View this article online: https://www.claimsjournal.com/news/west/2010/06/02/110389.htm
California Insurance Commissioner Steve Poizner announced the arrest of Leticia James Coral, aka Letty James Diaz, 56, of Pacifica, Calif., on charges of fraudulently disbursing public money. The former San Francisco City and County Claims Examiner self-surrendered to San Francisco County Jail on June 1. Bail was set at $75,000.
The CDI investigation revealed that during the course of her employment as a Claims Examiner with the City and County of San Francisco, Coral allegedly gifted more than $76,000 in public funds to an injured school district employee. Coral purportedly gifted the funds while knowing that the workers’ compensation claim was not worth the $85,000 in permanent disability advances that she issued the injured worker, CDI said. A qualified medical exam determined the injured worker was 17 percent disabled, which meant the injured worker was entitled to $9,320 in permanent disability payments, according to the Department.
It is alleged that Coral issued these huge advances, having arranged for the injured worker to loan or give Coral half of the money issued, the DOI said. These large permanent disability advances began in 1999 and ended in 2003.
In October 2009, after reviewing this particular claim file and suspecting fraud, Tristar Risk Management referred this case to the California Department of Insurance for investigation. Tristar is a third party administrator of workers’ compensation claims. The company was hired to administer claims for the City and County of San Francisco in 2004. The school district administered their own claims prior to Tristar’s assignment.
In July 2008, Tristar told the injured worker that she was overpaid by approximately $76,000 in permanent disability, CDI said. The injured worker then advised Tristar that she loaned half of the permanent disability advances to Coral. It is alleged that Coral had asked the injured worker to borrow half of the payments. The injured worker claimed she was unaware of the large discrepancy between what she was paid and the claim’s actual worth. According to the worker, she would meet Coral at a bank, cash the permanent disability check and give Coral half of the cash. The injured worker tried to get in touch with Coral several times in an attempt to get the money back that had been loaned to Coral. Coral never called the injured worker back and never paid any money back to her, according to the Department.
Source: CDI