Insurance fraud investigation initiated by ISI
A truck driver was sentenced with workers’ compensation fraud, placed on probation and ordered to repay ACM $27,955 after prosecution by the Ventura County DA’s office. Investigation Solutions, Inc. (ISI) was instrumental in the arrest and conviction.
Employed by Agromin in Santa Paula in 2010, the truck driver injured his shoulder, was placed on temporary total disability and had shoulder surgery. He remained off work, continuing to collect temporary total disability benefits of two-thirds of his salary.
However, in early 2012 Agromin received a tip that the driver was working on cars, engaging in physical activities contradicting his claimed physical limitations.
Agromin contacted ISI, who deployed private investigators.
More than seven hours of surveillance tape showed him working as an auto mechanic at his residence, removing a radiator from an engine compartment; removing and replacing batteries, wheels and tires. He was also recorded picking up a 36-pound floor jack and carrying it to his garage.
In a subsequent deposition, he claimed he was still disabled, unable to lift anything heavier than a bag of groceries.
ISI provided the surveillance tapes to the evaluating medical doctor, who changed his opinion regarding disability. ISI then presented the case to the Ventura County District Attorney’s office.
The truck driver was arrested in June 2014. He pled out just prior to his July 2019 trial date.
He was sentenced with workers’ compensation fraud and placed on formal probation for 36 months. He must serve 180 days in the Ventura County jail and repay ACM the $27,955 that was paid out to him in disability benefits and investigation costs.
“Workers’ compensation fraud is not a victimless crime. It impacts honest business owners who provide insurance coverage to their employees” said John Vanarelli, Ventura county senior deputy district attorney. “In the United States, fraudulent claims cost insured employers $2 billion annually, with much of these costs passed on to the public.
“Our office will vigorously prosecute unscrupulous employees who attempt to victimize employers,” he concluded.