CA - Twice-Convicted Fraudster Charged in Alleged $100M Scheme
10/15/2024 | 0
A man convicted of fraud in two separate cases 15 years apart and who was kicked out of California's workers' compensation system seven years ago is facing new fraud charges for a scheme that allegedly started in 2020.
The Orange County District Attorney's Office on Friday said David W. Fish, 55, and three co-defendants each face 13 felony charges, including illegal referrals for compensation, conspiracy, filing false or fraudulent claims and insurance fraud. Prosecutors allege that the three-year scheme generated nearly $100 million in fraudulent fees.
Fish allegedly formed a ma...
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A federal appellate court ruled that an injured longshoreman who has hearing loss in one ear and bilateral tinnitus is properly compensated at the statutory rate.
Case: Total Terminals International LLC v. OWCP, No. 23-179, 10/11/2024 published.
Facts: Robert Tower worked for Total Terminals International LLC. His job involved frequent exposure to loud marine operations.
In June 2019, Tower’s otolaryngologist diagnosed him with a 9.375% left monaural hearing loss and bilateral tinnitus.
Procedural history: Tower filed a hearing loss claim under the Longshore and Harbor Workers’...
West Virginia’s Intermediate Court of Appeals upheld a determination that a worker was not entitled to an increase in his permanent partial disability award.
Case: Alban v. West Virginia Division of Highways, No. 24-ICA-104, 10/01/2024, published.
Facts: Barry Alban worked for the West Virginia Division of Highways. He suffered injuries when he slipped and fell at work in December 2020.
A claims administrator for the division’s insurance carrier accepted liability for lumbar and cervical sprains, issuing Alban a 3% permanent partial disability award in June 2021.
Dr. Karl ...
The Commonwealth Court of Pennsylvania overturned a ruling that an employer had waived its subrogation claim for the benefits it paid to an injured worker in a settlement.
Case: American General Life Insurance Co. v. Grosso (WCAB), No. 860 C.D. 2022, 09/26/2024, unpublished.
Facts and procedural history: Joseph Grosso worked for American General Life Insurance Co. He injured his back at work in October 2015, allegedly due to the conduct of a third party. American accepted liability for his injury.
In September 2017, Grosso received a $150,000 settlement from the third party.
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By now, we’ve grown accustomed to the California Division of Workers’ Compensation utterly failing to manage the state’s medical provider network system.
However, even we were surprised to learn that the DWC can’t manage its MPN webpage. All MPN information has disappeared from the page twice and remains missing as of this writing.
Insurers and employers establish MPNs to restrict employees seeking care for their injuries to a chosen group of doctors. The DWC’s online MPN list is supposed to be ...
The Kentucky Court of Appeals upheld the calculation of an injured worker’s average weekly wage and a determination that her award was not subject to a multiplier.
Case: Burks v. United Parcel Service Inc., No. 2023-CA-1328-WC, 09/27/2024, unpublished.
Facts: Sarmarra Burks began working for United Parcel Service Inc. in 2019. Burks also worked concurrently as a driver for Uber and Lyft; in marketing for Pioneer Direct; and as a consultant.
In August 2020, Burks sustained an injury to her dominant right hand, fingers and arm while working for UPS. The company agree...
A federal judge ordered CSX Transportation Inc. to pay $453,510 to two railroad workers who were fired after raising workplace safety concerns in 2017.
The judge also ordered the company to reinstate the workers.
The Occupational Safety and Health Administration said the two workers reported a blue flag on railroad tracks at a railyard in Georgia and said they couldn't safely move the train.
Blue flags are typically used to mark tracks where people are working, and trains are not supposed to come within 50 feet of a blue flag.
After the workers reported the blue flag, they were removed...
Goldberg Segalla announced the addition of new attorneys to its workers' compensation defense offices in Philadelphia and Baltimore.
The firm added Angelina Nordeman to its work comp practice group in Philadelphia and Beteley T. Mulatu to its work comp practice group in Baltimore.
Nordeman focuses her practice on the defense and counsel of employers, insurance carriers and third-party administrators.
In addition to her experience practicing workers’ compensation law, Nordeman also worked on toxic tort matters and engaged in e-discovery services, the firm said.
Nordeman earned...
The Alabama Court of Civil Appeals upheld the denial of a widower’s claim for benefits for a nursing home worker’s death after her COVID-19 infection.
Rose Harrison worked for the Marion Regional Nursing Home.
Between March 1, 2020, and April 6, 2020, two Marion residents tested positive for COVID-19. A nurse who cared for the patients tested positive for COVID in March 2020.
Harrison also worked for Sunset Manor, which operated another nursing home, on two weekends in March 2020.
On March 21, 2020, Harrison reported she had possibly been exposed to COVID-19 at Sunset...
An Ohio appellate court upheld the dismissal of a public university worker's civil suit against his employer for injuries from a fall on a campus walkway.
Case: Marzan v. University of Cincinnati, No. 24AP-203, 09/26/2024, published.
Facts and procedural history: Angel Marzan worked for the University of Cincinnati. He allegedly suffered injuries when he tripped and fell at work in September 2019.
Marzan filed a civil suit against the university, asserting that his fall was caused by its negligence in maintaining the walkway.
The university moved for summary judgment dismissing the act...
West Virginia’s Intermediate Court of Appeals upheld the denial of a school worker’s claim of injury from a child tapping her on the head.
Case: Hill v. Wyoming County Board of Education, No. 24-ICA-174, 10/01/2024, published.
Facts: Clisty Hill worked for the Wyoming County Board of Education. She filed a report of injury claiming a child had hit her on the back of the head on Jan. 3 and again on Jan. 4, 2023. Hill was diagnosed with a concussion.
Dr. Randall Short performed a physician’s review of Hill’s claim. He also reviewed video footage of a second-grader tapp...
A New York appellate court ruled that a worker was entitled to summary judgment for his injuries from a falling while painting a bathroom.
Case: Mosquera v. TF Cornerstone Inc., No. 23663/16, 09/26/2024, published.
Facts: Julio Mosquera allegedly suffered injuries while working on a construction project. He said he fell off the edge of a bathtub he stood on to paint the room's upper corners because the ladders provided to him did not fit inside the tub.
Procedural history: Mosquera filed a Labor Law Section 240(1) claim against TF Cornerstone Inc.
Section 240(1) imposes absol...
The Pennsylvania General Assembly passed a bill that would make direct deposit the default method for paying workers' compensation benefits, and the Senate signed off on a measure that would make it easier for first responders to receive benefits for post-traumatic stress disorder.
The state House of Representatives on Wednesday voted 202-0 to pass SB 1232, by Sen. Tracy Pennycuick, R-Berks, authorizing direct deposit of benefits.
The one-year bill would allow insurers and self-insured employers to offer direct deposit. After a year, they would be required to use direct deposit ...
NATL. - WCRI: Medical Utilization Remains Down in Comp Post-Pandemic
Studies released Thursday by the Workers Compensation Research Institute found that utilization of medical services by injured workers has not rebounded to pre-pandemic levels in the majority of 17 states studied.
The 17 individual studies, addressing the percentage of claims receiving a particular medical service and the number of services provided, show that the industry “continues to see effects of the pandemic on 2022 claims with experience through March 2023,” said Sebastian Negrusa, vice president of research for WCRI, in a statement.
“Besides strained hospital capaci...
Enlyte on Thursday announced the launch of Apricus Physical Medicine, a network for rehabilitation services, including occupational therapy and physical therapy.
Enlyte said its specialty network brand will provide injured workers and payers with access to physical medicine services through a multidisciplinary specialty network. The program is integrated with bill review and data analytics programs. Case management and utilization review can also be integrated into Apricus.
Enlyte said the addition of physical medicine to the Apricus network enhances its ability to efficiently coordinate pat...
A Louisiana appellate court ruled that res judicata did not bar a school district employee’s intentional tort claim against a colleague even though she received a workers’ compensation settlement for her alleged injuries.
Elizabeth Hill worked for the East Baton Rouge Parish School Board at Broadmoor Middle School. Darcy Franklin was the school’s assistant principal of instruction.
On Feb. 3, 2012, Franklin and Hill disagreed with each other about a school policy and went to discuss it with the principal. While in the principal’s office, Franklin allegedly g...
