News 2018-02-14T17:45:37-08:00

DGC News

DGC Managing Attorney Jonathan Freeman (San Francisco) Assists In Fraud Conviction with $5,145.65 in Restitution Ordered

On May 8, 2019, having committed insurance fraud by lying about prior injuries and medical treatment to a PQME, an applicant pled no contest in the County of Sonoma to one count of insurance fraud under Insurance Code 1871.4(a)(1).

The applicant had claimed a neck and right shoulder injury via cumulative trauma through October 2015. Prior to the case being referred to DGC, the applicant was evaluated by a PQME. In that evaluation, the applicant falsely stated she had never had prior injuries to her right shoulder or neck and had never been involved in a motor vehicle accident. Based on that history, the PQME issued a report finding PD, with no non-industrial apportionment. Defendants began paying PDAs consistent with the rating. The case was then referred to DGC for finalization of stipulations at 15% PD.

However, when reviewing the file materials provided by the client, it became clear that the applicant had grossly misrepresented her medical and litigation history. She had been involved in a MVA resulting in neck pain in 2003. She had also filed a workers’ compensation claim for her right shoulder in 2006 while working for a different employer and had received substantial medical treatment. The medical records also showed that she had been involved in a MVA about 4 months prior to the industrial injury resulting in a whiplash injury to her neck. The applicant continued treating for the neck injury from the MVA until the day after her alleged work injury, at which time she commenced telling her workers’ compensation evaluators that she did not have prior injuries or symptoms. DGC’s Jonathan Freeman recommended a supplemental report to address apportionment before proceeding with stipulations, and recommended the filing of an FD-1.

After Jonathan cleared a cover letter and provided the PQME with these records, he reduced the rating by finding non-industrial apportionment to all body parts. Defendant by that time had a substantial PD overpayment due to the applicant’s material misrepresentations, and this formed the damages of the fraud case which was filed by the DA’s office in the County of Sonoma.

The applicant stipulated to restitution in the amount of $5,145.65, was sentenced to 75 days in jail with the option of entering a work release program, and was put on probation for 36 months.

You can read the redacted Minute Orders below.

 

Minute Orders – Superior Court of California, County of Sonoma:  Click here

 

Media Contact:
David Jankosky, Director of Client Services, DGC Attorneys
djankosky@dgcattorneys.com / (818) 654-9911, Ex. 1231

July 10th, 2019|News Articles|

Su Lai

The firm is pleased to announce the association of Su Lai as managing attorney in our Long Beach office.

May 16th, 2019|New Hires|

DGC’s Jonathan Freeman (Managing Attorney, San Francisco Office) Obtains Findings and Order from Oakland WCJ Denying TD, PD and Future Medical

On March 12, 2019, DGC attorney Jonathan Freeman obtained a decision awarding the applicant no benefits after trial at the Oakland WCAB.

The claimed injury involved an applicant in a warehouse who alleged she was struck in the head by merchandise in March of 2018. The injury appeared superficial, the diagnostics were unremarkable, and when the applicant was non-cooperative with discovery in the early stages of the claim, the case was denied.

When the applicant retained counsel, the case was referred to DGC in September 2018. Working with the employer and TPA, DGC attempted reasonable settlement at multiple stages for nominal value, but the applicant was unwilling to resolve her case and proceeded with a PQME. The PQME indicated that the applicant had 0% WPI and did not require a medical award. The applicant continued to refuse settlement but did not take further action to develop the record. DGC’s counsel was successful in quickly moving the case to an MSC, closing discovery, and obtaining favorable pre-trial stipulations regarding the applicant’s indemnity rate, periods of disability, and other matters in the pre-trial conference statement.

At an all-day trial on February 25, 2019, the applicant attempted to claim that the PQME’s report was not substantial evidence based on lay testimony and contradictory complaints about the evaluation process. Due in part to the DGC attorney’s vigorous cross-examination, the WCJ ultimately concluded that the applicant testimony regarding the PQME reporting was not credible and that although the applicant claimed to have problem slurring her words, this was not apparent at trial. DGC’s counsel also succeeded in barring applicant’s proposed witness from the stand and succeeded in barring the applicant from testifying to other claims and injuries that she planned to file.

The WCJ ultimately awarded $0.00 in TD, $0.00 in PD, $0.00 in attorneys’ fees and no medical award, essentially resulting in a “take nothing further” for the applicant subject to any petition to reopen. The decision has not been appealed and is therefore final.

You can read the redacted Minutes of Hearing and Summary of Evidence, and the WCJ’s Findings and Order and Opinion on Decision below.

 

Minutes of Hearing and Summary of Evidence:  Click here

WCJ’s Findings and Order and Opinion on Decision:  Click here

 

Media Contact:
David Jankosky, Director of Client Services, DGC Attorneys
djankosky@dgcattorneys.com / (818) 654-9911, Ex. 1231

April 24th, 2019|News Articles|
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