Tag: 2019 News

Less than six months after Massoud Kaabinejadian was hired as a senior vice president and credit administrator for Rabobank, his employment was terminated.

Following the termination, on September 20, 2006, he filed a workers’ compensation claim, contending that he suffered severe emotional distress because Rabobank discriminated and retaliated against him based on his national origin.

After approximately five years of litigating that claim, the Workers Compensation Appeals Board (WCAB) ultimately ruled against Kaabinejadian. The WCAB concluded that he did not meet the threshold of compensability for a psychiatric claim under Labor Code section 3208.3, subdivision (d).

Kaabinejadian then filed a petition for reconsideration of the WCAB’s ruling and a writ to the Court of Appeal, which were both denied.

Following the exhaustion of his appeals on the workers’ compensation claim, again representing himself, Kaabinejadian filed a civil complaint in San Bernardino Superior Court against Rabobank and its employee, Cheryl Walker, on December 1, 2011. He alleged a violation of FEHA statutes, and related causes of action.

On April 30, 2012, the court sustained Rabobank’s demurrer “without leave to amend,” dismissed the First Amended Ccomplaint, and denied Kaabinejadian’s motions to compel discovery as moot.

Following the dismissal of his San Bernardino County wrongful termination suit, Kaabinejadian filed a complaint in the instant case on June 4, 2012, in Sacramento County Superior Court against both Rabobank and its defense attorney McGensy, for abuse of process and Intentional infliction of emotional distress.

Defendants filed a special anti-SLAPP motion to strike plaintiff’s complaint. The trial court agreed with defendants, dismissed the case, and awarded defendants attorney fees. The dismissal was affirmed in the unpublished case of Kaabinejadian v McGensy.

“To combat lawsuits designed to chill the exercise of free speech and petition rights (typically known as strategic lawsuits against public participation, or SLAPPs), the Legislature has authorized a special motion to strike claims that are based on a defendant’s engagement in such protected activity.”

Are health insurance policies creating nightmares for physicians and hazards for their patients? A new study finds that nearly nine in ten doctors believe barriers set by insurance plans have led to worsened conditions for patients in need of care.

Researchers with Aimed Alliance, a non-profit that seeks to protect and enhance the rights of health care consumers and providers, say that doctors are so fed up with the constant headaches caused by insurers, two-thirds would recommend against pursuing a career in medicine, and nearly half (48%) are considering a career change altogether.

For the study, the organization polled 600 physicians in the U.S. practicing either family medicine, internal medicine, pediatrics, or obstetrics/gynecology. The group sought to understand the extent to which insurance policies impact primary care physicians, their practices, and their patients on a day-to-day basis. They also wanted to get a better understanding of mental health issues among providers, as well as the causes behind the national provider shortage.

Researchers found that physicians don’t think very highly of health insurance companies, and believe they’re putting patients at risk with policies such as prior authorizations ahead of filling prescriptions. In fact, 87% of doctors say patients’ conditions have grown worse because of such red-tape regulations, and 83% worry the patients will suffer prolonged pain as a result.

Prior authorizations are especially bothersome for doctors. More than nine in ten (91%) of those surveyed think the policy delays necessary care for patients. Similarly, the same number of doctors agree insurers engage in “non-medical switching,” which forces patients to take less costly – but potentially less effective – medicines.

Such policies are stressing many physicians out. Thirty-seven percent say half or more of their daily stress is caused by insurance issues, and 65% feel they’re facing greater legal risks because of decisions made by insurers. The vast majority (85%) are left frustrated by such issues, and many admit to taking their anger and emotions out on their staff and even family members.

“I can understand why many of the respondents reported that they would not recommend this career to anyone else,” Dr. Shannon Ginnan, medical director of Aimed Alliance, tells StudyFinds. “As practitioners, much of our time is spent on burdensome paperwork required from health insurers for our services to be paid for. This prevents us from spending as much time on patient care as we would like, and it doesn’t take much for all this paperwork to interfere with the services that we provide.”

To Ginnan’s point, the survey showed that 77% of doctors have had to hire more staffers to handle the heavier administrative load from insurance work. Ninety-percent say they have less time to spend with patients because of the burden.

As for the aspect of insurers’ policies that doctors would like to see changed most, the majority (55%) agreed on an insurers’ ability to override the professional judgment of physicians. About nine out of ten (87%) respondents felt that insurer personnel interfere with their ability to provide individualized treatments for each patient.

Beyond the harm that doctors say insurance policies cause patients in need of care, they also agree that patients are taking a hit in their bank accounts too. Doctors believe that insurers are contributing to the rising cost of healthcare more than anything else, including pharmaceutical companies, government policies, lawsuits, or hospitals.

A few weeks ago, the Insurance Journal reported a possible sale of workers’ compensation specialist Applied Underwriters.. The California Department of Insurance was reviewing an application for the sale of the Calif.-based Berkshire Hathaway subsidiary.

However, the buyer was not identified.”Once the application is determined complete, portions of the file will be public and available to be shared,” said CDI spokeswoman Nancy Goldberg.

Friday, the New York Post reported that Berkshire Hathaway agreed to sell Applied Underwriters, to Bahamas-based United Insurance Co., which was recently part-owned by Aon, according to a filing late Thursday with the California Department of Insurance.

The New York Post claims that UIC is acquiring Berkshire’s 81-percent stake in the insurer, as well as the stakes owned by two other executives, according to the filing. Financial terms of the deal weren’t disclosed.

One of the largest sellers of workers’ compensation insurance in the US, Applied Underwriters has been accused of being a “reverse Ponzi scheme” in a pending civil suit filed in 2016 by ex-clients – an accusation the company has denied.

Regulators also are probing the company over allegations of bait-and-switch tactics. The company is under investigation by New York and New Jersey regulators for selling unregistered insurance products. The company has denied any wrongdoing.

While Berkshire has never disclosed exactly how much it paid for Applied, a 2007 report from SNL financial put the deal price at $339 million.

That deal was apparently so expensive that Deloitte, in a 2015 report, excluded it from insurance deals because it would “skew” the data.

Nevertheless, “It’s probably been a successful investment,” Meyer Shields, analyst at KBW, told The Post, estimating it could now be worth between $1 billion and $1.2 billion.

In 2015, Berkshire told the Omaha World-Herald that Applied Underwriters had assets of $2.7 billion. But getting sold off by Berkshire – and losing Buffett’s sterling reputation – could negatively affect the value, too, Shields added.

A consortium of insurers and hedge funds was previously reported to be interested in the company, according to a February report in Reuters. Berkshire confirmed later that month it was divesting from Applied — a rare instance of Buffett walking away from an investment.

But, Applied Underwriters spokesman Mark Veverka said.”The story published today in the NY Post regarding Applied Underwriters is grossly inaccurate and incomplete.” He declined to elaborate

Encompass Health Corporation, based in Birmingham, Alabama, is one of the United States’ largest providers of post-acute healthcare services, offering both facility-based and home-based post-acute services in 36 states and Puerto Rico through its network of inpatient rehabilitation hospitals, home health agencies, and hospice agencies.

In California they operate the Encompass Health Rehabilitation Hospital of Bakersfield, on 5001 Commerce Drive, and Encompass Health Rehabilitation Hospital of Modesto located at 1303 Mable Avenue.

Encompass Health Corporation (formerly known as HealthSouth Corporation), has agreed to pay $48 million to resolve allegations that some of its inpatient rehabilitation facilities (IRFs) provided inaccurate information to Medicare to maintain their status as an IRF and to earn a higher rate of reimbursement, and that some admissions to its IRFs were not medically necessary.

Medicare and Medicaid use information about patients’ diagnoses to determine whether a facility is properly classified as an IRF, and to determine the level of reimbursement the facility is awarded for specific patients.

The government alleged that beginning in 2007, in order to insure compliance with Medicare’s rules regarding classification as an IRF, and to increase Medicare reimbursement, some Encompass IRFs falsely diagnosed patients with what they referred to as “disuse myopathy” when there was no clinical evidence for this diagnosis.

Additionally, Encompass IRFs allegedly admitted patients who were not eligible for admission to an IRF because they were too sick or disabled to participate in or benefit from intensive inpatient therapy.

“This important civil settlement concludes a lengthy, comprehensive investigation that brought to light a nationwide scheme that the government contends was intended to defraud our fragile public health programs,” said U.S. Attorney Maria Chapa Lopez. “In doing so, we confirm our commitment to civil health care fraud enforcement as a key component of the mission of our office.”

The settlements resolve allegations raised in three lawsuits filed by Dr. Emese Simon M.D., a former contract physician employed at an Encompass inpatient rehabilitation facility in Sarasota, Florida; Melissa Higgins the former Director of Therapy Operations at Encompass’s inpatient rehabilitation facility in Arlington, Texas; and Dr. Darius Clarke M.D. the former Medical Director at Encompass’s inpatient rehabilitation facility in Richmond, Virginia, and his company, Restorative Health & Wellness P.L.L.C.

The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery.

Here, the whistleblowers collective share of the settlement will be $12.4 million.

The three cases are captioned United States ex rel. Simon, et al. v. HealthSouth Corp., et al.; Case No. 08-CV-236 (M.D. Fla.); United States ex rel. Higgins v. HealthSouth Corp.; Case No. 3:12 CV 2496 (N.D. Tex.); and United States ex rel. Clarke et al. v. HealthSouth Corp.; Case No. 1:12 CV 853 (E.D. Va.). The claims resolved by the settlement are allegations only, and there has been no determination of liability.

More and more, employers are looking at how wearable technology can be implemented in the workplace, with improving employee safety as a primary goal. Devices can allow companies to monitor and track activities, analyze motions, alert for hazards, and augment physical capabilities, among other things.

Workers compensation has experienced a long-term decline in overall claim frequency, with a 19% decrease from Accident Year 2011 to Accident Year 2016. Among other causes, NCCI research points to automation, robotics, and continued advances in safety as contributing factors to the decrease. However, during this same time period, total claim severity increased 13%.

When it comes to workers compensation, wearables are in their infancy. While wearables are being tested today by insurance companies, as well as other employers and their workers, the technology and its potential is primarily in the proof-of-concept phase.

Companies are expressing interest in exploring uses for wearables as advances are made, yet only a handful of companies have piloted the technology to date, according to the stakeholders NCCI interviewed. Similarly, while some larger employers are piloting wearables, the actual use among employers overall appears limited so far.

Primary stakeholders in the implementation process for wearables include insurance companies, agents, policyholders/employers (including risk managers and human resources personnel), employees, and wearables vendors that provide the technology and can partner with insurance companies and employers on proof-of-concept/pilot projects.

Wearable technology, as it relates to workers compensation, ranges from measuring an employee’s physical activity, posture, or location to measuring multiple workplace conditions such as movement, light, humidity, temperature, and other environmental conditions. Some wearables can pair the data collected with third-party data—such as data about weather conditions—to provide a more complete picture of the working environment and associated risks.

In addition to preventing injuries, wearable devices could assist injured workers returning to work and help keep them there once they return. In a compelling example of how wearables can be used in workers compensation return-to-work scenarios, a first responder who suffered a spinal cord injury in the line of duty was fitted with an exoskeleton. The individual was able to return to work as a police officer six months after he was injured.

In terms of affordability, as with any new product, wearable costs are expected to decrease over time as new companies and products enter the marketplace. However, employers may have concerns about investing in wearable devices if they have short lifespans as next-generation technology and/or newer versions of the wearable devices become readily available.

The stakeholders NCCI spoke with believe that wearable technology has the potential to be a game-changer for workers compensation. One stakeholder indicated a 30% to 50% reduction in back-related injuries during the proof-of-concept stage and the potential for more reductions in injuries and claim costs as wearable technology improves and becomes more widely used.

As wearable technology advances, the interviewed stakeholders agree that wearables are well positioned to become an integral part of the future workplace and the workers compensation system. Notably, with more widespread use, wearables could provide data and information that could lead to safer workplaces and may help reduce recovery times, facilitate return-to-work, and reduce the overall costs of workers compensation claims.