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Busted, Now What?
Fraud Convictions And Pleas
Before The California WCAB
Presented by:
David H. Parker
Attorney at Law
Parker, Kern, Nard & Wenzel
All written and photographed material © 2012 David H. Parker.
This presentation is meant to convey general information only. It is not intended to impart specific legal advice concerning legal
problems or issues to individuals, public or business entities. Should you wish to refer a legal matter you must contact an attorney for
purposes of legal retention. No attorney-client relationship can be formed without a written retention agreement and/or fee agreement
signed by both the lawyer and the client defining the scope of the retention. Do not provide or impart confidential information through
this lecture until Parker, Kern, Nard & Wenzel confirms in writing the absence of a conflict of interest.
If you want legal advice from me or our firm:
RETAIN US @
4
David H. Parker
Attorney at Law
Parker, Kern, Nard & Wenzel
1111 E. Herndon Ave. Ste 202
Fresno, CA 93720
(559)-449-2558
dp@pknwlaw.com
www.pknwlaw.com
Disclaimer Violation
Legal Team.
This presentation is meant to convey general information only. It is not meant to impart specific legal advice concerning legal
problems or issues to individuals or other business entities. Should you wish to refer a legal matter you must contact an attorney for
purposes of legal retention. No attorney-client relationship can be formed without a written retention agreement and/or fee agreement
signed by both the lawyer and the client defining the scope of the retention. Do not provide or impart confidential information through
this lecture until Parker, Kern, Nard & Wenzel confirms in writing the absence of a conflict of interest.
5
What Is Workers’ Compensation
Fraud?
The Claims Fraud Statute
Insurance Code section 1871.4
What Is Workers’ Compensation
Fraud?
The Premium Fraud Statutes
Insurance Code sections 11760 and 11880
What is Workers’ Compensation
Fraud?
Common Definition of Fraud
(Plain Language):
When someone knowingly lies with an intention to do
the following:
1. Obtain a Workers’ Compensation Benefit
not due;
2. Deny a Workers’ Compensation Benefit due;
3. Obtain a Workers’ Compensation Policy of
Insurance at less than the proper rate, cost
or premium.
Definition of Fraud
(Legalese)
Any person who makes or causes to be made
any knowingly false
or fraudulent material statement
or material representation
For the purpose of obtaining or denying
workers’ compensation benefits or payments
is guilty of a felony.
What Is Workers’ Compensation
Fraud?
Some More “Legalese”
Penal Code 550(b)(3)
Concealing or knowingly failing to disclose the occurrence of an event that affects a person’s benefits – whether that be entitlement, amount or duration -- may constitute workers’ compensation fraud.
So, What Is Workers’
Compensation Fraud?
The seminal question, in plain language is:
Did the act or omission make any difference at all
to the determination and administration of
workers’ compensation benefits?
If It Is, What Can Happen Before
The WCAB?All Benefits Barred
Miller v. WCAB 33 CCC 621
Muniz v. WCAB 62 CCC 1597
Moore v. WCAB 63 CCC 204
Plass v. WCAB 62 CCC 705
Quiroz v. WCAB 62 CCC 987
Nolo Contendre or “conviction of
fraud” bars all benefits.
Some Benefits Barred
Zenith Insurance v. WCAB (Ball)
61 CCC 1107
Longs Drug Store v. WCAB (Sciutto):
61 CCC 1307
Conviction pursuant to IC 1871.4 bars
only those benefits received as a
result of the particular fraud.
Quiz: Is This Workers’
Compensation Fraud?
How About This, Is This Workers’
Compensation Fraud?
Umm, Is This Workers’
Compensation Fraud?
Okay, Parker, Why Isn’t This
Workers’ Compensation Fraud?
The seminal question, in plain language is:
Did the act or omission make any
difference at all to the determination and
administration of workers’ compensation
benefits?
Friendly Reminder:
How About This, Is This Workers’
Compensation Fraud?
Applicant’s Sworn Deposition
Testimony:
State Panel Doctor’s Reporting:
Payment of Benefits Based On
State Panel Doctor’s Initial, Pre-
Subrosa Reporting :
Yes, Virginia, There Is A Fraud
Prosecution!
Applicant was successfully prosecuted by The Fresno County
District Attorney’s Office, Workers’ Compensation Fraud
Division.
Thank you Edith Treviso, Trevor Oppliger and the entire
Investigative Team at
http://www.co.fresno.ca.us/DepartmentPage.aspx?id=5388
But, Virginia,
Subsequent to a nolo contendere misdemeanor, Count 7 of a
criminal complaint, the crime being “Grand Theft of Real
Property in violation of Penal Code Section 487(a)” related to
his own actions in regard to this claim, including no restitution
for Insurance Code section 1871.4 to 1871.5 but restitution in
the amount of $5,000.00 as part of the criminal plea
agreement…
And, Virginia,
Subsequent to a workers’ compensation trial regarding
restitution of the $40,000 plus in temporary total and other
benefits paid which all the State Panel Qualified Medical
Evaluators felt was paid based on applicant’s
misrepresentations…
And, Virginia,
Subsequent to a workers’ compensation Judge’s finding, in
spite of Labor Code section 3202 statutory liberal mandate
that …
And, Virginia,
Subsequent to a workers’ compensation Judge’s finding, in
spite of Labor Code section 3202 statutory liberal mandate
that…
Virginia, There Is No Workers’
Compensation Santa Clause.
Some Lessons Learned:
Criminal Action
1. The Burden of Proof is
HIGH – Beyond a
Reasonable Doubt.
2. Dueling Doctors – NOT
good.
3. Resources are limited.
4. Other Lessons?
WC Action
1. It’s a liberal system
(Labor Code section
3202);
2. Restitution is limited by
some judges opinions;
3. The plea matters:
ideally it is felony
Insurance Code sections
1871.4-1871.5.
Some Lessons Learned:
Victim(s)
1. The system is slow.
2. The system is frustrating.
3. The system is limited?
Busted, Now What?
Fraud Convictions And Pleas
Before The California WCAB
Presented by:
David H. Parker
Attorney at Law
Parker, Kern, Nard & Wenzel
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