A Fallen Fraudster

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Closeup rear low angle view of an early 60's senior gentleman having some back pain. He's at doctor's office having medical examination by a male doctor. The patient is pointing to his lumbar region.

California resident Fernando Torres Garcia was recently arraigned at the Kern County Superior Court after surrendering in early October. Garcia faces nearly a dozen counts of insurance fraud which alleges that he lied to his employer and the Federal Government in an attempt to receive workers’ compensation insurance benefits.

Garcia reported to his employer that he had injured his lower back and hip after slipping while working in a trench to repair a water line. (Sounds reasonable.) This injury occurred on July 16, 2018 and subsequently, he was diagnosed with a lumbar strain and placed on modified duty.

The employer accommodated Garcia’s condition and recognized the limitations caused by his injury. Garcia continued to see a doctor for pain management and claimed that he was not improving from August 2018 to March 2019. (This seems like a long time to be injured for someone who was in otherwise good health.)

Garcia’s continued complaints led to him amending his original workers’ compensation claim to encompass his entire back, right hip, right thigh, right leg, right elbow, both knees and cumulative trauma. ( He should have thrown in some emotional trauma from falling flat on his behind.)

The California Department of Insurance conducted surveillance on Garcia to investigate the claims that he was not improving. The investigation rendered that Garcia had been able to lift heavy objects multiple times and did not appear physically impaired. (That does seem suspicious.) The investigation and surveillance expenses reportedly totaled $5,873.50.

An orthopedic evaluation was also performed which revealed that Garcia had a maximum rating of five percent impairment for his lumbar (I think I have more impairment than that from slouching over my desk). This low percentage added to the suspicion that Garcia was lying about the amount of pain he was experiencing.

Garcia underwent a Panel Qualified Medical Evaluation on June 21, 2019 to determine his qualifications for permanent disability or ratable impairment. The evaluator took into consideration Garcia’s medical records and initial claim, the surveillance footage, and the orthopedic doctor’s evaluation. (What is more credible? Someone looking for a payday or hard evidence?)

The evaluator determined that Garcia was not eligible for permanent disability and that he believed Garcia greatly exaggerated his injuries to his employer and to medical professionals. (What a shock.) Garcia is considered innocent until proven guilty but will face insurance fraud charges in Kern County, Ca. for his alleged misrepresentations.

Today’s Fraud of the Day comes from an article, “California Nursery Worker Arraigned for Alleged Workers’ Comp Fraud,” published by Insurance Journal on October 2, 2020.

Fernando Torres Garcia, 46, self-surrendered and was arraigned at the Kern County Superior Court in California this week on nearly a dozen felony counts of insurance fraud after allegedly misrepresenting an injury in order to receive undeserved workers’ compensation insurance benefits.

On July 16, 2018, Garcia allegedly reported to his employer that he injured his lower back and hip after he slipped while working in a trench to repair a water line.

 

 

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.