Maintenance Worker | Felony Insurance Fraud Charges Filed

Los Angeles County, Calif., January 3, 2018 — This case involves a 48-year-old male maintenance worker who filed a workers’ compensation claim alleging a specific right knee injury sustained as a result of carrying a dresser down some stairs while working. The claim was immediately reported and benefits initiated.

After a period of time, with no indication of improvement, fairly significant ongoing subjective complaints, and a tip from the insured suggesting the claimant might be working as a contractor, Argus West was called in to initiate a surveillance investigation. Surveillance conducted over the course of several days found the claimant engaging in physical activities inconsistent with medical reporting. The claimant was exceeding restrictions and also performing work as a painter. He was found repeatedly traveling to a private residence where he used tools, went up and down ladders, and painted exterior fixtures.

In direct contrast to the surveillance evidence, the claimant told the insured he was in too much pain to return to work. He told his medical providers he had significant symptoms and was not working. He also told the field investigator who interviewed him that he had not performed any work of any type since his injury.

Argus West SIU prepared a full Documented Referral Package to the Los Angeles County District Attorney’s Office on January 3, 2018. Felony insurance fraud charges were filed on September 7, 2018 and the claimant’s arraignment is pending. The final restitution figure is pending conviction but estimated at approximately $21,982.