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Tag: 2022 News

California and U.S. Supreme Courts Face Off over Employer Arbitration

A landmark employment law case will soon be decided by the California Supreme Court, which will require California’s top court to go head-to-head with the United States Supreme Court, over the application of employer arbitration agreements that seek to limit employees from pursuing Private Attorney General Act (PAGA) claims against them, and proceed to arbitration instead.

The soon-to-be landmark decision involves Erik Adolph, who was a driver for UberEATS, a meal delivery service. The company through which drivers are connected with those in need of UberEATS’ services is owned by Uber Technologies Inc..

Before he began making deliveries for UberEATS in March 2019, Adolph created an account to use the UberEATS app. In creating his account, Adolph accepted an arbitration agreement, which “is governed by the Federal Arbitration Act.”

In October 2019, Adolph filed a putative class action complaint against Uber, claiming that Uber had misclassified employees as independent contractors, and had therefore failed to reimburse the class members for necessary work expenses. The complaint was amended to include only a California Private Attorney General Act (PAGA) cause of action. Uber filed a petition to compel arbitration of Adolph’s individual claims, strike the class action allegations, and stay all court proceedings.

But the trial court denied Uber’s petition to compel arbitration citing California Supreme Court’s decision in Iskanian v. CLS Transportation Los Angeles, LLC (2014) 59 Cal.4th 348, 384 and the cases following it, .

In Iskanian the California Supreme Court held “that an employee’s right to bring a PAGA action is unwaivable,” and that “here . . . an employment agreement compels the waiver of representative claims under the PAGA, it is contrary to public policy and unenforceable as a matter of state law.”

Uber appealed the ruling of the trial court. On April 11, 2022 the Court of Appeal affirmed the trial court in the case of Adolph v Uber Technologies Inc. – G059860 (consol. w/ G060198). The case was unremarkable at the time, hence it was “unpublished.”

The Court of Appeal acknowledged that about 11 days prior to its April 11 opinion the “United States Supreme Court heard arguments on March 30, 2022, in the case of Viking River Cruises, Inc. v. Angie Moriana, case no. 20-1573 (Viking).” And that the issue before SCOTUS was “Whether the Federal Arbitration Act requires enforcement of a bilateral arbitration agreement providing that an employee cannot raise representative claims, including under PAGA.”

Nonetheless, rather than waiting for a decision by the SCOTUS, the Court of Appeal went ahead and fell in line with other California decisions and concluded that “Unless and until the United States Supreme Court or the California Supreme Court directly overrules it, the courts of this state must follow the rule of Iskanian (Auto Equity Sales, Inc. v. Superior Court (1962) 57 Cal.2d 450, 455), which establishes that the trial court did not err by concluding that the initial issue of whether Adolph can pursue a PAGA claim as an aggrieved employee must be decided by the trial court, not an arbitrator.”

About two months later, SCOTUS published its decision in Viking on June 15, 2022, agreeing with the employer, and limiting the application of Iskanian in California. It said “When an employee’s own dispute is pared away from a PAGA action, the employee is no different from a member of the general public, and PAGA does not allow such persons to maintain suit.” As a result, Moriana would lack statutory standing to maintain her non-individual claims in court, and the correct course was to dismiss her remaining claims.

The U.S. Supreme Court decision in Viking has now – at least temporarily – disrupted the PAGA process against employer’s who have arbitration agreements in California Hence, on July 22, 2022 the California Supreme Court granted Uber’s Petition for Review in the Adolph case. The Uber case which was unremarkable is now remarkable, since the timing make it the case chosen to decide how Viking will work in California.

The case will now be the arena where California employers will wage their battle to limit the application of the Private Attorney General Act against them, in favor of arbitration of each employees individual claim. The outcome of the battle is uncertain, but will no doubt be closely followed, as it will have a major impact on California employment law – one way or the other.

NCCI Publishes New Countrywide Court Case Update

NCCI’s Countrywide Court Case Update provides a look at some of the cases and decisions monitored by NCCI’s Legal Team that may impact workers compensation (WC) across the states. This July 2022 edition contains updated information on cases previously introduced and presents new cases and decisions.

Stakeholders remain interested in COVID-19-related cases that could impact the WC system.

In California and Wisconsin courts have considered issues related to employer liability for injuries suffered by the spouse of an employee who allegedly contracted COVID-19 at work and spread it to the spouse at home.
In Texas, a federal court held that WC exclusive remedy bars a tort lawsuit brought against an employer by the family and estate of an employee who contracted and died from COVID-19.

And in Ohio, in Yeager v. Arconic Inc., an appellate court found that an employee’s contraction of COVID-19 was not an occupational disease in WC because the employee failed to show that the employment created a risk of contracting COVID-19 in a greater degree and different manner than the general public.

And the legal status of marijuana and its implications for Workers Compensation claims administrators remains a hot topic.

In 2022 Rhode Island legalized recreational marijuana (S 2430/H 7593), Maryland passed legislation (HB 1) allowing voters to decide on a constitutional amendment that would allow recreational use, and the Mississippi legislature enacted a bill (SB 2095) that legalizes medical marijuana.

So far, 20 jurisdictions have legalized recreational marijuana and 38 allow for medical use.

In the meantime, marijuana reimbursement in WC remains a state-by-state patchwork. On June 21, 2022, the United States Supreme Court denied the petition to review the case of Musta v. Mendota Heights Dental Center, where the court was asked to resolve the question of whether the federal Controlled Substances Act (CSA) preempts a state order requiring employers and insurers to reimburse claimants for their medical marijuana use.

The case was on appeal from the Supreme Court of Minnesota which, on October 13, 2021, ruled that the prohibition of marijuana possession under the CSA preempts an order made under Minnesota WC law that requires an employer to reimburse an injured employee for the cost of medical marijuana used to treat a work-related injury.

Courts have also reviewed employment-related marijuana questions. On January 14, 2022, the Supreme Court of New Hampshire, in Paine v. Ride-Away, Inc., ruled that the lawful use of therapeutic cannabis can be a reasonable accommodation for an employee with a disability under New Hampshire law.

For more information on cases monitored by NCCI’s Legal Team, visit previous Court Case Updates, COVID-19 Court Cases, and Court Case Insights on ncci.com.

City Sues Feds to Keep 150 Year Old 700 Patient Rehab Hospital Open

Laguna Honda and Rehabilitation Center is a skilled nursing and rehabilitation center owned and operated by the San Francisco Department of Public Health. It is located on a 62-acre campus in the heart of the city,

Laguna Honda is one of the largest skilled nursing facilities in the United States, and represents the one of the most extensive commitments by any city or county to therapeutic care for seniors and adults with disabilities. It was founded in 1866 to care for one of the first generations of San Franciscans, the Gold Rush pioneers. A century and a half later, it remains a civic icon representing San Francisco’s tradition of service to the underserved.

In July 2021, Laguna Honda self-reported two non-fatal overdoses to the California Department of Public Health (CDPH), per standard Laguna Honda policy and federal regulations. That report triggered a series of inspections by CDPH and CMS. Laguna Honda was cited for deficiencies in care related to cigarette lighters and drug paraphernalia found on campus, infection prevention and control, as well as two missed doses of a medication.

Despite Laguna Honda’s work to correct the cited deficiencies, CMS terminated Laguna Honda’s Medicare and Medicaid provider agreements as a result of the deficiencies. The City has appealed that decision, and Laguna Honda intends to apply for re-certification in both Medicare and Medicaid with CMS. However, to continue federal funding, Laguna Honda was forced to prepare a closure and transfer plan.

SFDPH proposed a number of options based on its assessment of the Laguna Honda patient population and the known lack of skilled nursing beds that would have lessened the impact on existing patients, including a re-certification process that would not require relocating existing patients; an 18-month transfer plan that would give appropriate time to find alternative care and living arrangements for all patients; and a phased transfer process wherein the most vulnerable patients would be transferred last.

On May 13, 2022, CMS rejected all of those options and insisted on an unreasonable deadline of September 13, 2022, giving Laguna Honda just four months before federal funding would be cut off, the facility would be forced to close, and close to 700 patients would have to be transferred or discharged. There is an acute shortage of skilled nursing beds throughout California and the Bay Area, and it is simply impossible to find skilled nursing beds for all of Laguna Honda’s patients within the timeframe mandated by CMS.

Additionally, the City filed three administrative appeals contesting the CMS decision to terminate its contract with Laguna Honda. Those administrative appeals will not be decided until well after the September 13 deadline to close the facility, effectively denying the City, Laguna Honda, and patients the due process they are owed.

Thus far, nine patients who have been transferred or discharged from Laguna Honda have died days or weeks after transfer or discharge, underscoring the incredibly high stakes of moving such a fragile population of people in a rushed manner. The federal government, through CDPH, have temporarily paused patient transfers, but the September 13 deadline remains, giving the City less time to complete this daunting and ill-advised process.

However San Francisco City Attorney David Chiu and former City Attorney Louise Renne announced that they filed a pair of lawsuits over the federal government’s decision to cut off federal funding to Laguna Honda Hospital & Rehabilitation Center and mandate that the facility transfer or discharge all patients by September 13, 2022.

The City’s lawsuit against the U.S. Department of Health and Human Services (HHS) and Health and Human Services Secretary Xavier Becerra alleges that the Centers for Medicare & Medicaid Services (CMS), which operates under HHS, forced the City to implement an unworkable closure and transfer plan that denies the City due process and puts Laguna Honda patients at risk.

The complaint lays out how CMS imposed an arbitrary September 13 deadline to transfer Laguna Honda’s patients and has denied the City due process as the facility is required to close well before the City’s administrative appeals can be decided – appeals that would render the transfers unnecessary.

The lawsuit seeks declaratory and injunctive relief to eliminate the September 13 deadline and extend federal funding to Laguna Honda at least until the appeals can be decided and all patients can be safely transferred or discharged.

Similarly, Louise Renne, founding partner at the Renne Public Law Group (RPLG) and former San Francisco City Attorney, announced that she has filed a class action lawsuit against the state and federal government on behalf of Laguna Honda patients and families.

The RPLG complaint alleges that the closure of Laguna Honda and rushed transfer process violate the Americans with Disabilities Act and deny patients and their families substantive and procedural due process. The RPLG lawsuit is seeking declaratory and injunctive relief to continue federal funding to Laguna Honda and to stop patient transfers and discharges.

Applicant Arrested Following Surveillance and Social Media Posts

Richard James McGee, 47, of San Bernardino, was arraigned on two felony counts of workers’ compensation insurance fraud after a Department of Insurance investigation found he allegedly misrepresented injuries to his employer in order to receive over $30,000 in undeserved disability payments.

In August 2019, while employed as a motorcycle mechanic, McGee allegedly suffered an unwitnessed work-related injury to his arm and right shoulder when a gas tank fell and pinned his arm against a motorcycle. McGee began receiving Temporary Total Disability payments when his work restrictions could not be accommodated.

The investigation began after McGee’s coworkers saw photos on multiple social media platforms in which he was actively racing his motorcycle and riding his downhill mountain bike – activities requiring the use of both his arms and shoulders.

It also was discovered that McGee was operating his own motorcycle mechanic shop out of his garage, Inland Empire Motorsports.

In August 2020 during a Qualified Medical Exam, McGee told the physician because of his injury he could no longer work as a motorcycle mechanic and he could no longer ride his mountain bike and had not done so since his injury in August 2019.

However, surveillance video showed McGee riding his mountain bike at a mountain bike park in Running Springs, California, in which he took his mountain bike off large jumps and crashed his mountain bike.

When Department detectives presented the social media posts and surveillance video to the physician who did McGee’s exam, the physician opined McGee had not accurately represented his injury and physical abilities, and that McGee had lied during his original exam.

As a result of misrepresenting his injury and physical capabilities, McGee received $30,629 in workers’ compensation benefits he was not entitled to receive.

Department detectives arrested McGee and he was booked into the West Valley Detention Center. The San Bernardino County District Attorney’s Office is prosecuting the case.

WCAB Has No Duty to “Rescue” Applicant From Take Nothing

Robert Backus, a 40-year-old salesman for Schireson Bros, Inc., dba Volutone, filed two Applications, alleging that on 12/13/17 and during the period commencing 1/13/17 through 1/13/18, he sustained injury arising out of and occurring in the course of employment to his low back and lower extremities. The claims were denied by the employer.

Backus testified at the trial and the matter was continued for further testimony. At the next hearing, he testified and Rossana Harris was called as witness by defendant. The trial was continued and at the third hearing no additional exhibits were offered and there was no testimony; the matter was submitted for decision

The WCJ found that Robert Backus did not sustain injury arising out of and occurring in the course of employment to his low back and lower extremities; and Ordered that he take nothing by way of his injury claim.

The WCAB denied his Petition for Reconsideration in the panel decision of Robert Backus v Schireson Bros, Inc. – ADJ11847265-ADJ11741978 (June 2022).

Backus contended on Reconsideration that the reports from QME Allen Fonseca, M.D., were not properly considered regarding the issue of injury AOE/COE, that the reports from Dr. Fonseca are substantial evidence, that the decision was based on a “partial and unsubstantial record,” that his “unimpeached and uncontradicted” testimony must be accepted as substantial evidence, and that the record should be further developed.

Both the Panel and the WCJ noted that regarding applicant’s “unimpeached and uncontradicted” testimony, the WCJ stated in the Report, Backus, ”had highly questionable credibility due to the fact that he failed to disclose his prior back injury to either examining physician” … “and initially denied such injury under oath until confronted with the records of same.” The WCJ also noted that applicant’s testimony, “was in fact rebutted by Defense witness Rossana Harris.”

The Panel cited numerous authorities for the proposition that “It is well established that a WCJ’s opinions regarding witness credibility are entitled to great weight.

The Panel went on to say that “most of applicant’s arguments are premised on his contention that the WCJ erred by not considering the reports from QME Dr. Fonseca.” However after having “reviewed the entire trial record, it is clear that the WCJ is correct; the trial record contains no reports from Dr. Fonseca.”

As to the issue of whether the record should be further developed, the panel said “applicant is correct that the Appeals Board has the discretionary authority to develop the record when the record does not contain substantial evidence pertaining to a threshold issue.”

Citing numerous case authorities, and referring to footnote 2 of the WCJ Report, the panel went on to say “if a party fails to meet its burden of proof by failing to introduce competent evidence, it is not the job of the Appeals Board to rescue that party by ordering the record to be developed.”

OSHA Repeatedly Cites 1,600 Store Retailer for “Flagrant” Violations

The U.S. Department of Labor has once again cited Dollar Tree Inc., one of the nation’s largest discount retailers, for workplace safety violations after it imposed $1.2 million in penalties following an inspection at two of its stores.

In it’s press release, OSHA claims that “one of the nation’s largest discount retailers continues to expose employees to the risk of injuries by flagrantly ignoring workplace safety regulations, this time with hazardous conditions found at two Ohio locations, in Maple Heights and Columbus.”

Since 2017, the U.S. Department of Labor’s Occupational Safety and Health Administration and state OSHA programs have conducted more than 500 inspections at Family Dollar and Dollar Tree – operated by their parent company, Dollar Tree Inc. – and found more than 300 violations. During these inspections,

OSHA says it routinely finds “exit routes, fire extinguishers and electrical panels dangerously obstructed or blocked; unsafe walking-working surfaces; and unstable stacks of merchandise.”

Following the Ohio inspections, OSHA proposed penalties of $1,233,364 for multiple violations.

“Family Dollar and Dollar Tree stores have a long and disturbing history of putting profits above employee safety,” said Assistant Secretary for Occupational Safety and Health Doug Parker. “Time and time again, we find the same violations – blocked or obstructed emergency exits and aisles, boxes of merchandise stacked high or in front of electrical panels and fire extinguishers. Each hazard can lead to a tragedy.”

On Jan. 31, 2022, OSHA initiated an inspection following an employee report of unsafe conditions at the Family Dollar store on Dunham Road in Maple Heights. The agency issued citations for one repeat violation and four willful violations, with proposed penalties of $685,777.

Two weeks later, OSHA opened an inspection on Feb. 10, 2022 in response to an employee complaint of water leaking through the ceiling causing wet floors and ceiling tiles on the floor at the Lockbourne Road store in Columbus. As a result, the agency proposed $547,587 in penalties for one serious and one repeat violation, and four willful violations.

In both inspections, OSHA found hazards related to, obstructed egress, unstable stacks, inaccessible electrical equipment and fire extinguishers, as well as trip and fall hazards caused by water, carts, boxes, trash and merchandise spread throughout walking-working surfaces in the retail areas and storerooms.

A Fortune 500 company, Dollar Tree has been a leading operator of discount variety stores in North America for more than 30 years.

Headquartered in Chesapeake, Virginia, the company operates more than 16,000 stores across the 48 contiguous states and five Canadian provinces, supported by a nationwide logistics network and more than 193,000 employees.

The company has 15 business days from receipt of its citations and penalties to comply, request an informal conference with each of OSHA’s area directors, or contest the findings before the independent Occupational Safety and Health Review Commission.

Website Only Businesses Exempt from Disability Access Laws

Abelardo Martinez, Jr. filed a civil lawsuit against Cot’n Wash, Inc. (CW) alleging a single violation of the Unruh Civil Rights Act (Civ. Code, § 51 et seq.). He alleged CW violated the Unruh Act by intentionally maintaining a retail website that was inaccessible to the visually impaired because it was not fully compatible with screen reading software.

The Unruh Act provides that “[a]ll persons within the jurisdiction of this state . . . no matter what their . . . disability . . . are entitled to the full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind whatsoever.” (Civ. Code, § 51, subd. (b).)

CW “owns, operates and provides to the public” a website that “provides access to [CW’s] array of products and services, including descriptions of its products, . . . [and an] online shop.” CW is not alleged to offer any products and services at any physical location, or in any manner other than through its website.

Martinez is “permanently blind and uses screen readers in order to access the internet and read website content.” There are “well-established, industry standard guidelines for ensuring websites are accessible to blind and visually-impaired people” using screen reading software.

The trial court sustained a demurrer to the complaint without leave to amend. The Court of Appeal affirmed the dismissal in the published case of Martinez v Cot’n Wash, Inc. – B314476 (August 2022).

On appeal, Martinez argues that the trial court erred in concluding (1) the alleged inaccessibility of CW’s website did not violate the Americans with Disabilities Act (42 U.S.C. § 12111 et seq.) (the ADA), specifically Title III of the ADA (42 U.S.C. §§ 12181−12189) (Title III) and (2) the complaint did not allege sufficient facts to establish CW’s discriminatory intent, which the Unruh Act requires in the absence of an ADA violation.

The Court of Appeal held that the trial court was correct on both points.The key issue was whether CW’s website constitutes a “place of public accommodation” for the purposes of Title III. (42 U.S.C. § 12182(a).)

“The ADA defines the phrase ‘. . . public accommodation’ by enumerating 12 categories of covered ‘places’ and ‘establishments,’ giving nonexclusive examples of types of enterprises falling into each category. [Citations.] The listed examples mainly reference physical locations. The implementing regulations similarly define a public accommodation by referring to a ‘facility,’ which is in turn defined as ‘all or any portion of buildings, structures, sites, complexes, equipment, rolling stock . . . or other real or personal property, including the site where the building, property, structure, or equipment is located.’ ‘

This is not surprising as there were no commercial websites when the ADA was enacted in 1990.

Martinez argued that the plain meaning of “place of public accommodation” is alone sufficient for the Court of Appeal to adopt the broader view taken by several federal courts – namely, that a physical place is not a necessary component of the ADA’s definition of a place of public accommodation.

However the opinion disagreed “that the plain language of the statute is alone sufficient to decide the issue – let alone sufficient to decide the issue in Martinez’s favor.” Dictionaries “overwhelmingly” define “place” as involving a physical location.

The opinion when on to note that “Congress and the DOJ have long been aware of the confusion in the courts regarding whether and when a website can be considered a ‘place of public accommodation,’ but have chosen not to clarify the issue through amendments to the statute or additional rulemaking. The federal circuit split began in the 1990’s, and resolving it – be it through judicial or legislative means – has been the topic of legal scholarship ever since then.”

“It thus appears that, no later than 2010, Congress and the DOJ (1) both recognized the need to clarify whether and under what circumstances a website might constitute a ‘place of public accommodation,’ and (2) agreed that such clarification should take a broad and inclusive approach. The only conclusion we can draw from their failure in the 12 years that followed to provide any such clarification through regulation or statute is that neither officially endorses this approach.

Medicare Reverses Plan To Limit Hospital Safety Data Next Year

The Centers for Medicare & Medicaid Services (CMS) has pulled back on plans to pause public reporting on certain hospital safety data in the wake of pushback from patient safety advocates.

In Monday’s release of the final Inpatient Prospective Payment System (IPPS), CMS detailed numerous changes from a fiscal year 2023 proposal it had laid out in April. Among these was a decision to pause a composite measure of 10 patient safety indicators including pressure sores, falls and sepsis called PSI 90.

According to the report by Fiercehealcare.com, the agency would have stopped calculating these composite indicators in hospitals’ quality ratings for Medicare reimbursement and stopped publishing them as part of the Star Ratings found on the government’s Care Compare website.

CMS said at the time its decision was intended to shield hospitals that had been harder hit by the COVID-19 pandemic and, subsequently, received a financial and publicity hit compared with hospitals in less impacted regions.

The agency now seems to have split the difference, announcing Monday that it would maintain public awareness while seeking to avoid the unintended financial penalty.

CMS will include the measure in Star Ratings in alignment with the feedback we received,” the agency wrote. “Although this measure will be publicly reported, it will not be used in payment calculations in the HAC to avoid unintentional penalties related to the uneven impacts of COVID-19 across the country.”

The agency’s decision received a warm welcome from The Leapfrog Group, a patient safety watchdog that has been petitioning the government via letters, reports and informational webinars to keep the hospital quality measure available to the public.

The agency’s new approach manages to continue reporting composite measures responsible for 25,000 deaths per year without the confounding influence of COVID-19, Leapfrog said in a release. More broadly, the group said it signals the agency’s “powerful support for transparency” and suggests similar data suppression proposals aren’t on the horizon.

We were gratified to hear CMS reinforce their longstanding commitment to transparency and patient safety,” Leapfrog President and CEO Leah Binder said in a statement. “We thank CMS for their leadership – for listening to and championing patients and families, patient safety advocates, employers, purchasers, clinicians and all Americans who are deeply concerned about patient safety.”

Also calling for the rollback was the National Alliance of Healthcare Purchaser Coalitions. The nonprofit representing private and public sector members had written to CMS warning that the data were vital to purchasers’ decisions when building high-quality networks which, alongside safety concerns, would lead to higher costs and the perpetuation of inequities.

WCAB Affirms Apportionment and Clarifies Hikida Rule

On March 6, 2015 Cristina Jackson was working as a package handler for FedEx Ground Package System, Inc. when she sustained injury arising out of and in the course of employment to her right knee and left knee. The employer accepted the claim and provided medical treatment and indemnity benefits.

Dr. Han reported in the case as a QME. He diagnosed her with bilateral post-traumatic osteoarthritis of the knee post knee replacement, internal derangement of the right knee with lateral meniscus tear and internal derangement of the left knee with lateral and medial meniscus tear. He described Applicant’s medical history which included prior bilateral meniscectomies in 1995 and 1996 and a left ACL reconstruction in 1992.

In his April 5, 2019 report, Dr. Han apportioned 60% of the disability to pre-existing and 40% to the industrial injury. He explained that Jackson had prior surgeries, fell off a curb in 2016, and had obesity resulting in degenerative changes that made the bilateral total knee replacement surgeries necessary, which is the basis for the permanent disability.

After a trial on the issue of permanent disability, the WCJ found that the injury resulted in permanent disability of 21%, after 60% apportionment to “other factors” of permanent disability under Labor Code section 4663(c)

In her Petition for Reconsideration, Jackson contends that the medical opinion of Dr. Han is not substantial evidence of apportionment under the requirements of Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 [Appeals Board en banc] and that since applicant’s permanent disability rating is based on her bilateral knee replacement surgeries necessitated by the industrial injury, she is entitled to an unapportioned award pursuant to Hikida v. Workers’ Comp. Appeals Bd. (2017) 12 Cal.App.5th 1249 [82 Cal.Comp.Cases 679].

The WCAB panel affirmed the apportionment, however it clarified the WCJ’s discussion of Hikida in the panel decision of Jackson v FedEx ADJ10048474 (June 2022)

After the panel concluded that “Dr. Han’s three medical reports, taken together, are substantial evidence justifying the WCJ’s determination that 60% of applicant’s permanent disability is caused by non-industrial ‘other factors’ under Labor Code section 4663(c)” it went on to review the Hikida decision in greater detail.

Dr. Han convincingly explained that apportionment of the need for those surgeries applied equally to apportionment of the permanent impairment. However, we do not adopt or incorporate the discussion of Hikida found in the WCJ’s Report.”

The panel went on to explain that “the Hikida principle is not limited to situations involving failed treatment or new injuries. In County of Santa Clara v. Workers’ Comp. Appeals Bd. (Justice) (2020) 49 Cal.App.5th 605, 615 [85 Cal.Comp.Cases 467], however, the Court of Appeal does seem to have made an attempt to limit Hikida, with the Court in Justice stating: ‘Hikida precludes apportionment only where the industrial medical treatment is the sole cause of the permanent disability.’ ” (Italics added.)

The instant case is more like Justice than Hikida. In Hikida, the injured employee developed the entirely new medical condition of CRPS following her treatment and surgery, whereas here, as in Justice, the applicant had a significant prior history of the same knee problems and degenerative conditions, some of them non-industrial, which continued to the date of injury.”

Insurance Commissioner Sues Carrier for Illegal Marketing Tactics

The California Insurance Commissioner announced a major legal action against Mercury Insurance for violating consumer protection laws, including by selling Mercury’s highest-priced policy to “good drivers” instead of the lowest-priced policy for which good drivers qualify. This legal enforcement action comes after a Department investigation found numerous areas where Mercury’s business practices harmed policyholders across its private passenger auto, homeowners, commercial auto, and commercial multi-policy lines of insurance.

This action comes after Mercury previously paid a $27.6 million fine in August 2019 that was levied by the Department of Insurance, the largest fine against a property and casualty insurer in Department history. The California Supreme Court upheld the Department’s action finding Mercury charged consumers unapproved and unfairly discriminatory rates.

Like that case, the Department’s latest legal action against Mercury also alleges numerous violations of Proposition 103, passed by the voters in 1988 to allow the Insurance Commissioner to protect consumers from excessive and unfairly discriminatory rates.

By passing Proposition 103 in 1988, California voters mandated a 20 percent “good driver discount” for consumers who maintain a safe driving record. The Department’s investigation found that Mercury attempted to evade the requirements of Proposition 103 by steering good drivers into a higher-priced plan.

Mercury maintains two insurance companies in California: Mercury Insurance Company (MIC), which is exclusively for “good drivers” and charges lower rates, and California Automobile Insurance Company (CAIC), which charges higher rates for nearly identical coverage and insures all drivers. The Department’s investigation found a number of ways that Mercury illegally sold and steered drivers to its company with the higher-priced plan, including:

– – Directing its agents to provide quotes in its higher-priced plan using artificially low mileage, giving the appearance of lower rates in order to entice consumers.
– – Directing its agents to refuse to sell a lower-priced policy if a good driver had been canceled for non-payment of premium or had an accident for which the driver was not at fault, neither of which is allowed under law.
– – Only offering a monthly payment option in the higher-priced plan.
– – Dissuading good drivers from switching to the lower-priced plan with misleading language for the nearly identical plans, including using language such as “an [MIC] policy may be offered for a lower premium, but also provides somewhat less coverage and more restrictive payment options than the [CAIC] policy you currently have.”
– – Falsely representing that both plans charge policy fees, when in fact only the higher priced plan charged policy fees.
– – Subjecting good drivers without prior coverage to different terms and conditions than other drivers.

The Department alleges that Mercury also overcharged businesses and homeowners in other lines of insurance through a variety of illegal practices that resulted in unfairly discriminatory rates. For instance, Mercury increased premiums for commercial drivers who had been in an accident where they were not at fault and charged a higher premium for commercial drivers who had previously held a Mercury policy but failed to satisfy a requirement that they be listed as the named policyholder with another company for the previous two years, treating them as if they were new drivers.

The allegations – 34 in all – are detailed in the Department’s Notice of Non-Compliance.