Tag: 2025 News

In 1996, Todd Hearn began working for PG&E as a meter reader. A few years later, he began training as a lineman and completed his apprenticeship in 2004. During the relevant time period, Hearn worked out of PG&E’s facility in Napa. PG&E became aware of performance issues at the Napa yard around 2016, including delays in maintenance and repair projects and rising overtime claims. Roy Surges, PG&E’s Electric Superintendent, began working with Tanya Moniz-Witten, a senior director at PG&E, to help address the situation.

In early 2018, Surges noted “excessive meal costs, suspicions of misconduct, a high number of rest periods, poor attendance, schedule performance, multiple retaliatory compliance and ethics complaints, poor moral and bad attitude” among “the bulk” of the senior crew and foreman in the Napa yard. Surges was working with the supervisors to provide “added oversight measures” and brought in corporate security to assist. PG&E began gathering data, including timecards and vehicle GPS records, in order to “deal with” some “bad apples.” Moniz-Witten also brought in ”HR/Labor” for “advisement and help” in addressing the situation.

The investigation was subsequently narrowed down to five and Hearn was identified as one of the five based on “potentially false time cards.” In late June 2018, Hearn and four other linemen were suspended. Hearn was informed he was being placed on “crisis leave” due to an “alarming amount of discrepancies” in Hearn’s timecards.The investigation was transferred to Kevin Cashman, a senior investigator in PG&E’s Corporate Security Department (CSD). In August 2018, Cashman interviewed Hearn.

PG&E then hired Tony Mar, a retired PG&E Director of Electric Operations, to conduct a separate investigation into the Napa yard. While Mar claimed he was not asked to investigate any specific employees, Mar acknowledged he only wrote reports on the five suspended linemen. In early December 2018, Mar informed PG&E he provided Internal Auditing “what we have identified related to Hearn,” including that he took multiple trips to his house, claimed overtime when he was not on site, requested unearned meals, and delayed his arrival to work locations.

Hearn presented evidence that beginning in 2017, he repeatedly expressed safety concerns to PG&E management about a device called a “Tripsaver” that PG&E began installing on its electrical lines in 2016. PG&E Superintendent Roy Surges responded negatively to Hearn and others who raised these safety concerns. As a result, PG&E retained a lawyer named Kelly Applegate to conduct an external investigation of retaliation claims made by employees against PG&E management, including the report Hearn made.

After additional investigations transpired, in a January 18, 2019 letter, PG&E informed Hearn his employment was terminated based on findings of an investigation into his conduct. Hearn filed a lawsuit against PG&E, alleging four causes of action: (1) retaliation for disclosing the company’s safety violations (Lab. Code, § 1102.5); (2) retaliation for lodging a bona fide complaint about unsafe working conditions (Lab. Code, § 6310); (3) wrongful termination in violation of public policy; and (4) defamation.

The jury found PG&E liable for defamation but rejected Hearn’s retaliation claim. The jury awarded damages totaling $2,160,417, comprised of separate awards as to past and future economic and non-economic damages. The verdict form did not ask the jury to consider or award any assumed reputational harm damages. The jury declined to award punitive damages.

On appeal, PG&E contends the trial court erred by denying its motion for judgment notwithstanding the verdict (JNOV) because Hearn’s defamation claim was not separately actionable – i.e., the defamation claim was premised on the same conduct that gave rise to his termination and the damages sought were solely related to his loss of employment. In his cross-appeal, Hearn alleges the verdict rejecting his retaliation claim is not supported by sufficient evidence and contends the trial court erroneously excluded relevant evidence.

The Court of Appeal reversed the judgment entered in Hearn’s favor on his defamation cause of action. The costs award premised on Hearn prevailing consequently was likewise reversed in the partially published case of Hearn v. Pacific Gas & Electric Co. -A167742 (January 2025).

The question PG&E asked to be resolved on appeal was “In a wrongful termination case, can a plaintiff recover in tort based on the same underlying harm as caused by the discharge?”

The California Supreme Court ruled that employees may generally assert tort claims against their employer, even in the context of their termination in three key cases, Foley v. Interactive Data Corp. (1988) 47 Cal.3d 654 (Foley), Hunter v. Up-Right, Inc. (1993) 6 Cal.4th 1174 (Hunter), and Lazar v. Superior Court (1996) 12 Cal.4th 631 (Lazar).

Specifically, the California Supreme Court has specified two hurdles employees must overcome: (1) such tort claims must be based on conduct other than that giving rise to the employee’s termination and (2) the damages sought cannot exclusively “result from [the] termination itself.”

“Based on these principles, the trial court erred in denying PG&E’s JNOV because Hearn may not recover for defamation when it arose from the same conduct giving rise to his termination and the only result is the loss of his employment. In other words, Hearn cannot recover damages for wrongful termination by recasting his claim as one for defamation.”

TUCHER, P.J., Dissented in part with the majority opinion.

Before Ozempic and similar “wonder drugs,” medically- assisted weight loss had to happen the old-fashioned way— surgical intervention. For Southern California residents in the 2010s the Wizard of Weight Loss was Dr. Julian Omidi. To make a long story short, Omidi helmed a massive health insurance fraud scheme called “Get Thin.” Omidi’s scheme promised dramatic weight loss through Lap-Band surgery and other medical procedures.

A grand jury indicted Omidi and his company Surgery Center Management, LLC (“SCM”) for mail fraud, wire fraud, money laundering, and other related charges arising from the Get Thin scheme. In a nutshell, the government alleged that Omidi and SCM defrauded insurance companies by submitting false claims for reimbursement.

The claims included, among other misrepresentations, fraudulent patient test results and false assertions that a doctor had reviewed and approved the medical procedures at issue. After three-and-a-half years of pretrial litigation and a 48-day jury trial, the jury convicted Omidi and SCM of all charges. The district court sentenced Omidi to 84 months imprisonment and fined SCM over $22 million.

At a subsequent hearing, the district court considered forfeiture for both defendants. The government argued that the total proceeds of Get Thin’s business during the fraud period – $98,280,221 – should be forfeited because the whole business was “permeated with fraud.” In other words, even if some parts of Get Thin seemed legitimate, the government argued that “all proceeds of that business are forfeitable,” as “the proceeds of that so-called ‘legitimate’ side of the business would not exist but for the ‘fraudulent beginnings’ of the entire operation” (namely, the call center). Omidi and SCM objected to the forfeiture amount, arguing that Get Thin was “not entirely a fraud,” and the forfeiture amount should be limited to the proceeds traceable to falsified insurance claims.

The district court agreed with the government. Reviewing the relevant statutes and persuasive out-of-circuit authority, it agreed that the $98,280,221 in proceeds were directly or indirectly derived from the fraudulent Get Thin scheme.

The 9th Circuit Court of Appeal affirmed in the published case of USA v Omidi – 23-1719 (January 2023).

The question in this case is whether the district court erred in ordering the forfeiture of all Get Thin’s proceeds, even though conceivably some of the incoming funds ultimately paid for legitimate and medically necessary procedures.

Under § 981(a)(1)(C), any property which “constitutes or is derived from proceeds traceable to” a mail or wire fraud scheme is subject to forfeiture. Section 981(a)(2)(A) defines “proceeds” in a health care fraud scheme as “property of any kind obtained directly or indirectly, as the result of the commission of the offense giving rise to forfeiture, and any property traceable thereto, and is not limited to the net gain or profit realized from the offense”

Said more simply, any proceeds that directly or indirectly derive from the fraudulent scheme must be forfeited, even if particular proceeds were not profits from the offense itself.

Applying the above rules to this case, any money acquired via the fraudulent Get Thin funnel was subject to forfeiture.”

Lien claimant Basso Pharmacy filed a lien pursuant to Labor Code section 4903(b) on April 17, 2008. The parties stipulated that lien claimant paid an activation fee of $100.00 on December 28, 2015 They further stipulated that lien claimant did not file a lien declaration pursuant to section 4903.05(c)(1).

Lien claimant contends that it was not required to file a declaration pursuant to section 4903.05 because the lien was filed in 2008, and it was never subject to the declaration requirement in section 4903.05(c)(1)

The WCJ found that as a result, lien claimant’s lien was dismissed with prejudice by operation of law as of Monday, July 3, 2017. Basso Pharmacy’s petition for reconsideration was denied in the panel decision of Carrillo v Troon Golf Management -ADJ4642758 (January 2025).

On Reconsideration Basso argued that it could not have legally filed such a declaration because its lien met none of the seven distinct requirements set forth in the Code. It had no obligation at the time of the original lien filing to consider any of these requirements because they in fact did not yet exist.

Sections 4903.05 and 4903.06 were added by Senate Bill (SB) 863 in 2012 and became effective January 1, 2013. Section 4903.05 was amended in 2016 by SB 1160 to add subdivision (c), the declaration requirement. The declaration requirement was described as an “anti-fraud measure.” (Sen. Rules Com., Off. of Sen. Floor Analysis, Analysis of Sen. Bill No. 1160 (2015- 1016 Reg. Sess.), as amended August 29, 2016, p. 4.)

Lien claimants had until Monday, July 3, 2017 at 5:00 p.m., to file a lien declaration. (Henkel Corporation v. Workers’ Comp. Appeals Bd. (Hernandez) (2018) 3 Cal.Comp.Cases 1424, 1426 [2018 Cal.Wrk.Comp. LEXIS 64] (Appeals Bd. en banc) (writ den.); Rodriguez v. Garden Plating Co. (2017) 82 Cal.Comp.Cases 1390 [2017 Cal.Wrk.Comp. LEXIS 124] (Appeals Bd. en banc).)

The legislative intent for the amendment of section 4903.05 to add the declaration requirement was to impose that requirement on “all lien claimants.” Section 4903.05(c)(1) addresses the declaration requirement for those liens filed after January 1, 2017, and section 4903.05(c)(2) addresses the declaration requirement for those liens filed before January 1, 2017.

The the WCAB panel concluded that “we will not – and cannot upset the legislative intent of the declaration requirement as requested by lien claimant. It is a cardinal rule of statutory construction that courts will choose that interpretation which most nearly effectuates the purpose of the Legislature. (Code Civ. Proc., § 1859.) “‘Once a particular legislative intent has been ascertained, it must be given effect even though it may not be consistent with the strict letter of the statute.’ “

“Accordingly, lien claimant was subject to the requirement to file a declaration pursuant to section 4903.05(c)(2), and had until 5:00 p.m. on Monday, July 3, 2017 to do so. As a result, lien claimant’s lien was dismissed with prejudice by operation of law as of Monday, July 3, 2017 at 5:01 p.m.”

The U.S. property/casualty (P/C) market in 2024 is forecast to have continued its trajectory of improving underwriting results, according to the latest report — Insurance Economics and Underwriting Projections: A Forward View – from the Insurance Information Institute (Triple-I) and Milliman, a collaborating partner. Further premium growth and improved underwriting performance should continue in 2025 and 2026, provided geopolitical and economic conditions remain relatively stable.

Key Performance Indicators

– – Economics: P/C underlying economic growth ended 2024 slightly below U.S. GDP growth at 2.3% versus 2.5% year-over-year (YOY). However, in 2025 and 2026, P/C underlying growth is expected to be above overall GDP growth, an improvement in year-end expectations. A further economic milestone occurred in 2024 with the number of people employed in the U.S. insurance industry surpassing three million.
– – Underwriting: P/C net combined ratio (NCR) estimate of 99.5 is a YOY improvement of 2.2 points, while net written premium (NWP) is estimated to increase 9.5% YOY. Personal lines 2024 NCR estimate improved by nearly 1 point relative to our prior estimates, primarily due to better-than-expected Q3 performance in personal auto. Commercial lines 2024 NCR estimate increased by 1.2 points due to commercial property and general liability. NWP growth rate for personal lines is expected to continue to surpass commercial lines by 9 points in 2024.

Additional Report Highlights

– – Personal lines: Personal auto projected 2024 NCR of 98.8 is 6.1 points better than 2023, with 2024 NWP growth rate of 14.0% the second highest in over 15 years. Homeowners projected 2024 NCR of 104.8 is a 6.1-point improvement over 2023 despite an above-normal hurricane season.
– – Commercial lines: Commercial property projected 2024 NCR of 91.2 is 3.3 points worse than 2023, with Hurricane Milton projected to be the worst catastrophe for commercial property insurance since Hurricane Ian in 2022 Q3. General liability projected 2024 NCR of 103.7 is 3.6 points worse than actual 2023 experience.

“Commercial lines continue to have better underwriting results than personal lines, but the gap is closing,” said Dale Porfilio, FCAS, MAAA, Triple-I’s chief insurance officer. “The impact from natural catastrophes such as Hurricane Helene in Q3 2024 and Hurricane Milton in Q4 2024 significantly impacted commercial property. The substantial rate increases necessary to offset inflationary pressures on losses have driven the improved results in personal auto and homeowners,” he added.

Turning to workers’ compensation, Donna Glenn, FCAS, MAAA, chief actuary at the National Council on Compensation Insurance (NCCI), provided a preview of this year’s average lost cost level changes and discussed the long-term financial health of the workers compensation system.

“The 2025 average loss cost decrease of 6% is moderate, which will inevitably have implications on the overall net written premium change,” Glenn said. She added that the –6% average loss cost level change in 2025 is notably different than was seen in 2024: an average decrease of more than 9%, representing the largest average decrease since before the pandemic.

“Payroll for 2025 will develop throughout the year resulting from both wage and employment levels. Therefore, overall premium will become clearer as the year progresses,” Glenn said.

Sutter Health is a comprehensive, integrated health system in northern California with 27 hospitals, 300 ambulatory sites, and imaging modalities.

Sutter Health and GE HealthCare just announced a seven-year strategic enterprise partnership, known as a Care Alliance, that aims to increase access to innovative imaging services and create a more seamless and coordinated experience for clinicians and patients across the Sutter Health system. This Care Alliance marks one of GE HealthCare’s largest ever enterprise strategic partnerships.

According to a report by Bloomberg the agreement is expected to generate $1 billion in revenue over the span of the partnership, GE Healthcare said. It marks one of the largest deals for the medical technology company since the firm was spun off from General Electric Co. two years ago.

GE HealthCare CEO Peter Arduini said he expects to enter into more strategic partnerships as consolidation of the health system continues and as the firm evolves from an imaging company to providing a variety of health-care solutions. Since the spinoff, the company has entered into more than 25 strategic partnerships, including a research and product development program with the Mayo Clinic and a 10-year partnership with the Ohio-based University Hospitals.

The first key focus area of the Care Alliance is an accelerated technology program across the Sutter Health system that will focus on some of the most advanced AI-powered imaging technology and digital solutions available to patients, including PET/CT, SPECT/CT, MRI, CT, X-ray, nuclear medicine and ultrasound. GE HealthCare’s interventional, mammography, diagnostic cardiology, maternal and infant care and anesthesia solutions will also be included in Sutter Health’s ambulatory care centers, helping to address the growing need for care outside of the traditional hospital setting.

This comprehensive technology refresh covers the breadth of GE HealthCare’s portfolio of solutions, providing clinicians with innovative options to meet changing patient needs more efficiently and quickly.

Imaging and ultrasound solutions, enabled by digital and AI advancements, will be implemented across the entire healthcare system over several years, reducing variation and providing the innovation clinicians need to best serve patients. Innovative new solutions include GE HealthCare’s Omni Legend PET/CT, StarGuide SPECT/CT and Vscan Air™ SL ultrasound with Caption AI™ software. Notably, GE HealthCare’s AIR™ Recon DL MR image reconstruction will be deployed and utilizes deep learning algorithms to improve image quality and MRI scan times. By optimizing image reconstruction AIR™ Recon DL reduces artifacts, and enhances image clarity and scan times, enabling clinicians to obtain high-quality diagnostic images while improving patient comfort and workflow efficiency.

The strategic partnership also supports Sutter Health’s larger access strategy, which includes opening dozens of new care sites across Northern California in the next few years. Additionally, it will further support the health system’s expansion of advanced service lines and destination centers of excellence including areas such as heart and vascular care, cancer care and neurosciences. This includes access to new technology and digital optimization to expand clinical procedures and services, helping enable precise, high-quality patient care from early screening to diagnosis to treatment to monitoring.

For example, Sutter Health plans to build a new cancer center on Sutter’s Memorial Medical Center campus in the California Central Valley and recently announced two new flagship campuses in Silicon Valley with specialty care focuses. Potential future areas of enhanced services across the Sutter Health system could include mental health, orthopedics, women’s health and pediatrics.

Sutter Health will adopt technology at a more rapid pace with an accelerated upgrade schedule, including the latest software releases to prevent obsolescence and keep technologies current over the long-term. The service delivery model will help ensure consistent operations and minimize unexpected disruptions—with patient safety, efficiency and reliability in mind.

The agreement will also include significant investment in Sutter Health’s workforce development programs to include ongoing training and education for technologists, nurses and physicians through Sutter Health University and other learning opportunities, which includes supporting the next generation of clinicians who are reflective of the communities they serve.

GE HealthCare plans to assist Sutter Health in the design of a scalable workforce and talent development program that includes talent pathway community outreach, collaborations with radiologic technologist schools, as well as talent acquisition, development and retention, including leadership and clinical learning journeys. The program will aim at addressing the critical clinician shortage and support healthcare providers’ clinical staffing needs.