Menu Close

Chiropractor Peyman Heidary to Serve 54 Years for $150M Comp Fraud

Former chiropractor Peyman Heidary owned and oversaw a network of medical clinics to generate fraudulent billings to workers’ compensation and insurance carriers.

As a non-attorney, he also allegedly controlled the day-to-day operations of various law firms, including California Injury Lawyers.He allegedly controlled or directed hiring and firing, legal decision making, and income flow to and from the law firm. Codefendants Cary Abramowitz, a lawyer, and Ana Solis allegedly assisted Heidary in these operations.

Heidary also allegedly formed and controlled several health clinics in Southern California. Each was staffed by front and back room support staff for scheduling and basic medical services .

Included were chiropractors operating as primary treating physicians, allegedly providing blanket, cookie-cutter services to each patient at Heidary’s direction and making as many medical specialist referrals as possible. Despite their qualifications, they also wrote medical legal reports using Heidary’s templates, the most expensive report in workers’ compensation.

Medical doctors, or specialists, allegedly provided blanket treatment and medlegals on Heidary’s orders. Billings were made in each provider’s name, and payments were made to their accounts. However, Heidary required fee-splitting and he was the only one allowed to withdraw funds. Heidary also had the doctors sell their accounts-receivables (AR) to him, which he then sold to third parties.

Under the alleged fraud scheme, injured workers appeared at the law firm, which would fill out boilerplate paperwork and, on Heidary’s order, direct the workers to one of his clinics to begin treatment. At the clinic, the workers underwent treatments, regardless of need, such as massage, chiropractic, acupuncture, psychiatric and other services. After the maximum number of visits, they were discharged regardless of medical status.

A Riverside County grand jury returned an indictment against Heidary and his codefendants Cary Abramowitz, Ana Solis, and Gladys Ross. The criminal defendants filed a demurrer, and later a motion to dismiss this indictment, challenging in part whether they had received notice of the charges and whether the indictment improperly aggregated multiple acts into single counts. The trial court denied both requests. Heidary appealed.

The Court of Appeal summarily denied the petition on August 8, 2017. On October 11, 2017, the California Supreme Court intervened directing the Court of Appeal to address these issues. After this ordered review, the trial court ruling was affirmed by the Court of Appeal in the published case of Heidary v Superior Court.

Heidary, is described in court records as a chiropractor and suspected architect of a “massive, fully integrated criminal enterprise” designed to commit workers’ compensation insurance fraud. According to the indictment, Heidary went by the aliases Brian Heidary, Number One and The Godfather. Heidary owned or ran numerous businesses, including law firms and health clinics, and relied on other people to disguise his involvement and create a complex and illegal ownership structure, according to court records.

The criminal activity dates back to at least 2009, according to investigators. Heidary was originally charged in July 2014, but an indictment filed in Riverside County Superior Court expands the case and named new co-conspirators.

Heidary was convicted by a Riverside County jury in January 2024 of 68 counts of insurance fraud, conspiracy, money laundering, and various other charges.

Although originally charged with $98 million in fraud, evidence presented at trial, including Heidary’s testimony, revealed that the actual damage was about $150 million. During the sentencing hearing on April 12, 2024, Judge Charles Koosed noted that Heidary possessed deep knowledge of the workers’ compensation system, stating, “’[Heidary] took advantage of that knowledge based on greed.”

On April 12, 2024, Heidary was sentenced to 54 years, eight months in state prison and ordered to pay more than $23 million in fines for his role in orchestrating a massive workers’ compensation fraud scheme totaling $150 million.

“The California workers’ compensation system is designed to help injured workers get back on their feet without ruining them financially,” said Riverside County District Attorney Mike Hestrin. “Sophisticated criminals like Mr. Heidary don’t just steal money, they take advantage of innocent patients. The sentence handed down today sends a strong message that these types of offenses will not be tolerated in Riverside County.”

Heidary used the sham law firm to recruit thousands of legitimately injured patients, referring them to his network of clinics to create unnecessary billing. One of the injured workers, Denise Rivera, slipped and fell while working as a certified nurse assistant for special needs children. Ms. Rivera testified that she was recruited into Heidary’s scheme, but never received any effective treatment.

“[Heidary’s employees] released me,” Rivera told jurors. “They told me – basically I was okay. My knee was okay.” When asked during the trial if her knee actually was OK, she simply responded, “No.”

SCOTUS Revisits Scope of Arbitration Exemption for Transportation Workers

In 2022 the United States Supreme Court issued its opinion in Southwest Airlines Co. v. Saxon, 142 S. Ct. 1783 (2022), a closely watched employment law case involving arbitration clauses in employment contracts. The opinion was a divergence from the Court’s tendency in recent years to favor arbitration. Instead of a company or industry wide exemption for mandatory arbitration, courts must instead use a fact-specific test focused on actual job duties of employees.

In the 2022 case, Latrice Saxon, was a ramp supervisor for Southwest Airlines at Chicago Midway International Airport. SCOTUS ruled that Saxon belongs to a “class of workers engaged in foreign or interstate commerce” to which the Federal Arbitration Act §1’s exemption applies. However, the Supreme Court rejected the contention that all airline workers are exempt from the FAA and instead used a fact-specific test focused on actual job duties.

California is home to over 1.5 million transportation workers. Of these workers, about 312,080 are truck drivers in a variety of industries, and many of these workers are directly related to the movement of goods, even if they do not directly work for a trucking company.  For these many California transportation workers, this week’s unanimous United States Supreme Court decision in the case of Bissonnette v. LePage Bakeries Park St., LLC, et al., clarified the scope of the exemption under the FAA will have a substantial impact on employment law litigation with many of these transportation workers. .

In this new case SCOTUS reversed the Court of Appeals for the Second Circuit and held that transportation workers do not need to work in the transportation industry to be exempt from the Federal Arbitration Act’s (FAA) arbitration requirements.

The employer in this case is Flowers Foods, Inc., is a multibillion-dollar producer and marketer of baked goods. that are distributed nationwide. It is the second-largest producer and marketer of packaged bakery foods in the United States It employs approximately 9300 workers. One of its flagship products is Wonder Bread,

Flowers also makes and markets other baked goods such as tortillas, bagels, Butterscotch Krimpets, and Jumbo Honey Buns in more than 40 bakeries located in 19 States. From there, these products are distributed across the country. Some of its subsidiaries use a direct-store-delivery” system in which franchisees buy the rights to distribute Flowers products in particular geographic territories. Those distributors purchase the baked goods from Flowers and then market, sell, and deliver them to retailers.

Neal Bissonnette and Tyler Wojnarowski were franchisees who owned the rights to distribute Flowers products in certain parts of Connecticut. Flowers baked the bread and buns and sent them to a warehouse in Waterbury. Bissonnette and Wojnarowski picked them up and distributed them to local shops. They allegedly spent at least forty hours a week delivering Flowers products in their territories. But their jobs extended beyond carrying the products from Point A to Point B. They also found new retail outlets, advertised, set up promotional displays, and maintained their customers’ inventories by ordering baked goods from Flowers, stocking shelves, and replacing expired products.

To purchase the rights to their territories, Bissonnette and Wojnarowski signed Distributor Agreements with Flowers. Those contracts incorporate separate Arbitration Agreements that require “any claim, dispute, and/or controversy” to be arbitrated under the Federal Arbitration Act.

In 2019, Bissonnette and Wojnarowski brought a putative class action claiming that Flowers had underpaid them in violation of state and federal law. Flowers moved to dismiss or to compel arbitration under the FAA, arguing that the contracts required the distributors to arbitrate their claims individually. The District Court dismissed the case in favor of arbitration. The Second Circuit Court of Appeals affirmed on the aground that Bissonnette and Wojnarowski” are in the bakery industry” and not the transportation industry. And under Circuit law, the panel explained, §1 of the FAA exempts only ” ‘workers involved in the transportation industries.’ “

A month after the Second Circuit decided the appeal in Flowers, SCOTUS decided Southwest Airlines Co. v. Saxon, 596 U. S. 450 (2022). In that case, SCOTUS determined that a ramp supervisor who “frequently load[ed] and unload[ed] cargo” from airplanes belonged to a “class of workers engaged in foreign or interstate commerce.” Id., at 463. It held that a “class of workers” is properly defined based on what a worker does for an employer, “not what [the employer] does generally.” Id., at 456.

The Second Circuit granted panel rehearing in the Flowers case – in light of Saxon – but adhered to its prior decision.

In the present Flowers case, SCOTUS again was asked to consider the scope of the FAA §1 exclusion clause as it did in Saxon, where it expressly declined to adopt an “industry wide” approach of the sort Flowers advances here.

It concluded “A transportation worker need not work in the transportation industry to fall within the exemption from the FAA provided by §1 of the Act. The Second Circuit accordingly erred in compelling arbitration on the basis that petitioners work in the bakery industry.”

“In other words, any exempt worker ‘must at least play a direct and ‘necessary role in the free flow of goods’ across borders.- 596 U. S., at 458 (quoting Circuit City, 532 U. S., at 121). These requirements “undermine[] any attempt to give the provision a sweeping, open-ended construction,” instead limiting §1 to its appropriately “narrow” scope. Id., at 118. * *

“The judgment of the Second Circuit is vacated, and the case is remanded for further proceedings consistent with this opinion.”

April 8, 2024 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Failure to Comply With WCAB Rules Precludes Newly Discovered Evidence. Federal Judge Vacates New NLRB Joint Employer Rule. Arbitration Agreement Does Not Extend to Re-Employment Case. Emergency Ambulance Employees May Remain On-Call During Rest Breaks. Tesla-Freemont to Face Hostile Work Environment Claims in Multiple Forum. Bakersfield Sting Operation Cites 12 Unlicensed Contractors. More SoCal Poultry Processors Accused of Using Illegal Child Labor. DOL Issues New Rule on Employee Representation During OSHA Inspection. NSC Releases New Report on Safety Hazards in Crane Industry. WCIRB Reports on Impacts of Employee Tenure on Claim Frequency.

Solano County Contractor Pleads Guilty to $382K SCIF Premium fraud

Kent Bo Fridolfsson, 67, of Benicia, pleaded guilty to six charges of insurance fraud and grand theft after a joint investigation with the California Department of Insurance, Solano County District Attorney’s Office and the Employment Development Department (EDD) revealed he underreported payroll by nearly $1 million to illegally save on workers’ compensation insurance and taxes.

Fridolfsson was placed on formal probation, ordered to pay over $725,000 in restitution, and ordered to surrender his contractor’s license.

The joint investigation began after one of Fridolfsson’s employees sustained a work-related injury and contacted State Compensation Insurance Fund (State Fund), who provided insurance coverage to Fridolfsson’s business. Fridolfsson was the former president and owner of the construction company Diversified Specialists and had been a licensed contractor in California since 1986.

Fridolfsson had insurance coverage with State Fund from 2010 to 2021 and was required to report payroll during each policy period. From 2010 to 2019 Fridolfsson reported zero payroll to State Fund; however, in January 2019 one of his employees contacted State Fund after sustaining a work-related injury. After being contacted by State Fund, the Contractors State License Board conducted a site inspection of Fridolfsson’s business and interviewed a number of his employees.

The joint investigation found that Fridolfsson underreported his payroll by $989,823. The failure to report employee payroll resulted in the illegal reduction of workers’ compensation insurance premiums, leading to approximately $382,104 in premium owed to State Fund.

The underreported payroll also resulted in an unpaid payroll tax to Employment Development Department of approximately $347,520.

Fridolfsson was convicted on April 5, 2024. This case was prosecuted by the Solano County District Attorney’s Office.

Final Defendants Sentenced in $65 Million TRICARE Fraud

The final two members of a massive conspiracy to bilk TRICARE, the military’s healthcare program, out of more than $65 million have been sentenced in federal court.

Former U.S. Marine Joshua Morgan and former U.S. Navy Sailor Kyle Adams were sentenced to 21 months and 15 months, respectively, and ordered to pay millions in restitution and forfeit the fruits of their criminal activity.

Morgan and Adams have admitted that they recruited fellow servicemembers and their dependents to receive expensive prescription compounded drugs, while others in the conspiracy wrote bogus prescriptions and filled out duplicitous paperwork to process fraudulent insurance reimbursements, resulting in at least $65 million in losses to TRICARE.

Both the defendants were working for Jimmy and Ashley Collins, a married couple living in Birchwood, Tennessee, who quarterbacked the scheme. Jimmy Collins received a 10-year prison sentence; Ashley Collins was sentenced to 18 months in home confinement. To account for all the fraud, the couple was ordered to pay $65,679,512.71 in restitution to Defense Health Agency and TRICARE. Other patient recruiters, including Daniel Castro, Jeremy Syto and Bradley White were previously sentenced to custody.

According to plea agreements, the servicemembers that Morgan and Adams recruited agreed to receive the pricey compounded medications in return for a monthly kickback of approximately $300. For young Sailors and Marines-turned-straw-beneficiaries, this money was equivalent to a significant portion of their monthly paycheck. Morgan noted that “it took very little work to sign people up to receive free money.”

For recruiting bogus patients, defendants Morgan and Adams were paid an illegal kickback of between 3 and 7 percent of the total TRICARE reimbursement paid to the pharmacy for the drugs sent to their recruits. By the time this fraud scheme was in full swing, the average cost for these compounded drugs was over $13,000 for a 30-day supply, peaking at around $25,000 for individual drugs.

Over the course of the conspiracy, those illegal kickbacks amounted to at least $2,633,942.69 for Morgan, which, in recognition of his role as the top-level recruiter in this multi-level marketing scheme, was more than twice as much as the next nearest patient recruiter. Meanwhile, Adams earned more than $1 million for his efforts.

To fund these kickbacks, based on false pretenses and representations, TRICARE paid at least $11,490,654.00 in insurance reimbursements for compounded medications prescribed to straw beneficiaries directly recruited by defendant Adams. During the same period, TRICARE paid at least $4,418,709 for compounded medications prescribed to straw beneficiaries directly recruited by defendant Morgan, although that amount underrepresents the severity of his criminal conduct due to his role as a top-level recruiter responsible in part for the losses to TRICARE caused by various sub-recruiters.

The doctors, Carl Lindblad and Susan Vergot, and a nurse practitioner, Candace Craven, who wrote the fraudulent prescriptions and filled out other duplicitous paperwork, were previously sentenced.  The pharmacy that filled the fraudulent prescriptions, CFK, Inc., also previously pleaded guilty.

According to the pleadings, the sharp increase in the number of bogus prescriptions for compounded drugs was the result of multiple fraud schemes, including this one, that popped up around the country.  As a result, the TRICARE program faced a $2 billion explosion in liability for compounded prescription drugs.

During the course of the investigation, authorities seized numerous items and properties purchased by the Collinses and others with the proceeds of the fraud, including an 82-foot yacht; multiple luxury vehicles, including two Aston Martins; a multimillion-dollar investment annuity; gold and silver bars; cashier’s checks; dozens of pieces of farm equipment and tractor-trailers; and three pieces of Tennessee real estate.

“NCIS will not stand by as individuals shamelessly attempt to disrupt the lives of those who have and continue to serve our country, and steal from what they rightfully earned,” said Director Omar Lopez, Naval Criminal Investigative Service. “This case highlights NCIS’ investigative capabilities and our commitment to collaborate with our law enforcement partners in detecting and dismantling these criminal acts of fraud.”

“Today’s sentencing demonstrates the Defense Criminal Investigative Service’s (DCIS) unwavering commitment to hold accountable those individuals who commit TRICARE fraud and imperil our military healthcare system,” said Kelly Mayo, Director DCIS.  “The outstanding work of the investigative team ensured the perpetrators were held criminally accountable.  I want to thank the U.S. Attorney’s Office and the Naval Criminal Investigative Service for their continuing dedication to the pursuit of justice.”

Two Year Statute of Limitations Bars Workers Fraudulent Concealment Claim

NuSil Technologies manufactures silicone and resins. NuSil utilized hazardous chemicals in the production and manufacture of products at its facility in Bakersfield, California. NuSil posted material safety data sheets with information about dangerous chemicals used at the facility.

Kevin O’Bryan worked for NuSil from 2006 to May 2016 at its facility in Bakersfield. O’Bryan’s work duties necessitated exposure to hazardous chemicals. NuSil provided training to O’Bryan about the chemicals he worked with and the use of personal protective equipment. Those trainings did not address formaldehyde. None of the material safety data sheets provided by NuSil mentioned formaldehyde.

In 2009, O’Bryan expressed concern to his supervisor about being exposed to chemicals. Around 2011 or 2012, O’Bryan again expressed concern about exposure to chemicals and was issued a full-face respirator. In 2013, O’Bryan’s doctor diagnosed him with “problems” that caused O’Bryan to be concerned about his workplace exposure. Around 2013, O’Bryan complained to the manufacturing supervisor about swelling and numbness in his hands, as well as extreme fatigue.

At some time between 2013 and May 11, 2016, O’Bryan complained to the site manager, that he believed formaldehyde was being generated by the distillation column on process at the facility. O’Bryan assumed there was formaldehyde because the smell was like “at the mortuary.

On May 11, 2016, O’Bryan took a disability leave of absence from work due to health symptoms he attributed to chemical exposure in the workplace at NuSil.O’Bryan filed a workers’ compensation claim against NuSil on June 27, 2016, alleging a cumulative trauma injury through May 10, 2016, to his hands, head, joints, respiratory system, central nervous system, and circulatory system from “exposure to toxic chemicals.”

At some point, O’Bryan filed a complaint about NuSil to California’s Division of Occupational Safety and Health. In its report, OSHA cited NuSil based on its finding that employees worked with formaldehyde in manufacturing rooms at the facility. O’Bryan was unaware of the presence of formaldehyde at the facility prior to OSHA’s report and learned of the presence of formaldehyde in approximately “May[ or] June” of 2017.

On September 18, 2018, O’Bryan settled his workers’ compensation claim for $235,000 by compromise and release which “does not resolve (or affect) any civil action (or right) applicant (may bring forth against NuSil) regarding this claim.”

On January 17, 2019, the O’Bryans filed a complaint against NuSil alleging two causes of action: fraudulent concealment on behalf of O’Bryan and loss of consortium on behalf of Tiffany O’Bryan. NuSil raised several affirmative defenses in its answer including that the claims were barred by the statute of limitations.

The parties stipulated and the trial court agreed to bifurcate the issues and try NuSil’s statute of limitations defense in a bench trial before trying the remaining issues. On July 1, 2022, “[p]hase 1” of the bench trial was conducted on the sole issue of the statute of limitations.The O’Bryans’ counsel conceded during closing argument that the applicable statute of limitations for the fraudulent concealment claim is two years.

On July 27, 2022, the trial court entered judgment for NuSil against the O’Bryans on “all claims in Plaintiffs’ Complaint in its entirety.” The Court of Appeal affirmed the trial court in the unpublished case of O’Bryan v. NuSil Technology -F084899 (April 2024).

An employee injured during the course of employment is generally limited to remedies available under the Workers’ Compensation Act. Certain types of injurious employer conduct bring the employee outside the compensation bargain. One exception to the exclusive remedy rule was identified by our Supreme Court in Johns-Manville Products Corp. v. Superior Court (1980) 27 Cal.3d 465.

The fraudulent concealment exception outlined in Johns-Manville was codified in 1982 as Labor Code section 3602, subdivision (b)(2). This statutory subdivision allows a civil suit “[w]here the employee’s injury is aggravated by the employer’s fraudulent concealment of the existence of the injury and its connection with the employment, in which case the employer’s liability shall be limited to those damages proximately caused by the aggravation.” (Lab. Code, § 3602, subd. (b)(2).).

A fraudulent concealment claim under Labor Code section 3602, subdivision (b)(2) requires the employee show three conditions: “(1) the employer must have concealed ‘the existence of the injury’; (2) the employer must have concealed the connection between the injury and the employment; and (3) the injury must have been aggravated following the concealment.” (Jensen v. Amgen Inc. (2003) 105 Cal.App.4th 1322.)

The parties agree the statute of limitations for the O’Bryans’ fraudulent concealment claim is two years pursuant to Code of Civil Procedure section 335.1. The question of when a “cause of action accrued is a mixed question of law and fact.” The O’Bryans filed their initial complaint on January 17, 2019. Thus, the O’Bryans’ cause of action was time-barred if all the elements of their fraudulent concealment claim accrued prior to January 17, 2017, absent an applicable exception to the general rule of accrual.

Here, O’Bryan suspected NuSil’s alleged wrongful conduct had injured him well before filing his civil complaint. By at least May 11, 2016, O’Bryan knew his health had been damaged by toxic chemical exposure at NuSil and suspected this exposure included formaldehyde, a chemical that was purportedly not being produced at the facility. At multiple times before May 11, 2016, O’Bryan expressed concern that his health was at risk from chemical exposure during his employment at NuSil.

The Court of Appeal rejected the O’Bryans’ contentions they could not assert their cause of action until the May 30, 2017 OSHA report confirmed the presence of formaldehyde at NuSil’s facility. This argument misapprehends the necessary facts to assert a cause of action. “A plaintiff need not be aware of the specific ‘facts’ necessary to establish the claim; that is a process contemplated by pretrial discovery.”

Restaurant SIG Endorses WCIRB Sept 1 Rating Changes

The California Restaurant Mutual Benefit Corporation (CRMBC) is endorsing the upcoming changes in workers’ compensation classifications for California’s restaurant and hospitality sectors, as announced by the Workers’ Compensation Insurance Rating Bureau of California (WCIRB).

CRMBC is a California Self-Insured Group (SIG) formed BY restaurant owners FOR restaurant owners. Choosing to opt out of commercial insurance that uses premiums to boost their substantial profits and overhead, CRMBC is a group of business-savvy restaurant owners who joined forces to self-insure their work comp for sustainable cost savings.

This significant update to the classification system will take effect on September 1, 2024. This update, a result of a comprehensive study, introduces six new classifications within the restaurant and hospitality sectors to better reflect the diverse operations and risk profiles across the industry.

The six new classifications, effective September 1, 2024, are:

– – 9058, Hotels, Motels or Short-Term Residential Housing – food or beverage employees
– – 9080, Restaurants – full service
– – 9081(1), Restaurants – N.O.C.
– – 9082, Caterers – not restaurants
– – 9083, Restaurants – fast food or fast casual
– – 9084, Bars or Taverns – not restaurants

The following classifications will also be included in the Food and Beverage Service Industry Group:

– – 8078(1), Sandwich Shops
– – 8078(2), Beverage Preparation Shops
– – 8078(3), Ice Cream or Frozen Yogurt Shops
– – 9081(2), Concessionaires ​​​​​
– – – – Classification Code changing from 9079(2) effective September 1, 2024

Previously consolidated under broad categories, these new classifications aim to provide a more accurate representation of risk, thereby enabling fairer premium assessments. The changes are designed to capture the evolving dynamics of the restaurant industry, addressing the need for granularity in risk assessment and insurance rate determination. This strategic adjustment is part of WCIRB’s ongoing efforts to enhance the standard classification system, ensuring it remains relevant and responsive to industry trends.

Kaya Stanley, CEO and Board Chair of CRMBC urges workers’ compensation brokers and restaurant owners to engage actively with the forthcoming changes. “Understanding the implications of the new classifications on policies and rates is crucial,” Stanely said. “While the immediate impact on rates is expected to be neutral, the long-term benefits of more accurately identifying risks and performance cannot be understated. This reclassification will enable more strategic decisions regarding loss prevention, safety programs, and overall risk management – ultimately benefiting the entire industry.”

According to the WCIRB, the changes to workers’ compensation classifications are more than administrative adjustments; they are a forward-looking approach to better serve the needs of California’s diverse restaurant industry. By breaking down the broad Classification 9079(1) category into six detailed classes, insurance will better align with businesses’ actual risks and operations.

Bill Mudge, WCIRB President and CEO, commented, “We appreciate the opportunity to educate all workers’ compensation system colleagues, including CRMBC members and restaurant owners across California, on the upcoming changes to Classification 9079, Restaurants or Taverns, as approved by the Insurance Commissioner and effective September 1, 2024. Stakeholders can find our latest interactive and educational resources on our website.”

WCAB Issues en bank Notice of Intent to Sanction Applicant Firm

The WCAB just published en banc orders that involve a course of conduct that appears to have occurred across eight (8) cases, involving attorney Susan Garrett and hearing representative Lance Garrett’s representation of seven applicants and one lien claimant.

It appears that in each of these cases Garrett Law Group through Susan Garrett or its hearing representative Lance Garrett, while supervised by attorney Susan Garrett, requested a series of continuances of multiple trial dates. However, the requests for continuance due to calendar conflict were not filed when the notice of hearing was issued. Instead, they waited until days before trial to request a continuance.”

“When the WCJ denied the request for continuance, they waited until the day of trial to file petitions for reconsideration in lieu of appearing for trial and to prevent the matters from proceeding, even though they were given notice by the Appeals Board in a prior decision that reconsideration is not proper from an order setting the matter for trial.”

“That is, based upon the timing of their filings, it appears that they filed the petitions for reconsideration solely to delay the trial proceedings in each case, as evidenced by their action of not appearing at trial in each case and not ensuring that their client appeared.”

“We emphasize that filing a petition for reconsideration does not by itself excuse any party from appearing at a properly noticed hearing because only the Workers’ Compensation Appeals Board can excuse an appearance. Moreover, their delay in seeking a continuance and filing for removal on or near the day of trial would not have provided sufficient time for the Appeals Board to act.”

Consequently, on April 10, 2024, the Appeals Board issued an en banc order consolidating eight cases and issued a notice of intention to impose costs and sanctions collectively up to $20,000.00 against attorney Susan Garrett (CA BAR #195580) in eight (8) instances where it appeared that she filed petitions for reconsideration with willful intent to disrupt or delay the proceedings of the Workers’ Compensation Appeals Board or with an improper motive, or where it appeared that such actions were indisputably without merit.

The Appeals Board issued a second notice of intention to impose costs and sanctions collectively up to $20,000.00 against hearing representative Lance Garrett in eight (8) instances where it appeared that he filed petitions for reconsideration with willful intent to disrupt or delay the proceedings of the Workers’ Compensation Appeals Board or with an improper motive, or where it appeared that such actions were indisputably without merit.

In the en banc notice of intent, the Appeals Board makes clear that a request for a continuance is not a final order as it does not resolve any threshold issue. Where a party files a petition for reconsideration without good cause, a notice of intent to impose sanctions may issue.

“In each of these cases, eight (8) instances total, attorney Susan Garrett and hearing representative Lance Garrett each appear to have engaged in the similar tactic of requesting trial continuances, then filing a petition for reconsideration of the order denying the trial continuance on or near the day of trial and then failing to appear at trial”.

Filing petitions for reconsideration designed to delay a trial can be described as frivolous and/or bad-faith conduct, which is sanctionable. (See United States Fire Ins. Co. v. Workers’ Comp. Appeals Bd. (Palafox) (2013), 78 Cal.Comp.Cases 1021 [2013 Cal. Wrk. Comp. LEXIS 137].) “Based upon our review of the record, it appears that the following same or similar sanctionable conduct has occurred in each of these cases.”

Both Susan and Lance Garrett have 20 plus 5 days to file a response to the notice.

En banc decisions of the Appeals Board are binding precedent on all Appeals Board panels and workers’ compensation administrative law judges. (Cal. Code Regs., tit. 8, § 10325; City of Long Beach v. Workers’ Comp. Appeals Bd. (Garcia) (2005) 126 Cal.App.4th 298, 316, fn. 5 [70 Cal.Comp.Cases 109]; Gee v. Workers’ Comp. Appeals Bd. (2002) 96 Cal.App.4th 1418, 1424, fn. 6 [67 Cal.Comp.Cases 236].) This en banc decision is also adopted as a precedent decision pursuant to Government Code section 11425.60(b).

It is interesting that the WCAB has elevated these cases to an en banc effort. One possible reason is that the WCAB intends to deal with frivilous petitions for reconsideration/removal more aggressively.

Insurance Industry Becoming Major User of Commercial Drones

Insurance is among the industries already deploying and expanding the potential of commercial drones,eyeing two strategic objectives: better risk management through improved data collection, analysis, and actionable insights; and reduced operational costs through improved efficiency and effectiveness in claims adjudication, claims processing, and customer experience.

Several leading insurance companies were first in the air, securing FAA permission as early as 2015 to use drones for aerial data collection, catastrophe response, research and development, underwriting, and claims resolution support. Since then, more insurance companies, both national and regional, have begun using drones.

Sensing disruptive potential, numerous insurance technology (insurtech) firms have entered the drone domain to offer both comprehensive and specialized services to the insurance industry.

For example,Betterview, an insurtech devoted to using drones for property inspections, has executed more than 6,000 rooftop inspections in the last two years. the company signed a partnership agreement with Loss Control 360, which makes software for insurance companies and inspectors. According to it’s website “Betterview is the Property Intelligence & Risk Management Solution the insurance industry depends on to identify and mitigate property risk, improve underwriting and inspection efficiency, and build a more transparent customer experience.​” Nearmap, one of the world’s largest location intelligence and aerial imagery solutions providers, has signed an agreement to acquire Betterview.

According to a report by Deliotte drone deployment is rapidly expanding and evolving, with current and potential applications spanning the insurance value chain. For example:

Pre-loss

– – Risk engineering and pricing – Aerial site assessments can identify property features that allow the owner either to seek a reduced risk profile or to take appropriate actions to lower overall risk and justify premium discounts.
– – Natural disaster monitoring – Drones can be quickly and safely deployed to monitor areas threatened by natural disasters. Governments working with insurance companies can monitor a situation and alert local residents to potential danger.

Post-loss

– – Inspection – Drones can provide a safer, faster, and more cost-effective way to conduct a site inspection, particularly in challenging working conditions.
– – Risk assessment – Drones may allow insurers to engage a generalist, rather than a specialist, to perform field assessments and obtain high-quality visuals.
– – Claims adjudication – The precise photos that drones take can potentially improve the quality of the claims adjudication process.
– – Fraud prevention – The moment a property claim is reported (First Notice of Loss), a drone could be deployed to inspect the claims site, increasing information capture accuracy and timeliness.

But Deloitte cautions that “Courts have upheld trespass claims involving aircraft operated below navigable airspace that interfered with a property owner’s use of their land.In addition, drone operators may be liable for trespassing for physically entering on land to retrieve a drone. In addition, where risk assessment is conducted by drone, regulators may expect insurers to seek prior approval from insureds. Because drones are capable of flying at lower altitudes than manned aircraft, common-law nuisance claims against drone operators might be successful.”

However, according to a recent report from The Wall Street Journal aerial home inspections are something insurance companies claim their customers give consent to when they purchase a policy, and that it allows them to “respond more quickly to disasters and charge rates that better reflect a property’s risk.” The companies also claim that aerial home inspections are “less intrusive” than visiting customers’ homes to do inspections.

Major insurance companies such as American International Group, State Farm and Allstate have gained approval from the Federal Aviation Administration to use drones for insurance adjustment claims over the past few years.

COVID-19 Fraud Enforcement Task Force Publishes 2024 Report

In May 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Justice Department in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud. The task force bolsters efforts to investigate and prosecute the most culpable domestic and international criminal actors and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts.

The Justice Department’s COVID-19 Fraud Enforcement Task Force (CFETF) just released its 2024 report detailing the efforts of the task force and its member agencies in response to widespread fraud involving many COVID-19 relief programs targeted by fraudsters and other criminals who sought to exploit the government’s relief efforts for their personal gain.

To date, the efforts of the task force’s member agencies has led to criminal charges against more than 3,500 defendants for losses of over $2 billion, civil enforcement actions resulting in more than 400 civil settlements and judgments of over $100 million, and over $1.4 billion seized or forfeited.

In addition to the efforts noted above, the CFETF has established five strike forces to focus on the most complex and harmful pandemic fraud – often committed by overseas, organized, or violent actors. Those strike forces, located in the U.S. Attorneys’ Offices across the country including the Districts of Maryland, New Jersey, Colorado, the Southern District of Florida, and a joint task force co-located in the Eastern and Central Districts of California, are responsible for indicting 250 defendants to date, including gang members, inveterate fraudsters, and overseas rings committing a myriad of cyber-enabled fraud against our citizens and government programs.

The Eastern and Central Districts of California joint COVID Fraud Strike Force was formed in August 2022. As strike force district, the Eastern and Central Districts of California oversee agents, analysts, and AUSAs to bring the most impactful criminal pandemic fraud cases, often involving multiple CARES Act programs, foreign actors, violent perpetrators, or large loss amounts.

Since the inception of the Strike Force, the Eastern District of California has criminally charged 17 cases with associated actual losses of over $20 million.

The Central District of California has joined with FBI, IRS CI, SBA-OIG, HHSOIG, DOL-OIG, TIGTA, USSS, and several local law enforcement agencies to initiate 37 criminal cases involving 72 individuals suspected of committing PPP, EIDL, UI, and ERC fraud, with losses identified of more than approximately $126 million. Approximately 15 of the 35 cases involve fraudulent UI claims with collective losses of more than $53 million. CDCA’s cases have covered a broad spectrum of criminal activity in its diverse population with a view

CFETF members also established the National Unemployment Insurance Fraud Task Force, a first-of-its-kind task force that developed a data sharing and lead development process within OCDETF’s International Organized Crime Intelligence Operation Center (IOC-2), using data from pandemic relief programs. The NUIFTF has used that process to disseminate over 100 leads and intelligence associated with over $3 billion in suspected pandemic fraud.

While this report highlights these accomplishments, much work remains in the fight against COVID-19 fraud. CFETF members have seen their budgets cut, straining resources to develop investigations and prosecute offenders. The first years of the pandemic fraud response were dedicated to coordination, data collection, and the establishment of interagency data sharing to generate actionable leads.