Workers’ Comp Fraud Case Results in Restitution

Recently we told you about a California woman who was charged with felony insurance fraud by the Los Angeles County District Attorney after discovering she lied about a pre-existing injury. The woman claimed her already-injured elbow was a part of a workplace injury for which she filed a workers’ compensation claim. As mentioned in part one of this story, first shared in February of 2022, an aggravation of a previously injured body part may be compensable under a workers’ compensation claim. However, the injured worker must disclose the medical history associated with that injury to ensure the proper care is provided and to confirm that the injury was, in fact, work-related. Failing to disclose a prior injury may affect how the claim is adjusted and could result in fewer benefits provided to the worker. For this woman, the investigation revealed she had medical treatment to the elbow five months prior to when she claimed to have injured it at work, calling into question the validity of the injury actually being work-related.  

Following the charges filed by the District Attorney, the ICW Group Special Investigation Unit worked with the prosecuting agency to negotiate a restitution figure that was fair and reasonable based on the fraud that was perpetrated. This resulted in a $4,200 award to ICW Group and one-year probation for the injured worker.

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