Dishwasher | Felony Insurance Fraud Charges Filed

Los Angeles County, Calif., April 2018 — This claim involves a 62-year-old male Dishwasher who filed a workers’ compensation claim alleging cumulative trauma injuries to multiple upper and lower extremities, his trunk, internal injuries and injuries to his eyes as a result of performing work from April 15, 2015 to April 15, 2016.

The claimant last worked for the insured on or about April 15, 2016 but then simply abandoned his job with no explanation. At no point during the course of his employment did he report sustaining any work-related injuries, but approximately two months after he stopped showing up for work, the claimant retained counsel and filed this claim.

To his treating physicians, the QME and during the deposition, the claimant consistently denied having prior work-related injuries, including prior problems with or treatment to the body parts alleged in the claim. Argus First was called in to assist with this case. In direct contrast to his reported history, Argus First identified and obtained records from the WCAB, which revealed the claimant had a prior workers’ compensation claim involving the same body parts. Argus First also identified a prior non-industrial slip and fall injury deemed to be severe, which resulted in multiple surgeries and permanent disability.

The QME issued a very favorable report to the defendants that found no evidence of an industrial injury and opining the claimant is not credible, since his issues were obviously pre-existing. Argus First SIU issued a full Documented Referral Package to the Los Angeles County District Attorney’s Office on March 22, 2017. Felony insurance fraud charges were filed on April 9, 2018, and the arraigned took place on May 18, 2018. The final restitution figure is pending conviction and is estimated to be approximately $25,900.