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Fraud in the Family – Claimant Doing Other Work while Receiving Comp Benefits

Jan 25, 2021 | MAD News, NYS Workers Compensation

The claimant injured his back working as a mechanic for a car dealership.

In November 2019 his wife’s niece requested on Facebook for recommendations for someone who could remodel her bathroom. The claimant’s wife responds that her husband, the claimant, is really good at it and would be happy to do it. He was receiving benefits at the total rate at the time, unknown to the niece.

The claimant’s wife is also currently in the process of purchasing the home they are living in from the niece, under some primitive land contract. The claimant’s wife told her niece that they are having some trouble paying the property taxes, and maybe the claimant could do the work to the bathroom if the niece paid the property taxes.

The niece paid the property taxes, and gives an additional $600 in cash to the claimant’s wife.

The claimant began work on the bathroom in December 2019 while receiving benefits at the total rate. New tiles were installed. A new vanity was installed. A wall was removed.  Late in December, the claimant and his wife split up. The claimant stopped working on the bathroom. The niece hired another contractor to finish the job.

The niece learned that the claimant was receiving Workers’ Compensation benefits when he was working on her bathroom. She contacted the State Insurance Fund fraud hotline. An investigator came to her home and took a statement. She explained the barter/payment situation.  Surveillance was placed on the claimant.

We are still waiting for the Judge’s decision on WCL 114-a, but confident in a finding of fraud based on the testimony of the niece, the investigator, and the claimant. The lesson: never underestimate the information that can be obtained from angry family (or former family) members.

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