Janitorial Worker | Felony Insurance Fraud Charges Filed

Los Angeles County, Calif., April 11, 2018 — This claim involves a 30-year-old female who worked for the insured as a full-time Janitor from March 20, 2013, until April 14, 2016, at which time her employment was ‘terminated-for-cause,’ stemming from customer complaints and a suspicion of theft. A coworker to the claimant was also let go for similar reasons.

Three years previously, on November 14, 2015, the claimant was involved in a Motor Vehicle Accident on her way to work. She did not report any injuries to the insured and continued with her customary job duties. During her employment with the insured, the claimant did not report any injury or illness arising from the performance of her job duties.

Five days after after her employment was terminated, the claimant retained counsel and filed two Workers’ Compensation claims, alleging multiple injuries from both the MVA and her customary job duties. From the initial medical treatment on April 27, 2016, the claimant reported significant discomfort and limitations, resulting in her treating physician deeming the claimant ‘TTD/unable to work.’ In addition, during the her deposition, the claimant reported significant subjective complaints and limitations, denying any subsequent work activities, post-termination.

Argus West conducted surveillance in July of 2016, and found the claimant to be engaged in physical activities exceeding her reported limitations and without any apparent discomfort. The claimant appeared to be performing cleaning duties at a residence, which matched a client of the insured where the claimant was assigned during her employment with the insured.

It is interesting to note that the claimant’s coworker who was let go the same day, retained the same counsel and filed WC claims almost identical to those filed by the claimant. During surveillance, the two were often seen together, exceeding their reported limitations and showing no apparent discomfort. Both claimant’s testified in depositions that they had not seen each other after termination.

Argus First SIU prepared and submitted a full Documented Referral Package to the Los Angeles County District Attorney’s office on December 20, 2016. Criminal charges were filed on April 11, 2018, and an arrest warrant is pending. Argus West was involved in locating and interviewing a coworker who had moved to Hong Kong. Argus West subsequently obtained an admission/confession from one of the claimants. the final restitution figure is pending conviction and is estimated to be approximately $36,419.