This case involves the Claimant, a 29-year-old male Technician who filed a workers’ compensation claim on December 16, 2015. The Claimant alleged that he sustained a right lower extremity, back, and stress injury while working for the insured. He alleged that his injury occurred when he was involved in a forklift accident. As a result of the injury, the Claimant was taken off work and received Temporary Disability (TD) benefits. While he remained off work, he continued to seek medical treatment for his injury where he presented himself as being injured to the level where he was unable to work.

While the Claimant remained off work, surveillance revealed he was physically active. The Claimant was seen jogging, riding a motorcycle, working on cars, lifting a toddler, lifting large objects, crouching, squatting, and racing vehicles. He performed these activities in a manner where he displayed no characteristics or signs of someone being severely injured. The Claimant later testified in a deposition that he had not ridden a motorcycle or performed any outdoor activities, nor could he lift over 30 to 35 pounds. However, surveillance video of the Claimant showed otherwise.

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. Additionally, the Claimant misrepresented himself to treating physicians to remain TD status. On October 26, 2018, a fraud referral was submitted to the San Diego County District Attorney’s Office and the California Department of Insurance. As a result of the referral, the San Diego County District Attorney’s Office conducted a criminal investigation into the matter.

In June 2020, criminal charges of workers’ compensation insurance fraud and perjury were filed against the Claimant by the San Diego County District Attorney’s Office. Due to COVID-19, there was an extended delay in court hearings for the Claimant. On February 9, 2022, a court readiness conference took place. As agreed, the Claimant pled guilty to one count of workers’ compensation fraud and provided an initial restitution payment in the amount of $12,625.78. He was placed on one year of probation, paid a fine of $500, and is to complete 40 hours of community service. In July of 2022, a hearing was held where the remainder of the restitution for the Claimant was imposed for $19,440.75, totaling a final restitution amount of $32,066.53.

The San Diego County District Attorney’s Office’s Workers’ Compensation Fraud Unit successfully prosecuted this case.