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| | Claimant Who Insisted She Couldn't Drive At All Appeals Her Workers' Compensation Fraud Conviction. But CA Court Of Appeals Affirms.
By Lonce LaMon - October 31, 2012
The Court of Appeal of the state of California on October 11, 2012, affirmed a judgment from the Superior Court of Los Angeles County, from the court room of Judge Barbara R. Johnson, for workers’ compensation insurance fraud against a claimant named Irma Hammond.
Irma Hammond had appealed the Superior Court judgment against her claiming there was insufficient evidence to support her conviction. However the Appeals Court found plenty of evidence to support the conviction and affirmed judgment.
Hammond had worked for Wells Fargo Bank, starting perhaps earlier than 1996, but it is known that she had her first on-the-job injury there in 1996. Wells Fargo Bank was handled by third-party-administrator Gallagher Bassett and claims adjuster Felicia Negrete when in 2004, several 25 pound boxes fell on Irma Hammond when she was placing them up on a shelf. Thus, the injuries starting from 1996 included her head, neck, right shoulder, and arm, and her back and lower right extremity—including her hip. But these injuries alleged compounded from there with another injury and claim in 1999 leading up to the next claim about the boxes falling on her in 2004.
The interesting point about this case is that the issue of fraud all revolved around her demands for transportation to and from her medical appointments. Which is strange. Why would someone go to such an extreme to misrepresent being capable of driving to the doctor? The different in disability from driving or not driving is not monumental.
But Hammond made numerous statements that she could not drive, and had not driven at all within the past three years. However, in spite of her insistence that she didn’t drive at all, she was caught on a surveillance camera by investigator Nestor Gomez pulling into her driveway one day in her Dodge and then leaving a few hours later in that same truck.
Her own husband even testified that sometimes she drove, although he often gave her rides to and from her medical appointments. But he was clear that sometimes she drove herself when he wasn’t able to get the time off from work in order to drive her.
He was also clear in expressing that his wife, the claimant, had her own vehicle with current insurance he provided for it. He testified that his wife was physically able to drive however she usually didn’t, as she used heavy medication which impaired her functioning. Her doctors also recommended that she not drive. But one statement the husband made was, “Oh, yes. She’s driven to the doctor many times herself.”
The claimant’s key statement that was material, was that when asked if she had driven within the last three years, she stated, “I don’t drive” and “I haven’t driven in the last three years”.
But, in reality, right when she said that, she had driven just eight days prior.
The claimant’s defenses were plenty, one being her claim that her attorney had advised her to answer the questions in general, and not specifically with irrelevant details. But the court found that the questions posed didn’t all call for general answers. The claimant’s claims that she had memory problems because of her medications, and that she got dates and years from the past enmeshed together, weren’t plausible either, because the court reasoned that it is reasonable for any person, no matter how drugged and forgetful of the past, can likely remember something he or she did just eight days ago. Especially when it comes to something like driving a vehicle.
The claimant was convicted of workers’ compensation insurance fraud because it’s unlawful to make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying any compensation as defined in Section 3207 of the Labor Code. The claimant claimed there was insufficient evidence to support a finding that she made a knowing, willful, material misrepresentation. But the Court of Appeal disagreed.
Here is the 14 page decision: filed 10/11/2012 in the Court of Appeal of the State of California, Second Appellate District, Division Five, B231927 (Los Angeles County Super. Ct. No. BA353660)
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