A recently hired painter filed a claim for a right elbow injury which he allegedly sustained while working. As a result of his claimed limitations, he was eligible for Temporary Total Disability payments and although he was taken off of work to recover, this worker’s symptoms reportedly worsened.
Proving the power of a Fraud Fighting Partnership, our customer was of the belief, and reported to ICW Group, that the painter may actually have a side business. The suspicion was that he may be engaging in this second job while claiming that he was unable to work as a painter. ICW Group’s SIU was immediately brought in and conducted an in-depth investigation that ultimately revealed the painter was, in fact, actively engaged in a similarly physical occupation but not disclosing this material information to his physicians nor ICW Group.
Surveillance confirmed that the painter was able to operate a mechanical bull and party rental business without any apparent difficulty following his injury. Statements secured from the worker confirmed that he was not being truthful about the extent to which he was physically limited nor his second stream of income.
ICW Group SIU referred this case to the San Joaquin District Attorney’s Office who ultimately charged the painter with two felony criminal counts of insurance fraud for which he pled no-contest. The painter was ordered to five years of probation, 80 days of jail time, a search warrant for stolen property.
