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School Employee Goes Down for Fraud

Hello, my beloved readers!

Welcome back to another wonderful day in the world of Workers’ Compensation.  Your humble blogger brings you a story today… one might say I am even telling tales out of school. I bring you today the story of one John Heaton, who alleged an industrial injury in November of 2015, and was convicted this month of insurance fraud, thanks to the diligent efforts of the Stanislaus County DA.

Apparently, Mr. Heaton made “material representations” to a return to work specialist about his physical abilities after sustaining an alleged injury while employed by the Stanislaus Union School District.

Unfortunately, the Bee report does not provide details about his statements or, more importantly, how they were discovered to be false.

The sentence includes 30 days in jail and restitution of just over $8,000.

So, this is cause for speculation, but speaking only hypothetically, how would one prove fraud based on misrepresentations to a return to work specialist.

A couple of suggestions (some of them pretty obvious):

  1. Sub-Rosa – showing applicant engaged in physical activity which he allegedly could not perform;
  2. Social Media – Facebook, Instagram, and whatever else the kids are thumbing away at with their smart phones these days;
  3. Co-worker statements – often enough, this is the starting point in an investigation, where co-workers will hear (or overhear) about activities that don’t comport with why their colleague is getting a paid vacation while they are stuck covering extra shifts.

But the real trick is getting the case picked up by law enforcement.  Due to limited resources, the Department of Insurance and the District Attorneys’ offices can only prosecute so many cases, many of which will be prosecuting employers operating without insurance.

In any case, a hearty congratulations is owed to the Stanislaus County DA and to the school officials for diligently detecting, investigating, and ultimately prosecuting this case.

Alright, dear readers, back to work!

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