Fraud and more Fraud
Quis custodiet ipsos custodes?
It is an unfortunate fact that insurance companies and self-insured employers often have to lose money to fraud: so-called injured workers who claim more disability than they have sustained.
Because of this fact, the cost of this fraud is passed on to the average consumer, who pays a higher price for goods and services, the higher revenues from which are used to pay for higher insurance premiums.
Private companies are not the only victims, and sometimes the government, sleepy eyed from collecting taxes from private companies (although, not all private companies) and citizens, has its own pockets picked.
It’s not Robin Hood that does this – there are no merry men in green tights involved.
In one recent case, an Oxnard police officer stands accused of workers’ compensation fraud. Edward Idukas, the law man in question, allegedly claimed he was too injured to work, but then an investigation revealed he was regularly playing baseball while collecting benefits.
In a similar story, Oscar Fuentes III, of Willits, was arrested for alleged insurance fraud after an investigation allegedly revealed that, while receiving workers compensation benefits, he was coaching baseball, performing yard work and other physical activities. It appears that an investigation was launched after Mr. Fuentes filed a petition to reopen, seeking to raise an in-place award for 45% permanent disability to 100% permanent disability.
Coincidentally, Mr. Fuentes was a manager of the Department of Corrections and Rehabilitation, San Quentin State Prison.
Private employers, public employers and insurance companies do well to hire veteran investigators with a nose for funny business. The seed money sown in an investigation unit that develops a cooperative relationship with law enforcement reaps not only the small amounts of funds recovered through restitution orders, but also the deterrence effect of prison time.
To the deputy district attorneys, to the private investigators, and to the determined adjusters that won’t have their companies robbed, I say in all sincerity: good hunting!
Hi Greg,
Nice article. I was a claims adjustor for an insurance company doing bodily injury and I can relate to the frustration.
As an adjustor I always felt that if we had more information, more ammo we could fight this. The main problem being, that companies were not willing to invest in the cost of investigations enough to do anything about it. SIU departments do make an impact but they are limited.
I am awaiting the bar results, but I think rather than being an attorney it would be more fun being an investigator who can really build a case.
This type of fraud is immoral, but it’s so easy for one to convince themselves that it is not. People may think that this is a victimless crime but as you stated the public does pay, and also the person doing this type of fraud needs to realize that this is dishonest. Yeah the person making an exaggerated claim didn’t punch, kick or kill someone, but you are still a dishonest person… you’re a liar.