Today, the California Supreme Court decided that the Workers’ Compensation Act [WCA] did not bar a derivative claim. However, using a public policy rationale, it did not extend an employer's duty of care to an employee's household contacts who contracted COVID-19.
Showing posts with label California. Show all posts
Showing posts with label California. Show all posts
Thursday, July 6, 2023
Wednesday, November 17, 2021
Amazon Settles with California Over Concealment of COVID Data From Warehouse Workers COVID-19
Historically workers have been denied adequate occupational exposure information, which has led to epidemics of disease/death and lawsuit, including workers' compensation claims. Exposure to the SARS-CoV-2 (Coronavirus) virus has been no exception.
Monday, July 26, 2021
California Implements First-in-the-Nation Measures to Encourage State Employees and Health Care Workers to Get Vaccinated
The State of California is taking decisive action to combat the spread of COVID-19 and protect vulnerable communities – implementing a first-in-the-nation standard to require all state workers and workers in health care and high-risk congregate settings to either show proof of full vaccination or be tested at least once per week, and encourage all local government and other employers to adopt a similar protocol.
Friday, October 11, 2019
CMS Cannot Seek Reimbursement from Insurance Guarantee Fund
The US 9th Circuit Court of Appeals has ruled that The Centers for Medicare and Medicaid [CMS] cannot not seek reimbursement from from the California Insurance Guarantee Association for workers' compensation payments.
Friday, May 10, 2019
Chlorpyrifos (CPS) Banned in California
Today's post is shared from khn.org
State Bans Pesticide Linked To Developmental Problems by Ana B. Ibarra, Kaiser Health NewsCalifornia will ban the use of a widely used pesticide in the face of “mounting evidence” that it causes developmental problems in children, state officials announced Wednesday.
State Bans Pesticide Linked To Developmental Problems by Ana B. Ibarra, Kaiser Health NewsCalifornia will ban the use of a widely used pesticide in the face of “mounting evidence” that it causes developmental problems in children, state officials announced Wednesday.
Thursday, December 21, 2017
Cries of High Costs and Fraud – Watch for Reforms
Today’s post comes from guest author Kit Case, from Causey Wright, Seattle, Washington..
There is always discussion, in every state, about the expense of workers’ compensation insurance to employers. It is common to hear stories of corruption and fraud when employer costs run high. This discussion can lead to cries of fraud, usually with fingers pointed towards claimants and often tied into efforts to reduce benefits to injured workers. As a recent example, take a look at the article published on July 23rd in the Fresno Bee, written by Dan Walters of CALmatters, titled “California workers’ compensation system plagued by high costs and fraud.” In the article, Mr. Walters points to Southern California as an area particularly afflicted by fraud, inserting the hot-button phrase “immigrant workers,” as follows:
There is always discussion, in every state, about the expense of workers’ compensation insurance to employers. It is common to hear stories of corruption and fraud when employer costs run high. This discussion can lead to cries of fraud, usually with fingers pointed towards claimants and often tied into efforts to reduce benefits to injured workers. As a recent example, take a look at the article published on July 23rd in the Fresno Bee, written by Dan Walters of CALmatters, titled “California workers’ compensation system plagued by high costs and fraud.” In the article, Mr. Walters points to Southern California as an area particularly afflicted by fraud, inserting the hot-button phrase “immigrant workers,” as follows:
Friday, November 17, 2017
California Court of Appeal Upholds Landmark Ruling Affirming $1.5 Billion Judgment Ordering the Removal of Lead Paint From Pre-1951 Homes
After a seventeen year legal battle that broke new legal ground, California’s Sixth District Court of Appeal unanimously upheld a lower court decision ordering three lead paint manufacturers to clean up lead paint inside older homes in the County of Santa Clara and nine other California cities and counties. Today’s ruling holds defendants Sherwin-Williams Company, NL Industries, Inc., and ConAgra Grocery Products Company responsible for the public nuisance created by lead paint inside pre-1951 homes.
Saturday, June 17, 2017
Governor of Nevada Vetoes Single-Payer Legislation
Nevada Governor Brian Sandoval has vetoed legislation that would have established a single-payer Assembly Bill 374 would have expanded a Medicare-type health care insurance plan. coverage to provide health care coverage to all Nevada residents.
Saturday, February 11, 2017
The Promise of State Initiatives to Prevent Long Term Work Disability
Every year, millions of Americans suffer from medical conditions that affect their ability to work. This puts them at risk of losing their jobs or being forced to rely on Social Security Disability Insurance (SSDI). States could help many of these workers stay in their jobs, but promising options for doing this remain largely untested. The five states with state-mandated short-term disability benefits— California, Hawaii, New Jersey, New York, and Rhode Island—are promising settings for such tests.
Sunday, April 3, 2016
Consequences of Increasing the Minimum Wage
The national wave toward raising the statutory minimum wage to $15.00/hour is going to have major consequences for the ailing national network of workers' compensation programs. Not only is it going to increase benefits for injured workers that are calculated on wages, but it is also going increase much needed premium dollars for insurance companies whose premiums are based on payroll costs.
Wednesday, February 24, 2016
Breast Cancer: California Discriminates Against Women
The California Applicants’ Attorneys Association (CAAA) joined Assemblywoman Lorena Gonzalez (D-San Diego) for the first ever Women in the Workplace Day at the State Capitol. The day was centered around Governor Brown’s veto of the CAAA sponsored AB 305 (Gonzalez, 2015), which sought to ensure that women are not compensated less than men for identical work injuries.
Wednesday, February 17, 2016
The State of Medical Care in California’s Workers’ Compensation System
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| Katherine Roe |
Todays' guest post is authored by Katie Roe* of the California Bar and was originally published at rivercityattorneys.com/blog (Fraulob & Brown).
When you’re injured at work, you expect that your employer’s insurance carrier will dutifully provide you with proper medical treatment for your injury. After all, future medical care is one of the “benefits” injured workers are entitled to in California. Denial of medical treatment is the number one frustration we hear from our clients on a daily basis.
What injured workers quickly discover is that their medical treatment is strictly controlled by the insurance carrier and their medical fate is in the hands of a doctor who has never treated them and may not even have their complete medical records. This process is called Utilization Review (UR). Under UR an outside physician gets to decide whether or not the insurance company should authorize the medical treatment prescribed by your primary treating physician. This doctor doesn’t even have to be licensed in California.
If the medical treatment prescribed by your physician is denied, your only recourse is to appeal the decision to an Independent Medical Reviewed (IMR). In California, MAXIMUS is the company contracted to conduct IMR reviews. Like UR doctors, the IMR doctor deciding your fate, has never met you or treated you and does not need to be licensed in California. In fact, their identity is protected. If your medical treatment is denied by UR, your chances of IMR overturning the decision are not good. California Workers’ Compensation Institute, an insurance research group, found that 91% of IMR decisions uphold the UR denial. If the treatment is denied by IMR, absent a change in circumstances, the denial will be in effect for one year.
While an injured worker has the right to appeal an IMR determination to the Workers’ Compensation Appeals Board, the only legal bases on which to appeal are fraud, conflict of interest, or mistake of fact. However, even if your appeal is successful the WCAB still cannot overturn the IMR doctor’s decision. If an appeal is granted, the remedy is referral to a different IMR for another review. Yes, you read that right, your award is to go through the IMR process again!
Many injured workers end up seeking treatment for their work related injuries through private insurance, Medicare or Medi-Cal. A study by J. Paul Leigh, a health economist at the University of California, Davis, estimated that only 1/3 of necessary medical treatment and lost wages is being paid for by workers’ compensation insurers.
The lack of adequate medical care for injured workers today is the result of Senate Bill 863, which was passed on August 1, 2012 and signed into law by Governor Brown on September 18, 2012. This law was the result of lobbying by big businesses and insurance companies, who have influence over the State Legislature and the Governor of California. We remind our clients that you also have a political voice. We recommend you go to Voters Injured at Work (www.viaw.org) for information on how to become involved with fixing this broken system.
To read more about the dismal state of medical treatment for injured workers all over America I encourage you to read Insult to Injury by Michael Grabell athttps://www.propublica.org/article/the-demolition-of-workers-compensation.
*Katherine Roe is originally from the San Francisco Bay Area. She attended University of St. Thomas, Saint Paul Minnesota for her undergraduate degree in Sociology with a minor in Criminal Justice. She earned her Master in Public Administration from University of Notre Dame de Namur, Belmont, CA. Katie graduated from University of the Pacific McGeorge School of Law in Sacramento where she received the Witkin Award for Health Law and Elder Law Clinic. She is a practicing attorney in the areas of Workers’ Compensation Law, Social Security Disability and Elder Law, including estate planning with wills, trusts, deeds, powers of attorney and health care directives.
While in college, Katie tutored grade school and high school students in low-income neighborhoods in Saint Paul and Minneapolis, MN and interned with the Oakdale, MN Police Department.
During law school, Katie interned with Legal Aid Society of San Mateo County, Human Rights Fair Housing Commission and the California Department of Insurance. While at McGeorge, she worked in the Elder and Health Law Clinic where she handled Medicare appeals, elder abuse cases, restraining orders, wills, trusts, consumer protection, special needs trusts, and powers of attorney.
While the Clinical Fellow at McGeorge she received the Cohn Sisters’ Scholarship for Patient Advocacy.
While in college, Katie tutored grade school and high school students in low-income neighborhoods in Saint Paul and Minneapolis, MN and interned with the Oakdale, MN Police Department.
During law school, Katie interned with Legal Aid Society of San Mateo County, Human Rights Fair Housing Commission and the California Department of Insurance. While at McGeorge, she worked in the Elder and Health Law Clinic where she handled Medicare appeals, elder abuse cases, restraining orders, wills, trusts, consumer protection, special needs trusts, and powers of attorney.
While the Clinical Fellow at McGeorge she received the Cohn Sisters’ Scholarship for Patient Advocacy.
Thursday, July 30, 2015
The Plot Thickens As Uber Turns to Leasing Vehicles
Uber is about to change "the rules" yet again by now leasing vehicles to its drivers. While there is great uncertainty of how "employment status" will be interpreted going forward in the new sharing economy, one thing is for certain, the concept will continue to evolve and redefine the traditional workplace.
Wednesday, April 15, 2015
It is not "How," It is "When"
Judge David Langham wrote a very enlightening blog post today about how advancing technology is impacting the world and more particularly the workers' compensation arena. As usual, he is right on target with the issue that is going to have the most influence over our changing world.
The Judge mentioned the advent of driverless technology. Ironically, it is national Distracted Driving Awareness Month. If you are driving about the State of New York with a phone in your hand you'll most likely get a ticket for sure this week. The driverless car is already under development with a target for production by major corporations such as Apple by the year 2020. In California Google already has test vehicles on the road.
The Judge mentioned the advent of driverless technology. Ironically, it is national Distracted Driving Awareness Month. If you are driving about the State of New York with a phone in your hand you'll most likely get a ticket for sure this week. The driverless car is already under development with a target for production by major corporations such as Apple by the year 2020. In California Google already has test vehicles on the road.
Sunday, December 14, 2014
California Medical Review: STEVENS WRIT GRANTED
| Containment of medical costs remain a major issue in all workers' compensation programs. The California process of "independent medical review" has turned into a nightmare for injured workers, their families and their advocates. The long awaited constitutional challenge to the process is slowly making its way through the California judicial system. Time will tell whether the judicial resolution will emerge as a solution to what was just terrible legislation. Today's post is authored by Julius Young and is shared from workerscompzone.com/ Could the California courts finally be ready to rule on the constitutionality of Independent Medical Review? We may be on the verge of seeing that issue decided. On December 3, 2014, the California Court of Appeal First Appellate District Division One granted the petition for writ of review filed San Francisco attorney Joseph Waxman on behalf of Frances Stevens (the case is Frances Stevens, Petitioner, v. WCAB and Outspoken Enterprises/State Compensation Insurance Fund ADJ1526353). In June 2014 the Court of Appeal had summarily denied a petition for a writ filed by Waxman in April 2014. At that time Waxman had not exhausted his administrative remedies. Waxman did so and then refiled for the writ, which was then granted. The basis facts in the case are important. Stevens had been found permanently and totally disabled (100%) by the workers’ comp judge. Her condition required use of a wheelchair and defendant had provided assistance by a home health aide.... |
Tuesday, October 21, 2014
Good Things: No Chief's Disease Here
Today's post is shared from guest author David DePaolo and is shared from http://daviddepaolo.blogspot.com/
The California Highway Patrol, criticized in the past for exploitative "Chief's Disease," has a program in place that demonstrates that workers' compensation can accomplish amazing things when all of the right motivations are in all of the right places and everyone does their job.
Last week, CBS Sacramento ran a story about CHP officer Mike Mitchell and the CHP's program.
Mitchell lost his leg in 2011 in an automobile crash when he was responding to a call in Amador County. His car hit a tree so violently that he doesn't remember the crash at all, and his injuries were so severe his right leg had to be amputated.
His employer offered him a chance to return to the force, but he had to prove himself physically (and mentally) capable by going through the academy again, this time with a computerized prosthetic that is the stuff of imagination 40 years ago (think "Six Million Dollar Man" with actor Lee Majors as the star).
The prosthetic didn't cost millions - the article says it cost about $100,000.
“I have kids at home and I can’t let them see me quit,” he tells his interviewer.
“Officer-safety wise I still have to able to be able to fight, I still have to be able to shoot and drive. Do everything I’m suppose to do,” he goes on.
After going through retraining and passing the physical assessment tests he regained his uniform and is back on the job patrolling in a CHP cruiser.
“I love doing it,” he said, reflecting the attitude that is necessary for an injured worker to overcome huge obstacles. “I love being out in the public.”
According to the story, there are four other full time officers who are amputees.
I'm sure there are also many failure stories where benefits were not provided timely, or there is a dispute about treatment or indemnity, or where an officer attempts to take advantage of the generous disability compensation system in place for California peace officers.
Those negative situations get a lot of attention. It's easy to focus on the bad, to criticize, and blame.
It's much harder to be successful, to overcome huge obstacles, to achieve cooperation between the many people that need to contribute for a successful outcome - that requires communication, vision, and a huge helping of positive attitude.
The CHP says on its website that, "When injuries occur, our obligation is to ensure all appropriate benefits are accessed and received by those injured employees."
I have to believe that statement when I see a story such as Mitchell's.
We at WorkCompCentral believe that success should be celebrated. So much of workers' compensation is draped in negativity - after all, going through a life altering event such as a work injury is steeped in uncertainty, stress and disappointment.
But there are success stories, many of them. We don't hear about those, and some people have been critical of the Comp Laude Awards for injured workers stating that we are making a mockery of the system.
Nothing could be further from the truth, and the fact is that we have had many, many injured workers nominated, and many other injured workers praising our efforts to recognize people who have overcome the odds.
And this happens with the help of the teams of people, the employers, claims adjusters, doctors, attorneys, doing their jobs the best they can.
Stay in this industry long enough and cynicism can dominate your thoughts.
Workers' compensation does good things. We just don't hear about them very often.
When you go to work this morning, do good things - make a case work properly, get an injured worker back on the job, celebrate positive outcomes!
And join us Saturday, December 6, to recognize people and companies that make a difference.
The California Highway Patrol, criticized in the past for exploitative "Chief's Disease," has a program in place that demonstrates that workers' compensation can accomplish amazing things when all of the right motivations are in all of the right places and everyone does their job.
Last week, CBS Sacramento ran a story about CHP officer Mike Mitchell and the CHP's program.
Mitchell lost his leg in 2011 in an automobile crash when he was responding to a call in Amador County. His car hit a tree so violently that he doesn't remember the crash at all, and his injuries were so severe his right leg had to be amputated.
His employer offered him a chance to return to the force, but he had to prove himself physically (and mentally) capable by going through the academy again, this time with a computerized prosthetic that is the stuff of imagination 40 years ago (think "Six Million Dollar Man" with actor Lee Majors as the star).
The prosthetic didn't cost millions - the article says it cost about $100,000.
“I have kids at home and I can’t let them see me quit,” he tells his interviewer.
“Officer-safety wise I still have to able to be able to fight, I still have to be able to shoot and drive. Do everything I’m suppose to do,” he goes on.
After going through retraining and passing the physical assessment tests he regained his uniform and is back on the job patrolling in a CHP cruiser.
“I love doing it,” he said, reflecting the attitude that is necessary for an injured worker to overcome huge obstacles. “I love being out in the public.”
According to the story, there are four other full time officers who are amputees.
I'm sure there are also many failure stories where benefits were not provided timely, or there is a dispute about treatment or indemnity, or where an officer attempts to take advantage of the generous disability compensation system in place for California peace officers.
Those negative situations get a lot of attention. It's easy to focus on the bad, to criticize, and blame.
It's much harder to be successful, to overcome huge obstacles, to achieve cooperation between the many people that need to contribute for a successful outcome - that requires communication, vision, and a huge helping of positive attitude.
The CHP says on its website that, "When injuries occur, our obligation is to ensure all appropriate benefits are accessed and received by those injured employees."
I have to believe that statement when I see a story such as Mitchell's.
We at WorkCompCentral believe that success should be celebrated. So much of workers' compensation is draped in negativity - after all, going through a life altering event such as a work injury is steeped in uncertainty, stress and disappointment.
But there are success stories, many of them. We don't hear about those, and some people have been critical of the Comp Laude Awards for injured workers stating that we are making a mockery of the system.
Nothing could be further from the truth, and the fact is that we have had many, many injured workers nominated, and many other injured workers praising our efforts to recognize people who have overcome the odds.
And this happens with the help of the teams of people, the employers, claims adjusters, doctors, attorneys, doing their jobs the best they can.
Stay in this industry long enough and cynicism can dominate your thoughts.
Workers' compensation does good things. We just don't hear about them very often.
When you go to work this morning, do good things - make a case work properly, get an injured worker back on the job, celebrate positive outcomes!
And join us Saturday, December 6, to recognize people and companies that make a difference.
Wednesday, August 27, 2014
IF THINGS GO VERY WRONG
| Bay Area residents were awakened last night to a 6.0 earthquake in Napa. News reports indicated that Napa County’s old courthouse was among the downtown buildings sustaining major damage. For many years, California has been lucky in not having an earthquake that caused widespread loss of life. But what if a major earthquake struck during work hours, killing or severely injuring scores of workers in a facility operated by one of California’s public entities? Such a scenario is clearly not out of the question, as schools, courthouses, hospitals, municipal administration buildings and other large structures are located in at-risk fault zones up and down California. Such structures could also be at risk for a terrorist incident. Hospitals could be at risk for a severe infectious disease incident. Many California public entities are self-insured. How would they deal with a widespread catastrophic incident? Thinking about this made me turn to a recent study that is currently posted on the CHSWC site for public comment. The study, titled “California Public Sector Self-Insurance” (link to the study can be found at the end of this post) was produced by Mark Priven, an actuary with Bickmore Consulting. Priven’s study examines many aspects of public sector workers’ comp insurance in California, including a section on solvency. Recent municipal bankruptcies of cities such as Vallejo and Stockton have not resulted in defaults on workers’ comp... |
Preventing Heart Attacks in Firefighters
| Every year nearly 100 firefighters die on the job and one half of those deaths are from fatal heart attacks. These statistics remain consistent year in and out. The very nature of the job automatically puts them at a higher risk. “Being a firefighter, you never know when the bell is gonna ring, when the alarm is gonna sound. We basically go from 0 to 100 like that,” said Rich Mikutsky, vice president of the Firefighters Mutual Benevolent Association (FMBA). Doctors say it’s hard to pinpoint exactly why firefighters have some of the highest rates. But those in the business have a few ideas. “There’s the obvious weight of our equipment, our tools, our Scott Pack, but then there’s the other part of it where we start and stop quickly, ya know, at anytime at night when we could be at full rest we may have to get up and be at full speed,” said Paterson firefighter Kyle Hughes. Extended exposure to traumatic stress, both mentally and physically, boosts inflammation in the body, increasing the risk. Continuous disruptions to the sleep-wake cycle can lead to lower metabolic rates linked directly to heart failure. “Yesterday we had a big fire in Clifton. It started around 1 p.m. and we had a number of guys that suffered heat exhaustion, smoke inhalation, had to be taken to the hospital and fortunately everyone was all right but I saw a couple of them last night around 8 o’clock and they were exhausted.... |
The Word Didn't Get There
| Problems with the national workers' compensation system are addressed in today guest post authored by David DePaola and shared from http://daviddepaolo.blogspot.com/ Then I get an email from a former claims professional turned auditor that completely deflates my enthusiasm and makes me angry. The emailer has been in the process of auditing some cases on behalf of an insurance carrier whose cases are administered by a Third Party Administrator. This is a pretty typical arrangement. Carriers are very good at "writing the paper" and all the processes involved from brokerage administration to determining the risk (underwriting) and marketing. Then the job of actually handling the claims gets outsourced to specialized companies: TPAs. The auditor writes she's appalled; outraged at the lack of any sense of urgency, the lack of responsiveness to defense attorneys, not to mention applicant's attorneys. She's astounded at the failure to pay temporary total disability, the failure to advance permanent disability a year after the Agreed Medical Examiner's findings are undisputed to a person who's getting $500.00 a month from Social Security. She's offended that the TPA lets the defense attorneys handle the files, lets cases linger until a pinky finger from 2008 ends up turning into hand, arm, neck, back, internal, sleep, psyche, etc., etc. - on a case that was really ready to settle no less than 4 years ago. She asks, "Why would these cases still be open (excluding those with obvious complex if not catastrophic issues) when the file reflects many opportunities for settlement that slipped away?" Of... |
Monday, August 25, 2014
The Father of the 11th Circuit Court Decision
| Today's post is authored by Peter Rousmaniere and shared from workcompcentral.com The Florida 11th Circuit Court decision on Aug. 13 appears to be the first state court decision in many years to declare an entire workers’ compensation statute as unconstitutional. The fingerprints of the Dean of Workers’ Compensation Research John Burton are all over Judge Jorge Cueto’s reasoning. Since the 1970s, Burton, with a law degree and PhD in economics, has been the leading academic scholar in workers’ compensation, even now years after his retirement from a faculty position at Rutgers University. Burton surely thinks that this decision is long coming. So, what’s his complaint? Cueto wrote that through the years, the state has cut back permanent partial disability benefits so severely that the state “no longer provides any benefits for this class of disabled worker.” Burton’s writings indicate that he holds that whatever permanent disability benefits there are in Florida, they are so low and PPD so significant, that the entire workers’ comp system in Florida is inadequate. Cueto agrees. He cites National Council on Compensation Insurance estimates that legislative changes in 1979, 1990, 1994 and 2003 cut PPD benefits severely. Per Burton, Florida “eviscerated the permanent partial benefit system.” The current benefits are “less than available during the 1970s and markedly lower than... |
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