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Injured Workers’ Advocates Call for Penalties, Investigation: Lyons Magnus Insurer Failed for Ten Years to Provide Medical Care, Disability Compensation Drove Fresno Woman into Homelessness, Lost Custody of Children Insurer Also Contributed to Death of Ventura Co. Man
Protest lack of effective penalties when workers’ compensation insurance companies harm patients through delaying and denying medical care



FOR IMMEDIATE RELEASE: Tuesday, August 6, 2013 Contact: Steve Hopcraft 916/457-5546,; Twitter: @shopcraft



FRESNO, CA – An injured Fresno food processing worker today protested outside Lyons Magnus headquarters and called for sanctions against, and an investigation into, serious and willful misconduct by the company’s workers’ compensation insurer. Guadalupe Ortega fell at work in 2002, and injured her back, neck and shoulder. Lyons Magnus never disputed that her injury was work-related, and the doctor the company agreed to found Ms. Ortega to be 70% disabled. But Lyons Magnus’ insurance carrier, Sedgwick Claims Services, has refused to pay for medical care or disability compensation for more than a decade, driving Ortega into homelessness and a resulting loss of custody of her two children. Sedgwick was recently found to have shown callous indifference to, and reckless disregard for, the health and welfare of Charles Romano, a Camarillo Ralph’s Grocery Co. worker, which resulted in his death.
“Even after a doctor agreed to by the company and their insurer determined Guadalupe’s injury was a result of her work accidents, the insurance carrier continued to refuse medical care and disability compensation,” said Bret Grove, Ms. Ortega’s attorney. “The insurance company drove Guadalupe into homelessness and despair. She lost her job, her health and custody of her children. Why does the State of California allow workers’ compensation insurance companies to damage patients through delaying and denying medical care and disability compensation?”
“I sorted strawberries, made boxes and inspected fruit juice bottles for Lyons Magnus. I slipped on a wet floor at work and fell on my back. I injured my neck, right shoulder and back,” Guadalupe Ortega told a news conference. “The company’s doctor gave me a sling, and a neck brace and said I could return to work doing light duty. I was in pain and my legs were weak, but I continued to work in order to keep my job. The following week, I fell down the stairs at work. Again, falling on my back, worsening the injury. I then saw Dr. Paul Schroeder, who said he couldn’t understand how I was still walking, never mind working. A Qualified Medical Evaluator also determined that I was 70% disabled.
“All I wanted was to get medical care to heal my injuries, be compensated for my permanent disabilities and return to work as best I could. But instead, Sedgwick has turned my life into a living hell,” said Ortega. “I have not been able to work since my injury. The insurance company has refused to cover my medical care, or compensate me for my permanent disabilities. They had me followed and sent me back to the same doctor over and over, only to have him confirm my injuries and disabilities. This has gone on for ten years, and as a result, I lost my home, my marriage and custody of my children. How can the State of California allow this insurance company to refuse to pay legitimate claims for over a decade?”
“Lyons Magnus and Sedgwick have mistreated, harassed and damaged the life of this worker. Their behavior is outrageous, inhumane, and should be illegal,” said Grove. “The State of California has allowed this insurer to engage in misconduct repeatedly and over a long period of time. Insurers who repeatedly fail to pay claims and benefits should lose their license to administer workers’ compensation claims in California.”
Ms. Ortega and Mr. Grove called upon Insurance Commissioner Dave Jones, the Division of Workers’ Compensation and Ortega’s Assembly representative, Henry Perea, to investigate Sedgwick Claims and hold them accountable for their refusal to pay for legitimate work injuries.
In the Camarillo man’s death, 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 ... demonstrated a callous indifference to the catastrophic consequences of its delays, inaction and outright neglect. ...” (emphasis added) To read the Romano decision, click here:
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