| Summer 2010
Fraud-Fighting Corner
By Tim Riley • Manager of Special Investigations
Fraud costs the workers’ compensation system $7.2 billion a year, according to the National Insurance Crime Bureau. Texas Mutual is doing its part to protect your premium dollars. Last year, our investigators saved, identified or recovered $16 million through our zero tolerance for fraud program.
Courts order claimants to repay combined $34K to Texas Mutual
In unrelated cases, Travis County district courts sentenced Lashantae Reeves of Houston and Jason Whatley of Borger on workers’ compensation fraud-related charges.
The court sentenced Reeves to one year of deferred adjudication and ordered her to repay $21,000 in benefits. Whatley was ordered to repay $13,488 in benefits and pay a $500 fine.
Reeves and Whatley claimed they were unable to work due to on-the-job injuries, and Texas Mutual began paying income benefits to them.
Meanwhile, the company uncovered evidence that both claimants were working other jobs 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 Mora of Brownsville. Mora’s sentence included 10 days in jail, three years’ probation and 100 hours of community service. Mora was also ordered to repay $3,533 in benefits.
SENTENCED—Allen Brown of Cedar Hill. Brown was sentenced to serve five years’ probation, perform 200 hours of community service and repay $2,701 to Texas Mutual.
SENTENCED—Wallace Sorrells of Giddings. Sorrells was sentenced to 60 days in the county jail.
INDICTED—Janet Fanning of Kirbyville, Sergio Garcia of El Paso and Margarito Robles of San Antonio.
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:
- Tip from a credible source
- New or disgruntled worker
- No witness to alleged injury
- Inconsistent or illogical description of incident
- Hard to contact injured worker
- Injured worker acts upset when contacted
- Suspicious injury on Monday or Friday
Fraud-fighting resources on the Web
Visit the Fighting Fraud section at texasmutual.com to read our fraud-fighting success stories, report suspected fraud, and get a Fraud StoppersSM poster for your workplace.
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