Investigation Shows Possible Work Comp Fraud

A 31-year-old California man claimed to injure multiple body parts while working as a plumber. As a result, the plumber received income replacement benefits as part of his workers’ compensation claim. Income replacement benefits are intended for individuals who are not able to work while recovering from their work injury. 

Months into his claim, red flags began to rise due to possible malingering and/or exaggeration of his symptoms. ICW Group’s Special Investigations Unit turned to surveillance to find out what was going on. Surveillance found the plumber, despite his ongoing claims of being unable to physically do his job, actively employed as a plumber by a new company. Additionally, he was observed using his leisure time to push and ride a dirt bike. 

During his deposition, the man denied working in any capacity nor any attempts to gain employment while he was receiving income replacement benefits via his workers’ comp claim. ICW Group’s investigation confirmed that he had applied for and gained employment with a different plumbing company while receiving benefits. 

ICW Group’s Claims Department, in collaboration with its Special Investigations Unit, coordinated the investigation of this case, which was referred to the California Department of Insurance and Los Angeles County District Attorney’s Office for criminal investigation consideration. Multiple felony counts were ultimately filed for work comp insurance fraud and attempted perjury. This individual is presumed innocent until proven guilty. ICW Group will continue to cooperate with law enforcement as this matter progresses through the criminal justice system.

Christopher Dill
Christopher Dill
Christopher Dill is the Special Investigations Unit Director at ICW Group Insurance Company. A Fraud Claims Law Specialist designee, he was a recipient of the National Health Care Anti-Fraud Association’s Investigation of the Year Award for his significant contribution to the successful resolution of “Operation Back Lash” – one of the largest workers’ compensation health care bribery schemes ever uncovered in San Diego County. Christopher has participated in over 30 criminal cases surrounding medical and legal providers attempting to defraud the Workers’ Compensation system. Christopher’s approach to insurance fraud investigations is a holistic one. From preventative education campaigns, to data analytics, to time tested investigative, and intelligence gathering techniques, it is Christopher’s belief that a multi-faceted approach to insurance fraud is necessary to a successful defense.

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