Silva Ordered to Pay for Texas Workers’ Comp Fraud

April 8, 2003

The 132nd District Court in Scurry County, Texas, sentenced Jake V. Silva to two years imprisonment (probated to five years on probation) and 160 hours of community service after finding him guilty of fraudulently obtaining workers’ compensation benefits. According to Texas Mutual Insurance Company, the court also ordered him to pay: $1,000 in fines; $283 in court cost; $4,855 in restitution (payable at $110 per month); and $40 per month in probation fees.

Thanks to evidence gathered by Texas Mutual investigator Tommy Jones and Texas Mutual workers’ compensation specialist Danny Gentry, the prosecution was able to present a clear-cut case demonstrating that Silva deliberately committed fraud. Silva continued to collect temporary income benefits (TIBs) checks after he returned to work at a different company.

During the course of his claim, Silva received regular notices with each TIBs check reminding him that Texas Workers’ Compensation Commission Rule 129.3 requires injured workers to tell their insurance carrier if they return to work, earn wages, or receive an offer of employment. The prosecution presented the notices as evidence.

To prove fraud, however, the prosecution had to show that Silva knowingly lied in order to receive benefits. The prosecution’s strongest evidence was a recorded conversation between Gentry and Silva, in which Gentry informed Silva of his obligation to notify Texas Mutual Insurance Company if he began working while collecting TIBs.

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