CA - Plea Deal Prohibits Doctor From Participating in Compensation
02/15/2019 | 2058 | 0 | 27 min read
A Beverly Hills orthopedic surgeon is permanently disqualified from being a provider in the state's workers’ compensation system as part of an agreement to plead guilty to two felony counts of billing fraud involving hardware used in spinal surgeries.
The Los Angeles County District Attorney’s Office announced Dr. Gil Tepper, 59, was ordered at a hearing on Thursday to pay $1.7 million in restitution to nine insurance companies. The doctor was also ordered to serve six months of electronic monitoring and complete 300 hours of community service.
Prosecutors said they inten...
Read More
Two years into a 14-year prison sentence, the mastermind behind a far-flung scheme to defraud the federal workers' compensation program has had plenty of time to consider how he plans to pay $18 million in restitution.
But now, Garry Craighead has something else to think about: More than $10 million in damages he must pay, the result of a civil suit brought by a whistleblower and the U.S. government.
U.S. District Court Judge Xavier Rodriguez this week ordered triple damages in the case that involved kickbacks and 11,900 false claims filed with the federal Office of Workers'...
A group that recently adopted a model law pertaining to physician dispensing in workers’ comp has now set its sights on a model act for work comp drug formularies.
The National Council of Insurance Legislators, or NCOIL, is using as its starting point Indiana’s Senate Bill 369, which created a workers’ comp formulary that took effect on Jan. 1.
Indiana Rep. Matt Lehman, who is NCOIL’s vice president, has proposed that the bill be used to kick off discussions of a possible formulary model act that states could use as a strategy to help lower drug costs.
The NCO...
A Texas appellate court on Thursday ruled that contractor’s employee could not proceed with a personal injury suit against the property owner that had hired his employer for work on the property.
Chapter 95 of the Texas Civil Practice & Remedies Code provides that a property owner cannot be held liable for failing to provide a safe workplace to the employee of a contractor who performs work on the property unless the owner had control over the manner in which the work is performed, and actual knowledge of the dangerous condition.
The Court of Appeals for the 11th District...
The issue of safety incentive programs in the workplace has been current for a number of years now. A common concern is that safety programs that promise a periodic bonus to all, if no injuries occur, may create anxiety among workers that they should avoid reporting their injuries.
A thoughtful new discussion is by Leavitt Group's Patrick Hagge, Safety Incentive Programs: Best Practices and Common Pitfalls.
This anxiety came to life in a March 2018 unreported workers’ compensation opinion here in Pennsylvania (Burch v. WCAB (Graham Packaging)).
In that case, the...
A California appellate court upheld the dismissal of a legal assistant’s tort claim against her employer for alleged injuries from exposure to mold.
Case: Ruiz v. Carter & Carter, No. E068632, 02/13/2019, unpublished.
Facts: Evangelina Ruiz worked as a legal assistant for the law firm of Carter & Carter.
In 2011, the firm accepted a case involving claims of black water and mold in a house. Ruiz was given the job of inspecting documents related to the case.
Ruiz claimed the documents contained mold and mold spores. As a result, Ruiz allegedly fell ill.
Procedur...
The Alaska Supreme Court ruled that an injured worker could not set aside his partial settlement of his workers’ compensation claim, nor could he enforce an alleged agreement with his employer for the payment of future medical benefits.
Case: McKee v. Alaska Functional Fitness, No. S-16954, 02/14/2019, unpublished.
Facts and procedural history: Charles McKee slipped and fell while cleaning shower stalls at Alaska Functional Fitness in December 2014.
McKee filed two separate workers’ compensation claims. With the assistance of a non-attorney representative, McKee was able to nego...
The Ohio Supreme Court ruled that the Industrial Commission can compel an injured worker to submit to additional medical examinations if it explains why they would be necessary or helpful in determining eligibility.
Case: State ex rel. Mignella v. Industrial Commission, No. 2018-0085, 02/13/2019, published.
Facts and procedural history: Mary Mignella suffered multiple injuries in a fall in March 2011 while working as a teacher for the Warren City School District.
After she filed an application for permanent total disability benefits in January 2015, the Industrial Commission required that s...
The Kentucky Court of Appeals partially revived an injured worker’s tort claims against a group of defendants allegedly at fault for his conveyor belt accident at a meat processing plant.
Case: Cabrera v. JBS USA LLC, No. 2017-CA-001658-MR, 02/08/2019, published.
Facts and procedural history: Jorge Martell Cabrera worked for Packers Sanitation Services.
While he was cleaning a pork processing facility in Louisville, his right arm became entrapped in a conveying system, and he suffered injuries.
Cabrera filed a workers' compensation claim and received benefits from his employer. H...
The battle over the reform of Oklahoma's workers' compensation law continues to churn, now with Republicans sparing with each other over how far worker-friendly changes should go.
At a meeting of the House Judiciary Committee this week, Chairman Chris Kannady, R-Oklahoma City, postponed discussion of the much-anticipated HB 2367, a comprehensive bill designed to correct some of the 2013 benefit reductions that the state Supreme Court held were unfair to workers, and unconstitutional.
Kannady announced in the committee meeting that he needs to adjust some of the provisions of...
The Montana Senate passed a bill that would create a presumption that certain diseases developed by firefighters are occupational in nature.
The Senate on Wednesday voted 35-15 to pass SB 160, by Sen. Nate McConnell, D-Missoula. The bill lists a dozen conditions including certain types of cancers and pulmonary disease that are presumed compensable when diagnosed after a specific period of employment.
For example, bladder cancer would be presumed compensable after 12 years of employment, while leukemia would be compensable after five years.
Conditions would also have to be diagnosed with...
Utah lawmakers are sending Gov. Gary Herbert a bill that would authorize add-on fees when injured workers successfully challenge denied medical claims.
The House of Representatives on Wednesday voted 72-0 to pass Senate Bill 76, by Sen. Karen Mayne, D-West Valley City. Mayne has not amended the measure since the Senate voted 29-0 to pass it Feb. 5.
Senate Bill 76 would require add-on fees in cases where workers are awarded medical treatment that was initially denied, and the fees would vary depending on the venue awarding the benefits.
The fee would be the lesser of $25,000 or 25% of th...
An injured worker would not have to wait for a claim to be filed or even for approval from the employer before seeking up to $2,000 in medical care, according to two bills filed in the Kansas Legislature.
House Bill 2313 and its nearly identical Senate companion, Senate Bill 172, would raise the limit on initial medical treatment, from $500 to $2,000.
“Without application or approval, an employee may consult a health care provider of the employee's choice for the purpose of examination, diagnosis or treatment, but the employer shall only be liable for the fees and charges of su...
American International Group Inc. has reported a net loss of $622 million in the fourth quarter of 2018, compared to a $6.7 billion net loss in the prior-year quarter.
In the company’s General Insurance division, net premiums written for North America commercial lines were up 20% in the fourth quarter, to $2.16 billion. The commercial lines fourth quarter net underwriting loss of $541 million compares to a $16 million underwriting gain in the prior-year quarter.
The combined ratio for commercial lines in the fourth quarter increased, to 120.9%, from 99.2% in the same quarter o...
Texas Mutual Insurance Co. has asked Insurance Commissioner Kent Sullivan to repeal an order that will eliminate Classification Code 0923, used for household domestic servants.
An order approved by Commissioner David C. Mattax in November 2016 made several changes to the National Council on Compensation Insurance Manual, including the elimination of the 0923 code, which more officially is titled "Domestic Workers-Residences-Payroll Basis."
The manual change reclassified all domestic workers to Texas classification code 0913 and expanded the classification wording for...
The U.S. Occupational Safety and Health Administration has cited a Florida roofing contractor for allegedly exposing employees to fall hazards at residential work sites in Port St. Lucie and Naples.
Sarasota-based Crown Roofing LLC faces proposed penalties of $265,196 in connection with the citations, which OSHA issued on Feb. 7. The company has 15 business days to contest the citations.
OSHA initiated the inspections in August and October as part of the agency's Regional Emphasis Program for Falls in Construction, after inspectors allegedly saw the company's employees working on roo...
