View this article online: https://www.claimsjournal.com/news/west/2007/04/19/78833.htm

Calif. State Fund To Receive $46,000 in Workers’ Comp Fraud Case

Imperial Valley, Calif., County Superior Court Judge Poli Flores has ordered an employee of an El Centro, Calif., hay exporter to pay $45,996 in restitution to the State Compensation Insurance Fund in a workers’ compensation insurance fraud case. Judge Flores also sentenced Jose D. Estrada, a machine operator at Kuhn Hay in El Centro, to five years formal probation, after he pleaded guilty to one count of felony workers’ compensation insurance fraud. Estrada earlier this week paid State Fund $18,000 as part of the total restitution. He was also ordered by the court to pay a $100 fine.

According to SCIF, Estrada reported an injury his right ankle when he was struck from behind by a fork lift while at work in April 2003. The fraud was later discovered by his employer in September of that year, when he saw Estrada walking without an orthopedic boot that he was supposed to be wearing for his injury. The employer called State Fund that same day and an investigation was launched.

State Fund hired a private investigator to do sub Rosa surveillance of Estrada, and shortly thereafter, the investigator filmed Estrada at his home and then driving to a physical therapy appointment, SCIF said. Estrada did not wear the orthopedic boot at home or on his drive. When he arrived at the physical therapist’s office, he put on the boot in the parking lot. He also used a cane when walking into the appointment. After the appointment, he took off the boot in the parking lot. State Fund concluded that Estrada was wearing the orthopedic boot and using the walking cane to his various health care appointments for the purpose of exaggerating his alleged ankle injury.

After completing its investigation, State Fund turned over its suspected fraud case to the Imperial County District Attorney’s Office for review. The Department of Insurance (CDI) also assisted in the investigation. The DA’s office charged Estrada with three counts of Insurance Code 1871.4 of which Estrada pleaded no contest to one count.

Kuhn Hay, Estrada’s employer, was insured by State Fund from 2000 until 2004.

Source: SCIF