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Thursday, August 29, 2013

Claims Adjuster, TPA Could Face Criminal Charges for Worker Fatality

Today's post was shared by WCBlog and comes from

The egregious ­mismanagement
of a California workers’ compensation
claim is being blamed for an
injured worker’s severe infection
and resultant death.

The ongoing case is drawing ire from various associations, including the California Applicants’ Attorneys Association (CAAA), which is lobbying that criminal charges be filed against Sedgwick Claims Management Services, the third-party administrator involved in the claim, as well as one of its adjusters.

The initial workers’ compensation claim originated when Charles Romano injured his shoulder and cervical spine on Dec. 20, 2003 while stocking shelves at a Ralph’s grocery store (part of The Kroger Co.) in Camarillo, Calif. After undergoing surgery for the resultant injuries on August 29, 2005, Romano contracted methicillin-resistant straphylococcus aureus (MRSA), which not only caused renal and pulmonary failure but also paralysis below the shoulders (from C8 down).

Romano later sought treatment for the serious infection at the Ventura County Medical Center, where he had no choice but to use Medi-Cal—the state’s version of Medicaid—because Sedgwick refused to authorize treatment. In fact, Medi-Cal paid for Romano’s medical bills dating from November 2005 through February 2007, ultimately picking up a tab for $300,000.

Fatal Consequences
On October 25, 2006, a workers’ compensation judge issued an amended findings and award,ruling that the MRSA infection was a...
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