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Tag: 2022 News

NEXT Partners with Intuit For Comp Insurance in Quckbooks Ecosystem

NEXT Insurance provides small business insurance with simple, digital and affordable coverage tailored to the self-employed. It offers policies that it says are easy to buy and provides 24/7 access to Live Certificates of Insurance, Additional Insured, and more, with no extra fees.

The company is headquartered in Palo Alto, has received a total of $881 million in venture capital funding, is rated “A- Excellent” by AM Best and has been recognized by CNBC Disruptor 50, Forbes Fintech 50, Inc.’s Best-Led Companies, and Forbes Best StartUp Employers.

NEXT Insurance Intuit Inc. just announced the launch of NEXT Connect for Intuit QuickBooks, an embedded insurance solution that provides customers with seamless access to digital-first insurance products within the QuickBooks ecosystem.

QuickBooks is an accounting software package developed and marketed by Intuit. First introduced in 1983, QuickBooks products are geared mainly toward small and medium-sized businesses and offer on-premises accounting applications as well as cloud-based versions that accept business payments, manage and pay bills, and payroll functions.

QuickBooks is the accounting software of choice for more than 29 million small businesses in the U.S. They have over 80% market share and have a diverse product offering suited to help both small businesses QuickBooks Desktop, and Quickbooks Online and larger growing companies (QuickBooks Enterprise) and everything in between (QuickBooks Pro, QuickBooks Premier)

As QuickBooks’s premier insurtech with a proprietary pay-as-you-go system that integrates directly with Intuit QuickBooks, this embedded solution enables small businesses to quickly set up a plan that seamlessly handles payments, streamlines cash flow and ensures they only pay for the coverage they need.

Small businesses and accountants can obtain insurance quotes and bind coverage without leaving their QuickBooks account. Additionally, users can benefit from NEXT’s technologically advanced, in-house pay-as-you-go offering for workers’ compensation, consult with a trusted insurance advisor as well as access multiple A-rated national carrier products, including NEXT.

Guy Goldstein, CEO of NEXT Insurance said that “Our partnership with Intuit QuickBooks enables NEXT to ease significant pain points for the small business community by providing easy access to customized coverage and payments directly tied to a company’s payroll for their workers’ compensation policies – all without leaving their Intuit QuickBooks accounts.”

NEXT’s pay-as-you-go offering was built in-house to provide small businesses with a convenient option to pay for their insurance “as they go” versus all up front, preserving cash flow and reducing the likelihood of year-end audits.

NEXT’s pay-as-you-go offering now uses Stripe Financial Connections to link to a customer’s bank account and automatically handle payments on an ongoing basis. Customers benefit from being able to easily set up billing and having it run automatically along with their payroll. All of their policy, billing and payment information is in one place to easily manage

Jessica Hidalgo, Group Product Manager at Intuit QuickBooks said “NEXT Connect’s embedded insurance offering and pay-as-you-go solution allow us to not only provide QuickBooks customers with seamless access to trusted insurance carriers, but also offer payment options adjusted to a company’s payroll.”

WCIRB Publishes 2022 Interactive Industry Stats Report

The Workers’ Compensation Insurance Rating Bureau of California has released the Interactive Industry Stats – 2022 Edition. This report provides premium, exposure and loss information based on unit statistical report data submitted to the WCIRB for policy years 2003 to 2019. In addition to policy year information, some loss information by accident year is also included.

The Interactive Industry Stats – 2022 Edition report offers a spreadsheet-based user interface. This allows users to browse loss, exposure and premium information and filter data by North American Industry Classification System (NAICS) sector, claim status and claim type.

Data elements provided in the Excel pivot tables include:

1. Policy Year
2. Accident Year
3. Report Level
4. NAICS Sector Code and Description
5. Dominant NAICS Sector Code and Description
6. Final Premium Size Interval
7. Payroll
8. Pure Premium
9. Modified Premium
10. Final Premium
11. Injury Type
12. Claim Count
13. Paid Indemnity
14. Paid Medical
15. Paid Total Loss
16. Incurred Indemnity
17. Incurred Medical
18. Incurred Total Loss
19. Policy Count

Detailed instructions on how to use the Interactive Industry Stats – 2022 Edition are included in the report. The report is available on the Interactive Industry Statistics page in the “Research” section of the WCIRB website.

Weedwacker Injury Not a “Violent Act” for Psyche PD Add-On

Leslie Elizabeth McCain was employed as a laborer by Wallis Construction, Inc., sustained injury AOE/COE to her left elbow, left wrist, right wrist, and psyche on September 24, 2014, and claims to have sustained injury AOE/COE to her neck and shoulders, consisting of myofascial pain.

She waited roughly 1½ months to seek treatment for her physical injuries, at which point she visited Doctors on Duty, where she was evaluated by Michael Luder, M.D. During her visit, applicant informed Dr. Luder that, when the injury occurred, she was “using a weed whacker, lost her footing and hit her left elbow into a wall.

On December 2, 2014, she visited an Urgent Care facility where she similarly told Robert Martin, PT (physical therapist) that the injury occurred when “[s]he was weedwhacking in [a] small space …. She lost footing and fell into [a] wall hitting (L) elbow with wall and weedwhacker.”

She then provided various different versions as to how her injury occurred during subsequent doctors’ visits between 2015 and 2017, stating at various times that: (1) her injury was caused by repetitive use working in construction; (2) that a “jackhammer” fell on her arm; (3) that a “hand held compactor” struck her left elbow when she tried to block it from striking a door; (4) that a “200-pound” weedwhacker fell on her left arm; (5) that the weedwhacker became stuck, she tripped, fell backward, and the machine struck her left elbow; and (6) that her feet got stuck in the mud, she fell backward, and the weedwhacker’s handle hit her left elbow.

On April 28, 2022, the parties proceeded to trial. Among the issues raised was whether or not the ‘violent act’ exception applied. Applicant did not testify, and the matter was submitted.

The WCJ found that McCain’s psyche injuries did not result from a “violent act,” and that, as a result, she was not entitled to an award of permanent disability for the psychiatric consequences of her physical injuries pursuant to Labor Code section 4660.1(c)(2)(A). Her reconsideration was denied in the panel decision of McCain v Wallis Construction Inc – ADJ11102338 (August 2022).

The WCAB panel noted that “is undisputed that her psyche injury was not a “direct” injury, and that it was a compensable consequence of her physical injuries.” In the case of Wilson v. State Cal Fire (2019) 84 Cal.Comp.Cases 393 (Appeals Board en banc) it was explaining that section 4660.1(c) applies to compensable consequence injuries. Thus, there is no dispute that section 4660.1 applies.

The parties dispute whether applicant may receive an increased permanent impairment rating under section 4660.1(c)(2)(A), and applicant bears the burden of proving that her psyche injury resulted from either being a victim of a violent act or direct exposure to a significant violent act.

Several panel decisions have followed the definition of a “violent act” for purposes of section 4660.1 as an act that is characterized by either strong physical force, extreme or intense force, or an act that is vehemently or passionately threatening.

Here, the WCJ found that applicant’s psyche injury was not compensable under section 4660.1(c)(2)(A) because the act of slipping and falling and being struck in the elbow by a weedwhacker was not a “violent act” within the meaning of the statute.

The WCAB panel agreed with the WCJ. “Significantly, since applicant did not provide testimony at trial, it is unclear exactly how the injury occurred, and the WCJ was unable to weigh the testimony and determine whether the event was of the type that would be considered a violent act.”

“Even accepting the version of events that were contained in QME Dr. Lopez’s report, the force of this incident cannot be characterized as either extreme or intense, and applicant did not lose consciousness after her fall and kept working after the incident, explaining that she “fully expected her symptoms to resolve promptly.’ ”

Applicant’s injuries are instead akin to those that we have previously determined were not the result of a violent act….”

Long Beach Dockworkers Fraudulently Bill Health Plan $2.1M

Federal prosecutors filed criminal charges against nine defendants – seven of them dockworkers at the Port of Long Beach – who allowed more than $2.1 million in fraudulent claims to be submitted to their labor union’s health insurance plan for sexual services or for physical therapy that never was provided.

The conspiracy’s ringleader, Sara Victoria, 46, of San Pedro, is charged in an information filed today with one count of conspiracy to commit health care fraud and one count of aggravated identity theft.

The plea agreements for Victoria and the other eight defendants were filed in United States District Court, and they are expected to make their initial court appearances in the coming weeks.

According to her plea agreement, from January 2017 to August 2021, Victoria owned and operated three business: Back to Life Wellness Center LLC and The Chiroman Wellness Center – both based in San Pedro – and the Wilmington-based Waterfront Wellness Center Inc. These companies offered patients chiropractic services, acupuncture treatments, and also sexual services.

Victoria knew that dock workers and others involved in the shipping industry in Long Beach had health insurance under the International Longshore and Warehouse Union – Pacific Maritime Association (ILWU-PMA) benefit plan. This plan generally covered all chiropractic services with no deductible and without requiring plan members to contribute any copay amount or out-of-pocket services.

Victoria hired women to provide sexual services to dock workers at her companies and recruited them through referrals and from strip clubs in the Long Beach area. In exchange for obtaining sexual services for themselves and their friends, ILWU-PMA plan members authorized Victoria to submit false claims for reimbursement for services not actually rendered, including chiropractic and physical therapy, using their names or the names of their family members, such as their spouses and children. Victoria also agreed to pay ILWU-PMA plan members cash kickbacks in exchange for authorization to submit false claims for reimbursement for services not actually rendered.

Victoria also admitted to using someone else’s identity without the person’s consent during the commission of the health care fraud conspiracy.

In total, Victoria submitted approximately $2,110,920 in claims to the ILWU-PMA plan, for which the plan paid approximately $551,810.

After Victoria enters a plea of guilty, she will face a statutory maximum sentence of 12 years in federal prison.

Also charged this week was Cameron Rahm, 39, of Pico Rivera, a Long Beach longshoreman and ILWU member whom a federal grand jury charged in an indictment with one count of conspiracy to commit health care fraud, two counts of health care fraud, and one count of making false statements to federal investigators.

Rahm allegedly was one of the customers of Victoria’s businesses and agreed to have her submit to the ILWU-PMA plan fraudulent claims for services not rendered or for sexual services. He also allegedly lied to FBI agents investigating this case when he denied allowing anyone to bill his health insurer for sexual services. He is expected to appear for this arraignment this afternoon in United States District Court in Los Angeles.

If convicted of all charges, Rahm would face a statutory maximum sentence of 10 years in federal prison for the conspiracy and health care fraud counts, and five years in federal prison for the false statements count.

Cal/OSHA Posts Guidance on Protecting Workers from Monkeypox

Cal/OSHA just posted guidance on monkeypox (MPX) to ensure workers in California are protected from the aerosol transmissible disease. This guidance applies to workplaces covered by the Aerosol Transmissible Diseases (ATD) standard, including health care facilities, medical transport, police, public health services and more.

This guidance provides a brief overview of some, but not all, of the requirements of Title 8 CCR section 5199 as it applies to protection of workers from MPX. Employers not covered by section 5199 are not discussed in this guidance but must protect their employees under the Injury and Illness Prevention Program (section 3203), sanitation requirements (section 3362), and other laws and regulations.

Monkeypox (MPX) spreads primarily by close or direct contact, but can also become airborne. Thus, MPX is an aerosol transmissible disease covered by Cal/OSHA’s Aerosol Transmissible Diseases (ATD) Standard which contains mandatory requirements that certain employers must follow to protect their employees.

For example, regulations require employers to:

– – Implement a written program to prevent or reduce the transmission of aerosol transmissible diseases specific to the workplace and operations.
– – Provide and ensure the use of respiratory protection.
– – Ensure that personal protective equipment (PPE) is provided and used by employees exposed to persons with or suspected to have MPX, or to linens or surfaces that may contain the virus.
– – Implement written procedures for exposure incidents.
– – Report the exposure to the local health officer.

Cal/OSHA’s Aerosol Transmissible Diseases (ATD) Standard has differing requirements for three different types of employers – (1) referring employers, (2) laboratories, and (3) all other employers. Details about the requirements for each of these categories start on page 3 of the Cal/OSHA MPX Guidance.

MPX spreads primarily by close or direct contact with infectious rashes, lesions, scabs, or body fluids. It can also spread through touching materials used by a person with MPX that haven’t been cleaned, such as clothing, towels, and bedding. The virus can become airborne during changing or handling of contaminated linen. In addition to lesions on the skin, lesions may be located in the mouth or throat, and research is underway to further understand the role of respiratory fluids, droplets, and particles in the transmission of MPX.

Infection with MPX may start with symptoms similar to the flu, including fever, low energy, swollen lymph nodes, and general body aches, although some patients do not have these symptoms. After the fever starts, the person can develop a rash or lesions. The lesions will develop through several stages, including scabs, before healing. They can look like pimples or blisters and may be painful and itchy. The illness typically lasts 2-4 weeks.

During the current outbreak, skin lesions have presented most commonly in the anogenital area, followed by trunk and limbs, face, and palms or soles. Lesions may also occur in the mouth and throat.

Since May 2022, there has been a rapid rise in cases of MPX in many regions, including California. The disease is typically self-limited (resolves on its own without treatment) but may be severe in young children or immunocompromised individuals, such as those infected with HIV.

On August 1, 2022, Governor Newsom issued a statewide proclamation of emergency due to MPX. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. MPX outbreak to be a public health emergency.

S.F. Contractor Faces Multiple Felony Charges for Premium Fraud

The San Francisco District Attorney announced multiple felony charges against Gemma Maher, office administrator of Cullinane Plastering, for insurance and tax fraud. Her employers, Denis Cullinane, owner of Cullinane Plastering, and Jeremiah “Jerry” Cullinane, owner of Cullinane Construction, have warrants outstanding for charges related to insurance and tax fraud.

Maher and her employers are alleged to have engaged in a years long scheme to defraud their victims by concealing approximately $5.8 million in unreported payroll to avoid paying insurance premiums and payroll taxes. Denis and Jerry Cullinane remain at large.

The Court previously entered an order freezing all the defendants’ assets to prevent them from dissipating those assets and to preserve the funds for victim restitution. The three defendants are residents of San Francisco and operate the local construction company Cullinane Plastering which has been licensed by the CSLB since 1989.  

The alleged fraud was discovered after a Cullinane Plastering employee was seriously injured while working on a job site on May 8, 2019.

Instead of informing the injured worker that he was entitled to workers’ compensation benefits, Denis Cullinane, Jerry Cullinane, and Maher allegedly concealed the employee’s existence and injury from their workers’ compensation insurance carrier, State Compensation Insurance Fund (SCIF), for almost a year.

When Maher finally disclosed the injury to SCIF on March 12, 2020, she made multiple alleged misrepresentations about the worker’s employment history and injury to further the fraud.

The resulting investigation revealed that Denis Cullinane, Jerry Cullinane, and Maher utilized Jerry Cullinane’s Cullinane Construction company to conceal the injured worker’s wages from SCIF and the Employment Development Department (EDD) in violation of California law.

In addition, the investigation uncovered that Denis Cullinane, Jerry Cullinane, and Maher submitted allegedly fraudulent employee payroll information to SCIF from 2018 through 2020 and to EDD from 2017 through 2020. These fraudulent reports artificially lowered their workers’ compensation insurance premiums and tax contributions – both of which are determined in part by employee payroll.

This resulted in an estimated $270,000 loss to SCIF in unpaid premiums and an estimated loss to EDD of over $300,000 in unpaid payroll taxes (and over $1.5 million in unpaid taxes and penalties).

This case was developed through a multi-agency operation led by San Francisco District Attorney Senior Investigator Jennifer Kennedy and conducted in collaboration with investigators from the San Francisco District Attorney’s Office, the California Department of Insurance, and the Employment Development Department.

Assistant District Attorneys Stephanie Zudekoff and Rebecca Friedemann are the prosecutors assigned to the case.

Prevailing in WCAB 132a Claim is Not Res Judicata in FEHA Case

Gurdip Kaur started working at Foster Farms in 2001 and worked for nearly 15 years. From 2008 to 2016, Kaur worked as a yield monitor at Foster Farms’ Cherry Avenue plant, a chicken processing facility.

On April 24, 2013, Kaur slipped at work while wearing company-issued rubber boots; and she broke her left wrist. Prior to the injury, she had slipped because of these boots, and attempted to avoid slipping by requesting new boots. Kaur is originally from India, and believed that she and other Indian employees at the plant frequently encountered difficulties in obtaining work-related gear, because they were Indian.

After a surgery to her broken wrist, she was restricted in the use of her left hand and wrist for work. She went back to her regular position as a yield monitor, with no modification in her duties, and complained that she needed light duty given the restrictions on using her left hand. She claims her request was never appropriately addressed by Foster Farms.

In May 2016, Foster Farms announced it would undergo a restructuring that would affect its Cherry and Belgravia chicken processing plants. The Cherry plant would lose 500 positions, while the Belgravia plant would gain 300. July 22, 2016, Kaur was terminated after numerous efforts to identify and train her for a job she could do at Belgravia. The sole reason for Kaur’s termination was that she “chose not to take the [one] accommodation” offered by the company (i.e., the pallet jack driver position); it was not a performance-related termination.”

In October 2017, Kaur filed a lawsuit against Foster Poultry Farms. The first five causes of action arose under FEHA: (1) discrimination on the basis of race/nationality and disability; (2) failure to provide reasonable accommodation; (3) failure to engage in an interactive process; (4) failure to take all reasonable measures to prevent discrimination; and (5) retaliation for asserting FEHA rights. The sixth cause of action asserted in the complaint was retaliation in violation of Labor Code section 1102.5.

Prior to filing the civil action she filed a petition against Foster Farms with the WCAB, asserting claims under Labor Code section 132a, which was litigated over three days, spread over the course of a year, before WCAB ALJ Debra Sandoval. On July 9, 2019 ALJ Sandoval denied the 132a petition.

Foster Farms then amended its answer in the civil case to assert an affirmative defense that all of Kaur’s disability-related claims were barred by res judicata and collateral estoppel based on the workers’ compensation ALJ’s ruling. It then moved for summary judgment on the basis of this affirmative defense.

The trial court granted summary judgment in favor of Foster Farms, holding that the WCAB opinion barred Kaur’s disability-related and other claims under FEHA and Labor Code section 1102.5, and that Kaur’s race/nationality discrimination action was time barred. The Court of Appeal reversed in the published case of Kaur v. Foster Poultry Farms LLC F081786 (September 2022).

The primary issue on appeal is whether the decision by the WCAB denying Kaur’s 132a claim has a res judicata or collateral estoppel effect on the claims at issue in this civil FEHA action.

Kaur’s petition before the WCAB alleged that Foster Farms “[was] aware that [Kaur] had suffered a work place injury on April 24, 2013.” The petition further alleged that Foster Farms “did intentionally and by means of retribution [discriminate] against [her] and said discrimination was in response and in retribution for [her] claim of injury and her filing of her workers’ compensation claim for benefits.”

As to her disability discrimination claim the Court of Appeal noted that “Labor Code section 132a proscribes a relatively narrow range of discriminatory conduct by employers, while FEHA targets a much broader range of discriminatory conduct and imposes affirmative duties on employers as to disabled employees.”

And it went on to say that “Kaur’s FEHA claims for disability discrimination, failure to provide reasonable accommodation, and failure to engage in a good faith interactive process involve entirely different inquiries and issues than her claims under Labor Code section 132a and encompass a whole range of affirmative duties and other requirements applicable to the employer (e.g., continuing obligations to make reasonable accommodations and engage in an interactive process), as well as benefits that accrue to the employee (e.g., preferential treatment with regard to open positions), that have no relevance to a Labor Code section 132a proceeding.”

The Court of Appeal concluded that the WCAB’s decision on Kaur’s Labor Code section 132a claim does not have preclusive effect on Kaur’s disability related FEHA claims, and the trial court therefore erroneously granted summary adjudication in favor of Foster Farms.

Newsome Signs Law Extending Time to Study UR

Gavin Newsom signed AB 2848, which amended Labor Code Section 4610 to require a study of possible changes to the workers’ compensation utilization review process.

SB 1160 (Mendoza, Chapter 868, Statutes of 2016) created the existing period of study and report by the Director related to the provision of medical treatment. The law required the DWC Administrative Director to contract with an outside independent research organization to evaluate and report on the impact of the provision of medical treatment within the first 30 days after a claim is filed, for claims filed on or after January 1, 2017, until January 1, 2019. The report was to be completed by January 1, 2020.

According to the author of the new law, the “current period of evaluation for the impact of the provision of medical treatment report is not sufficient to capture the effect of workers’ compensation claims filed after January 1, 2019. This bill will help gather more information on the workers’ compensation system by extending the period of review to January 1, 2021, so that the State can better understand workers’ use of medical treatment in the workers compensation system.”

However according to information provided by the author as noted in the March 2022 legislative analysis, this bill was intended to “be amended in the Senate to be a larger workers’ compensation reform package. The amendments will have the goal of raising permanent disability benefits, minimizing delays associated with medical treatment requests, and reducing frictional costs within the workers’ compensation system.”

Those proposed amendments apparently did not take place.

The California Labor Federation, a co-sponsor of the bill, wrote in support of the proposed law that “as written, AB 2848 extends the period of study for a previously mandated report regarding medical treatment within the first 30 days following a workers’ compensation claim. The bill extends the period of evaluation from the existing period of January 1, 2017 – January 1, 2019, to January 1, 2017 – January 1, 2021. The bill will also require the report to be completed by July 1, 2023, as opposed to the previously required completion date of January 1, 2020.”

“By adding two years’ worth of data to what will be considered by this change, AB 2848 will help gather a more comprehensive understanding of the workers’ compensation system. The amended completion date will also better align the expanded data collection with the amount of time necessary to compile and analyze the data.”

There was no opposition to the proposed law in the legislative record.

In summary, a proposed law that was aimed at increasing benefits to injured workers, ended up simply extending the time limits for a study that was specified back in 2016. Otherwise, there are no substantive changes that require the attention of claims administrators.

Employers Must Set “Date Certain” for Emergency Leave Ending

Reena Johar, a home improvement salesperson for Success Water Systems, left work to care for a terminally ill relative, and while she was away her employer decided she had quit. She was gone about a week.

Upon her return, the employer told her business was slow and gave her no new sales appointments. Johar eventually made a claim for unemployment benefits with the Employment Development Department (EDD), telling the EDD she lost her job due to a “temporary layoff.”

The employer denied laying Johar off. While conceding that she left with her supervisor’s approval, the employer advised the EDD that Johar’s failure to provide a return date or otherwise communicate with her supervisor while she was away amounted to a voluntary quit.

According to Johar, she was hired with the understanding that she might need to take leaves from time to time to care for her grandmother. She had two approved leaves of absences for this purpose before this controversy.

EDD conducted an interview with the employer who conceded they approved her leave to go to Chicago, but stated that the approved leave was not indefinite. They said that Johar failed to respond to repeated requests for a return date, and was eventually deemed absent without leave.

The EDD accepted the employer’s position, found Johar ineligible for unemployment benefits, ordered reimbursement of benefits improperly paid, and imposed a penalty for willful misrepresentation in seeking benefits. An administrative law judge sustained the EDD’s ruling, and the California Unemployment Insurance Appeals Board (CUIAB) affirmed, finding that “Basically, [Johar] abandoned her job.”

When she initiated her appeal at the CUIAB she was in pro per. After the hearing she secured representation from the Workers’ Rights Clinic, one of the Community Justice Clinics affiliated with the Hastings College of the Law. The Clinic proffered some new evidence that had not been available at the time of the ALJ hearing. CUIAB said that it did “not think that the additional evidence is relevant.”

The Court of Appeal reversed in the published case of Johar v. California Unemployment Insurance Appeals Board – A162563 (September 2022).

Three days after the CUIAB issued its decision denying Johar’s appeal and refusing to consider the new evidence she proffered, Division One of this court filed its opinion in Land v. California Unemployment Insurance Appeals Board (2020) 54 Cal.App.5th 127 (Land).

In that case, the CUIAB, just as it did here, refused to consider the new evidence, citing due process concerns. The Land court viewed the proffered new evidence there to be “pivotal” and vacated the CUIAB’s affirmance of the ALJ’s decisions. The court remanded with directions that the CUIAB either take the new evidence into account directly, or remand to the ALJ to “make new findings of fact” and issue “new reasons for decision.”

However, “in the case a remand to review the new evidence was not necessary, because “the CUIAB’s decision was incorrect on the administrative record before it.” Thus the Court of Appeal held ” it was an abuse of discretion to withhold mandamus relief pending further administrative proceedings.”

Here there “was no evidence that, when Johar left, SWS had an established leave of absence policy which Johar knew or should have known, and simply ignored. And to the extent there was an informal leave protocol established by the parties’ prior conduct, Johar followed it.”

The dispositive question in this case is whether, having voluntarily left work for good cause, Johar manifested an intention to abandon her job while she was gone. Johar claims she did not.

An anticipatory breach of contract occurs when one contracting party “positively repudiates the contract by acts or statements indicating that [she] will not or cannot substantially perform essential terms thereof . . . .” [Citation.] “Anticipatory breach must appear only with the clearest terms of repudiation of the obligation of the contract.”

In the eight days between Johar’s departure and the “quit” date SWS reported to the EDD) or for that matter in the 13 days between her departure and the day her supervisor sent out Johar’s “final check,” nothing on this record comes close to meeting this test.

SWS took the position in the proceedings before the ALJ that Johar’s intention to quit may be inferred by her silence in the face of Mari Lynn Johnson’s post-departure requests for a specific return date.

But that is not enough to show a repudiation of future contractual duties. The emails of record show that Johar did eventually respond, saying she would “get back to you when the emergency ceases.” But even if we assume arguendo she failed to respond at all, as Mari Lynn Johnson testified, the evidence is still insufficient to show a “positive” repudiation in “the clearest terms.”

61% of 6.2 Million Disabled People are Episodic and Not Permanent

The term “permanent disability” is frequently used in legal definitions, medical and rehabilitation terminology, insurance coverage, and government compensation programs. People with episodic disabilities who need to use a variety of financial support programs face challenges since the definitions of these programs and benefits vary from one source to the next.

An episodic disability is characterized by periods and degrees of wellness and disability that fluctuate over time. A growing percentage of people are affected by episodic disability.

According to a Statistics Canada survey report, “of the 6.2 million Canadians with disabilities aged 15 years and over, just 39 percent (2.4 million) experienced conventional, continuous limitations, while 61 percent (3.8 million) experienced some type of disability dynamic..

Many people suffer from episodic disabilities, and the unexpected nature of their illnesses makes it difficult for them to achieve long-term goals, find work, maintain a stable income, or get social assistance. Moreover, these phases of health and disability are unpredictable. Consequently, a person may enter and exit the labor force with unpredictability.

In 2015, the Episodic Disabilities Employment Network (EDN) updated its list of episodic conditions, which is continuously expanding with time. The diseases and conditions that are the potential causes of episodic disabilities include; arthritis, asthma, some forms of cancer, chronic obstructive pulmonary disease, chronic bronchitis, emphysema, chronic fatigue syndrome, chronic pain, chronic inflammatory demyelinating polyneuropathy (CIDP), Crohn’s & colitis, diabetes, epilepsy, fibromyalgia, hepatitis C, human immunodeficiency virus/ Acquired immunodeficiency syndrome (HIV/AIDS), lupus, depression, anxiety, bipolar disorder, schizophrenia, Meniere’s disease, multiple sclerosis, migraines, Parkinson’s disease, and systemic exertion intolerance disease (SEID).

In California workers’ compensation the distinction between episodic and permanent disabilities can make a major difference in long term benefit awards. This is especially significant when consideration is given to claims of “Kite” disability (Athens Administrators v. Workers’ Comp. Appeals Bd. (Kite) (2013) 78 Cal.Comp.Cases 213),  In Kite cases total disability can be awarded when a vocational rehabilitation expert claims an injured worker is unable to compete on the open labor market at all – forever.  

Such a conclusion must consider the episodic nature of some disabilities.

Rehabilitation involves any services or providers who address or prevent disability experienced by people living with chronic episodic illness. Rehabilitation should be disability focused, goal oriented, person centered, focused on function and tailored to an individual’s goals, abilities and interests.

The bulk of the literature on episodic disabilities and rehabilitation has been related to those suffering with HIV. And currently the issue of episodic disabilities is resurfacing for those with Long COVID.

For example one study found that “Contextual factors that influenced disability were integral to participants’ experiences and emerged as a key component of the framework. Extrinsic contextual factors included social support (support from friends, family, partners, pets and community, support from health care services and personnel, and programme and policy support) and stigma. Intrinsic contextual factors included living strategies (seeking social interaction with others, maintaining a sense of control over life and the illness, “blocking HIV out of the mind”, and adopting attitudes and beliefs to help manage living with HIV) and personal attributes (gender and aging). These factors may exacerbate or alleviate dimensions of HIV disability.”

Perhaps it is now prudent to consider concepts learned from the growing body of literature on episodic disability when evaluating a claim of disability based on the Kite decision. Is there enough data to be deemed that such an injured worker will not be employable forever, no matter what?  Or is is episodic, meaning perhaps for now and the immediate future, but not necessarily forever.