View this article online: https://www.claimsjournal.com/news/southcentral/2005/06/20/56337.htm
Texas Mutual Insurance Company reported that, in unrelated cases, Texas grand juries indicted two former prison guards on workers’ compensation fraud-related charges. Both guards were allegedly “double-dipping,” a term investigators use for claimants who collect income benefits by saying they unable to work while they are actively employed.
A Dallas County Grand Jury indicted Ron L. Dawson for aggregated theft over $1,500. Dawson received temporary income benefits (TIBs) after telling Texas Mutual he was unable to work due to his 2001 workplace injury.
Dawson allegedly hurt his back while working as a security guard for a Dallas homeowners association. He said he was unable to work; however, a Texas Mutual investigation discovered that he took a new job as a prison guard for Dawson State Jail from June 27, 2002, through February 13, 2003. During this time, he received over $6,300 in TIBs.
In Austin, a similar case played out when the 299th Judicial District Grand Jury indicted Lloyd Davis on fraud-related charges. Davis had applied for supplemental income benefits (SIBs) in December 2000, stating that he was not employed and was unable to work due to a workplace injury from his previous job.
Davis had received over $8,600 in SIBs when a claim reviewer noticed some irregularities in his file. The subsequent Texas Mutual investigation discovered that Davis had worked since 1999—without any disability—as a prison guard at the T. Don Hutto Correctional Facility, a state jail operated by a private company.
Texas Mutual immediately disputed Davis’ entitlement to further benefits and presented its case to the Travis County District Attorney’s Office. On May 4, 2005, a grand jury indicted Davis. He was arrested on May 20 and held in custody pending his trial.
“Double-dipping” scams are so-called because the perpetrator, in effect, gets paid twice: once by his new employer for working and again by his previous employer’s insurance company for being too injured to work. If allowed to continue, double-dipping can lead to a higher workers’ comp insurance premium for the first employer when the company renews its coverage.
To help ensure injured workers understand their responsibilities under the law, Texas Mutual Insurance Company includes a statement with every income benefit check reminding the injured worker to contact the adjuster if he or she returns to work. Additionally, Texas Mutual adjusters often contact claimants directly to determine their work status.