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Employers must conduct basic investigations into fraud

Workers compensation fraud is the scourge of the industry. It costs billions per year in money essentially wasted on people who are not legally entitled to benefits. It never ceases to amaze us how may people attempt to circumvent  the system, but they still do. We have written a number of posts on how employees are caught by detectives from the California Department of Insurance and prosecuted for fraud, and the latest cases suggest that people will continue to hijack the system until they are caught.

A former mail processing clerk form San Jacinto was arrested and taken into custody on suspicion of workers’ comp fraud. It is alleged that the clerk submitted nearly 250 false claims for mileage reimbursement stemming from a bogus claim. She received approximately $13,990 in reimbursement dollars, and submitted a claim for $65,273.43 for transportation costs before she was arrested.

In a different, yet similar case, a former school district police officer attempted to receive an additional $15,000 in permanent disability benefits when he falsified his prior injury history, as well as the injuries he suffered that led to his claim. Essentially, he initially indicated that his right knee, foot and hand were injured in a bicycling accident while on the job. However, he added back, hip and knee injuries after consulting with an attorney.

Subpoenaed medical records showed that the officer did not sustain injuries to his back, hips or knees.

The stories are examples of why it is important for employers to conduct basic investigations into workers’ compensation claims, so that fraud can be ruled out. 

Source: “Pair charged in separate California fraud cases,” ReduceYourWorkersComp, June 4, 2014

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