The National Safety Council released the 2023-2024 MSD Solutions Index Pledge Community Report, a benchmarking survey which has revealed meaningful progress in addressing one of the most pervasive workplace injuries: musculoskeletal disorders, or MSDs. MSDs impact employees across numerous industries and cost U.S. businesses billions annually. Recognizing the effects these injuries have on workers and employers, NSC formed the MSD Solutions Lab in 2021 with funding from Amazon (NASDAQ: AMZN) to solve work-related MSDs. “This year’s report reflects the dedication of the MSD Pledge community to building safer workplaces and protecting workers’ health,” said Katherine Mendoza, senior director of workplace safety programs at NSC. “With the insights from the MSD Solutions Index, we see organizations are making significant strides and identifying critical areas for improvement, proving that the MSD Pledge can drive real change in the safety and wellbeing of workers worldwide.” The 2023-2024 MSD Solutions Index survey, conducted from December 2023 to June 2024, included responses from 44 MSD Pledge members, with data compared to the previous year’s findings. Organizations received an overall index result, as well as results for the three pledge commitment subsections, that fell into one of five categories representing MSD prevention maturity: novice, reactive, advancing, proactive and innovating. Key takeaways included: - - Higher overall results: 81.4% of organizations achieved overall ratings in the advancing or proactive categories, with 11.6% reaching the innovating category — an improvement from the 2022-2023 cycle, where no organizations received innovating scores. - - Enhanced use of ergonomics programs: Nearly 89% of respondents have some form of MSD prevention and ergonomics program, which is up from about 83% last year. Organizations with ergonomics programs also reported higher scores across all MSD prevention areas. - - Increased focus on leading indicators of MSDs: This year, 65.1% of respondents reported prioritizing leading indicators over lagging ones, a significant increase from 42% in the prior year. This shift reflects a growing focus on proactive measures to prevent MSDs before they occur. - - Broader employee involvement in safety decisions: Nearly 68% of respondents engage frontline workers in safety-related decision-making, with employees regularly consulting on workstation design, job tasks and workflow. This approach is associated with stronger safety cultures and greater trust across organizational levels. - - Increased reporting of common MSD risk factors: Awkward postures, lifting and prolonged sitting and standing were among the top risk factors cited, with low back pain emerging as the most common MSD-related ailment — reported by 77.3% of respondents, in comparison to only 57.7% last year. - - Expanded sharing of effective MSD solutions: This year saw a rise in organizations sharing MSD prevention successes internally and externally, with 76.7% reporting they share solutions beyond their organization. Collaborative efforts were also highlighted, with almost 87% engaging in or researching MSD prevention technologies. While the report highlighted several areas of success among the MSD Pledge community, it also identified ongoing areas of opportunity, such as in quantifying non-physical risk factors like mental fatigue, expanding the use of technology, and engaging smaller organizations that may lack the resources of larger companies. To advance MSD prevention efforts, the report recommends organizations adopt the following strategies: - - Engage leadership to help foster a strong safety culture, which is crucial for effective MSD prevention. - - Prioritize employee feedback and collaboration by involving frontline workers in ergonomic assessments and decision-making. - - Set targeted goals for risk reduction by developing clear, measurable objectives that can help guide organizations and track progress. - - Leverage and explore new technologies and innovations, from ergonomic assessment tools to automation, to help reduce MSD risks. The MSD Solutions Index is one of several initiatives led by NSC to achieve its goal of preventing MSDs before they start. To learn more about these efforts or sign up for the MSD Pledge 2.0, visit nsc.org/msd ...

In response to the raging fires in Los Angeles County, and the threatened exodus of fire insurance companies, state legislators introduced Assembly Bill 226 on January 9 2025, a proposed law named the FAIR Plan Stabilization Act. The California FAIR Plan Association is a joint reinsurance association in which all insurers licensed to write basic property insurance participate in administering a program for the equitable apportionment of basic property insurance for persons who are unable to obtain that coverage through normal channels. Existing law requires the association’s plan of operation and any amendment to the plan to be approved by the Insurance Commissioner. Existing law establishes the California Infrastructure and Economic Development Bank and authorizes it to issue bonds to provide funds for the payment of costs of a project for a participating party or upon request by a state entity. This bill would authorize the association, if granted prior approval from the commissioner, to request the California Infrastructure and Economic Development Bank to issue bonds, and would authorize the bank to issue those bonds to finance the costs of claims, to increase liquidity and claims-paying capacity of the association, and to refund bonds previously issued for that purpose. The bill would specify that the association is a participating party and that financing all or any portion of the costs of claims or to increase liquidity and the claims-paying capacity of the association is a project for bond purposes. The bill would authorize the bank to loan the proceeds of issued bonds to the association, and would authorize the association to enter into a loan agreement with the bank and to enter into a line of credit agreement with an institutional lender or broker-dealer. This bill would require the association, if the above-described bonds, loan agreements, or lines of credit received the prior approval of the commissioner, to assess members in the amounts and at the times necessary to timely pay in full all obligations of the association with respect to those bonds, loan agreements, or lines of credit and related agreements, as specified. This bill would declare that it is to take effect immediately as an urgency statute. “AB 226 will alleviate some of the uncertainty that FAIR Plan policy holders may encounter as a result of this tragedy,” said Assemblymember Lisa Calderon, a Whittier Democrat, chair of the Assembly Insurance Committee and one of the bill’s authors, in a statement reported by Courthouse News. “We remain steadfast in acting with urgency to support the impacted communities during this difficult time. “This bill is an excellent first step, among many we must take, to stabilize California’s insurance market by protecting the FAIR Plan,” said Assemblymember David Alvarez, a San Diego Democrat and the bill’s other author, in a statement. “When disaster strikes, Californians should be able to count on their insurance coverage to pay out valid claims.” Assembly Speaker Robert Rivas, a Hollister Democrat, announced plans for the bill on Thursday. He said many of his colleagues are in Los Angeles to help, volunteering with local efforts and ensuring people and organizations have the resources they need. Speaking to the media, Rivas said the Assembly will introduce legislation focused on recovery efforts, as well as a bill to expedite homeowner insurance claims ...

New data from the California Workers’ Compensation Institute (CWCI) shows recent shifts in the types of drugs prescribed to injured workers in California, and in the distribution of payments for those medications, with anti-inflammatory drugs ranking first in terms of the number of prescriptions, but dermatologicals, which include a number of high-priced, private label drugs, accounting for the biggest share of the total drug spend. A review of total payments by drug ingredient shows that from January through June of last year, the dermatological lidocaine (average payment $159: $216 brand, $151 generic) ranked first among all drugs in terms of the California workers’ compensation total drug spend, accounting for 8.5% of all payments. That was more than twice the percentage noted for the anti-inflammatory naproxen, which ranked second with 4.2% of the prescription dollars, just ahead of the anticonvulsant pregabalin, which ranked third with 4.1%. The dermatological diclofenac sodium (topical) ranked fourth, consuming 3.1% of the pharmaceutical payments, while the anti-inflammatory meloxicam and the migraine drug rimegepant sulfate rounded out the top 6 drugs, each consuming 2.8% of the total drug spend in the first half of 2024. CWCI analysts noted the shifts in prescription drug utilization and reimbursement among the drug groups suggested an association between the ongoing decline in opioid use with the state’s adoption of the Opioid and Pain Management Guidelines into the Medical Treatment Utilization Schedule (MTUS) in late 2017, and the implementation of the MTUS Formulary in 2018. The historical data show that anti-inflammatories such as ibuprofen and naproxen, often used as non-narcotic alternatives to treat pain, surpassed opioids to become the top drug group in 2016, and by 2021 they accounted for a record 35.3% of all prescriptions dispensed to California injured workers. Dermatological drugs are often used to treat pain, and with opioid use declining their share of the workers’ comp prescriptions grew from 4.9% in 2016 to 12.6% in the first half of 2024. Though many different dermatologicals are used to treat injured workers, the breakdown by drug ingredients shows most of that growth was due to the increased use of prescriptions containing lidocaine and/or diclofenac sodium, which together increased from 46% of the dermatological prescriptions in 2016 to 81.6% in the first half of 2024. In 2022, anticonvulsants, which are often used to treat neuropathic pain, surpassed opioids to become the third most prescribed workers’ comp drug group and since then they have maintained that ranking, while antidepressants surpassed opioids in 2023 (accounting for 8.0% of the prescriptions) and they remained the fourth most prescribed drug group in the first half of 2024 (8.1%). Like opioids, musculoskeletal drugs have seen their share of the prescriptions drop sharply over the past 8-1/2 years, falling from 10.7% of the prescriptions in 2016 (third behind anti-inflammatories and opioids) to 5.8% in 2021 before they leveled off at just over 6% over the past 2-1/2 years (sixth among all drug groups). This decline coincided with the implementation of the Formulary in January 2018, as under the Formulary, musculoskeletal drugs are not exempt from utilization review except for limited special fill or perioperative use where only limited quantities can be dispensed. CWCI has published additional details and complete lists of the top 10 California workers’ compensation therapeutic drug groups based on prescription volume and payments from 2016 through June of 2024 in Bulletin 2025-01 ...

The Party Staff, Inc. was founded in 1989 and is headquartered in Oakland California. The company has supplied staff for more than 100,000 events from backyard barbecues to black-tie dinners, cocktail parties to corporate events. The company provides formal and banquet servers, buffet attendants, tray passers, bartenders, cooks/chef/prep, grillers/carver/captains, event managers, host/hostesses, event attendants, set-up and break-down, concessions, coat check, permanent placements. According to multiple media reports the company has filed a groundbreaking lawsuit on January 8, 2025 against many of their competitors challenging their claim to have exempt employees who are part of the gig economy. The case is The Party Staff v. Qwick, California Superior Court, San Francisco County, No. CGC-25-621259. According to The Party Staff allegations, "This case is brought under the California Unfair Competition Law, Cal. Bus. & Prof. Code § 17200, et seq. (“UCL”), based on Defendants’ widespread misclassification of employees as independent contractors in violation of numerous provisions of the California Labor Code, as well as under California Labor Code § 2753, which imposes liability upon persons who knowingly advise employers to classify individuals as independent contractors to avoid employee status." "In accordance with the California Labor Code, Plaintiff classifies its workers as employees and thus bears the typical costs of being an employer, such as paying minimum wage and overtime and complying with other Labor Code protections, maintaining workers’ compensation insurance, and paying significant payroll taxes." "However, in recent years, Plaintiff has been increasingly undercut significantly by competing companies that bill themselves as “gig economy platforms”, such as Defendants Qwick, Instawork, and Tend, which have lifted a page from the “Uber” playbook, and misclassified their workers as independent contractors rather than employees." "In reality, Qwick, Instawork, and Tend are hospitality staffing companies (just like Plaintiff), and they have violated California law by classifying their workers as independent contractors. In so doing, they have been able to offer lower prices than Plaintiff, thereby gaining a significant competitive advantage." The Party Staff goes on to allege that "companies such as Defendants Aramark and ISS Guckenheimer that hold contracts for dining and catering services with large institutions have then contracted with Qwick, Instawork, and Tend for staffing, allowing Aramark and ISS Guckenheimer to profit from and perpetuate this misclassification as joint employers of those workers." "Plaintiff, which has complied with the law by classifying its workers as employees, has had its business significantly undercut by Defendants’ actions and has lost numerous clients as a result, significantly impacting its revenue. Defendants’ conduct is both unlawful and unfair, in violation of California’s Unfair Competition law." The Party Staff is seeking injunctive and declaratory relief in the form of an order directing Defendants to comply with the California Labor Code, among other relief. Boston-based lawyer Shannon Liss-Riordan, who represents The Party Staff, said the lawsuit is the first of its kind involving staffing firms. "When companies misclassify workers, they make it very difficult for law-abiding companies to compete, and they drive an economic race to the bottom," Liss-Riordan told Reuters ...

A new fact sheet titled “Wearables in the Workplace: The Use of Wearables and Other Monitoring Technology Under Federal Employment Discrimination Laws,” released by the U.S. Equal Employment Opportunity Commission (EEOC) addresses use of wearable technologies in the nation’s workplaces. These technologies can be used to track various physical factors, such as an employee’s location, heart rate, electrical brain activity, or fatigue. The new fact sheet reminds employers that employment discrimination laws apply to the collection and use of information from wearables. It also addresses the need for employers to provide reasonable accommodations related to wearables. Employer-mandated wearables, such as watches, rings, glasses, or helmets which collect information about a worker’s health and biometric data may be conducting a “medical examination” as defined by the Americans with Disabilities Act(ADA). If the wearables require employees to provide health information (including in the setting up of the device), the employer may be making “disability-related inquiries.” The ADA limits the use of medical examinations or disability-related inquiries by employers and also requires employers to safeguard medical records. “With the increasing availability of wearable technologies, some employers may be considering implementing them in their workplaces. It’s important that employer keep in mind that some uses of wearables can violate federal antidiscrimination laws,” said EEOC Chair Charlotte A. Burrows. “If they do choose to bring this technology into the workplace, employers must be vigilant in following the law to ensure that they do not create a new form of discrimination. There is no high-tech exemption to the nation’s civil rights laws.” In addition, an employer’s improper use of information that wearables collect may raise concerns under other federal anti-discrimination laws. Employers should be careful about using data collected by wearable devices to determine sex, age, genetic information, disability, or race to take an adverse action against an employee. The new resource provides a number of examples to avoid. Lastly the new document reminds readers that employers using wearables may need to provide reasonable accommodations for workers under the Pregnant Workers Fairness Act, or as a religious or disability accommodation. For more information on the EEOC’s initiative on artificial intelligence and algorithmic fairness visit the EEOC’s website at https://www.eeoc.gov/ai ...

Bonnie Ducksworth and Pamela Pollock were customer service representatives at Tri-Modal Distribution Services. Tri-Modal promoted others but, for decades, never promoted them. Ducksworth and Pollock believed this was due to discrimination against African-Americans. They sued. In 2018, Pamela Pollock also sued her supervisor Michael Kelso for sexual harassment and, on grounds of race, refusing to promote her. Pollock alleged Kelso asked her for sexual intercourse in 2016 and, after she rejected him, he promoted five less qualified people of other races to positions she sought. The trial court ruled Pollock’s suit was time-barred. In 2020 the Court of Appeal affirmed. (Ducksworth v. Tri-Modal Distribution Services (2020) 47 Cal.App.5th 532.) The case implicated employer Tri-Modal, but it was not involved in this appeal. In 2021, the Supreme Court reversed and rendered three holdings. First, the statute of limitations in this type of case begins to run when plaintiffs knew or should have known of the adverse promotion decision. (Pollock v. Tri-Modal Distribution Services, Inc. (2021) 11 Cal.5th 918, 941.) Second, the defense bears the burden on this issue. (Id. at p. 947.) Third, under the Fair Employment and Housing Act, an appellate court may not award costs or fees on appeal to a prevailing defendant without first determining that plaintiff’s action was frivolous, unreasonable, or groundless when brought, or that plaintiff continued to litigate after it clearly became so. (Id. at pp. 947–951.) Following the Supreme Court’s directions, in 2021 the Court of Appeal remanded and ordered costs for Pollock. In the trial court, Pollock moved for $526,475.63 in attorney fees under subdivision (c)(6) of Government Code section 12965 in late 2021. In March 2022, the trial court awarded $493,577.10. Kelso filed his notice of appeal. In February 2023, Kelso and Pollock settled the bulk of their case. Pollock moved to dismiss her underlying case with prejudice, except for the attorney fee award that Kelso was appealing. The Court of Appeal approved the trial court award of costs in the published case of Pollock v. Kelso -B320574 (January 2025). Kelso argues that, first, Pollock was not a prevailing party, and second, the award was too high. When the trial court set a trial date and it grew near, Kelso decided to settle. Kelso declines to lodge the "confidential" settlement agreement with this court in camera, which Pollock’s counsel maintains expressly identifies Pollock as the prevailing party. At oral argument, Pollock’s attorney brought the settlement document to counsel table, but Kelso’s appellate attorney claimed she had never seen it. She declined to view it. Kelso’s reluctance, and Pollock’s willingness, reveal that Pollock won something tangible. Pollock’s gain postdates the trial court’s fee award, but it has significance for this appeal: the case is over and, as a practical matter, the time is ripe to consider a fee award. The Court then turned to issue number two: the size of the award and noted "Kelso maintains the amount of the trial court’s fee award - $493,577.10 - is unreasonable. The court abused its discretion, Kelso asserts, by failing to apportion the award among “the defendants involved in the appeal.” Kelso, however, fails to identify who these other defendants were, how their issues might have been different from Kelso’s, and in what degree. Kelso forfeited this argument by failing to elaborate his argument in meaningful detail in his opening brief. It is not fair for Kelso to ask this court to spell out the particulars of his vague argument. His approach, were we to indulge it, would not give Pollock reasonable notice of the thrust she must parry." The opinion reviewed the evidence submitted and arguments made to the trial court that computed the attorney fee in great detail. It reviewed case law that established the proposition that "trial judges are in the best position to evaluate attorney fee awards." Ultimately the Court of Appeal affirmed the trial court ...

The Department of Industrial Relations (DIR) and its California Division of Occupational Safety and Health (Cal/OSHA) has cited Safeway $182,000 in proposed penalties for significant safety violations that put approximately 1,700 workers at risk of serious injuries at the company’s warehouse in Tracy, their largest facility in the nation. Cal/OSHA issued citations for 27 violations, including 8 that were serious in nature, after completing a comprehensive inspection at Safeway’s Northern California Tracy Distribution Center. Key Issues Identified during this high-hazard industry inspection Include: - - Manual material handling injuries: Safeway failed to identify and fix issues related to lifting, carrying, and moving heavy items; and did not provide effective training to their supervisors or workers on these hazards. - - Recordkeeping violations: The employer failed to ensure the accuracy of annual employee injury and illness summaries, and failed to provide injury and illness recordkeeping documents to Cal/OSHA in a timely manner for their review. - - Indoor heat hazards: Safeway failed to establish and maintain effective procedures to address indoor heat hazards in the warehouse’s dry building, which is not temperature controlled, and failed to effectively train employees on the hazards of indoor heat. Additionally, the company failed to provide access to proper cool-down areas for workers to use during meal breaks. - - Chemical and health hazards: The employer provided inadequate ventilation or exhaust systems for employees welding in two buildings, risking exposure to toxic substances. Access to eye wash stations and safety showers was deficient in multiple work areas where employees interacted with corrosives. - - Electrical hazards: The worksite had multiple damaged electrical cords and unsafe electrical panelboards. - - Training for truck operators: Safeway failed to provide effective refresher training and evaluations for industrial truck operators to ensure that operators had the skills needed to operate trucks safely. Employers have the right to appeal any Cal/OSHA citation and notification of penalty by filing an appeal with the Occupational Safety and Health Appeals Board within 15 working days from the receipt of notification ...

The Paperwork Reduction Act (H.R. 3797) ("PBRA"), passed by the 118th Congress on December 11, 2024, is legislation aimed at reducing the administrative burden on businesses and individuals.This legislation aims to significantly reduce the administrative burden faced by businesses and individuals. Here's a breakdown of the Paperwork Reduction Act key provisions: - - Focus on Employer Reporting: A central focus of the act is to ease the reporting requirements for employers, particularly those related to health insurance coverage. - - Simplified 1095-C Forms: The act modifies provisions under the Affordable Care Act. Employers will no longer be obligated to send physical copies of the 1095-C form, which provides employees with information about their health insurance coverage. - - Alternative Reporting Methods: Employers will have the option to provide employees with clear and accessible instructions on how to request a copy of their 1095-C form. This shift from mandatory physical distribution to an "on-demand" system is intended to streamline the process. - - Reduced Administrative Costs: By simplifying reporting requirements and eliminating the need for mandatory paper forms, the act aims to reduce administrative costs for businesses of all sizes. This could translate into cost savings that can be reinvested in other areas of their operations. - - Improved Efficiency: The streamlined reporting process is expected to improve efficiency for both employers and employees. Employers will spend less time on administrative tasks related to health insurance reporting, allowing them to focus on other priorities. Employees will have greater flexibility in accessing their coverage information. The Paperwork Reduction Act represents a significant step towards reducing the administrative burden on businesses. By simplifying employer reporting requirements related to health insurance coverage, the act aims to create a more efficient and less costly system for both employers and employees. And employers may benefit from another new federal law.The Employer Reporting Improvement Act (H.R. 3801) ("ERIA") was passed alongside the Paperwork Reduction Act in December 2024. It focuses on streamlining Affordable Care Act (ACA) reporting requirements for employers, specifically: - - Codifying Existing IRS Regulations: The ERIA codifies certain IRS regulations designed to simplify ACA reporting for employers. This provides legal certainty and reduces the risk of future regulatory changes that could increase the burden on businesses. - - Establishing a Statute of Limitations: A crucial provision of the ERIA establishes a six-year statute of limitations for penalty assessments related to ACA coverage failures. This provides much-needed clarity and limits the potential for indefinite liability for employers. - - Flexibility in Reporting: The ERIA allows employers greater flexibility in fulfilling their reporting obligations. For example, it permits electronic delivery of 1095-B and 1095-C forms to employees who consent to receive them electronically. - - Alternative Identifier for Social Security Numbers: The ERIA allows employers to use an individual's date of birth as an identifier in certain situations where the Social Security Number is unavailable. This helps to ensure accurate reporting even in cases where obtaining a Social Security Number may be challenging. - - Extended Response Time for IRS Notices: The ERIA allows employers more time to respond to Employer Shared Responsibility (ESR) letters from the IRS, giving them additional time to investigate and address any potential issues. The ERIA complements the Paperwork Reduction Act by providing specific, targeted improvements to ACA reporting requirements. By codifying existing regulations, establishing a statute of limitations, and increasing flexibility for employers, the ERIA aims to significantly reduce the administrative burden associated with ACA compliance. The specific provisions and their impact may vary depending on individual circumstances and the specific requirements of the IRS ...

The State Compensation Insurance Fund announced that it will declare an approximate $149 million dividend to qualifying policyholders with policies that took effect between January 1 and December 31, 2024. This dividend equals approximately 15% of the estimated annual premium reported during that period. In 2024, SCIF reported approximately $993 million in estimated annual premium (EAP) and netted $572 million in investment income. “We’re proud to be able to return money to our policyholders for the sixth consecutive year,” said SCIF President and CEO Vern Steiner. "California business owners and entrepreneurs are working hard to keep up with the rising costs of doing business. So we’re working hard to provide them with as much value as possible.” Over the past six years, we've declared more than $630 million in dividends. Payment of the 2024 dividend for eligible policyholders is dependent on timing of final audit and payment of final bill and will occur no sooner than 18 months after policy inception. Policyholders will receive a Policyholder Dividend Statement that explains whether they have been deemed eligible for a dividend. Eligible policyholders will receive a dividend check with the Policyholder Dividend Statement. For more information about the 2024 dividend, please see the SCIF's answer to Frequently Asked Questions ...

On July 29, 2024, applicant’s attorney, John R. Ramirez, filed a petition for attorney’s fees pursuant to section 5710. He represented that he personally represented applicant at deposition, and requested a fee award of one hour of preparation time and 3.6 hours of actual deposition time. And he requested a fee issue at the hourly rate of $425.00 per hour, or $1,955.00 total. The workers WCJ issued an orderer that defendant pay $1,840.00 as a reasonable fee after finding that he was entitled to a rate of $400.00 per hour.The order contained a self-destruct clause advising that a timely objection within 20 days would void the order. Attorney Ramirez filed an objection letter along with a declaration of readiness to proceed to a mandatory settlement conference on the issue of 5710 fees.Accordingly, the dispute in this case is over an additional $115.00 fee. After a hearing on October 3, 2024. The WCJ ordered the matter taken off calendar over the objection of attorney Ramirez, and deferred the issue of the remaining L.C. 5710 attorney fees. On October 15, 2024 attorney Ramirez and The Ramirez Firm, filed a Petition for Reconsideration objecting to the Order taking the case off calendar. Specifically, in the Petition, Mr. Ramirez alleges that he is entitled to the unpaid portion of attorney’s fees and seeks to proceed to a trial on the issue of attorney’s fees. The WCAB denied his Petition for Reconsideration, and denied his Petition for Removal, and instead, it Granted Removal on Motion of the Appeals Board, and issued a Notice of Intent to Impose Sanctions against Attorney John R. Ramirez in the panel decision of Armando Amezcua v Milgard Windows Manufacturing - ADJ19104113, ADJ19104112, ADJ19104123, ADJ19104121 (December 2024). The WCAB noted that "it appears that Mr. Ramirez improperly filed a Petition for Reconsideration in response to a non-final order. It appears that Mr. Ramirez did this in six different cases and he was admonished in five of those cases to review his filings and make necessary corrections. Moreover on November 5, 2024, just a few months ago, the Appeals Board issued a significant panel decision in Latrice Reed v. County of San Bernardino. (2024 Cal. Wrk. Comp. LEXIS 69.) and admonished Mr. Ramirez who was the applicant attorney in that decision without imposing sanctions. Instead it said "for the purpose of this decision, we will assume that the filing of a petition for reconsideration rather than one for removal was merely a careless error. Accordingly, we do not take up the issue of sanctions at this time.” However, on this newest case, the WCAB concluded "It does not appear that Mr. Ramirez responded to any of the admonishments given to him. It appears that Mr. Ramirez filed a frivolous petition for reconsideration in this matter and allowed it to proceed on the merits, taking no steps to either withdraw or amend the pleading. It does not appear that our admonishments have had the actual effect of correcting Mr. Ramirez’s conduct". "Accordingly, and good cause appearing, pursuant to section 5813 and WCAB Rule 10421 we will issue a notice of intention to impose sanctions against John Ramirez (SBN 201939) in an amount up to $750.00 as he filed a petition for reconsideration from a non-final order, which appears to constitute frivolous conduct, particularly since Mr. Ramirez was admonished on five occasions to correct his conduct, and it appears that he failed to act." ...

A new California law (SB 1120) requires a health care service plan or disability insurer, including a specialized health care service plan or specialized health insurer, that uses an artificial intelligence, algorithm, or other software tool for the purpose of utilization review or utilization management functions, or that contracts with or otherwise works through an entity that uses that type of tool, to ensure compliance with specified requirements, including that the artificial intelligence, algorithm, or other software tool bases its determination on specified information and is fairly and equitably applied, as specified. The new law prohibits the AI, algorithm, or other software tool from denying, delaying, or modifying health care services based in whole or in part on medical necessity. Instead the law requires a medical necessity determination to be made only by a licensed physician or other licensed health care professional competent to evaluate the specific clinical issues involved in the health care services requested by the provider, as provided in existing law, by reviewing and considering the requesting provider’s recommendation and based on the patient’s medical history or other clinical history, as applicable, and individual clinical circumstances. According to the author of this new law, "recent reports of automated decision tools inaccurately denying provider requests to deliver care is worrisome. While AI has the potential to improve healthcare delivery, it must be supervised by trained medical professionals who understand the complexities of each patient’s situation. Wrongful denial of insurance claims based on AI algorithms can lead to serious health consequences, and even death. This bill strikes a common sense balance that puts safeguards in place for automated decision tools without discouraging companies from using this new technology." The new law was supported by several medical organizations including the California Medical Association, California Academy of Family Physicians, California Chapter of American College of Cardiology California Dental Association, California Hospital Association, California Orthopedic Association California Podiatric Medical Association, California Rheumatology Alliance, and others. There was no opposition to this new law voiced by any organization according to the Bills history. The California Medical Association, sponsor of this bill, writes while AI tools can improve access to care and assist providers, they have also faced criticism for inaccuracies and biases. This bill addresses those issues by guaranteeing that a provider has final approval of utilization review decisions when AI is being used. According to a report about this new law by Government Technology Today newsletter, last year, about a quarter of all health insurance claims were denied in California — a reality mirrored nationwide that has stoked public anger toward health care companies, and led to accusations that such decisions lack human empathy. According to 2024 data from the California Nurses Association, approximately 26% of insurance claims are denied, one of many factors that inspired the law’s primary author, state Sen. Josh Becker, a Menlo Park Democrat. “In 2021 alone, (nationwide) data showed that health insurance companies denied more than 49 million claims,” said Becker, citing data from the Kaiser Family Foundation. “Yet customers appealed less than 0.2% of them.” In November 2023, a lawsuit against UnitedHealthcare spotlighted concerns about the misuse of AI in health insurance decision-making, accusing the company of using artificial intelligence to deny claims. While SB 1120 does not entirely prohibit the use of AI technology, it mandates that human judgment remains central to coverage decisions. Under the new law, AI tools cannot be used to deny, delay or alter health care services deemed medically necessary by doctors ...

Blue Cross and Blue Shield of Oklahoma (“BCBSOK”) have filed a civil Racketeering (RICO) action against South Coast Behavioral Health LLC (“SCBH”), Excellence Recovery LLC (“Excellence Recovery”), Everything in Excellence Recovery LLC (“EIE”), Rad Life Recovery, LLC, (“Rad Life”), and individuals involved with those companies, that are California addiction treatment centers mostly located in Orange County. The lawsuit was filed in the United States District Court Central District of California (case 2:24-cv-10683-MWC-AJR). According to the allegations of the complaint, "Since at least 2020, BCBSOK and hundreds of individuals suffering from Substance Use Disorder (“SUD”) have been victimized by California-based SUD treatment providers and their co-conspirators." "California and Oklahoma are separated by over 1,000 miles and multiple states. There are hundreds, if not thousands, of SUD treatment providers between them. And yet, in the last few years alone, thousands of alleged Oklahoma residents have been trafficked across the country to California under the guise of obtaining SUD treatment. The one thing they have in common is that they are members of BCBSOK health benefit plans, most of them having been enrolled right before their arrival in California." "This surprising migration is not a result of quality treatment. Rather, it is driven by an army of fraudsters that have overrun certain parts of California’s SUD treatment industry to prey upon alleged Oklahoma residents, many of whom are members of Native American tribes." Oklahoma, according to many sources has the fifth highest rate of SUD in the country, at 16.1% of its population."The combination of a state plan offering robust out-of-state benefits and a large population in need of treatment provided a perfect target for profiteers like Defendants." "These SUD providers employ a range of fraudulent tactics. They hire “body brokers” to hunt down potential patients in exchange for kickbacks. Body brokers work with insurance agents to fraudulently enroll individuals in insurance plans. Once enrolled, patients are shipped across the country to receive “treatment,” the main goal of which is to enrich the providers, body brokers, insurance agents, and the others involved in the schemes. There are unlawful kickbacks at every level. In fact, many patients themselves receive cash, free “treatment,” and housing, which unlawfully influences their choice of providers and induces them to stay under the control of a particular provider so that their insurance can continue to be billed. It is becoming exceedingly difficult for good, quality, providers to operate in an industry awash in kickbacks and de facto bribes." "When insurance payments run out, the SUD providers kick patients to the curb, leaving these vulnerable individuals to fend for themselves thousands of miles from their homes. Often, these individuals are given no notice of their impending evictions and suddenly find themselves on the streets with no money to afford housing or the necessities of daily life, much less an expensive trip back home. Putting these already-vulnerable individuals in such desperate circumstances only heightens the chances for relapse." Plaintiffs go on to allege "the defendants here are among the worst perpetrators of these tactics. Collectively, they have caused BCBSOK plans alone to make over $36 million in wrongful payments." Last month, Blue Cross and Blue Shield of Oklahoma told the Southern California News Group that it will stop paying for all addiction treatment in California on Jan. 1, with a few exceptions. Young and associates are being sued by insurer Aetna in a fraud case that echoes this one. Young has countersued Aetna, saying the insurer is just trying to avoid paying what’s owed. It all echoes the battle between Health Net and now-defunct Sovereign Health that began in 2016. Health Net won big, with $45 million in damages and interest against Sovereign ...

Claims administrators are reminded that the Annual Report of Inventory (ARI) must be submitted in early 2025 for claims reported in calendar year 2024. The California Code of Regulations, title 8, Section 10104 requires claims administrators to file, by April 1 of each year, an ARI with the Division of Workers’ Compensation (DWC) indicating the number of claims reported at each adjusting location for the preceding calendar year. Even if no claims were reported in the prior year, the report must be completed and submitted to the DWC Audit Unit. Each adjusting location is required to submit an ARI unless its requirement has been waived by DWC. When ARI requirements are waived, claims administrators must file an annual report of adjusting locations. This report is to be filed annually on April 1 of each calendar year for the adjusting location operations as of December 31 of the prior year. Please submit the form prior to the April 01, 2025 deadline. Any document received after the date of April 01, 2025 is late and subject to a penalty for late reporting. The preferred method of delivery is email to Audit Unit email box at DWCAuditunit@dir.ca.gov. Once the document is received by the Audit Unit, the sender will receive an email confirmation. Claims administrators are required to report any change in the information reported in the ARI or annual report of adjusting location within 45 days of the effective date of the change. Penalties of up to $500 per location for failure to timely file this Report of Inventory may be assessed under Title 8, California Code of Regulations, Section 10111.1(b)(11) or 10111.2(b)(26). The form for 2024 can be found on the DWC website and the form was emailed to all Claims Administrator contacts in November. If your Company needs a copy, please email: DWCAuditunit@dir.ca.gov. Questions about submission of the ARI or the annual report of adjusting locations may be directed to the Audit Unit: State of California Department of Industrial Relations Division of Workers’ Compensation – Audit Unit 160 Promenade Circle, Suite #340 Sacramento, CA 95834-2962 Email: DWCAuditUnit@dir.ca.gov, FAX 916.928.3183 or phone 916.928.3180 ...

Taylor Capito received treatment in the emergency room of San Jose Healthcare System LP dba Regional Medical Center San Jose on two occasions. Regional is a major hospital in San Jose with an emergency room. Capito filed a class action complaint against Regional under the Consumer Legal Remedies Act (CLRA), challenging Regional’s “unfair, deceptive, and unlawful practice of charging [an EMS fee] without any notification of its intention to charge a prospective emergency room patient such a Fee for the patient’s emergency room visit.” Regional demurred and moved to strike the class allegations. In doing so, it briefed the legislative history behind the Payers’ Bill of Rights (Health & Saf. Code, § 1339.50 et seq.) and other federal and state regulations governing its pricing disclosures.The trial court sustained the demurrer and dismissed the case. And the Court of Appeal affirmed the dismissal in the unpublished case of Capito v. San Jose Healthcare System, LP – H049022, – H049646 (April 2023). However, there are conflicting opinions on this issue in other California courts. In another case, Joshua Naranjo filed a class action lawsuit against the Doctors Medical Center of Modesto Inc., seeking similar relief, however his case resulted in a conflicting opinion. In Naranjo v. Doctors Medical Center of Modesto (2023) 90 Cal.App.5th 1193, a published decision of the Fifth Appellate District in which the court had ruled that the hospital was required to further disclose the EMS fee prior to treating ER patients. The California Supreme Court agreed to hear the Capito case, and it resolved the conflicting decisions in the case of Capito v. San Jose Healthcare System, LP -S280018 (December 2024) The question here is whether hospitals have a duty, beyond what is required by the relevant statutory and regulatory scheme, to notify emergency room patients that they will be charged EMS fees. "Hospitals do not have a duty under the UCL or CLRA, beyond their obligations under the relevant statutory and regulatory scheme, to disclose EMS fees prior to treating emergency room patients. Requiring such disclosure would alter the careful balance of competing interests, including price transparency and provision of emergency care without regard to cost, reflected in the multifaceted scheme developed by state and federal authorities. Capito has not sufficiently alleged facts showing that the lack of such disclosure is “unlawful, unfair or fraudulent” on any theory she presents under the UCL or CLRA." Accordingly, the California Supreme Court affirmed the Court of Appeal’s judgment in favor of Regional ...

A former Van Nuys physician, a medical center he founded, a laboratory he co-owned, and an executive at these entities have agreed to pay $15 million to settle allegations that they submitted false claims to Medicare and Medi-Cal from the payment of illegal kickbacks and self-referring patients. Mohammad Rasekhi, who surrendered his medical license in December 2024; Sheila Busheri; Southern California Medical Center (SCMC); and R & B Medical Group, Inc. d/b/a Universal Diagnostic Laboratories (UDL) agreed to pay the amount. Rasekhi is the founder and chief medical officer of SCMC and the co-owner of UDL. Busheri is the chief executive officer of SCMC and the co-owner and chief executive officer of UDL. SCMC is a federally qualified health center that operates six clinics in Southern California. UDL is a reference and esoteric laboratory in Southern California. Medicaid is funded jointly by the states and the federal government. The State of California paid a portion of the Medicaid claims at issue and will receive approximately $7 million from the settlement. The United States alleged that the defendants knowingly submitted or caused the submission of false claims to Medicare and Medi-Cal by: - - paying kickbacks to marketers to refer Medicare and Medi-Cal beneficiaries to SCMC clinics in violation of the Anti-Kickback Statute (AKS): - - paying kickbacks to third-party clinics in the form of above-market rent payments, complimentary and discounted services to clinic staff, and write-offs of balances owed by patients and clinic staff in exchange for referring Medicare and Medi-Cal beneficiaries to UDL for laboratory tests in violation of the AKS; and - - referring Medicare and Medi-Cal beneficiaries from SCMC clinics to UDL for laboratory tests in violation of the Stark Act’s prohibition against self-referrals. The AKS prohibits parties who participate in federal health care programs from knowingly and willfully offering or paying remuneration in return for referring an individual to, or arranging for the furnishing of any item or services for which payment is made by, a federal health care program. Likewise, the Stark Act, which is also known as the Physician Self-Referral Law, prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies. The settlement announced resolves claims brought under the qui tam, or “whistleblower,” provisions of the False Claims Act in a joint filing by Ferzad Abdi, Julia Butler, Jameese Smith, and Karla Solis, who were former employees or managers of SCMC and UDL. The qui tam provisions permit a private party called a “relator” to 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. Abdi v. Rasekhi, No. 18-cv-03966 (C.D. Cal.). The settlement includes a $10 million payment for the portion of the case handled by the United States and a $5 million payment in a separate settlement between the relators and the defendants. Assistant United States Attorney Jack D. Ross of the Civil Fraud Section and Justice Department Trial Attorney Samson Asiyanbi of the Fraud Section handled this matter for the United States. The claims resolved by the settlement are allegations only and there has been no determination of liability ...