Tag: 2021 News

In 2003, defendants Jose Luis Alvarez, and Kim Marugg, (at the time known as Kim Alvarez) pled guilty to charges they had defrauded the State Compensation Insurance Fund. At the time, Alvarez and Marugg were husband and wife and operated Alverez Construction Company. Some of the workers were paid in cash by an intermediary and as a result SCIF was not paid workers’ compensation premium.

Marugg later claimed that, although she “was not guilty of the charges and . . . insistent on moving forward to trial,” she nonetheless pled guilty in December 2003 because the plea agreement “sounded like a sound financial decision.”

Marugg and Alvarez separated in February 2003; and began dissolution of marriage proceedings in 2004. She then married the prosecutor in her criminal case after she and the prosecutor began a personal relationship on some undisclosed date. The prosecutor died in October 2013, while they were still married.

Marugg testified she had ‘since learned’ that, at time she pled guilty in 2003, her criminal defense counsel was colluding with Jose Luis Alvarez’s family law attorney. and her criminal conviction had an adverse effect on her community property rights.

In January 2007, Marugg started her court battled and filed what she calls a “Petition for Expungement” of the conviction, seeking relief under Penal Code sections 1203.4 and 1203.4a which was taken off calendar and not resolved.

In November 2009, Marugg discovered another woman who previously had been prosecuted by the same deputy district attorney, and with whom the prosecutor later engaged in a romantic relationship. This other woman’s story was “almost identical” to Marugg’s.

This woman complained to the district attorney’s office, and at some point during the August – October 2010 time period, the office commenced an internal affairs investigation of the prosecutor. During the investigation, Marugg learned that the prosecutor had engaged in “personal” and “romantic” relationships with other defendants he had prosecuted, as well as one of the principal witnesses, the SCIF investigator, whom the prosecutor had presented to the grand jury in May 2002 in his effort to indict Defendants.

After the investigation, in May 2011, the superior court ruled in favor of this other woman, finding in her case “that there have been substantial irregularities in the prosecution of this case, of which the court was unaware until this petition, that undermine the lawfulness of defendant’s conviction.”

In September 2011, at Marugg’s request, the prosecuting deputy district attorney (who, by this time, was Marugg’s husband) provided Marugg with a declaration that she submitted to the State Bar of California as part of a complaint she filed against the defense attorney who represented her at the time she pled guilty and was sentenced in 2003. In part, the prosecutor testified that, as early as 2002, he knew that “[Marugg] was not the guilty party.”

A year later, in September 2012, Marugg wrote a letter to the district attorney, asking that the People stipulate to allow Marugg to withdraw her plea. The People declined Marugg’s request in an October 2012 letter.

After gaining information in 2015 regarding what Marugg considered to be criminal behavior of one of the SCIF investigators who testified before the grand jury in May 2002, Marugg requested and obtained copies of all of the state’s records from its investigation into the activities of Alvarez Construction that led to the grand jury evidence, the indictment, and the convictions. She received the initial documents in July 2015 and retained a forensic accounting firm in November 2015.

In 2016, Marugg filed petitions for writs of error coram nobis and section 1473.7 motions to vacate her convictions. Much of Marugg’s January 2017 testimony attempts to impeach evidence presented to the grand jury in May 2002. Marugg denied portions of witnesses’ grand jury testimony, presented evidence that she contended contradicted grand jury evidence, and identified facts that she believed discredited grand jury witnesses.

Based on what she found, Marugg testified that her criminal defense attorney “completely failed to identify and present evidence that exonerated [her] as well as failed to challenge by way of motions false evidence that was presented to the Grand Jury and challenge the prosecutor’s failure to present exonerating evidence to the Grand Jury.”

The trial court denied the requested relief. The Court of Appeal gave her a second chance in the unpublished case of People v  Marugg I (2018).

Since the trial court procedurally failed to hold a hearing as statutorily required and timely requested by Marugg before ruling on Marugg’s section 1473.7 motion. The case was remanded in 2018 for that purpose.

Subsequently, the trial court made procedural errors in resolving her claims even after her successful appeal. The case was again remanded back to the trial court to hold an evidentiary hearing, and specify a basis for its ruling in the unpublished case of People v Marugg II  (2021).

The Division of Workers’ Compensation announced on September 15th, that the 2022 minimum and maximum temporary total disability (TTD) rates will not change.

They said in that announcement that the minimum TTD will remain $203.44 and the maximum TTD rate will remain $1,356.31 per week.

However, that announcement was premature.

This week the DWC announced that the September 15, 2021 newsline that established the 2022 minimum and maximum temporary total disability (TTD) rates has been withdrawn.

The decision to withdraw the September 15 newsline is based on finding that the State Average Weekly Wage (SAWW) data posted by the U.S. Department of Labor (DOL), data which under Labor Code Section 4453(a)(10) is used to determine annual TTD rates in California, was preliminary and incomplete.

The TTD rates in the September 15 newsline should not be used or relied upon in determining indemnity benefits for the upcoming year.

DWC will issue a new newsline with the correct 2022 TTD rates when the correct data is posted and confirmed by DOL.

Workers with low back pain (LBP) who received manual therapy (MT) early within two weeks of their physical therapy care (PT) had lower medical costs and fewer days away from work than those who received it later, according to a new study from the Workers Compensation Research Institute (WCRI). MT is hands-on therapy that improves range of motion and reduces pain.

“This is a unique study that addresses an unfamiliar but important health care issue in workers’ compensation,” said John Ruser, president and CEO of WCRI. “Although the findings only provide evidence of association between the use and early use of MT and outcomes, it helps fill information gaps in medical and health care policy research regarding this therapy.”

The study, Outcomes Associated with Manual Therapy for Workers with Non-Chronic Low Back Pain, focuses on LBP claims in 28 states. It compares costs and outcomes between claims with early and late MT and between claims with and without MT. The following are among the study’s findings:

– – Among workers with LBP who received MT, early MT (within 2 weeks of PT care) was associated with lower costs and shorter temporary disability (TD) duration as compared with late MT (after 2 weeks of PT care). Early MT was also associated with a lower likelihood of receiving magnetic resonance imaging (MRI), pain management injections, and opioids, as compared with late MT.
– – Among workers with LBP, those who received MT had higher costs and slightly longer TD durations than those who did not receive MT but received other PT services. These differences may partly reflect dissimilarities in injury severity or underlying health conditions that cannot be measured in the data. Also, longer periods of observation (more than 18 months) may be important to consider when addressing the cost effectiveness of MT treatment.
– – Large interstate variations in the utilization of MT services were seen across the 28 study states, which could be explained, to some extent, by differences in state policies influencing provider practices and billing.

The findings are based on statistical analysis that controls for various factors affecting treatment choice and outcomes. Data used for the analysis capture medical services and benefit payments at 18 months postinjury for workers with LBP who did not have surgery but received MT and other medical services provided by non-chiropractic providers.

The 28 study states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

The owners of Sonoma County’s only psychiatric hospital, Aurora Santa Rosa Hospital, have agreed to pay $2.85 million to settle a lawsuit that alleges a number of state labor code violations, including significant understaffing that led to unsafe working conditions for nurses and other staff.

In 2018, the former director of nursing Teresa Brooke filed a lawsuit – Brooke v. Aurora Behavioral Healthcare-Santa Rosa, LLC et al. – alleging that understaffing and related issues caused pervasive Cal-OSHA violations at a Santa Rosa behavioral healthcare hospital operated by Signature Healthcare Services, LLC, one of the largest privately-held behavioral health hospital conglomerates in the U.S.

Using PAGA, the plaintiff sought to recover Labor Code penalties on behalf of the State of California for unlawful working conditions experienced by nurses and other hospital staff.

On August 25, the Superior Court of California approved a settlement including a Gross Settlement Fund of $2,850,000 – with $2,046,750 being paid to the State of California and $682,250 being paid to hospital staff, based on formulas mandated by the PAGA statute.

The court-approved settlement also includes various additional programmatic measures agreed to by the parties, including notice to employees that they will not face repercussions for speaking up regarding unsafe or unlawful practices.

The settlement further provides for the parties to jointly retain an outside expert to evaluate the hospital’s policies, practices, and procedures and make recommendations for any changes it may deem needed to improve working conditions for front-line staff who care for acute patients.

“This is the first of its kind, a significant PAGA settlement centering on occupational health and safety in a hospital,” said Xinying Valerian, one of Plaintiff’s lead attorneys and principal of Valerian Law. “The settlement is heavily focused on the employee population who have been most impacted – nurses and mental health workers, and we have not seen any other case of this kind. There’s still work to be done, but we’ve accomplished something through a civil penalties PAGA case that has not happened before.”

“In approving the settlement, the Court recognized that the settlement provides genuine and meaningful relief that will benefit the Santa Rosa hospital employees as well as the public,” according to Andrew Melzer, co-lead counsel and partner at Sanford Heisler Sharp LLP. “This case reinforces that we can and should be pursuing Labor Code and whistleblower actions aimed at deterring violations and improving conditions for hospital workers.”

Qiaojing Ella Zheng, a partner at Sanford Heisler Sharp’s San Francisco Office, added, “the resolution of this matter not only presents the employees in the Santa Rosa facility with an outstanding result, but also sets an example of how psychiatric hospitals all over the state should protect the health and safety of these frontline healthcare workers.”

Valerian and Melzer said staffing ratios of registered nurses to patients at the the hospital, at times 19 patients to one registered nurse and another licensed staff member, created unsafe working environment for nurses and other staff.

According to the law firms, other employment rights cases remain pending against Signature Healthcare.

Further information about the PAGA settlement will be made available to the 1,000 or so employees later in September.

According to the new report by Global and Markets, Global Insurance Fraud Detection Market Report and Forecast 2021-2026, the global insurance fraud detection market attained a value of approximately $2.7 billion in 2020. Aided by rising adoption of fraud detection services in small and medium enterprises, the market is projected to grow at a Compound Annual Growth Rate of 25.6% between 2021-2026 further to reach $10.75 billion by 2026.

Insurance fraud detection refers to services and systems which are deployed to track and analyse data to identify irregularities and provide real-time monitoring for fraud prevention. Different types of frauds can include identity theft, billing and payment frauds, cyber-attacks, and false claims. Fraud detection solutions like fraud analytics, authentication, and governance, risk, and compliance are employed for effective management of fraudulent activities. Fraud detection systems are crucial to safeguard the interests of both, insurer and insured across various sectors including the healthcare, automobile, and infrastructural.

The market growth of insurance fraud detection can be attributed to integration of technological advancements in detection services including Artificial Intelligence (AI), Machine Learning (ML) and Internet of Things (IoT).

The healthcare sector witnessed an invigorated rise in the number of suspicious claims globally, and hence insurance companies are making robust investments in fraud detection services, which is augmenting the market growth.

With the outburst of coronavirus pandemic, and the subsequent digitisation of operations, rising cases of cyber-attacks and identity thefts are propelling the market growth of fraud detection services. With rising prevalence of e-commerce retail channels and mobile banking applications increasing adoption of authentication solutions like biometric solutions, and face and voice recognition systems are fuelling the growth of the industry. In addition, the healthcare sector witnessed an invigorated rise in the number of suspicious claims globally, and hence insurance companies are making robust investments in fraud detection services, which is augmenting the market growth.

Furthermore, with availability of cost-friendly, effective, and advanced fraud detection services, small and medium enterprises are increasingly deploying fraud analytics in their working systems to protect the business from potential risks of frauds, hence, adding to market growth.

The market report analyses the market based on technologies, organization, deployment, applications, and major regions. The report looks into the market shares, plant turnarounds, capacities, investments, and mergers and acquisitions, among other major developments of the key players in the industry.