WCDefenseCA

Happy Wednesday, dear readers!

I know we got a lot of aches and pains defending these claims, but it is a cause for celebration when fraud is identified and prosecuted.

A caregiver named Elizabeth Hernandez (from Salinas) has plead guilty to charges related to workers’ compensation fraud.  While collecting TD benefits from her employer’s workers’ compensation carrier, she secured a second job as a caregiver working for the County of Monterey.  She thus was able to collect her full pay from the second employer while collecting benefits for her first job.

The press release advises that the criminal investigation started off with “an investigative lead from the workers’ compensation insurer” which, to someone outside of our little swamp of workers’ compensation, might paint an exciting picture: late one night, as the DA’s investigation unit is sitting at their desks, sleeves rolled up, smoking cigarettes and working through files, an anonymous call comes in: “Hey, check out that Elizabeth Hernandez… she doesn’t ‘give a care’ about workers comp laws! She’s double-dipping!”

And from that point on, the investigators set up surveillance, sting operations, and even decoy infirm patients to catch her in the act…

So, usually, the way it happens is the insurer puts together just about all the evidence, including any sub rosa footage, and presents a case with all the work done to the DA.  The DA then sends the investigator to verify the facts before commencing with prosecution.

What would be educational for us in the defense community is what tipped off the insurer to start investigating the injured worker.  But, unfortunately, it would be equally educational to the potential fraudsters out there who would seek to evade capture in the same way.

As for Ms. Hernandez, she is set to be sentenced on June 27, 2018.