For a pair of California residents, the law has paid them a visit.
In the first case, Jackie Sebastian, 60, from San Jacinto was taken into custody in May by Department of Insurance detectives.
Sebastian, a postal service mail processing clerk, is facing felony insurance fraud and grand theft charges for submitting 249 false claims for mileage reimbursements associated with an allegedly fraudulent workers compensation claim.
“Some individuals are under the misconception that cheating the workers’ compensation system a little bit is not going to land them in trouble,” said Commissioner Dave Jones. “These small deceptions can quickly add up to a significant amount of money. Honest consumers are punished for these crimes by paying increased premiums to make up for the fraud loss.”
Defendant Filed Claim for Nearly $66K
A joint investigation revealed that Sebastian had filed a workers comp claim for $65,273.43 for transportation costs associated with mileage to and from her medical appointments.
Sebastian filed a total of 249 claims and received $13,990 for mileage reimbursement, which according to department detectives was not associated to any legitimate medical or pharmacy visits.
If convicted Sebastian faces a maximum of five years in jail, a possible fine and full restitution.
In another case, a former Los Angeles Unified School District police officer, Pedro Plascencia, 48, of Canyon Country, was arrested this spring for workers comp fraud.
Plascencia is being charged with presenting a false material statement, concealment, and perjury for attempting to defraud the insurance company by exaggerating the extent of his injuries.
Plascencia allegedly sustained a work-related injury while patrolling the school campus on his patrol bicycle he ran over a wayward cantaloupe and lost control of his bicycle. Plascencia originally claimed injury to his right knee, right foot and right hand, but after obtaining legal counsel he added injury to his back, hips and both knees. Plascencia originally denied any prior medical injury, however subpoenaed medical records indicated that Plascencia, did in fact, sustain prior injuries to those body parts.
Plascencia’s permanent disability finding was changed when the treating doctor was supplied with the medical records reflecting the true injury history.
Had the department not stepped in and assisted Plascencia would have unfairly received approximately an additional $15,000 in permanent disability benefits.
Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com. Contact: [email protected].
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