The Argus West SIU team received a referral from a client for a possible claimant fraud case. This claimant filed a workers’ compensation claim alleging to have sustained a specific injury to bilateral knees by bumping his knees on the center console of his delivery van. The claimant is suspected of misrepresenting his prior injuries to the Claims Examiner, AOE/COE Statement Investigator, and medical providers in relation to his left knee injury.  The alleged injured worker was employed with the insured as a Delivery Driver and raised the following red flags:

• The claimant had only been employed with the insured for 1 month at the time of his alleged injury.
• The claim suggested the injured worker was misrepresenting prior injuries sustained to the left knee.
• Nearly 800 pages of medical records obtained revealed entries related to body parts listed on the claim.

SIU filed an FD-1, and a Documented Referral Package was prepared and submitted to the Riverside County District Attorney’s Office. Charges were filed against the claimant by the Riverside District Attorney. The case is now proceeding to the restitution phase and the parties involved are discussing restitution amounts that will be awarded to our client!