Three Strikes, You’re Out

219
hand holding American dollar currency isolated on blurred blackground injured woman with broken hand and green cast on arm, insurance health concept.

An Oxnard, California woman tried to file multiple workers’ compensation claims for injuries to the same body parts over 13 years. Following the third attempt, she struck out after her employer discovered she was attempting to commit workers’ compensation fraud.

The Californian, who worked for an insurance company as a field worker in Oxnard, filed a workers’ compensation claim stating she had received injuries to her back, neck and knees. (It would be interesting to know how that injury occurred. Who knew that being an insurance field worker was such a dangerous job?) She qualified for workers’ compensation benefits and began receiving medical treatment for her injuries plus temporary total disability benefits from her employer.

Here’s where she got into trouble. She lied three times – once to her physicians, then to a Qualified Medical Examiner, and finally during a deposition. She denied that she had filed prior workers’ compensation claims regarding injuries to the same body parts. (She filed and settled two previous workers’ compensation claims for the same body parts in 2002, 2010 and again in 2015.)

 It looks like the third lie was also her third strike. (Her employer cried, “foul.”) The insurance field worker from Oxnard pleaded guilty to workers’ compensation fraud and was sentenced to three years of probation. She has already paid restitution in the amount of $9,333.50 and will serve 150 days in the Ventura County jail as a condition of her probation sentence.

Today’s “Fraud of the Day” is based on an article, CA: Oxnard Resident Sentenced in Workers’ Compensation Insurance Fraud Case,” published by WorkersCompensation.com on August 22, 2019.

Ventura, CA (WorkersCompensation.com) – – District Attorney Gregory D. Totten announced today that Ernestina Rodriguez (DOB 2/27/1963), of Oxnard, was placed on formal probation for a period of 36 months after having pled guilty to a felony violation of lnsurance Code section 1871.4(a)(l), making a false or fraudulent statement of a material fact for the purpose of obtaining workers’ compensation benefits. She had previously made restitution in full to the victim, Zenith Insurance Company, in the amount of $9,333.50 and will serve 150 days in the Ventura County jail as a condition of probation.

Rodriguez was employed as a field worker in Oxnard and filed a workers’ compensation claim for injuries to her back, neck, and knees on February 14, 2015. She was placed off work and began receiving medical treatment and temporary total disability benefits provided by Zenith Insurance. During the time she received treatment, she denied to her treating physicians, a Qualified Medical Examiner, and at a deposition that she had ever filed any prior workers’ compensation claims involving the same body parts as she was claiming in February 2015. In fact, the defendant had filed and settled two prior workers’ compensation claims for the same body parts in 2002 and 2010. Her material misrepresentations affected the way her claim was apportioned and caused Zenith Insurance to pay her $9,333.50 in benefits that she was not entitled to receive.

SHARE
Previous articleStretching a Dollar
Next articleDefining Necessary
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.