Workers' Comp Fraud Blotter (9/29/2011) – Slippery Slope: Injured Worker Received Benefits While Working Secretly As a Ski Instructor

Workers' Comp Fraud Blotter (9/29/2011) – Slippery Slope: Injured Worker Received Benefits While Working Secretly As a Ski Instructor

Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, convictions and investigations.


Workers' Comp Fraud Blotter - September 29, 2011

Slippery Slope: Injured Worker Received Benefits While Working Secretly As a Ski Instructor (WA) - Robert Rood has pled guilty to four counts of theft, in a case where he claimed to be too injured to work, while at the same time performing physically demanding work. Rood filed an industrial insurance claim for a low back injury suffered while doing masonry work and received time-loss benefits. After it was reported that he was working as a sales consultant at a home show, investigators also found that that he was doing a variety of seasonal work. In the summer, he worked as a deckhand on an Alaskan fishing boat. In the winter, he was working as a ski school instructor, where investigators observed him skiing at the advanced/expert level with no signs of injury.   Read more

Police Officer Indicted on Workers' Compensation Fraud Charges (NY) - Camille Bishop, who is an inactive municipal police officer, has been indicted by a county grand jury. She is accused of filing false workers' compensation claims of more than $50,000 relating to a back injury.   Read more

Electrician Sentenced For Workers' Compensation Double-Dipping (TX) - Thomas Mikulenka has been ordered to pay restitution and perform community service after his conviction on workers' compensation fraud charges. Mikulenka began receiving income benefits from Texas Mutual Insurance Company after he was injured while working as an electrician. Although he stated that he was unable to work, he later began secretly working as a laborer.   Read more

Auditor For State Workers' Comp Agency Underreported Her Payroll On Her Side Business (WA) - Cynthia Blancaflor, who is an auditor with the Washington Department of Labor and Industries, which regulates workers' compensation in that state, has been convicted of theft and false reporting. Blancaflor operated an adult-family home business, and she underreported her payroll, which unlawfully decreased her workers' compensation insurance premiums by more than $10,000.   Read more

President of Staffing Company Pleads Guilty To Wire Fraud Involving Workers Compensation (IA) - Dinesh Sethi, the president of DES Staffing Services, has pled guilty in federal district court to one count of wire fraud in connection with defrauding insurance companies out of workers compensation insurance premiums that were due and owing. Sethi admitted that he and his Director of Finance, Randy Stringer, shifted payroll from high premium job classifications to lower premium job classifications to fraudulently reduce workers compensation insurance premiums.   Read more

Postal Employee Charged With Workers' Compensation Fraud and Lying to Postal Personnel (PA) - Jeffrey Allen Gogets has been indicted by a federal grand jury in Pittsburgh on charges of workmen's compensation fraud and false statements. Gogets alleged that he was assaulted and robbed at the Post Office where he worked as a supervisor.  He then applied for and received worker's compensation benefits.  Gogets allegedly staged the assault and made misrepresentations to Post Office personnel about the incident.   Read more

Trucking Company Owner Intends to Plead Guilty to Running Postal Trucks Without Workers' Compensation Insurance (PA) - Douglas A. Pifer, the owner of  Douglas A. Pifer Trucking Co., has waived his right to a preliminary hearing and plans to enter a guilty plea to charges that he failed to maintain workers' compensation insurance. Pifer worked as a contractor for the U.S. Postal Service, and he was paid $95,000 under that contract for the cost of workers' compensation insurance, which he did not purchase.   Read more

Detective Operated Businesses While On Stress Disability (CA) - John Vach Jr., a Los Angeles police detective, has pled no contest to charges of workers' compensation fraud. While Vach was off work on a job-related stress disability claim, he operated two private businesses. As part of a plea bargain, Vach has agreed to resign as a police officer and to pay back $105,000 of salary and medical benefits that he received while on leave.   Read more

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