Monday, November 2, 2015

10 charged in workers’ comp fraud cases since 2013

PROVIDENCE, R.I. (WPRI) — Out of the dozens of tips state investigators receive each year alleging workers’ compensation fraud, only a handful lead to criminal charges.
In 2013, the R.I. Department of Labor and Training (DLT) began funding a prosecutor’s position to work directly with the attorney general’s office. Since that time 67 tips have been examined by DLT investigators and 10 of them have been referred to the attorney general’s office for prosecution; all have resulted in no contest pleas. None of the defendants received jail time.
The stiffest sentence was for Elizabeth Adams, who began collecting workers’ comp benefits after she said she hurt herself working for a roofing company in 2010.
Liberty Mutual, the insurance company paying Adams’ benefits, hired a private investigator, citing inconsistencies in her story, according to court documents.
Prosecutors said video showed Adams arriving at Workers’ Compensation Court on crutches, but earlier in the day she was seen on tape entering a corner market crutch-free. Adams was also videotaped making improvements on her house and moving a large carpet.
The video was shown to one of the doctors who had diagnosed her, and he “found there were gross inconsistencies from his exam.”

“He determined she was capable of returning to full duty as a roofer without restrictions,” prosecutors wrote.
Slip Slidin' Away chart
Interactive Chart: Compare workers’ comp claims made by state employees vs. claims made by all employees statewide »
Adams – whose attorney declined comment – eventually pleaded no contest to one count of obtaining money under false pretense. She was sentenced to two years of home confinement, six years of probation and ordered to repay $12,000 in restitution.
Amy Kempe, a spokesperson for Attorney General Peter Kilmartin, said $6,159.17 of that restitution went to pay for the private investigator who tailed Adams.
By law, any allegation of workers’ comp fraud is forwarded to the DLT by insurance companies which investigated the claim. Often the evidence gathered by the insurance company is used in a criminal case, as it was in the Adams prosecution.
DLT spokesperson Mike Healey said combating fraud is a major priority for the agency.
“Our job is to make sure that the system works for everybody and a big piece of that is accountability,” Healey said. “We do not tolerate fraud and abuse and we have a process and a system to deal with that.”
Healey said DLT has a five-person fraud and compliance unit, but the majority of the cases they handle are checking to make sure employers are paying into the workers’ compensation system.
Q&A: Tim White discusses the increase in taxpayer spending for workers’ compensation claims by state employees »
Q&A: Tim White discusses the increase in taxpayer spending for workers’ compensation claims by state employees »
In 2014, for example, 97 employers were penalized for failing to carry workers’ compensation insurance, while three employees were charged with illegally collecting benefits for claiming job-related injuries.
“The burden of proof in a fraud case is very high,” Healey said.
The prosecutors assigned to workers’ comp cases also handle fraud cases involving unemployment and temporary disability insurance (TDI) benefits.
“Any labor-related case that starts at DLT we can turn to Attorney General Kilmartin’s office and go to our prosecutor and say, ‘Here’s a case that we’ve screened and prepared for you to prosecute,'” Healey said. “It’s been a very productive partnership.

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