State Disability Insurance is designed to provide wage replacement benefits to people unable to work because of a non-work-related injury, illness, or condition. In California, the Employment Development Department (EDD) manages and provides these benefits to a person who files a claim and certifies that they are unable to work due to his or her condition. When a work-related injury is involved, wage replacement benefits are provided by the workers’ compensation insurance carrier. The two benefits are generally not paid concurrently or for the same injury.
In 2022, a cable installer working for an ICW Group customer alleged injuries related to a fall from a ladder while on the job, and a workers’ comp claim was filed. During the claim investigation, the ICW Group Claims Examiner received information that the injured worker applied for another job just two months following the report of his claim, all the while receiving benefits from EDD and requesting Temporary & Total Disability (TTD) benefits from ICW Group as it related to his work injury.
In his deposition, the injured worker denied having current employment because his doctor told him he could not work. He further testified to being in significant pain with limitations. He also denied to the medical expert that he had not worked since leaving the insured employer.
Contrary to his testimony under penalty of perjury, records from the subsequent employer revealed the worker signed employment documents for his new job just seven days before his deposition. Payroll records supported the income he earned while receiving over $26,000 in disability benefits from EDD. In short, the worker filed a claim seeking workers’ compensation benefits while receiving benefits from EDD and working a new job, all at the same time.
Due to the material misrepresentations made under oath and to his physician and what appeared to be a fraudulent collection of benefits from EDD, ICW Group’s Special Investigations Unit referred the case to law enforcement for investigation. In May 2024, the District Attorney charged the worker with two counts of felony insurance fraud and grand theft against EDD. The injured worker remains innocent until proven guilty.
