Alleged Claimant Fraud
June 20, 2022
This claim involves a 32-year-old male Agricultural Worker. The claimant reported back pain to the employer, but initially refused medical treatment. He then obtained medical treatment and was released to full duty status. The claimant resigned from the employer a few days later and subsequently retained an attorney. A second claim was filed with the insurer, alleging cumulative trauma (CT) injuries to his wrist, hand, shoulders, leg & feet.
Red flags were identified early in the claim, suggesting the claimant was misrepresenting the nature and extent of his back injury. Despite being released to full duty status days after the original date of loss, the claimant continued to treat, reported significant pain levels with limited objective findings.
Surveillance investigation was initiated and found the claimant to be active and doing agricultural work on numerous days. The claimant denied to the QME and at deposition his subsequent employment during which, he also continued to receive EDD benefits.
Argus West SIU uncovered the claimant utilizing his brother’s name while working for the subsequent employer.
Argus West SIU filed an FD-1 on February 16, 2018, and later followed up with a Criminal Referral Package to law enforcement.
On March 1, 2022, Kern County District Attorney’s Office issued a warrant for the claimant. An arrest was made on March 24, 2022. The claimant is scheduled for a pre-preliminary hearing in June 2022.