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Cooking Up WC Fraud

Happy Hump Day, dear readers!  Are you starving for workers’ compensation knowledge?  Are you curious what Chef Humble Blogger has cooking for you?

How about a blog post about a cook pleading no contest to workers’ compensation fraud charges?  (See what I did there? Stay tuned – more cooking puns to follow!)
Sven Hoffman of Marina, a lovely little town in Monterey County, has plead no contest to fraud charges brought by the Monterey County District Attorney.  He claimed a cumulative trauma to his right wrist from kneading dough, and then amended his claim to include the left wrist as well.
However, investigators documented him working out at the gym, doing cooking demonstrations, building a fence, assembling furniture, and working as a consulting chef… all while collecting temporary disability benefits because he “couldn’t work.”  You could say he went from using a cook book to using a … WAIT FOR IT… crook book!
After charges were brought, Mr. Hoffman plead “no contest” and awaits sentencing in late September.
A search of EAMS reflects that there appears to be a match, and the case appears to be active.
So, what happened here – Mr. Hoffman claimed he couldn’t work, and while collecting benefits, was actually working elsewhere.  The defense managed to obtain some pretty damning footage and the DA’s office ran with in.  So, what’s the problem?
Some of my readers have experienced the difficulty involved in pursuing these fraud cases — there are times when law enforcement is just not interested in pursuing fraud perpetrated by workers (rather than illegally uninsured employers).  There are times when the damage done isn’t high enough.
In this case, the DA picked up the defendant’s ball and ran with it, which warrants a very courteous hat tip from your humble blogger.  Unfortunately, this does not appear to be the norm, and getting charges filed can be a difficult process.
Now, if the DA isn’t interested, you can try going through the WCAB, but that doesn’t always work either.  Many WCJs are disinclined to interpret sub rosa footage that indicates a worker is exceeding his reported restrictions, and will punt to the QME, who may not want to jeopardize his or her status as an “applicant friendly” evaluator.
In other words, there’s a lot that has to come together just right to get fraud investigated and prosecuted.
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