in this fraud is Defendant Greg Khounganian, a spinal surgeon who owns and controls GSK Spine, an orthopedics practice. Working with personal injury coordinators at Defendant Radiance Surgery Center, a surgery center which specializes in treating patients with pending personal injury lawsuits and which also does business as Sherman Oaks Surgery Center. Following these three RICO cases, there were more to come, with Federal Express joining as a plaintiff, when Uber Technologies and Federal Express sued Philadelphia personal injury attorney Marc Simon, his firm Simon & Simon P.C., and several medical professionals — chiropractors Ethel Harvey and Daniel Piccillo of Philadelphia Spine Associates, pain management physician Clifton Burt of Premier Pain & Rehab Center, and medical examiner Lance Yarus — under the federal Racketeer Influenced and Corrupt Organizations Act (RICO). The companies alleged the defendants ran a coordinated fraud scheme spanning dozens of lawsuits filed over the past four years in Philadelphia County courts. According to the complaint, the scheme worked like a conveyor belt. Simon & Simon would sign up clients involved in motor vehicle accidents with Uber or FedEx drivers — clients who typically suffered minimal or no injuries and often carried limited-tort insurance. The firm then directed those clients to the same small group of medical providers. Drs. Harvey and Piccillo administered extensive chiropractic treatments and ordered MRIs that came back negative or showed only mild degenerative changes unrelated to the accidents. Despite those results, the chiropractors continued treatment at the lawyers' direction, generating voluminous records that in some cases reflected care that was allegedly never actually delivered or was documented using cut-and-paste boilerplate. On May 11, 2026 the court denied the defendants' motion to dismiss in its entirety in the case of Uber Technologies v. Simon & Simon P.C., Case No. 25-5365 (E.D. Pa.) (May 2026) allowing all of Uber's RICO claims to proceed to discovery. Every defense raised — Noerr-Pennington immunity, res judicata, the Rooker-Feldman doctrine, and challenges to the sufficiency of the RICO allegations — was rejected at this stage. Noerr-Pennington immunity is a common defense raised in these cases. The defendants argue their conduct was protected petitioning activity under the First Amendment. The Philadelphia court acknowledged that filing and serving lawsuits is classic petitioning activity, but held the alleged pre-filing conduct — directing doctors to create false medical records and manufacture evidence — was not "incidental" to petitioning. Even assuming the conduct could qualify as petitioning, the court found Uber plausibly invoked the sham litigation exception. Under the series-of-petitions framework from California Motor Transportation Co. v. Trucking Unlimited, 404 U.S. 508 (1972), the allegations supported an inference the lawyers filed cases without regard to merit and to extract settlement value through the litigation process itself. The abrupt dismissal of claims once discovery threatened to expose the scheme was particularly telling. Ford Motor Company v. Knight Law Group LLP et al., 2:25-cv-04550, was filed May 21, 2025 in the Central District of California. Plaintiff alleged that attorneys with Knight Law Group, Altman Law Group, and Wirtz Law APC submitted thousands of fictitious time entries in Lemon Law cases over the past decade to extract more than $100 million in inflated legal fees. The legal hook is California's Song-Beverly Consumer Warranty Act (the state's Lemon Law), which is fee-shifting — prevailing consumer plaintiffs recover their attorneys' fees from the manufacturer. Ford's audit allegedly identified 34 days in which a lawyer claimed more than 24 hours of work and 66 entries showing over 20 hours in a single day, including one entry for "an ostensibly heroic but physically impossible 57.5-hour workday in November 2016." Ford also cited instances where attorneys billed for multiple full-day depositions in different locations on the same day. On November 24, 2025 the court granted Knight's motions to dismiss with leave to amend. The dismissal turned on the Noerr-Pennington doctrine — the First Amendment-rooted rule shielding petitioning activity from liability. The court reasoned that Ford was attempting to impose RICO liability "for conduct connected to Defendants' fee petitions," and that a successful RICO claim would "quite plainly" burden defendants' ability to seek fees for their litigation activity, since seeking fees is at least "incidental to the prosecution of the suit". This is the same doctrinal wall the Gori firm is now invoking against J-M, and the same wall that defeated parts of J-M's earlier suit against Simmons Hanly Conroy. Ford did not appeal; it pivoted. In an amended complaint filed January 5, 2026, Ford withdrew its RICO claims against Knight Law Group as an entity, along with Altman Law Group, Wirtz Law APC, and several attorneys and a former paralegal, and instead strengthened its case against three individual attorneys formerly associated with Knight Law — founding partner Steve B. Mikhov, managing partner Roger Kirnos, and partner Amy Morse — alleging perjury and obstruction of justice for submitting false statements to courts about how legal fee records were created. And another case recently filed case by a California employer adds asbestos claims instead of Uber type automobile type litigation. J-M Manufacturing (the Los Angeles-based pipe maker that does business as JM Eagle) filed its federal RICO complaint against The Gori Law Firm on January 29, 2026 in the U.S. District Court for the Southern District of Illinois, asserting claims under RICO along with common-law fraud, unjust enrichment, and civil conspiracy. It's based on information from a "whistleblower" attorney who formerly worked at the Gori firm. J-M accuses the Gori firm of establishing a "bounty" system since at least 2018, in which "depo attorneys" who took clients' depositions could earn up to 2% of total settlement proceeds if they successfully coached clients to testify they were exposed to J-M's (and other companies') products. The complaint alleges depo attorneys were trained to tell plaintiffs that even if they couldn't recall the products, "the Gori Firm had done lots of research, and based on their research, the plaintiff was exposed to the products of the defendants recommended for inclusion by the attorney" Gori named J-M in more than 400 asbestos lawsuits since 2018, mostly in Madison and St. Clair counties in southern Illinois ...

A class action under ERISA was filed U.S. District Court for the Eastern District of California on behalf of participants and beneficiaries of the Sutter Health 403(b) Savings Plan. The claims alleged breaches of fiduciary duty in the management of the retirement plan.The case was filed in 2020 (case number 1:20-cv-01007). The class was certified by stipulation on January 26, 2024. Specifically the Plaintiffs allege that Defendants breached their fiduciary duties of prudence and loyalty under ERISA by retaining underperforming funds with excessive fees, instead of offering less expensive, readily available prudent alternative investments. Specifically, Plaintiffs assert Defendants were imprudent in offering the Fidelity Freedom Funds target date series, the Parnassus Core Equity Fund, the Dodge & Cox Stock Fund, and the Lazard Emerging Markers Equity Fund. Plaintiffs also argue that Plan participants paid excessive recordkeeping and administrative fees and the Plan’s total plan cost was too high. This case falls within a large wave of ERISA excessive-fee lawsuits targeting 403(b) retirement plans at nonprofit hospital systems and universities — cases that accelerated after the Supreme Court's 2015 decision in Tibble v. Edison International 135 S.Ct. 1823 (2015) 575 U.S. 523, which clarified fiduciaries' ongoing duty to monitor plan investments. The Uniform Prudent Investor Act confirms that "[m]anaging embraces monitoring" and that a trustee has "continuing responsibility for oversight of the suitability of the investments already made." § 2, Comment, 7B U.L.A. 21 (1995) (internal quotation marks omitted)." These are the standard categories of claims in the 403(b) excessive-fee litigation wave, and the Sutter Health case fits squarely within that pattern. Similar cases were filed against Dignity Health, Providence Health, Kaiser Permanente, and many other large nonprofit health systems during the same period. A settlement was reached through mediation with an experienced neutral mediator, after the parties had sufficient information to evaluate the case's settlement value.The fairness hearing was held April 10, 2026, and final approval was entered May 11, 2026 by Judge Lee H. Rosenthal. The Settlement Class includes all participants and beneficiaries of the Plan at any time during the Class Period, including beneficiaries of deceased participants and Alternate Payees under QDROs. Excluded are Sutter Health itself, the Defined Contribution Oversight Committee, the Board of Directors, and their individual members and beneficiaries. The Settlement Amount was $4,300,000. The court found this amount fair, reasonable, and adequate given the costs, risks, and delay of continued litigation. Distribution requires no claim filing for participants with active accounts; former participants without active accounts need only submit a modest claim form. The court awarded Class Counsel attorneys' fees of $1,433,333.33 (approximately one-third of the settlement fund), plus applicable interest and litigation expenses. Class Representatives were awarded $12,500 each as compensatory awards for costs and expenses related to their representation of the class. All amounts are payable from the settlement fund within 35 business days of the Effective Date. Upon entry of the order, all class members fully and permanently release the Defendant Released Parties from all Released Claims, regardless of whether a class member received notice, filed a claim, objected, or received any monetary benefit. The court retains exclusive jurisdiction over disputes related to the settlement's performance, interpretation, or enforcement. If the Settlement Agreement is terminated, the order becomes void and the case reverts to its pre-settlement status. The Settlement Administrator has final authority over allocation decisions, and unresolved distribution questions for active account holders are referred to the Plan's fiduciaries ...

What began as a routine workers' compensation insurance premium audit mushroomed into a 20-year dispute that wound through nine separate decisionmaking bodies, including two state appellate courts, two federal courts, and a bankruptcy court. At its core, the case asked a deceptively simple question: did nurse-staffing agency ReadyLink Healthcare, Inc. owe State Compensation Insurance Fund (SCIF) an additional $555,327.53 in premiums for the 2005 policy year? ReadyLink operated by paying its nurses wages far below the California average — in many cases just above minimum wage at $6.75 per hour — while supplementing their pay with large, tax-free daily "per diem" payments. Under workers' compensation insurance, premiums are calculated based on payroll. If per diem payments counted as payroll, ReadyLink owed more in premiums. For five consecutive policy years (2000–2004), SCIF's auditors reviewed ReadyLink's records, which openly disclosed the per diem program, and said nothing. Then, during the 2005 audit, a SCIF auditor — who had never seen an agency pay more than 50 percent of compensation in per diem form — demanded documentation. ReadyLink provided none. SCIF included the per diem payments in payroll and invoiced ReadyLink for $555,327.53 in additional premiums. ReadyLink refused to pay and challenged the audit through a cascade of proceedings. An administrative law judge (ALJ) ruled against it, finding the per diem payments did not qualify for exclusion from payroll under the California Workers' Compensation Uniform Statistical Reporting Plan (USRP), because ReadyLink had paid nurses without verifying whether they actually incurred duplicate living expenses — and, notably, 108 of its 257 nurses lived within 20 miles of their job assignments, with 11 living in the same zip code. The Insurance Commissioner adopted the ALJ's decision as precedential. The Los Angeles County Superior Court denied writ review. The Second District Court of Appeal affirmed in ReadyLink Healthcare, Inc. v. Jones (2012) 210 Cal.App.4th 1166. A federal class action was dismissed on abstention grounds, and the Ninth Circuit affirmed that dismissal in ReadyLink Healthcare, Inc. v. State Compensation Insurance Fund (9th Cir. 2014) 754 F.3d 754. Still, ReadyLink did not pay. SCIF filed a breach of contract action in Riverside County Superior Court in 2015. In defending that suit, ReadyLink made a significant discovery: the prior proceedings had all assumed that the USRP governed premium calculation, but ReadyLink claimed that SCIF had filed its own "rate deviation" with the Insurance Commissioner that set a different — and ReadyLink argued more lenient — standard for excluding per diem payments from payroll. Under the SCIF rate filing, per diem could be excluded if based on "actual or documented expenditures" of a type not normally assumed by an employee, rather than the USRP's requirement that expenditures be "reasonable" and supported by records showing the employee worked at a location requiring additional expenses. ReadyLink argued its payments qualified because they tracked IRS federal CONUS reimbursement tables. In 2020, the Fourth District reversed an earlier judgment on the pleadings, holding in State Compensation Insurance Fund v. ReadyLink Healthcare, Inc. (2020) 50 Cal.App.5th 422 that the amount actually owed had never been fully litigated and that ReadyLink was entitled to present its defenses at trial. When the case returned to the Riverside County Superior Court, the court navigated a thicket of pretrial motions. It denied SCIF's motion for summary judgment, finding a triable issue on ReadyLink's estoppel defense, but granted summary adjudication dismissing ReadyLink's fraud and Insurance Code section 381 defenses. It sustained demurrers to ReadyLink's amended cross-complaint on all claims except breach of contract. It then granted motions in limine and a bifurcation motion that excluded evidence about the SCIF rate filing from the jury trial, sent SCIF's breach of contract claim and ReadyLink's waiver defense to the jury, and reserved ReadyLink's estoppel defense for post-verdict determination. At trial, SCIF presented two witnesses — a 30-year premium collection specialist and an independent certified public accountant — who each confirmed that the $555,327.53 additional premium had been correctly calculated. ReadyLink did not rebut the testimony and affirmatively stipulated that the mathematical calculations were correct. The jury was instructed that it could not revisit the determination that per diem payments constituted payroll. Both opening and closing arguments by ReadyLink's counsel framed the sole remaining question as whether SCIF had waived its right to collect the additional premium by accepting ReadyLink's exclusion of per diem payments in the five prior policy years. The jury answered "No" on waiver — against ReadyLink — but then awarded zero damages. After the verdict, the trial court also found against ReadyLink on its estoppel defense. SCIF moved for judgment notwithstanding the verdict (JNOV) and for a new trial. The court granted both motions and entered an amended judgment awarding SCIF $555,327.53. The Fourth District Court of Appeal affirmed the amended judgment in favor of SCIF in the unpublished case of State Compensation Insurance Fund v. ReadyLink Healthcare, Inc., Case No. D083359 (May 2026). 1. Exclusion of the SCIF Rate Filing Evidence. ReadyLink argued the trial court committed reversible error by excluding evidence about SCIF's rate filing and by dismissing its rate-filing-based defenses and cross-claims before trial. The court disagreed. Even accepting ReadyLink's interpretation of the rate filing's "documented expenditures" standard as permitting reliance on CONUS tables, the ALJ had already found — in findings affirmed through multiple prior proceedings — that ReadyLink had made no effort to ascertain the distance between nurses' homes and their job assignments and had kept no documentation of how per diem funds were actually spent. The court concluded that "documented," however broadly construed, cannot mean blanket, per-employee application of CONUS table amounts without any individualized record-keeping to verify eligibility. Because the factual deficiencies were the same under either standard, the exclusion of rate-filing evidence was not prejudicial. 2. The JNOV Was Proper. The court applied the well-established standard that JNOV is appropriate when no other reasonable conclusion is legally deducible from the evidence — citing In re Lances' Estate (1932) 216 Cal. 397, 400. The analysis was straightforward: SCIF presented unrebutted expert testimony that the additional premium owed was $555,327.53; ReadyLink stipulated to the accuracy of the calculations; the jury rejected ReadyLink's only liability defense (waiver); the trial court rejected the remaining defense (estoppel); and no other defenses remained. Under those circumstances, a jury verdict of zero damages was unsupportable. ReadyLink's argument — that SCIF suffered no "real" harm because it could have chosen not to collect the premium or could have enforced its rights only prospectively — misunderstood contract damages law. Once a breach is established and defenses are defeated, the measure of damages is the benefit of the bargain: the full amount promised under the contract. SCIF was owed $555,327.53, and nothing in the record supported any other figure. 3. New Trial Order Was Moot. Under Code of Civil Procedure section 629, subdivision (d), a new trial order entered alongside a JNOV takes effect only if the JNOV is reversed on appeal. Because the court affirmed the JNOV, the new trial order never took effect, and ReadyLink's challenge to it was moot. SCIF is entitled to costs on appeal. A separate appeal concerning $907,998.38 in prejudgment interest awarded by the trial court remains pending as Case No. D086045 ...

Antonio Guzman worked as a rebar ironworker for Harris Rebar Northern California for approximately 25 years. The work was physically grueling by any measure — Guzman testified that his daily duties amounted to carrying and bending tons of rebar, with individual rods sometimes weighing over 100 pounds. He filed a workers' compensation claim for continuing trauma injuries sustained over that career, alleging damage to his low, thoracic, and cervical spine, bilateral knees, shoulders, hips, wrists, a psychiatric injury, and hearing loss. The case was tried before a workers' compensation arbitrator (WCA). The employer's insurer, BITCO Insurance/Old Republic General Insurance (administered by Gallagher Bassett Services), presented a report of a QME, Dr. Charles Xeller, who found injury limited to the left knee, low back, neck, and bilateral shoulders. Guzman was evaluated by his own physicians, Dr. Henri and Dr. Newton (an agreed medical evaluator in neurology), who found a broader range of industrial injuries consistent with his complaints. On the question of vocational rehabilitation and permanent disability, the defense argued that Guzman possessed transferable skills — pointing to his claimed GED, bilingual ability, and smartphone use — and that apportionment to non-industrial factors was appropriate, including a 40% apportionment of his hearing loss to age-related presbycusis. On January 15, 2026, the arbitrator issued a Findings and Award in Guzman's favor on virtually every disputed issue. The arbitrator found: (1) all claimed body parts, including the thoracic spine, right knee, bilateral hips, bilateral wrists, and psychiatric injury, were industrially caused; (2) permanent disability was 100%; (3) there was no valid apportionment to non-industrial factors; (4) Guzman was entitled to future medical care; (5) outstanding medical bills were the defendant's responsibility; and (6) his attorney was entitled to a 15% fee. The defendants Petitioned for Reconsideration. In his Report on Reconsideration, the arbitrator was plainly skeptical of the defense's position, describing as absurd the notion that 25 years of heavy ironwork would injure only selected body parts and not others. He also dismissed the defense's transferable-skills arguments point by point: Guzman's claimed GED was unsupported by any certificate or documentation; his "bilingual" ability amounted to a limited capacity to understand — not speak — English; his smartphone use consisted of making calls and playing games downloaded by his daughter; and when defense counsel asked whether his job required critical thinking, Guzman answered that when you spend hours carrying rebar on your shoulders, "I don't think you need too much thinking." The arbitrator recommended that reconsideration be denied. The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration in the panel decision of Guzman v. Harris Rebar Northern California; BITCO Insurance/Old Republic General Insurance, -ADJ12909831; -ADJ12910091 (May 2025). However the WCAB panel expressly stated that this was not a final decision on the merits. The Board deferred issuance of a final decision pending further review of the record and applicable law. The Board's decision to grant reconsideration rested on procedural and record-completeness grounds, not on any disagreement with the arbitrator's substantive findings. The central reason for granting reconsideration was that the arbitration record forwarded to the Board was materially incomplete. Citing WCAB Rule 10914 (Cal. Code Regs., tit. 8, § 10914(c)), the Board identified five categories of required documents that were missing: minutes of the arbitration proceedings; pleadings, briefs, and responses filed by the parties; a clear identification of exhibits offered and any objections thereto; the parties' stipulations and the issues submitted for decision; and the arbitrator's summary of evidence with evidentiary rulings. Only the transcript of the November 18, 2025 hearing had been received. The Board emphasized that meaningful review of an arbitrator's decision requires an "ascertainable and adequate record," including an orderly identification of what evidence was submitted, admitted, or excluded — relying on Lewis v. Arlie Rogers & Sons (2003) 69 Cal.Comp.Cases 490, 494, and Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc). Without such a record, the Board stated it could not evaluate whether the arbitrator's findings were supported by substantial evidence, the governing standard under Braewood Convalescent Hospital v. Workers' Compensation Appeals Board (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], and Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc). The Board underscored that administrative efficiency cannot come at the cost of due process, citing Fremont Indemnity Co. v. Workers' Compensation Appeals Board (1984) 153 Cal.App.3d 965, 971 [49 Cal.Comp.Cases 288], and Ogden Entertainment Services v. Workers' Compensation Appeals Board (Von Ritzhoff) (2014) 233 Cal.App.4th 970, 985 [80 Cal.Comp.Cases 1]. Every party seeking reconsideration is entitled to a meaningful, de novo consideration of the merits based on the evidentiary record and applicable law. Finally, the Board noted that granting reconsideration has the effect of reopening the entire record — not just the issues raised in the petition — citing Great Western Power Co. v. Industrial Accident Commission (Savercool) (1923) 191 Cal. 724, 729 [10 I.A.C. 322]. The Board retains full authority under Labor Code section 5803 to rescind, alter, or amend any order or award for good cause at any time ...

A Huntington Park-based medical practice and its physician have agreed to pay more than $6.73 million to resolve allegations that they violated the False Claims Act by submitting false claims for medically unnecessary vascular interventional procedures on 20 Medicare beneficiaries. The United States alleged that, from 2016 to 2024, Dr. Feliciano Serrano of Serrano Kidney & Vascular Access Center performed medically unnecessary dialysis access interventions, including angioplasty and stent procedures, on 18 patients, purportedly to treat stenosis in patients’ dialysis segments. Dr. Serrano scheduled interventions on a routine basis, without waiting for complications to present, and he frequently repeated procedures on patients every few days or weeks despite that the procedures were not effective and did not result in any clinical benefit. One Medicare patient received approximately 42 stents in the dialysis segment between 2016 and 2023, including during a period when Dr. Serrano informed the patient he did not need dialysis. The United States also alleged that from 2019 to 2024, Dr. Serrano performed medically unnecessary peripheral artery disease interventions, including stent and atherectomy procedures, on 17 patients, purportedly to treat stenosis in patients’ legs. Dr. Serrano performed interventions on patients who had only mild or no stenosis and who had only minor symptoms. Although patients complained of pain only in one leg, he performed procedures on both legs and then repeated procedures on both legs every few months. Dr. Serrano told patients that if they did not receive the procedure, their legs would need to be amputated, when, in fact, there was little risk of amputation for mildly symptomatic peripheral artery disease. One Medicare patient received approximately 16 atherectomies in his legs between 2019 and 2023. The United States alleged that across both categories of procedures, Dr. Serrano performed interventional procedures on vessels that did not qualify for treatment under accepted standards of medical practice; overstated the degree of stenosis to make the procedures appear to meet generally recognized medical standards when, in fact, they did not; falsely documented patient symptoms and conservative therapy measures in medical records to justify the procedures; and performed procedures in excess of accepted standards of medical practice. As a result of the settlements, Dr. Serrano will pay nearly $6.51 million to the United States and nearly $229,000 to the State of California. The civil settlement includes the resolution of claims brought by Lincoln Analytics, Inc. under the qui tam or whistleblower provisions of the False Claims Act. Under the act, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States and State of California ex rel. Lincoln Analytics, Inc. v. Dr. Feliciano Serrano, et al., Civil Action No. 23-cv-04178 (C.D. Cal.). Lincoln Analytics, Inc. will receive approximately $976,000 as its share of the federal recovery. The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the United States Attorney’s Office for the Central District of California, and the California Department of Justice, with assistance from the Department of Health and Human Services, Office of Inspector General. Assistant United States Attorney Karen Y. Paik of the Civil Frauds Section and Justice Department Trial Attorney Tiffany L. Ho of the Civil Division’s Commercial Litigation Branch, Fraud Section handled this case. The claims resolved by the settlement are allegations only and there has been no determination of liability ...

A federal jury convicted Colin Jackson of conspiracy to commit wire fraud, wire fraud, and money laundering. The jury’s verdict followed a seven-day trial before U.S. District Judge Trina L. Thompson. The jury found that Jackson conspired with others, including a previously convicted defendant, Kirill Afanasyev, to defraud an automobile insurance company concerning the submission of a fraudulent insurance claim on an already-wrecked car in 2018. According to court documents and the evidence presented at trial, Jackson, 39, of San Francisco, obtained an insurance policy on an undrivable car in June 2018. He made a number of misstatements in his application for that policy, including regarding his estimated annual mileage on the car. Five months later, in November 2018, Jackson and Afanasyev worked together to submit a fraudulent claim concerning a fake accident to the insurer. Unaware it had insured a wrecked car, the defrauded automobile-insurance company approved the claim and paid Jackson about $27,000—the insurer’s estimate of the replacement value of the car, which had been titled in Jackson’s name. The 2018 fraud followed a similar scheme in 2017, when Jackson and Afanasyev obtained a payout from the insurer of approximately $30,000 on another already-wrecked car titled in Jackson’s name. United States Attorney Craig Missakian, FBI Acting Special Agent in Charge Matthew Cobo, and IRS Criminal Investigation (IRS-CI) Oakland Field Office Special Agent in Charge Linda Nguyen made the announcement. Jackson is next scheduled to appear before Judge Thompson for sentencing on September 25, 2026. With the jury’s verdict against Jackson, more than a dozen defendants have either pleaded guilty or been convicted at trial as part of an ongoing federal investigation into automobile insurance frauds and an unrelated arson conspiracy involving an overlapping defendant, Jose Badillo, who previously pleaded guilty to participating in both parts of the scheme. Operation Hammer Down was a federal investigation into automobile-insurance frauds orchestrated by Afanasyev and Badillo, the former owner of Jose’s Towing, Auto Towing, and Specialty Towing. In total, Afanasyev, Badillo, and others submitted and conspired to submit more than 50 fraudulent insurance claims that caused in excess of $1.5 million dollars in losses to automobile insurance companies. Operation Hammer Down also concerned arsons orchestrated by Badillo, who sought to impede his competitors’ business prospects to exact revenge against them for perceived wrongs. For his role in the arson campaign, Badillo was sentenced in February 2026 to 60 months in custody by U.S. District Judge Rita F. Lin ...

Salud Para La Gente, is a nonprofit network of primary care clinics serving low-income individuals and families in Santa Cruz County and Monterey County. Salud was founded in 1978 as a single free clinic offering healthcare primarily to farmworkers living and working on California’s Central Coast. Since that time, Salud has become a federally qualified health center (FQHC), and grown to five clinics and four school-based health centers providing healthcare to nearly 27,000 patients. Among the services it provides, Salud offers contraceptive care, including etonogestrel marketed under the brand name Nexplanon, to Medicaid beneficiaries. Nexplanon is a thin rod that is inserted under the skin of a patient’s upper arm that, once implanted, works to prevent pregnancy. It is a prescription birth control for the prevention of pregnancy for up to 5 years. Salud has agreed to pay a total of $750,000 to resolve allegations that it submitted false claims for payment to the Medicaid program in connection with its purchase and administration of misbranded contraceptive implants. United States Attorneys Office for the Northern District of California alleged that between May 17, 2017, and Sept. 11, 2020, Salud purchased misbranded Nexplanon from an unlicensed wholesaler and administered the misbranded Nexplanon to Medicaid patients. According to the United States, Salud knowingly submitted false claims for payment to Medicaid by using incorrect National Drug Code numbers, unique drug identifiers used by the FDA for reporting and patient safety purposes, for the misbranded Nexplanon and for its administration. “Patient safety must be at the forefront of medical decision-making,” said United States Attorney Craig H. Missakian. Using misbranded drugs jeopardizes public health and constitutes a serious False Claims Act violation. We will continue to hold violators accountable.” “It’s clearly dangerous and unethical for health care providers to administer misbranded drugs obtained from unlicensed sources to their patients,” said Special Agent in Charge Robb R. Breeden of the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG). “Working with our law enforcement partners, HHS-OIG will continue to aggressively protect the health and well-being of patients and the integrity of federal health care programs.” Assistant U.S. Attorney Michelle Lo handled this matter. The resolution resulted from a coordinated effort between the U.S. Attorney’s Office for the Northern District of California, HHS-OIG, and FDA’s Office of Criminal Investigations. The claims resolved by the settlement are allegations only, and there has been no determination of liability ...

New research from the Workers Compensation Research Institute (WCRI), based on data from 18 study states, found that total workers’ compensation claim costs grew by an average of 6 percent per year from 2022 to 2025 in the median study state. “The increase reflects sustained growth in the last few years across all major components of a claim, including medical payments, indemnity benefits, and benefit delivery expenses,” said Sebastian Negrusa, vice president of research at WCRI. “Workers’ compensation costs were fairly flat through 2022, but in the last few years, costs began to rise again, driven by increasing wages, higher medical prices, longer disability duration, and rising costs to administer claims.” Key findings from the studies include: - - Medical payments per claim increased, primarily by price growth for medical services rather than changes in utilization, with high‑cost claims a key driver of growth in some states. - - Indemnity benefits per claim continued to rise, as longer durations of temporary disability placed upward pressure on benefits; wages for injured workers continued to grow but at a slower pace in more recent years. - - Benefit delivery expenses per claim grew steadily, reflecting increases in medical cost containment expenses and litigation expenses. - - Cost growth was widespread across states, with most study states experiencing rising total costs per claim and increases in most cost components. The findings are drawn from CompScope™ Benchmarks, 2026 Edition, a series of studies covering 18 states that monitor the changes in workers’ compensation claim costs and their components. The studies examine claims with more than seven days of lost time, evaluated at 12 months of experience through 2025. The study states are Arkansas, California, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin. California specific research questions include: - - How have California’s system performance metrics changed recently? - - How does California’s workers’ compensation system compare with 17 other states? - - What has been the impact of changes in the economic environment during the recovery from the pandemic on California’s workers’ compensation system? All state studies included in this edition are available free to WCRI members and for a fee to nonmembers ...

Robert Toothman was hired by Apex Life Sciences, LLC, a temporary staffing agency, which placed him on assignment at Redwood Toxicology Laboratory, Inc. As a condition of that placement, Toothman signed both an Employment Agreement and a companion Arbitration Agreement with Apex. The Arbitration Agreement bound "Employee" (Toothman) and "Company" — defined as Apex and "its affiliates, subsidiaries and parent companies" — to arbitrate any dispute "arising out of or related to" Toothman's employment with, or termination from, Company. It also waived class and representative claims. Toothman's Apex assignment ended in April 2018. Two days later, Redwood hired him directly — without any new arbitration agreement and without any reference to the Apex documents. Toothman worked for Redwood until June 2022. In September 2022, he filed a class action against Redwood alleging Labor Code violations covering the period of his direct employment, starting no earlier than September 26, 2018 — well after his Apex tenure had ended. After Redwood subpoenaed Apex and obtained a copy of the Arbitration Agreement, Toothman filed an amended complaint that redefined the proposed class to exclude workers staffed by third parties while on assignment, but retained individuals like Toothman himself who had transitioned from staffed to direct employment. Redwood moved to compel arbitration of Toothman's individual claims and to dismiss his class claims, arguing three alternative theories: (1) it was a party to the Arbitration Agreement as an "affiliate" of Apex; (2) it could enforce the agreement as a third-party beneficiary; and (3) Toothman was equitably estopped from resisting arbitration. The Sonoma County Superior Court denied the motion in its entirety. The First Appellate District affirmed the trial court's denial of the motion to compel arbitration in the published case of Toothman v. Redwood Toxicology Laboratory, Inc. Case No. A171567 (May 2026). The court reviewed the matter de novo, as the material facts were undisputed. The court first addressed who bore the burden of proof. Because Redwood was not a signatory to the Arbitration Agreement, it could not simply produce the agreement and shift the burden to Toothman to defeat it. Relying on Jones v. Jacobson (2011) 195 Cal.App.4th 1, the court held that a nonsignatory moving party must affirmatively establish its entitlement to enforce the agreement as part of its own initial burden — whether proceeding as a party, a third-party beneficiary, or under equitable estoppel. Redwood argued it qualified as an "affiliate" of Apex and was therefore a "Company" party to the agreement. The court rejected this, applying standard California contract interpretation principles. The term "affiliates," appearing alongside "subsidiaries and parent companies," plainly connoted relationships of common ownership or corporate control — not arms-length commercial arrangements. The companion Employment Agreement used the separate term "Clients" to describe businesses like Redwood, and the parties never incorporated that term into the Arbitration Agreement's definition of "Company." Accepted dictionary definitions — including Black's Law Dictionary (10th ed. 2014) at page 69 — confirmed that "affiliate" in a corporate context means entities related "by shareholdings or other means of control." The court also noted the practical absurdity of Redwood's theory: it would mean that Apex unilaterally prescribed dispute resolution procedures for its clients' own direct-hire employees without those clients' knowledge or consent. Even assuming Redwood could qualify as a third-party beneficiary, the court held that Toothman's claims still fell outside the Arbitration Agreement's substantive scope. The agreement covered only disputes "arising out of or related to" employment with "Company" — i.e., Apex. Toothman's claims arose entirely from his direct employment with Redwood, which began after his Apex employment ended. The court cited Vazquez v. SaniSure, Inc. (2024) 101 Cal.App.5th 139 for the principle that an arbitration agreement from one period of employment does not automatically govern disputes arising in a separate, subsequent period. Finally, the court rejected Redwood's argument that Toothman was equitably estopped from contesting arbitration. Equitable estoppel applies when a plaintiff's claims are "dependent upon, or founded in and inextricably intertwined with" the underlying agreement containing the arbitration clause — as articulated in Goldman v. KPMG, LLP (2009) 173 Cal.App.4th 209. Here, Toothman's Labor Code claims depended entirely on his employment agreement with Redwood, not on the Apex Arbitration Agreement. The court also rejected Redwood's contention that Toothman's amendment of the class definition was an implicit admission that his claims were intertwined with the Arbitration Agreement, finding no authority to support that proposition and noting that a plaintiff's decision to narrow or limit claims does not constitute the kind of "artful pleading" that triggers estoppel ...

When the White House announced a Most Favored Nation (MFN) drug pricing agreement with Regeneron Pharmaceuticals on April 23rd, it wasn't just another deal. It was the final piece of a puzzle the Trump administration had been assembling for over a year. Regeneron was the 17th — and last — of the major pharmaceutical companies targeted by the administration to sign on, completing a full sweep that few in Washington had expected to happen this quickly. What Is "Most Favored Nation" Pricing? The concept is straightforward, even if the politics are anything but. For decades, Americans have paid dramatically more for prescription drugs than patients in other wealthy nations. The same medication sold in Germany, Japan, or Canada often carries a fraction of the U.S. price tag. The administration's MFN policy aims to fix that by tying what American patients pay to the lowest price offered in comparable developed nations — ensuring the U.S. gets the same deal as everyone else. President Trump signed an executive order outlining the initiative in May 2025 and launched TrumpRx.gov on February 5, 2026, a government portal where patients can access drugs at MFN-aligned prices. Since then, administration officials have been negotiating voluntary pricing agreements one company at a time. Under the deal, Regeneron committed to several significant concessions: - - Medicaid access at MFN prices — Every state Medicaid program will now have access to Regeneron products at MFN pricing, with the White House projecting hundreds of millions in savings for the program that serves the country's most vulnerable patients. - - Future drugs at MFN rates — Regeneron agreed to align pricing for all new innovative medicines it brings to market with prices set in the comparable group of developed nations — a notably forward-looking commitment. - - Praluent on TrumpRx.gov — The company's cholesterol-lowering drug will be available at a discounted price through the government portal. - - A free gene therapy — Coinciding with the announcement, Regeneron received FDA approval for Otarmeni, the first gene therapy for genetic hearing loss. As part of the deal, the company agreed to make it available at no cost to eligible U.S. patients. - - $27 billion U.S. investment — Regeneron separately announced a commitment to invest $27 billion in American research, development, and manufacturing by 2029, more than doubling its domestic biologic production capacity. Regeneron co-founder and CEO Dr. Leonard Schleifer didn't sound like a reluctant partner in his statement. "For too long, American patients and taxpayers have shouldered a disproportionate share of the cost of biotechnology innovation," he said, adding that other high-income nations have not been "paying their fair share" for the breakthroughs they rely on. Schleifer has reportedly made this argument privately for over a decade — the MFN framework, in his framing, gave him a mechanism to finally act on it. The Regeneron deal brings the total number of MFN agreements to 17, encompassing pharma giants including Pfizer, AstraZeneca, Eli Lilly, Novo Nordisk, Amgen, Bristol Myers Squibb, Gilead Sciences, Merck, Novartis, Sanofi, Johnson & Johnson, and AbbVie, among others. The White House estimates that combined U.S. pharmaceutical investment commitments under President Trump now total $448 billion over just 15 months. The administration has also signaled it intends to expand the framework beyond the original 17, with expectations of reaching similar agreements with most manufacturers of sole-source brand-name drugs and biologics. Efforts are also underway to codify the voluntary agreements into law through Congress, which would lock in the pricing protections for the long term. Whether the MFN model delivers lasting relief for American patients will depend on several factors still unresolved: how aggressively the agreements are enforced, whether Congress acts to make them permanent, and how drug companies manage pricing globally as they balance domestic commitments against foreign markets. Critics have also raised questions about potential impacts on pharmaceutical innovation incentives over the long run. For now, though, one chapter has clearly closed. Every company on the administration's list has signed on — and the last holdout brought a gene therapy giveaway and a $27 billion investment pledge along with it ...

The California Department of Insurance announced a major enforcement action against State Farm General Insurance Company after an expedited investigation uncovered significant mishandling of insurance claims filed by survivors of the 2025 Los Angeles wildfires. Acting on consumer complaints, Insurance Commissioner Ricardo Lara ordered a Market Conduct Examination that documented a pattern of unlawful behavior in more than half of the claims reviewed. State Farm policyholders filed approximately 11,300 residential claims related to the Los Angeles wildfires, nearly one-third of the 38,835 claims filed across all insurers, according to the Department’s official claims tracker. The violations identified by the Department indicate that thousands of survivors may have been affected. The Department’s enforcement action seeks millions of dollars in penalties, considered the largest amount pursued this century following a wildfire disaster. In addition to penalties, the Department is requiring State Farm to take corrective actions to speed up payments and resolve outstanding claims Department examiners reviewed a sample of 220 claims and found 398 violations of state law in 114 of those claims, many of which contained multiple violations. Major violations mirror the delays and denials reported by wildfire survivors to the Department, including: - - Slow and inadequate investigation: State Farm failed to begin investigating claims within 15 days, failed to accept or deny claims within 40 days, and failed to pay accepted claims or provide written notice of the need for additional time within 30 days, as required by law. - - Underpayment of claims: State Farm made unreasonably low settlement offers and underpaid claims. - - Multiple adjusters causing confusion: State Farm failed to assign adjusters within statutory timelines and reassigned adjusters repeatedly, creating what survivors described as “adjuster roulette.” - - Smoke damage claim denials and delays: Smoke damage claims represented nearly half of all consumer complaints. Examiners found that State Farm failed to provide required written denials for hygienist and environmental testing, misclassified testing costs, and misrepresented policy provisions related to inspections. - - Inadequate communication: State Farm failed to respond to policyholders, send required status letters, or provide notice when additional time was needed to determine claims. Since last January, the Department has recovered more than $280 million from all insurance companies for survivors of the Eaton and Palisades fires through direct intervention. As of March 3, 2026, insurers have paid out more than $23.7 billion to residential, commercial, and auto policyholders impacted by the fires. The Department has filed an Accusation and Order to Show Cause against State Farm -- the first step toward a public hearing before an administrative law judge. The filing alleges violations of the Unfair Insurance Claims Practices Act and related regulations, including the 398 violations identified in the Market Conduct Examination and 34 additional violations based on consumer complaints. Under California Insurance Code Section 790.035, penalties may reach $5,000 per violation, or $10,000 for willful violations. Penalties may be imposed by the Commissioner following the administrative hearing. Wildfire survivors experiencing delays, disputes, smoke damage issues, or other claim problems are encouraged to file a formal complaint with the Department of Insurance at insurance.ca.gov or by calling (800) 927-4357. Separate from today’s action, the California Department of Insurance, Consumer Watchdog, and State Farm General recently reached a three-party settlement agreement over State Farm’s emergency rate request, now set to be reviewed by an impartial Administrative Law Judge. State Farm said in a statement it rejected any suggestions it “engaged in a general practice of mishandling or intentionally underpaying wildfire claims" and called the state’s insurance market “dysfunctional.” The company said it has paid out more than $5.7 billion on 13,700 auto and home insurance claims related to the fires. “The threat to suspend State Farm General’s ability to serve customers over primarily administrative and procedural errors is a reckless, politically motivated attack that could ultimately cripple California’s homeowners insurance market," the statement said ...

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization founded in 1983. WCRI provides objective information through studies and data collection that follow recognized scientific methods and rigorous peer review.. A new report from the WCRI gives policymakers an understanding of how hospital outpatient payments for common knee and shoulder surgeries compare across states and how payment rules shape costs. “With many states reexamining hospital fee regulations, this study provides meaningful state comparisons and shows how different regulatory approaches influence payment growth and payment levels,” said Sebastian Negrusa, vice president of research at WCRI. The report, Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 2026 Edition, benchmarks hospital outpatient payments related to surgeries in 36 states, covering 88 percent of U.S. workers’ compensation benefits. States included in the study are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin. It also compares workers’ compensation payments with Medicare rates and examines the impact of major fee regulation changes from 2005 to 2024. Key findings include: - - Faster payment growth in states without fixed-amount fee schedules: From 2011 to 2024, hospital outpatient surgery payments rose by roughly twice as much in charge-based states and states without fee schedules, compared with the typical fixed-amount fee schedule state. - - Higher payments in non-fee-schedule states: Payments were substantially higher—often more than double—than in fixed‑amount states. - - Wide variation across states relative to Medicare: Payments ranged from 35 percent ($2,711) below Medicare in Nevada to 471 percent ($28,713) above Medicare in Alabama. The study, authored by Drs. Olesya Fomenko and Rebecca Yang, is free for members and available to nonmembers for a fee ...

Arturo Vela was hired by Harbor Rail Services of California, Inc. (Harbor) as a railcar repairman and was terminated five months later in October 2021. Before beginning work, Vela signed a mutual arbitration agreement covering all employment-related claims. The agreement also contained a class and representative action waiver, meaning Vela gave up his right to pursue claims on behalf of other workers. Harbor was not itself a railroad, it was a repair and inspection contractor working under a service agreement with Pacific Harbor Line (PHL), a short-line railroad operating a train yard in Wilmington, California. Larger railroads Burlington Northern Santa Fe and Union Pacific would deliver freight cars to PHL's yard, where the cars were disconnected from locomotives, taken out of service, and left for inspection and repair. Vela's work consisted of changing wheels and brake pads, disassembling and reassembling train cars, and welding and fabricating metal components — all performed on decommissioned cars sitting in the yard. Once repaired, the cars were returned to PHL and eventually back to the freight railroads. In October 2023, Vela filed suit in Los Angeles County Superior Court against Harbor, asserting a slate of California Labor Code violations — unpaid overtime, missed meal and rest period premiums, unpaid minimum wages, late final wages, noncompliant wage statements, and unreimbursed business expenses — along with an Unfair Competition Law claim. Vela brought these claims on his own behalf and on behalf of a proposed class of current and former Harbor employees. Harbor moved to compel Vela's individual claims to arbitration and to dismiss his class claims. The trial court held multiple rounds of briefing and, after receiving supplemental evidence and argument, granted Harbor's motion in February 2025. The court ordered Vela's individual claims to arbitration and dismissed and struck his class claims, finding the Federal Arbitration Act (FAA), 9 U.S.C. § 1 et seq., governed the parties' agreement and that no exemption removed it from the FAA's reach. The Court of Appeal affirmed the dismissal and striking of Vela's class claims in the published case of Vela v. Harbor Rail Services of California, Inc., Case No. B344723 (May, 2026). Railroad Employee. Section 1 of the FAA exempts "contracts of employment of seamen, railroad employees, or any other class of workers engaged in foreign or interstate commerce." Vela argued he qualified as a "railroad employee" because his work was performed for PHL under Harbor's service contract with that entity. The court rejected this theory on a threshold ground: a "contract of employment" under Section 1 must have the qualifying worker as one of its parties. Vela had no contract with PHL. Citing Fli-Lo Falcon, LLC v. Amazon.com, Inc., 97 F.4th 1190, 1196–1197 (9th Cir. 2024), and Amos v. Amazon Logistics, Inc., 74 F.4th 591, 596 (4th Cir. 2023), the court held that the Harbor–PHL service agreement — a business-to-business contract — could not qualify. The court also rejected Vela's reliance on the Railway Labor Act's definition of "employee," finding no evidence that PHL supervised or directed Vela's work; Harbor, by contract, retained exclusive control over its workers. The FAA Exemption — Transportation Worker. The Supreme Court's decision in Southwest Airlines Co. v. Saxon, 596 U.S. 450 (2022), requires courts to (1) identify the class of workers to which the individual belongs based on the work they typically perform, and then (2) determine whether that class is "engaged in foreign or interstate commerce." Under Saxon, workers who are "directly involved in transporting goods across state or international borders" fall within the exemption. For workers whose duties are more removed from that activity, they must play a "direct and necessary role in the free flow of goods across borders" to qualify. The Ninth Circuit subsequently applied Saxon in Ortiz v. Randstad Inhouse Services, LLC, 95 F.4th 1152, 1160 (9th Cir. 2024), requiring that a worker's relationship to the movement of goods be "sufficiently close enough" to play "a tangible and meaningful role" in interstate commerce, and in Lopez v. Aircraft Service International, Inc., 107 F.4th 1096, 1101 (9th Cir. 2024), which found an airplane fuel technician qualified because refueling was a "vital component" of an aircraft's ability to engage in interstate transportation. Applying this framework, the court held that Vela's class — workers who inspect and repair freight cars that have been removed from service and placed in a maintenance yard — is too far removed from actual transportation to qualify. The cars were decommissioned and unusable until Vela and his coworkers finished their tasks. It was only after repairs were completed that the cars re-entered service and resumed a role in moving goods. The court also noted the absence of any evidence that Vela's class typically worked on cars that still contained freight. Cases Vela cited in support, including Betancourt v. Transportation Brokerage Specialists, Inc., 62 Cal.App.5th 552 (2021) (package delivery driver), and Nieto v. Fresno Beverage Co., Inc., 33 Cal.App.5th 274 (2019) (delivery truck driver), were distinguished because those workers played active roles in moving goods — Vela did not. Because the FAA applied and no exemption saved Vela from it, the class action waiver in his arbitration agreement was enforceable under federal law, which preempts California doctrine that would otherwise void such waivers. See Iskanian v. CLS Transportation Los Angeles, LLC, 59 Cal.4th 348, 359 (2014) ...

Modern Nuclear Inc. (MNI), a La Habra-based mobile PET scan company, has agreed to pay more than $8.3 million plus additional money based on future revenue to resolve False Claims Act allegations that it violated federal law by paying referring cardiologists excessive fees to supervise positron emission tomography (PET) scans. According to the Justice Department, from September 2016 to January 2025, MNI knowingly submitted false or fraudulent claims to federal health care programs arising from violations of the Anti-Kickback Statute. Specifically, MNI allegedly paid kickbacks to referring cardiologists in the form of above-fair market value fees, ostensibly for cardiologists to supervise PET scans for the patients they referred to MNI. These fees substantially exceeded fair market value for the cardiologists’ services because MNI paid the referring cardiologists for time they spent in their offices caring for other patients or while they were not on site at all, or for additional services beyond supervision that were never or rarely actually provided. MNI purported to rely on an attorney-opinion letter regarding fair market value that the United States alleged was premised on fundamental inaccuracies and that the consultant ultimately withdrew. In connection with the settlement, MNI entered into a five-year corporate integrity agreement (CIA) with the United States Department of Health and Human Services Office of Inspector General (HHS-OIG). This agreement requires, among other compliance provisions, that MNI implement measures designed to ensure that arrangements with referring physicians are compliant with the Anti-Kickback Statute. The agreement also requires that MNI implement a compliance program to identify and address the Anti-Kickback Statute risks associated with other financial arrangements and retain an Independent Compliance Expert to perform a review of the effectiveness of the compliance program. The civil settlement resolves claims brought under the qui tam or whistleblower provisions of the False Claims Act by relators Matt Lieberman and James Whitney. Under those provisions, a private party or relator can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Lieberman v. Modern Nuclear, Inc., et al. (No. 8:23-cv-01646-DOC-KES) (C.D. Cal.). The relators will receive 16% of the total recovery in this matter. The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the Central District of California, with assistance from the HHS-OIG and the Defense Health Agency Office of Inspector General. Assistant United States Attorney Paul B. La Scala of the Civil Division’s Civil Fraud Section and Senior Trial Counsel Sanjay M. Bhambhani of the Justice Department’s Civil Division handled this matter. The claims resolved by the settlement are allegations only and there has been no determination of liability ...

For half a century, the medical world has classified traumatic brain injuries using essentially the same tool: the Glasgow Coma Scale, a bedside scoring system developed in 1974 that rates a patient's eye opening, verbal responses, and motor function on a 15-point scale. A score of 13 to 15 is "mild," 9 to 12 is "moderate," and 3 to 8 is "severe." That three-tier system has driven clinical decision-making, research design, insurance determinations, and — critically for this audience — workers' compensation claims adjudication for decades. That system is now being replaced. In May 2025, an international team of 94 experts from 14 countries, led by the National Institutes of Health and the National Institute of Neurological Disorders and Stroke, published a new classification framework in The Lancet Neurology. Called CBI-M, it represents the most significant change in how traumatic brain injuries are assessed and categorized since the Glasgow Coma Scale was introduced. Trauma centers nationwide are beginning to test it, and workers' compensation professionals handling head injury claims need to understand what is coming. The problem with the mild/moderate/severe classification is not that it is inaccurate — it is that it is incomplete. Within the "mild" TBI category alone, there is enormous variation. One patient might sustain a brief blow to the head with no loss of consciousness and a momentary gap in memory. Another patient in the same "mild" category might lose consciousness for 20 minutes and have a small brain bleed visible on imaging. Under the current system, both receive the same classification, the same label, and — too often — the same clinical follow-up, which for "mild" TBI frequently means discharge from the emergency department with minimal arrangements for ongoing care. The new framework does not discard the Glasgow Coma Scale — it expands on it. CBI-M stands for Clinical, Biomarker, Imaging, and Modifier, representing four pillars of assessment that together provide a multidimensional picture of the injury rather than a single number. The clinical pillar retains the Glasgow Coma Scale but uses each component score individually rather than collapsing them into a single sum. It also incorporates pupillary reactivity — whether the pupils respond normally to light — which is a significant predictor of outcomes that the traditional GCS sum score alone does not capture. The biomarker pillar is entirely new to TBI classification. It incorporates blood-based measures that can detect the presence and extent of brain injury. The FDA approved the first blood test for brain injury in 2018, and the technology has advanced rapidly since. Specific proteins released when brain tissue is damaged — including glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B) — can now be measured from a standard blood draw within hours of injury. Elevated levels indicate that brain injury has occurred, even when the patient's clinical presentation appears mild and CT imaging looks normal. The imaging pillar formalizes the role of brain imaging — CT and MRI — in characterizing the injury. Rather than simply asking whether a scan is "positive" or "negative," the framework categorizes the specific types of pathology present, such as contusions, hemorrhages, or diffuse axonal injury, each of which carries different implications for recovery. The modifier pillar accounts for individual factors that influence clinical presentation and outcome: the mechanism of injury, the patient's age, preexisting medical conditions, prior head injuries, and psychosocial factors. These modifiers have always been relevant to prognosis, but the current classification system ignores them entirely. Independent medical examinations will need to adapt. Medical evaluators who currently rely on the GCS classification to frame their opinions about injury severity and causation will need to engage with the new framework. The biomarker pillar deserves special attention because it introduces something the workers' comp system has never had for traumatic brain injury: an objective, measurable indicator of injury that does not depend on patient self-reporting or clinical judgment. Brain injury has historically been one of the most difficult conditions to evaluate in the claims context precisely because it lacks the kind of objective evidence — an X-ray showing a fracture, an MRI showing a disc herniation — that other orthopedic injuries produce. Blood-based biomarkers change that equation. This does not mean biomarker testing will resolve all disputes. Elevated protein levels indicate brain injury but do not, by themselves, predict the duration of symptoms or the degree of functional impairment. And the science is still maturing — reference ranges, timing windows for testing, and interpretation standards are all subjects of active research. But the direction is clear: TBI evaluation is moving from subjective to objective, and the workers' comp system will need to keep pace. The CBI-M framework is not yet in universal clinical use. The authors describe it as a framework that will require validation and refinement before full adoption. But it is being tested at trauma centers now, it was published in one of the world's leading neurology journals, and it carries the imprimatur of the NIH. The trajectory is unmistakable. For further reading, the CBI-M framework was published in The Lancet Neurology in May 2025: A New Characterisation of Acute Traumatic Brain Injury: The NIH-NINDS TBI Classification and Nomenclature Initiative. The NIH-NINDS also published an accessible summary: New Framework for Classifying Traumatic Brain Injury ...

The DOJ has called Southern California a "high-risk environment" for health care fraud. The FBI's Los Angeles Field Office has also pledged to crack down on health care fraud with the National Fraud Enforcement Division within the DOJ. This week a federal court has granted a request from the United States to seize more than $2 million from a Pasadena-based advanced wound care clinic accused of defrauding Medicare for reimbursements for skin graft substitutes and skin grafts that never were performed on patients. According to an affidavit filed with a federal seizure warrant, from September 2025 to April 2026, Expert Wound Care submitted more than $46.6 million in claims to Medicare for skin substitute products and wound care services purportedly provided to 78 beneficiaries. Medicare approved payments of approximately $34,031,382 on these claims, which included skin substitutes and skin grafts as well as skin application procedures. From January 2025 to June 2025, the national average for a billing provider’s allowed amount per claim for skin substitute grafts was $16,837. From July 2025 to March 2026, Expert Wound Care averaged approximately $37,449 in allowed amount per claim for substitute skin grafts, more than double the national average. The clinic increased its Medicare billing from $4,975 in July 2025 to approximately $33 million in December 2025, according to the affidavit. One beneficiary had a total payment amount to Medicare of approximately $6,232,645, and the average paid amount per beneficiary was approximately $299,639. One of the most alarming details involves a single patient. From October 2025 to February 2026, Expert Wound Care billed Medicare for approximately $2,611,105 and was paid approximately $2,039,792 for skin substitute grafts and 52 skin graft application services purportedly provided to one beneficiary. Law enforcement determined that the beneficiary did not receive any skin grafts as part of his treatment and did not receive any type of home service in December 2025 despite the fact Expert Wound Care filed 27 claims for services on this beneficiary’s behalf for that month. And there seems to have been some statistical red flags. Expert Wound Care’s percentage of total beneficiaries receiving substitute skin grafts of 38.5%, more than six times the national average of 6%. Its percentage of total claims for substitute skin grafts was 63%, approximately nine times the national average. Finally, Expert Wound Care’s percentage of total allowed amount for substitute skin grafts was 99.9%, more than double the national average. Homeland Security Investigations and the United States Department of Health and Human Services Office of Inspector General are investigating this matter. Assistant United States Attorney Jonathan S. Galatzan of the Asset Forfeiture and Recovery Section is handling this case. The Department of Justice has created the National Fraud Enforcement Division. The core mission of the Fraud Division is to zealously investigate and prosecute those who steal or fraudulently misuse taxpayer dollars. Department of Justice efforts to combat fraud support President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chair by Vice President J.D. Vance to eliminate fraud, waste, and abuse within federal benefit programs ...

On the morning of Monday, September 12, 2022, Kai-Lin Chang was riding his bicycle on Victory Boulevard in West Hills when Dr. Brittany Doremus, a palliative care physician employed by Southern California Permanente Medical Group (SCPMG), made a left turn across his path while pulling into a dry cleaner's parking lot to drop off her children's Halloween costumes. Chang collided with her vehicle and was hospitalized with injuries. He sued both Doremus and SCPMG, alleging Doremus was acting within the scope of her employment at the time of the accident and that SCPMG was therefore vicariously liable under the doctrine of respondeat superior. Doremus's work schedule was not a simple nine-to-five arrangement. On Mondays and Tuesdays she worked at her office at the Woodland Hills Medical Center. On Wednesday mornings she could work from home, on Thursday and Friday she worked with patients at the medical center's hospital, and when on call on nights or weekends she worked from home. SCPMG also provided its physicians with employer-issued cell phones equipped with special communication software. On the morning of the accident, Doremus testified she had left home around 8:30 a.m. to drive to the office and was on a purely personal errand — dropping off the costumes — when the collision occurred. She did not recall being on any call before the accident. Following the collision she called 911, then sent a group text to the nurse and social worker on her team to cancel her appointments for the day. SCPMG produced a text message log from Doremus's wireless carrier showing no texts between 8:30 and 8:44 a.m., with a cluster of messages beginning at 8:44 — the post-accident notifications to her coworkers. A call log showed no work calls before the accident. The trial court granted SCPMG's motion for summary judgment. The court found the going and coming rule plainly applied: Doremus was commuting to work on a Monday, as she did every week, and was in the middle of a personal errand — wholly unrelated to her employment — when the accident occurred. The court found no recognized exception to the rule applied: Doremus was driving her own personal vehicle that SCPMG neither provided nor required, she was on no special errand for her employer, and SCPMG derived no incidental benefit from her use of the vehicle. The court overruled Chang's evidentiary objections to the call and text records, noting that Chang himself had relied on those same records in his opposition. Chang appealed. The Second District affirmed summary judgment for SCPMG in full in the published case of Chang v. Southern California Permanente Medical Group Case No. B340770 (April 2026). The court awarded SCPMG its costs on appeal. The opinion was originally filed April 9, 2026 without publication, then certified for publication on April 28, 2026, with no change in judgment. SCPMG met its burden of proof; Chang did not meet his. The court emphasized that in respondeat superior cases involving driver testimony, an employer does not have to eliminate every conceivable possibility of work activity — sworn testimony that the driver was not working is sufficient to shift the burden. Doremus's deposition testimony that she was commuting on a personal errand, not on a call, and driving her own vehicle accomplished exactly that. Chang then had to offer admissible contradictory evidence, and he failed to do so. The "hybrid worker" argument failed on the facts. Chang's more novel contention was that because Doremus sometimes worked from home, her home had become a second worksite, and her Monday morning drive was therefore transit between worksites rather than an ordinary commute — placing her within the scope of employment. The court rejected this categorically. Doremus worked at the medical center on Mondays without exception. Even accepting the premise that a home can become a second worksite, it is only a worksite when the employee is actually working from home — not as a permanent all-day status. On Monday mornings Doremus was not working from home; she was driving to the office. The court found that none of the cases Chang cited — including Wilson v. Workers' Comp. Appeals Bd. (1976) 16 Cal.3d 181, 184, Bramall v. Workers' Comp. Appeals Bd. (1978) 78 Cal.App.3d 151, Zhu v. Workers' Comp. Appeals Bd. (2017) 12 Cal.App.5th 1031, and State Ins. Fund v. Industrial Commission (Utah 1964) 15 Utah 2d 363 — supported the proposition that a hybrid worker's home is a second worksite on days when she is not working from it. Workers' compensation cases are the wrong measuring stick. The court also noted — pointedly, since Chang had himself argued below that workers' compensation cases had "no applicability in tort cases" — that the going and coming rule as applied in tort is more restrictive than in workers' compensation. Citing Pierson v. Helmerich & Payne Internat. Drilling Co. (2016) 4 Cal.App.5th 608, 619, the court observed that workers' compensation law resolves any reasonable doubt in the employee's favor, a policy tilt that does not carry over to third-party tort liability against employers. Policy reinforced the holding. The court offered a final, practical observation: ruling for Chang would effectively abolish the going and coming rule for any employee who sometimes works from home, creating a perverse incentive for employers to curtail workplace flexibility to avoid expanded tort exposure. The court found no sound policy rationale for that result ...

On April 20, 2026, Rideshare Drivers United — which says it represents more than 20,000 drivers in California — filed a lawsuit in San Francisco Superior Court alleging that Uber is not providing the benefits to California drivers that Proposition 22 requires in order to treat them as independent contractors. The case is Rideshare Drivers United v Uber Technologies Inc., Case Number: CGC26636126. California has adopted the ABC test to determine if a worker is an independent contractor or an employee. The ABC test presumes a worker is an employee and places the burden on the hiring entity to establish three factors: “(a) that the worker is free from control and direction over performance of the work, both under the contract and in fact; (b) that the work provided is outside the usual course of the business for which the work is performed; and (c) that the worker is customarily engaged in an independently established trade, occupation or business (hence the ABC standard). In 2020, a coalition of companies, including Uber, initiated a ballot initiative to overturn the ABC test for drivers and instead declare all “app-based drivers” who met certain conditions to be independent contractors and not employees. Prop 22 was approved by voters in 2020 and established that drivers for app-based transportation services like Uber and Lyft are independent contractors — not employees — under state law. However, it only applies if drivers are provided with certain benefits, including a minimum wage, subsidies for health insurance, and the ability to appeal terminations Bus. & Prof. Code § 7452(c). The Plaintiff Rideshare Drivers United (“RDU”) is a California nonprofit corporation with a principal place of business in Pasadena, California. It was founded in 2018 and registered as a nonprofit corporation in 2020. RDU’s declared mission is to support “app-based drivers”, including Uber drivers, organizing to improve their working conditions and rights on the job. The RDU lawsuit alleges that "Uber has failed to comply with Proposition 22 since its enactment in various ways." And it claims that "Allowing Uber to wield Proposition 22 as a shield against driver misclassification claims, while simultaneously flouting its legal obligations under the law, is fundamentally unjust and unlawful." Plaintiffs allege Uber has failed to create an appeals system to give drivers due process when they're kicked off the app. The measure had included a promise that drivers would have an appeals process. Many deactivated drivers report that they struggle to appeal their cases — they say they are initially sent to sites where they appear to be talking with bots, then eventually reach agents working from a script who appear to be in another country, and rarely reach people who are empowered to truly help them. Plaintiffs thus allege Uber has not provided any bona fide appeals process for drivers to challenge their terminations (or “deactivations”, as Uber calls them), and "certainly no appeals process that comports with any standards of due process." The plaintiffs also allege that Uber deactivates drivers based on grounds not specified in its "Platform Access Agreement," and that the company does not provide drivers with enough information about their earnings to verify they are receiving 120% of minimum wage. The lawsuit seeks a declaration that Uber has violated Prop 22 and "is barred from asserting that its drivers are independent contractors," which would open the door for drivers to sue Uber for wage law violations. Rideshare Drivers United is seeking legal fees and costs but no monetary damages directly from this suit. However Attorney Shannon Liss-Riordan stated she is at some point seeking back pay and other damages for drivers who were unfairly deactivated, as well as their rights under the labor code. This lawsuit is the latest of many legal challenges against Prop. 22, which CalMatters has found has no state agency assigned to enforce it. The state Supreme Court upheld the gig-work law in 2024. Separately, Uber is also facing a lawsuit by the state Justice Department and the cities of San Francisco, Los Angeles, and San Diego over thousands of wage-theft claims that predate Prop. 22, with a trial-clock deadline set for December 2027 ...