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DWC Reports 1,542 COVID-19 Coded Claims – So Far

The Claims Journal reports that data from the California Division of Workers’ Compensation as of Thursday April 16, 1,527 claims coded for COVID-19 on claims notices had been filed, according to agency spokeswoman Erika Monterroza.

Some experts say that COVID-19 claims that require admission to an intensive care unit will likely run into the six figures for medical costs alone. What’s more, employers will be taking full responsibility for whatever complications arise from a coronavirus infection far into the future.

According to Science Magazine, the lack of oxygen and widespread inflammation caused by COVID-19 can damage kidneys, liver, heart, brain and other organs. Studies show that severe pneumonia caused by other diseases sometimes lead to scarring that causes long-term breathing problems. Pneumonia also increases the risk of future illnesses, including heart attack, stroke and kidney disease.

In one study of 138 patients hospitalized in Wuhan, China due to pneumonia from COVID-19, 20 percent suffered acute respiratory distress syndrome.

A separate study published by the New England Journal of Medicine in 2011 found that of 109 survivors of ARDS, 51% suffered physician-diagnosed depression, anxiety or both. Perhaps more relevant to workers’ comp, that study found that just 77 percent of the 83 patients who survived throughout the study period had returned to work five years after being treated. The study found that only 39% of patients were able to walk the distance expected for their age group in six minutes five years later, suggesting a high degree of physical impairment.

The governors of Kentucky, Arkansas, North Dakota and Florida and state regulators in Illinois, Washington, Michigan and Missouri have issued executive orders or amended rules to expand eligibility for workers’ compensation.

Most of those decrees ease the path for benefits only for healthcare workers and first responders, but an emergency order by the Illinois Workers’ Compensation Commission creates a presumption that work is the cause of COVID-19 if contracted by any “frontline worker” identified in Gov. J.B. Pritzker’s March 20 stay-at-home order. That includes workers at grocery stores, laundries, banks and hardware stores, among other businesses.

Kentucky Gov. Beshear issued a similarly broad executive order that created a COVID-19 presumption for workers in grocery stores, child-care centers, domestic violence shelters and rape crisis centers, in addition to first responders and healthcare workers.

In the meantime state legislators are also pushing to expand benefits for COVID-19. Earlier this month, Alaska Gov. Mike Dunleavy (R), Wisconsin Gov. Tony Evers (D) and Minnesota Gov. Tim Walz (D) signed into law bills that create a COVID-19 presumptions for first responders and some healthcare workers.

Bills to create presumptions for COVID-19 have been introduced in the New York, New Jersey, Pennsylvania, Ohio and Utah state legislatures.

SCIF Announces $165 Million in Additional COVID-19 Support

State Compensation Insurance Fund announced another series of actions designed to support policyholders and workers affected by the COVID-19 crisis.

These actions include:

Doubling the size of the Essential Business Support Fund announced earlier this week to $50 million. In the four days since the fund was announced, State Fund has received over 700 applications for COVID-19 workplace safety support funds. The first several payments, all at the maximum $10,000 reimbursement, were sent to qualified applicants today.

Creating a new, $50-million Returning California to Work COVID-19 Safety Protocol Fund. This fund will operate in a similar way to the Essential Business Support Fund but is designed to help businesses that were not deemed essential by Governor Newsom’s executive order after he removes statewide stay-at-home restrictions. The fund will provide grants to qualified policyholders to help defray the costs of safety-related expenses, planned or already incurred, related to protecting their workforces from COVID-19. Individual grants can total up to $10,000 or two times the policyholder’s premium, whichever is less. Applications for this fund will be made available at StateFundCA.com after statewide stay-at-home restrictions are lifted.

— Effective immediately, accepting any claim by an essential worker – as defined by Governor Newsom’s Executive Order N-33-20 – for a diagnosed case of COVID-19 regardless of whether or not that worker can demonstrate the virus was contracted during the course of employment. The diagnosis must include a confirmed positive test for COVID-19 and must occur during the period of time between when the Governor issued his stay-at-home order and before that order is lifted. This action effectively replaces the Essential Worker Support Fund announced earlier this week as all employees who would have been covered under that fund are now entitled to full workers’ compensation benefits. State Fund currently estimates these added benefits will require approximately $90 million in addition to the previously committed funds for a total of $115 million. State Fund will still provide temporary disability benefits to any covered essential worker who must self-quarantine if they are not covered by another source.

“We are doing everything we can to provide our customers and injured workers with the support they need to make it through the COVID-19 crisis,” said State Fund President & CEO Vern Steiner. “We have worked hard to be in a position where we can help, and we’re proud to stand with the essential workers who are risking their lives every day to hold our communities together.” More information about State Fund’s actions in response to the COVID-19 pandemic can be found at StateFundCA.com.

April 13, 2020 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: California Class Action Filed Against Cigna and Viant, Medicare Sues Lawfirm to Challenge Jurisdictional Issues, WCAB Orders Additional Emergency Filing Rules En Banc, COVID-19 Fraud Task Force Organizes in Arizona, OSHA Issues Respirator Interim Guidance, WCIRB Responds to COVID-19 Rating Issues, U.S. Plans to “Ease” Back to Normal.

Carmel Valley Physician Charged for COVID-19 “Miracle Cure”

Dr. Jennings Ryan Staley, a licensed physician and the operator of Skinny Beach Med Spa in San Diego, was charged with mail fraud in connection with the sale of what he described as a “100%” cure for COVID-19 that he said would render customers immune to the virus for at least six weeks.

FBI Agents began investigating this COVID-19 related fraud immediately upon receiving a tip from the public and shortly thereafter introduced an undercover agent. FBI Agents also executed a search warrant at the business of Skinny Beach Med Spa located in Carmel Valley. Skinny Beach Med Spa, offered a range of beauty-related services such as botox, hair removal, and fat transfer.

In late March, Skinny Beach allegedly began sending emails advertising “COVID-19 treatment packs,” described as a “concierge medicine experience” priced at $3,995 for a family of four, that included among other things access to Dr. Staley, the medications hydroxychloroquine and azithromycin, and “anti-anxiety treatments to help you avoid panic if needed and help you sleep.”

In a recorded call in which Dr. Staley was selling his services to a would-be customer – in fact, the undercover FBI agent – Dr. Staley described the medication he was offering as “an amazing cure” and a “miracle cure” that would cure COVID-19 “100%.” He added that if you take the medication without having the disease, “you’re immune for at least 6 weeks.”

Staley referred to medication he offered as a “magic bullet,” and said, “It’s preventative and curative. It’s hard to believe, it’s almost too good to be true. But it’s a remarkable clinical phenomenon.”

Staley also stated, “I’ve never seen anything like this in medicine, just so you know. Really, I can’t think of anything. That, you’ve got a disease that literally disappears in hours.”

Dr. Staley was interviewed a week later by the FBI as part of the overt investigation. When Dr. Staley was asked by agents whether Skinny Beach has told patients that the treatments are a 100% effective cure for COVID-19, Dr. Staley said, “No, that would be foolish. We would never say anything like that.” He also told the FBI that it was “not definitive” that the medication he offered cures COVID-19.

As set out in the complaint, Dr. Staley also offered the would-be customer Xanax (alprazolam) – a Schedule IV controlled substance – as part of his concierge package, and shipped the drug without conducting any sort of medical examination. He claimed that his broker was smuggling hydroxychloroquine from China to make his own pills, and had concealed the shipment from customs authorities by describing it as sweet potato extract. Shipping records confirmed that Dr. Staley was indeed importing a shipment of “yam extract,” scheduled to arrive in the U.S. in a matter of days.

“The sale of false cures, especially by a medical professional, will be vigorously investigated by the FBI,” said Omer Meisel, the Acting Special Agent in Charge of the FBI’s San Diego Field Office. “The FBI is using a variety of tools to identify anyone who exploits the current crisis with fraudulent scams or a variety of cyber schemes – and is proactively warning the public about products claiming to save lives, before losing their money or creating false hope. Scammers seeking to profit by exploiting fear and uncertainty during this COVID-19 pandemic will be brought to justice.”

DME Operator Charged in Telemedicine Kickback Scheme

The operator of a Los Angeles company is facing federal charges for his alleged participation in a massive telemedicine health care fraud scheme that reached the southern part of Georgia, the U.S. Department of Justice announced Thursday.

Scott M. Hirsch, who ran JI Medical, a durable medical equipment company formerly based in the Miracle Mile area of Los Angeles, is accused of conspiring to pay kickbacks in exchange for obtaining orders that the company would then bill to Medicare, according to the DOJ.

As part of the scheme, federal prosecutors allege, the physicians receiving kickbacks from JI Medical knowingly signed false medical records describing telephonic “consultations” of Medicare patients.

Hirsch is the 22nd defendant charged in Georgia as part of an investigation that uncovered more than $410 million in alleged phony claims to Medicare, according to the DOJ.

“Telemedicine is an important tool for legitimate providers – but paying kickbacks is not part of telemedicine and will not be tolerated under any circumstances,” said Bobby L. Christine, the U.S. attorney for the Southern District of Georgia.

“While many of our prosecutors and law enforcement partners may be working remotely during the COVID-19 pandemic, this office continues to work day and night to bring bad actors to justice,” Christine said.

Previous charges in the case were brought against eight physicians, two nurse practitioners, two operators of telemedicine companies and two brokers of patient data, according to the DOJ.

California First Responders Alarmed by COVID-19 Risks

The Press Democrat reports that law enforcement, firefighters and other first responders are raising alarms about the unique threat posed by the novel coronavirus to their health – and the need to protect personnel who get sick.

Some states have changed regulations to provide swifter access to workers’ compensation coverage for essential workers in the community during the coronavirus pandemic. These employee- funded benefits can cover lost wages, additional sick leave, job protections and death benefits.

Not yet in California, where lawmakers and Gov. Gavin Newsom have not taken up the issue, leaving each claim to be evaluated on a case- by-case by employers and insurance carriers.

Nine Santa Rosa police officers and one Sonoma County sheriff’s lieutenant have so far tested positive for the coronavirus, including longtime Santa Rosa Detective Marylou Armer, who died March 31 of complications from COVID-19, a respiratory disease caused by the disease. One Santa Rosa firefighter has tested positive for the virus.

The state must act – and soon – to assure these front-line workers don’t have to worry about lost wages, benefits and time away from work if they get sick, said Stephen Bussell, president of the Santa Rosa Police Officers’ Association. “We definitely have a higher risk level than the general public,” Bussell said.

Employees seeking workers’ compensation generally must prove they acquired the illness or got hurt on the job in order for their claims to be approved. There are exceptions for law enforcement and firefighters in California. State law provides automatic workers’ compensation eligibility if they get diseases like tuberculosis, cancer and pneumonia.

Those are just some of the ailments on a list of conditions that, if acquired while employed, allow police and firefighters to receive workers’ compensation benefits without having to document where they got sick or injured. Last year, that list was expanded to include post-traumatic stress syndrome, a change made to acknowledge the heavy and growing toll of wildfires.

“That gets them treatment and paid time-off faster,” said Laura Rosenthal, a Santa Rosa attorney who specializes in workers’ comp claims for law enforcement.

As a new disease, COVID-19 is not included on the list of conditions that make it easier for police officers and firefighters to file a workers’ comp claim.

But those employees who develop pneumonia while battling COVID-19 may have an easier time accessing workers’ compensation benefits because the lung infection is part of the state exemption, Rosenthal said.

No such protections for any workplace-acquired diseases or injuries exist yet for nurses or health care workers. Rosenthal said she hopes the pandemic pushes the state to consider adding protections for health care workers.

“You have law enforcement transporting an individual with a staph infection to the hospital, and he’s covered if he gets it,” Rosenthal said. “But the minute you drop them off at hospital, the workers there don’t get the same protection.”

Bussell said the Santa Rosa Police Department has so far been supportive of employees with coronavirus who are filing workers’ compensation claims, but it’s no easy task to document where they got it. Officers are in the community on patrol and various assignments, they often take individuals to hospitals and are in a variety of settings where they may come in close contact with people carrying the virus.

“Right now we’re doing our best to document exposures. It’s challenging to document it and be accurate,” Bussell said. “But the likelihood that it happened at work is greater than not.”

Scientists Study Cause of COVID-19 Relapse

South Korean health officials are investigating several possible explanations for a small but growing number of recovered coronavirus patients who later test positive for the virus again. Among the main possibilities are re-infection, a relapse, or inconsistent tests, experts say.

South Korea had reported 141 such cases as of Thursday, according to the Korea Centers for Disease Control and Prevention (KCDC).

Although re-infection would be the most concerning scenario because of its implications for developing immunity in a population, both the KCDC and many experts say this is unlikely.

Instead, the KCDC says it is leaning toward some kind of relapse or “re-activation” in the virus.

A relapse could mean that parts of the virus go into some kind of dormant state for a time, or that some patients may have certain conditions or weak immunity that makes them susceptible to the virus reviving in their system, experts said.

A recent study by doctors in China and the United States suggested the new coronavirus can damage T lymphocytes, also known as T cells, which play a central role the body’s immune system and ability to battle infections.

Kim Jeong-ki, a virologist at the Korea University College of Pharmacy, compared a relapse after treatment to a spring that snaps back after being pressed down. “When you press down a spring it becomes smaller, then when you take your hands off, the spring pops up,” he said.

Even if the patients are found to have relapsed rather than to have been re-infected, it could signal new challenges for containing the spread of the virus.

“South Korean health authorities still haven’t found cases where the ‘reactivated’ patients spread the virus to third parties, but if such infectiousness is proven, that would be a huge problem,” said Seol Dai-wu, an expert in vaccine development and a professor at Chung-Ang University.

Patients in South Korea are considered clear of the virus when they have tested negative twice in a 48-hour period.

While the RT-PCR tests used in South Korea are considered generally accurate, experts said that there are ways they could return false or inconsistent results for a small number of cases.

“RT-PCR tests boast an accuracy of 95%. This means that there still can be 2-5% of those cases that are detected false negative or false positive cases,” Kim said. Remnants of the virus could remain at levels too low to be detected by a given test, Seol said.

On the other hand, the tests may also be so sensitive that they are picking up small, potentially harmless levels of the virus, leading to new positive results even though the person has recovered, Kwon Jun-wook, deputy director of KCDC said at a briefing on Tuesday.

The tests could also be compromised if the necessary samples are not collected properly, said Eom Joong-sik, professor of infectious diseases at Gachon University Gil Medical Centre.

WCIRB Considers COVID-19 Regulatory Changes

The WCIRB’s Classification and Rating Committee is considering three rule changes that WCIRB staff are recommending in response to the impact of the coronavirus disease 2019 (COVID-19) pandemic on California employers and workers. The Committee is considering changes that, if approved by the Insurance Commissioner, would:

Exclude Payments to Employees Who Continue to Be Paid While Not Working

The Committee will review a proposal to exclude from reported payroll the payments made to employees who are continuing to be paid while not engaged in any work activities. This exclusion would apply while California’s stay-at-home order is in place and for up to 30 days thereafter if the employee continues not to work. Excluding this payroll recognizes the extraordinary circumstances resulting from the stay-at-home order and the fact that employees not engaged in work activities have virtually no work-related exposure. Allow Assignment of Classification 8810 for Temporary Change in Duties

The Committee will review a proposal to allow the assignment of Classification 8810, Clerical Office Employees, to the payroll of employees whose job duties, during California’s stay-at-home order, meet the definition of a Clerical Office Employee. This provision would apply while California’s stay-at-home order is in place and for up to 30 days thereafter if the employee continues to meet the definition of a Clerical Office Employee, but does not apply to the payroll of employees whose payroll is otherwise assignable to a standard classification that specifically includes Clerical Office Employees.

Exclude COVID-19 Claims from Experience Rating

The Committee will review a proposal to exclude claims with a diagnosis of COVID-19 and an accident date on or after December 1, 2019 from the experience rating calculations of individual employers. Since the occurrence of COVID-19 workers’ compensation claims are unlikely to be a strong predictor of future claim costs incurred by an employer, their inclusion in an experience modification calculation would not meet the intended goal of experience rating.

This is a high-level summary of the proposed regulatory changes. Details regarding the proposed changes and the full agenda, including the teleconference login information, are available on the Committee Documents page in the Filings and Plans section of the WCIRB’s website.

Comp Industry Survey Shows COVID-19 Disruption Patterns

Health Strategy Associates has published the key findings of “The Impact of COVID-19 on Workers’ Compensation” survey. HSA Principal Joe Paduda interviewed 15 workers’ compensation insurance carriers, third-party payers, government entities, and other self-insured employers over a seven-day period ending April 6.

“I wanted to gather information to help payers learn from each other so they could adapt more quickly to this fluid and entirely unforeseen event,” Paduda said.

Among the initial impacts raised were:

— Declining payrolls
— Access-to-care issues
— Spike in demand for telemedicine, telerehab and other telehealth services
— Delayed return to work
— Transitioning employees to work from home (WFH)
— Determining which COVID-19-related claims should be accepted — Dealing with WFH claims

Respondents noted the challenge of shifting operations from managing injury-related claims to disease-related ones. Prior to the pandemic, roughly 95 percent of claims resulted from injuries and investigating them was usually straightforward.

With COVID-19, you need to try to figure out where the exposure occurred. Could it have happened outside the workplace? Adjusters need to ask about travel, family health, potential contact with infected people, and determine whether to test or not,” Paduda said.

States have different presumption standards, and some link COVID-19 to specific occupation types,” he added.

Paduda will conduct a second survey on the impact of COVID-19 on workers’ compensation in a few weeks. He plans to expand the types of respondents to include managed care organizations and others that support workers’ compensation payers as well as payers. Anyone interested in participating can email jpaduda@healthstrategyassoc.com. While the full report is available only to respondents, an abstract can be found at https://tinyurl.com/HSACOVIDsurvey.

Based near Syracuse in Skaneateles, New York, Health Strategy Associates consults with insurers, employers, medical management companies, health care providers, and venture capitalists.

En Banc WCAB Invalidates AD Rule 10133.54 on SJDB Jurisdiction

Anthony Dennis sustained an injury in 2013 to his right wrist while working as an inmate for the California Department of Corrections and Rehabilitation. The parties stipulated to an award in 2017. This did not include his claim for a SJDB voucher.

Prior to the stipulation, defendant sent Dennis a Notice of Offer of Regular, Modified, or Alternative Work. The Notice also stated “SUBJECT TO APPLICANT VERIFYING THEY ARE LAWFULLY QUALIFIED TO ACCEPT EMPLOYMENT AS AN INMATE LABORER, YOU HAVE VOLUNTARILY TERMINATED YOUR EMPLOYMENT DUE TO YOUR RELEASE FROM PRISON AND ARE NO LONGER AVAILABLE FOR EMPLOYMENT[sic].”

Dennis filed a Request for Dispute Resolution Before Administrative Director, to resolve the issue of entitlement to a SJDB voucher. the AD did not issue a determination, and pursuant to the Rules, the request was therefore deemed denied.

Dennis then filed a DOR with the Sacramento District Office asking it to adjudicate his claim to this benefit. The WCAB rescinded the Award, and substituted a new Finding that applicant is entitled to a SJDB voucher.

It concluded that the WCAB maintains exclusive jurisdiction to adjudicate SJDB disputes irrespective of AD Rule 10133.54, which provides that the parties may request a dispute resolution with the Administrative Director before appealing the Administrative Director’s decision to the WCAB.

The Defendant, newly aggrieved, sought reconsideration of the new decision, which the WCAB granted. In the tentative En Banc decision it concluded that AD Rule 10133.54 exceeds the authority granted in sections 4658.5(c) and 4658.7(h), which authorizes the Administrative Director to adopt regulations for the administration of the supplemental job displacement benefits program. Neither statute authorizes the Administrative Director to adjudicate SJDB disputes.

It went on to note that it was “cognizant that employment in a prison setting is unique in that inmate workers cannot return to an inmate job once they are released from prison, making it impossible for a prison employer to make a bona fide job offer. Our review of statutes and case law, however, leads us to conclude that an employer’s inability to offer regular, modified, or alternative work does not release an employer from the statutory obligation to provide a SJDB voucher.”

In concluding, the WCAB issued its notice of intent to issue a decision after affording the Administrative Director 30 days to file a response to this Notice of Intention.

The Administrative Director responded contending that: (1) it has the adjudicatory authority to resolve disputes over the SJDB and that its dispute resolution process is valid; (2) its dispute resolution process is voluntary and does not usurp the jurisdiction of the WCAB; and (3) the WCAB cannot invalidate AD Rule 10133.54 because the issue is not ripe since applicant did not properly file his Request for Dispute Resolution Before Administrative Director.

Nothing in the Administrative Director’s Response changed the views as expressed in the Notice of Intention.  Its. final En Bank decision of Dennis v Department of Corrections, the WCAB provided a thorough and detailed iustification of this position.