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Keyword: ‘305’

AB 305 Dies on the Vine – Apportionment to Pregnancy to Continue

October 14th, 2015 No comments

Hello, dear readers!

Your humble blogger loves few things more than to bring good news to his fellow members of the workers’ compensation community, and today is one of those days.

Governor Brown has declined to sign Assembly Bill 305, which would have barred the workers’ compensation system from apportioning permanent disability to various physical conditions such as pregnancy and menopause.

“[T]his bill is based on a misunderstanding of the American Medical Association’s evidence-based standard, which is the foundation of the permanent disability ratings, and replaces it with an ill-defined and unscientific standard.”

This is a good thing, dear readers.  Don’t get me wrong – in your humble blogger’s ideal world, no one would ever get hurt.  But chipping away at apportionment is not the way to keep our state afloat, and it’s not the way to help employers keep California’s economy going.

Ultimately, this bill highlights a truth that we all know too well – life isn’t fair.  So, who is going to bear the burden of the unfairness?  The bill would shift the burden to the employer, and from where your humble blogger sits, the California employer has been burdened enough.

Kudos to you, Governor Brown.

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AB305 Headed to Guv; California Headed to Insanity

September 16th, 2015 No comments

Greetings, dear readers!

Do you ever sit back, with your feet on your desk, a fine scotch in your glass, and a puzzle dancing in your mind – why can’t we have nice things?  Well, dear reader, THIS IS WHY!

Assembly Bill 305 has passed both the Senate and the Assembly and is now headed for the Governor’s desk.  If signed into law, it would prevent apportionment of permanent disability to pregnancy, menopause, or, in the case of psychiatric injuries, sexual harassment, menopause, or pregnancy.

I’m sure the proponents of this bill see themselves as some sort of champions for the oppressed.  Certainly, it’s not fair that women face some difficulties not visited on men.  Surely, the world would be a better place if no one ever got hurt.  When people do get hurt, the world would be a better place if one’s sex did not exacerbate the burden such injury places on the injured.  Can’t we all think of ways the world could be a better place?

In fact, what we’re going to see is a further increase in the cost of labor in California.  Do you want to see the effect of such policies in the aggregate?  Take a look at data recently released by the IRS for 2012-2013.  California continues to see a dramatic decline in tax-generating population (and tax dollars as well).

What goes with these particular individuals, as they cross state lines? Jobs.  These are the jobs that generate revenue that keeps the government lights on and our absurdly horrible roads in one of California’s two favorite conditions – in need of repair or closed for repair.  California will continue to lose the jobs and services we all enjoy and rely on to other states (or to the abyss).

Or, we can look forward to having many of those jobs replaced by automation: Fast-Food will replace workers with kiosks; warehouses will replace workers with machines; even manufacturing will continue to go automated, as one company in Australia reported replacing 60 welders with 3 robots costing $150,000 each.  These results neither generate income tax revenue for state coffers, nor provide employment for humble bloggers of the workers’ compensation defense variety.

This insanity has to stop.  It is not unusual for California’s legislature to have absolutely no understanding of the difficulties faced by small businesses in keeping the lights on.  It is, however, a bit of a surprise that the same legislators are equally deaf to the difficulty labor is facing in finding work.  Minimum wage can be raised to $1,000 per hour, and PD benefits can be magnified 100 fold, but neither will benefits Californians who cannot find work.

Putting things in proportion, dear readers, I get it – the small increase this particular bill will cause in the cost of workers’ compensation coverage is not to blame for the difficulty that industries employing workers earning less than $100,000 per year are facing in California.  But, as stated before, it is a symptom of a disease, or, rather, a diseased mindset when it comes to how California functions.

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Jurisdiction! Yes, It Still Matters!

May 23rd, 2016 No comments

Hello dear readers!

How often do you deal with the issue of jurisdiction?  It’s a rare bird, to be sure, and why? Most cases include injuries sustained in California, and that’s typically enough to grant jurisdiction.  Labor Code section 5305 holds that the DWC and the WCAB have jurisdiction over any case where the injury occurred outside of California, but the contract of hire was made in California.  (Please note, dear readers, that the clause “where the injured employee is a resident of this state” was found unconstitutional in Alaska Packers Assn. v. IAC, but, for some reason, the language remains in the labor code.)

Once in a while, though, it does come up, and, with such frequency, that every claims examiner and defense attorney should have a mental warning bell whenever one of them non-Californians comes round these parts and wants to get a fixin’ to workers compensatin’!  We don’t take kindly to such antics around here!

The issue came up in the matter of Walkerv. Petrochem Insulation, Inc.  The injured workers sustained an injurious exposure while working in Utah, but was hired in Georgia via e-mail.  The contract was signed in Georgia, scanned and e-mailed back to the employer’s office in Utah.  Slam dunk, right?

Not according to the applicant – the employer has a presence in California, and copies of the signed contract were eventually forwarded to the California offices.  Applicant was required to join a union based in California and the pay stubs originated in California as well.  In a world of e-mails flying through the internet, what is the actual place of employment?

Well, the WCJ put emphasis on some of the other facts: applicant’s supervisor was in Utah when he e-mailed him the contract and received a signed copy back.  Furthermore, applicant did no work in California, but only in Utah.

Ultimately, the WCJ held that applicant failed to carry the burden of showing that California had Jurisdiction, and the WCAB agreed.

But why go to such great lengths to get California benefits?  After all, why not seek out benefits where the injury occurred?  Surely, California is not out of pace with what the rest of the Union is providing to injured workers… right?

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Another LEO Charged with WC Fraud

August 5th, 2015 No comments

Once again, dear readers – Quis custodiet ipsos custodes?

The Orange County District Attorney has announced that it has charged a Costa Mesa Police Officer with insurance fraud, claiming that he faked a work-injury of striking his fist against a wall during an arrest.  An internal investigation “uncovered evidence contradicting [the officer’s] account of how and when the injury occurred.”  Your humble blogger is declining to name names at this time, as this is only an accusation, and falls short of a conviction.

As noted on this blog a time or two, certain public employees, typically law enforcement officers and firefighters, hold a certain degree of public trust.  Only in a society as confused as ours, are workers’ compensation defense bloggers and attorneys not the pride of the population… To abuse that trust does a considerable amount of damage to society in general.

But, bitter cynic that your humble blogger is, he can’t help but wonder about two particular issues in such scenarios.

On more than one occasion, your humble blogger has met some resistance from law enforcement agencies in having obvious, obnoxious, and borderline heinous instances of fraud ignored – the damages are too small, the fraud not high-profile enough, etc., etc.  How often does a law enforcement agency decline to prosecute a person who steals from its coffers on those very grounds?

Furthermore, we obviously have instances of fraud on the part of law enforcement officers.  This blog has documented sheriff’s deputies, police officers, firefighters (pretend they enforce the law against fires), and CHP officers charged with and convicted or confessed to various forms of workers’ compensation fraud.  It is possible to be an officer of the law and steal from your employer (and the tax payers)!  Why, then, do we continue to offer so many presumptions to favor LEOs in workers’ compensation cases?  Nothing against cops or firefighters – of course there are some great folks in uniform that are honest, hard-working, and brave, but why the kid gloves and special treatment?

There are construction workers that are honest, hard-working, and brave.  There are lots of professions that expose people to dangerous conditions.  Even workers’ compensation defense attorneys can encounter danger from time to time (sometimes parties can react violently to not getting certain benefits, after all).

It’s obvious that the badge or the fire truck don’t make one a paragon of truth and justice – even the rotten ones get to play with the siren or shoot the water hose.

Perhaps we need more powerful lobbying groups – perhaps workers’ compensation defense attorneys should maneuver the legislature into various presumptions to favor our interests – such as conclusive presumptions that we’re handsome devils; witty and charming beyond contest; and when we turn to blogging, there is an irrefutable presumption that we’re humble.

Given the considerably disconcerting events involving law enforcement officers making the news lately, perhaps it’s time we departed from the hero-worship that leads congenital heart conditions to be found compensable and instead subject law enforcement officers’ claims to the same scrutiny as the common man – both as to the veracity of claims and the burden of proof in establishing compensability.

That is, of course, until the defense attorney lobby gets going and membership in the profession establishes a presumptively compensable psyche claim…

Power through, dear readers, your weekend is just around the corner!

Cop Pulls Over Donut Truck

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Sexism and WC

March 20th, 2015 No comments

Alright, dear readers, it’s Friday, and the subject of today’s post is sexism and workers’ compensation, but your humble blogger doesn’t want to tell any sexist jokes, so here’s a video of construction workers NOT cat-calling:

Ok, so, the buzz around all the workers’ compensation (and some of the non-workers’ comp) news sources is that Assembly Bill 305 is going to strive to reverse sexism in workers’ compensation law.  Now, AB-305, introduced on February 12, 2015 by Assemblywoman Gonzalez, has absolutely nothing to do with workers’ compensation, but from the looks of it, California Applicants’ Attorneys’ Association has a draft of the language that may eventually be introduced here.

Basically, the idea is that Labor Code section 4663, which requires “[a]pportionment of permanent disability [to] be based on causation” to be amended to specifically exclude pregnancy, breast cancer, menopause, or osteoporosis from the apportionment analysis.

Now, your humble blogger is no political analyst, but I’m guessing that this would not be an issue, and no such bill would be necessary, if doctors never apportioned the cause of permanent disability to these conditions.  I’m also not a physician, but I’m going to go out on the proverbial limb and say that some doctors could reasonably conclude that the effects of pregnancy, breast cancer, menopause, or osteoporosis might contribute to the overall permanent disability of an industrially injured worker.

As such, if, non-industrial conditions are causing permanent disability, and AB 305 would prohibit apportionment to them as non-industrial causes of permanent disability, aren’t we just forcing employers to provide permanent disability benefits for non-industrial disability?

The language in this proposed piece of legislation continues that “[a]pportionment in cases of psychiatric injury may not be based on psychiatric disability or impairment caused by sexual harassment.”  Again… if a portion of an injured workers’ psychiatric permanent impairment is caused by sexual harassment, particularly non-industrial sexual harassment, why should the employer be forced to pay for the same?

Interestingly enough, and I hesitate to write this less I provide anyone with ideas, Labor Code section 3208.3(b)(1) requires that the injured employee claiming a compensable psychiatric injury prove, by a preponderance of the evidence, that actual events of employment were predominant as to all causes combined of the psychiatric injury.  So, if 50% of the permanent disability of the non-psychiatric injury is caused by menopause, and we can’t apportion the PD to the menopause, the menopause is still not an actual event of employment.  Causation of permanent impairment and causation of injury are different points of analysis, after all.

Now, on the “bright side,” that means more money for injured workers and more money for the attorneys of injured workers.

On the other hand, in the long run, when we reach the tipping point and start losing more jobs.  You see, dear readers, in the circle of economic life, applicants’ attorneys need injured employees.  But, of course, injured employees (and non-injured employees) need employers.  It goes without saying that insurance companies and defense attorneys are in the same cycle of economic life.

With all due respect to assemblywoman Gonzalez, I am hoping this idea has a bright and short life in the discussion pools, and then settles comfortably into a footnote status that some researcher will uncover in 50 years (Did you know that in 2015, some people wanted to exempt from apportionment certain conditions which are typically suffered by women?).

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Fraudster Nabbed Frolicking in the Garden

January 25th, 2013 No comments

When a worker claims to be injured and unable to work, what can we expect about his capabilities?  In theory, at least, when a worker is able to return to his usual and customary duties, he should not be entitled to temporary disability benefits.  What’s more, his permanent disability should be relatively low, and my beloved readers have even seen Almaraz-Guzman applied to lower the permanent disability indemnity in cases where an applicant could fulfill all her job duties.

And then there’s the following story.  Jose Cortez of San Bernardino County sustained an injury while working as a gardener after a branch fell and landed on him.

While Mr. Cortez was collecting disability payments, private insurance investigators observed him on six occasions performing his usually gardening duties, and referred the case to the District Attorney’s office, who then took the case the rest of the way and filed criminal charges.  (Although the D.A.’s office deserves credit for its investigation and impending prosecution in this case, the insurer’s investigators are to be commended for providing the Department of Insurance with a packaged case ready for the slam-dunking.)

Your humble blogger has been known to rant and rave about what such fraud does to California, which can be boiled down to criminal waste – someone is getting free money without providing society with any sort of labor or product in return.  Law enforcement dollars are wasted on investigation and prosecution, and private companies waste dollars on investigators while their policy holders must chip in extra to root such frauds out.

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Touchdown For Employers on CA Jurisdiction Issue

November 12th, 2012 No comments

Some of your humble blogger’s readers really like football.  And some are interested in workers’ compensation.  For that narrow sliver of overlap, I offer the following post, which relates the story of the recent writ denied case of Michael Barrow v. Dallas Cowboys Football Club.  The issue raised in that case was whether California had jurisdiction of Mr. Barrow’s claim of cumulative trauma while playing for various football teams, allegedly sustained from 1993 to 2006.  Interestingly, Mr. Barrow had never played a single game in California, and so could not claim jurisdiction on those grounds.

So, what was Mr. Barrow’s theory?  How was he hoping to “score a touchdown” against his employers?  (Get it?  Because it’s a story about football?)  California sets its jurisdiction for out-of-state injuries based on where the contract of hire was completed.  (See Labor Code sections 3600.5(a) and 5305).  Therefore, an employee who signs his employment contract in California, or orally accepts the terms of employment over the phone while physically in California, can later invoke California jurisdiction.

But Mr. Barrow didn’t live in California, nor was he in California when he signed any of his contracts.  His theory relied on his attorney and agent, who had an office in Los Angeles.  This attorney negotiated all of Mr. Barrow’s contracts and communicated their terms to him by phone.  When Mr. Barrow became inclined to accept, he would tell his attorney, who would then call the team office and let them know.  Mr. Barrow was then flown out to that office and signed the contract in person.

Isn’t that enough?  After all, the lawyer was in California and there were phone calls made and shouldn’t California be able to give a proverbial arm and an equally proverbial leg from the football teams to Mr. Barrow?  After all, he’s suffered so much, just look at this video of him suffering as he takes what meager employment he can due to his severe injuries…

Well, the workers’ compensation Judge agreed.  The WCJ found that, in communicating his intent to accept to his lawyer, who was in California, and then having his lawyer communicate this intent to the team with which Mr. Barrow was signing on, California jurisdiction was activated.

The Workers’ Compensation Appeals Board, however, was not persuaded.  Although the WCAB recognized that California has jurisdiction over injuries sustained out of an employment contract accepted within the state, this requires the presentation of “sufficient evidence to show that the contract was actually accepted, and thus became binding, within California’s borders.”

The fact that, after all was said and done, applicant still had to fly out to and sign a contract, proves fatal to any argument in support of California’s jurisdiction.  The employment contract became binding somewhere other than California.

So, what lesson can employers take away from this case?  It doesn’t matter if you’re a professional sports team or a hospital or a widget factory – if you’re interested in hiring someone who resides in California for work outside of California, make sure they have to travel to the nearest town in Nevada, Arizona, or Oregon to sign their contract of employment.  It might sound silly to waste a plane ticket in our modern world of scanners, e-mail, and genetically engineered (and delicious) carrier pigeons – but it’s worth it.

California is one of the most expensive states when it comes to workers’ compensation, and the cost of litigation alone (not to mention medicals and permanent disability indemnity) will quickly outpace this simple precaution.

 

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Facebook Used to Catch Workers’ Compensation Fraudster

May 10th, 2012 No comments

Facebook.  In days like these, we cannot afford to brush it off as just a venue for attention-seekers to document every meaningless aspect of their lives for the world to see.  It is also a great resource for catching fraudsters and plugging workers’ compensation leaks.

There are sophisticated methods of using Facebook to catch injured workers exceeding their “physical limitations.”  For example, you might catch a TTD applicant posting pictures of himself playing basketball, or that spinal injury case might be uploading video of herself doing tricks on a jet-ski.  But sometimes the lies are even more glaring.

Kristi Denise Motty was convicted for workers’ compensation fraud following a two-day trial.  For this case, the deputy district attorney stepped back from the trees and showed the jury the forest – it didn’t matter what Ms. Motty was posting on Facebook; she didn’t need to discuss mountain climbing or bear-wrestling.

While Motty was off work, she entered nearly 200 updates on her Facebook account, even though “it was impossible to write or type” and her pain from doing so was “excruciating.”  Motty worked as an office technician at Corcoran’s California Substance Abuse Treatment.

Motty was also photographed loading textbooks into her car, attending nursing school classes, taking out the trash, texting on her phone, and carrying heavy grocery bags.

WCDefenseCA sends its congratulations to the Tulare County District Attorney’s Office for a job well done!

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Stipulations: A Crutch You Can Lien On

Imagine this scenario: you enter into a stipulation to resolve a lien with a lien claimant’s hearing representative.  The stipulations are signed and approved by the workers’ compensation Judge.  When the lien claimant hears about the stipulation terms, it wants out of the agreement, claiming the hearing rep. exceeded the authority granted to settle.  Well, one WCJ issued an order rescinding the stipulation and releasing the lien claimant from its binding effect.

In the case of Ronald Houghton v. All Brands Sewing and Vacuum, defendant and lien claimant Express Case Management entered into a stipulation to settle the lien of $14,639 for $1,411.  The lien claimant then filed a petition for reconsideration arguing that “its hearing representative mistakenly took defendant’s offer, thinking it was appropriate.”  Even though the defendant was not served with the petition, the WCJ rescinded the earlier order, setting the lien claimant free.

The defense, upon receipt of the order (22 days after it was issued) filed a petition for reconsideration.  After addressing the issue of timeliness, and finding that defendant’s petition was timely, the Workers’ Compensation Appeals Board rescinded the WCJ’s order, reinstating the original stipulations.

A law professor once told me that the governing motivation for almost any judge or panel of judges is “judicial economy.”  The reasoning in this panel opinion shows that to be true.  The WCAB cited Robinson v. Workers’ Comp. Appeals Bd., in that the purpose of stipulations is to expedite trials and hearings, and that “if a party had the right to withdraw from a stipulation, ‘hearings would be subject to uncertainty and disruption in order for the parties to gather and present evidence on issues thought to have been laid to rest by the stipulation.”

In other words, if a hearing representative exceeds his authority, perhaps you should retain a different hearing representative.  It’s not the defendant’s problem, and it certainly isn’t the WCAB’s problem.

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Opt Out of Workers’ Comp? Not in California!

March 21st, 2012 No comments

Maybe this whole workers’ compensation thing isn’t worth it.  After all, the purpose of the workers’ compensation system was a trade-off: employers get caps on their liability, employees get quicker access to benefits, and the variable of fault is no longer part of the equation.  So, slip on a banana peel at the supermarket where you work, and you get benefits, unless you were shopping on your day off, then you’re just a klutz.

But what if you’re an employer and you’re fed up with this ridiculous system!  You’re tired of applicant’s attorneys demonizing you to your employees; you’re tired of paying insurance companies or defense lawyers or being audited again and again by the state just for self-insuring?  What if you could just opt out?

What if an employer could opt out of the workers’ compensation system?

That’s not the thinking in California, but it is in Oklahoma.  Having passed the House and the Senate of the state where hard work still conquers all, the law now awaits calibration between the two houses of the state Legislature before going to the Governor’s desk.  Texas already has an opt-out process for workers’ compensation, but in typical Texas fashion, was the only state to do so (until now).

One of the stated purposes of House Bill 2155 is to “[a]ssist the state in attracting and retaining business, thereby contributing to the overall economic development and well-being of its citizens.”

But where would Oklahoma, as a state, attract business from … except other states?  Perhaps other states like … California?

Sacramento – the rest of the Union is out to poach California businesses.  Please don’t make it easy for them to do so by driving every employer off.

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