Sewing Machine Operator  | Felony Insurance Fraud Charges Filed

Los Angeles County, Calif., April 11, 2018 — This case involves a 44-year-old female Sewing Machine Operator, who is alleging a cumulative trauma injury to her back, shoulder, knee, ankle, hand, hips, and other multiple body parts, and also stress. The claim was denied.

Throughout the course of her medical treatment, the Claimant reported significant complaints of pain and injury, causing her treating physician to deem her Temporarily Totally Disabled.

Argus West Surveillance found the claimant to be active and engaging in employment activities, doing work similar to what she did for the insured.  Subpoenaed records and further investigation confirmed suspicions that the claimant was engaging in employment activities, which overlapped the period of EDD-SDI benefits she was receiving. Throughout the course of the claim, the claimant consistently denied engaging in employment activities prior to being released from care. She further denied prior injuries and treatment to the same body parts, despite repeated questioning regarding that issue from treating physicians and the QME.   The claimant testified at four depositions, changing her story each time. Ultimately, the QME found the Claimant lacked credibility and found no periods of disability and no need for future medical care.

Argus First SIU prepared and submitted a full Documented Referral Package to the Los Angeles County DA’s Office on May 3, 2017.  Criminal charges were filed on April 11, 2018 and an arrest warrant is pending. The final restitution figure is pending conviction, but is estimated to be upwards of $90,000.00.