WCDefenseCA

Happy Monday, dear readers!

Your humble blogger hopes that Cinco de May took no heavy toll on you and that you are ready for another exciting week in the whimsical world of Workers’ Compensation.

And, what would a week in workers’ compensation be without another workers’ compensation fraud arrest?

A certain gentleman, who shall remain nameless, has been arrested in Daly City on charges of a National Treasure level workers’ compensation and theft crime spree.

This applicant-turned-criminal defendant is alleged to have collected TD benefits after sustaining an injury from one job, while working a second job and claiming injury on that job too.  He then (allegedly) collected TD benefits from TWO jobs (with two different carriers) while working a third job!

There’s also a bit about being accused of using his former employer’s credit card for a bunch of personal purchases, including an engagement ring.

Assuming, just for a second, that this defendant did do all the things of which he is accused, what are some detection methods that could be used to nip these things in the bud?  After all, the two injuries in question happened in 2014 and 2015, respectively.

Well, if you’re the first employer, you have your typical options: sub rosa, social medial check, word of mouth.

If you’re the second employer, you have all that and you can run a claims check – wait, this guy just had an injury last year, and it isn’t resolved yet?  I better contact THAT insurer and find out what’s going on!

In addition to proudly bearing the title of humble blogger, I also occasionally am saddled with the title of broken record, so I’m going to repeat here a frustration that I have voiced many times in the past.

The money involved in conducting the investigation, preparing the prosecution referral, and hoping it will get picked up just doesn’t come back.  Law enforcement organizations don’t have the resources to prosecute every slam dunk case – let alone every case in general.

So the defendants foot the bill of the investigation for a small chance of the case being picked up, prosecuted, and reaching conviction.  In those rare cases, the victory is often a hollow one – the criminal defendant, once convicted, has no money to pay back the benefits (or only has some of the money).

I don’t have the answer, dear readers, but I will respectfully submit the observation that our present system allows for the incentives to commit workers’ comp fraud to remain high, while the risk and extent of consequences remains far too low.

And on that cheerful note, back to our files!