This case involves a 70-year-old Field Collection Representative who filed a workers’ compensation claim for an alleged cumulative trauma injury. The Claimant filed Applications for Adjudication before the Workers’ Compensation Appeals Board (WCAB) from 2001 through 2002 alleging injuries to his knees, left pinky finger, and hernia. His application was later amended to include psyche. The Claimant obtained medical evidence which indicated he suffered additional injuries to his left shoulder, low back, and internal. He claimed to have remained off work since he was terminated in July 2002 where he collected State Disability Benefits and TD benefits from the insured.

During the claims process, it was learned the Claimant had been employed with a municipal government. An ISO search revealed the Claimant to have been involved with potentially 25 other claims where he sought treatment for various body parts but denied sustaining injuries to those body parts to treating physicians on those claims. While off work and receiving TD benefits, he received monetary funds from promissory and real estate notes.

An SIU investigation was conducted where it was believed the Claimant was suspected of knowingly and intentionally making extensive material misrepresentations in numerous different workers’ compensation and personal automobile claims in order to obtain benefits that he was not entitled to. Subsequently, a fraud referral was made to the California Department of Insurance and the Los Angeles County District Attorney’s Office.

An investigation conducted by the Los Angeles County District Attorney’s Office resulted in a felony complaint where an arrest warrant was issued for the Claimant for workers’ compensation fraud charges. The Claimant was later arrested on those charges. Numerous court hearings took place over the years which resulted in the case being successfully prosecuted where the Claimant was convicted of workers’ compensation fraud on November 23, 2020. As part of the conviction, the Claimant pled guilty to one (1) felony count of workers’ compensation fraud. He received three years of felony probation, 300 hours of community service, and is to pay restitution in the amount of $100,000.00. Sentencing is scheduled for May 23, 2022 for the Claimant to provide completion of his community service and paid restitution.