I bring you the story of another “successful” fraud prosecution, this one of Yeimi Espinoza, as reported by WorkCompCentral.
Espinoza pleaded guilty to one count of “concealing or failing to disclose an event in order to receive benefits.” To wit, she testified that she had no other employment even though surveillance conducted earlier on the day of her deposition showed her working in a field.
She was ordered to pay $11,238 in restitution and was placed on probation for one year.
The trigger for the investigation? Espinoza was “reportedly observed working in a blueberry field.” That’s a lucky catch and not a systemic response.
While this certainly may have helped offset some of the wrongfully imposed costs on her employer’s insurer and likely damaged her credibility as to her claim, I must sadly reflect that this result seems a limited deterrence to the workers’ compensation population at large. When one is caught with one’s hand in the cookie jar, simply releasing the cookie and going on as if nothing happened is unlikely to dissuade the next cookie bandit.
I hope that in the future, we can see the California Legislature take a break from its crusade to drive out any remaining business in the state to help protect the population at large from fraud.
As we all know, workers’ compensation fraud has a seemingly endless list of victims. Insurers and employers are cheated of resources. Employees with legitimate claims are seen more skeptically because of the prevalence of fraud. Prices on consumers go up to cover the cost of absorbing, investigating, litigating and punishing fraud.
I tip my hat to Intercare for investigating and referring this case, and to the district attorney for taking up the case and prosecuting it. Another reminder of our never-ending duty of vigilance.
Gregory Grinberg is managing partner of Gale, Sutow & Associates’ S.F. Bay South office and a certified specialist in workers’ compensation law. This post is reprinted with permission from Grinberg’s WCDefenseCA blog.
Dec 9, 2021 – Sep 9, 2022
The Business Insurance Women to Watch Awards is the only recognition program that celebrates leadi …
Aug 21-24, 2022
The Workers’ Compensation Institute (WCI) is a nonprofit educational organization that serves as a …
Sep 6-9, 2022
When there is teamwork and collaboration, wonderful things can be achieved. ?The WCRC has a missi …