Even during a troubled economy, and possibly because of it, business has never been better for Paul Colbert.
His Meridian Investigative Group in St. Petersburg grew 50 percent last year, snooping on workers who fake on-the job-injuries to get workers’ compensation checks.
That tracks with figures from the Florida Division of Insurance Fraud, which reported double-digit increases in workers compensation fraud during 2010.
“Some people make it a career,” Colbert said. “They’re career claimants.”
Colbert has 100 investigators in 14 states, armed with covert cameras and producing about 100 surveillance tapes a week that show able-bodied workers who are suspected of pretending to be lame or sick.
One of Colbert’s surveillance videos shows a woman barrel racing at the same time she was claiming neck and shoulder injuries at work.
Read more…
Investigators say a 26-year-old Southern California skateboarder fell and broke his elbow, then claimed more than $15,000 in workers’ compensation by saying he stumbled at work.
Rudy Matthew Ursua is charged with nine felony counts, including making fraudulent statements and lying about his injuries in violation of Insurance Code and grand theft.
The Victorville Daily Press says Ursua filed for workers’ comp benefits in 2008 while working for RCR Plumbing & Mechanical. Ursua claimed he was injured at work when he stepped on plumbing fittings on the warehouse floor.
But San Bernardino County district attorney’s office investigator Hank June says it was later determined Ursua fell and fractured his left elbow while skateboarding at his girlfriend’s house.
View Source…
MORGANTOWN, W.Va. — A Morgantown lawyer who embezzled workers’ compensation funds from clients has been ordered to get a job and repay more than $36,000.
Monongalia County Circuit Judge Russell Clawges sentenced Carey Patrick Carrick to six to 60 years in prison Monday. He’d pleaded guilty to six counts of embezzlement in January.
Then the judge suspended the sentence, imposed five years’ probation and ordered Carrick to pay more than $7,000 a year in restitution to his victims.
Clawges said he doesn’t understand how Carrick has remained unemployed in the seven months since his guilty plea but ordered him to get a job.
Carrick lost his law license and is not allowed to seek or accept a job that involves handling other people’s money.
View Source…
A 43 year-old Pennsylvania waitress is being charged with two counts of workers’ compensation fraud and one count theft. Why? Because you are not really injured if you can still strip. Christina Gamble filed a workers’ compensation claim based on slip and fall-related back injuries sustained while waitressing at a local restaurant in October 2008, and has been collecting monthly benefits ever since. Her restaurant chain’s insurance company then did some dirty detective work and taped Gamble working at a Gentleman’s club.
Having collected $22,727 in disability benefits and $4,118 in medical expenses, Christina Gamble had been working more than just the stripper pole for the last couple years. Gamble claimed that she was unable to work as a waitress because her injuries prevented her from standing or changing positions. Lucky for her, she’ll be sitting before the court on charges that could land her in prison for seven years and cost her $15,000 per count, NBC reports.
Workers’ compensation is an employer-sponsored insurance plan for employees who suffer job-related injuries and illnesses. In exchange for benefits, employees lose the right to later sue their employer for damages in court, unless the actions of the employer amount to intentional or reckless behavior. Almost any work-related injury will qualify an eligible employee for workers’ compensation benefits, even those injuries that were caused by the employee’s own carelessness whlie on the job. Of course, there are some obvious limiting factors that serve to disqualify an employee: injuries relating to drugs and alcohol, self-inflicted injuries, injuries sustained while committing a crime, injuries suffered while the employee was not on the job, and injuries resulting from actions in violation of company policy.
Read more…
Claims adjusters look for the presence of red flags in workers’ compensation (WC) claims to determine whether or not a claim is legitimate. Red flags consist of particular conditions or behaviors commonly found in fraudulent claims. While the primary responsibility of recognizing red flags lies with both employers and claims adjusters. Private investigators should at least be familiar with them. Seeing one or two red flags does not necessarily indicate fraud however it should, at the very least, alert the adjuster to the possibility of fraud. The fact is workers do get injured on the job. According to Jody Ball in The Bible on Worker’s Comp Investigations, “While most insurance claims are legitimate, fraud is wide-spread, involving approximately 30% of all claims.” Of those that aren’t, some are outright intentional fraud while others consist of exaggerated claims or malingering. Claimants who malinger are those who more than likely began with a legitimate claim and injury but have since recovered. However, they continue to pretend they are incapacitated to avoid having to return to work.
Upon receiving a new WC assignment investigators should discuss with the adjuster the specific red flags that were observed. Being aware of the particular red flags that led an adjuster to consider fraud as a possibility will help investigators conduct a more cost-effective and successful investigation. For example, if the adjuster states that the claimant’s home address on file appears to be a family or friends address the investigator will know that the first step will be to research and locate the claimant’s current residence.
Let’s take a look at the top 40 most common red flags associated with WC claims. We will consider what these red flags mean and what adjusters and investigators can do about them.
There are no witnesses to the injury or the only witnesses are the claimant’s “close” co-workers Yet another reason to advise employers to install security cameras in the workplace. John J. Fay in The Encyclopedia of Security Management states that cameras can be used to “…identify unsafe practices…” and “…to prevent accidents…” In fact, the installation of cameras can decrease the number of fraudulent WC claims.
Read more: http://pursuitmag.com/top-40-red-flags-which-may-indicate-workers-compensation-fraud/#ixzz0vwj8SZDx
Read more…
(CN) – A water district employee who said “hello” to a co-worker by shaking his butt might be entitled to workers’ compensation benefits after the co-worker accidentally hit him with a truck trying to return the unusual greeting, the Iowa Supreme Court ruled.
Norman Vegors and Casey Byrd worked for the Xenia Rural Water District, and they sometimes acknowledged each other in odd ways, such as by waving the boom of a track hoe at each other.
One day, Vegors’ hands were full, so he wiggled his butt at Byrd to say hello. Byrd tried to respond by tapping Vegors with his truck’s mirror, but he accidentally hit Vegors with the truck bed instead.
Xenia contested Vegors’ workers’ compensation claim on the grounds that Vegors had been engaging in horseplay.
The trial court agreed with Xenia and reversed Vegors’ award.
But the state Supreme Court overturned the decision and sent the case back to the workers’ compensation board for a determination of whether Vegors’ butt-shaking had been in the course of his employment.
“The character of Vegors’ action of shaking his rear end — and not the serious injury resulting from being hit with a truck — must be analyzed to determine whether it is a deviation sufficient to bar recovery,” Justice Michael Streit wrote.
View Source…
FACT: Your employees will file Workers Compensation claims . . .
FACT: Not all of them will be legitimate.
Unfortunately, many try to beat the system by filing fraudulent or frivolous claims. The National Insurance Crime Bureau estimates Workers Compensation claim fraud costs the industry $5 billion per year. This occurs when your employees falsely claim to injure themselves at work; exaggerate minor work injuries to receive benefits; and/or take sick leave from your company while working another job. You become the victim. THE BOTTOM LINE: It costs you a lot of money!
Private Detective Agencies Can Verify ALL Claims
Hiring a reputable, experienced and credentialed Private Detective Agency for workers compensation claim verification can go a long way to deter would-be fraudsters. Private investigative services are routinely used by employers, claims adjusters and third-party administrators to confirm the legitimacy of certain claims where fraud is already suspected. But when investigators are hired after a claim has been filed and much time has elapsed, it costs you more money in surveillance fees. In these cases, insurance companies (and ultimately, the policyholder) and self-insurers pay for the “pound of cure.” WCxKit
Consider this potential solution to reducing surveillance fees and creating a blanket of deterrence to throw over those people waiting to cash-in on your workers compensation insurance: hire a Private Detective Agency to take the initial report of ALL workers compensation claims. In most cases, HR personnel take the initial report of a workplace injury. Likewise in most cases, HR personnel are not trained fact-finders or interview specialists. Good Private Investigators know the right questions to ask and are experienced in determining and documenting the facts you need to know. When suspected fraud is discovered, investigators are already familiar with the case and can capture the necessary evidence to prove it.
Read more…
The California Department of Insurance is awarding $30 million in grants to local district attorneys to be used to find and prosecute workers’ compensation insurance fraud.
“Workers’ compensation insurance fraud creates costs that are a burden on our economy at the time it can least sustain it,” said Insurance Commissioner Steve Poizner. “We must care for injured workers so they get the timely medical care they need and return to work, but for those bilking the system will be caught and prosecuted.”
Funding for the grants is the result of an assessment on employers as determined by the Fraud Assessment Commission. Counties apply annually for these grants. The applications are reviewed by the Workers’ Compensation Grant Review Panel based on a number of criteria, including the previous year’s performance. The panel makes a recommendation to the Insurance Commissioner, who can accept or amend the panel’s recommendation. At that point, the Insurance Commissioner’s final decision must be ratified by the Fraud Assessment Commission.
These grants are still subject to approval in the final state budget.
* Alameda $1.27 million
* Amador $425,000
* Butte $200,000
* Contra Costa $625,000
* El Dorado $275,000
Read more…
The 43-year-old woman claimed she fell and hurt her back while working at a restaurant in 2007 and told a doctor it was difficult for her to stand or change positions.
But somehow she managed to do both while working as a stripper, even as she collected worker’s compensation payments, according to the state Attorney General’s office.
She may call it a spread eagle, but the A.G. calls it: insurance fraud.
Officials say Gamble, of Quakertown, Pa., received more than $22,000 in disability benefits, even though she kept on working at C.R. Fanny’s Gentlemen’s Club and Sports Bar.
Gamble was arraigned Thursday, April 29 on two counts of insurance fraud and one count of theft by deception. She was released on her own recognizance, according to The Express-Times.
View Source…
A Pennsylvania woman is facing insurance fraud charges after authorities say she worked as a stripper while collecting worker’s compensation payments. The state Attorney General’s office said 43-year-old Christina Gamble, of Quakertown, collected thousands of dollars in insurance payments while working at C.R. Fanny’s Gentlemen’s Club and Sports Bar.
According to a complaint, Gamble claimed she fell and hurt her back while working at a restaurant in 2007 and told a doctor it was difficult for her to stand or change positions. Authorities say she received more than $22,000 in disability benefits.
Gamble was arraigned Thursday on two counts of insurance fraud and one count of theft by deception and released on her own recognizance.
A phone listing for Gamble could not immediately be located.
View Source…
A Boston police officer was charged Tuesday in federal court with fraud involving a work-related disability claim.
Eliezer Gonzalez, 48, of Boston, was charged with 34 counts of mail fraud after a joint investigation by the U.S. Attorney’s Office, the FBI and the Boston Police Department.
The indictment alleges that the city of Boston and a private supplemental insurer were defrauded by Gonzalez after he went out on injury leave after an alleged on-the-job injury in September 2007.
Gonzalez immediately began receiving tax-free injury pay and also filed for accidental disability retirement. According to the indictment, Gonzalez exaggerated and falsified both his injuries and ongoing physical issues and fraudulently collected both injured leave pay from the city, as well as insurance benefits.
Gonzalez was also accused of feigning injuries on or near the same days that he was videotaped acting injury-free, according to the indictment.
Read more…
Rep. Sal Pace, D-Pueblo, crafted H.B. 1012 in response to complaints from injured workers about Pinnacol Assurance, the state-chartered but independently run and funded workers’ compensation insurance firm, during a series of legislative hearings last fall that examined the insurer’s operational and management practices. Pace said several individuals claimed that Pinnacol abused its ability to use surveillance and inferred that the insurer used it as a tool to intimidate claimants in an effort to secure settlements.
The original intent of the bill was to restrict workers’ comp insurers’ use of video surveillance to only cases where the insurer has a reasonable basis to suspect fraud. It also would have imposed a significant fine on insurers that violated the rule. However, the legislation was amended after lawmakers raised concerns that it would seriously hinder insurers’ efforts to prevent fraud.
Read more…
