A new law that enables corporate directors and officers owning at least 10 percent of a business to opt out of workers’ compensation coverage goes into effect on July 1.

The law is intended to reduce the threshold of ownership, and is part of an effort to help eliminate workers’ comp fraud. Under the new law, directors and officers who want to opt out of worker’s comp must sign a waiver stating that they are covered by a health insurance plan.

Michael Williams, 34, of Daly City, Calif., has been arrested on 21 felony counts of insurance fraud and grand theft after allegedly working for multiple employers while collecting over $85,000 in workers’ compensation benefits from two different insurers.

In November 2014, Williams was reportedly working as an electrician when he sustained a work-related injury. He filed a workers’ comp claim with the State Compensation Insurance Fund and began collecting temporary workers’ comp benefits.

The number of California workers’ compensation inpatient hospital stays fell 31.2 percent between 2008 and 2016 compared with a 19.6 percent drop in hospital stays paid under private plans, a new California Workers’ Compensation Institute study shows.

The study also shows a 2.4 percent increase in Medicare inpatient stays, and a 19.6 percent increase in inpatient stays paid by Medi-Cal, which saw a huge jump in enrollment with the rollout of Affordable Care Act plans.

Efforts to curb the use of opioids in California’s workers’ compensation system appear to be paying off.

New research from the California Workers’ Compensation Institute on prescription drugs used to treat injured workers shows that opioids now account for less than a quarter of all workers’ comp prescriptions in the state, down from nearly a third a decade ago.

The number of qualified medical evaluators resolve disputes over California workers’ compensation claim issues fell 20 percent between January 2012 and September 2017, according to a new California Workers’ Compensation Institute study.

However, the CWCI study shows that the impact on QME accessibility was partially offset by an increase in the median number of office locations per QME, which doubled over the same period.

Injuries to workers can occur in many ways, but few employers expect such injuries to come out of an employee's nightmare. When that happens, is the injury covered by workers' compensation? According to the Court of Appeals of Arkansas, the answer is no. But why?

In November 2015, Shawn Hansen was employed by the City of Siloam Springs, Ark., as a firefighter and an EMT. Hansen worked 24-hour shifts. During his shifts, he was required to stay on premises unless he was performing a work-related errand or activity. Because of the 24-hour scheduling scheme, the city provided sleeping arrangements and encouraged the employees to sleep during nighttime hours.

"Everybody plays the fool, there's no exception to the rule." — The Main Ingredient (1973)

The great majority of workers’ compensation claims are valid.

You’ve probably heard that sitting is the new smoking. Actually, that’s a bit of a misnomer.

It’s not the sitting in and of itself that is the problem, it’s the sedentary lifestyle many people lead.

The California Division of Workers’ Compensation has suspended 21 more medical providers from participating in the state’s workers’ compensation system, bringing the total number of providers suspended this year to 115. The providers were suspended for fraud or other criminal actions.

The suspensions were made possible by the passage last year of Assembly Bill 1244, which requires the DWC administrative director to suspend any medical provider convicted of a crime involving fraud or abuse of the Medi-Cal or Medicare programs or the workers’ comp system, a patient, or related types of misconduct.

From Insurance Journal
November 20, 2017

Jaime Rosario Del Real, 61, and son Israel Del Real, 37, have both pleaded guilty to four felony counts for their role in a $400,000 insurance fraud scheme denying workers’ compensation insurance and medical care for injured workers.

The father and son were sentenced to 250 days in jail, 10 years of felony probation and ordered to pay $382,951 in restitution. This case was prosecuted by the Monterey County District Attorney’s Office.