As the 2023 calendar year comes to an end, we hope that you reflect on the promise that 2023 has brought to each of us. Amidst the dynamic shifts within the legal landscape, we have collectively grown, adapted, and persevered.
With the holidays upon us and a new year approaching, our gratitude and hope for each of you remain the same. We wish you all a Happy Holiday and New Year!
TEMPORARY DISABLITY RATES WILL NOT CHANGE FOR 2024
On November 27, 2023, the Department of Industrial Relations (DIR) announced that the 2024 minimum and maximum temporary disability rates will not change. The minimum temporary disability rate is $242.86, and the maximum temporary disability rate is $1,619.15 per week.
Labor Code (LC) Section 4453(a)(10) requires that benefits be increased by an amount equal to the percentage increase in the State Average Weekly Wage (SAWW) in comparison to the prior year. As noted by the DIR, the SAWW is defined as “the average weekly wage paid to employees covered by unemployment insurance as reported by the U.S. Department of Labor for California in the 12 months ending March 31 in the year preceding the injury.” Notably, in the 12 months ending March 31, 2023, the SAWW experienced a decline from $1,651 to $1,642.
Pursuant to Labor Code Section 4659(c), workers who sustained an injury on or after January 1, 2003, and are currently receiving life pension or permanent total disability benefits are eligible for a periodic adjustment of their weekly life pension or permanent total disability rates based on the SAWW.
Given that there was no SAWW increase, there will be no life pension or permanent total disability rate increases for 2024.
BAY AREA PANEL QME AND APPLICANT TREATER CHARGED WITH FRAUD!
In a press release dated December 7, 2023, the Office of the District Attorney for the City and County of San Francisco (hereinafter, DA’s Office) announced that Dr. Gary Martinovsky, his office assistant and mother-in-law, Ms. Raisa Rikoshinsky, and a business he owns, Integrated Pain Care (IPC), have been criminally charged with 40 counts of insurance fraud under PC 550(a)(5), PC 550(a)(7), and PC 550(a)(8), for fraudulent billing, double billing, and billing for services not rendered.
District Attorney Brooke Jenkins said that “[m]edical provider fraud is a major cost driver for Workers Compensation insurance in our State … These scams serve to enrich unscrupulous providers while driving up costs for the rest of us. My office will not tolerate scams like this and will seek to hold those responsible accountable.”
According to the DA’s office, Dr. Marinovsky, IPC and Ms. Rikoshinsky filed liens with the Workers’ Compensation Appeals Board (WCAB), seeking payment of bills which had already been paid in full or in part. In support of their liens, “defendants submitted fraudulent documents and/or failed to disclose that they had already received payments for the billed services. In addition, Dr. Martinovsky and IPC billed three insurers for services not rendered, by claiming $625 numerous times for services not provided to injured workers.”
The DA’s office said that according to the DIR, Dr. Martinovsky had 3,005 liens claiming a total outstanding balance of $29,443,467 as of October 2023. In terms of the number of liens filed from 2022 to present, IPC was second only to the State of California Employment Development Department (EDD), which maintains records for more than 19 million workers.
Dr. Martinovsky and Ms. Rikoshinksy are scheduled to be arraigned on January 12, 2023, at 9:00 a.m. and face up to five years in State Prison if convicted of all charges.
The DA’s office said that although charges have been filed, the investigation remains active and that anyone with information should call the San Francisco District Attorney’s Investigation Tip Line at (628) 652-4362.
DWC ACCOUNCES MOVE OF STOCTON DISTRICT OFFICE
On November 6, 2023, the DWC announced that the Stockton district office of the WCAB will be moving to Lodi on December 12, 2023.
The DWC said that the Stockton district office will operate virtually from December 7, 2023, through December 11, 2023, to accommodate the move. All in-person trials and expedited hearings have been rescheduled. All conferences will proceed as scheduled via the judge’s teleconference lines.
The DWC is encouraging parties to file documents electronically or through the mail. If a party needs to file a document in person from December 7, 2023, through December 11, 2023, they can do so at the Sacramento district office.
The Lodi district office will be located at 3021 Reynolds Ranch Parkway, Suite 130 in Lodi, CA 95240.
ASSEMBLY BILL 1213 VETOED
In last months’ Bulletin, we discussed Assembly Bill (AB) 1213, which would have discounted time spent appealing Utilization Review (UR) decisions from the 104-week aggregate cap on temporary disability. After the Bulletin was published, we discovered that Governor Gavin Newsom vetoed the bill. Governor Newsom explained that although he understood the goals of the bill, there is a lack of data to support such a change. Governor Newsom explained further that under “the existing workers’ compensation system, employers are required to establish a UR process to evaluate the necessity and appropriateness of requested medical treatments. This process is in place to ensure that employees receive the appropriate evidence-based medical care.” Governor Newsom recognizes that realigning policy incentives are an important tool to return injured workers back to work. “Such realignment should be done cautiously to avoid further friction in the system that frustrates the objective of providing timely treatment, prompt payment of benefits and returning injured workers back to work[,]” he said. Given that AB 1213 was vetoed by the Governor, the law will not come into effect.
Bill Status – AB-1213 Workers’ compensation: aggregate disability payments. (ca.gov)
This Bulletin was written by Steve Rosendin, Associate Partner in our San Francisco office. A copy of this Bulletin and the most current twelve months are available on our website at www.mulfil.com/bulletins.
