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Workers’ Compensation: Fraud Costs Billions Every Year

Flagrant workers’ compensation fraud continues to plague California. The number of workers claims for non-existent injuries, doctors bills, medical procedures never done, and employers underreporting their payrolls to avoid increased premiums increases every year. Fraud is so widespread that the Los Angeles District Attorney’s Workers’ Compensation Fraud Unit dedicated to investigating suspicious claims, and in recent years even arrested two of their own officer for fraudulent claims. Of the many workers’ compensation fraudsters, these two LAPD officers should have known better; a false claim is a felony crime that can send you to jail for up to five years and cost you a fortune in fines.

 

 

 

 

 

 

Over the course of his career, a Los Angeles Workers’ Compensation Private Investigator can easily interview up to 2,000 witnesses, interview hundreds of claimants not represented by an attorney, examine thousands of hours of covert surveillance videos, spend countless hours in a car surveilling suspects, and spend thousands of hours writing reports.

LA Private Investigators expose hundreds of workers who claim injuries where there aren’t any, exaggerate minor injuries. They also claim injuries occurred in the place of employment when they did not, and claim that old injuries are new ones

Case Study:

Donald Ray Simmons Jr. is a prime example of a workers’ compensation fraudster. In 2013, he worked as a concrete cutter in Santa Clara, California. He claimed an injury to his left hand that he said was so painful he couldn’t use his left arm; he couldn’t drive and couldn’t return to work.

After three months a private investigator videotaped him giving skydiving lessons, getting on a plane with skydiving equipment, and landing a parachute with clients tied to his body. He rolled up his parachute with no difficulty. He drove himself to the airport, and his left arm was in good working order. Mr. Simmons has been arrested and charged with workers’ compensation fraud; the case is ongoing.

Companies and Medical Providers

But it’s not only workers who commit workers’ compensation fraud. In 2017, the California Division of Workers’ Compensation suspended 21 medical providers accused of fraud. Among them was Marisa Schermbeck Nelson who pled guilty to conspiring with orthopedic surgeon Munir Uwaydah to fraudulently bill $150 million to the Workers’ Compensation Insurance Companies. Private investigators found that more than 20 patients underwent surgery performed by Dr. Uwaydah’s assistant who had never attended medical school. The scheme also included payments for criminal referrals. The case is very complicated due to its many moving parts, and Ms. Nelson is now a state witness in Dr. Uwaydah’s trial.

And then some employers are also fraudsters. In 2016, Aileen Ramirez was convicted of felony workers’ compensation insurance premium fraud. She underreported her payroll by $2.8 million which cost California $525,253.58 in workers’ compensation premiums. Ms. Ramirez pled no contest; she was sentenced to 120 hours of community service, three years of probation, and has to pay back the  $ 525,253.58.

 

 

How Common?

Some experts estimate that between 10% and 20% of workers’ compensation claims are fraudulent or false, and the California Department of Insurance estimates that workers’ compensation fraud is costing the state between $1 billion and $3 billion a year. The result of this huge loss is that workers’ compensation premiums keep rising and honest claimants are not receiving the benefits they deserve.

Now, your turn: You can see how bad these worker’s compensation fraud costs you. Don’t even think about it. If you are experiencing anything related to worker’s compensation fraud, then our Los Angeles Private investigators are ready to take up the case and investigate to the final result.

For Investigation Requirments: visit www.wincor.com or write at win@wincor.com,

Call us at: (877) 885-5220

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