Following up on a work comp fraud case we featured in an article last year, a 28-year-old San Diego plumber pled guilty to felony insurance fraud charges surrounding his attempt to defraud an ICW Group policyholder and the workers’ compensation system.
Extensive surveillance showed this gentleman off-roading and working as a plumber on the side – all the while receiving benefits under a workers’ compensation claim. This gentleman claimed to be in severe pain and unable to work, even at a sedentary work assignment. His misrepresentations ultimately resulted in extensive medical treatment and diagnostics, in addition to payments for the time he claimed he was unable to work in any capacity.
In light of the guilty conviction, the court pursued restitution. At a hearing in April 2022, a representative from ICW Group’s Special Investigations Unit (SIU) testified on all of the claim expenses incurred. Testimony also included educating the parties about the costs associated with the workers’ compensation process. The defendant’s attorney argued against the restitution figure presented to the court. The Judge ultimately rejected the attorney’s arguments and approved a full restitution award in the amount of $104,000. The defendant will now be making arrangements to reimburse his debt of ill-begotten gains.
This plumber scam is one example of how ICW Group fights fraudulent workers’ compensation claims. If you suspect fraud, call our anti-fraud hotline at 855.ICW.FRAUD (855.429.3728).
