Woman Sentenced in Massachusetts Insurance Fraud Case

Workers’ compensation fraud is not limited to instances in which a worker fakes an injury in order to make money. It can also exist where a person has a legitimate injury, but lies about the extent of the injury or lies about whether or not she has recovered or lies about her capacity to work. When investigating workers’ compensation insurance fraud, investigators may use a number of different methods to figure out whether the claimed injury is a legitimate one. An investigator may use surveillance, interviews, background checks, and even your social networking accounts, such as Facebook, Twitter, Tumblr or Instagram.

Surveillance can include the use of private investigators who watch your home to see whether there are actions you are able to do that you have claimed you are unable to do. For example, if you have claimed you have a serious back injury and then lift weights or do heavy yard work, your credibility may be called into question. Background checks can include a check into your past medical history and your past jobs to see whether there is a pattern of taking advantage of systems put in place to help workers. The background checks may include talking to past employers.

Earlier in September, a 39-year-old woman pled guilty to perjury and fraudulently collecting workers’ compensation benefits. The woman started getting workers’ compensation benefits after a legitimate work injury in 2005. However, two years later she started a home daycare business and continued to collect more than $5000 in workers’ compensation benefits. She earned more than $5000 over several months.

In August 2007, the woman submitted an employee earnings report to her employer’s insurer certifying no earnings for the prior six months. The woman also lied under oath at the Department of Industrial Accidents (DIA) hearing. In Massachusetts, workers’ compensation benefits are administered by the DIA. At the hearing, she claimed she had no earnings for the prior six months.

However, at a later DIA hearing and when personally interviewed by investigators in 2012, she admitted she had run a daycare business while collecting benefits. An administrative judge at DIA referred the matter to the attorney general’s office when he determined she had lied under oath.

She was indicted by a grand jury in 2013 and pled not guilty initially. She was released from custody. However, she pled guilty this September.

The assistant attorney general who prosecuted the woman recommended she be sentenced to 2 1/2 years in the House of Correction with only one year to be served and the rest of the sentence suspended with 3 years probation. She also recommended restitution.

The woman’s attorney claimed that she had serious personal problems at the time of the fraud. The judge placed the woman on probation for five years and ordered more than $5000 in restitution.

The Insurance and Unemployment Fraud Division investigates and prosecutes those who defraud any type of insurer. In this case, it investigated the woman in connection with the workers’ compensation system. One reason for the vigorous prosecution of insurance fraud is that defrauded insurers must increase premiums in order to cope with fraudulent claims. In 2012, the department acquired over $1.6 million in restitution orders related to insurance fraud.

If you are injured at work, an experienced Massachusetts workers’ compensation attorney may be able to help you obtain benefits and advise you on next steps. Contact us by calling 800-367-0871 or using our online contact form.