An injured worker filed a workers’ compensation claim in April 2015 . After the employer’s workers compensation carrier became insolvent , CIGA became responsible for paying the claim Sedgwick is a third party claims administrator for CIGA and handled the worker’s claim

When the examiner reviewed the file, it was noted that a chiropractor, Andrew John Miles, was treating the injured worker. But under Labor Code section 4600, a chiropractor may only serve as a primary treating physician under limited circumstances.

Accordingly, the examiner prepared a computerized diary entry that instructed a claims assistant to send a letter to the worker letting him know that Miles could not be his primary treating physician and he should select a different provider to fill that role. The diary entry specifically identified Miles as the subject of the letter.

The examiner also saw that one of the worker’s other medical providers, Dr. Rosen, was no longer an approved medical provider for CIGA claims because the DIR had included Rosen on a list of medical providers who had been indicted for fraud or abuse. So the examiner instructed the assistant to send several form letters to the worker, including one notifying the worker of the indictment issue and another instructing him to select a new provider.

The claim assistant received the two diary entries created by the examiner at the same time and assumed both entries related to chiropractor Miles by mistake, and the letters referred to Dr. Miles as the person indicted, not Dr. Rosen.

Chiropractor Miles received the letter, called the examiner and pointed out the mistake, and the examiner took several actions that day to correct them. Nonetheless, Chiropractor Miles sued CIGA and Sedgwick for defamation, intentional interference with prospective business relations, and negligent interference with prospective business relations.

CIGA and Sedgwick moved for summary judgment which the trial court granted and the Court of Appeal affirmed in the unpublished case of Miles v Sedgewick, – B311520 (April 2022)

CIGA and Sedgwick asserted three affirmative defenses – the litigation privilege under Civil Code §47(b), – the common interest privilege under §47(c), – and the limited liability provided to CIGA and its agents under Insurance Code sections 1063.12 and 1063.2. The case was resolved on the “common interest privilege” and the others were not discussed in the opinion.

Defendants argued that the communication was privileged because the drafter and recipients of the letter s shared a common interest in the worker’s claim and in the insurance eligibility of the medical providers and treatment the worker received As for malice, defendants explained the false statements were inadvertent and therefore not malicious. The Court of Appeal agreed.

“CIGA, and Sedgwick as its agent, were obligated to reimburse the worker for medical treatment covered under the workers’ compensation policy at issue. And the purpose of the indictment letter and follow up letter was to ensure that plaintiff continued to receive care from medical providers approved by CIGA so that the care would be covered under the insurance policy In sum, the communications from CIGA by Sedgwick as its agent, to the worker and worker’s counsel furthered the mutual interest of all parties regarding covered medical claims.”