Spring 2008

Fraud-Fighting Corner
By Tim Riley • Manager of Special Investigations

Fraud costs the Texas workers’ compensation system millions of dollars every year. Texas Mutual Insurance Company works hard to stamp it out, and we get results. These investigations are part of our zero tolerance for fraud policy.

Claimant earns $10K a week while stealing benefits
The 331st Travis County District Court sentenced Richard Brooks of Buna on workers’ compensation fraud-related charges. Brooks must serve five years’ deferred adjudication and repay $19,945 in benefits to Texas Mutual Insurance Company.

Brooks reported a job-related injury while working as a foreman for Boiler Services Inc. The Beaumont-based company specializes in construction and maintenance at refineries and petrochemical plants.

Brooks claimed he was unable to work as a result of the injury, and he began collecting income benefits.

Meanwhile, Texas Mutual Insurance Company uncovered evidence that Brooks had accepted a contract job working in Iraq. The job paid $10,000 a week.

Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work.

Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.

Payroll scheme results in indictment
A Travis County grand jury indicted Ameripro Drivers L.L.C. of Dallas and Joffrey Majors of Parker on workers’ compensation fraud-related charges. The indictments allege that Ameripro and Majors were involved in a scheme to lower Ameripro’s premium by concealing part of its payroll.

Ameripro Drivers L.L.C. is a temporary labor service that specializes in providing drivers to freight trucking companies and retailers. Majors, who was the company’s office manager, handled its insurance matters.

The indictments allege that between Nov. 8, 2003 and Nov. 8, 2005, Ameripro Drivers L.L.C. and Majors concealed payroll and employees from Texas Mutual Insurance Company in an undisclosed company, Ameripro Drivers 2000 L.L.C.

Because workers’ compensation insurance premium is based, in part, on payroll, this type of scheme can result in a business being charged a lower premium than it actually owes. By hiding payroll to pay a lower premium, an employer can gain an unfair advantage over competitors.

Agent sentenced for perjury
A licensed independent insurance agent pled no contest to a charge of perjury in a workers’ compensation fraud-related case. A Travis County district court sentenced Richard Brian Aube of Dallas to one year of deferred adjudication and ordered him to pay a $4,000 fine.

Aube presented false testimony on matters relating to one of his clients in February 2005. Texas Mutual Insurance Company was investigating the client for misrepresenting payroll to get a lower workers’ comp premium.

In other fraud-fighting news
Four individuals were indicted, in separate cases, by a Travis County grand jury on workers’ compensation fraud-related charges. The individuals allegedly collected a combined $24,153 in workers’ comp benefits they were not entitled to.

All four cases involved a scam that investigators call double-dipping. Double-dipping occurs when claimants collect benefits for being too injured to work when they are, in fact, gainfully employed.

Here are the individuals who were indicted, along with the amount of benefits they allegedly collected illegally.

INDICTED— Dennis Aguilar of Mt. Pleasant, $13,054

INDICTED— Daniel Beck of Fort Worth, $5,040

INDICTED— Gilbert Madrid of Odessa, $3,818

INDICTED— Robert Brumley of Abilene, $2,241

Note: A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.

Fraud-fighting resources on the Web
Visit the Fighting Fraud section to read our fraud-fighting success stories, report suspected fraud, learn the red flags for fraud and get a
Fraud Stoppers_SM poster in English and Spanish.

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COMPNEWS - Spring 2008
Make a Habit of Return-to-Work
Why Return-to-Work?
Summer Safety Tips
Certified Fraud Examiners Protect Your Premium Dollars
Fraud-Fighting Corner
Important Reminders
President's Message: 
In Cyberspace or Face to Face, Safety is Our Business
You Need to Know: 
State to study networks’ effectiveness
Get answers to your workers’ comp questions
New fee guidelines take effect
You Need to Know More

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