CA - Cop Convicted of Comp Fraud Must Repay Insurance Premiums as Restitution
04/16/2021 | 0
A California appellate court upheld a restitution order requiring a police officer to reimburse his employer for health insurance premiums it paid while he was on administrative leave because he was being investigated for workers’ compensation fraud.
The decision comes a little more than a week after another appellate court determined that State Compensation Insurance Fund and the California Highway Patrol were entitled to more than $70,000 in restitution for costs incurred investigating a former state trooper who was convicted of fraud.
The latest decision involves Ryan P. Natividad, ...
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A Texas appellate court upheld the dismissal of a worker’s premises liability claim against her non-subscribing employer based on her alleged injuries from a malfunctioning elevator.
Case: Hudson v. Memorial Hospital System, No. 01-19-00300-CV, 04/15/2021, published.
Facts: Michelle Hudson worked for the Memorial Hermann Health System, a non-subscriber under the Texas Workers’ Compensation Act. She was allegedly riding in an elevator on Memorial Hermann’s premises when the elevator suddenly and violently stopped. Hudson claimed she pushed the elevator buttons and felt ...
The South Carolina Court of Appeals upheld an award of benefits to the children of a hotel’s live-in housekeeper who was shot and killed during an armed robbery.
Case: Patel v. BVM Motel LLC, No. 5813, 03/31/2021, published.
Facts: Hansanben Patel worked at the Best Western Point South in Yemassee as a housekeeper.
As a condition of her employment, Patel was required to live at the motel and be on call around-the-clock when on the premises. Patel lived in the provided room with her husband.
On Aug. 16, 2015, an intruder fatally shot Patel and her husband during a robbery.
Procedural...
The California Workers’ Compensation Institute said its analysis of Assembly Bill 1465 found that the proposal to create a statewide medical provider network would essentially eliminate contractual discounts and result in employers paying an extra quarter of a billion dollars to providers every year.
At the same time, CWCI said there is no evidence that the bill would improve access to care.
AB 1465, by Assemblywomen Eloise Reyes, D-San Bernardino, and Lorena Gonzalez, D-San Diego, would create the California Medical Provider Network, or CAMPN. Injured workers would be allowed to c...
I’ve had several conversations with claims and managed care folks over the last few months about measuring performance, outcome metrics versus process metrics, and the challenges of data collection, aggregation and analysis.
Two takeaways.
Too often the discussion has been too focused on process, too down in the weeds, too concerned about how and what to measure. While process and detail are important, they are secondary to the “why” question.
The most important question is “why.”
Why are you doing this? Why are you using that metric? Why do...
A spokeswoman for a South Florida sheriff’s department was arrested on charges of workers’ compensation fraud and official misconduct after allegedly lying about being injured during a fall at work, according to a report by the NBC affiliate in Miami.
The Broward County Sheriff’s Office arrested communications officer Jennifer Blum on Wednesday.
According to the report, Blum told superiors she was injured in a fall on Aug. 13, 2020, while working at the Central Communications Center. The Sheriff’s Office covered more than $1,300 in medical bills on the claim.
After r...
Insurance Commissioner Ricardo Lara on Wednesday reappointed two public members to the Governing Committee for the California Workers’ Compensation Insurance Rating Bureau.
Lara reappointed employer representative Diana Rich and labor representative Mitch Steiger for terms that run through April 14, 2023.
Rich is director of risk management for Foundation Building Materials LLC, where she is responsible for risk management and claims. She also serves as principal for Clark Enterprise Partners, which delivers risk management and workers’ compensation expertise to a variet...
Lawmakers in Washington state approved a bill that would create a presumption that COVID-19 is an occupational condition for frontline employees.
The Senate on Wednesday voted 32-16 to approve amendments to Senate Bill 5115, by Sen. Karen Keiser, D-Des Moines, that were made while the measure was in the state House of Representatives.
The House on April 5 voted 68-30 to pass a version of the bill that eliminated a requirement that employers with 50 or fewer employees report COVID cases to the state. The amended bill also added language declaring that the presumption terminates automatically ...
The Oklahoma Workers’ Compensation Commission is seeking comments about potential revisions to the current Medical Fee Schedule and ground rules.
The commission last amended the fee schedule in May 2020 and is required by law to submit proposed fee schedule updates to state lawmakers every two years.
The WCC said it is working with its external consultant, FAIR Health, on drafting the proposed 2022 fee schedule and is seeking comments from the public about possible changes.
Written comments must be submitted by email to okfeedback@fairhealth.org. Comments are due by May 21.
The ...
SALT LAKE CITY- April 12, 2021- Optimized Outcome Solutions, LLC announces it is now partnering with claims organizations and workers' compensation insurers to assist injured workers in the recovery process. A seriously injured worker who is suddenly removed from both their livelihood and social network commonly feels isolated, worrying about when or if they can return to work. Optimized Outcome Solutions util...
Arizona Gov. Doug Ducey enacted a law that eliminates some criteria that firefighters and peace officers must satisfy before state law presumes they contracted cancer through employment.
Ducey on Wednesday signed Senate Bill 1451, by Sen. Paul Boyer, R-Phoenix.
The bill eliminates a requirement that a firefighter or police officer prove exposure to a known carcinogen reasonably related to the claimed cancer to invoke the presumption.
SB 1451 also adds fire investigators to workers covered by the presumption, and it adds breast cancer and ovarian cancer to the list of conditions that ar...
The Texas Division of Workers’ Compensation said it will resume in-person hearings Aug. 2.
“The Texas Department of Insurance, Division of Workers’ Compensation, has been monitoring the latest developments related to COVID-19,” the agency said in a statement. “Due to increasing vaccine availability and ongoing safety improvements to field offices, DWC has determined that in-person contested case hearings will resume Monday, Aug. 2.”
The division said it encourages parties to begin preparing for in-person hearings.
Court documents will start to show the re...
The next few months could be chaotic for California stakeholders trying to adhere to a recently updated Medical-Legal Fee Schedule, but officials are hoping all sides involved in the evaluation process will make life easier for one another as they become more familiar with the new guidelines, panelists said during a Division of Workers’ Compensation informational session Tuesday.
Many questions submitted for the virtual question-and-answer session referred to the fee schedule’s new attestation provision, which requires the party sending records to a qualified medical evaluator or ...
A federal appellate court ruled that payment of workers’ compensation benefits to an injured housekeeper did not bar the employer from liability for alleged interference in the employee’s ability to exercise her rights under the Family Medical Leave Act.
Case: Ramji v. Hospital Housekeeping Systems LLC, No. 19-13461, 04/06/2021, published.
Facts: Noorjahan Ramji seriously injured her knee while working for Hospital Housekeeping Systems LLC. HHS told Ramji nothing about her rights under the Family Medical Leave Act and handled the injury solely as a workers' compensation ...
A Texas appellate court revived a civil lawsuit seeking to hold an employer vicariously liable for the negligence of an employee who was allegedly responsible for causing a fatal car accident.
Case: Painter v. Amerimex Drilling I Ltd., No. 08-19-00226-CV, 04/12/2021, published.
Facts: Sandridge Energy Inc. hired Amerimex Drilling I Ltd. to drill oil and gas wells on the Longfellow Ranch in Pecos County.
Amerimex provided mobile bunkhouses for its crews and typically located them at the drilling site. However, Sandridge did not allow bunkhouses on the ranch, requiring them to be moved a...
A New York appellate court reinstated a worker’s Labor Law claim for his injuries from being knocked off a ladder when an air conditioning unit fell on his head.
Case: Erby v. 36 LLC, No. 161985/15, 04/01/2021, published.
Facts: Baron Erby suffered injuries when an air conditioning unit fell on him during a construction project.
According to Erby, the unit fell while he was standing on the fourth rung of an A-frame ladder, which he had set up on a solid and clean part of the floor and had been using without incident, directly under the unit.
He had been trying to follow his fore...
A New York appellate court ruled that a worker should have been allowed to proceed with his Labor Law claims based on injuries from a trip-and-fall accident at a construction site.
Case: Gallina v. MTA Capital Construction Co., No. 157087/15, 04/01/2021, published.
Facts and procedural history: Vito Gallina filed a Labor Law Section 241(6) action against the MTA Capital Construction Co. after he allegedly suffered injuries from tripping and falling while working on a construction project.
Section 241(6) imposes a nondelegable duty upon owners and contractors to provide reasonable,...
