Texas Mutual Insurance Company announced that, thanks to a recent anonymous tip, it is ready to recover over $8,200 in restitution and save over $26,000 in estimated future income benefits. Additionally, the confidential informant will receive a $1,000 reward.
Without the tip, Texas Mutual Insurance Company might still be paying income benefits to an Austin company’s worker who claimed he could not work, but secretly was working at a new job.
State law requires injured workers to report any change in work status to the insurance carrier. Despite being asked several times, this employee continued to claim to his doctor and to Texas Mutual Insurance Company that he could not work or participate in any physical activity.
The worker’s manager reported his suspicions about the claim last year. He requested a review by Texas Mutual fraud investigators. Although the investigation supported the employer’s concerns, the investigators could not establish enough evidence to prove fraud.
About two months later, the manager received new information on the claim. A confidential informant told the manager that the employee was working a new job while still collecting temporary income benefits.
Based on the tip, a new Texas MutualSM investigation uncovered clear evidence that the claimant was physically active and working at another job. Texas Mutual Insurance Company discontinued the worker’s income benefits and asked the Travis County District Attorney Office to prosecute the case.
While most Fraud StoppersSM rewards begin with an anonymous call directly to the Fraud StoppersSM hotline at (800) 488-4488 or by email at email@example.com, the program is flexible enough to reward other informants who provide information that leads to a fraud-related indictment or conviction. In this case, Texas Mutual Insurance Company has authorized the maximum award, $1,000, to the confidential informant who provided the case-breaking tip.
The Fraud StoppersSM award is part of the Texas MutualSM “Zero Tolerance for Fraud” program. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
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