Four Indicted on Workers’ Comp Fraud Charges
March 20, 2007 - Texas Mutual Insurance Company reported today that four individuals were indicted, in separate cases, in Travis County on workers’ compensation fraud-related charges. The individuals allegedly collected a combined $13,672 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: Michael Thomas of Humble, $4,630; Joshua Hall of Lake Worth, $4,112; Jesse Roberts of Tomball, $3,403; and Bruce Pittman of Houston, $1,527.
Texas Mutual Insurance Company is the state’s leading provider of workers’ comp insurance and its insurer of last resort. These cases are part of the company’s “zero tolerance for fraud” policy. For more information, visit the Fighting Fraud section.
Note: A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.
TPA Earns Second Consecutive Texas Mutual Dividend
February 21, 2007 - Texas Mutual Insurance Company announced a $43,392 dividend for the Texas Produce Association (TPA) purchasing group today. Premium volume and loss ratio were key factors in the group’s second consecutive dividend.
Members earn a premium discount based on the premium volume of the entire group, and they retain their own experience modifier. They also have access to a safety plan developed specifically for their industry.
The group is open to growers; domestic, import and specialty shippers; distributors; material and service providers; and others in the produce industry. Any licensed Texas agent can submit a qualifying client for group membership. For more information on purchasing groups, click here.
Texas Mutual Insurance Company notes that past dividends are not a guarantee of future dividends, and the Texas Department of Insurance must approve all dividends.
TSG Earns Third Consecutive Texas Mutual Dividend
February 19, 2007 - Texas Mutual Insurance Company announced a $256,134 dividend for the Texas Schools Group (TSG) purchasing group today.
Premium volume and loss ratio were key factors in calculating the group’s third consecutive dividend. Texas Mutual Insurance Company has paid over $331,000 in dividends to TSG since 2005.
TSG is open to qualifying schools. Any licensed Texas agent can submit a qualifying client for group membership. TSG group members earn a premium discount based on the premium volume of the entire group, and they retain their own experience modifier. They also have access to a safety plan developed specifically for their industry.
Perry Hunter Hall Insurance administers the TSG purchasing group, and Texas Mutual Insurance Company underwrites it. For more information on purchasing groups, click here.
Texas Mutual Insurance Company notes that past dividends are not a guarantee of future dividends, and the Texas Department of Insurance must approve all dividends.
Texas Mutual Awarded Over $7.5M in Civil Fraud Case
February 9, 2007 - A Travis County jury found that Gary C. Quintinsky of Houston committed civil fraud against Texas Mutual Insurance Company. The jury awarded the company over $5 million in actual damages and $2.5 million in punitive damages. The award is expected to exceed $8 million after prejudgment interest is calculated. This marks the largest premium fraud verdict in Texas Mutual Insurance Company history.
The lawsuit alleged that Quintinsky was involved in a conspiracy with other individuals and companies to defraud Texas Mutual Insurance Company of approximately $5 million through workers’ compensation policies issued to United Crane Inc., International Holdings Inc., United Crane Sales & Leasing Inc., Austin United Inc., Conroe United Inc., United Payroll Services Inc., Management Payroll Services Inc., United Fleet Maintenance Inc. and United Crane Rental Inc.
Texas Mutual Insurance Company, represented by attorney Robert M. O’Boyle of Strasburger & Price LLP, presented evidence of fraud involving false payroll records and other information given to Texas Mutual Insurance Company. The scam resulted in an undercharging of premium in the millions of dollars.
The Quintinsky investigation is part of the Texas Mutual Insurance Company “zero tolerance for fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
Harvester Sentenced for Workers’ Comp Fraud
February 7, 2007 - Texas Mutual Insurance Company reported today that Patricia Chavez of Sabinal, Texas pleaded guilty to workers’ compensation fraud-related charges. The Travis County 390th Judicial District Court sentenced Chavez to three years of deferred adjudication. The court also ordered Chavez to perform 200 hours of community service, pay a $250 fine and repay $2,959 in benefits she fraudulently obtained from Texas Mutual Insurance Company.
Chavez reported a job-related injury while working as a seasonal harvester for Holmes & Holmes Inc. of Knippa, Texas. She claimed she was unable to work as a result, and Texas Mutual Insurance Company began paying her workers’ comp income benefits.
Meanwhile, Texas Mutual Insurance Company obtained video surveillance evidence that Chavez was feigning her inability to work. Feigning occurs when claimants fake their disability and inability to work. The video showed Chavez was able to walk and move without restriction.
The Chavez investigation is 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.
Texas Mutual Expands Network Service Areas
January 24, 2007 - Texas Mutual Insurance Company announced that the Texas Department of Insurance approved the expansion of its workers’ compensation health care network option. The new service areas include west Texas cities such as Abilene, Midland and Odessa, as well as Nacogdoches, Texarkana and Orange to the east. With the expansion, the network option will be available to approximately 95 percent of the company’s policyholders.
Texas Mutual Insurance Company will begin to offer the workers’ compensation health care network option to policyholders in the additional areas in the next few weeks.
Employers who are eligible for and participate in the network option benefit from occupational health care services designed to control the costs of workplace injuries. The network’s focus is on helping injured workers get well and back on the job. Most eligible policyholders also receive a 12 percent annual network premium discount.
Texas Mutual Insurance Company is the state’s leading provider of workers’ compensation insurance. To learn more about the company’s workers’ compensation health care network, click here.