Winter 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, and we get results. These investigations are part of our zero tolerance for fraud policy.

Five claimants sentenced for double-dipping
Texas courts sentenced five workers’ compensation claimants, in separate cases, for fraud. The claimants collected a combined $21,266 in benefits they were not entitled to.

All five cases involved a scam that investigators call double-dipping.

Double-dipping happens when claimants collect benefits for being too injured to work when they are, 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.

SENTENCED—Jose Rubio of Houston. A Travis County court ordered Rubio to serve one year of probation and pay $4,320 in restitution to Texas Mutual Insurance Company, plus fines and fees.

SENTENCED—James N. Vavra of Bryan. A Travis County court sentenced Vavra to two years’ deferred adjudication. It also ordered him to perform 80 hours of community service and repay $3,920 in benefits to Texas Mutual Insurance Company.

SENTENCED—Chris C. McCall of May. A Brown County court ordered McCall to serve a five-year probated sentence and pay $8,283 in restitution to Texas Mutual Insurance Company, plus fines and fees.

SENTENCED—Rufino Montiel-Lopez of Austin. A Travis County court ordered Montiel-Lopez to serve 18 months’ probation, perform 80 hours of community service and repay $3,188 in benefits to Texas Mutual Insurance Company.

SENTENCED—Marvin Reyes of Del Valle. A Travis County court ordered Reyes to serve two years’ probation, perform 100 hours of community service and repay $1,555 in benefits to Texas Mutual Insurance Company.

ZIPCO Services indicted
A Travis County grand jury indicted ZIPCO Services Inc. and its owner, Jerry Don Calicutt, on workers’ compensation fraud-related charges. The indictments allege that ZIPCO Services Inc. defrauded Texas Mutual Insurance Company of over $100,000 in premium.

ZIPCO Services Inc. is an oil and gas contractor located in Kilgore. The indictments allege that the defendants misrepresented the size of ZIPCO’s operations and number of its employees to Texas Mutual Insurance Company. Because workers’ comp premium is based in part on payroll, the scheme allowed the company to pay less premium than it actually owed.

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

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 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 - Winter 2007
Safety Tips From the Pros
Texas Tops Nation in Workplace Fatalities
The Cold Facts About Winter Driving
Free Workshop Coming to a City Near You
President's Message: 
Think Safety First, Second and Third
You Need to Know: 
Update your workers’ comp forms
State issues first network report card
Remember to deliver required notices
Electronic billing starts January 1
You Need to Know More
Fraud-Fighting Corner

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