Texas Mutual Insurance Company reported that Minerva Davila of New Braunfels pleaded guilty to workers’ compensation fraud-related charges. The Travis County 147th District Court sentenced Davila to two years’ deferred adjudication and ordered her to pay $4,599 in restitution to Texas Mutual Insurance Company, perform 160 hours of community service, and attend treatment and counseling as recommended by probation.
Davila allegedly suffered on-the-job injuries while working at Comal County Child Emergency. Texas Mutual began paying her temporary income benefits (TIBs) after her doctor placed her in an off-work status.
A Texas Mutual investigation uncovered evidence alleging that Davila had worked as a housekeeper at a New Braunfels conference center less than one month after her alleged injury. Meanwhile, Davila continued to tell Texas Mutual that she could not work, and she continued to collect TIBs.
State law allows injured workers to receive TIBs only while they are unable to work. The law also requires injured workers to notify their workers’ compensation insurance company when they begin working again. Investigators call this sort of scam “double-dipping” because the claimant is getting paid by her new employer for working and, in effect, getting paid by her previous employer’s insurance company for being too hurt to work. Double-dipping scams, if allowed to continue, can lead to a higher workers’ comp insurance premium for the first employer when the company renews its coverage.
With every TIBs check, Texas Mutual Insurance Company includes a statement reminding the claimant to contact the adjuster if he or she returns to full-time or part-time work. Additionally, Texas Mutual adjusters often contact claimants directly to determine their work status.
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