5/07/2009 San Francisco County Arrest

The claimant testified during deposition that he doesn’t drive due to lack of right hand grip, and that he has not worked since date of  injury. Probe’s surveillance team found the claimant driving, and working at a construction site. The claimant was charged with three counts felony insurance fraud after Probe’s investigation revealed evidence that claimant was working while collecting workers’ compensation benefits.

4/28/2009 Felony Insurance Fraud in San Joaquin County

Surveillance found the claimant exceeding her restrictions while on TTD. Based on this, the claimant made material misrepresentations to medical providers, as evidence by surveillance, to obtain benefits that she was not entitled to. Probe referred the case to the San Joaquin District Attorney on suspicion of fraud, and the claimant was charged with two counts felony insurance fraud.

4/08/2009 Felony Forgery in Contra Costa County

The claimant faces three felony counts including forgery and fraud after attempting to cash a TTD check he reported as “lost” and the replacement TTD check. Probe’s SIU referred the case to the Contra Costa District Attorney for attempted theft.

4/01/2009 Santa Clara County Conviction

Probe’s Surveillance team conducted multiple days of surveillance which found the claimant performing at a higher level of physical capability than expressed in her deposition. The insured was willing to accommodate any modified restrictions; however the claimant stated that she was not able to work at a modified capacity. The claimant made numerous material misrepresentations regarding her employment status and physical capabilities to medical providers. Probe’s SIU referred the case to the Santa Clara County District Attorney. The claimant pled guilty to felony insurance fraud and she paid $20,000 in restitution.

3/31/2009 Sacramento County Arrest

Surveillance captured the claimant working outside of his restrictions. Probe’s SIU presented the film to the claimant’s doctor who reported that the claimant was capable of returning to work. The claimant made numerous verbal and non-verbal material misrepresentations regarding his physical capabilities and employment status during medical appointments and during a recorded statement in order to obtain TTD benefits that he was not entitled. Evidence was presented to the Sacramento County District Attorney’s Office and the claimant was arrested for felony insurance fraud.

2/19/2009 San Joaquin County Conviction

Surveillance found the claimant working outside of his restrictions. The claimant made material misrepresentations to the claims adjusters and medical providers, regarding his work status and outside income, to obtain benefits which he was not entitled to. Probe’s SIU presented this case to the San Joaquin County District Attorney. The claimant was convicted of felony insurance fraud, sentenced to 3 years probation, and paid $28,000 in restitution.

1/22/2009- Yolo County Arrest

Surveillance found the claimant performing activities outside of his restrictions. The claimant's recorded statement was obtained and he denied the ability to perform activities observed on surveillance video. The claimant made material misrepresentations regarding his physical limitations in order to obtain disability benefits that he was not entitled to. The claimant was arrested and charged with 6 counts of felony insurance fraud.

1/21/2009- Fresno County Conviction

Probe’s surveillance team found the claimant only utilizing a cane at medical appointments. The claimant made misrepresentations regarding her physical capabilities. Probe referred this case to the Fresno County District Attorney's Office. The claimant pled guilty to misdemeanor insurance fraud and was sentenced to pay $15,000 in restitution.

10/27/2008 – Yolo County Arrest

Surveillance found the claimant performing activities outside of their restriction and denied the ability to perform these activities to medical providers and in their deposition. Probe’s SIU presented the evidence to the Yolo County District Attorney’s office and the claimant was arrested on 12 counts of felony insurance fraud. 

08/14/2008 –Alameda County Arrest

Surveillance found the claimant performing activities outside of their restrictions and denied the ability to perform these activities to medical providers and in their deposition. Probe’s SIU presented the evidence to the Alameda County District Attorney’s Office and the claimant was arrested on 22 counts of felony insurance fraud.

07/18/2008 – Fresno County Arrest

During surveillance, the claimant was found working while collecting TTD benefits. The claimant testified that they had not earned any income since their initial injury. Probe’s SIU presented the case to Fresno County District Attorney’s Office who filed charges for insurance fraud to which the claimant pled guilty and was sentenced to 2 years probation, 10 days in jail and ordered to pay fines and restitution.

06/11/2008 – Fresno County Arrest

Probe’s surveillance team found that claimant utilized a cane only at medical appointments. Probe’s SIU obtained the claimant’s recorded statement wherein the claimant lied and stated that she uses the cane all the time except when she is in the shower. Probe’s SIU referred this case to the Fresno County District Attorney’s office and the claimant was arrested on charges of felony insurance fraud.

05/06/2008 – Sutter County Conviction

Surveillance found the claimant performing activities outside of their restriction and denied the ability to perform these activities to medical providers and in their deposition. Sutter County District Attorney ‘s office convicted the claimant, who was sentenced to 3 years formal probation, 30 days in jail and ordered to pay over $6,200 in restitution.

05/05/2008 – Stanislaus County Employer saves money by terminating TTD benefits

Surveillance found the claimant performing activities beyond the limitations described to medical providers and during a recorded statement. Probe’s SIU presented the surveillance to the claimant’s PTP, who stated the claimant “misrepresented his symptoms to us reporting a high level of disability when, in fact, he is observed to be functioning normally. Had the claimant accurately represented his symptoms to me, I would have returned him to his usual and customary duties.” As a result of Probe’s efforts, TTD benefits stopped and the claimant returned to full duty.

05/01/2008 – Stanislaus County Claimant returned to full-duty

Surveillance found the claimant performing activities beyond the limitations described to medical providers and during a recorded statement. Probe’s SIU presented the surveillance to the claimant’s PTP, who stated the claimant’s “activities were a dramatic contradiction to her statements in our office. It is readily apparent that the claimant misrepresented her symptoms and her level of disability to me during my treatment of her syndrome. Given the extremely high level of misrepresentation with which the claimant presented her symptoms to me, it is medically probable that she was able to continue at her usual and customary duties throughout her time of treatment with me.” As a result of Probe’s efforts, TTD benefits stopped and the claimant returned to full duty.

03/20/2008 – Fraud Fighter of The Year

Dalene Bartholomew, CFE, CIFI, is the Director of the SIU at Probe. At the annual conference she was honored with the Fraud Fighter of the Year Award by the Northern California Fraud Investigators Association. Dalene has been with Probe for 4 years and has successfully investigated and referred many fraudulent claimant’s to the DOI Fraud Division and District Attorneys for prosecution.

02/13/2008 – Fresno County Conviction

Claimant reported a slip and fall resulting in a branch poking their right eye and the claim was initially accepted. Further investigation by Probe’s SIU revealed that the claimant was hit in the eye during horseplay. Probe’s SIU presented the case to the Fresno Department of Insurance. The Fresno County DA’ office convicted the claimant of insurance fraud and sentenced to 3 years probation, 320 hours of community service, served 13 days in jail and ordered to pay over $32,000 in restitution.

01/21/2008 – Santa Clara County Arrest

During surveillance the claimant was observed working while collecting 4850 benefits. The claimant testified that they had not earned any income since their initial injury. Probe’s SIU met with the Primary Treating Physician who stated claimant would have been released back to work had they been honest. Probe’s SIU presented the case to Santa Clara County District Attorney and claimant has been arrested for charges of felony insurance fraud and arraignment is pending.