A maintenance worker has been charged with felony insurance fraud following an investigation by the ICW Group Special Investigation Unit (SIU) and the Ventura County District Attorney’s Office.
The case was brought to the attention of SIU thanks to a lead from the worker’s employer, an ICW Group policyholder, when the worker filed a claim after being injured on the job. The information suggested the worker was employed by another farm and using a different identity, all the while collecting Temporary and Total Disability (TTD) benefits from ICW Group. Upon receipt of intel provided by the employer on the worker’s potential whereabouts, SIU dispatched surveillance to confirm the lead and captured the worker arriving to work at the farm of his new employer for multiple days. To make matters worse, the worker never reported this income to ICW Group while earning TTD and never reported to his physicians that he was back working a new job.
The first line of defense
In this case, the employer’s initial lead was pivotal to the investigation which led SIU to refer the case to the District Attorney’s office for prosecution. Employers are often the first line of defense for potentially fraudulent workers’ compensation claims. ICW Group encourages employers to notify claims examiners and our SIU team if a claim or element of the claim becomes questionable and requires further investigation.
You can find resources on how employers can investigate injury claims at our Policyholder Center. We also have a hotline, 855-ICW-FRAUD (855-429-3728), for employers, workers, or anyone who wants to report work comp fraud.