This case involves the Claimant, a 33-year-old female Program Manager who filed a workers’ compensation claim on December 21, 2017. The Claimant alleged that she sustained an injury to her neck, shoulders, back, and left arm while working for the insured. The injury was the result of being involved in a motor vehicle accident during the course of her employment. As a result of the injury, the Claimant was taken off work and received Temporary Disability (TD) benefits. The Claimant remained off work and continued to seek medical treatment for her injury. She presented herself as having chronic pain and that her pain was so severe it interfered with her activities of daily living and prevented her from doing various activities.

While the Claimant remained off work, surveillance was conducted, and it revealed that she was physically active. The Claimant was seen going to the gym, working out, and utilizing exercise equipment. She was also seen attending concerts for several hours at a time, walking around, socializing, eating, and consuming alcoholic beverages. She performed these activities in a manner that displayed no characteristics or symptoms of someone being severely injured. The Claimant’s social media account referenced her participating in various activities while remaining off work, where she attended baseball games, traveled out of the country, hiked, canoed, and attended rock concerts. The Claimant later testified in a deposition where she made material misrepresentations regarding her level of physical activity and limitations.

The SIU investigation revealed the Claimant to be malingering and overexaggerating her physical limitations to obtain workers’ compensation benefits to which she was not entitled. She also misrepresented herself to treating physicians to maintain TD status. On November 19, 2018, a fraud referral was submitted to the San Bernardino County District Attorney’s Office and the California Department of Insurance. As a result of the referral, the San Bernardino County District Attorney’s Office conducted a criminal investigation into the matter.

In October 2020, criminal charges of workers’ compensation insurance fraud and attempted perjury were filed against the Claimant by the San Bernardino County District Attorney’s Office. During court hearings, the Claimant made a request for Mental Health Diversion. In July of 2021, the court granted the Claimant’s request for Mental Health Diversion, where she will receive no conviction, and her case will be dismissed if she successfully completes the program. In January of 2022, the Claimant was ordered restitution to be paid for $35,110.00.

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