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You are here: Home / Claim Management / Fight Workers Comp Fraud & Abuse / Housekeeper Jailed for Alleged Work Comp Fraud Caught After Bragging About Fooling Insurance Company

Housekeeper Jailed for Alleged Work Comp Fraud Caught After Bragging About Fooling Insurance Company

February 1, 2010 By //  by Robert Elliott, J.D. Leave a Comment

A woman  was taken into custody at her home by police, the day after a district judge signed a warrant for her arrest and authorized a $100,000 bond. She is alleged to have collected more than $25,000 in workers’ compensation payouts after making alleged fraudulent claims about how she hurt her ankle. The worker is being held in jail on suspicion of felony counts of theft, making false statements and forgery. 

A former housekeeper  at a local hotel, the woman claimed she fell in April when trying on a pair of shoes she had discovered at the hotel’s “lost and found” repository according to an affidavit. A doctor assessed the injury as a minor sprain and gave her an air cast. According to authorities, the woman delayed reporting the injury for nearly a month. Three days later, a doctor recommended surgery after tests revealed further damage to the ankle, and the surgery took place  in June, according to the affidavit.


The woman
 started receiving temporary partial disability and wage replacement benefits from Pinnacol Assurance, and to date she has received $25,509, according to the affidavit.

Investigators
 with Pinnacol Assurance began researching the woman's story in August when, following a tip that she had “been bragging that she had fooled the insurance company into paying for her injury and that it was not work-related.,”

The woman's work
 supervisor said the suspect repeatedly told her in April or May the injury wasn’t work-related, but later said she tripped over linens while on the job. Despite the conflicting accounts, the claim went forward. According to the supervisor, “It’s the employer’s policy to file a claim when an injured worker reports it to be work-related, despite any concerns, and then later advise of possible fraud to Pinnocal Assurance.” Another hotel worker said the suspect in April or May said she “had got really drunk and fell on a curb.”

Authorities say
 the woman initially claimed her on-the-job fall was witnessed by another woman, who, when interviewed by an investigator, denied seeing anything. The same woman said the suspect told her she hurt her ankle while walking into a nightclub on April 16, the day before she insisted she hurt herself on the job ,according to the affidavit. (workersxzcompxzkit)

The woman's  supervisor told an investigator with the Colorado Attorney General’s office the woman’s personal health insurance was at its “lowest level” at the time of her injury, covering about $1,500 and leaving the remainder for her to pay.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/index.php


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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: Fight Workers Comp Fraud & Abuse, Litigation Management Tagged With: Legal Issues: Employers & Employees

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