As has been made clear in previous posts, employers of all sizes in all industries and in both public and private sectors must remain vigilant when it comes to potentially fraudulent and frivolous work comp claims. In fact, one of the more common instances of this type of employee fraud is misrepresentations by the employee regarding the severity or symptoms of their injury.
To illustrate, consider a case out of Sacramento, where a California Highway Patrol officer was arrested earlier this week and charged with workers' compensation fraud.
According to reports, CHP Officer Tony Y. claimed to have suffered a back injury on May 13, 2011, while participating in firearms training at the CHP Academy and subsequently filed a claim for work comp benefits on August 11, 2011. In the aftermath of the back injury, he was assigned to an administrative position, meaning one with minimal physical exertion.
Over the next few months, Tony Y., 38, informed his treating physicians that his back pain was so debilitating that he was unable to perform even the office work required by his new administrative position. Consequently, the physicians recommended major back surgery.
However, a subsequent investigation by the CHP Office of Internal Affairs Workers' Compensation Fraud Investigation Unit provided video surveillance of Tony Y. engaging in physical activities that should have been impossible due to the severity of his purported back injury.
Interestingly, the investigators also determined that Tony Y. had not been using the training equipment that he said was responsible for his work injury on the day in question and that he had not disclosed a previous back injury he suffered in a non-work related car crash.
"It is a sad day for the CHP when something like this happens," said CHP spokesperson Fran Clader.
Tony Y. is currently on administration leave pending completion of an internal investigation.
Workers compensation fraud/employee fraud is a very serious crime. If you suspect that such a crime has been perpetrated against your organization, you should strongly consider speaking with an experienced workers' comp defense attorney.
This post was provided for informational purposes only and is not to be construed as legal advice.
The Sacramento Bee, "CHP officer accused of workers' comp insurance fraud," Cathy Locke, April 11, 2012