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Workers' Compensation Daily News for Sep 03, 2010
The Politics of California Workers' Compensation
Fri, 3 Sep 2010 04:41:09 - Pacific Time
The California Society of Industrial Medicine and Surgery and The California Applicants’Attorneys Association have scheduled a cocktail reception for Attorney General Jerry Brown on Sunday, September 19, 2010. The this event costs $1000 per couple. The event will be held at the home of "Arny" Gilberg, M.D., Ph.D.,1230 Shadow Hills Way, Beverly Hills, CA 90210. Dr. Gilberg is often used by litigants as an AME in psychiatry. The announcement for this event indicates that "Under California law, Brown for Governor 2010 ID # 1321867 may accept contributions up to $51,800 ($25,900 each for primary and general elections) from individuals, businesses, corporations, unions, PACs or other legal entities. Contributions to Brown for Governor 2010 are not tax deductible." CSIMS states that "The announcement was not printed or mailed at public expense." However, their fund raiser may be too late. The new SurveyUSA poll of the California gubernatorial race gives Republican Meg Whitman an expanding lead over Democrat Jerry Brown. The numbers: Whitman 47%, Brown 40%. The survey of likely voters has a ±4.2% margin of error. In the previous Survey USA poll from three weeks ago, Whitman was only ahead by a narrow 44%-43%. According to Rasmussen polls, Republican Meg Whitman is coming off last weekend’s state GOP Convention, moving out to her best showing yet in the race to be the next governor of California. The latest Rasmussen Reports telephone survey of Likely Voters in California finds Whitman earning 48% support, while Democrat Jerry Brown picks up 40% of the vote. Six percent (6%) prefer some other candidate in the race, and six percent (6%) are undecided. These new numbers move California from a Toss-Up to Leans GOP in the Rasmussen Reports Election 2010 Gubernatorial Scorecard. The Brown fund raiser organized by the California Society of Industrial Medicine and Surgery, and by the California Applicant Attorneys Association leave little doubt that the injured worker advocates see a win by Attorney General Brown as a key goal for their side. On the other hand, the direction of the current polls, and the few weeks remaining before the November elections leaves deteriorating hope that they will succeed in helping Brown take the Governor's seat next year. Read More...
CWCI Study Confirms Concern Over Compounded Pharmaceuticals
Fri, 3 Sep 2010 04:04:28 - Pacific Time
The California Workers' Compensation Institute recently studied the use of the state's workers' compensation prescriptions. According to CWCI, the Food and Drug Administration (FDA) has become increasingly concerned about potential health and safety issues associated with compound drugs, and has ratcheted up its monitoring and enforcement efforts. Regardless, compound drugs, co-packs and medical foods have been promoted to workers' compensation physicians and injured workers as an alternative to FDA-approved pain management pharmaceuticals, and like repackaged drugs, anecdotal reports suggest that these therapies are often used as a means to supplement physician revenue. To estimate changes in the volume and cost of these prescriptions, CWCI examined data on California workers' compensation prescriptions filled between 2006 and the first quarter of 2009 - a sample that encompassed more than 3 million prescriptions identified by specific National Drug Codes (NDCs) or product billing codes. After calculating quarterly distributions for the various prescriptions, the Institute analyzed the growth in the use of bulk and component drugs used in compound medications, co-packs and medical foods across the 40-month study period. The results show that the percentage of California workers' compensation prescription codes linked to compound drugs, co-packs and medical foods nearly quadrupled from 1.2 percent in the first quarter of 2006 to 4.7 percent in the first quarter of 2009; with the biggest surge coinciding with the regulatory elimination of differential pricing for repackaged drugs in March 2007. A closer look revealed that the sudden increase in the volume of these prescriptions in the second quarter of 2007 was initially fueled by the expanded use of co-packs and medical foods, though within a year, the use of compound drugs was up sharply as well. The growth in the billed and paid amounts for these products showed a similar pattern, as compound drugs, co-packs and medical foods climbed from 2.2 percent to 11.8 percent of the total amount billed for California workers' compensation prescriptions between 2006 and 2009, and from 2.3 percent to 12 percent of the total dollars paid for injured worker prescriptions. he Institute study shows that that even though reforms such as modified fee schedules and non-differential pricings for repackaged drugs have curbed some of the excesses in California workers' compensation, compound drugs, co-packs and medical foods have emerged as a significant pharmaceutical cost driver in the system. This trend is likely to continue until state policymakers enact specific statutory controls and administrative oversight in order to determine the true efficacy and the appropriate use and reimbursement of these products, CWCI said. Read More...
Several Comp Bills Await Governor's Signature While Major Issues Remain Unresolved
Thu, 2 Sep 2010 07:31:03 - Pacific Time
The California Legislature took action on several workers' compensation measures recently, passing bills that, among others, would extend death benefits until the youngest child reaches 19 if the parent died while serving in certain law enforcement services (AB 1696); and require a physician who conducts a utilization review of workers' compensation medical treatment to be licensed in California (AB 933). According to AB1696 text, children under age 19 can receive workers' compensation death benefits if the parent died while on duty as a specified law enforcement officer or during firefighting services. Additionally, AB 2253 presumes that cancer is assumed to be a compensable injury among active firefighting members of certain state and local fire departments and certain peace officers, and therefore should be compensable even after employment is terminated. Existing law establishes a presumption that the cancer for these special officers is presumed to arise out of, and in the course of, employment, unless proven otherwise. AB 2253 extends the presumption to a member following termination of service for a period of three calendar months for each full year of the requisite service, but not to exceed 120 months in any circumstance, commencing with the last date actually worked in the specified capacity. AB 2253 was in response to lobbying efforts by the police and firefighter's unions and shows a continuing proclivity of the California legislature to shed special benefits and protections to unionized governmental employees no matter what the condition of the state economy. Previously, the law said the presumption could not exceed 60 months in any circumstance. A so called "anti-discrimination" bill passed the legislature that would reduce opportunities for apportionment based upon race, religious creed, color, national origin, age, gender, marital status, sex, sexual orientation, or genetic characteristics (SB 145). This bill was ostensibly politically crafted as an "anti-discrimination bill" but at a deeper level it is squarely aimed at apportionment based upon genetic risk factors. These bills, and others acted on in the last month of the 2009-2010 legislative session, are awaiting the governor's signature and it is likely that he will veto some if not all of them. The Association of California Insurance Companies (ACIC) is not happy with the legislative year. According to their spokesman "In spite of the mounting cost pressures in workers' compensation, little was done to address challenges in the system," said ACIC Vice President Mark Sektnan. "We were disappointed with the failure of AB 2779 (Solorio) which would have closed a loophole in the pharmacy fee schedule that is driving up pharmacy costs significantly. We have seen example of drug costs for individual patients increasing ten fold through the use of compound drugs without any proof that the drugs are more effective or even safe. Other bills passed by the Legislature like AB 933 (Fong D-Cupertino) and SB 145 (DeSaulnier D-Walnut Creek) which would weaken the 2004 reforms and further increase the cost of workers' compensation for California's employers. ACIC will be requesting vetoes of these two bills." Read More...
Couple Arrested for Forging Work Comp Insurance
Thu, 2 Sep 2010 07:25:46 - Pacific Time
California Department of Insurance detectives arrested Sir Isaac Lindsay, 61, and his wife Veronica Lindsay, 57. They are charged with felony forgery after allegedly presenting fake documents to demonstrate that their business had workers' compensation insurance, when they were not insured. The Lindsays were booked at the Central Detention Center in San Bernardino County with bail set at $25,000 each. If convicted, the Lindsays could face a prison sentence of up to 18 years. Sir Isaac Lindsay, owner of Lindsay Motorcade and Protective Services, bid and was awarded a contract to provide security services to the Moreno Valley Unified School District. As part of the bid process, Lindsay provided documentation the school district required to be awarded the contract. Among the documents required was proof of insurance, including workers' compensation coverage, which Lindsay and his wife provided. On August 14, 2006, an employee of Lindsay Motorcade and Protective Services was murdered while patrolling one of the school district's campuses. As a result of this incident, it was discovered that Sir Isaac Lindsay did not have workers' compensation coverage and the documentation he submitted to secure the contract with the school district was fraudulent. The fraudulent documents reflected that Lindsay Motorcade and Protective Services was insured with State Compensation Insurance Fund, but because the documents were fraudulent, the school district was responsible for paying more than $100,000 in relation to the murder of Lindsay's employee.The case is being prosecuted by the San Bernardino County District Attorney's Office. Read More...
U.S. Risk Acquires Workers' Compensation Wholesaler - Unisource
Wed, 1 Sep 2010 07:17:17 - Pacific Time
U.S. Risk is is an independently owned and managed sales and service organization and one of the largest wholesale brokerage and specialty lines underwriting managers in the United States. They are headquartered in Dallas, Texas and operate out of office locations throughout the U.S. including San Francisco and Santa Ana. U.S. Risk Insurance Group Inc. has taken over Florida-located Unisource Program Administrators, a wholesaler of workers' compensation, for an undisclosed sum. The deal will enable the Dallas-based U.S. Risk to double its workers' compensation written premium and to add four A-rated national carriers to its markets line-up, the company said in a statement. The takeover is also expected to enable U.S. Risk to offer monoline workers' compensation on a national scale. According to CEO Randall Goss, the transaction is a "strategic acquisition to enhance our product offerings and expand the production footprint." The specialty workers' compensation office in Sarasota will continue to operate as Unisource Program Administrators. U.S. Risk will gain the ability to offer additional workers' compensation markets to its network of 4,000 retail producers. Unisource's existing distribution network of 1,900 retail producers will be able to access to the U.S. Risk product portfolio which offers all forms of property, casualty, automobile, umbrella, professional, and risk management products and services. "Unisource has been seeking this kind of opportunity to better serve our agents by adding other lines of insurance and to continue expanding our workers' compensation footprint," said Karen Bolinder, vice president of Operations at Unisource Program Administrators. Read More...
WCIRB Reports California Workers’ Comp Combined Ratio is Highest Since 2001
Wed, 1 Sep 2010 06:57:47 - Pacific Time
The WCIRB has completed its review of March 31, 2010 experience submitted by insurers and a has released its findings as of August 26. The ultimate accident-year 2009 combined ratio is estimated to have reached 124 percent, the San Francisco-based Workers’ Compensation Insurance Rating Bureau of California said. California workers’ compensation insurers’ combined ratios climbed during 2009 to the highest level since 2001, while average claims costs continued increasing, according to a quarterly report on insurer experience. A ratio below 100% indicates that the company is making underwriting profit while a ratio above 100% means that it is paying out more money in claims that it is receiving from premiums.The combined ratio is comprised of the claims ratio and the expense ratio. The claims ratio is claims owed as a percentage of revenue earned from premiums. The expense ratio is operating costs as a percentage of revenue earned from premiums. The combined ratio is calculated by taking the sum of incurred losses and expenses and then dividing them by earned premium.The bureau estimated that the average cost, The ultimate accident-year 2009 combined ratio is estimated to have reached 124 percent, the San Francisco-based Workers’ Compensation Insurance Rating Bureau of California said in its "Summary of March 31, 2010 Experience." That is 14 percentage points higher than for 2008 and the highest level since 2001, when it declined to 143 percent from 184 percent in 1999. The bureau also projected an ultimate accident-year loss ratio of 80 percent for 2009, which is about 9 points above 2008 and the highest accident-year loss ratio since 2002. The calendar-year combined ratio for 2009 is 116 percent, which is 15 points higher than for 2008, it said. Combined ration is a measure of profitability used by an insurance company to indicate how well it is performing in its daily operations. or severity, of a 2009 indemnity claim will reach $60,000, a 5 percent increase over 2008. That comes after three years of severity increasing at about 15 percent per year.Meanwhile, average statewide insurer rate per $100 of payroll for policies written in 2010 is $2.47, or 5 percent above the average rate charged for 2009. These quarterly findings leave little doubt about where insurance premiums are headed next year. Read More...
Court of Appeal Clarifies Standard for Proving Causation of Valley Fever
Tue, 31 Aug 2010 04:49:41 - Pacific Time
Rudy Miranda worked as a locksmith at a university campus in Fullerton. His office was located next to a vacant lot known as Dumbo Downs, used in 2005 for stockpiling excess dirt from a large construction project on the campus. Miranda contracted the infectious fungal disease Coccidioidomycosis, commonly called "Valley Fever." He sued general contractor, Bomel Construction Co., Inc. (Bomel), and subcontractor, J/K Excavation and Grading Co., Inc., (J/K) claiming they negligently graded dirt on the construction site. He also filed a workers' compensation case against the University.. The defendants in the civil case filed a motion for summary judgment. Many experts on Valley Fever provided sworn declarations on how these fungus particles become airborne and have been known to travel as much as 500 kilometers from the point of origin. During a motion for summary judgment, the trial judge must read these decelerations and decide if there is any credible evidence to support a plaintiff's claim. If not, the case ends without any trial. In this case, the trial court found no credible evidence to support that Miranda's Valley Fever was caused by the construction next door and ruled in favor of the defendants. The Court of Appeal in a published option agreed. Essentially, the Court ruled that Miranda could not prove where the Valley Fever came from. He must prove his case with medical testimony that shows it was probable, not just possible that the fungus came from the construction site next door. "There can be many possible "causes," indeed, an infinite number of circumstances which can produce an injury or disease. A possible cause only becomes "probable" when, in the absence of other reasonable causal explanations, it becomes more likely than not that the injury was a result of its action." A number of medical experts provided declarations claiming the construction site was the cause. For example, Norman Brautbar M.D. his workers' compensation treating physician, opined that exposure to dust from soil was the "critical factor in determining the risk for infection of Valley Fever." He noted the incubation period from the time of exposure to the appearance of symptoms ranged from one to four weeks. Brautbar concluded Miranda's exposure to dust from the large pile of dirt stockpiled next to his office "was a substantial factor in causing [his] Valley Fever” to a “reasonable degree of medical probability." The Superior Court rejected these expert causation opinions as speculative and the Court of Appeal agreed. "While medical and scientific data certainly supported their claim exposure to dust was a critical factor, neither expert accounted for the undisputed facts showing there were other reasonable and likely sources of the fungus spore causing Miranda's injury. Neither expert offered an opinion on whether there was a way to medically or scientifically determine the origins of the infecting fungal spore. Nor did they dispute the fungus grows all over California, the spores become airborne, spores are not visible to the naked eye, spores sometimes can be in dust-free air, spores are not immediately detectable, infection does not always generate symptoms, others working or living near Dumbo Downs were not infected with Valley Fever, and Miranda did not spend all his time near Dumbo Downs. In light of the above undisputed evidence, the fact Miranda was infected, standing by itself, does not create a reasonable inference the dust from Dumbo Downs, as opposed to another location, was the source of the disease." The summary of evidence prepared by the Court of Appeal in this case contains considerable scientific evidence presented by both sides on the topic of Valley Fever. The fact that none of this medical evidence credibly proved causation sufficient to overcome a summary judgment motion in Superior Court, nor satisfy the scrutiny of the Court of Appeal. However since this same evidence would support causation before the WCAB, this case shows the stark contrast in how these two judicial tribunals view the same evidence. The published opinion is Rudy Miranda v. Bomel Construction Co. Inc., Court of Appeal, Fourth Appellate District, G042073, filed 7/30/2010, certified for publication on 8/30/2010. Read More...
Los Angeles WCAB Schedules Conference to Discuss Consolidation of Compound Pharmacy Liens
Tue, 31 Aug 2010 04:49:37 - Pacific Time
The Los Angeles district office of the Division of Workers’ Compensation has made a motion to consolidate lien proceedings regarding compound pharmacy liens. The hearing is scheduled for 10 a.m. on Wednesday, Oct. 6 in the court’s first floor auditorium at 320 W. 4th St. in Los Angeles. All compound pharmacy lien claimants with pending liens should attend, along with their representatives and defendants. However, injured workers and lien claimants without compound pharmacy liens should not attend. Parties do not need to bring their files. The court took this action because there are common issues of law and fact in the approximately 400 compound pharmacy liens filed each month at the Los Angeles district office. Processing liens is time consuming, and the Los Angeles court can only accommodate 145 lien hearings per month. "In the event that the cases merit consolidation there can be a system-wide savings by reducing repetitive litigation. That is what consolidation is all about - finding common issues of law and fact that can allow a court to step in and get parties to cut to the heart of things," said Court Administrator Keven Star. "On the other hand, the cases may not be ripe for consolidation. We will see what takes place at the hearing and what the parties present to the court on both sides of the discussion." Los Angeles Presiding Judge Jorja Frank will preside over the Oct. 6 proceedings, along with Mark Kahn, the associate chief judge for the southern region. Kahn has jurisdiction over other courts in case the issues go beyond just those cases scheduled in Los Angeles. The conference will take place on Wednesday, Oct. 6, 2010at 10 a.m. at the Division of Workers’ Compensation Los Angeles district office located at 320 W. 4th St., 1st floor auditorium, Los Angeles, CA 90013 Read More...
AG Eric Holder Speaks At Los Angeles Health Care Fraud Summit
Mon, 30 Aug 2010 04:34:09 - Pacific Time
Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius kicked off the second in a series of daylong summits bringing together a wide array of federal, state and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system. The August 26 summit in Los Angeles included educational panels featuring law enforcement officials, including Assistant Attorney General Lanny A. Breuer of the Criminal Division, consumer experts, providers and key government agencies. Announced during the summit was a final regulation issued by the Centers for Medicare and Medicaid Services (CMS) increasing protections for both Medicare and Medicare beneficiaries from potentially fraudulent suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The new regulation enhances Medicare enrollment standards for DMEPOS suppliers by adding several new standards and strengthens existing standards that suppliers must meet before being able to furnish equipment and supplies to Medicare beneficiaries. The Affordable Care Act builds on innovative strategies to fight fraud, such as the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the joint operation between the Department of Justice (DOJ) in partnership with the 94 U.S. Attorneys’ Offices, CMS and the HHS Office of Inspector General that has expanded Medicare Fraud Strike Force teams from South Florida and Los Angeles to now operating in seven regions to target health care fraud hot spots including Houston; Detroit; Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla. On June 8, 2010, President Obama announced this nationwide series of regional fraud prevention summits as part of a multi-faceted effort to crack down on health care fraud. The Los Angeles summit was the second in a series, with additional summits to follow in the coming months in Detroit, Boston, New York, Philadelphia and Las Vegas. One of the questions from the audience concerned the use of the EOB form and other methods of soliciting information from patients. At one time CMS provided notice to beneficiaries that there is a reward for successfully reporting fraudulent medical care to CMS. The presenter indicated that there still is a federal regulation that authorizes CMS to pay a reward for fraud reporting, and they are considering placing this notice on EOB forms nationwide. It was a successful when it was briefly tried on the east coast. Information on the federal website www.stopmedicarefraud.gov confirms that "If the suspicious activity turns out to be fraud, you may be eligible for a reward of up to $1,000." To be eligible for a reward the beneficiary must report their suspicion, the suspicion must be forwarded to the Inspector General's office for review, the reported fraud must not already be under investigation, the report must directly relate to the recovery of over $100, and the beneficiary must not be related to people who work for certain federal agencies. Read More...
Sacramento Physician Pleads Not Guilty to Rape Charges
Mon, 30 Aug 2010 04:11:53 - Pacific Time
Scott Dodd Anderson MD , 60, was arrested in April and booked into the Sacramento County Main Jail on suspicion of multiple charges, including felony sexual exploitation by a physician, rape and attempted sodomy, booking records show. At least some of the examinations were related to workers compensation claims and took place between May and September of 2009. He plead not guilty to these charges last Thursday. He also pleaded not guilty to special allegations of violating business and professional codes. Anderson's medical license has been temporarily suspended pursuant to Penal Code section 23, and he no longer works at the clinic. In all, Anderson faces 30 counts of abuse, according to the Sacramento County District Attorney's complaint against him. Sacramento County sheriff's detectives began investigating Anderson in December, after one of his three victims told her family of the alleged abuse, said sheriff's Sgt. Tim Curran. The woman's family encouraged her to contact authorities. Detectives identified two more alleged victims during the course of their investigation, Curran said. The women range in age from their early 30s to their early 60s. The women suffered the alleged abuse while visiting Anderson at the U.S. HealthWorks clinic on Folsom Boulevard, near La Riviera Drive, between May 2009 and September 2009, Curran said. The women were being examined in connection with workers compensation claims. Curran said Anderson left that clinic in September 2009, and investigators could not find any record of him practicing medicine since then. Detectives suspect there are more victims who have not come forward, Curran said. Anderson graduated from the Tufts University School of Medicine in 1975 and received his California license to practice medicine two years later, according to the Medical Board of California's online records. His license, which is renewed and current, is is now suspended and scheduled to expire in May 2011, the records show. According to Sacramento Superior Court records, Anderson pleaded no contest to a misdemeanor charge of disturbing the peace in 1999. Records show he was not given probation for the conviction. Read More...
Past Work Comp Academy News Articles
• Exclusive Remedy Defeats Television Extra's Premises Liability Claim Against CBS: Fri, 27 Aug 2010 07:39:12 - Pacific Time: Read More...
• DWC Announces Activities for "Labor Rights Week 2010": Fri, 27 Aug 2010 06:58:30 - Pacific Time: Read More...
• DWC Posts Proposed Amendments to Benefit Notice Regulations: Thu, 26 Aug 2010 07:15:23 - Pacific Time: Read More...
• FDA Tells J and J Unit to Halt Hip and Knee Device Sales: Thu, 26 Aug 2010 07:12:02 - Pacific Time: Read More...
• "Dallas" Jones Cancer Presumption Act of 2010 Awaits Governor's Signature: Wed, 25 Aug 2010 07:17:09 - Pacific Time: Read More...
• Bill to Stop 'Tax and Workers' Compensation Fraud Epidemic' Set for Vote: Wed, 25 Aug 2010 06:12:06 - Pacific Time: Read More...
• Division of Workers’ Compensation Marks Second Anniversary of EAMS: Tue, 24 Aug 2010 05:14:03 - Pacific Time: Read More...
• Radiologists Call For Curbs on Overuse of Imaging: Tue, 24 Aug 2010 05:08:51 - Pacific Time: Read More...
• SCIF Loses Fraud Recovery to Bankruptcy Court Trustee: Mon, 23 Aug 2010 05:43:05 - Pacific Time: Read More...
• Workplace Fatalities Decline in 2009: Mon, 23 Aug 2010 05:36:45 - Pacific Time: Read More...