The Sacramento County District Attorney’s office announced that fraudster Gustavo Cisneros has pled no contest to felony insurance fraud.
According to this press release, “Cisneros had at least six previous workers’ compensation claims. In these claims, Cisneros used different social security numbers and dates of birth to make his actions more difficult to detect.” The sentence for this fraud is 150 days in county jail, 2 years of formal probation, and restitution to the victim.
As always, your humble blogger is happy to see that the fraud has been detected and that the prosecutor has taken up the case. However, this is far from a perfect result.
Only a fraction of the fraud referrals sent to the district attorney’s office are taken up.
But this tactic used by Cisneros is not uncommon. Often enough, we see applicant’s represented by the same applicant attorney filing claims with “typos” on the date of birth or the spelling of the name. If you’re a cynic like your humble blogger, there’s no “error” here but a deliberate effort to conceal prior claims.
The WCAB appears to offer no remedy for this – there is no penalty for an incorrect DOB, social security number, or failing to list prior workers’ compensation claims or injuries in paragraph 8 of the application.
Certainly, defendants can explore this with a deposition or an ISO report, but these methods take time and carry their own expense. Furthermore, even when these discovery methods are used, when you have an applicant such as Cisneros who is actively trying to avoid detection of prior claims and is willing to engage in fraud, a deposition under oath is of limited assistance.
What are the remedies that are available for such issues?
When it is the allegedly injured worker filing the application, a government photo ID would address some of these issues, especially if the failure of the pleadings to conform to the government ID data (date of birth, spelling of name, etc.) is a basis to dismiss the application.
Furthermore, when an applicant attorney is involved, perhaps the failure to disclose prior WC claims for which the same firm represented the same applicant should be sanctionable. If an applicant attorney assumes representation after an application has been filed, an amended application listing prior claims for which the same firm represented the same applicant can be filed within 45 days of assuming representation.
I defer to the wisdom of the legislature and the WCAB if the added burdens on applicants and their attorneys from the suggestions above outweigh the public’s interest in deterring and preventing fraud and reducing the delays and costs of workers’ compensation litigation.
What do you think, dear readers?
Have a great weekend!