On January 3, 2018, at a Lien Conference at the Santa Ana WCAB, the lien holders of record withdrew all liens for medical treatment provided to a California school district cafeteria worker convicted of workers’ compensation insurance fraud under Insurance Code §1871.4, subd. (a) (4), for fraudulently obtaining medical treatment.  The claimant was sentenced to three years’ probation and ordered to pay restitution.

Securing deposition testimony and a well-timed workers’ compensation claim dismissal, DGC’s Jeff Hammill assisted in the criminal prosecution.  In further obtaining the withdrawal of all liens, Jeff wrapped up the defense for his client in the workers’ compensation case.  The file was referred to Jeff from the start of litigation in January 2014.

On December 14, 2017, in support of Riverside County’s fraud conviction, the Fourth District Court of Appeal upheld a restitution order for $34,925.09 in medical, deposition, investigation, and salary reimbursement expenses to be paid by the convicted claimant.  The claimant challenged the majority of this amount, claiming abuse of judicial discretion and arguing culpability only for costs incurred after being caught “milking” the claim.  The court reminded the claimant that by pleading guilty to a misdemeanor on a felony insurance fraud charge, she had by law already admitted to “faking” the entire injury.

Claimant had claimed a specific injury to her low back, spine and spinal cord from lifting a box of frozen burritos. She subsequently told her doctor about inability to lift her arms, sit for prolonged periods, or walk without a limp.  However, video surveillance obtained while treatment was ongoing, and shown to the treating orthopedist, clearly showed claimant walking with a normal gait through a pumpkin patch with children, squatting and bending with no evidence of pain, driving for long distances, carrying items, shopping, and gambling in Palm Springs, CA.

Minutes of Lien Hearing: Click here

4th Appellate District Opinion: Click here

Order Dismissing WC Case: Click here

On August 29, 2017, Jonathan Freeman, managing attorney of DGC’s San Francisco office, obtained a “take nothing” order from a WCJ at the Oakland WCAB. No reconsideration was sought, so the decision is final.

The claimed injury involved an itinerant teacher who regularly rode a bicycle to and from work and was injured during her commute by an allegedly negligent automobile driver. The accident caused injury to the applicant’s neck and left shoulder and fractured her left humerus. The employer timely denied liability for the claim based on the going and coming rule.

The employer referred the file to DGC in March of 2017, and the case was immediately fast-tracked for trial, which was completed in July 2017.

At trial, the applicant attempted to show that her home was a second worksite due to the work she did at home, including preparing lesson plans and sending and receiving emails. The applicant also tried to link her commute to her work by emphasizing the work tools and materials she transported to and from her home each day, including musical instruments and paperwork.

DGC was successful in asserting the going and coming rule to completely defeat applicant’s claim by showing that the applicant’s situation fit closely with existing case law barring regular-commute injuries. The WCJ also emphasized – as has the California Supreme Court – that there is no special exception to the going and coming rule for white collar workers who regularly take work home but are not specifically required or instructed to do so.

Findings and Award & Opinion and Decision: Click here

On September 9, 2017, having committed perjury under oath in violation of Penal Code Section 664/118(a), a hospital worker pled guilty in the Los Angeles County Superior Court to three felony counts of workers’ compensation fraud under Insurance Code 1871.4.

A specific eye injury was claimed from a fire extinguisher falling to the floor and discharging chemicals into the claimant’s eyes. Medical treatment stalled. Client referred matter to DGC’s Robert Robinson. At his suggestion, video surveillance was obtained documenting applicant’s capabilities. Claimant’s deposition was scheduled, and testimony inconsistent with claimant’s capabilities was obtained. Claimant was boxed into denying under oath any ability to drive a car or water the lawn, having previously been recorded on video doing both denied activities. Detailed advocacy letters shaping the evidence assisted the ophthalmic QME in finding no permanent ophthalmic disability and no reason for claimant’s continued claims of eye disability other than “hysterical blindness” or malingering.

Working with Probe SIR, the full deposition testimony, surveillance video, and med-legal evidence were packaged and submitted to the Los Angeles County District Attorney’s Office and shepherded through prosecutorial review. Now convicted, the claimant was ordered to pay restitution in the amount of $12,946 on or before February 27, 2018.

Felony Complaint For Arrest Warrant:  Click here