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Denial of Workers’ Comp Benefits Spurs Call for Criminal Investigation

By Renee Nordstrand on June 25, 2013

A workers’ compensation advocacy group is asking the Ventura County District Attorney’s Office to launch a criminal investigation into the death of a Camarillo Ralph’s employee who died from complications after being injured on the job.

There is no doubt that the grocery worker suffered neck and back injuries while on the job at Ralph’s. In fact, he was given worker’s compensation benefits to cover the cost of a surgery to repair the injury. However, the man developed a severe staph infection during the operation that required further care.

The advocacy group alleges that a third-party workers’ compensation insurance adjuster for Tennessee-based Sedgwick Claims Services refused to pay for the expensive follow-up medical care needed to deal with the infection and that the refusal of benefits lead to the worker’s death five years ago.

The group claims that Ralph’s, which is a part of the Krogers food chain, and Sedgwick denied the worker’s medical claims 11 times. Reportedly, a court order and a decision by the Worker’s Compensation Appeals Board that the companies needed to pay for the medical care allegedly was not enough incentive to spur the grocer and insurance company to do so.

The Appeals Board was blunt in its assessment of the insurance company, calling its actions a “blithe disregard for its legal and ethical obligation to provide medical care to a critically injured worker.” The board determined that Sedgwick had “unreasonably” delayed medical care. Allegedly, the insurer even delayed the final payment for hospitalization after the patient had died.

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