Workers' Compensation: Criminal Charges Urged Against Sedgwick

"Why is it not criminal when workers? compensation insurance companies kill patients through delaying and denying medical care?"

?Even after a judge determined Charles? illness was a result of his work injury, the insurance carrier continued to refuse medical care. Charles soon died,? said Jill Singer, a Ventura workers? compensation insurance attorney, and Central Coast CAAA Chapter President. ?Why is it not criminal when workers? compensation insurance companies kill patients through delaying and denying medical care??

Sid Freeman was Charles Romano?s friend, and helped care for him during the final months of his life. ?Charles and I were friends for over 27 years.? He was like a brother to me. Charles was only in his 40?s 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, kidneys and paralyzed him,? said Freeman. ?Sedgwick, the insurer, refused to pay for the necessary care for the infection. Ms. McDivitt, the claims adjustor, said the infection was unrelated to Charles? work injury. This lack of needed care led to a horrific downward spiral in Charles? health. Sedgwick drove Charles to want to die. He said, ?I?m tired of having to fight for everything.? Two weeks later, he died.?

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 a relatively small monetary penalty, which means little to a huge corporation.

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. ?? (emphasis added) To read the Romano decision, click here: http://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. Mr. Romano?s care was costing $24,000 per day. Instead of paying those medical care costs, Ms. McDivitt?s employer is now free of any payment, as Mr. Romano is dead,? Singer said.

Ms. McDivitt, who had 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, Charles could stop breathing and die.

??Is there a 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,? said Singer.

Source: http://workers-compensation.blogspot.com/2013/06/criminal-charges-urged-against-sedgwick.html

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