Colorado Governor Proposes Privatization of State Workers’ Comp Carrier to Bolster Budget
In a strategic move to address Colorado’s budget shortfall, Governor Jared Polis has proposed privatizing Pinnacol Assurance, the state’s workers’ compensation carrier of last resort. By divesting the state’s interest in this quasi-governmental entity, Polis aims to generate additional revenue and ease fiscal pressure on Colorado’s general fund. Colorado Governor Privatization as a Financial Strategy Governor Polis’s proposal comes as Colorado faces significant budget challenges. According to a report by Colorado Politics, the plan could reduce the state’s general fund by approximately $630 million. This reduction is critical as Colorado confronts a projected budget gap of $672 million. If lawmakers allocate the mandated $350 million to a new law enforcement fund, the gap could exceed $1 billion. Privatizing Pinnacol Assurance could help the state bridge this gap. Polis believes the move will reclaim the state’s investment and redirect funds to cover pressing financial needs, as reported by the Denver Post. Historical Context and Legislative Considerations Privatizing Pinnacol Assurance is not a new idea. Over the past decade, similar proposals have surfaced, but lawmakers have not reached consensus. Current discussions indicate that legislators may require more detailed information to assess the plan’s feasibility and benefits. Pinnacol Assurance, established in 1915, provides workers’ compensation coverage to over 50,000 businesses in Colorado. However, its structure limits the company to selling policies only within the state and solely for workers’ compensation. This restriction has hindered Pinnacol’s growth and competitiveness, as noted by Colorado’s Sum & Substance publication. Future-Proofing Pinnacol Assurance Governor Polis believes that privatizing Pinnacol could allow the company to expand beyond state lines and diversify its services. This strategy could enhance Pinnacol’s financial stability and adaptability in a changing business environment. The governor’s plan includes drawing $100 million annually from Pinnacol for five years to support the transition and reform efforts. Polis emphasizes the importance of modernizing Pinnacol to better serve Colorado’s employers and employees. For more insights into Colorado’s policy changes and economic strategies, visit JacobiJournal.com. Additional details about Governor Polis’s proposal and its implications can be found in the original reporting by Colorado Politics.
Sanford Health to Settle Allegations of Violating Pregnancy Leave Laws with $220K Payment
Violating Pregnancy Leave Laws: Sanford Health, a leading medical clinic network, will pay $220,000 in back wages and damages after the Minnesota Department of Labor and Industry (DLI) found the company violated state laws related to pregnancy accommodations and parental leave. This settlement follows an investigation into Sanford’s practices during the 2023-2024 period. Sanford’s Violations and the Settlement Agreement On November 18, 2024, Sanford Health signed a consent order with DLI. The order requires Sanford to follow Minnesota’s Women’s Economic Security Act (WESA) at all its facilities. The investigation revealed that Sanford reduced a pregnant employee’s weekly hours from 40 to 32 after she requested a reasonable accommodation. Additionally, Sanford terminated the employee after she requested her right to take 12 weeks of parental leave. As part of the agreement, Sanford will pay back wages, compensatory damages, and liquidated damages to the employee. Furthermore, the company faces a $40,000 civil penalty for willfully violating the law. An additional $160,000 in penalties will remain suspended as long as Sanford complies fully with the consent order. Violating Pregnancy Leave Laws Commitment to Compliance and Future Action This agreement underscores Sanford Health’s responsibility to comply with state laws on pregnancy accommodations and parental leave. DLI’s findings highlight the need to protect workers’ rights and ensure fair treatment. Sanford Health now has a set period to make necessary changes and prevent future violations. For more details on the consent order, visit the official Minnesota Department of Labor and Industry. Stay updated on healthcare and labor law stories by visiting JacobiJournal.com.
Former Sewerage & Water Board Employee Arrested for Workers’ Compensation Fraud
The Louisiana Bureau of Investigation (LBI), under Attorney General Liz Murrill, has arrested Ederik Trask, a former employee of the Sewerage & Water Board of New Orleans. Trask, who resides in Metairie, is accused of workers’ compensation fraud. Specifically, he allegedly misrepresented his employment status while receiving benefits. Complaint and Investigation On August 27, 2024, the Sewerage & Water Board formally complained to the LBI, alleging fraudulent activity by Trask. Investigators soon discovered that Trask had been working for a rideshare company while collecting workers’ compensation benefits. This dual employment, however, violates Louisiana law, which mandates truthful reporting for benefit claims. Sewerage & Water Board Employee Legal Action Taken by Sewerage & Water Board After gathering sufficient evidence, LBI Special Agents quickly obtained an arrest warrant for Trask. He is now charged under Louisiana Revised Statute 23:1208 C.1, which forbids false statements about claims exceeding $10,000. Subsequently, on December 20, 2024, Trask surrendered at the Orleans Parish Jail. There, authorities arrested and booked him without any issues. Ongoing Investigation The investigation is ongoing, as authorities continue to examine the details surrounding the alleged fraud. Meanwhile, the Louisiana Attorney General’s Office emphasizes its commitment to holding individuals accountable for abusing public resources. Consequently, they are determined to maintain the integrity of the workers’ compensation system. For updates and in-depth reporting on similar cases, visit Jacobi Journal.
BTW Solutions Faces Accountability in Federal Workers’ Compensation Billing Case
BTW Solutions, a Benton, Arkansas-based drug wholesaler and billing service, recently agreed to pay $1.5 million to settle a federal lawsuit. The lawsuit alleged fraudulent practices within the federal workers’ compensation program. Federal prosecutors accused BTW of selling drugs to physicians at cost while billing the Office of Workers’ Compensation Programs (OWCP) at inflated rates—sometimes up to 12 times the original cost. According to court documents, the company shared these inflated profits with participating doctors. BTW Solutions: How the Scheme Operated BTW Solutions marketed its services as a way for physicians to increase revenue by prescribing certain pain creams and durable medical equipment. The company’s promotional materials suggested that doctors could earn more than $100,000 annually by prescribing to just five patients per week. Although BTW claimed it did not bill Medicare or Medicaid, it incorrectly asserted that federal anti-kickback statutes (AKS) did not apply to its operations. However, prosecutors clarified that these laws cover all federal healthcare programs, including the OWCP. The Whistleblower’s Role The scheme was exposed through a whistleblower lawsuit filed by Elizabeth Young, a former sales agent for BTW. Young, now residing in Florida, filed the qui tam lawsuit in 2017 after leaving the company. With over 25 years of experience in medical product sales, she alleged that BTW, along with a compounding company and 10 physicians, engaged in illegal activities. These practices allegedly violated both the AKS and the federal False Claims Act. In 2023, the U.S. government intervened, significantly increasing the case’s importance. Legal and Financial Implications Faced with a lengthy legal battle, BTW chose to settle without admitting guilt. OWCP Director Christopher Godfrey highlighted that the settlement helps recover funds and reinforces the integrity of the Employees’ Compensation Fund. Peter Leary, the U.S. Attorney for the Middle District of Georgia, emphasized that the resolution demonstrates the Anti-Kickback Statute’s vital role in protecting medical decisions from improper financial incentives. Unanswered Questions The settlement raises questions about the fate of the accused physicians and the compounding company involved. Additionally, the portion of the settlement awarded to Young, under the qui tam provisions, has not been disclosed. Typically, whistleblowers receive between 15% and 25% of the recovered funds. Looking Ahead This case serves as a stark reminder of the legal and ethical standards governing federal healthcare programs. For more investigative pieces and updates on cases like this, visit Jacobi Journal. For the original source of this report, click here.
Lifetime-Banned Fraudster Faces New Charges in $100M Workers’ Compensation Scheme
Lifetime-Banned Fraudster: In a stunning development, a man previously banned from California’s workers’ compensation system for life has been charged with orchestrating a fraud scheme that racked up nearly $100 million in fraudulent claims. David Fish, alongside a San Diego-based neurosurgeon and two other alleged co-conspirators, faces 13 felony counts, including insurance fraud and conspiracy. The Alleged Scheme Lifetime-Banned Fraudster: David Fish, 55, of Laguna Niguel, collaborated with Martin Brill, 78, Robert Lee, 61, and Dr. Vrijesh Tantuwaya to form Southern California Injured Workers (SCIW), a management company providing medical services. They also created a medical group, Injured Workers Medical Group, where Dr. Tantuwaya acted as CEO. Through this network, SCIW reportedly steered patient referrals to a limited group of providers who agreed to pay illegal referral fees. These services ranged from diagnostic testing to prescriptions from compound pharmacies. Between 2020 and 2023, the defendants allegedly billed workers’ compensation insurers close to $100 million, funneling profits from unlawful referrals back into the network. Charges and Potential Penalties The Orange County District Attorney’s Office charged the group following a three-year investigation. The 13 felony counts include violations of labor laws, conspiracy statutes, and insurance fraud regulations. If convicted: Deputy District Attorney Kelly Albright of the Insurance Fraud Unit is leading the prosecution. Ongoing Issues in Workers’ Compensation This case highlights the challenges California’s workers’ compensation system faces in combating fraud. Illegal schemes not only drain resources but also harm injured workers who depend on the system for proper medical care and fair compensation. For more insights into legal developments and their implications, visit JacobiJournal.com. Source: Orange County District Attorney’s Office Read more from the official source here.
Intoxicated Worker’s Injury Claim Approved Despite Employer Objections
Intoxicated Worker’s Injury: In a significant ruling, a New York appellate court upheld a Workers’ Compensation Board decision granting benefits to an injured employee who was intoxicated at the time of his workplace accident. The court found that while intoxication contributed to the fall, it was not the sole cause, affirming the employee’s right to compensation under state law. Intoxicated Worker’s Injury: Background of the Case The worker, employed by an electrical contracting company, sustained serious injuries when he fell approximately eight feet from a ladder while retrieving items from an elevated shelf. A toxicology report revealed that the employee was severely intoxicated at the time of the accident. Despite this, the court determined other factors contributed to the fall, making the claim compensable. Legal Framework and Presumption of Compensability New York’s Workers’ Compensation Law presumes that injuries occurring during employment are compensable, except when intoxication is the sole cause of the accident. The burden of proof falls heavily on the employer and insurance carrier to demonstrate that intoxication alone caused the injury. In this case, the employer and their insurer denied the claim, arguing that the worker’s intoxication was the sole cause of the accident. However, the Workers’ Compensation Board disagreed, ruling in favor of the employee. Evidence Presented The employee testified that on the day of the incident, he was working alone due to a busy schedule, a deviation from the standard practice of having one worker hold the ladder while another climbed. He explained that as he descended the ladder carrying a heavy object, the ladder shifted and collapsed, causing him to fall. The employer’s general manager, relying on secondhand information, claimed the fall was due to the worker misplacing his foot. A medical toxicology expert confirmed that severe intoxication impairs balance and judgment, but acknowledged that factors such as a wobbly ladder, carrying heavy items, or working without assistance could independently increase the risk of falling. Court’s Findings The appellate court concluded that substantial evidence supported the Workers’ Compensation Board’s decision. It noted that several factors—including the absence of a colleague to steady the ladder, the inherent risks of working at height, and the lack of safety features—could have contributed to the accident. While intoxication played a role, the court ruled that it was not the sole cause. Consequently, the presumption of compensability remained intact, and the carrier’s appeal was denied. Implications for Employers and Workers This decision reinforces the high burden employers face when denying workers’ compensation claims on the grounds of intoxication. It also highlights the importance of maintaining workplace safety protocols, including proper supervision and equipment use. For more in-depth coverage of legal and workplace issues, visit JacobiJournal.com. Source: Supreme Court, Appellate Division (Third Judicial Department) Read the original decision here.
Virginia Employee Denied Workers’ Compensation for Elevator Incident
Virginia Employee Denied: A health insurance company employee’s claim for workers’ compensation benefits for psychological injuries has been denied. The Virginia Workers’ Compensation Commission (VWCC) recently upheld a deputy commissioner’s decision. They ruled that the employee’s experience did not qualify as a compensable workplace injury under state law. Incident and Psychological Impact The claimant testified that on September 5, 2023, she became trapped in an elevator after it malfunctioned. She reported that the elevator’s panic button and emergency phone did not work, and her initial attempts to contact her supervisor and 911 also failed. After 30 minutes, emergency responders helped her exit the elevator. Although she sustained no physical injuries, the employee later reported psychological symptoms. These included insomnia, headaches, and feelings of entrapment. She sought medical treatment and began counseling sessions with a licensed clinical social worker. Legal Standards and Denial of Benefits Under Virginia law, psychological injuries are compensable only if they result from a physical injury or a sudden, shocking event at work. Examples include post-traumatic stress disorder caused by a traumatic incident. In this case, the deputy commissioner ruled that the employee’s experience did not meet these criteria. The evidence did not link her psychological symptoms to a compensable “sudden shock or fright,” nor did she suffer a related physical injury. The commission noted that her medical records and the social worker’s report did not specifically reference the elevator incident as the cause of her symptoms. “The evidence does not constitute a sudden shock or fright as contemplated by Virginia law,” the deputy commissioner wrote. He concluded that her psychological injuries stemmed from the inconvenience and stress of being trapped, which does not qualify as compensable under state standards. Virginia Employee Denied: Appeal Rejected The employee appealed the decision, attempting to introduce new evidence. However, the full VWCC upheld the deputy’s ruling. They stated that the claimant had failed to identify any errors in the findings or conclusions of law. The commission also determined that the additional evidence could have been submitted during the original hearing. Conclusion This case highlights the stringent requirements for compensable psychological injuries under Virginia workers’ compensation law. For more workplace and legal insights, visit JacobiJournal.com. Source: Virginia Workers’ Compensation Commission Read the official documentation here.
Oregon Contractor Faces $135K Fine for Persistent Safety Violations
Oregon’s Occupational Safety and Health Division (OSHA) has imposed a $135,407 fine on Newberg-based contractor View Top Construction LLC for repeatedly neglecting to protect employees from dangerous fall hazards. This significant penalty reflects Oregon OSHA’s strict enforcement of workplace safety standards and its zero-tolerance policy for recurring violations. Details of the Violations of Oregon Contractor The penalty followed an inspection at a Hillsboro job site where View Top Construction was working on the roof of a residential property. As part of Oregon OSHA’s prevention-focused emphasis program targeting fall hazards across all industries, inspectors observed an employee installing roofing materials without properly using the provided fall protection system. Although the employee wore a fall protection harness, it was not connected to a fall protection anchor, exposing the worker to a potential 17-foot fall. Oregon OSHA cited the company for three distinct violations under the Oregon Safe Employment Act: Increased Penalties for Repeat Violations of Oregon Contractor Under Oregon OSHA’s penalty structure, fines escalate significantly for repeated noncompliance. Despite earlier citations, View Top Construction continued to expose employees to preventable risks, prompting this substantial financial penalty. Workplace Safety Emphasis This case underscores the importance of adhering to workplace safety regulations. Preventable incidents not only jeopardize employees’ well-being but also lead to costly consequences for employers. For more updates on workplace safety and regulatory compliance, visit JacobiJournal.com. Source: Oregon OSHA Read the official release here.
West Haven Recovers $1 Million in Stolen COVID Relief Funds
Stolen COVID Relief Funds: The city of West Haven, Connecticut, has secured more than $1 million in reimbursement from its insurance provider after two city employees embezzled federal pandemic relief funds three years ago. Swift Action Leads to Recovery of the Stolen COVID Relief Funds Former state Rep. Michael DiMassa and John Bernardo orchestrated a scheme that defrauded West Haven taxpayers of $1.2 million. In response, Mayor Dorinda Borer acted swiftly to recover the stolen COVID-19 funds, which resulted in a $1.2 million settlement with The Hartford Financial Services Group. According to The Hartford’s fidelity crime claims division, after subtracting the $79,177.98 received in court-ordered restitution and a $100,000 deductible, the insurance will cover a net loss of $1,037,363.82. “This is a huge victory for our taxpayers,” Mayor Borer stated. Details of the Fraud Authorities arrested DiMassa, 32, on October 20, 2021, and he pleaded guilty on November 1, 2022, to three counts of conspiracy to commit wire fraud. In May 2023, a court sentenced him to 27 months in prison, followed by five years of supervised release. Additionally, he must perform 100 hours of community service and pay $856,844.45 in restitution. Similarly, Bernardo pleaded guilty on June 14, 2022, to one count of conspiracy to commit wire fraud. By March 2023, he received a 13-month prison sentence and was ordered to pay $58,927.25 in restitution. How the Schemes Unfolded DiMassa, serving as an administrative assistant to the West Haven City Council, had the authority to approve COVID-19 relief funds for reimbursement. Between July 2020 and September 2021, West Haven received $1,150,257 in CARES Act funds. Exploiting this role, DiMassa submitted fraudulent invoices for services and goods that were never provided. One scheme involved Compass Investment Group, LLC, a company DiMassa formed with Bernardo. They fraudulently billed the city $636,783.70 for consulting services that were never performed. Court documents revealed that DiMassa withdrew large sums of cash from the Compass account, which he used for gambling at Mohegan Sun Casino. Moreover, DiMassa conspired with his wife, Lauren DiMassa, to submit fake invoices for a youth violence prevention program. Lauren collected $147,776.10 for services she never delivered. She pleaded guilty on July 14, 2022, and received a six-month prison sentence along with a restitution order for the full amount. In another scheme, DiMassa partnered with John Trasacco, using fraudulent invoices from two companies, L&H Company and JIL Sanitation Services. They received $431,982 for bogus services, including work on a vacant school building. A jury found Trasacco guilty in December 2022, and he was sentenced to 96 months in prison with a restitution order of $143,994. Investigation and Legal Outcomes The Federal Bureau of Investigation and the U.S. Department of Housing and Urban Development led the investigation. Attorneys from the office of Vanessa Roberts Avery, U.S. Attorney for the District of Connecticut, prosecuted the case. For more news on legal and government accountability, visit JacobiJournal.com. Source: U.S. Department of Justice Read the official release here.
Cal/OSHA Fines Animal Shelter $563K Over Employee Safety Failures
Worker Injury Spurs Significant Penalties Employee Safety Failures: A San Pedro animal services center faces $563,250 in fines after a serious workplace injury exposed critical safety violations. The California Division of Occupational Safety and Health (Cal/OSHA) penalized Harbor Animal Services Center following an incident where an employee’s leg was mauled by a dog on May 31, 2024. The injury, which required hospitalization, highlighted longstanding safety lapses at the facility. Overcrowding and Training Failures Identified Cal/OSHA’s investigation revealed multiple failures by Harbor Animal Services Center to protect its workers. These findings include: These violations directly contributed to the serious injury sustained by the employee, according to Cal/OSHA. Nature of the Citations Harbor Animal Services Center, operated by Los Angeles City Animal Services, received citations for six violations. These include one general violation, two willful serious violations, and three willful serious accident-related violations. The willful nature of these offenses underscores the employer’s disregard for worker safety. Employer Accountability “Employers have a legal obligation to maintain a safe workplace,” stated a Cal/OSHA representative. The penalties issued to Harbor Animal Services Center reflect the seriousness of their safety failures and the impact on employee well-being. Learn More About Workplace Safety Stay informed about workplace safety regulations and enforcement by visiting Jacobijournal.com, your trusted source for legal and safety news. For additional details, read the full report on the Cal/OSHA website here.