Insurance Fraud Charge Leads to Restitution

In a 2021 Fraud Friday feature, we told you about a California man charged with eight felony counts of insurance fraud and attempted perjury after filing a workers’ compensation claim for injuries he sustained during a rollover auto accident while he was working.

The case was brought to the attention of the ICW Group’s Special Investigation Unit (SIU) through a tip made by an informant who believed the man was working another job while collecting insurance benefits. In collaboration with ICW Group’s Claims Department, SIU investigated the case leading to a referral to law enforcement which led to charges being filed by the District Attorney. The claim was dismissed after the worker failed to appear for multiple hearings at the Worker’s Compensation Appeals Board, following his attorney recusing himself from the case once the charges were filed.

Following several months of legal proceedings, our fraud-fighting team worked with the prosecuting agency in negotiating a restitution amount that was fair and reasonable based on the fraud that was perpetrated. Ultimately, the efforts led to ICW Group being awarded $83,987 in restitution and another example of how we fight fraud.

If you suspect workers’ compensation fraud, call ICW Group’s anti-fraud hotline at 855.ICW.Fraud (855.429.3728). All statements are confidential and available only to our Special Investigations Unit.

Lindsey McLain
Lindsey McLain
Lindsey is a Supervisor in the Special Investigation Unit at ICW Group. Lindsey has investigated 100s of cases; many resulting in criminal charges filed by state prosecutors, and thousands of dollars in restitution paid to ICW Group. In addition to conducting fraud investigations, she also presents and produces anti-fraud training for ICW Group personnel, and hosts fraud prevention webinars that reach thousands of customers nationwide.

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