ADJ13445593 · November 10, 2025

The judge found Defendant unreasonably rejected liability for the heart injury by denying the claim in writing during the ongoing PQME investigation and failing to timely authorize necessary diagnostic testing, violating Labor Code Section 5814.3.

From the decision · page 15"The judge is asked whether Defendant unreasonably rejected liability for the heart. The answer is yes. It was unreasonable for Defendant to not timely authorize the CT angiogram. It was unreasonable for Defendant to issue a written denial of the heart in the middle of the PQME 's investigation. It was also unreasonable for Defendant to perform an overall underwhelming investigation despite their duty to do so under the law.

Defendant denied the heart injury claim in writing on 9/26/22 during ongoing PQME investigation.

Favours Applicant prevailed

This denial was premature and unreasonable as the investigation was incomplete and diagnostic testing was not authorized timely, violating Labor Code Section 5814.3.

From the decision · page 10On 9/26/22 Defendant issued another partial denial. This document is noteworthy in that liability for the heart was specifically denied due to "no substantial factual legal or medical evidence to support your allegations of injury. " (Exhibit K)

Defendant failed to timely authorize cardiac CT angiogram requested by PQME Dr. Grodan, delaying the investigation and treatment.

Favours Applicant prevailed

Failure to authorize necessary diagnostic testing delayed the investigation and was a key factor in finding unreasonable rejection of liability.

From the decision · page 10Apparently, even after one more effort, Applicant attorney's attempts to elicit a response from Defendant were met with radio silence. The County of Los Angeles has never explained why no one responded to the doctor's request, attorney's letter and email, and why they did not simply arrange for the test once put on notice so many times. The judge could not ignore the fact that no witness on behalf of Sedgwick attempted to explain what happened.

Found industrial causation of gastrointestinal claim due to medication side effects for work-related injuries; recommended referral to cardiologist for further evaluation of hypertension claim.

From the decision · page 6PQME Rahban in gastroenterology examined the Applicant on 11/5/20. (Exhibit II) After noting that hypertension had been claimed on the injury, he reported in his impressions that Applicant should be "referred to cardiologist for further evaluation and diagnosis. "

Found industrial causation for cervical spine, lumbar spine, right shoulder, and both knees injuries.

From the decision · page 7The orthopedic PQME would be Dr. Darakjian and he signed his first report on 7/19/21 after an exam on 6/29/21. (Exhibit ZZ) The report contained only preliminary findings, but they were of industrial causation. The PQME would next report on 9/20/21. (Exhibit AAA) Injury was specifically found by the PQME for the cervical spine, lumbar spine, right shoulder and both knees.

Found hypertension entirely industrial due to occupational stress and orthopedic injury; recommended cardiac CT angiogram for further evaluation; noted Defendant failed to timely authorize necessary diagnostic testing.

Defendant unreasonably rejected liability for the heart injury by denying the claim during ongoing investigation and failing to timely authorize diagnostic testing as required by law.

From the decision · page 9PQME Grodan found hypertension was out of control. He wrote in his discussion:

Labor Code Section 5814.3

Labor Code Section 5814.3 prohibits unreasonable rejection of liability for industrial injury and provides for penalties.

Applied to find Defendant unreasonably rejected liability for the heart injury by denying claim during ongoing investigation and failing to timely authorize diagnostic testing.

From the decision · page 15"The judge is asked whether Defendant unreasonably rejected liability for the heart. The answer is yes. It was unreasonable for Defendant to not timely authorize the CT angiogram. It was unreasonable for Defendant to issue a written denial of the heart in the middle of the PQME 's investigation. It was also unreasonable for Defendant to perform an overall underwhelming investigation despite their duty to do so under the law.

Defendant failed to timely authorize cardiac CT angiogram requested by PQME Dr. Grodan, delaying investigation and treatment.

From the decision · page 10Apparently, even after one more effort, Applicant attorney's attempts to elicit a response from Defendant were met with radio silence. The County of Los Angeles has never explained why no one responded to the doctor's request, attorney's letter and email, and why they did not simply arrange for the test once put on notice so many times. The judge could not ignore the fact that no witness on behalf of Sedgwick attempted to explain what happened.

Defendant issued written denial of heart injury claim on 9/26/22 during ongoing PQME investigation, which was unreasonable.

From the decision · page 10On 9/26/22 Defendant issued another partial denial. This document is noteworthy in that liability for the heart was specifically denied due to "no substantial factual legal or medical evidence to support your allegations of injury. " (Exhibit K)