A Vinton (Gallia County), Ohio woman recently pleaded guilty to workers compensation fraud and forgery after she was found forging documents in order to receive undue injured worker benefits.
According to the Ohio Bureau of Workers Compensation (BWC), Maria Patterson must repay more than $7,000 as a result of her attempt to extend the benefits she was receiving for a prior workplace injury beyond her eligibility.(WCx)
"Physicians are an important part of the process of evaluating the condition of injured workers and whether they are able to return to work," said Steve Buehrer, Administrator/CEO of the Ohio Bureau of Workers Compensation. "Forging a provider's name to extend benefits is not only illegal, it denies them their role in guiding a medical treatment plan designed to get injured workers back on the job."
BWC's Special Investigations Department (SID) opened an investigation after receiving an allegation from a BWC employee who suspected that Patterson submitted three falsified C-84 forms. These forms are used by injured workers and their physicians to initiate or extend payment of temporary total disability benefits.
The investigation revealed Patterson did in fact falsify three forms by signing her doctor's name and misrepresenting her dates of disability. As a consequence, she was paid benefits she would not otherwise have been eligible to receive.
Patterson pleaded guilty May 8 to one felony count of workers comp fraud and one felony count of forgery. Franklin County Judge Guy Reece sentenced Patterson to 180 days incarceration on each count and ordered her to pay $7,450.63 in restitution. [WCx]
Patterson is currently serving a nine-year sentence for unrelated charges of burglary, two counts of theft, tampering with evidence and breaking and entering.
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. Contact: Mstack@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
A California amusement park owner charged with workers comp fraud and tax evasion has entered into a plea agreement with the San Bernardino District Attorney’s Office.
Following a suspected fraudulent claim referral form from the insurance company, investigators from the San Bernardino County District Attorney’s Office, Workers Comp Fraud Unit, served a search warrant on various properties owned and/or controlled by Thomas, 58, and Sharie Davis, 54, both of Fontana. Thomas and Sharie Davis are the owners of Davis Enterprises, a carnival and amusement park business. This is all according to the DA's office.[WCx]
During the course of the investigation it was found that Davis had illegally operated at the Del Mar Fairgrounds in San Diego County and other carnivals in Los Angeles and San Bernardino counties. Following the investigation, it was determined that the Thomas and Sharie Davis underreported the amount of their company payroll in order to pay smaller premiums to the State Compensation Insurance Fund, said Deputy District Attorney Michael Chiriatti, Jr., who is assigned to the case.
In addition to the insurance fraud, Thomas and Sharie Davis also failed to pay payroll tax between April 2010 and March 2011.
According to the plea agreement, Davis agreed to pay $195,937 to the State Compensation Insurance Fund and $18,206 to Employment Development Department. In exchange for her pleas, the charges against her husband were dropped. [WCx]
“As of result of their fraud, Davis Enterprises illegally pocketed over $200,000 in taxes and insurance premiums,” said Chiriatti. “This is felony conduct, and I am happy that the defendant has been held responsible for her fraudulent behavior.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
When an employee commits workers compensation insurance fraud, they are stealing direct from the employer. While the insurance carrier or the self-insurance program may write the check, the cost of workers comp fraud comes right out of the employer’s pocket. The fraudulent workers comp claim is included in the calculation of the insurance premium, the same as legitimate workers comp injuries.
Per the Coalition against Insurance Fraud, bogus claims cost employers $6 billion a year. It is estimated that nearly 25% of the workers comp claims contain some element of fraud, whether it is the outright bogus claim or the employee who stays off work when he knows he could be working light duty. [WCx]
The employer should know the indicators of fraud, often referred to as the red flags. Something unusual about the claim does not indicate fraud, but unusual things can point to the possibility of fraud. When any of the following exist, consider a fraud investigation:
- Late reporting of the injury: real injuries get reported quickly.
- Accident details that do not fit: the accident details are sketchy or vague, the employee has difficulty describing what happened, and the employee gives more than one version of what happened.
- Witnesses: there are no witnesses, especially when the employee normally works around other employees, or the witnesses’ version differs from the employee’s version of the accident.
- Disgruntled employee: the employee has previous express dissatisfaction with supervision or management, the employee did not get a promotion she wanted, the employee is on "positive improvement needed" status, the union has announced an impending strike; the factory is closing, etc.
- Medical care: the injuries are subjective, i.e., low back pain, complaints of pain out of proportion to diagnostic findings, the employee changes doctors, the employee attempts to add additional body parts to the medical treatment.
- Monday morning claims: the injury, usually with no witnesses, occurs early Monday morning shortly after the employee gets to work (the injury occurred over the weekend while the employee was away from work). [WCx]
Unfortunately, when it comes to workers comp fraud, some employers take the defeated approach with “there is nothing we can do about it” line of thinking. There are many approaches the employer can follow to reduce and/or eliminate fraud including:
1. Having an established practice of investigating every workers comp claim. If the employees know it will not be easy to commit fraud, they are less likely to try it.
2. A required transitional duty program that all employees know about will prevent the employee who wants to “take a vacation on comp” or to work another job while collecting workers comp benefits.
3. Make sure all employees are aware that workers comp fraud is a crime and you strongly prosecute insurance fraud.
4. Make fraud beneficial to the employee who reports it. Have a published policy of paying a reward to the employee who provides information leading to the conviction of the criminal committing the fraud.
5. Report ALL questionable claims to the Special Investigative Unit of the insurer or third party administrator.
6. Have a strong safety program which will remove many of the scenarios the fraud prone employee can use to create a bogus claim.
7. Avoid hiring people of questionable ethics. Complete a thorough background check including criminal history and credit score (the lower the credit score, the higher the probability of a questionable workers comp claim). If you do not have the time to do an in-depth background check, consider a member of the National Association of Professional Background Screeners, www.napbs.com.
Fraud should never be tolerated and should be fought any time it occurs. As the employer, you should learn as much as possible about defeating workers comp insurance fraud. Our 2012 Manage Your Workers Compensation: Reduce Costs 20% to 50% has an entire chapter on Fighting Fraud and Abuse. It will show you many additional steps you can take as the employer to combat workers compensation fraud.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20% to 50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
© 2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer recently announced seven individuals were convicted of or pleaded guilty to charges related to defrauding Ohio's workers comp system during a 30-day period. The court actions are the result of investigations conducted by BWC's Special Investigations Department (SID), which works to deter, detect, investigate, and prosecute workers comp fraud.
The following is a sampling of cases that resulted in a guilty plea or a conviction.
Nancy Madewell, dba Bagel Cafe Inc. (Kettering, Montgomery County), pleaded guilty to three counts of failure to comply for operating her business without workers comp coverage. Numerous attempts were made by BWC's Employer Compliance Department to bring Madewell into compliance, but she continued to operate without proper workers comp coverage. Madewell failed to appear for trial and a warrant was issued. She then reported to Kettering Municipal Court in response to the warrant and entered a guilty plea. Madewell was sentenced to 60 days in jail suspended on the condition of not violating her three-year, unsupervised probation. [WCx]
Jose Ramirez (Cleveland, Cuyahoga County) was sentenced to one felony count of workers comp fraud for working while receiving benefits. SID opened an investigation after receiving an allegation that Ramirez was working on cars in his driveway. The investigation found that Ramirez was working for a transmission repair service while receiving temporary total disability benefits. Ramirez conducted various tasks, such as, sweeping the floors, cleaning the shop, delivering parts to customers, picking up parts from suppliers, supervising/assisting other mechanics with repairs, and driving business tow trucks to pick up vehicles. Ramirez worked up to four days per week and was paid in cash. Ramirez pleaded guilty in Franklin County Common Pleas Court and was convicted.
Mitchell Oakley (Harrod, Allen County) pleaded guilty to one count of workers comp fraud for filing a false claim. Oakley filed a claim indicating he was injured on his first day of work for an employer. However, SID found that Oakley was actually injured moving boxes at home prior to his employment. He was sentenced in Lima Municipal Court to 30 days suspended and must repay $150 in court costs.
Victoria Hall (Toledo, Lucas County) was sentenced to a felony count of workers comp fraud for working while receiving benefits. SID investigators obtained undercover surveillance video showing her working at a convenience store while receiving temporary total disability benefits. Hall was previously injured at the same gas station and returned to work there after the gas station was under a different name and owner. Hall admitted to wrongdoing during an interview and pleaded guilty. Hall was sentenced to three years of community control and ordered to pay restitution in the amount of $7,754.97 and investigative costs of $1,000. The conditions of her community control are to pay the restitution and maintain employment. If Hall violates her probation, the judge stated that he will send her to jail for a term of 12 months.
Nancy Palmer (Cleveland, Cuyahoga County) was sentenced on a felony count of workers comp fraud for working while receiving benefits. SID received an allegation that Palmer had been working at a local veterinary hospital. Investigators found she had returned to work as a veterinary assistant while receiving temporary total disability benefits. She was performing duties such as office work, assisting during surgeries, cleaning and taking care of animals. It was also found that Palmer was working as a telephone solicitor for a local charity. Palmer entered a guilty plea and the judge ordered her to pay $7,457.72 in restitution and $1,000 for investigative costs. She was also sentenced to seven months in prison suspended, for 18 months of community control. [WCx]
Randall Schornack (Austintown, Mahoning County) was sentenced on a felony count of workers comp fraud for working while receiving benefits. SID received an anonymous tip on the fraud hotline that Schornack was working as a disc jockey at area bars under the name "DJ Randy Stevens." SID's investigation determined that Schornack was working as a DJ for several bars in Mayfield and also for a professional DJ service in Girard while receiving temporary total disability benefits. The SID obtained video of Schornack unloading and carrying speakers and other equipment from his vehicle into different establishments on a weekly basis and performing work services as a DJ. Schornack was ordered to pay $27,202.62 in restitution He was also sentenced to 18 months in prison suspended, for five years of community control.
Information from Ohio BWC
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
A former MBTA driver (Massachusetts) is looking at a fall trial on charges that she staged an armed robbery, lied about it to police, and then claimed more than $7,000 in workers compensation funds, Suffolk County District Attorney Daniel Conley reported.
Nancy Parker, 53, of Burlington was arraigned recently in Suffolk Superior Court on charges of workers comp fraud, making a false police report, and misleading an investigator, a subsection of the state’s witness intimidation statute. (WCxKit)
Assistant District Attorney David McGowan told the court that Parker was driving an MBTA bus on Route 111 in the area of Garfield Avenue and Exeter Street in Chelsea on the afternoon of Oct. 2, 2007, when she made the initial false report.
When MBTA Transit Police along with Chelsea Police and other law enforcement officials responded to a call for shots fired, Parker allegedly told them that she was heading inbound when she stopped to pick up a passenger. The man, that Parker allegedly told Transit Police detectives about, pulled a gun, demanded her money, and shot at her. He shot her once as she sat in her seat and three more times after she tried to rush past him and he pushed her to the ground, where he took her wallet and fled.
Though she claimed ignorance as to his identity or motive beyond the robbery, Parker allegedly gave a detailed description of the assailant. This description led Transit Police to conduct an extensive investigation into who he might have been. After posting a composite sketch to the Massachusetts Most Wanted web site and circulating it among local businesses, Transit Police received a tip that led to particular scrutiny of a suspect in past offenses. He was eventually cleared of wrongdoing in the bus incident.
Parker also allegedly showed investigators her uniform jacket, which had three holes in it. Though she described them as bullet holes, she suffered no injuries from the shooting she described. She did, however, leave work and file a workers comp claim which amounted to $7,750.87, plus an additional $2,063.07 in payments to medical providers.
In a second interview with Transit Police, Parker allegedly stated that she had lied in her initial statement. This time she allegedly indicated that a former intimate partner had sent the gunman to collect a $5,000 debt Parker had incurred about 14 years earlier.
After interviewing that former partner, conducting further investigation, and attempting to contact Parker only to be met with evasiveness or, on one occasion, shouted profanities, Transit Police determined that her story was a fabricated.
Parker was first charged in Chelsea District Court on April 30, 2009. A judge dismissed the case of prosecutor objections in 2010. Conley’s office put the matter to a grand jury last year, leading to her Dec. 20 indictment. (WCxKit)
Her trial is now scheduled for Oct. 15, and she is due back in court soon.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Oklahoma Attorney General Scott Pruitt recently charged two men with workers compensation fraud. Charlie Jones, 45, of Norman faces one count of workers comp fraud.
According to charges filed in Oklahoma County District Court, Jones had filed a claim for injuries to his right arm and hand allegedly sustained while working. He was awarded permanent total disability (PTD) benefits. In a medical re-evaluation two years later, Jones claimed constant pain with limited mobility.
During the investigation, Jones was observed feeding animals and cleaning his pool with no clear signs of pain or lessened mobility. The fraud resulted in Jones receiving $11,385 in benefits to which he was not entitled.
Meantime, Johnny Lee Crowder, 42, of Lawton also was charged with one count of workers comp fraud. According to charges filed in Oklahoma County District Court, Crowder filed a claim for injuries to his left hand when he tripped and fell while working. Crowder sought medical treatment for an injury to his hand sustained while at home. (WCxKit)
During the investigation, investigators found discrepancies in Jones’ claim and medical records. On the day in question, the business was closed for holiday and the ambulance picked him up at home not at work as he originally stated.
Ohio Man Not Liking the Tune of Workers Comp Fraud
An Austintown (Mahoning County), Ohio man was sentenced recently for workers comp fraud after Ohio Bureau of Workers Compensation (BWC) investigators caught him on video entertaining partygoers and bar patrons as a disc jockey.
According to the BWC, Randall Schornack pleaded guilty and must repay more than $27,000 he collected illegally while receiving benefits for a workplace injury. (WCxKit)
BWC's Special Investigation Department (SID) received an anonymous tip on the fraud hotline that Schornack was working as a disc jockey at area bars under the name "DJ Randy Stevens."
SID's investigation determined that Schornack was working as a DJ for several bars in Mayfield and also for a professional DJ service in Girard while receiving temporary total disability benefits. The SID obtained video of Schornack unloading and carrying speakers and other equipment from his vehicle into different establishments on a weekly basis and performing work services as a DJ. (WCxKit)
Schornack was sentenced in a Franklin County courtroom and the judge ordered him to pay $27,202.62 in restitution He was also sentenced to 18 months in prison, suspended for five years of community control.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
The Florida Department of Financial Services Division of Insurance Fraud reports that it has charged an Orlando man with workers compensation fraud and grand theft after an investigation claimed he fraudulently collected more than $115,000 in benefits.
According to the office of Florida Chief Financial Officer Jeff Atwater, Keith Jackson falsely reported that his injuries took place at the time of his employment as an Orange County corrections officer. Jackson could receive up to 30 years in prison if convicted.
“It is one of my missions as your CFO to root out fraud of all types,” CFO Atwater commented in a statement. “Those who are looking to game the system are ultimately putting the financial burden on all of Florida’s consumers. If you bilk the system, we will find you and put you behind bars.”
Atwater’s office reports that Jackson had claimed to have injured his back and foot while taking part in defense tactics training as an Orange County corrections officer.
“Jackson’s claim was initially deemed compensable; however, it was determined that Jackson made false statements and omitted material information about his medical conditions,” Atwater’s office reported. [WCx]
Anyone with information regarding suspected insurance fraud is asked to call 1-800-378-0445. Individuals who provide tips can remain anonymous and are eligible for a reward of up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
California Fraud Case
Manuel Perales, 50, of Fontana, Calif., has been charged with two counts of workers compensation insurance fraud, according to the San Bernardino County District Attorney's Office.
Recently, members of the DA’s Office, Workers Compensation Fraud Prosecution Unit, began an investigation into allegations of possible insurance fraud involving Perales. (WCxKit)
Perales reportedly sustained an industrial injury, while working for a local company. During the workers comp process, Perales withdrew his claim after being confronted with evidence that supported the incident was not true.
Although Perales withdrew his claim; he subsequently filed a second workers comp claim alleging that he sustained the same injuries, along with other industrial injuries, over a specific period of time, not including his original date of injury.
During this investigation evidence revealed that the allegations of workers comp insurance fraud were substantiated. As a result, an arrest warrant showing a bail amount of $100,000.00 was issued, charging Perales with insurance fraud. (WCxKit)
Later, Perales was located and arrested pursuant to the arrest warrant. He was transported, booked and housed at the San Bernardino County Sheriff’s West Valley Detention Center to await trial in this matter. Perales is scheduled for arraignment some time in 2012.
Ohio Fraud Case
A Cleveland (Cuyahoga County) woman was sentenced recently for fraud after Ohio Bureau of Workers Compensation (BWC) investigators found she was working for a veterinary hospital and a local charity while receiving benefits for a workplace injury. Nancy Palmer pleaded guilty and must repay more than $8,000.
BWC's Special Investigations Department (SID) reports it received an allegation that Palmer had been working at a local veterinary hospital. Investigators found she had returned to work as a veterinary assistant while receiving Temporary Total Disability benefits.(WCxKit)
According to the report, Palmer was performing duties such as office work, assisting during surgeries, cleaning and taking care of animals. It was also found that Palmer was working as a telephone solicitor for a local charity.
Palmer entered a guilty plea recently to a felony count of workers comp fraud. The judge ordered Palmer to pay $7,457.72 in restitution and $1,000 for investigative costs. She was also sentenced to seven months in prison, suspended for 18 months of community control.(WCxKit)
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
A Yolo County, California jury has convicted a West Sacramento resident and 25-year employee of The Sacramento Bee of workers compensation insurance fraud.
According to the Yolo County District Attorney's Office, Linda Vela, 58, was convicted of seven counts of workers comp fraud, three counts of presenting false statements concerning payment on an insurance policy and two counts of attempted perjury in connection with disability claims made over a two-year period. [WCx]
Vela, who was employed as a member of The Bee's finance department, left her position on disability and was diagnosed with bilateral carpal tunnel syndrome.
Vela, who had surgery on her right wrist, complained that she was still in pain after the surgery and that she could not go back to work despite the surgeon's recommendation that she return to work. Due to Vela's complaints of pain and her reported inability to use her hands, her physician kept her off work as "totally disabled."
As a result, Vela obtained workers comp benefits from The McClatchy Co., parent company of The Sacramento Bee, along with payment through Liberty Mutual Insurance Co.
Not long after starting to receive payments, Vela was nabbed on video doing many of the things that she told doctors she could not do.
An orthopedic surgeon who watched the surveillance video testified that Vela could go back to work with the restriction that she "avoids power gripping and torqueing." [WCx]
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Benjamin Lawsky, superintendent of the Financial Services, recently reported that 18 people in 13 New York counties have been arrested in the latest effort to save businesses money by cracking down on workers compensation fraud.
The arrests were the result of a series of joint investigations led by the Department of Financial Services (DFS). Joining DFS in the investigations were the Office of the Inspector General (OIG) of the New York State Workers Compensation Board, the New York State Insurance Fund (NYSIF) and other insurers. (WCxKit)
The 18 arrests included:
Albany County — Charles Foster, 48, of Hoosick Falls, collected $22,800 in benefits after hurting his leg when cutting down a tree while employed by the Village of Hoosick Falls in February 2010. However, investigators found that he was managing a storage facility and running a scrap metal business while collecting the benefits from NYSIF. He is charged with workers comp fraud.
Schenectady County — Lee Kittle, 49, of Scotia, collected $22,600 in compensation from NYSIF after suffering an injury while employed at a mill in 1993. He was found to be working at Schenectady County Community College as a tutor and the Saratoga Race Track as a teller. He gave authorities a written confession. He is charged with offering a false instrument for filing in the first degree and workers comp fraud.
Erie County – John Czechowski, 45, of West Seneca, collected $12,000 from NYSIF after he was classified as totally disabled for a back injury he suffered working as a roofer. However, investigators discovered he was working off the books for a contracting company while collecting the benefits. He is charged with third degree insurance fraud, grand larceny, offering a false instrument for filing and workers comp fraud.
Onondaga County — Kemberlei Senke, 44, of Liverpool, is accused of claimant fraud for collecting $26,000 in benefits issued by NYSIF between June 2009 and January 2011. She reported suffering a knee injury while employed by Artistry in Wood. The investigation disclosed that she falsified reports to the NYSIF to inflate her wages and employment status. She is charged with insurance fraud in the third degree, offering a false instrument for filing in the first degree and workers comp fraud.
Onondaga County — Cheryl LaQuay, 62, of Calcium, is accused of fraudulently collecting $53,000 in benefits from the NYSIF between Oct. 2006 and Sept. 2011, while working as a home health aide. She is charged with insurance fraud in the second degree, offering a false instrument for filing in the first degree and workers comp fraud.
Oneida County — Aaron McElhinney, 26, of Vernon, is accused of collecting $11,600 in benefits from Chartis Insurance Company after falsely reporting that he suffered a work-related injury. Investigators found that he told his girlfriend and her mother that he was going to fake the injury so he could go to Florida. Co-workers corroborated that he did not hurt himself. He is charged with insurance fraud in the third degree and workers comp fraud.
Oneida County — William Ellis, 43, of Utica, admitted working for a construction company from 2004 through 2007 doing roofing, siding, plumbing and masonry while collecting $15,000 in benefits from NYSIF for an injury he suffered while working for a paving and excavating company in 1993.
Oneida County – William O'Neil, 30, of Rome, is accused of collecting $1,790 in benefits from 21st Century North American Insurance Company while working for a moving company. He was collecting benefits after suffering an injury while working as a carpenter. He is also accused of giving false testimony at a workers compensation hearing and causing a false independent medical examination report to be prepared and filed as part of his claim. He is charged with perjury in the first degree and workers comp fraud.
Ulster County — Sergio Cortez, 37, of Rosendale, collected $6,800 in benefits from NYSIF after claiming he suffered a slip and fall injury while working as a carpenter for ABD Stratford LLC in September 2009. However, investigators found that he was working as a landscaper while collecting benefits. He is charged with insurance fraud in the third degree and workers comp fraud.
Ulster County — Willie Dixon, 47, of New Paltz, collected benefits from NYSIF for an injury he reportedly suffered while working for the New York State Office of Family and Children Services in May 2010. An investigation revealed he failed to disclose on work activity reports that he was employed as a coach while collecting $4,700 in benefits. He is charged with insurance fraud in the third degree and workers comp fraud.
Ulster County – James Roy, 51, Hyde Park, is accused of attempting to collect benefits after falsely reporting that he suffered a work-related injury while employed by a tool-making company. He claimed that the injury occurred when he slipped on ice in the company’s parking lot, but witnesses contradicted his claim. He never received compensation because his claim was discovered to be false before benefits were issued. He is charged with workers comp fraud.
Otsego County — Susan Gridley, 61, of Schuyler Lake, started collecting benefits after an injury she sustained while working at a horse farm in 1986. She later failed to disclose on work activity reports submitted to the NYSIF that she was working as horse boarder and trainer while collecting $4,700 in benefits.
Oswego County — Kimberly Harrington, 53, of Lacona, is accused of cashing her dead husband’s workers comp benefit checks totaling $2461.90. The checks were issued by the NYSIF. She is charged with grand larceny in the fourth degree.
Warren County — Jeffrey Hamblin, 45, of Glens Falls, reportedly suffered a knee injury while employed as a truck driver for HR Logic/Doberts Dairy in November 2001. An investigation revealed he was employed as a general contractor for Painters Plus and worked for a doctor while collecting $7,700 in benefits from Liberty Mutual Insurance Company. He is charged with falsifying business records in the first degree and insurance fraud in the third degree.
Chenango County – Patricia Wilcox, 60, of Oxford, started collecting benefits from NYSIF after claiming she suffered a broken ankle while working as a teacher’s aide at the Chenango County Head Start program. Investigators found that her injury actually occurred at her home. She fraudulently collected $12,900 in benefits. She is charged with falsifying business records in the first degree and workers comp fraud.
Tompkins County – Steven Odum, 65, of Ithaca, is accused of failing to disclose work activity as the lead guitarist with the “Steve Odum Trio” on reports he sent to the NYSIF while collecting $11,300 in benefits after suffering an injury in 1988 while working at a residential child care institution. He is charged with offering a false instrument for filing in the first degree and workers comp fraud.
Clinton County – Leonard Drown, 63, of Morrisonville, is accused of collecting $25,500 in benefits from Pennsylvania Manufacturers Association Insurance Company after claiming that he was not working because of an injury. Investigators found that he was, in fact, working while collecting the benefits. (WCxKit)
Broome County – Olga Shelestovsky, 43, of Johnson City, is accused of working as a waitress while collecting $2,200 in benefits from NYSIF and claiming that she was unable to do any physical work. She is charged with offering a false instrument for filing in the first degree and workers comp fraud.
All of the accused are innocent until proven guilty.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He recommends the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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