CRMBC Announces 5th Arrest for Workers' Compensation Fraud
A restaurant employee who allegedly collected disability checks while working a second job has been arrested on two counts of insurance fraud by investigators from the California Department of Insurance. The July 13, 2009 arrest is the fifth in the ongoing campaign by the California Restaurant Mutual Benefit Corporation to protect members and their employees from the impact of Workers’ Compensation fraud on the financial health of their businesses.
The case involved an employee who alleged that he sustained an injury to his right shoulder and arm while moving boxes. Under the direction of the treating physician and with employer cooperation, the employee was allowed to continue working at the restaurant with appropriate restrictions to prevent additional injury. When the restaurant was unable to continue the modified work position, the employee began to receive temporary total disability payments while continuing to be treated. The employee subsequently obtained legal counsel.
According to the investigation by Intercare, the independent claims administration company employed by CRMBC, it was revealed that the employee was allegedly working for another restaurant while collecting disability benefits. Investigation further indicated the alleged use of a different name and social security number. Additional charges relating to these issues are under consideration.
Members of the California Restaurant Mutual Benefit Corporation are able to use a special hotline to report possible fraud. Developed by the program administrator CHSI, the CHSI Solutions Hotline is available 24 hours a day, seven days a week.
Chair of the Board of Trustees of CRMBC, David Mitchell, commented:
“It is critical for our members that we attack fraud aggressively in Workers’ Compensation. The great majority of work injuries are legitimate and we focus on getting our employees the best care as quickly as possible to help them return to work and support their families. Fraud hurts everybody. It makes it tougher for businesses to survive and it reduces employment.”
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