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Criminal Prosecution for Zealous Adjusters?

July 15th, 2013

This past Saturday night, your humble blogger’s Facebook, text-messaging, and social media was focused on one topic: the verdict in a certain Florida trial.  Without stepping on that landmine of an issue, may I direct your still burning interest in criminal prosecution to a story of interest in the workers’ compensation community?

The California Applicants’ Attorneys Association has called for the criminal prosecution of a Sedgwick adjuster.  As far as your humble blogger can gather, the repeated denial of medical benefits, even in the face of several penalties and fines and Orders issued by a workers’ compensation Judge, led to a denial of care.  Ultimately, the applicant died as a result of an infection sustained during a surgery to treat the industrial injury.

If this should become a criminal case, we can expect a lot more facts and details to come out.  But the idea itself is a scary one – if the adjuster denies benefits of one sort or another, can he or she be criminally liable for the consequences?

What about the defense attorneys?   Perhaps the claims assistants can be charged with criminal conspiracy?

Your humble blogger held off on addressing this issue (note the article is from June) because a response from the Ventura district attorney’s office was a possibility.  As the DA has (very correctly) chosen to ignore this publicity stunt, it looks like we can all go about our daily affairs in safety… for now.

Bear in mind, dear readers, that CAAA, in making this display, had a single goal in mind – to try to scare the defense community.  There’s a monster under your bed, meanie adjusters, and he only comes out when you deny benefits!

The fact of the matter is that there are already penalties for unreasonable denial of benefits – the Audit unit can shut you down if you do too much wrong too often.  And, on top of that, there’s the monetary penalties ordered by the workers’ compensation Judges.

Note, dear readers, that there was no outrage on the part of CAAA for the physicians that exposed the applicant to an antibiotic-resistant staph infection during the shoulder surgery in the first place.  Nor is there any outrage on the part of CAAA when it came to national attention that California spinal surgery centers were maiming and crippling injured workers after sedating them with promises of quick recoveries.  (Recall, again, dear readers, it wasn’t the defense community leading the injured workers to the operating table).

The Romano case is tragic, it is heart-wrenching, and it is sad.  From a simple shoulder injury, an injured worker was paralyzed, mistreated, and ultimately died of an infection sustained while under the care of his surgeons.  Is it appropriate to compound the tragedy by seeking criminal charges against the adjuster?

Fortunately (and hopefully) the Ventura District Attorney’s Office has real criminals to focus its attention on.  Your humble blogger is equally hopeful that the same will be true of the other 57 California counties.

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