Joined: Mar 2003
Monday July 07, 2003 9:47 AM
The effort to prosecute bona fide fraud cases is most encouraging. This should receive even greater support so that District Attorneys will be more aggressive in opting to prosecute fraud.
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The California Department of Insurance has published a "most wanted" list on its website, targeting several individuals for workers' compensation fraud:
Thomas Spencer, a heavy equipment operator formerly residing in Redding, CA., alleged that he injured his neck while working at a construction site. He received both workers' compensation insurance benefits and State Disability Insurance benefits. The investigation revealed that Spencer was working as a heavy equipment operator for another employer while he was receiving benefits. He testified in his deposition that he was not working, and he failed to inform the Employment Development Department that he was working. On April 28, 1997, the Ventura County District Attorney's Office filed insurance fraud, State Disability insurance fraud and perjury on Spencer. A warrant for his arrest was issued with a bail amount of $5,000. On May 22, 1997, Spencer was arrested in Redding, California. He failed to appear for arraignment in Ventura, California, and a bench warrant for his arrest was issued with a bail amount of $5,000.
Efrain Ceballos, a migrant worker who resides in Mexico several months out of the year, filed a workers' compensation claim after he allegedly fell off an 18 foot ladder into the center of a tree while picking oranges. Ceballos complained of injury to his back, abdomen, head, lower extremities, groin area, right leg, and knee. Within thirty days, Ceballos was assaulted by an associate, and suffered injury to his right leg and ankle. Subsequently, Ceballos underwent open reduction and internal fixation of his right ankle. Thereafter, Ceballos claimed this injury as part of his original industrial injury to the point of denying involvement in an altercation and sustaining injuries, during a deposition. The warrant was issued on January 10, 1997. When in the U.S., Efrain stays with friends, coworkers and relatives, making him difficult to locate. Extradition is only approved within the United States, out of country extradition is not approved.
Melton Delaney, an inmate/laborer with the California Department of Corrections, filed a workers' compensation claim allegedly as a result of an industrial accident while incarcerated. Delaney was paid medical benefits totaling $5,156.14. Delaney's injury was the result of an altercation with another inmate.
Roberto Granados-Moreno, while working for Blackbeards Family Center as a gardener, filed an allegedly false workers' compensation claim that resulted in over $9,000 being paid out by T.I.G. Insurance Company. Granados-Moreno normally works as a laborer and is known to be a heavy drinker, according to the DOI Most Wanted site. Charges were filed in Fresno County for Insurance Fraud and Grand Theft and a warrant was issued on 7/24/96 for his arrest.
Gonzalo Rosales filed an allegedly false workers' compensation claim against Reuben's Restaurant where he worked as a busboy. Rosales continued to work as a busboy at another restaurant while he pursued his claim against Reuben's Restaurant. Traveler's Insurance Company has paid out over $23,000 in expenses on the claim. Charges of insurance fraud, Perjury and Grand Theft were filed on March 31, 1993, in Los Angeles County, and a warrant for his arrest was issued. The bail is $80,000.
Andrew Barrington filed an allegedly false workers' compensation claim for a lower back injury suffered while loading junk tires into a trailer during his employment. The criminal complaint says Barrington sustained the injury at home while moving a refrigerator.
According to the DOI, during fiscal year 2000/2001, the Fraud Division identified and reported 3,548 suspected fraudulent claims; assigned 476 new cases and made 170 arrests.