The FirstComp Special Investigation Unit (SIU) is dedicated to fighting claimant fraud. The team works extensively with Department of Insurance Fraud Bureaus, State Attorney Generals, and District Attorneys across the country to ensure successful criminal convictions for claimant fraud. In 2009 the SIU assisted in bringing 11 suspects to justice by obtaining 11 convictions for fraud. These convictions are great news for Tim Chlebinski, FirstComp manager. “The Special Investigation Unit team is dedicated to fighting fraud that ultimately impacts policyholders and businesses,” says Chlebinski. Below are just a few examples of claimant fraud suspects brought to justice with the help of the FirstComp SIU.
San Diego Claimant Indicted for Six Felony Counts including Insurance Fraud
On March 22, 2010, the San Diego District Attorney’s Office indicted Mario Noe Sanchez for violating California Penal Code 550 – Insurance Fraud. In addition, the DA’s office charged Sanchez with an additional five felony counts of attempted perjury under California Penal Code 118. An investigation revealed that Sanchez exaggerated his injuries in a claim filed on June 27, 2008. While receiving benefits for the claim, Sanchez also worked as a security guard. This type of claimant fraud is commonly referred to as “double dipping.” He was arraigned on April 27, 2010. Suspects are considered innocent until convicted by a court of law.
Mechanic Convicted of Insurance Fraud
On April 14, 2010, Charles Highfill, Jr., a claimant in Lexington, South Carolina, pled guilty to insurance fraud for violating South Carolina Section 38-55-540 “Making false statements to an insurance company.”
Highfill filed a claim on Monday April 14, 2008 stating he injured his elbow while working as a mechanic for Ken’s Repair Service. Based on a number of fraud “red flags,” investigators closely examined the details of the claim and discovered that Highfill had been injured the previous weekend while climbing a tree in a neighbor’s yard. This type of claimant fraud is commonly referred to as a “Monday morning injury.” By claiming the injury occurred at work, Highfill intended to be off work while receiving workers’ compensation benefits. Highfill served two days in jail for the conviction and was ordered to pay restitution.