Working on behalf of our carrier client, we filed a work comp fraud case with the District Attorney, obtaining a conviction of a former employee hired as a driver. The driver filed a fraudulent claim after he was terminated. He was found guilty of insurance fraud and ordered to pay more than $84,000 in restitution. The… Read More
Work Comp Fraud: Hell hath no fury…
A day laborer reported back and neck injuries after falling 10 feet off a water tank, landing on his back. Sometime later, the claimant’s ex-girlfriend called his then-employer, wanting to testify that he had not been injured and his claim was fraudulent. The ex-girlfriend also said that he was currently working and did not appear… Read More
Premium Fraud: Cutting corners by cutting premiums lands them in deep water
This insured company presented themselves to their insurer as a pool cleaning and repair company to keep their premiums low, but was suspected of actually building pools. Investigation by our SIU confirmed the employer was actively doing construction work, including decking and swimming pool construction, although they claimed all pool building was done by subcontractors…. Read More
Medical Provider Fraud: Settlement rather than lengthy litigation
While preparing for a lien consolidation with a well-known medical group recently indicted by Los Angeles County, SIU was approached by the provider’s attorney to discuss settlement options. SIU aggressively pursued pressuring the vendor into coming to the global settlement table. As the result of aggressive settlement discussions and negotiations, the vendor agreed to a global… Read More
Auto Fraud: Who’s in the passenger seat?
An insured driver was allegedly rear-ended by another car. Both the insured driver and his passenger sought PIP benefits under the insured policy. An investigation revealed valid insurance in force for the at-fault vehicle, negating the PIP claim; plus no medical charges were ever presented. Additionally, ISI found the passenger provided fake ID to police… Read More
Work Comp Fraud: On-the-job “injury” provides paid time to work elsewhere
While lifting a heavy cabinet, the claimant heard his knee pop. An orthopedic doctor placed him in off-work status. Surveillance found him playing beach volleyball, with good range of motion and gait. He was also filmed purchasing construction supplies and offloading them at a home where he was building a deck. When interviewed by our… Read More