30 year old Alexander Cody Smith, of Canoga Park was arraigned on three felony counts of workers’ compensation insurance fraud after allegedly misrepresenting past injuries to receive over $38,000 in undeserved medical treatments and temporary disability benefits from his employer’s insurance company.

Smith, while working for Engen Enterprises Inc., claimed he injured his back on March 16, 2018, as he was lifting a box.

Over the course of his medical treatment, Smith complained of back pain to his treating physician and later added complaints of neck pain to the claim. According to his claim and his doctor’s medical report, Smith denied any previous injuries or complaints about his back, specifically to his thoracic or lumbar spine.

An investigation by the California Department of Insurance revealed a history of medical complaints related to both Smith’s neck and back, which reportedly began in October 2015, according to subpoenaed records from his former health care provider and rehabilitation specialists.

The records show Smith received medical treatment from February 25, 2017, through March 13, 2018, and according to the records, it was at this time Smith reported feeling depressed due to his pain. This was just three days prior to the date he claimed he got injured at work while lifting the box.

The Department’s investigation revealed Smith misrepresented the history of his prior back injuries. Smith’s actions were likely made in an attempt to continue treatment for his ongoing condition, which was not work-related. Smith provided false information regarding his prior existing issues, which resulted in excessive and unnecessary medical evaluations, treatments, and temporary disability benefits at a cost of $38,746 to his employer’s insurance company.

Smith was arrested on October 28, 2020 and arraigned on October 30, 2020. The Los Angeles County District Attorney’s Office is prosecuting this case.

Medical provider networks for workers compensation have become increasingly popular over the last two decades. In conjunction with increased market penetration, some MPNs have broadened their services: As a way to improve outcomes, they do not just provide medical care, they manage the medical services on a claim, including interacting with the patient.

A new report published by NCCI looked at the impact of MPNs on workers compensation claim costs for 10 common WC injuries.

Comparing claims managed in-network to claims managed out-of-network across states and for 10 common injuries:

— Average paid medical costs are higher in-network for the more costly back and shoulder injuries and lower for several less costly injuries.
— In-network cases have more and higher-level office visits,as well as more physical therapy modalities,than comparable out-of-network cases.
— Except for the more costly back injuries, in-network claims (as compared with out-of-network):
— — Are less likely to be admitted to a hospital.
— — Cost less for hospital outpatient services.
— — Cost more for physician services.
— For all 10 injuries and for both permanent partial and temporary total claims, the average total incurred cost per claim for in-network claims is lower than, or about the same as, that for out-of-network claims.
— In-network claims are more likely to have permanent injury awards than out-of-network claims; selection bias may play a role here
— WC medical costs for physician services are higher than comparable Group Health costs. The main driver of this difference is higher utilization of services to treat WC cases.
— For all but a few injuries with comparatively small numbers of cases, greater MPN penetration in a state is associated with greater MPN utilization of physician services in the state.

Differences at a state level may be considered in a follow-up study performed later.

The Travelers Companies, Inc. announced the launch of Global Companion Plus+. This new product builds upon the company’s broad property and casualty offerings for U.S. firms with foreign exposures.

Features of Global Companion Plus+ include:

— Primary Foreign Voluntary Workers Compensation: Protects employees who are working outside of their home countries.
— Financial Interest: Provides a separate $1 million limit for U.S.-based companies as an extra layer of protection when an eligible foreign subsidiary suffers a covered loss.
— Global Panel Counsel Service: Helps businesses in need of legal assistance abroad find in-country representation experienced in local regulations and languages.
— Emergency Evacuation Coverage: Offsets the cost of employees who must evacuate while abroad. This now includes coverage for natural disasters, political unrest and endemic disease.

“Even if a business does not have a physical foreign footprint, having international customers, worldwide vendors or employees who occasionally travel to different countries could create exposures that may not be covered by a typical domestic business insurance policy,” said Tony Giannone, Vice President of the Multinational Accounts Practice at Travelers. “We have updated our Global Companion Plus+ product to include a more robust offering that fills coverage gaps for our customers who could experience claims or lawsuits outside of the U.S.”

Travelers provides global coverage in conjunction with its strategic alliances in the International Network of Insurance (INI), which includes major international insurance companies from more than 150 countries. As the INI’s exclusive U.S. insurer, Travelers is able to offer customers access to experts around the world who have a deep understanding of local laws, regulations, customs and services, including specialized local claim professionals coordinated through Travelers’ Global Claim team.

INI Partners are independent insurers as well as experienced leaders within their respective markets. Each network partner is approved by the INI Board of Directors and follows the same contractual membership obligations and service guideless worldwide. Partners carefully picked based on defined criteria such as: financial strength, servicing capabilities and experience and claims handling expertise.

To learn more about Global Companion Plus+, visit Travelers.com/GlobalSolutions.

Angela Stubblefield, 49, of Tacoma, Washington, was sentenced by U.S. District Judge Kimberly J. Mueller to two years and six months in prison and ordered to pay $219,871 in restitution for a disability benefits fraud and identity theft scheme.

According to court documents, between June 14, 2013, and May 1, 2017, Stubblefield and co-defendant Katherine Decker participated in a scheme to defraud the State of California by filing fraudulent claims for disability insurance benefits with the California Employment Development Department (EDD).

In furtherance of the scheme, Decker and Stubblefield used Decker’s position as an employee with the EDD to file fraudulent claims for disability benefits and to fraudulently extend existing disability claims, using the names and identities of real persons with and without their knowledge. In total, the conspiracy resulted in 15 fraudulent disability claims, resulting in a loss to the EDD of approximately $373,566.

Stubblefield was ordered to report to begin service of her sentence by Feb. 1, 2021. On Sept. 14, Stubblefield’s co-defendant Katherine Decker was sentenced by Judge Mueller to three years and seven months in prison for the disability benefits fraud and identity theft scheme.

“EDD employees rigorously work to protect the confidentiality of our claimant’s information and the integrity of the Disability Insurance program for Californians in need,” said EDD Director Sharon Hilliard. “We are grateful for the partnership of our federal and state partners in prosecuting any violator of that policy to the fullest extent of the law.”

This case was the product of an investigation by EDD’s Investigation Division and the Federal Bureau of Investigation. Assistant U.S. Attorneys Shea J. Kenny and Amy S. Hitchcock prosecuted the case.

The California workers’ compensation COVID-19 monthly claim count may have peaked in July, but the latest tally by the California Workers’ Compensation Institute shows that as of November 2, there have been 50,592 COVID-19 claims reported to the state Division of Workers’ Compensation so far this year – including 282 death claims.

That translates to 1 out of every 9 California job injury claims reported for accident year 2020.

The latest figures show that after climbing rapidly over the first 7 months of this year and hitting a record 14,453 claims in July, the number of COVID-19 workers’ compensation claims reported to the DWC began to dwindle. The updated count shows 6,710 claims with August injury dates, 3,779 claims with September injury dates, and 2,016 claims with October injury dates.

A significant number of claims from September and October could still be reported, but the initial claim counts from both these months were well below the early counts from June and July, so even accounting for the reporting lag associated with COVID-19 claims, those figures suggest a significant downtrend.

CWCI now projects that there could ultimately be 15,786 COVID-19 claims with July injury dates, 6,910 claims with August injury dates, 4,535 claims with September injury dates, and 5,242 claims with October injury dates, which puts the projected number of COVID-19 claims for the first 10 months of 2020 at 57,833.

Notably, denial rates for COVID-19 claims have stabilized within a narrow range, holding between 28.7 percent and 31.3 percent from April through August, while denial data on September and October claims is still too green for analysis as many of those claims remain under investigation.

The distribution by industry shows that COVID-19 claims remain heavily concentrated among a small number of industry sectors, with more than three quarters of the claims from the first 10 months of this year involving workers in health care (37.1 percent); public safety/government (15.0 percent); manufacturing (8.3 percent); retail (7.9 percent); transportation (5.1 percent), and food service (4.4 percent).

The data on claims reported through October is included in the latest update to CWCI’s COVID-19 and Non-COVID-19 Interactive Claim Application, an online tool that integrates data from CWCI, the DWC, and the Bureau of Labor and Statistics.

CWCI updates its COVID-19/Non-COVID 19 data app with new data every two weeks and plans to expand its features as more data on claim type and systemwide costs become available.

The application is available to the public.