Overstaying Your Benefits

Sad disabled girl complaining looking at camera sitting on a couch in the living room at home

In most cases, injured workers legitimately qualify for and begin to collect deserved benefits. However, there are times when deceptive workers decide to forego returning to work even though they are physically and mentally able to do so. (This is called workers’ compensation fraud.) Sometimes they even start another job, but don’t report their new employment situation so they can keep collecting the workers’ compensation benefits from the old job. (That’s fraud too, which means big penalties if caught.)

That is the case with a truck driver in California. The 47-year-old Fillmore man was sentenced to six months in the county jail and three years of probation. And, he had to repay nearly $28,000 to American Claims Management, the company that processed his fraudulent claims.

Ventura County prosecutors say the man was employed as a truck driver when he injured his shoulder. He was placed off work on temporary total disability and had shoulder surgery.

The truck driver remained off work and continued to collect two-thirds of his salary, tax-free, for 17 months. (That sounds like a pretty good gig for him seeing that he could have been working.)

The trucking company received a tip that the man was working on cars and doing physical activities that contradicted his work limitation claims. (No one likes to see others wrongly collecting benefits, unless you’re a fraudster.) The Californian pleaded guilty to a felony charge of making a fraudulent statement to obtain workers’ compensation benefits.

Today’s Fraud of the Day comes from the article, “Workers’ comp fraud draws jail time, probation,” published in the Ventura County Star, July 19, 2019.

Sentencing has been handed down in a workers’ compensation fraud case involving a truck driver.

The Ventura County District Attorney’s Office announced Friday that Jaime Serna , 47, formerly of Fillmore, was placed on three years of probation after pleading guilty to a felony violation of making a fraudulent statement of a material fact for the purpose of obtaining workers’ compensation benefits.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.