Busted, Now What?

Fraud Convictions And Pleas

Before The California WCAB

Presented by:

David H. Parker

Attorney at Law

Parker, Kern, Nard & Wenzel

All written and photographed material © 2012 David H. Parker.

This presentation is meant to convey general information only. It is not intended to impart specific legal advice concerning legal

problems or issues to individuals, public or business entities. Should you wish to refer a legal matter you must contact an attorney for

purposes of legal retention. No attorney-client relationship can be formed without a written retention agreement and/or fee agreement

signed by both the lawyer and the client defining the scope of the retention. Do not provide or impart confidential information through

this lecture until Parker, Kern, Nard & Wenzel confirms in writing the absence of a conflict of interest.

If you want legal advice from me or our firm:

RETAIN US @

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David H. Parker

Attorney at Law

Parker, Kern, Nard & Wenzel

1111 E. Herndon Ave. Ste 202

Fresno, CA 93720

(559)-449-2558

dp@pknwlaw.com

www.pknwlaw.com

Disclaimer Violation

Legal Team.

This presentation is meant to convey general information only. It is not meant to impart specific legal advice concerning legal

problems or issues to individuals or other business entities. Should you wish to refer a legal matter you must contact an attorney for

purposes of legal retention. No attorney-client relationship can be formed without a written retention agreement and/or fee agreement

signed by both the lawyer and the client defining the scope of the retention. Do not provide or impart confidential information through

this lecture until Parker, Kern, Nard & Wenzel confirms in writing the absence of a conflict of interest.

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What Is Workers’ Compensation

Fraud?

The Claims Fraud Statute

Insurance Code section 1871.4

What Is Workers’ Compensation

Fraud?

The Premium Fraud Statutes

Insurance Code sections 11760 and 11880

What is Workers’ Compensation

Fraud?

Common Definition of Fraud

(Plain Language):

When someone knowingly lies with an intention to do

the following:

1. Obtain a Workers’ Compensation Benefit

not due;

2. Deny a Workers’ Compensation Benefit due;

3. Obtain a Workers’ Compensation Policy of

Insurance at less than the proper rate, cost

or premium.

Definition of Fraud

(Legalese)

Any person who makes or causes to be made

any knowingly false

or fraudulent material statement

or material representation

For the purpose of obtaining or denying

workers’ compensation benefits or payments

is guilty of a felony.

What Is Workers’ Compensation

Fraud?

Some More “Legalese”

Penal Code 550(b)(3)

Concealing or knowingly failing to disclose the occurrence of an event that affects a person’s benefits – whether that be entitlement, amount or duration -- may constitute workers’ compensation fraud.

So, What Is Workers’

Compensation Fraud?

The seminal question, in plain language is:

Did the act or omission make any difference at all

to the determination and administration of

workers’ compensation benefits?

If It Is, What Can Happen Before

The WCAB?All Benefits Barred

Miller v. WCAB 33 CCC 621

Muniz v. WCAB 62 CCC 1597

Moore v. WCAB 63 CCC 204

Plass v. WCAB 62 CCC 705

Quiroz v. WCAB 62 CCC 987

Nolo Contendre or “conviction of

fraud” bars all benefits.

Some Benefits Barred

Zenith Insurance v. WCAB (Ball)

61 CCC 1107

Longs Drug Store v. WCAB (Sciutto):

61 CCC 1307

Conviction pursuant to IC 1871.4 bars

only those benefits received as a

result of the particular fraud.

Quiz: Is This Workers’

Compensation Fraud?

How About This, Is This Workers’

Compensation Fraud?

Umm, Is This Workers’

Compensation Fraud?

Okay, Parker, Why Isn’t This

Workers’ Compensation Fraud?

The seminal question, in plain language is:

Did the act or omission make any

difference at all to the determination and

administration of workers’ compensation

benefits?

Friendly Reminder:

How About This, Is This Workers’

Compensation Fraud?

Applicant’s Sworn Deposition

Testimony:

State Panel Doctor’s Reporting:

Payment of Benefits Based On

State Panel Doctor’s Initial, Pre-

Subrosa Reporting :

Yes, Virginia, There Is A Fraud

Prosecution!

Applicant was successfully prosecuted by The Fresno County

District Attorney’s Office, Workers’ Compensation Fraud

Division.

Thank you Edith Treviso, Trevor Oppliger and the entire

Investigative Team at

http://www.co.fresno.ca.us/DepartmentPage.aspx?id=5388

But, Virginia,

Subsequent to a nolo contendere misdemeanor, Count 7 of a

criminal complaint, the crime being “Grand Theft of Real

Property in violation of Penal Code Section 487(a)” related to

his own actions in regard to this claim, including no restitution

for Insurance Code section 1871.4 to 1871.5 but restitution in

the amount of $5,000.00 as part of the criminal plea

agreement…

And, Virginia,

Subsequent to a workers’ compensation trial regarding

restitution of the $40,000 plus in temporary total and other

benefits paid which all the State Panel Qualified Medical

Evaluators felt was paid based on applicant’s

misrepresentations…

And, Virginia,

Subsequent to a workers’ compensation Judge’s finding, in

spite of Labor Code section 3202 statutory liberal mandate

that …

And, Virginia,

Subsequent to a workers’ compensation Judge’s finding, in

spite of Labor Code section 3202 statutory liberal mandate

that…

Virginia, There Is No Workers’

Compensation Santa Clause.

Some Lessons Learned:

Criminal Action

1. The Burden of Proof is

HIGH – Beyond a

Reasonable Doubt.

2. Dueling Doctors – NOT

good.

3. Resources are limited.

4. Other Lessons?

WC Action

1. It’s a liberal system

(Labor Code section

3202);

2. Restitution is limited by

some judges opinions;

3. The plea matters:

ideally it is felony

Insurance Code sections

1871.4-1871.5.

Some Lessons Learned:

Victim(s)

1. The system is slow.

2. The system is frustrating.

3. The system is limited?

Busted, Now What?

Fraud Convictions And Pleas

Before The California WCAB

Presented by:

David H. Parker

Attorney at Law

Parker, Kern, Nard & Wenzel