Tag: 2025 News

According to a study published this year in the Journal of Inflammation Research – Mechanisms and Factors Influencing Resorption of Herniated Part of Lumbar Disc Herniation: Comprehensive Review – Lumbar disc herniation (LDH) is a common condition causing low back pain, radiating leg pain, and neurological symptoms.

Clinically, the phenomenon of spontaneous shrinkage or disappearance of a herniated disc without surgical intervention is called resorption. Spontaneous resorption of herniated disc material without surgical intervention is a well-documented phenomenon, occurring in approximately 70% of cases, offering a basis for conservative treatment.

Here are some of the mechanisms that play a role in resorption:

– – Inflammation and Macrophage Infiltration: The herniated nucleus pulposus (NP) is recognized as a foreign antigen, triggering an autoimmune response. Macrophages, particularly M1-type (pro-inflammatory) and M2-type (anti-inflammatory), infiltrate the herniated tissue. M1 macrophages produce pro-inflammatory cytokines (e.g., TNF-α, IL-1β, IL-6), which stimulate matrix metalloproteinases (MMPs) like MMP-3 and MMP-7. These enzymes degrade collagen and proteoglycans, facilitating resorption. M2 macrophages support tissue repair and resolution of inflammation in later stages.
– – Neovascularization: New blood vessel formation around the herniated disc enhances macrophage access and nutrient supply, aiding resorption. Cytokines such as vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (bFGF) drive angiogenesis.
– – Apoptosis and Autophagy: Programmed cell death (apoptosis) and autophagy (cellular self-degradation) in the herniated tissue contribute to its breakdown. The Fas-FasL pathway mediates apoptosis, reducing disc volume.
– – Dehydration and Retraction: Dehydration of the NP reduces disc volume, while mechanical retraction of the herniated material back into the annulus fibrosus may occur, particularly in cases with intact fibrous rings.
– – Matrix Degradation: MMPs, activated by inflammatory mediators, break down the extracellular matrix of the herniated disc, accelerating resorption.

And there are several factors that influence resorption:

– – Herniation Type and Size: Extruded and sequestered discs are more likely to resorb (87.77% and 66.91% incidence, respectively) compared to protruded (37.53%) or bulging discs (13.33%). Larger herniations, particularly those exceeding 50% of the spinal canal diameter (“giant” herniations), show higher resorption rates due to greater exposure to epidural vessels
– – Posterior Longitudinal Ligament (PLL) Integrity: Rupture of the PLL allows the NP to contact epidural vessels, promoting resorption. Intact PLL may hinder this process.
– – Composition of Herniated Tissue: Discs with a higher proportion of NP (high water content) are more prone to resorption than those with cartilaginous endplate material or Modic changes, which resist vascularization and macrophage infiltration.
– – Rim Enhancement on MRI: Greater rim enhancement on gadolinium-enhanced MRI indicates increased neovascularization and inflammation, predicting higher resorption likelihood.
– – Sagittal Parameters and Posture: Studies suggest that lumbar spine alignment, such as greater L4 posterior vertebral height and sacral slope, correlates with faster resorption, possibly due to biomechanical influences.
– – Disease Duration and Age: Shorter disease duration and younger age are associated with higher resorption rates, likely due to more robust immune responses and tissue plasticity.
– – Inflammatory Mediators: The balance of pro-inflammatory (e.g., TNF-α) and anti-inflammatory mediators influences resorption speed. High levels of MMPs and chemokines enhance matrix degradation.

Spontaneous resorption of LDH is a complex process driven by inflammation, macrophage activity, neovascularization, apoptosis, autophagy, and dehydration. Predictive factors such as herniation size, type, PLL rupture, and MRI rim enhancement guide clinical decision-making. Conservative treatments show promise in promoting resorption, reducing the need for surgery. Further research is needed to refine predictive models and optimize non-surgical strategies.

The Legislative Analyst’s Office (LAO) has provided fiscal and policy advice to the Legislature for 75 years. It is known for its fiscal and programmatic expertise and nonpartisan analyses of the state budget. The office serves as the “eyes and ears” for the Legislature to ensure that the executive branch is implementing legislative policy in a cost efficient and effective manner.

The LAO just published a new analysis of the Subsequent Injury Benefit Trust Fund (SIBTF), which was created as a narrow supplement to California’s workers’ compensation system. The state first enacted SIBTF to offset employers’ workers’ compensation costs for veterans and other workers whose serious pre-existing disabilities made a new work injury more disabling and, therefore, more expensive. The program had the effect of providing additional lifetime benefits to a small number of workers facing steep barriers to employment.

Over time, however, SIBTF has grown dramatically in both size and scope. Today, it operates alongside the standard workers’ compensation system but with broader eligibility, less rigorous standards, and more generous benefits.

SIBTF claims are paid out of the state fund, but the fund itself is supported by a tax that employers pay on their workers’ compensation insurance premiums. (This tax is sometimes referred to as an assessment.) All employers pay the same tax rate, levied as a flat percentage of the employers’ insurance premium total. Insurers collect the tax as part of the premium payments and remit the collections to the state. Employers that self-insure for workers’ compensation remit a commensurate payment to the state. The statewide SIBTF employer tax totaled $848 million in 2024-25.

In recent years, the SIBTF program has evolved from a narrowly focused benefit to support a small number of severely injured workers into a much larger and broader disability benefits program. Many more workers file claims with SIBTF today than a decade ago. These claims typically pay more generous benefits than standard workers’ compensation and many include compensation for common chronic illnesses, as opposed to severe pre-existing disabilities. The result is a benefit program that now rivals standard workers’ compensation in size and that may no longer align with the program’s original legislative intent.

Between 2005 and 2015, the state received about 1,000 SIBTF claims annually and was able to process roughly half of those claims each year. The number of injured worker submitting SIBTF claims has increased in recent years. The state now receives around 3,000 SIBTF claims per year, of which it has been able to process 500 to 1,000 claims annually. Submitted claims are held as “case inventory” until state staff can process and initiate benefit payments. The state’s case inventory of unprocessed SIBTF claims now sits at roughly 25,000 claims.

Insured employers pay roughly $1.4 billion in permanent disability payments. Self-insured employers – private and public – likely add another $500 million to $1 billion. Together, total annual permanent disability payouts under the standard workers’ compensation system likely total about $2 billion. SIBTF, once a relatively small program, now pays more permanent disability payments ($2 billion to $3 billion) than the state’s core workers’ compensation program.

SIBTF claim payments and associated medical and legal payments have increased rapidly in recent years, resulting in annual increases in the employer paid taxes that replenish the SIBTF. The 2024-25 tax is expected to generate $850 million, nearly double the amount necessary to replenish the fund in the prior year. However, the current employer tax does not fully capture employers’ financial exposure to SIBTF claims because most claims each year go unprocessed. In recent years, the state has processed between 500 and 800 claims annually, or roughly one fifth of all incoming claims.

This means current employer tax rates only reflect a small portion of claims submitted, masking the full fiscal effect to come. Should the state progress through the backlog of SIBTF claims at a faster rate, employers’ annual taxes will grow commensurately.

Looking broadly at incoming claims each year, employers likely face lifetime SIBTF costs totaling $2 billion to $3 billion for each cohort of claims that injured workers submit each year. If the number of claims remains steady at around 3,000 per year and the state processes all incoming claims, the annual employer tax would climb to $2 billion to $3 billion before stabilizing near that level.

At the conclusion of the report, the LAO suggests “the Legislature look to refocus SIBTF to more closely align with its original purpose. To do so, the Legislature would need to reassess several dimensions of the program. Key options include: (1) establishing stricter criteria for pre-existing conditions, (2) returning the eligibility threshold to only cover moderate and severe work injuries, (3) requiring that pre-existing conditions were previously documented, (4) requiring claims to be reviewed by an agreed-upon physician, (5) limiting SIBTF to pre-existing disabilities that actually worsen the work injury, and (6) revisiting how multiple conditions are added together. We also recommend the Legislature consider fast-tracking backlogged claims from workers with the most severe pre-existing conditions.”

California Senate Bill 84 if past by the California legislature “prohibits a construction-related accessibility claim for statutory damages from being initiated in a legal proceeding against a defendant unless the defendant has: 1) been served with a letter specifying each alleged violation of a construction-related accessibility standard; and 2) the alleged violations have not been corrected within 120 days of service.

This bill also provides that a defendant is not liable for statutory damages, costs, or plaintiff’s attorney’s fees for an alleged violation that is corrected within 120 days of service of a letter. The provisions of this bill apply to a defendant who employs 50 or fewer individuals as of the date of the receipt of the letter or for any period over the past three years from the date of the receipt of the letter.”

According to the authors of  SB 84 since “the pandemic there has been a surge in ADA lawsuits filed across California, typically by very few repeat plaintiffs. Two plaintiffs filed more than 1,000 combined ADA lawsuits across California from 2020-2021 and are some of the most frequent filers in Northern California, according to an NBC Bay area analysis. In 2021, California had more disability access lawsuits filed than the remaining 49 states, combined.”

“Across the state, businesses are being targeted for failing to be in compliance with disability access guidelines, resulting in lawsuits that cost the business thousands, and put money in the pockets of serial plaintiffs without ever actually improving accessibility to people with disabilities.

Amongst the suits filed are those for a bathroom mirror being one and a half inches too high, the handicap sign on a restroom being the wrong shape, and the color of the handicap parking space sign not being the specified shade of blue.”

“Because California law provides that the plaintiff is entitled to a minimum damages that can start as high as $4,000 per violation, triple the damages, and may be awarded attorney’s fees, mom-and-pop businesses are finding themselves fixing a $10 mirror, but owing tens of thousands of dollars to the plaintiff’s attorneys for their fees.”

“The average settlement can be as much as $14,000, but the cost of litigating will easily cost hundreds of thousands of dollars in legal fees. This leads to businesses settling out of court for far more than what it would cost to repair the violation. As such, this problem is putting many small businesses out-of-business, and its further adding to the stigma that California is a bad place to open a business and create jobs. Balance must be struck to protect both our disabled population, as well as business owners being targeted from untoward use of the law. SB 84 strikes this balance by placing the emphasis on increased access through curing an alleged violation.”

This bill is author sponsored and supported by the Civil Justice Association of California and other business organizations. The bill is opposed by Disability Rights California and other organizations that support the civil rights of disabled people.

According to a report on the proposed law by Courthouse News, Senator Roger Niello, a Fair Oaks Republican and coauthor of the bill said “The predatory law firms have accelerated their abuse all over the state.” Senators from both sides of the aisle have joined Niello as coauthors.

The report goes on to say “Democrats stood by Niello’s side, signing onto his bill and urging its passage. State Senator Aisha Wahab, a Silicon Valley Democrat, said she had discussions about the bipartisan effort last fall, working on the best way to correct the problem. Wahab wants to ensure those with disabilities have proper access while helping small business owners.”

“I do hope to see that move all the way to the governor’s desk,” she added.

Jacobo Melcer, a Bonita resident and businessowner, pleaded guilty in federal court admitting that he conspired with others to defraud Medicare of millions of dollars and to pay unlawful kickbacks for patient referrals.

According to his plea agreement, Melcer submitted more than $5.88 million in false and fraudulent claims to Medicare through his ownership and operation of two durable medical equipment (DME) companies, which sold orthotics – including back, wrist, and knee braces – to Medicare beneficiaries.

Melcer admitted that in operating the DME companies, he paid unlawful kickback payments to multiple companies for the referral of Medicare beneficiaries and prescriptions for DME, knowing that the prescriptions were signed by physicians who had no legitimate doctor-patient relationship with the beneficiary and had not conducted a legitimate medical evaluation of the beneficiary.

In total, Melcer admitted that he paid more than $227,000 in kickbacks, and fraudulently billed Medicare $5,885,382 and was paid $3,479,303. As part of his guilty plea, Melcer agreed to forfeit and pay restitution in the amount of $3,479,303.

Melcer further admitted that he created and sold two DME companies to a co-conspirator for the sole purpose of putting the ownership under a nominee owner to conceal the true ownership from Medicare due to Medicare suspending the co-conspirator as a Medicare provider and the co-conspirator’s inability to continue to submit claims to Medicare.

Melcer’s sentencing is scheduled for October 10, 2025. The case is being prosecuted by Assistant U.S. Attorney Blanca Quintero of the Southern District of California.

Framee Jones while employed during the period November 7, 2023, through January 26, 2024, as an Occupational Therapy Assistant by Vista Knoll Specialized Care, claimed to have sustained injury arising out of and in the course of employment to her psyche.

This matter proceeded to trial over four days, concluding on March 6, 2025. Multiple employer witnesses testified about the incidents in which applicant alleged had caused her an industrial psychiatric injury. Multiple employer witnesses all agreed that Jones was good at her job as an Occupational Therapy Assistant (OTA). However, the witnesses also stated to the Court that her moods were unpredictable, she created an environment in which everyone would “walk on eggshells”, she was more excitable than average, and she could be snappy. On the last day of trial, the matter was submitted.

The WCJ found applicant had not met her burden of proof establishing an industrial injury and  issued an Order that applicant take nothing.

The WCAB denied reconsideration of the take nothing in the panel decision of Jones v Vista Knoll Specialized Care – ADJ19555636 (June 2025).

Labor code § 3208.3 states that in order to establish industrial causation of a psychiatric injury, an injured worker must show by a preponderance of the evidence that actual events of employment predominantly caused the psychological injury. (Lab. Code, § 3208.3(b)(1).

The WCJ relied on the analysis of Verga v. WCAB, (2008) 159 Cal.App.4th 174, 73 CCC 63 in deciding this case. In Verga, the court of appeal agreed with the WCAB in concluding that the disdainful reactions of a supervisor and co-workers to an employee’s mistreatment of them do not constitute “actual events of employment” for which the employee can obtain worker’s compensation benefits for the psychological stress that the employee experiences because of those disdainful reactions to her inappropriate conduct.

Jones attempts to distinguish that the worker in Verga received across the board negative reviews regarding her attitude and performance, while in the current matter every employer witness had nice things to say about her.

The WCJ noted that however “what Petitioner fails to acknowledge is that the standard in Verga establishes that in order to prevail, the worker needs to show ‘objective evidence of harassment, persecution, or other basis for the alleged psychiatric injury.’ “

The WCAB panel denied reconsideration, stating that it has “given the WCJ’s credibility determinations great weight because the WCJ had the opportunity to observe the demeanor of the witnesses. (Garza v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500].) Furthermore, we conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ’s credibility determinations. (Id.) Thus, we do not disturb the WCJ’s conclusions.”