Fresno workers' compensation case highlights statewide problems

The activities of Sedgwick Claims continue to draw attention in California as the issue of inadequate delivery of medical care to injured workers becomes more acute. Workers' Compensation was intended as social remedial legislation providing benefits to injured workers in an efficient and effective manner. The system just isn't working any longer as the economics of reform emasculated the benefit program. Today's post was shared by Workers Comp Brief and comes from www.fresnobee.com

A workers' compensation company is being criticized for failing to provide medical care for a Fresno woman injured on the job more than 10 years ago.

The employee, Guadalupe Ortega, spoke out with her lawyer Tuesday morning during a press conference held by the California Applicants Attorneys Association across the street from her former employer, Lyons Magnus, a major food processor in Fresno.

Although doctors and Lyons Magnus confirmed her injuries are work related, the company's insurance carrier, Sedgwick Claims Management Services, only provided two years of temporary disability compensation — even though a qualified medical evaluator confirmed she is 70% disabled, Ortega said.

Ortega's plight highlights a larger problem for injured workers statewide who have run into more roadblocks over the past eight years to receive workers' compensation, said Ortega's lawyer, Brett Grove of Keeling Grove Law Offices in Fresno.

"Unfortunately, her experiences are not unique in the workers' compensation arena," Grove said.
Ortega's severe neck, shoulder and back injuries resulted in her losing her job, she said. Ortega became homeless, and her children were taken away from her.

"Sedgwick has turned my life into a living hell," Ortega said. "How can the state of California allow this insurance company to fail to pay legitimate claims?"

Sedgwick officials were unavailable for comment. The company is based in Memphis, Tenn., and calls itself the leading North American provider for...

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Criminal Charges Urged Against Sedgwick

Injured Workers’ Advocates Seek Criminal Penalties for Death After Insurer’s “Callous Indifference, Reckless Disregard of Care”

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

Several attorneys from the Central Coast Chapter of the California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, held a news conference today on the steps of the Ventura County District Attorney Gregg Totten’s (DA) office and called for the DA to file criminal charges against a claims adjuster for Sedgwick Claims Services, and against Sedgwick itself, for their callous  indifference to, and reckless disregard for, the health and welfare of Charles Romano, a Ralph’s Grocery Co. worker, which resulted in his death.

“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.”