If you could ask employers “what does the workers’ compensation fraudster look like?” they would probably describe a burly guy who did manual labor, was out of shape and didn’t like to work. They would be wrong.
Fraud Not Limited By Gender, Age, Race, or Type of Occupation
People who commit workers’ compensation fraud are not limited by gender, age, race or type of occupation. Take for instances the example of Shawna Lynn Palmer, age 22, of Long Beach, CA. Ms. Palmer worked for the Stater Brothers grocery store in Riverside, CA as a supermarket clerk.
Per the California Department of Insurance, Palmer reported on March 10, 2014 that she had fractured a toe on her left foot. Due to her injury, she could not put weight on her foot or wear a shoe. Palmer obtained from her doctor a special orthopedic shoe and crutches. Initially, Palmer was instructed to stay off work until March 19, 2014, nine days after the injury. At her second medical appointment and subsequent medical appointments, Palmer continue to complain of pain and the inability to wear a shoe. The doctor kept her off work until recently.
Palmer’s slow medical recovery became a concern for the workers’ compensation insurer. Even though Palmer continue to report that she was unable to stand on her injured foot, the insurer’s investigation, followed by an investigation by the California Department of Insurance told a different story.
Claimant Participating In Beauty Pageant Wearing Bikini & Stilettos
Palmer had participated in several area beauty pageants including three in March – March 14th (4 days after the injury), March 19th and March 27th. At the March 14th beauty pageant, Palmer was photographed posing in a bikini and a pair high stilettos.
Following the March 14th beauty pageant, Palmer returned to the doctor for a second visit. Palmer continued to complain of pain and the inability to stand on her foot at this doctor’s visit and at subsequent doctor visits. The doctor kept Palmer off work due to her painful injury.
Palmer would continue to stay off work, collecting indemnity benefits, and spend her time competing in more beauty pageants. Palmer was proud of the fact that she won third place in the Harley Davidson bikini contest on July 3, 2014. She posted to her Facebook page a picture of her and the other contestants. She was wearing a black bikini and her towering black stilettos shoes. In her Facebook post, Palmer thanked her family, friends and boyfriend for their support in the beauty pageants.
In the meantime, Palmer settled her workers’ compensation claim for $24,000 as she continued to claim she was unable to put any weight on her foot or to wear any shoes.
Investigation Locates Pageant Photos & Video, Claimant Arrested
The reader may remember the Amaxx article about insurance adjusters turning to Social Media to defeat workers’ compensation fraud. The Facebook post with Palmer standing without any difficulty in her high black stilettos was soon discovered by the insurance company, as they had begun their own investigation into why the toe injury was taking so long to heal.
As the investigation continued a You Tube clip of Palmer competing in the April 10, 2014 Miss Toyota Long Beach Gran Prix beauty contest was discovered. The video clip showed her walking, without any difficulty, across the stage wearing high heels.
The insurance company referred the matter to the California Department of Insurance. Bryon Tucker of the state’s deputy insurance commissioner office told a local news organization “…here’s a young lady who had beauty….but it really didn’t add up on the brains side of it.” “She lied to her employer, she lied to her doctor, she lied to a lot of people”. “She eventually got arrested and busted for this.”
Palmer was booked on three counts of insurance fraud and has been released on $5,000 bail. She is facing a court date of October 3, 2014 in the Riverside County Superior Court. If convicted of insurance fraud, Palmer could receive a sentence of one year in county jail, three years of probation and be required to pay up to $24,000 in restitution.
Never Assume And Do Not Delay Investigation
The next time you think you know what a work comp fraudster looks like, remember the serial beauty pageant contestant. Ryan Pischke, Executive Vice President at GCS Nationwide Investigative Services states “Unfortunately in our industry, often we see an employer wait 6-9 months to do any type of investigative work on cases like this. Through the use of proactive investigative resources, such as social media investigations or a medical canvas, at the onset of a claim or very shortly thereafter, employers can save themselves time spent on the claim as well as thousands of dollars in undue payout to the claimant, and all for less than the cost of a trip to the ER “
All workers’ compensation claims should be considered legitimate but be properly investigated. If you need any assistance with your workers’ compensation fraud prevention program, please contact us.
Author Michael B. Stack, CPA, Principal, 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. http://reduceyourworkerscomp.com/about/. Contact: [email protected].
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.
