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Summer 2007
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.
These cases are examples of a scam that investigators call double-dipping. Double-dipping happens
when employees collect benefits for being too injured to work when they are, in fact, employed. State law
requires claimants to notify their workers’ comp insurance carrier when they return to work.
Claimant Works Three Times Harder Than Allowed
Leonard Cano of Houston pleaded guilty to workers’ comp fraud-related charges. A Travis
County district court ordered Cano to serve a five-year probated sentence, repay $8,893 in benefits and
pay a $250 fine.
Cano reported a job-related injury while working as a chemical blender for Minute Man of America
Inc. in Houston. He claimed he was unable to work as a result of the injuries, and Texas Mutual Insurance
Company began paying him disability income benefits. An investigation found that Cano was working for
three different employers while collecting benefits.
In other fraud-fighting news
SENTENCED—Sheryl K. Reynolds of Houston. A Travis County district court ordered Reynolds to serve a 10-year probated sentence, repay $21,976 in benefits and pay a $1,000 fine.
SENTENCED—Cecil R. Bryant of DeSoto. A Dallas County district court ordered Bryant to serve a
five-year probated sentence, repay $11,814 in benefits and pay a $1,500
fine.
INDICTED—Michael Thomas of Humble. Thomas allegedly collected $4,630 in benefits he was not
entitled to.
INDICTED—Joshua Hall of Lake Worth. Hall allegedly collected $4,112 in benefits he was not entitled
to.
INDICTED—Jesse Roberts of Tomball. Roberts allegedly collected $3,403 in benefits he was not entitled
to.
INDICTED—Bruce Pittman of Houston. Pittman allegedly collected $1,527 in benefits he was not entitled to.
Note: A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.
Zero tolerance for fraud
All of these investigations are part of the Texas Mutual Insurance Company “zero tolerance for fraud” policy. The company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
We need your help
Many of our investigations start when a policyholder reports suspicious activity by a claimant, health
care provider or another policyholder. You can help us win the fight against fraud if you:
- Adopt a zero tolerance for fraud policy.
- Notify us if you suspect a claimant, health care provider or policyholder is committing fraud.
- Work with the investigator assigned to the case.
- Stay in touch with injured employees who are off work.
- Notify the investigator if the employee’s work status changes.
- Attend hearings when requested.
- Allow employees to testify if necessary.
Fraud-fighting resources on the Web
Visit the Fighting Fraud section to read more about these cases and others, report suspected fraud, learn the red flags for fraud and download a Fraud StoppersSM poster.
COMPNEWS - Summer 2007
Keep Older Workers Healthy and Productive
Texas Mutual Pays $125M in Dividends
PAG Asks the Questions You Want Answered
Learn How to Control Your Workers’ Comp Costs
President's Message:
Another typical day at the office?
Sample Workplace Violence Policy
You Need to Know:
Legislature passes workers’ compensation bills
New disability management rules take effect
State to release first network report card this fall
Learn more about the workers’ comp system
You need to know more
Fraud-Fighting Corner
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