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You are here: Home / Medical Cost Containment / Coordinating Medical Care / Independent Medical Exam Uncovers Workers Compensation Fraud

Independent Medical Exam Uncovers Workers Compensation Fraud

December 23, 2009 By //  by Robert Elliott, J.D. Leave a Comment

A Florida man pled guilty in Suffolk Superior Court to charges he schemed to collect falsely workers’ compensation benefits and lied under oath. The defendant, formerly from Massachusetts, pled guilty to two charges of charges of workers’ compensation and perjury. The defendant collected a total of $3,960 in workers’ comp benefits to which he was not entitled.

The man was injured while working as an asbestos technician in Massachusetts. He applied for and received receiving total disability benefits from his employer’s insurance company from December 2003 through March 2004. During part of this time, he was employed full-time with a new employer.

The man’s total disability benefits were terminated in April 2004 as a result of an Independent Medical Examination (IME), which cleared him to work without restriction. In an attempt to obtain partial disability benefits for his December 2003 injuries, he reopened his claim in March 2005 and was subjected to a second IME, at which time he underreported his work hours despite being employed full-time with a new employer.

As the result of a modification hearing held by the Massachusetts Department of Industrial Accidents (DIA) in May 2005, ordered the original employer’s insurance company to provide partial disability benefits to the individual while he was working full-time. At this hearing before the DIA, the man gave false testimony regarding his work hours and duties with this new employer.

The insurance company conducted an investigation and found multiple discrepancies between the Employee Earnings Report (EER) submitted by the individual in June 2005 and records of his employment at the second employer, including his dates of employment, hours worked and job classification. (workersxzcompxzkit)

Following a guilty plea, the court sentenced the defendant to one year in the House of Correction on the fraud count, with the three-year perjury sentence suspended. On the two counts of workers’ compensation fraud, he was sentenced to three years probation and was ordered to pay $3,960 in restitution.

“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.

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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.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@WorkersCompKit.com

Filed Under: Coordinating Medical Care, Fight Workers Comp Fraud & Abuse, Litigation Management, Medical Issues Tagged With: Independent Medical Evaluations

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