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| | TPA Probe Leads To Filing Of Charges By Press Release - April 25, 2006San Bernardino_A workers' compensation claimant from San Bernardino, California, who allegedly continued to work a second job while collecting disability benefits has been arrested and charged.
American Commercial Claims Administrators (ACCA) announced the case against Estella Ramos, 52. Authorities arrested her April 10 on insurance-fraud charges.
The arrest was the first made on behalf of National Liability & Fire (NLF), according to ACCA, which investigated the case on behalf of its insurer client. NLF is a member of the Berkshire Hathaway Cos. and has partnered with ACCA to administer workers' compensation claims along with ACCA's sister company, American All Risk Insurance Services (AARIS), a program administrator, to underwrite workers' compensation policies throughout California since October 2004.
Ramos said in a deposition she had worked concurrently for another employer until she sustained an injury with ACCA's insured, the claims administrator said. Because of her injury, she was unable to continue working at her second job.
ACCA obtained records from Ramos' second employer and discovered a potential material misrepresentation from the deposition, the TPA said. The records allegedly showed Ramos never stopped working her second job or earning income while collecting disability benefits from ACCA's insured, the TPA reported.
ACCA's Special Investigations Unit (SIU) turned the matter over to Los Angeles County District Attorney's Office, which filed several charges against Ramos on March 22. The charges include insurance fraud.
Ramos was arrested April 10 and is due in court May 1 for arraignment.
ACCA is a California Workers' Compensation third-party administrator (TPA) and managed-care organization that serves carriers.
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