SALT LAKE CITY — It's hardly breaking news that we all pay for insurance fraud in the form of higher insurance rates. The exact cost is unknown, but the National Insurance Crime Bureau reports that billions of dollars of false claims are submitted each year.
At Workers Compensation Fund, our special investigations unit's efforts saved $2.8 million in 2013. WCF also saw a 54 percent increase in the number of claims flagged to be investigated in 2013. With March being International Fraud Prevention Month, below are four WCF conviction stories from 2013.
The Quarterback
Neither the X-ray nor an MRI explained the Quarterback's continued complaints of severe elbow pain preventing his return to work. He told his doctor he was unable to move his right elbow due to severe pain with even the slightest movement.
During its investigation, WCF obtained surveillance video showing the quarterback pushing a three-ton Ford Expedition after he ran out of gas. He was then videotaped throwing a football with his injured arm.
When the felony workers compensation fraud warrant was served on the quarterback, he had large amounts of illegal drugs and a firearm in his possession. He was charged with felony possession with the intent to distribute and a federal offense of possession of a firearm by a restricted person. He pleaded guilty to workers compensation fraud and was ordered to pay WCF full restitution, which will be a condition of his post-sentence probation.
The Waitress
The waitress filed a claim for a lower back injury caused by a fall at work. She reported she was no longer able to perform regular work duties stocking shelves and lifting boxes.
During the investigation, a witness informed WCF's investigator that they had seen the waitress working at a local diner. Surveillance footage confirmed the witness's account. The waitress denied any outside employment and continued to claim that she couldn't walk or stand for long periods.
The waitress pleaded guilty to felony workers compensation fraud and was ordered to pay $1,800 in restitution
The Dancing Fisherman
The Dancing Fisherman injured his leg on a brine shrimp boat and stated that he could not do his regular work duties. He said his leg was so bad that he couldn't even walk and would arrive at his medical appointments on crutches.
WCF special investigation unit found that as soon as he was away from his medical providers, his story changed. He was videotaped dancing at his uncle's house with no signs of limping or pain.
The fisherman was charged with a felony workers compensation fraud and pleaded guilty to a class A misdemeanor. If WCF had not discovered the fraud, the claim would have cost more than $40,000.
The Music Man
The music man filed a claim for a back injury that happened while working at a music shop. He would have his wife drive him to his medical appointments and ask to be met by nurses with a wheelchair and warm blankets to help ease his pain.
WCF's special investigations unit found that the Music Man appeared to be in perfect health. He was filmed walking his dog, carrying groceries, and jumping out of a chair with no pain. He pleaded guilty to a class A misdemeanor and served 60 days in home confinement. He was also ordered to pay restitution of over $2,000 dollars.
If you suspect that someone's actions are fraudulent, whether it's an employer, injured employee, or medical provider, review the red-flag indicators of fraud or contact WCF's special investigations unit.
