Jacobi Journal of Insurance Investigation

Unveiling the truth behind insurance claims.
Protecting integrity in every investigation.

Cal/OSHA Penalizes Plumbing Companies $529K for Trench Collapse Violations

Cal/OSHA Penalizes Plumbing Companies $529K for Trench Collapse Violations

Failure to Follow Safety Rules Led to Serious Worker Injury Cal/OSHA Penalizes Plumbing Companies: The California Division of Occupational Safety and Health (Cal/OSHA) has fined Smelly Mel’s Plumbing and Sewer Rat Plumbing a total of $529,640 for trench safety violations. The penalties follow an August 2024 trench collapse in San Mateo, which severely injured a construction worker. Investigation Reveals Multiple Safety Failures Cal/OSHA Penalizes Plumbing Companies: Cal/OSHA’s investigation found serious violations that put workers at high risk. As a result, inspectors issued eight citations to each company. Key violations included: Trench Safety Is Critical Trenching accidents can be deadly if safety measures are ignored. To prevent collapses, Cal/OSHA requires protective systems like trench boxes and shoring. Daily inspections are also mandatory to identify potential hazards. “Ignoring these safety requirements puts workers’ lives at risk,” a Cal/OSHA representative stated. “Employers must follow trench safety laws to prevent serious injuries and fatalities.” Stronger Enforcement for Workplace Safety California regulators are increasing safety enforcement to hold employers accountable. This case highlights the severe consequences of workplace negligence. For more updates on workplace safety, visit JacobiJournal.com. Read the official Cal/OSHA citation details here.

‘Old-School’ Job Search Secures Lost Wages for Injured Worker

‘Old-School’ Job Search Secures Lost Wages for Injured Worker

Lost Wages for Injured Worker: Virginia Workers’ Compensation Panel Upholds Benefits for Veteran Technician An injured 60-year-old service technician secured lost wages after a Virginia Workers’ Compensation Commission (VWCC) panel ruled in his favor. His employer and workers’ compensation insurer argued that his job search lacked effort, but the commission found his approach reasonable given his circumstances. Worker’s Injury and Return to Light Duty Lost Wages for Injured Worker: Mark Shumate, a senior maintenance technician at a manufacturing company, sustained injuries while moving pallets on October 27, 2023. He suffered neck, right shoulder, right hand, and right leg injuries. Both parties agreed the incident was a compensable workplace accident, entitling him to medical benefits and temporary total disability payments. In January 2024, Shumate returned to light-duty work with his employer accommodating his restrictions, which included a 15-pound lifting limit, no bending or pushing, and scheduled breaks. However, in May 2024, he was laid off, prompting a job search to qualify for wage loss benefits. Dispute Over Job Search Efforts Shumate, who described himself as “old-school” with no computer skills, approached his job search traditionally. He researched potential jobs by calling friends and checking phone directories. Each Friday, he contacted five employers and extended his search across seven communities. He avoided industrial maintenance positions due to physical demands but sought supervisory roles and other maintenance-related work. Despite his persistence, he did not receive job offers. The employer and insurer argued his job search was inadequate, pointing out that he only contacted five employers weekly, didn’t utilize online job searches or newspapers, and registered with the Virginia Employment Commission four months late. They claimed he merely “went through the motions” rather than making a serious effort to find employment. VWCC Ruling and Justification A VWCC deputy commissioner ruled in favor of Shumate, affirming his consistency and sincerity in job hunting. The deputy commissioner acknowledged imperfections in his search but found it reasonable given his background and lack of digital literacy. “In the end, Mr. Shumate’s job search was neither perfect nor even successful, but it was reasonable—a consistent, good-faith effort to find suitable work,” the ruling stated. The employer and insurer appealed the ruling, but the three-member VWCC panel upheld the decision. The commission considered multiple factors, including Shumate’s age, experience, education, physical limitations, job market conditions, and intent. They concluded that his search was genuine and aligned with his physical capabilities. The VWCC emphasized that Shumate’s job search efforts, though unconventional, demonstrated a genuine attempt to mitigate his wage loss. His focus on maintenance-related jobs, despite shifting to lighter roles, was seen as a reasonable approach. Employer’s Right to Appeal The employer still has the option to appeal the decision to the Virginia Court of Appeals. However, the VWCC’s ruling highlights that a claimant’s job search doesn’t have to be flawless—only reasonable and in good faith. For more legal and employment news, visit JacobiJournal.com. Read the full ruling from the Virginia Workers’ Compensation Commission.

Washington Man on Workers’ Comp for 3 Years Caught Lifting Heavy Table

Washington Man on Workers’ Comp for 3 Years Caught Lifting Heavy Table

Washington Man Caught Lifting: A Pierce County man must repay more than $60,000 to Washington’s workers’ compensation fund after investigators discovered he had been working while collecting benefits. Despite claiming his injuries left him unable to work, video evidence showed him lifting a 48-pound table—far exceeding his medical restrictions. Claimed Injury, But Kept Working Juan P. Delgado, a roofer in Tacoma, suffered back, ankle, and knee injuries in March 2019 after falling over six feet from a ladder. His doctor determined he could not work, and Delgado repeatedly submitted official forms affirming his inability to hold a job. However, in early 2021, a private investigator—hired by his former employer—reported that Delgado had been working. The Washington State Department of Labor & Industries (L&I) launched its own investigation and found that just weeks after his injury, he resumed working as a custodian, roofer, and house-cleaner. Video Evidence Uncovers the Truth Washington Man Caught Lifting: In October 2022, an undercover L&I investigator approached Delgado near a Tacoma house and asked if he could have a discarded table. Delgado agreed and carried it alone for more than 50 feet—unaware that another investigator was filming the scene. Later, investigators weighed the table and found it was 48.6 pounds, nearly double the 25-pound limit imposed by his doctor. After reviewing the footage, Delgado’s physician concluded he had misrepresented his physical abilities and could have resumed roofing work much earlier. Guilty Plea Leads to Restitution and Sentencing Delgado, 51, pleaded guilty to second-degree malicious mischief, a felony, for unlawfully collecting workers’ compensation payments from April 2019 to January 2022. A Pierce County judge ordered him to pay $60,116 in restitution and serve 20 days on electronic home monitoring. The Washington State Attorney General’s Office prosecuted the case. For more industry updates, visit JacobiJournal.com. Read the full report from Washington State L&I.

Sky Zone in Washington Fined for Violating Teen Labor Laws

Sky Zone in Washington Fined for Violating Teen Labor Laws

Violating Teen Labor Laws: A trampoline park in Tukwila, Washington, faces over $68,000 in fines for violating labor laws. The violations included overworking teenage employees and failing to provide required meal breaks. L&I Investigation and Citations Violating Teen Labor Laws: The Washington State Department of Labor & Industries (L&I) investigated Sky Zone Seattle after receiving a complaint. The investigation revealed several labor law violations. It found that 57 minors worked more than five consecutive hours without meal breaks on 537 occasions. Additionally, 19 minors worked over 20 hours per week during a school week on 43 occasions. Similarly, 34 minors worked over four hours on a school day before another school day 154 times. Moreover, 15 minors worked more than eight hours on a non-school day during a school week on 32 occasions. Safety Violations and Prior Citations The L&I probe began with a workplace safety complaint. A teen was reportedly asked to fix a zip line 12 feet off the ground without proper training or fall protection. This led to a citation for Sky Zone for failing to conduct required safety meetings. This is the second time a Sky Zone location has been cited. In 2024, L&I cited a Vancouver, Washington, location for similar violations. There, 43 teens worked without meal breaks over 250 times and exceeded the allowed hours on more than 350 occasions. Franchise in Hot Water Again Sky Zone operates about 200 indoor trampoline parks across the U.S. This fine highlights the importance of following youth employment laws at all Sky Zone locations. Stay Updated on Labor Law Violations For more information on labor law violations and safety standards, visit JacobiJournal.com. For further details, read the full report from Washington State Department of Labor & Industries.

Fake Deer-Collision Claim Leads to South Carolina Fraud Charges

Not a Bear But a Fake Deer-Collision Claim Results in South Carolina Fraud Charges

Fake Deer-Collision Claim: A South Carolina woman faces fraud charges after allegedly filing a false insurance claim, falsely stating that her car was damaged in a deer collision. Investigators uncovered inconsistencies in her claim, leading to her arrest. Insurance Fraud Uncovered Queen Viola Arthur, 33, of Hartsville, reported to Progressive Insurance that she hit a deer, causing damage to her vehicle. However, Progressive denied her claim after metadata from the digital photographs she submitted revealed that the images were taken before the alleged accident and even before her policy began. According to South Carolina Law Enforcement Division (SLED) investigators, who acted on behalf of the state Department of Insurance, the fraud attempt occurred in October 2023. Authorities arrested Arthur earlier this month, though she was later released on bond. Fake Deer-Collision Claim Attempted Fraud and Legal Consequences The arrest warrant stated that Arthur falsely claimed her vehicle had no prior unrepaired damage. By submitting the fraudulent claim for $2,014, she attempted to secure an undeserved financial payout. The warrant also noted that Arthur admitted to at least some of the allegations. A Trend in Fake Animal Collision Claims? Arthur’s case follows a similar incident in California. Just two months earlier, four Los Angeles residents faced fraud charges after claiming a bear caused more than $141,000 in vehicle damage. Investigators later determined the “bear” was actually a person in a costume. Stay Informed on Insurance Fraud Cases For more insights on insurance fraud and legal trends, visit JacobiJournal.com. For the full report, refer to the South Carolina Department of Insurance.

Denied Workers Compensation Claim for School Employee Kicked Repeatedly Over 11 Days

San Joaquin County DA Secures Felony Conviction in Workers’ Comp Fraud Case

Denied Workers Compensation Claim” A Virginia school employee’s workers’ compensation claim was denied after suffering knee injuries from repeated kicks. The Virginia Workers’ Compensation Commission (WCC) upheld this decision, ruling that the injuries didn’t meet the criteria for compensation under state laws. Allegations and Medical Diagnosis The claimant, a behavior assistant at Loudoun County Public Schools, filed his claim on July 18, 2022. He explained that, on September 30, 2021, a student kicked him in both knees 25 times over 11 days. After seeking medical treatment on February 27, 2023, the doctor diagnosed him with “prepatellar bursitis in both knees” caused by the repeated kicks. School System’s Objection The school system disputed the claim, arguing that the injury did not result from an identifiable incident. Virginia law compensates only injuries caused by sudden events, not cumulative trauma. In September 2023, a deputy commissioner denied the claim because it lacked an identifiable incident. Cumulative Trauma and Its Legal Implications Although the claimant admitted that his injury occurred over time, his reports showed that repeated kicks caused the trauma. The injury report, filed in April 2022, detailed the 25 kicks he received during a week in September. In a July 2022 interview, the claimant confirmed that the injury occurred over 11 consecutive days, not from a single event. Additionally, the physician’s March 2024 report linked the knee injuries to the repeated kicks. Virginia Case Law on Workers Compensation The WCC agreed with the deputy commissioner’s ruling, concluding that the claimant’s injuries were caused by cumulative trauma. The ruling cited a 2007 case, which found that injuries must result from a sudden, identifiable event and cause an obvious structural change in the body. The commission also referenced 1985 and 1996 cases where injuries from repetitive motion or cumulative trauma were deemed non-compensable. Right to Appeal The claimant has the right to appeal the decision to the Court of Appeals of Virginia. For more updates on legal actions and regulatory news, visit Jacobi Journal. For more updates on legal actions and regulatory news, visit Jacobi Journal.

Texas Drywall Company Owner Indicted for Workers’ Compensation Fraud

Texas Drywall Company Owner Faces Workers' Compensation Fraud Charges

Texas Drywall Company Owner: Cristino Tapia Castaneda, the owner of Texana Drywall Construction, is scheduled to appear in Travis County District Court on February 12 to face three counts of fraud totaling $170,000, according to the Texas Department of Insurance Division of Workers’ Compensation (DWC). Charges Against Castaneda and Texana Drywall Construction In November, a grand jury indicted Castaneda on charges of Securing Execution of Document by Deception, a second-degree felony. Additionally, Texana Drywall Construction faces accusations of Insurance Fraud and Fraudulently Obtaining Worker’s Compensation Coverage, both classified as state jail felonies. Texas Drywall Company Owner Allegations and Investigation Findings The DWC’s Compensation Fraud Unit conducted a detailed investigation, revealing that Castaneda and his company allegedly misled multiple workers’ compensation insurance providers. They reportedly secured coverage for large, high-profile construction projects in Austin through deceptive means. Furthermore, the investigation uncovered that Castaneda falsified payroll information to significantly reduce the premiums his company had to pay. Insurance Providers Affected These fraudulent activities impacted major insurance carriers, including Texas Mutual and National Specialty Insurance, as reported by the DWC. The insurers were deceived by the manipulated information provided by Castaneda and his company. For more updates on similar cases, visit Jacobi Journal. Source: Business Insurance.

Construction Firm Owner Sentenced for Fraud Involving Taxes, Mail, and Workers’ Compensation

Construction Firm Owner Sentenced: A Hopkinton, Massachusetts man received an 18-month prison sentence on Jan. 10, 2025, in federal court in Boston for defrauding the Internal Revenue Service (IRS) and Travelers Insurance Co. over employee wages at his construction firms. Sentencing and Restitution Orders According to U.S. Attorney Joshua S. Levy, Dariusz Pietron was sentenced to 18 months in prison, followed by three years of supervised release. He was also ordered to pay $1,107,000 in restitution to the IRS and $244,000 to Travelers Insurance Co. Guilty Plea and Fraud Details In May 2024, Pietron pleaded guilty to charges of failing to pay employment taxes to the IRS and committing mail fraud by underreporting workers’ compensation insurance premiums. Construction Firm Owner Sentenced Between 2012 and October 2018, Pietron owned and operated TJM Construction, Inc. (TJM) and Point Construction, Inc. He failed to report employee wages to the IRS, did not withhold required income taxes, and neglected to pay necessary employment taxes. Additionally, he misrepresented the wages paid to his employees to Travelers, resulting in lower workers’ compensation insurance premiums than owed. Scheme Involving Shell Companies Prosecutors revealed that Pietron paid two employees to create three shell companies, making it seem as though TJM and Point’s employees were subcontractors. This setup allowed Pietron to avoid tax and workers’ compensation obligations. Consequently, he evaded over $1.1 million in employment taxes and defrauded Travelers of approximately $244,000. For more updates on legal and business news, visit Jacobi Journal. For further details, refer to the original article from Business Insurance.

Federal Court Dismisses Wrongful Termination and FEHA Violation Claim Against Costco

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A California federal court recently granted Costco Wholesale Corp. summary judgment, dismissing a claim of wrongful termination and Fair Employment and Housing Act (FEHA) violation filed by an injured worker. The court determined that Costco had met its obligation to accommodate the worker’s disability. Background of the Case Margarita Zamora, a long-time Costco employee, filed a lawsuit after a shoulder injury prevented her from lifting, pulling, or pushing more than 10 pounds. This injury made it impossible for her to return to her original job as a stocker. Zamora suggested she could perform other tasks, like cleaning, if the company modified her role. However, the court ruled that FEHA does not require employers to create light-duty positions for workers unable to do essential job functions. Costco was not obligated to offer her a modified position with non-essential tasks, according to the court. Court’s Ruling Violation Claim Against Costco: The court found that Costco made reasonable efforts to accommodate Zamora. Despite trying to find alternative roles for her, the company could not offer a position that met her medical restrictions. In January 2021, Costco terminated her employment. The court concluded, “Costco reasonably accommodated Zamora by offering vacant positions that aligned with her medical limitations.” The court emphasized that Costco had no duty to create a new position with tasks outside of Zamora’s restrictions. Legal Precedents and Implications This case reinforces that employers must engage in good-faith efforts to accommodate employees with disabilities. However, employers are not required to create modified roles or change essential job functions. They must demonstrate reasonable attempts to adjust existing roles to fit the employee’s medical needs. For more updates on workplace and employment law, visit Jacobi Journal. For further details, read the original article from WorkCompCentral.

CFPB Files Lawsuit Against Walmart and Branch Messenger Over Alleged Unlawful Pay Practices for Gig Workers

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CFPB Files Lawsuit Against Walmart and Branch Messenger Over Alleged Unlawful Pay Practices for Gig Workers. The Consumer Financial Protection Bureau (CFPB) has taken legal action against Walmart and scheduling platform Branch Messenger, accusing the companies of illegal pay practices that impacted delivery drivers in Walmart’s Spark program. The lawsuit claims that Walmart and Branch misled workers about their wage access and forced them to use costly deposit accounts. Alleged Violations Affecting 1 Million Gig WorkersFiled last week, the lawsuit alleges that for nearly two years, starting in 2021, Walmart and Branch violated federal law by requiring drivers in the Spark program to use Branch’s accounts for payments. According to the CFPB, Walmart and Branch forced around 1 million drivers to use these accounts and threatened termination for those who opted out. CFPB Files Lawsuit Against Walmart and Branch Messenger Over Alleged Unlawful Pay Practices for Gig Workers Walmart’s Spark program relies on gig workers for “last mile” deliveries from Walmart stores to customers’ homes across the country. The lawsuit highlights concerns over workers being misinformed about how to access their earnings and being charged fees for using the required deposit accounts. The CFPB’s suit brings attention to the growing scrutiny of gig economy labor practices, particularly in relation to how companies manage compensation and pay methods. For more updates on the case and the implications for gig workers, visit JacobiJournal.com. For further details, read the full report on Bloomberg.