This case involves the Claimant, a 47-year-old male Shipper, who filed a workers’ compensation claim on June 13, 2017. The Claimant alleged that he sustained a lower back injury while working for the insured. He alleged that his injury occurred when he was on his pallet jack when he was struck by a forklift operated by a coworker, which caused him to fall off near some metal racks. The Claimant returned to work for a short time but eventually got off work, where he received Temporary Disability (TD) benefits. While he remained off work, he continued to seek medical treatment for his injury, where he complained of severe and widespread pain throughout his back and most of his body.

While the Claimant remained off work, surveillance was conducted, and it revealed him to be physically active. The Claimant was seen walking, standing, bending at the waist, utilizing a garden hose, carrying a piano keyboard, carrying a piano keyboard stand, driving, holding, and carrying water bottles, entering/exiting a vehicle, and opening/closing doors. The Claimant was also seen walking with a limp at times, and at other times, that showed no limping. He performed these activities in a manner where he displayed no characteristics or signs of someone being severely injured.

The SIU investigation revealed the Claimant to be malingering and overexaggerating his physical limitations in obtaining workers’ compensation benefits to which he was not entitled. On October 22, 2018, a fraud referral was submitted to the Los Angeles County District Attorney’s Office and the California Department of Insurance. As a result of the referral, the California Department of Insurance conducted a criminal investigation into the matter.

On September 21, 2020, the Claimant was arraigned in Fresno County Superior Court on multiple felony counts of workers’ compensation fraud after defrauding his employer. In December of 2021, the Claimant pleaded to one felony count of workers’ compensation fraud and agreed to pay restitution in the amount of $32,474.00. He was sentenced to 180 days in county jail, two years of probation, and other miscellaneous court fines and fees were imposed. As part of the sentence, the Claimant is to obey all laws, possess no weapons, and obtain employment.

This case was successfully prosecuted by the Fresno County District Attorney’s Office, Workers’ Compensation Fraud Unit.