On November 28, 2022, the San Mateo District Attorney’s Office filed nine counts of felony insurance fraud, as well as a count of attempted perjury, against an applicant in a case handled by Jonathan Freeman of DGC’s San Francisco Office.

Although the case was accepted and temporary disability was being paid, through discovery including subpoenas and a deposition on August 2, 2022, Mr. Freeman established that the applicant was cashing temporary total disability checks while concurrently working for a delivery service.

Additionally, it appeared from the records that the applicant lied about his work with the delivery service at deposition, at first saying that he had not worked anywhere since his date of injury on January 2, 2021. Only later in his deposition did he put forth that he had indeed worked for the delivery service around May of 2021, stating however that it was only for two months.

In reality, the subpoenaed records of the delivery service showed that the applicant had worked for the delivery service for approximately six months, including the day before the deposition and further continuing after the deposition, all while still cashing TTD checks and not reporting his wages to the insurance carrier.

The accused applicant failed to appear at his arraignment on January 11, 2023, and as of January 24, 2023, a bench warrant was issued.

All defendants in a criminal action are presumed innocent until proven guilty in a court of law.

Media Contacts:
Company Name: Dietz, Gilmor & Chazen, APC
Full Name: David Jankosky, DGC Client Services (213-278-1513)
Email Address: djankosky@dgcattorneys.com

The applicant in this case alleged a cumulative trauma to her upper extremity from May 18, 2020 to May 18, 2021 from working at a deli in Sunnyvale, California.  Through discovery including subpoenas and a deposition, Mr. Freeman was able to establish that the applicant had medical problems for the claimed body part which pre-existed the policy in the case and was actually on state disability for a non-industrial surgery to the claimed body system prior to the policy going into effect.

Mr. Freeman was able to control the specialty of the panel and obtained a PQME report indicating that the applicant did not have an industrial injury.  The PQME maintained this position after a supplemental report.  The PQME’s opinion was that the applicant’s upper extremity problems were related to her pre-existing non-industrial surgery and recovery therefrom.

Applicant attorney obtained a competing chiropractic medical legal report from a PTP which indicated that the applicant had cumulative trauma.  After settlement discussions were not successful, the case proceeded to two days of trial.  After hearing testimony and reviewing defendant’s trial brief, the WCJ issued a decision following the PQME’s report and finding that the applicant did not sustain an injury arising out of and arising in the course of employment to the upper extremity.  Applicant attorney did not file a petition for reconsideration and the applicant will take nothing on the claim.

You can read a redacted version of the Findings and Order and Opinion on Decision below.

Findings and Order and Opinion on Decision:  Click here.

Media Contacts:
Company Name: Dietz, Gilmor & Chazen, APC
Full Name: David Jankosky, DGC Client Services (213-278-1513)
Email Address: djankosky@dgcattorneys.com