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(c) 2010-2026 Jon L Gelman, All Rights Reserved.

Thursday, September 26, 2013

California employer sentenced for insurance fraud

Employer fraud is rampant. As costs to do business increase the underground economy continues to expand. Today's post was shared by votersinjuredatwork and comes from www.dailynews.com


A West Hills man was sentenced Thursday to 29 days in county jail and three years’ probation after pleading guilty to one count of insurance fraud for failing to report employee income in order to pay lower premiums on his air-conditioning company’s workers’ compensation policy.

Officials with the California Department of Insurance said Douglas Lambert, 48, did not report or under-reported employee income to Clarendon National Insurance Co. from 2006 to 2009 for Lambert Air Conditioning, a company he owned and operated in Visalia, near Fresno in Northern California.

“Fraud is a multimillion-dollar enterprise, which costs consumers over $210 million annually,” said Insurance Commissioner Dave Jones in a statement.
“Lambert cheated both Clarendon National and the State of California out of over $110,000, and by doing so passed the cost of his fraud onto consumers across the state,” Lambert was living and working in Tulare County at the time the initial complaint was filed with the Department of Insurance and was prosecuted in Northern California.

Authorities said he filed at least one workers’ compensation claim for an employee’s injury during the time frame of the investigation even though he was not paying insurance on the employee’s wages.

He was ordered to pay $110,381 in restitution and will serve his sentence in Los Angeles County jail.

While he was living up north, a spokesman for the department said he...
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Thousands of California injury claims made by professional athletes

Professional football injuries have taken the national spotlight as workers' compensation claims are being outlawed and restrcted in many jurisdictions. The path being taken, elimination of insurance coverage, is one that will ultimately result in the elimination of body contact sports. Economic incentives, and the lack of them, direct the business of professional athletes and ultimately the root to a healthier workplace. Today's post was shared by votersinjuredatwork and comes from www.latimes.com


The National Football League’s increasingly visible injury legacy has become a topic of national debate, one that threatens to cast a lasting shadow over the country’s most popular, and profitable, sport.

Far less attention has been paid to the physical woes of other athletes, but a review of injury filings in California suggests that professional athletes of all stripes walk away from their sports with nagging and often permanent injuries.

Over the past two decades, more than 2,500 claims have been filed by former baseball, basketball, hockey and soccer players against their former teams in California’s workers’ compensation system.

In the past six years, more than 940 of them -- among them stars such as two-time baseball most valuable player Juan Gonzalez and basketball legend Kareem Abdul-Jabbar -- have made filings alleging serious brain and head injuries.

The claims were isolated as part of a Los Angeles Times analysis of more than 3 million filings made to the California Division of Workers’ Compensation. Last month, The Times published a searchable database of claims by football players, and now it's being updated will all other major team sports.

Database: workers' comp claims by baseball players
Database: workers' comp claims by basketball players
Database: workers' comp claims by hockey players
Database: workers' comp claims by soccer players
Database: workers' comp claims by women's basketball players
Although the total...
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U.S. Sees Direct Threat in Attack at Kenya Mall

Terrorism is a valid concern in the workplace. Safety in shopping malls may require additional security requirements for malls. In Israel metal-detectors have been used to check patrons entering malls. Today's post was shared by The New York Times and comes from www.nytimes.com


Viewing the deadly siege at a shopping mall in Kenya as a direct threat to its security, the United States is deploying dozens of F.B.I. agents to investigate the wreckage, hoping to glean every piece of information possible to help prevent such a devastating attack from happening again, possibly even on American soil.

For years, the F.B.I. has been closely watching the Shabab, the Somali Islamist group that has claimed responsibility for the Nairobi massacre and recruited numerous Americans to fight and die — sometimes as suicide bombers — for its cause.

The Shabab has already attacked most of the major actors trying to end the chaos in Somalia — the United Nations, Uganda, aid groups, the Somali government and now Kenya. The United States has spent hundreds of millions of dollars bankrolling anti-Shabab operations for years, and there is growing fear that the group could turn its sights on American interests more directly, one of the reasons the Obama administration is committing so many resources to the investigation in Kenya.

“We are in this fight together,” said Robert F. Godec, the American ambassador to Kenya. “The more we know about the planning that went into this, the way it was conducted, what was used, the people involved, the better we can protect America, too.”

Less than a day after the bloody standoff ended, more than 20 F.B.I. agents wearing flak jackets and helmets were combing through the...
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N.J. boosts public workers' insurance coverage for alcoholism, drug addiction

Obesity is a front page story in NJ every day as Governor Christie struggles to loose weight. While the Governor spoke in April 2013 about revising the state's workers' compensation system, he has been silent on the subject after his initial announcement. With an election quickly approaching in November he has turned to the endorsement of legislation to treat drug addiction  mental illness and obesity.  All of these efforts are strong indicators that a healthier workforce is being encouraged and will ultimately benefit the workers' compensation system by reducing pre-existing and co-existing conditions. Today's post was shared by WCBlog and comes from www.nj.com


Gov. Chris Christie, shown here in Asbury Park at an unrelated event today, announced that the state's health benefits plan for public workers will cover alcoholism and drug addiction the same as other mental illnesses starting next year.Tony Kurdzuk/The Star-Ledger

More than 200,000 public workers in New Jersey will get enhanced insurance coverage for mental illnesses such as alcoholism and drug addiction beginning next year, Gov. Chris Christie announced today.

A committee of state and union officials approved "mental health parity" on Friday for the state's second-largest health benefits plan. It means the same level of coverage now provided for a biologically-based mental illness — such as schizophrenia or bipolar disorder — will apply to other types of illnesses such as alcoholism, drug addiction and eating disorders.

The expansion is expected to cost "less than $5.1 million a year" and will affect more than 217,000 current and retired workers enrolled in the State Health Benefits Program, Christie's office said in a news release today. The insurance plan covers state, county and local government workers as well as employees of New Jersey's public colleges and universities, and their dependent family members.

Along with that change, the committee approved "four new lower-cost health plan options" and a new "wellness program" that seeks to encourage healthier lifestyles by offering workers gift cards worth $100 to $250 per person every...
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Votive Candle Holders Sold at Cracker Barrel Old Country Store Recalled Due to Fire Hazard; Made by Mercuries Asia

Mercury has been long known to be a dangerous substance for workers. In fact, the Mad Hatter who is described in the Alice in Wonderland, suffered from mercury poison. Today's post was shared by U.S. CPSC and comes from www.cpsc.gov


Consumers should stop using this product unless otherwise instructed. It is illegal to resell or attempt to resell a recalled consumer product.
Mercuries Asia “Ant” Votive Holders Packaging

Recall Details

Units
About 7,900
Description
This recall involves candle holders designed to resemble a large ant. The black metal candle holders are 6 ½-inches tall and were sold as either a male or female. The male ant has a polka dot bow tie and the female has a white pearl necklace. Both ants hold up a clear glass votive cup. The words “Backyard BBQ” and “Glass Votive Holder” are printed on the front of the packaging. SKU number 426154 can be found on the underside of the packaging.
Remedy
Consumers should immediately stop using the recalled votive candle holders and return them to any Cracker Barrel Old Country Store location or mail to Mercuries Asia USA, Ltd., 1501 Gary Street, Bethlehem, PA 18018 for a full refund, including shipping.
Sold exclusively at
Cracker Barrel Old Country Store locations nationwide from May 2013 through June 2013 for about $6
Importer
Cracker Barrel Old Country Store® of Lebanon, Tenn.
Manufacturer
Mercuries Asia Ltd., of Taipei, Taiwan
Manufactured in
China

The U.S. Consumer Product Safety Commission (CPSC) is still interested in receiving incident or injury reports that are either directly related to this product recall or involve a different hazard with the same product. Please tell us about your experience with the product on SaferProducts.gov...
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Work Comp Steps Up to ACA

The Affordable Care Act's impact on workers' compensation is going to take many forms. David DePaolo points out in his shared blog today some of the aspects as the ACA is close to launch. Whether the ACA is going to emasculates the workers' compensation system is yet unknown  It is sure heading that way in the new less litigious and aging society.

One of the big questions I have had since the Affordable Care Act became law was how the workers' compensation underwriting market would react since it seemed that there would be a broadening in the class of health care workers coming into the scene.

That question was given some evidence yesterday when ProAssurance, a writer of medical professional liability insurance based in Birmingham, Ala., announced a proposed acquisition of Pennsylvania-based workers' compensation writer Eastern Insurance Group for $205 million.

Eastern offers workers’ compensation to employers with generally 1,000 employees or less that traditionally pay an average premium per policy of $21,956, according to filings with Securities & Exchange Commission. Also, Eastern concentrates on low- to middle-hazard classes of businesses, primarily in the Mid-Atlantic, Southeast, and Midwest regions. In 2012, it reported workers comp premiums written of $182.9 million.

Among those employers Eastern counts as policy holders are small hospital systems, long-term care facilities, physician and dental practices and home health care providers....
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Wednesday, September 25, 2013

Chart of the Day: Hands-Free Talking Is as Bad as Talking on a Handset. Maybe Even Worse.

Distracted driving doesn't get better by the use of hands free technology. Today's post was shared by Mother Jones and comes from www.motherjones.com


Michael O'Hare points us this morning to a study of cell phone usage in cars that confirms the obvious: it's dangerous. More dangerous than driving drunk, in fact. What's more, as the chart on the right shows, hands-free talking doesn't help. In fact, for certain
tasks it makes things even worse. O'Hare explains what's going on:
To understand the reason, consider driving while (i) listening to the radio as I was (ii) conversing with an adult passenger (iii) transporting a four-year-old (iv) sharing the front seat with a largish dog.
Why are the first two not dangerous, and the last two make you tense up just thinking about them? 
The radio is not a person, and you subconsciously know that you may miss something if you attend to something in the road ahead, but also that you won’t insult it if you “listen away”, and it won’t suffer, much less indicate unease. The adult passenger can see out the windshield and also catch very subtle changes in your tone of voice or body language. 
If you stop talking to attend to the car braking up ahead, the passenger knows why instantly, and accommodates, and because you know this, you aren’t anxious about interrupting the conversation. The dog and the child, in contrast, are completely unaware of what’s coming up on the road or what you need to pay attention to; the former is happy to jump in your lap if it seems like a good idea at any moment, and the child demands attention on her own schedule and at...
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Judge again asks sides to settle in Calif. lead paint case

Lead paint litigation is facing a sentinel decision that will set the direction for the future of environmental and occupation litigation. Today's post was shared by Legal Newsline and comes from legalnewsline.com


Santa Clara County Superior Court Judge James Kleinberg on Monday ended proceedings in a 13-year-old case against paint companies by admonishing both sides, again, to settle.
Kleinberg

Kleinberg made his remarks after closing arguments in The People of California v. Atlantic Richfield Co. et. al., which seeks to hold five defendant paint companies liable for an alleged lead paint public nuisance in 10 county and municipal jurisdictions in the state.

“Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passion, they cannot alter the state of facts and evidence,” Kleinberg said, quoting John Adams who defended British soldiers in the Boston Massacre trial of 1770.

Kleinberg also recalled a one-word response made by a judge in a civil case he tried as a lawyer. The judge, he said, asked the plaintiff’s lawyer how his clients felt about their prospects, to which the lawyer responded “Very confident.”

“Why,” asked the judge.

Kleinberg said the case settled a few days later.

Saying it is “never too late to settle,” Kleinberg encouraged the sides to bring an end to the litigation that has spanned more than a decade and could put the defendants – Atlantic Richfield Co., ConAgra, DuPont, NL Industries and Sherwin Williams – on the hook for more than $1.4 billion to abate lead paint in pre 1978-built homes. Kleinberg said it takes He said it...
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Prescription-Drug Coupons — No Such Thing as a Free Lunch

The cost of pharmaceuticals prescribed in workers' compensation claims remains a seriously advancing cost to the system.  Employers blame injured workers for the cause and the demand. Is the actual demand being driven by the pharmaceutical industry? The following is shared from The New England Journal of Medicine www.nejm.org.

Visit nearly any official website for a brand-name drug available in the United States and, mixed in with links to prescribing and safety information, you'll find links to drug “coupons,” including copayment-assistance programs and monthly savings cards.

Most offers are variations on “Why pay more? With the [drug] savings card, you can get [drug] for only $18 per prescription if eligible” or “Get a free 30-capsule trial of [drug] with your doctor's prescription and ask your doctor if [drug] is right for you.” Why do manufacturers offer drug coupons? Are they good for patients in the long run? Are they even legal?

Commercial drug-insurance plans typically have tiered pharmaceutical formularies to guide prescription-drug use, requiring relatively small patient copayments (approximately $5 to $15) for inexpensive generic drugs and higher copayments (perhaps $25 to $100) for brand-name drugs. Manufacturers use coupons to reimburse patients for this difference in copayments when they buy brand-name medications, so that, for people with commercial insurance coverage, the out-of-pocket costs are the same as those for generic drugs.

Drug coupons are implemented through subsidies paid by drug manufacturers. Patients nearly always print coupons off...
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Joseph S. Ross, M.D., and Aaron S. Kesselheim, M.D., J.D., M.P.H.
N Engl J Med 2013; 369:1188-1189 September 26, 2013 DOI: 10.1056/NEJMp1301993

Prospect voters choose to abolish Fire Department

Residents of the Village of Prospect voted Tuesday to abolish its Fire Department.
The 82-46 vote comes as the village faces possible bankruptcy as it struggles to cope with a 2008 workers compensation claim from a volunteer firefighter that amounts in the hundreds of thousands of dollars.

As of 8 a.m. Wednesday, any fire in Prospect will be covered primarily by Barneveld’s department, and also by Remsen, Mayor Fran Righi said. The Prospect fire station likely will become a satellite station.

“As of right now, the village owns all their assets,” Righi said of the Prospect Fire Department. “As of 8 a.m., the tones will not sound, we will be changing the locks and taking an inventory.”

Late Tuesday afternoon, there was a slow but steady trickle of voters coming to the Prospect Village municipal building to vote.

The sky was clear, the scent of wood smoke hung in the air and the clock at the corner of Upper State and Summit streets pointed to high noon.

Of the roughly 175 people eligible to vote, 128 cast ballots. Few, however, would disclose to the media their decision.

“I’m for the Fire Department,” said resident Kim Fazekas. “I think there is a different solution.”
But George Zacek said he had voted to abolish the department.

“The way it is structured now, there’s just a small number of families that are liable for every comp case that arises,” he said. “It puts a tremendous burden on the...
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Questionable Workers Comp Claims Report: Fewer Claims and More Disputes

The National Insurance Crime Bureau (NICB) today released an analysis of workers’ compensation (WC) questionable claims (QC) referrals submitted from Jan. 1, 2011, through June 30, 2013. 

The report finds that while the total number of WC claims has been decreasing, the percentage that is deemed “questionable” has been rising. 

QCs are claims that NICB member insurance companies refer to NICB for closer review and investigation based on one or more indicators of possible fraud. A single claim may contain up to seven referral reasons.
 
California ranked first generating a total of 2,270 WC QCs. It was followed by Illinois with 689. New York was third with 688. 

In 2011, 3,349,925 WC claims were found in the Insurance Services Office (ISO) ClaimSearch® database. That number decreased to 3,244,679 in 2012, and is on track to decrease again in 2013 based on the 1,498,725 claims received in the first half of 2013. 
In 2011, 3,474 WC QCs were referred to NICB. That number increased to 4,460 in 2012 — a 28 percent rise. WC QCs accounted for 3.5 percent of the 100,201 QCs submitted in 2011, and increased to 3.8 percent of the 116,171 QCs in 2012.  

Through the first half of 2013, 2,325 WC CQs have been referred to NICB (3.7 percent of 62,352 total QCs), compared with 1,681 through the first half of 2011 and 2,174 through the first half of 2013.

The distribution of WC QCs follows a standard Monday–Friday workweek with...
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Join us for the 6th Annual Worldwide Photo Walk October 5, 2013

If you are going to be in South Florida for the WILG meeting in October 2013, I would like to invite you to join me for a photo walk that is absolutely for fun and FREE.


Bring any type of camera, from a camera-phone to a sophisticated DSLR.
Boca Raton, FL United States (Mizner Mall)
Join us for the 6th Annual Worldwide Photo Walk
Register for FREE now!
Registration is limited.
Sponsored by the National Association of Photoshop Professionals.

Photo Walk Description

Walk to Begin at E Boca Raton Rd & NE 1st Street, Boca Raton, FL. It will end at Starbucks at Mizner Park. Mizner Park is an upscale lifestyle center in downtown Boca Raton, Florida. Besides upscale shops, Mizner is also composed of rental apartments and offices. The Centre for the Arts at Mizner Park is a cultural center on the north end of the development, which is embodied by an amphitheater and the Boca Raton Museum of Art. The art museum, Victor’s Antiques & Fine Arts, Addison Gallery and the luxurious iPic movie theater are the center’s anchor stores, along with highly rated restaurants Max’s Grille, Villagio, and Truluck’s. Cooper Carry designed the architecture of Mizner as a Mediterranean revival town center.

Read more about the Worldwide Photo Walk

Public Disclosures Don't Bar Halliburton FCA Suit, Court Says

Today's post is shared from law360.org.

The False Claims Act’s public disclosure bar does not prevent a water purification specialist's lawsuit accusing Halliburton Co and KBR Inc of violating contractual duties to test and purify lavatory and drinking water used by U.S. troops in Iraq, a federal court in Virginia ruled on Thursday.

The FCA’s public disclosure bar jurisdictionally bans claims based on matters that were publicly disclosed unless the relator was the original source of the allegations. Although the court ruled that the companies did make public disclosures about the information at-issue, it determined that it was more likely than not that whistleblower Benjamin Carter did not base his claims on that information.

“Carter has shown that he had independent knowledge of the facts underlying his claim and that he derived his allegations from his own independent knowledge,” the court wrote.

Carter, a former reverse osmosis water purification unit operator, has long been locked in a legal battle against Halliburton and KBR affiliate Kellogg Brown & Root Services Inc. over claims they billed the government for water purification work they never did at U.S. bases in Al Asad and Ar Ramadi, Iraq.

Halliburton had argued that Carter got his information from prior allegations brought against the oil company, but the district court ruled that Carter based his claims on first-hand experiences.
“Although the...
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Tuesday, September 24, 2013

Mesothelioma: Two Groundbreaking Trials Into Treatments for Asbestos-Related Cancer

Mesothelioma is causally related to asbestos exposure. Asbestos use is not yet banned in the US. This story is shared from sciencedaily.com.

University of Leicester researchers are leading two major trials into treatments for a type of cancer which affects those exposed to asbestos.

Professor Dean Fennell, of the University's Department of Cancer Studies and Molecular Medicine, is leading two groundbreaking trials into mesothelioma -- a form of lung cancer strongly linked with exposure to asbestos.

Mesothelioma most commonly starts in the inner lining of the chest wall, causing it to thicken, reducing lung capacity -- which in turn puts a strain on other organs including the heart.
Since the 1960s, it has been known that the disease can be triggered by the inhalation of asbestos fibres.

Despite the UK's ban on asbestos issued in 1985, the number of deaths caused by the disease each year has grown from 153 in 1968 to 2,321 in 2009 -- the highest incidence in the world.

This number is set to continue to rise sharply over the next 20 years, with a peak coming in 2020.
Two studies involving the University of Leicester aim to test new potential treatments which could improve survival and quality of life for mesothelioma patients.

Meso2, a study funded by Synta Pharmaceuticals, aims to test the effectiveness of a drug called ganetespib in preventing mesothelioma tumors.

Ganetespib inhibits the action of a protein in cells called heat shock protein 90 (HSP90) -- which is...
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