Texas Mutual Insurance Company reported that Ruben Perez of Dallas pleaded guilty to workers’ compensation fraud-related charges and received a two-year deferred adjudication sentence. The court ordered him pay $6,000 in restitution to Texas Mutual, and sentenced him to serve 160 hours of community service.
Perez’s reported scam was not an uncommon one, according to Texas Mutual. He was injured on-the-job and began to collect temporary income benefits (TIBs) from Texas Mutual. After he returned to work, he repeatedly lied to a Texas Mutual claim adjuster by saying that he was still unable to work as he continued to receive $356 per week in TIBs.
Investigators call this sort of scam “double-dipping” because the claimant is getting paid by his employer for working and, in effect, getting paid by the insurance company for being too injured to work.
State law allows injured workers to receive TIBs only while they are unable to return to work. The law also requires injured workers to notify their workers’ compensation carriers when they return to work.
When Texas Mutual investigator Sandra Milburn uncovered evidence against Perez, she contacted Assistant District Attorney Donna Crosby, who prosecuted the case on behalf of the Travis County District Attorney office.
Three years ago, Milburn had investigated Perez’s employer for premium fraud, and Crosby prosecuted that case too. Ultimately, the court ordered the employer to pay $200,000 in restitution to Texas Mutual, and the owner received a five-year probated sentence.
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