Several attorneys from the Central Coast Chapter of the California Applicants’ Attorneys Association, whose members – myself included – represent Californians injured on the job, held a news conference outside Ventura County District Attorney Greg Totten’s office calling for criminal charges to be filed against a claims adjuster for Sedgwick Claims Services, and against Sedgwick itself, for their cruel indifference to, and reckless disregard for, the health and welfare of Charles Romano, a Ralph’s Grocery Co. worker.
Mr. Romano was only in his 40s when he was injured on the job. He had surgery to repair his injuries and afterwards contracted a highly resistant staph infection that attacked his lungs and kidneys and paralyzed him. Sedgwick claims adjustor Teresa McDivitt said the infection was unrelated to Mr. Romano’s work injury and refused to pay for necessary care. This lack of needed care led to a horrific downward spiral in his health and ultimately to his death.
Even after a judge determined Mr. Romano’s illness was a result of his work injury, the insurance carrier, Sedgwick, continued to refuse medical care.
Why is this not criminal?
The Workers’ Compensation Appeals Board (WCAB) found that Sedgwick Claims Management Service, a third-party claims administrator, defied a judge’s order to provide needed medical care. Sedgwick faces only a relatively small monetary penalty.
Again, I ask, why is this not criminal?
The WCAB wrote: “We have rarely encountered a case in which a defendant has exhibited such blithe disregard for its legal and ethical obligation to provide medical care to a critically injured worker,” the [Workers’ Compensation] Appeals Board said. “Sedgwick CMS, acting as claims administrator for the Kroger Co./ Ralph’s Grocery Co., demonstrated a callous indifference to the catastrophic consequences of its delays, inaction and outright neglect. …”
To read the Romano decision, visit this web address: https://www.workcompcentral.com/pdf/2013/misc/RomanovKroger.pdf .
The fact that Ms. McDivitt’s employer profited from Mr. Romano’s death makes criminal sanctions even more important. Instead of paying for court approved medical care, Ms. McDivitt’s employer is now free of any obligation, as Mr. Romano is dead.
Ms. McDivitt, who has more than 30 years’ experience in this field, knew that Mr. Romano’s injury included the lungs; that liability for medical care cannot be apportioned; that, even if a medical condition was not occupationally related, the employer must provide care if such care is necessary to cure or relieve the industrial injury; and that she, as a lay insurance claims examiner, could not refuse to authorize medical treatment under the Utilization Review statute on grounds that it was not necessary to cure or relieve Mr. Romano’s injury. Despite all that, Ms. McDivitt and Sedgwick unilaterally denied authorization for a BiPAP, even though she knew that without it, he could stop breathing and die.
Why is there no criminal sanction for defying a judge’s order that results in the death of a disabled patient known to be in extremis? When a drunk driver kills a pedestrian, it’s manslaughter. When a physician overprescribes painkillers and the patient dies, it’s criminal. Similarly, when a workers’ compensation insurance carrier acts the same way, it should be a criminal act.
Jill Singer is a Workers’ Compensation insurance attorney, and Central Coast CAAA Chapter President.
To read the entire letter to the District Attorney, or for more information, please visit: www.caaa.org