The Case of the Double Dipping Upholsterer

A 36-year-old upholsterer alleged multiple injuries against his employer of three years, following his termination for stealing company materials. A week after his termination, he sought medical treatment and was given modified work duties through the month, at which time he stopped attending his medical appointments. Two months later, he resumed treatment with a different provider who placed him off work and began receiving Temporary and Total Disability benefits.

Around this time, his previous employer received a call from his current employer, notifying them of the worker’s newfound employment and bragging to co-workers about the claim he is pursuing and the benefits he is receiving while working a new job.

ICW Group’s Fraud Team Steps In

ICW Group’s Special Investigations Unit (SIU) contacted the new employer to verify the intel. Through statements and subpoenaed records, SIU learned the worker had obtained new employment using a false ID card and Social Security Number. At the same time, he sought medical treatment for this claim. He was hired as an upholsterer and worked for four months, earning almost $11,000 at the same time he had earned over $6,000 disability benefits from ICW Group.

What’s more, in his deposition with ICW Group, he denied any income since being terminated from this previous employer. He also testified that he couldn’t find work because he was unable to lift heavy weight. These misrepresentations related to his employment, income and physical limitations were material to this case. The worker was paid benefits while earning an income and failed to report this information to ICW Group, which is required by law. This information has a material impact on the benefits he was receiving by ICW Group. Had his medical provider been made aware of his employment, it’s possible he would’ve returned him to full duty and benefits would’ve been ceased.

Because of the material misrepresentations, SIU referred this matter to law enforcement and the District Attorney’s office is currently investigating the case. The fate of this upholsterer now remains in the hands of the judicial system.

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.

Related Articles

Retail Gift Card Scam Alert

Gift cards are a quick and easy way to give the recipient the freedom to pick out something nice for themselves. According to Statista, nearly 50 percent of U.S....

Your Employee is Involved in a Fraud Scheme, Now What?

We've talked about what not to do as an employer to help prevent the likelihood that a professional fraudster will target and hook one of your employees into committing...

What Fraudsters do not Want Employers to Know

Members of fraud syndicates understand that committing insurance fraud, such as creating false work comp claims, is far less dangerous than running guns and drugs or robbing banks. Often,...

Sign up for the Work Comp Connect newsletter

Subscribe today and get work comp insights from ICW Group in your inbox.

Sign up for the newsletter