Plumber Claimant | Felony Insurance Fraud Charges Filed

Napa County, Calif., September, 2018 — This case involves a 57-year-old male plumber who worked for the insured from August 2016 until approximately July 2017. The claimant filed a workers’ compensation claim for an injury to his back, which was sustained when he struck it against a slab of marble at a jobsite. Although he initially declined treatment, he later requested treatment, and the claim was reported to the carrier. Benefits were then initiated, since the insured did not dispute the claim.

After a period of no reported improvement, claimant consistently reporting highly subjective complaints, and the claimant’s failure to return to modified duty work that the insured was making available, Argus West was called in and a surveillance investigation was initiated. Surveillance conducted on multiple days in August and October of 2017 found the claimant engaging in contractor-type employment activities, including visiting numerous private residences where construction was taking place and wearing work attire while carrying and using various tools and equipment.

In direct contrast to surveillance, medical reporting reflected the claimant denied working, demonstrated significant limitations, and reported constant pain. In addition, during his December 6, 2017 deposition, the claimant testified he had not performed any work or employment activities for anyone since approximately June/July 2017.

Argus West SIU prepared a full Documented Referral Package to the Napa County District Attorney’s Office on January 22, 2018. Felony insurance fraud and perjury charges were filed on September 13, 2018 and the claimant’s arraignment is pending. The final restitution figure is pending conviction and is estimated at approximately $25,261.