• About us
• Contact us
• Careers
• En español

• Employers
• Agents
• Providers
• Injured workers
• Health care network
• Safety
• Fighting Fraud
• Newsroom

  | Summer 2009

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

Fraud costs the workers’ compensation system $7.2 billion a year, more than Yahoo! Inc.’s revenue in 2007, according to the National Insurance Crime Bureau.

Texas Mutual is doing its part to protect your premium dollars. In 2008, our investigators uncovered $10.7 million in fraud and abuse That is:

Mt. Pleasant man pleads guilty to workers’ comp fraud
A Travis County district court sentenced Denniss A. Aguilar of Mt. Pleasant on workers’ compensation fraud-related charges. The court ordered Aguilar to repay $16,676 to Texas Mutual. It also sentenced him to four years’ probation and 40 hours of community service.

Aguilar reported a job-related injury while working as a truck driver for Welder’s Equipment Inc. of Pasadena. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying him income benefits.

Meanwhile, Texas Mutual uncovered evidence that Aguilar worked for four different employers while receiving income benefits.

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.

In other fraud-fighting news
SENTENCED— Michael Burnett of Graham. Burnett was ordered to repay $8,736 to Texas Mutual, serve five years’ probation and perform 100 hours of community service.

SENTENCED— Connie Snowden of Bloomington. Snowden was ordered to repay $8,088 to Texas Mutual, serve four years’ probation, perform 40 hours of community service and pay a $500 fine.

SENTENCED— David John Beatty of Flower Mound. Beatty was ordered to repay $5,074 to Texas Mutual, serve five years’ probation and perform 100 hours of community service.

INDICTED— Wallace Sorrells of Austin. Sorrells allegedly obtained $6,197 in benefits he was not entitled to.

INDICTED— Gary C. Quintinsky and Ellynn A. Ogilvie of Houston, operators of United Crane Inc. and multiple related companies in Houston, Kyle and Fort Worth. The indictments allege that Quintinsky and Ogilvie concealed payroll and employees from Texas Mutual. The scam allowed them to obtain a lower premium than they actually owed.

INDICTED— Trans X Corp of Arlington and its owner-president, Cheryl Ann Bussey of Mansfield. Texas Mutual alleges that Bussey intentionally gave Texas Mutual false information about her workforce in her applications for coverage and provided incomplete payroll records. The scam allowed her to obtain a lower premium than she actually owed.

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

We need your help
Many of our fraud investigations start when a policyholder reports suspicious activity. If you see two or more of these red flags in a claim being handled by Texas Mutual, notify us immediately at fraudstoppers@texasmutual.com or (800) 488-4488:

Fraud-fighting resources on the Web
Visit the Fighting Fraud section to read our fraud-fighting success stories, report suspected fraud, and get a FraudStoppers^SM poster for your workplace.

Back to top