A HVAC duct installer complained of low back and neck injuries following a work-related vehicle accident. He continued working for the employer in a light duty capacity based on his physical complaints and reported disability. Zenith investigators observed the claimant dancing and lifting large speakers at a family reunion. These activities were a sharp contrast to what the claimant told his doctors and the claim adjuster he was capable of doing. The claimant also made false statements concerning his activities and physical abilities in his deposition. Following the deposition, the claimant’s attorney withdrew his representation. When the claimant failed to appear at a subsequent hearing, the claim was dismissed.

The Result: The claimant was arrested on charges of insurance fraud and false swearing.

An employee filed a workers’ compensation claim against her employer for continual stress and strain to her right shoulder, neck, and back. Throughout the course of the claim, the claimant denied a history of prior injury to the neck and back, both to medical providers and during her deposition.

Subpoenaed records obtained through Zenith’s investigation revealed that the claimant filed a workers’ compensation claim against a previous employer for injuries to the same body parts and was ultimately awarded $17,500. The claimant testified under oath at trial that she did not recall receiving a settlement from her previous workers’ compensation claim.

The Result: The claim was dismissed and the claimant was arrested on fraud and perjury charges.

A vineyard worker reportedly sustained an injury to her neck, back, and right shoulder when she tripped over a vine. The claimant denied any prior injuries, however, when her primary care physician’s records were obtained, it was documented that a back injury had occurred at home. Zenith’s investigators also secured the records from the Employment Development Department documenting the prior non-industrial back injury. Zenith reviewed the evidence and determined that the claimant made “material misrepresentations” at her deposition and medical evaluations.

The Result: Prosecutors arrested the claimant, and the claimant was later convicted of workers’ compensation fraud.

An employee of a large fruit tree farm located in the Central Valley of California was formally charged with two felony counts of insurance fraud in a criminal complaint.

The employee filed a workers’ compensation claim two weeks after he had been hired as a tree pruner, alleging an injury to his lower back. He was subsequently placed on temporary total disability (TTD). He received TTD payments until the claimant’s medical treatment and diagnostic tests resulted in negative findings.

After he began missing medical appointments, Zenith opened an investigation. The employee was followed from his residence one morning to a dairy (coincidentally also a Zenith policyholder) where he remained for several hours.

Zenith investigators subsequently made contact with the owners of the dairy. Zenith determined that the claimant had been recently hired at the dairy but under a false name, social security number, and date of birth. Shortly after being hired at the dairy, the employee filed yet another workers’ compensation claim alleging an injury to his back.

After Zenith investigators interviewed the employee, the claimant sought legal representation. During his subsequent deposition, the employee denied any prior back injuries or worker’s compensation claims.

During a recent activities check, the claimant was followed to a third place of employment, another dairy, where Zenith investigators determined he was working under a third name, social security number, and date of birth.

The Result: Prosecutors arrested the claimant on felony charges of insurance fraud and identity theft.

An employee alleged he injured his back while bending over to pick up saw horses on a job site. During the course of the claim, the claimant denied to Zenith and treating physicians that he had any previous medical history of back pain or back injury requiring medical treatment. He denied several times during his sworn deposition that he ever had any previous treatment for back pain had never sustained a previous back injury.

Zenith obtained medical records via subpoena that proved to be contrary to the claimant’s sworn testimony. The records reflected that the claimant had an extensive medical history dating back ten years through the date he alleged the claim with Zenith. These records revealed that the claimant was treated approximately 25 times at multiple locations, of which seven visits were to hospitals for back pain. The claimant’s prior treatment included x-rays and pain medication. The records also revealed that the claimant reported a fractured back from a previous injury.

The Result: The claimant was arrested, convicted, and sentenced to 18-months in state prison to be followed by probation and ordered to pay restitution in the amount of $28,000.