The Division of Workers’ Compensation’s 2024 audits of claims shops found that over 10% of randomly selected claims had unpaid benefits owed to injured workers. Overall, 271 workers were owed an average of $1,625 each (or a total of $440,714), but the amounts varied greatly by adjuster. Applicant’s attorneys routinely cite an injured worker’s inability …
The Fourth District Court of Appeal ruled that a lower court was correct to dismiss an injured employee’s lawsuit alleging fraud and violations of California’s unfair competition law and the federal RICO Act. The court says the actions of the third-party administrators, claims adjuster, and provider were all covered under the Workers’ Compensation Act’s exclusive …
Federal prosecutors secured a guilty plea in a $270 million Medi-Cal fraud scheme that submitted fraudulent bills for high-cost compounded medications made from generic ingredients that were not medically necessary or, in many cases, not even provided. It was a page straight out of the workers’ compensation fraud handbook – literally. Pleading guilty was Paul …
The Yolo County District Attorney filed criminal charges, including conspiracy and murder, against individuals connected to a deadly explosion last year that killed seven workers. Included among the charges are allegations that the business ownership was cheating on its workers’ comp insurance by paying workers in cash and not reporting the payroll to lower its …
A seemingly routine panel discussion at a recent Commission on Health, Safety, and Workers’ Compensation may prove to be the starting point for California’s next round of workers’ compensation reforms. Representatives for injured workers, providers, and payers were discussing what is and isn’t working in the system when a representative for employers and workers’ comp …
Assemblyman Rick Chavez Zbur (D-Los Angeles) amended AB 2039 last week to propose strict penalties for attorneys caught in capping arrangements. The bill would require an attorney to be disbarred if convicted as part of a capping scheme. The measure also proposes protections for whistleblowers who expose wrongdoing. The California State Bar is notorious for …
New York Marine and General Insurance is asking for a jury trial in federal district court to collect over $5 million in collateral, which it contends is owed by a California towing company that was in a group captive program covering AAA’s preferred towing operators. The carrier is going after United Towing & Transport, which …
The Division of Workers’ Compensation’s annual educational forum opened last week under the direction of a new leadership team at the Division and the Department of Industrial Relations. DIR Director Jennifer Osborn noted that she is still months away from her first anniversary in the position, and acting DWC Administrative Director Nicole Richardson has been …