If a picture is worth a thousand words, a videotape can be worth many times more when a surveillance camera catches an employee in the act of dramatizing a phony workers’ comp injury. That’s what happened in a recent case that resulted in the criminal conviction of a malingering employee who was also ordered to repay thousands of dollars in workers’ comp benefits. We’ll look at the case and offer suggestions for combating fraudulent claims.
Worker Slips On Lemon Peel
Belquis Amin was a Hilton Hotel waitress in Pleasanton when she slipped on a lemon peel, fell and hurt her back. She filed a workers’ compensation claim, but the extent of her injuries was unclear. Two and a half years after the accident, Amin said her condition was worse than ever, causing severe low back pain that left her unable to do household chores, walk without difficulty or drive her car.
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Insurer Launches Investigation
Amin and Hilton’s workers’ comp insurer, Fireman’s Fund, selected a doctor to examine her. The physician suspected that Amin was exaggerating because her complaints far exceeded what would be expected from her injuries. As a result, Fireman’s Fund began an undercover video surveillance of Amin—and it hit pay dirt.
The company captured two incriminating incidents on film. First, Amin was caught driving her children to school and walking in high heels. A second sequence showed her walking away from her home without any trouble, driving to a friend’s apartment, and then being driven by the friend to a workers’ comp medical appointment. At the doctor’s office, Amin was suddenly unable to walk without her friend’s help and the use of a walker.
As she left the office, she moved very slowly, limped severely, used a cane, and needed assistance to get into the car. Back at her friend’s apartment less than an hour later, Amin easily walked down some stairs without using a handrail, got into her car, and drove away.
Criminal Charge Filed
In light of the videotape evidence, Amin pleaded guilty to criminal workers’ comp fraud. As part of a plea bargain, she was ordered to pay $29,983 in restitution to the insurer, including $9,822 in benefits and about $20,000 in attorneys’ fees, costs and investigation expenses.
Worker Appeals To Avoid Restitution
Amin appealed, claiming she shouldn’t have to pay restitution because she did suffer a legitimate work-related injury.
A California Court of Appeal disagreed. The court said Amin may have sustained an injury, but the videotapes showed she grossly exaggerated it. Plus, in her plea bargain, she had expressly agreed to the payback in return for probation instead of jail. And, she was repaying only a fraction of the benefits she had received.
How To Prevent Fraud
Here are some basic steps you can take to guard against phony workers’ comp claims:
- Investigate suspicious claims. If you suspect an employee is faking or exaggerating an injury, call your insurer immediately and request an investigation. A videotape demonstrating the employee’s capabilities can help resolve disputed claims quickly.
- Monitor medical progress. Closely follow the recovery of all injured employees. Look for red flags such as a medical professional questioning the severity or duration of a worker’s symptoms.
- Prosecute fraud. Successfully prosecuting an employee for workers’ comp fraud sends a clear signal to other workers that you won’t tolerate fraud—and can go a long way toward deterring other workers’ comp abuses. But to avoid defamation claims, be sure to report only the objective facts of the case to the police or district attorney.