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.