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September 12, 2019
California Division of Workers’ Compensation Announces Temporary Total Disability Rates for 2020

September 6, 2019
California Division of Workers’ Compensation Posts Adjustment to Official Medical Fee Schedule Inpatient Hospital Section to Conform to Medicare Changes

September 5, 2019
California Division of Workers’ Compensation Posts Order Adopting Updates to Medical Treatment Guidelines

August 19, 2019
APEX Investigation (SC) Announces Michael A. Gomez as Executive Vice President of Business Development and General Partner

September 4, 2019 - Los Angeles, CA- Benjamin Sample, a 69-year-old male bus driver for MV Transportation, filed a workers’ compensation claim on April 18, 2018. The Claimant alleged injuries to his head, neck, and back as a result of being attacked from behind by a passenger on the bus he was operating. The Claimant sought medical treatment for his injuries and was taken off work and placed on TTD. During the claims process, surveillance was conducted, which revealed the Claimant to be active and able to jog and play tennis. He later denied being able to do such activities.

“Since April 18, 2018 to the present, have you played any tennis?” asked the defense attorney representing the employer. To which the Claimant answered, “No.” This not only occurred once, but numerous times throughout the Claimant’s deposition testimony.

Due to the Claimant being suspected of falsely overexaggerating his physical limitations and underexaggerating his physical capabilities in order to obtain workers’ compensation benefits, the case was referred to the APEX SIU Department. The SIU investigation revealed the Claimant made several material misrepresentations throughout the claims process and during deposition testimony.

A fraud referral was submitted to the Los Angeles County District Attorney’s Office and the California Department of Insurance. APEX was notified that a criminal investigation would be opened as a result of our fraud referral. The Claimant was criminally charged with two felony counts of workers’ compensation fraud and attempt perjury, and a warrant was issued for the Claimant’s arrest. Initially, the Claimant refused to surrender to authorities, but eventually surrendered and was booked at the Los Angeles County Jail. He pled guilty to one felony count of workers’ compensation fraud and one felony count of attempt perjury. During court proceedings, the perjury charge was dismissed as part of the Claimant’s plea and he was placed on felony probation for 3 years. There is a pending court date where restitution will be addressed.

“Convictions like this help send the message that fraud is taken seriously by the employer and these convictions act as a strong deterrent for other employees who are considering committing insurance fraud,” said JR Robles, President of APEX Investigation.

This case was successfully prosecuted by the Los Angeles County District Attorney’s Office. Thank you to all who assisted with this successful case.

About APEX Investigation

As a nationwide leader in Insurance, Workers’ Compensation, Liability and Human Resources Investigations, managing risk is an area where APEX Investigation excels. Not only do we have experience investigating hundreds of thousands of cases, we also adapt to the ever-changing laws across the country—from state to federal—that impact our clients. www.apexpi.com

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