This case involves the Claimant, a 37-year-old Environmental Services Technician who filed a workers’ compensation claim on May 20, 2018. The Claimant alleged a right knee injury caused while cleaning several gurneys at her work, bending and crouching to clean under the gurneys. She was seen at the emergency room and eventually diagnosed with a sprain. She was given a walker to help her ambulate. Based on her representations to her Primary Treating Physician (PTP), the Claimant was placed on Temporary Total Disability (TTD).

During this time, surveillance was conducted on the Claimant, which revealed her walking without her walker or limp, carrying large bags such as a trash bag, driving, and even briefly jogging. However, when attending medical appointments, the Claimant was observed utilizing her walker and walking with an obvious limp. She was depicted stopping at a parking lot to switch sides with her passenger and then proceeding to her doctor’s office location. The Claimant’s recorded statement was obtained where she affirmatively denied that she had not driven since her injury, denied walking without her walker for long periods, as well as stated an inability to bend or carry something as small as a purse. She said that she could not walk without her walker or a severe limp at any time. A surveillance video was shown to the PTP, and he concluded that the Claimant had been untruthful to him regarding her physical limitations and abilities. Had he seen the video before placing the Claimant on TTD, he would instead have released the Claimant to full duty with no restrictions of any kind.

The SIU investigation revealed the Claimant was suspected of falsely malingering and overexaggerating her physical limitations and underexaggerating her physical capabilities to obtain workers’ compensation benefits to which she was not entitled. On July 20, 2018, a fraud referral was submitted to the Los Angeles County District Attorney’s Office and the California Department of Insurance. On October 16, 2018, the Los Angeles County District Attorney’s Office notified APEX that they would open a criminal investigation due to our fraud referral. Subsequently, a Documented Fraud Referral was provided to the Los Angeles County District Attorney’s Office pursuant to the 1877 demand letter. Ultimately, it was also investigated by the California Department of Insurance.

On May 21, 2019, the Claimant was arrested and criminally charged with two (2) counts of workers’ compensation fraud, and she was arraigned on June 12, 2019. The Claimant pleaded not guilty and pursued a jury trial. On June 24, 2019, an SIU Investigator testified at the Claimant’s preliminary hearing, where she was held to answer. On March 26, 2021, during a court hearing, the motion for pre-trial diversion was granted by the court, as the Claimant continued her plea of not guilty to the charges and agreed to be placed on an informal judicial diversion program for 18 months. As a part of her informal judicial diversion, the Claimant is to obey all laws and orders of the court, perform 50 hours of community service, and pay $200 to the Victims Crime Fund. The Claimant is to provide proof of completion of the community service by March 26, 2022. A restitution hearing is still pending for the near future.

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