A worker has been crushed to death by pallets of mushrooms at Monterey Mushrooms Inc. plant in Zellwood, Florida

Mushroom pallets crush worker to death at plant

Published June 08, 2016
Associated Press
 

ZELLWOOD, Fla. – A man has died after being crushed by pallets of mushrooms at a plant in central Florida.

The Orlando Sentinel reports Orange County sheriff's spokeswoman Rose Silva says 45-year-old Bruce Edward Stephenson Jr. of Tavares was moving the pallets Monday with a forklift at the Monterey Mushrooms Inc. plant in Zellwood when the pallets began swaying.

Silva says Stephenson jumped off the forklift, but the pallets fell on him before he could get away.

He was taken to a hospital, where he died.

Deputies and the Occupational Safety and Health Administration are investigating.

Monterey Mushrooms general manager Brian Hesse said he couldn't comment due to the ongoing investigation.

The company describes itself on its website as an "international, multi-facility company with 10 mushroom growing farms located throughout North America."

Successful subrogation in the context of a workers’ compensation case

Successfully Identifying Workers’ Comp Recovery Opportunities
Subrogation in the context of workers' comp comes in several distinct fact patterns.
By Christopher Capalbo

A day in the life of a workers’ compensation claims professional can be hectic to say the least. New losses that demand immediate attention come in continually. Each claim brings in calls and correspondences from applicant attorneys, doctors, employers, case managers, investigators, defense attorneys, lien claimants, and injured workers. With every request for treatment and report that comes in, there are rules and hidden deadlines around every corner. Supervisors require diary reviews, updates, and plans of action, and clients seek account audits. On top of all that, the claims professional also is responsible for identifying subrogation recovery potential for each claim.

The picture illustrated above is daunting, but subrogation does not have to be a thorn in the claims professional’s side. Familiarity with basic workers’ compensation subrogation fact patterns and the steps to take once they have been identified can ease this task. In general, subrogation in the context of a workers’ compensation case comes in several distinct fact patterns.

Motor Vehicle Accidents

The easiest of all fact patterns to identify with subrogation potential is a motor vehicle accident. When a report comes in that mentions an injury that was caused by a car accident, subrogation should be pursued to determine who was at fault for the accident. Securing a copy of the police report is key for this purpose.

Once the report is received, the responsible driver and owner should be put on notice of the carrier’s intent to pursue subrogation. A demand must be made for the insured to open a claim with his auto insurance carrier. A request should be made to the employer and employee for any photographs of the vehicles involved, documentation of any repairs made to the vehicles involved, and a statement made by anyone involved in the accident or who witnessed it.

Construction Site Accidents

Accidents on construction sites come in all shapes and sizes. Early identification of subrogation potential involving a construction site accident is paramount because the scene of the accident and instrumentation involved often can change quickly. Even a short delay of a week or so in getting a subrogation inquiry up and running can prejudice the chances of recovery. Thus, when an injury comes in and the employer identifies the accident locale as a construction site, an immediate subrogation review needs to be done.

Some of the more common fact patterns with subrogation potential include injuries involving heavy machinery, scaffolding, falls from heights, materials falling and striking workers, and failures to guard against dangerous conditions. Once subrogation potential is identified, requests should be made for witness statements, Occupational Safety and Health Administration (OSHA) reports, contractor reports, photographs of the scene, rental agreements, and job site contracts.

Premises Liability

Of all the subrogation fact patterns, these types of cases are the most often overlooked by claims professionals and insured employers alike. Subrogation potential in slip, trip, and fall scenarios often is discounted quickly on the assumption that it was nothing more than an accident caused by the injured worker not paying attention.

While contributory fault of the injured worker is a consideration in all premises liability cases, it does not mean that there is no subrogation potential. Any time an injury involves a slip, trip, fall, or some other accident caused by an encounter with a condition present on the property, the claims professional should take a moment to step back and consider whether a third party was involved in creating the condition that led to the injury. Once identified, photographs of the condition responsible for the injury immediately should be secured.

Products Liability

These cases have the most obvious fact patterns but can be the most expensive and problematic to pursue. When an injury occurs due to an encounter with a machine, tool, or piece of equipment, subrogation should be considered. Discussions with the employer and employee should focus on whether a defect or failure of the equipment contributed to the accident. Oftentimes these fact situations involve contributory fault of the injured worker and employer surrounding misuse of equipment or failure to train. Nonetheless, if the scope of the injury is large, at least a basic analysis of product design or manufacturer defects should be completed.

Securing a copy of the OSHA report often can assist in the fact gathering and analysis of the issues involved. In very serious cases, an expert can be consulted early on to inspect the product. Ultimately, these cases hinge on the testimony and opinion of an expert concerning the product.

Miscellaneous Patterns

Not all subrogation fact patterns fit neatly into a category. Any time an accident occurs and you find yourself asking, “How did that happen?” it’s probably a good indication that there may be subrogation potential. Follow that intuition by asking questions of the employer and employee to determine whether a third party potentially could be involved in the cause of the injury. If there is ever a doubt, it is better to be safe than sorry. Remember, help is always available from subrogation specialists, vendors, or attorneys who can assist with the questions to ask and evidence to preserve to make sure that subrogation opportunities are not missed. Sometimes a phone call is all it takes

3 New Defendants Plead Guilty in Scheme Involving Nearly $600 Million in Fraudulent Claims by SoCal Hospitals

By WorkersCompensation.com 06/07/2016 09:00:00
 

Santa Ana, CA (WorkersCompensation.com) - As two criminal cases became public this week, the Justice Department today announced three cases in which additional defendants have pleaded guilty to federal charges for participating in a long-running health care fraud scheme that illegally referred thousands of patients for spinal surgeries and generated nearly $600 million in fraudulent billings over an eight-year period.

The three new defendants join six others who were previously charged in relation to the government’s ongoing investigation into kickbacks for patient referrals and fraudulent bills for spinal surgeries performed at Pacific Hospital in Long Beach. The scheme involved tens of millions of dollars in illegal kickbacks to dozens of doctors, chiropractors and others. As a result of the illegal payments, thousands of patients were referred to Pacific Hospital, where they underwent spinal surgeries that led to more than $580 million in fraudulent bills being submitted during the last eight years of the scheme alone. Many of the fraudulent claims were paid by the California worker’s compensation system and the federal government through the Federal Workers’ Compensation System.

Two of the three new cases were recently ordered unsealed by United States District Judge Josephine L. Staton. The documents in the two unsealed cases became publicly available this week. In the now-unsealed cases and another case recently filed:


Michael R. Drobot, 44, of Newport Beach, the son of Pacific Hospital owner Michael D. Drobot (Drobot Senior), pleaded guilty on March 4 to conspiracy and illegal kickback charges. Drobot Junior is scheduled to be sentenced on November 18.


Chiropractor Michael E. Barri, 48, of San Clemente, who owned and operated the Santa Ana companies Tri-Star Medical Group and Jojaso Management Company, pleaded guilty on March 11 to a conspiracy count and admitted that he received illegal kickbacks for referrals to Pacific Hospital from 2009 through October 2013. During a nine-month period that ended in 2013, Barri admitted receiving $158,555 in illegal kickbacks after referring a dozen patients to Pacific Hospital, where they had back surgeries. As a result of his referrals, Pacific Hospital billed insurance carriers approximately $3.9 million for spinal surgeries. Barri is scheduled to be sentenced by Judge Staton on January 13, 2017.


Linda Martin, 66, of Clovis, California, who was a marketer for Pacific Hospital who recruited medical professionals and others to refer patients with promises of kickbacks, pleaded guilty to a conspiracy charge on May 27. She is scheduled to be sentenced on August 19.

These three defendants join six others – including Drobot Senior – who have also pleaded guilty. All nine defendants have agreed to cooperate with the government’s ongoing investigation – dubbed “Operation Spinal Cap” – into the kickback scheme, which involved dozens of surgeons, orthopedic specialists, chiropractors, marketers and other medical professionals.

“Federal law prohibits kickbacks to health care professionals because these payments impose additional costs on all patients and corrupt the relationship between the doctor and patient,” said United States Attorney Eileen M. Decker. “This scheme resulted in what can only be called a massive amount of fraudulent billing. The continuing investigation into the scheme demonstrates our commitment to protecting patients and prosecuting those in the health care industry who care more about money than those in their care.”

“The guilty pleas announced today are the latest step in holding accountable the individuals who co-opted doctors and other specialized healthcare workers to carry out multiple kickback conspiracies that abused the state and federal healthcare systems for more than a decade,” said Deirdre Fike, the Assistant Director in Charge of the FBI's Los Angeles Field Office. “The continuing results of Operation Spinal Cap are based on a tremendous effort by investigators and prosecutors handling this case, which is among the largest healthcare fraud schemes to be perpetrated in the state of California.”

As described in court documents, Drobot Senior – who was the owner and/or CEO of Pacific Hospital of Long Beach until late 2013 and who pleaded guilty in April 2014 – ran a 15-year-long scheme in which he and others submitted hundreds of millions of dollars in bills to workers’ compensation insurers and the U.S. Department of Labor for spinal surgeries and other procedures performed on patients who had been referred by dozens of doctors, chiropractors and others who were paid illegal kickbacks.

As part of the scheme, members of the conspiracy typically paid a kickback of $15,000 for each lumbar fusion surgery and $10,000 for each cervical fusion surgery. Some of the patients lived hundreds of miles away from Pacific Hospital, and closer to other qualified medical facilities. The patients were not informed that medical professionals had been offered kickbacks to induce them to refer the surgeries to Pacific Hospital. From 2005 through 2013 (which is only part of the overall scheme), Pacific Hospital billed insurers more than $580 million for spinal surgeries related to over 4,400 patients. Insurers paid the hospital more than $226 million for the surgeries performed as a result of illegal kickbacks.

Those involved in the scheme concealed the kickback payments by entering into bogus contracts to provide a “cover story” for the doctors, chiropractors and others who received illegal payments. For example, a number of doctors entered into agreements with a company owned by Drobot Senior, Pacific Specialty Physician Management (PSPM), under which the doctors received as much as $100,000 per month from PSPM in return for the right to purchase their medical practices – an option that was never exercised. In other cases, Pacific Hospital entered into contracts with doctors under which the doctors were to help the hospital collect on its surgery bills to insurance companies, but the hospital’s own collection staff, rather than the doctors, actually performed the collections work. Several doctors entered into lease agreements under which PSPM or Pacific Hospital paid rent for the use of office space, but rarely used the space. And other doctors had agreements to provide consulting services to Drobot’s companies, but did not actually provide the services. Still others, including marketers who introduced doctors to Pacific Hospital, had additional agreements with Drobot’s companies.

Two other Drobot companies – California Pharmacy Management (CPM) and its successor, Industrial Pharmacy Management (IPM) – were also important players in the scheme. Both companies set up and managed what were essentially mini-pharmacies within doctors’ offices. CPM and IPM bought and dispensed medication that the doctors prescribed to their patients, and these businesses received a portion of the money reimbursed by insurance companies for the medications. Drobot Senior, along with others at CPM and IPM, often agreed to increase the doctors’ shares of the insurance claims in return for those doctors’ referral of patients to Pacific Hospital. In many cases, for doctors who made such referrals, the conspirators “advanced” payments from CPM and IPM before the companies had collected any money for the medications or even prescribed them, and often simply wrote off these payments as losses when collections fell short. Drobot Junior was involved in these companies for over a decade, first as the manager of CPM, and then as co-owner and manager of IPM.

In his plea agreement, Drobot Junior admitted participating in the kickback scheme, primarily through his operation of CPM and IPM. As far back as 2005, Drobot Junior began personally soliciting doctors and chiropractors to enter into contracts with CPM and specifically discussed kickback arrangements, which were finalized by his father. Drobot Junior later acted a liaison when disputes arose concerning the payment of kickbacks to medical professionals or when those kickback recipients did not refer as many patients as expected.

Drobot Junior also admitted that he induced doctors who had contracted with CPM or IPM to also use products and services by companies he was affiliated with, including Medi-Lab Corporation. In return for referrals to Medi-Lab, Drobot Junior received monthly payments, some of which he used to make kickback payments to the doctors.

“These unscrupulous defendants thought they had figured out a clever scheme to line their pockets in their bilking of the insurance system. Federal and state worker’s compensation programs were not designed as a slush fund for the greedy,” stated IRS Criminal Investigation Acting Special Agent in Charge Anthony J. Orlando. “Law enforcement is serious about investigating these crimes and holding accountable those who defraud government health care programs and deprive patients of their right to honest services.”

“Kickback schemes such as these threaten the financial integrity of public healthcare programs,” said Special Agent in Charge Scott Pierce, USPS Office of Inspector General, Contract Fraud Investigations Division. “The workers’ compensation program benefits thousands of postal employees who have received legitimate on-the-job injuries. This case should send a clear message to all health care providers that workers’ compensation fraud is a federal crime that carries serious consequences and will not be tolerated.”

When he is sentenced, Drobot Junior will face a statutory maximum penalty of 10 years in federal prison.

Barri and Martin each face potential prison sentences of five years as a result of their guilty pleas.

Last year, the United States Attorney’s Office announced charges against five other defendants, including two doctors involved in the Pacific Hospital kickback scheme, and a similar scheme involving Tri-City Regional Medical Center in Hawaiian Gardens.

The ongoing investigation into abuses involving kickbacks paid for spinal surgery patients is being conducted by the Federal Bureau of Investigation; the United States Postal Service, Office of Inspector General; IRS Criminal Investigation; and the California Department of Insurance.

Guerra v. Jorge Garcia, Vivian Armas, et al.: Barratry Class Action Filed Against Texas Hail Attorneys, Roofing Contractor

Barratry Class Action Filed Against Texas Hail Attorneys, Roofing Contractor
May 17, 2016
 


Thousands of Texas homeowners victimized by severe weather may also be victims of a wide-ranging conspiracy involving door-to-door solicitors, public insurance adjusters and attorneys, according to a class-action lawsuit filed in Dallas.

The lawsuit claims that individuals, companies and law firms purportedly representing residents with property damage insurance claims are actually operating a pyramid scheme to collect unlawful and fraudulent fees that can make completing the repairs almost impossible.


According to court documents, the scheme typically begins when a door-to-door solicitor working on behalf of a roofing contractor claims that his company can get the homeowner’s insurance company to pay for property damage, such as a new roof. After the initial insurance payment arrives, the solicitor keeps the funds and brings in a so-called “public adjuster” to inspect the home and seek additional payment from the insurance company, charging a fee of 10 percent of the total claim plus other expenses.

The solicitor also tells the homeowner that a lawyer must be hired to get still more payments from the insurance company, adding a 25 percent to 40 percent fee for any recovery. Having never met or even spoken with the homeowner, the attorney then files a lawsuit against the insurer without the homeowner’s knowledge, agrees to a mediation, and settles the matter without the approval of or consultation with the homeowner. When a settlement check finally arrives, the payment often is not enough to pay for roof repairs because of deductions to cover the fees and expenses of the attorney, public adjuster and solicitor.

“This is a very real and deceitful scheme that is carried out in this state every day by those who are supposed to be helping homeowners, not ripping them off,” said attorney Mark Ticer, who represents Dallas resident Juan Guerra in the lawsuit.

Guerra was approached in 2014 by a representative of Arlington-based roofing contractor Lambcorp, who said the company could handle his insurance claim for a new roof. Guerra turned over the payment from his insurer to Lambcorp, which demanded that he hire Arlington-based National Claims Negotiators LLC, a public adjusting firm, and the San Antonio law firm of Speights & Worrich to obtain additional payments from his insurer insurer.

Guerra still has not received the new roof he was initially promised by the solicitor, nor have the insurance proceeds taken by Lambcorp been returned to him.

“This lawsuit is bringing to light an elaborate web of conspirators and con artists who are lining their pockets at the expense of innocent and unsuspecting homeowners, with a goal of bringing accountability, honesty and integrity back into the system,” said attorney Van Shaw of the Law Offices of Van Shaw in Dallas, co-counsel for Guerra and the proposed class.

Dallas attorney Steven Badger of Zelle LLP has been vocal on behalf of the insurance industry in responding to the dramatic increase in hail damage lawsuits. In addition to his work defending insurance companies, Badger represents a group of homeowners in a class action lawsuit against North Texas roofing contractor Lambcorp alleging the unauthorized practice of public adjusting and other improper conduct. The Guerra class action was filed as an intervention into Badger’s lawsuit, as it also named Lambcorp as a defendant.

Ticer and Shaw say the lawsuit also exposes a troubling increase in Texas of an illegal practice called barratry, which includes the improper solicitation of potential cases by individuals not associated with the lawyer handling the matter.

“Such conduct is unfortunately becoming increasingly common, but Texas law provides victims of barratry a private right of action against the violating lawyers,” said Ticer.

“The allegations of solicitation and barratry set forth in Guerra’s lawsuit are typical of what those of us involved in defending these lawsuits believe is going on all across Texas,” Badger said.

Badger expects to see additional barratry lawsuits filed in the months ahead. “Each and every week I am contacted with concerns about Texas attorneys and their door-to-door canvassers following the same model described in the Guerra lawsuit.”

Badger said he is encouraged to see well-known plaintiffs’ attorneys like Mark Ticer and Van Shaw taking steps to address apparent illegal conduct by other attorneys. “Mark and Van should be commended for their willingness to take on this important issue.”

The case is Guerra v. Jorge Garcia, Vivian Armas, et al., No. DC-15-03338, in the 134th District Court in Dallas.






Latest Comments


May 23, 2016 at 3:07 pm
Bob says:
I'm an adjuster and we see this ALL the time. It's truly amazing how people hate insurance companies but are so quick to either try to rip them off or blame them when things g... read more



May 23, 2016 at 1:25 am
Ty Smith says:
It's a shame how people get taken advantage of. Situations like this make roofing contractors, like myself, look untrustworthy. With so many homes affected by the recent storm... read more



May 18, 2016 at 12:40 am
Exadjuster says:
Crooked lawyers and Public Adjusters??? I find this hard to believe. lol

Lightering operations complete on motor vessel Roger Blough

Jun 7th, 2016


The U.S. Coast Guard continues to monitor the motor vessel Roger Blough June 7, 2016. Lightering operations transfered its cargo to the Philip R. Clarke and Arthur M. Anderson. (U.S. Coast Guard photo by Craig Groman)

SAULT STE MARIE, Mich. — The U.S. Coast Guard continues to monitor and respond to the motor vessel Roger Blough, Tuesday, after the vessel ran aground May 27 on Gros Cap Reef in Whitefish Bay in Lake Superior.

Lightering operations were completed around 10:30 a.m. Tuesday.

The cargo on board the Roger Blough was successfully offloaded onto two vessels, the Philip R. Clarke and Arthur M. Anderson. Each of the receiving vessels have departed the Waiska Bay anchorage to deliver the iron ore to its intended destination.

A detailed damage assessment of the Blough will be conducted once favorable weather conditions are met. Results from the assessment will determine the extent of repairs and mode of transit to its final destination.

The Waiska Bay anchorage area remains closed to all vessels not part of the operation.