On January 25, 2011 the Los Angeles County District Attorney's Office filed a criminal complaint for the arrest of a school district employee on charges of workers’ compensation fraud. The employee was arrested and taken into custody by local police later that day.
GMK partner, Jon Yudin, obtained critical information during sworn deposition testimony which determined that the applicant was collecting workers’ compensation temporary disability while earning wages at a second job.
Obtaining this information under oath is a crucial piece of the criminal complaint. An essential element of workers’ compensation fraud is a material misrepresentation or concealment of a material fact for the purpose of gaining benefits to which the employee is not entitled.
Some prosecutors have identified the essential element of workers’ compensation fraud as identifying “the lie” and having the evidence to prove it.
In the instant claim red flags arose early. Sub rosa investigation revealed that the employee was engaging in physical activity inconsistent with the information provided to her physicians and in excess of her work restrictions. Although the applicant admitted concurrent employment she consistently resisted efforts at discovery of her earnings.
By obtaining the sworn deposition testimony regarding the applicant’s second job, additional discovery provided the evidence of fraudulent concealment of earnings. The key to the success of the provision of this crucial evidence was the coordination between the employer and GMK defense counsel.
What this means for you
GMK takes fraud issues very seriously and works closely with both employers and carriers to assure that all relevant information necessary to support criminal investigation is obtained. If you suspect claimant or provider fraud consultation with GMK regarding the suitability for prosecution referral is recommended. We will work with you to develop the necessary elements for criminal prosecution where appropriate.