Jury Awards $145M for Unreasonable Denial of Comp Claim
April 14, 2025 | JacobiJournal.com – Jury Awards $145M: Insurance company held accountable for denying worker’s legitimate claim: A California jury has awarded $145 million to a worker after determining that his workers’ compensation claim was wrongfully denied by his employer’s insurance company. The ruling highlights the financial consequences that insurers face when denying legitimate claims in bad faith. Case Background The worker, employed in construction, suffered serious injuries after falling at his worksite. His workers’ compensation claim was submitted in accordance with California law but was rejected by the insurance company, which cited insufficient evidence of injury severity. As a result, the worker had to pay for his medical treatments out of pocket, leading to financial and emotional distress. Legal Ruling and Jury’s Decision After a lengthy trial, the jury ruled that the insurance company acted in bad faith by unreasonably denying the claim. The jury found that the insurer’s actions caused undue hardship for the worker, who had no alternative for covering medical expenses and lost wages. Jury Awards $145M “This ruling sends a strong message to insurers that they cannot deny legitimate claims without facing serious consequences,” said the worker’s attorney. “This award speaks to the harm caused by bad faith actions in workers’ compensation claims.” Broader Implications for Insurers This landmark case is expected to set a significant precedent for future workers’ compensation lawsuits in California. Legal experts suggest that insurers will now face heightened scrutiny regarding their claim review processes. The verdict underscores the importance of ensuring timely and fair compensation for workers injured on the job. Source: Legal News Network FAQs: Jury Awards $145M Workers Comp Claim What led to the Jury awards $145M workers comp claim verdict? The case stemmed from an insurer’s bad faith denial of a legitimate construction worker’s compensation claim, which left the worker covering his own medical costs. How does the Jury awards $145M workers comp claim ruling impact insurers? It signals heightened scrutiny of insurers’ claims practices, warning that unreasonable denials may result in massive financial penalties. Why is the Jury awards $145M workers comp claim significant for workers? The verdict reinforces workers’ rights to fair compensation, discouraging insurers from delaying or denying legitimate claims without evidence. FAQs: Jury Awards $145M Workers Comp Claim What led to the Jury awards $145M workers comp claim verdict? The case stemmed from an insurer’s bad faith denial of a legitimate construction worker’s compensation claim, which left the worker covering his own medical costs. How does the Jury awards $145M workers comp claim ruling impact insurers? It signals heightened scrutiny of insurers’ claims practices, warning that unreasonable denials may result in massive financial penalties. Why is the Jury awards $145M workers comp claim significant for workers? The verdict reinforces workers’ rights to fair compensation, discouraging insurers from delaying or denying legitimate claims without evidence. Stay informed on landmark rulings like the Jury awards $145M workers comp claim decision. Subscribe to JacobiJournal.com today for expert legal insights and trusted fraud case updates. Read More from JacobiJournal.com
Three Floridians Plead Guilty in Workers’ Comp, Tax Fraud Scheme
April 10, 2025 | JacobiJournal.com — Three Floridians Plead Guilty: Three Orlando residents have pleaded guilty to federal charges in a sweeping fraud scheme that evaded tens of millions of dollars in workers’ compensation insurance premiums and payroll taxes, according to federal prosecutors. The case, now gaining national attention, highlights how construction-related fraud can undermine both state insurance funds and the IRS. Federal officials emphasized that when Three Floridians Plead Guilty to orchestrating such a large-scale scheme, it signals a broader warning to contractors and business owners who might consider similar tactics. Authorities noted that this case is part of a coordinated effort to dismantle “ghost employee” networks and shell company operations that cheat insurers and taxpayers. By entering their guilty pleas, the defendants admitted to conduct spanning nearly a decade and involving millions in fraudulent transactions. Legal analysts point out that the outcome in which Three Floridians Plead Guilty also underscores the government’s aggressive stance on holding individuals accountable for both workers’ compensation and tax fraud. Plea Agreements and Potential Sentences Eduardo Anibal Escobar, Carlos Alberto Rodriguez, and Adelmy Tejada, all legal permanent residents from El Salvador, admitted to conspiring to commit wire fraud and tax fraud. Each defendant now faces up to 20 years in prison for the wire fraud charge and up to 5 years for the tax fraud offense. Three Floridians Plead Guilty As part of the plea deal, the court ordered the trio to forfeit $8.76 million in profits and two Orlando homes purchased with illicit funds. Additionally, they must pay restitution totaling: How the Scheme Operated Beginning in January 2015 and continuing through August 2024, the defendants carried out a complex scheme to defraud the insurance system and the IRS. They registered shell companies with the State of Florida, secured workers’ compensation policies that listed only a few employees and minimal payroll, and then falsely claimed to employ hundreds of subcontractors. To execute the scheme, the trio partnered with construction subcontractors who needed insurance coverage. These subcontractors, often employing undocumented workers, paid the defendants to falsely represent that the workers were on their payroll. In return, the defendants provided documents to general contractors claiming the workers were insured through their companies. As a result, the general contractors issued checks to the defendants’ shell companies. The trio then distributed the funds to the subcontractors’ workers—while keeping 6% to 8% in fees. The Financial Impact Over the course of the scheme, approximately $146 million in payroll flowed through the defendants’ companies. However, they failed to report this payroll to the IRS and avoided paying the associated taxes. Had they reported it properly, they would have owed nearly $37 million in payroll taxes. Furthermore, insurance companies believed they were covering only the limited payroll amounts reported on the applications. In reality, they unknowingly provided coverage for the much larger unreported payroll, missing out on an estimated $13 million in premiums. Ongoing Federal Crackdown This case forms part of a broader federal effort targeting fraud in the construction industry, particularly the use of “ghost” employees and shell companies. The investigation was led by Homeland Security Investigations, IRS-Criminal Investigation, and the Florida Department of Financial Services. Assistant U.S. Attorney Arnold B. Corsmeier is prosecuting the case, while Jennifer M. Harrington is handling asset forfeiture. Although the sentencing dates have not yet been set, authorities emphasized that similar investigations remain ongoing. For official updates on federal labor fraud enforcement, visit the U.S. Department of Justice – Criminal Division. FAQs: Three Floridians Plead Guilty Fraud Case What charges did the three Floridians plead guilty to in the fraud case? The three Floridians pleaded guilty to conspiring to commit wire fraud and tax fraud, charges that carry up to 20 years and 5 years in prison, respectively. What restitution was ordered in the three Floridians plead guilty case? The court ordered $12.99 million to insurers, nearly $37 million in payroll taxes, and $397,895 for fraudulent workers’ comp claims. How did the scheme in the three Floridians plead guilty case operate? The defendants used shell companies and false payroll reports to avoid paying premiums and taxes, while subcontractors paid them for fraudulent coverage. Stay ahead of fraud news and enforcement actions. Subscribe to JacobiJournal.com today for weekly updates on workers’ comp, tax fraud, and public integrity cases. 🔎 Read More from JacobiJournal.com:
LA Delivery Owners Ordered to Pay $2.25M in Restitution
April 9, 2025 | JacobiJournal.com — LA Delivery Owners Ordered: The owners of three Los Angeles-based delivery companies have been ordered to pay more than $2.25 million in restitution after underreporting over $21 million in employee payroll to avoid workers’ compensation insurance premiums. This ruling underscores how seriously California regulators and prosecutors are cracking down on payroll fraud in the delivery and logistics sector. By deliberately misclassifying payroll and concealing true employee numbers, the defendants were able to gain an unfair advantage over compliant businesses while exposing their workers to significant risk. The decision comes amid a broader state and national push to hold business owners accountable for misreporting payroll and avoiding legally mandated insurance obligations. With the restitution amount exceeding $2.25 million, the case highlights the real financial impact of enforcement actions and sends a message to other companies considering similar misconduct. Sentencing Details On April 3, 2025, the California Department of Insurance (CDI) announced that John Nemandoust, 70, and Annette Assil, 62, were sentenced for their roles in the scheme. Nemandoust received 60 days in county jail, while Assil received 30 days. Both were also sentenced to 10 years of felony probation and must repay $2,254,748 in unpaid insurance premiums. LA Delivery Owners Ordered How the Scheme Worked The couple operated A-1 Valley Services, Prompt Delivery, and Affordable Messenger. Between 2013 and 2017, they only purchased workers’ comp coverage for A-1 Valley Services. Meanwhile, the other two companies remained uninsured. When workers from the uninsured companies were injured on the job, the owners allegedly filed the claims under A-1 Valley’s insurance policy. Investigative Findings A forensic audit revealed that the companies had a combined gross payroll of more than $25 million. However, they only reported $1.4 million to their insurance carrier. This misreporting allowed them to evade approximately $3 million in insurance premiums. The Los Angeles County District Attorney’s Office prosecuted the case following a CDI investigation. Source: Los Angeles County District Attorney’s Office For official details, see the California Department of Insurance report: California Department of Insurance – News Releases. FAQs: LA Delivery Owners Why were the LA delivery owners ordered to pay $2.25M in restitution? They underreported more than $21 million in payroll to avoid workers’ compensation insurance premiums, leading to their sentencing and restitution order. What penalties did the LA delivery owners face besides restitution? John Nemandoust received 60 days in jail, Annette Assil received 30 days, and both were sentenced to 10 years of felony probation. How did investigators uncover the fraud involving the LA delivery owners? A forensic audit by the California Department of Insurance revealed the misreported payroll and fraudulent use of one company’s insurance policy for claims. Stay ahead on major insurance fraud prosecutions like this one. Subscribe to JacobiJournal.com for breaking fraud news and legal updates. 🔎 Read More from JacobiJournal.com:
San Diego Plumber Fined Over $1M for Workers’ Comp Fraud
April 7, 2025 | JacobiJournal.com — San Diego Plumber Fined: Daniela G. Birdwell, a Spring Valley-based plumbing contractor and owner of GPS Plumbing, has been ordered to pay $1,030,062 in restitution. The penalty follows her guilty plea in a workers’ compensation premium fraud case, according to the San Diego County District Attorney’s Office. The plumber fined in this case admitted to intentionally underreporting payroll in order to avoid paying higher workers’ compensation premiums, a scheme that allowed her business to operate at a lower cost while putting employees and honest competitors at a disadvantage. Prosecutors emphasized that this type of fraud is not a victimless crime. Workers lose the protection they are legally entitled to if injured on the job, while insurers and policyholders shoulder increased costs. Sentencing and Penalties As part of the plea agreement, Birdwell will serve two years of probation. She must also complete 320 hours of community service and pay $10,000 per month toward restitution. District Attorney Summer Stephan commented on the case: “Employers who engage in premium fraud are not only breaking the law, but they also gain an unfair advantage over their competitors. Our Insurance Fraud Division remains committed to holding these businesses accountable, protecting workers, and ensuring a level playing field.” Discovery of the Fraud The fraud was discovered during a routine audit by the State Compensation Insurance Fund. Investigators noticed major differences between payroll figures reported to the Employment Development Department (EDD) and those reported during the company’s insurance audits. San Diego Plumber Fined As a result, the State Fund found millions of dollars in unreported payroll between June 2016 and May 2021. The Investigation and Prosecution Following the audit, the State Fund’s Special Investigation Unit submitted its findings to both the San Diego County District Attorney’s Office and the California Department of Insurance. Consequently, this led to Birdwell’s prosecution and sentencing. The Broader Impact of Insurance Fraud Insurance fraud remains a serious and costly issue. Nationwide, it costs consumers between $80 billion and $90 billion annually. In California, it accounts for nearly $15 billion each year. Notably, it ranks as the second-largest economic crime in the state, just behind tax evasion. For official guidance and updates on workers’ compensation fraud cases, visit the California Department of Insurance – Workers’ Compensation Fraud. FAQs: About San Diego Plumber Fined Case What was the San Diego plumber fined for? The San Diego plumber fined over $1M, Daniela Birdwell, was convicted of workers’ compensation premium fraud after underreporting payroll for years. How much must the San Diego plumber fined in the fraud case pay back? Daniela Birdwell was ordered to pay $1,030,062 in restitution, with $10,000 monthly installments, alongside probation and community service. Why is the San Diego plumber fined case significant for businesses? The San Diego plumber fined case highlights how insurance fraud gives businesses an unfair advantage and puts honest employers and workers at risk. How was the case uncovered? The San Diego plumber fined more than $1 million was investigated after a State Compensation Insurance Fund audit revealed discrepancies between payroll records reported to state agencies and insurance audits. Why is the case significant for California? The San Diego plumber fined case highlights how workers’ comp fraud undermines fair business practices, drives up costs for honest employers, and impacts the integrity of California’s insurance system. Stay informed on the latest fraud cases and accountability news. Subscribe to JacobiJournal.com for weekly updates on workers’ comp fraud, healthcare fraud, and public integrity prosecutions. 🔎 Read More from JacobiJournal.com:
Los Angeles Delivery Owners to Repay for Workers’ Comp Fraud
April 7, 2025 | JacobiJournal.com — Los Angeles delivery owners to Repay for workers’ compensation fraud: On April 3, 2025, the California Department of Insurance (CDI) announced the sentencing of John Nemandoust, 70, and Annette Assil, 62, for a long-running workers’ compensation fraud scheme. The Los Angeles couple underreported more than $21 million in employee payroll across their three delivery companies. Sentencing and Restitution A judge sentenced Nemandoust to 60 days in county jail and Assil to 30 days. In addition, both received 10 years of felony probation and must repay $2,254,748 in restitution for unpaid workers’ compensation insurance premiums. The restitution order is intended not only to recover the financial losses caused by their scheme but also to reinforce the seriousness of workers’ compensation fraud in California. The probation terms mean the couple will remain under close supervision for a decade, with any violations potentially resulting in harsher penalties. Restitution payments are also structured to ensure accountability over the long term, signaling that financial misconduct in the insurance system carries lasting consequences for those involved. Uninsured Companies and Fake Claims CDI began investigating after learning that two of the couple’s businesses—Prompt Delivery and Affordable Messenger—operated without workers’ compensation insurance. The third company, A-1 Valley Services, held an active policy. Between 2013 and 2017, the couple only insured Valley Services. When employees from the uninsured companies suffered work-related injuries, Nemandoust and Assil submitted their claims under Valley Services’ policy. Investigators confirmed that at least 20 claims were improperly filed during this time. Los Angeles Delivery Owners Massive Payroll Underreporting A forensic audit revealed that the companies had a combined gross payroll of over $25 million, but only reported about $1.4 million to their insurer. As a result, they dodged nearly $3 million in workers’ comp premiums. The scale of the underreporting highlighted how even large operations can conceal payroll numbers to manipulate premium costs. Auditors determined that the gap between the actual payroll and reported figures was so significant that it could not have been the result of simple clerical errors. Instead, the evidence pointed to a deliberate effort to avoid paying into the workers’ compensation system. This manipulation not only harmed the insurance carrier but also placed honest businesses at a disadvantage by distorting the true cost of coverage in the industry. Prosecution The Los Angeles County District Attorney’s Office prosecuted the case, emphasizing the importance of holding business owners accountable for defrauding state insurance systems. For readers seeking more information on how California combats workers’ compensation fraud, visit the California Statewide Law Enforcement Association. FAQs: Los Angeles Delivery Owners Fraud Case Why were the Los Angeles Delivery Owners sentenced? The Los Angeles delivery owners were sentenced for underreporting more than $21 million in payroll across their three companies to avoid paying workers’ compensation insurance premiums. How much must the delivery owners repay? The court ordered the Los Angeles delivery owners to pay $2,254,748 in restitution to cover unpaid workers’ comp insurance premiums. What fraudulent actions did the delivery owners commit? They operated two companies without workers’ comp insurance and filed at least 20 fake claims under their insured company’s policy, while misrepresenting payroll. What does this case mean for other employers? This case highlights that employers who commit payroll or insurance fraud will face prosecution, restitution, and potential jail time under California law. Stay updated on workers’ compensation fraud cases and legal accountability. Subscribe to JacobiJournal.com for the latest news and expert analysis. 🔎 Read More from JacobiJournal.com:
CA Delivery Company Owners Fined $2M for Workers’ Comp Fraud
April 4, 2025 | JacobiJournal.com — CA Delivery Company Owners: A Los Angeles couple received sentences after an investigation uncovered that they underreported $21 million in payroll for their delivery companies. Authorities say the scheme lasted several years and gave them an unfair advantage over competitors by cutting down on required workers’ compensation insurance premiums. The fraud not only reduced their business costs but also put employees at risk by leaving them without proper coverage in the event of a workplace injury. According to investigators, this type of underreporting shifts the financial burden to insurers and the state, while undermining companies that comply with the law. The case against the delivery company owners highlights how payroll fraud can ripple through the entire workers’ compensation system, affecting honest employers, employees, and ultimately taxpayers. Uninsured Companies and Fraudulent Claims John Nemandoust (70) and Annette Assil (62) were sentenced for committing workers’ comp fraud. Nemandoust received 60 days in county jail, and Assil got 30 days. They also received 10 years of felony probation and must pay $2.2 million in restitution for unpaid premiums. CA Delivery Company Owners The California Department of Insurance (CDI) began the investigation after reports indicated that two of the couple’s companies, Prompt Delivery and Affordable Messenger, had no insurance. Between 2013 and 2017, the couple only maintained workers’ comp insurance for A-1 Valley Services, their third company. Underreported Payroll and Fraudulent Claims Investigators found that when employees from the uninsured companies suffered work-related injuries, the couple submitted fraudulent claims under A-1 Valley Services’s policy. Over the four years, the couple filed claims for at least 20 employees from the uninsured companies. A forensic audit showed that the companies reported only $1.4 million in payroll to their insurance carrier, though their actual payroll exceeded $25 million. This underreporting allowed the couple to evade $3 million in workers’ comp premiums. Prosecution and Legal Consequences The Los Angeles County District Attorney’s Office prosecuted the case, emphasizing the seriousness of workers’ compensation fraud and its impact on both employees and the broader business community. Prosecutors argued that the scheme carried out by the delivery company owners was not just about unpaid premiums, but about creating an uneven playing field that disadvantaged legitimate businesses that follow state labor laws. As part of the sentencing, the court stressed that felony probation and restitution payments serve as a warning to other employers who might consider similar fraudulent practices. Legal experts note that California continues to prioritize these types of prosecutions, as workers’ comp fraud undermines the integrity of the insurance system and can leave injured employees without the benefits they are entitled to. This case stands as an example of how state authorities are working in collaboration with the California Department of Insurance to hold business owners accountable, ensuring that fraud does not go unpunished. For more detailed guidance on workers’ compensation insurance compliance and fraud prevention, visit the California Department of Insurance official resource: California Department of Insurance – Workers’ Compensation Fraud. FAQs: CA Delivery Company Owners Workers’ Comp Fraud Why were the CA Delivery company owners fined $2.2 million? They were ordered to pay restitution after underreporting $21 million in payroll, which allowed them to avoid nearly $3 million in workers’ comp insurance premiums. How did investigators uncover the fraud by the CA delivery company owners? A forensic audit and insurance review revealed a significant payroll gap, along with fraudulent claims filed under their insured company, A-1 Valley Services. What companies were involved in the case? The couple operated Prompt Delivery, Affordable Messenger, and A-1 Valley Services. Only A-1 was insured, yet claims from the other two companies were falsely filed under it. What legal consequences did the delivery company owners face? They received county jail sentences, felony probation, and were ordered to repay $2.2 million in restitution for their fraudulent scheme. Stay informed on the latest insurance fraud prosecutions, workers’ comp fraud cases, and public integrity updates. Subscribe to JacobiJournal.com today for expert reporting delivered directly to your inbox. 🔎 Read More from JacobiJournal.com:
CA Plumbing Contractor Fined $1M for Workers’ Comp Fraud
April 3, 2025 | JacobiJournal.com — A California plumbing contractor fined $1 million in restitution has been ordered to compensate the State Compensation Insurance Fund after admitting to a long-running workers’ compensation insurance fraud scheme. Prosecutors said the case highlights how underreporting payroll to reduce insurance premiums not only cheats the system but also puts employees at financial and medical risk when workplace injuries occur. The contractor, identified as Daniela G. Birdwell, 41, of GPS Plumbing, pleaded guilty after a state investigation uncovered millions in unreported payroll. Authorities say the restitution order is intended to recover losses sustained by the insurance system and to send a strong deterrent message to other employers who may consider similar practices. Fraud Discovery and Investigation Authorities reported that Daniela G. Birdwell, the owner of GPS Plumbing, carried out the scheme by intentionally misrepresenting payroll records, allowing her to significantly reduce the workers’ compensation insurance premiums owed by her company. The State Compensation Insurance Fund’s Special Investigation Unit (SIU) began reviewing GPS Plumbing after identifying discrepancies between payroll data reported to the Employment Development Department (EDD) and the information submitted during insurance policy audits. A deeper audit revealed that millions in payroll had gone unreported, exposing a scheme that not only placed workers at risk but also shifted financial burdens onto the state’s compensation system. The SIU then referred the case to the San Diego County District Attorney’s Office and the California Department of Insurance for prosecution. Legal Consequences Birdwell pleaded guilty to a felony count of workers’ compensation premium fraud. As part of the sentencing, the court imposed: Deputy District Attorney David Bagheri, who led the prosecution, emphasized that such cases highlight the importance of protecting workers and ensuring fair contributions to the state insurance fund. The ruling serves as a warning to other business owners that intentional underreporting of payroll to reduce premiums can lead to severe financial and legal consequences. Broader Impact on Workers’ Compensation Enforcement Cases like this underscore California’s commitment to enforcing workers’ compensation laws and deterring fraud that undermines the insurance system. By holding employers accountable, the state seeks to ensure that workers injured on the job receive proper benefits while maintaining fairness for businesses that comply with the law. Source: Insurance Journal FAQs: California Plumbing Contractor Fined Why was the California plumbing contractor fined? She was fined for underreporting payroll to reduce workers’ compensation insurance premiums, which is considered insurance fraud. How much restitution did the plumbing contractor have to pay? The court ordered her to pay $1 million in restitution to the State Compensation Insurance Fund. What penalties did the plumbing contractor receive besides restitution? She received two years of felony probation, 320 hours of community service, and structured monthly restitution payments. What does this plumbing contractor fraud case mean for other employers? It reinforces that fraudulent payroll reporting can lead to criminal charges, large financial penalties, and reputational damage. What are the penalties for a plumbing contractor convicted of workers’ compensation fraud in California? Penalties can include felony probation, community service, restitution payments, and in more severe cases, prison time. Contractors may also face loss of licenses and long-term reputational damage. Stay informed on major insurance fraud prosecutions, enforcement actions, and compliance updates. Subscribe to JacobiJournal.com for weekly coverage on fraud, law enforcement, and public integrity cases. 🔎 Read More from JacobiJournal.com:
Washington Dairy Worker Workers’ Comp Scam
March 22, 2025 | JacobiJournal.com – Washington Dairy Worker Workers’ Comp Scam: A Washington farmhand faces felony theft charges for allegedly stealing over $122,000 in workers’ compensation benefits. Authorities claim that Efrain Alatorre Camarena secretly worked at another dairy farm while continuing to collect payments. Fraud Uncovered by L&I Investigation The Washington State Department of Labor & Industries (L&I) launched an investigation that uncovered the alleged fraud. Investigators found that Camarena, 58, had worked on another dairy farm while earning more than $172,000 in income. Despite working, Camarena reportedly collected over $122,000 in L&I payments for more than three years. Washington Dairy Worker Workers’ Comp Scam Background: Original Injury and Return to Work Camarena initially reported that he suffered neck and back pain after an accident involving a runaway cow at a Skagit County dairy in 2006. A doctor determined he was unable to work, leading him to receive L&I payments for over five years. After undergoing surgery in early 2020 related to his original injury, he resumed receiving benefits. Fraudulent Work While Collecting Benefits In 2023, L&I investigators discovered that Camarena was actively working despite claiming to be unable to work. This discrepancy led to felony theft charges. Legal Proceedings and Next Steps Camarena is now facing felony charges for theft and fraud. A conviction could result in significant fines and possible imprisonment. For further authoritative information on workers’ compensation fraud: Washington State Department of Labor & Industries. FAQs: Washington Workers’ Comp Scam Case How much money was involved in the Washington workers’ comp scam? Authorities allege the dairy worker fraudulently collected over $122,000 in benefits. How was the Washington workers’ comp scam discovered? An investigation by the Washington State Department of Labor & Industries revealed the worker was secretly employed while receiving benefits. What charges can result from a workers’ comp scam? In this case, felony theft and fraud charges were filed, which could lead to fines and imprisonment. What role did the worker’s original injury play in the workers’ comp scam? The worker initially qualified for benefits due to a 2006 injury but later worked secretly while still collecting payments. Stay informed on workers’ compensation fraud cases, legal updates, and enforcement actions. Subscribe to JacobiJournal.com for expert reporting on fraud and financial crime. Read More from JacobiJournal.com
Employee Denied Workers’ Compensation for TopGolf Injury
March 19, 2025 | JacobiJournal.com – Employee Denied Workers’ Compensation: An employee who claimed to have injured his knee during a TopGolf event sponsored by S&P Global failed to qualify for workers’ compensation benefits after the Virginia Workers’ Compensation Commission (VWCC) upheld the denial. Lack of Proof and Delayed Reporting The employee alleged that he hurt his knee on June 10, 2024, while attending a TopGolf event. He claimed that his right knee buckled on the first swing, causing a “popping sound” and pain. Despite the injury, he continued participating in the event, attended lunch, and played for another hour afterward. He testified that he informed his supervisor about the injury on the day of the event and mentioned it again during a team meeting and a one-on-one meeting weeks later. However, his supervisor, whom the deputy commissioner found credible, denied these claims. She testified that the injury was never reported until weeks later, after the employee’s termination. Supervisor’s Testimony Contradicts Employee’s Claims The supervisor stated that if the claimant had reported a work injury at the event or soon afterward, HR would have investigated and arranged for medical treatment. Instead, the employee waited over six weeks to seek medical care and reported the injury only on July 16, 2024, the same day his employment ended. Employee Denied Workers’ Compensation The claimant, who worked as a customer service specialist for S&P Global, argued that his delay in reporting should not affect the validity of his claim. However, the VWCC deputy commissioner ruled that the delay in reporting, failure to seek timely medical treatment, and lack of an incident report weakened his case. VWCC Affirms Deputy Commissioner’s Decision The claimant appealed to the full VWCC panel but maintained that the deputy commissioner placed too much emphasis on his supervisor’s contradictory testimony. He argued that her testimony was only relevant to notice and not whether an injury by accident occurred. The VWCC disagreed and upheld the original decision, emphasizing: “The Deputy Commissioner considered all of the evidence, including the claimant’s failure to report the incident, delay in seeking medical treatment, and failure to file an incident report until after termination. These factors were determinative in the decision,” the VWCC stated. Key Takeaway for Employers and Employees This case highlights the importance of timely reporting of workplace injuries and maintaining accurate documentation. Employees must report incidents immediately and seek prompt medical treatment to preserve their eligibility for workers’ compensation benefits. Learn about workplace injury reporting requirements on the Virginia Workers’ Compensation Commission’s official site. FAQs: TopGolf Workers Compensation Denial What led to the TopGolf workers compensation denial? The denial resulted from delayed reporting, lack of timely medical treatment, and no incident report filed immediately after the alleged injury. How does delayed reporting affect workers’ compensation claims? In cases like the TopGolf workers compensation denial, delayed reporting can weaken credibility, making it difficult to prove the injury was work-related. What evidence was most influential in the VWCC decision? The VWCC noted the lack of immediate medical care, no official incident report, and credible testimony from the supervisor in affirming the TopGolf workers compensation denial. Can an employee appeal a workers’ compensation denial? Yes. The claimant in this TopGolf workers compensation denial case appealed, but the VWCC affirmed the decision due to insufficient supporting evidence. Stay informed on major workers’ compensation rulings and legal updates. Subscribe to JacobiJournal.com for in-depth coverage and expert insights. Read More from JacobiJournal.com
Healthcare Software Firm Pleads Guilty in $1B Medicare Fraud Scheme
March 18, 2025 | JacobiJournal.com – Medicare fraud continues to draw federal scrutiny, with a major case resulting in a guilty plea from a healthcare software executive. A Kansas-based vice president of a healthcare software company pleaded guilty to conspiracy to commit healthcare fraud, admitting to operating an internet-based platform that defrauded Medicare and other federal programs of over $1 billion. Massive Fraud Scheme Through Internet Platform Healthcare Software Firm” Gregory Schreck, from Johnson County, Kansas, admitted that he and his co-conspirators targeted hundreds of thousands of Medicare beneficiaries through misleading mailers, TV ads, and offshore call centers. These tactics lured beneficiaries into providing personal information and agreeing to receive medically unnecessary orthotic braces, pain creams, and other items. Schreck and his team operated DMERx, an internet platform that generated false doctors’ orders for these items. He connected pharmacies, durable medical equipment (DME) suppliers, and marketers with telemedicine companies willing to accept illegal kickbacks in exchange for signed orders. These fraudulent orders were then transmitted via the DMERx platform, resulting in Medicare and other insurers paying more than $360 million in false claims. False Medical Orders and Illegal Kickbacks Court documents revealed that the orders generated by DMERx falsely claimed that doctors had examined and treated Medicare beneficiaries. In reality, doctors were paid by telemedicine companies to sign off on orders after brief or non-existent interactions with the beneficiaries. DME suppliers and pharmacies then billed Medicare based on these fraudulent claims, leading to massive losses for the federal healthcare system. Guilty Plea and Possible Sentencing Schreck pleaded guilty to conspiracy to commit healthcare fraud and faces a maximum penalty of 10 years in prison. His sentencing date will be scheduled later, with a federal district court judge determining the sentence after considering the U.S. Sentencing Guidelines and other statutory factors. Agencies Leading the Investigation The investigation was led by: Supervisory Official Antoinette T. Bacon of the Justice Department’s Criminal Division, along with several other high-ranking law enforcement officials, announced the guilty plea. Fighting Fraud: Protecting Medicare The Justice Department, in collaboration with multiple federal agencies, remains committed to combating fraud that undermines the integrity of Medicare and other federal healthcare programs. For more details on how Medicare combats fraud, visit HHS-OIG’s official fraud prevention page. FAQs: Medicare Fraud Software Case What is the Medicare fraud software case about? The Medicare fraud software case involves a platform called DMERx, used to generate false medical orders and defraud federal healthcare programs. How much was lost in the Medicare fraud case? The fraudulent scheme generated more than $360 million in false Medicare claims, with overall losses from the conspiracy exceeding $1 billion. What penalties does the executive face in the case? The executive pleaded guilty and faces up to 10 years in prison, with sentencing based on federal guidelines and statutory factors. Which agencies led the Medicare fraud software case investigation? Agencies included HHS-OIG, FBI, VA-OIG, DCIS, and the Justice Department’s Criminal Division. Stay informed on major healthcare fraud cases and federal enforcement actions. Subscribe to JacobiJournal.com for expert legal coverage and real-time updates. Read More from JacobiJournal.com