GUILTY OF WORKERS’ COMPENSATION FRAUD

Prison Employee Commits a Crime She Was Employed to Prevent

Barry Zalma

Mar 26, 2024

Transcript

FACTS

On January 10, 2022, Jones was found guilty by a jury. Jones was sentenced on September 30, 2022. Jones was granted probation for a term of two years. One of the conditions of probation was that Jones serve the first 180 days of her probationary period in jail.

The Prosecution’s Case

Jones worked for a state prison in May 1995. She was a return to work coordinator for the prisons. If a staff member was injured, they would go through the return to work office to file workers compensation claims so the staff member could be paid while he or she was off work.

On February 14, 2014, Jones filed a DWC-1 form (an application to file a workers’ compensation claim), alleging that on February 11, 2014, a large file shelf fell on her, injuring her left thigh and below her knee.

As soon as a workers’ compensation claim is filed, the state prison informs the insurance company. The insurance company does an investigation, and either accepts or denies the claim. If it is accepted, the insurance company lets the state prison know, and the state prison will pay the injured worker for the first 52 weeks. This is referred to as industrial disability leave (IDL).

Injured workers are allowed to get a second job, but they need to report the income to the insurance company (reporting a second job, without reporting the income, is not sufficient). The insurance company then reduces the amount it pays the injured worker by the amount the injured worker makes at his or her second job.

In February of 2017, Jones began working for a real estate company as a sales associate. Jones’s IRS form 1099 for 2017 from the real estate company indicated that, after certain amounts were deducted, Jones earned $25,095.

Jones did not report that she was earning secondary income to her claims adjuster at the insurance company, and the adjuster never asked. Jones did fill out a secondary employment form from the state prison, listing her secondary employer as a real estate company. It was approved on behalf of the warden on or around April 24, 2017, as required by the state prison’s policy. Jones was deposed on October 11, 2017, regarding her workers’ compensation claim. When asked how many houses she had in escrow, she responded, “Two.” However, based on Jones’s 1099 form from the real estate company, prior to the date of the deposition Jones had already closed seven home sales and earned $20,312.

DISCUSSION

When evaluating a sufficiency of evidence claim, the appellate court will review the whole record in the light most favorable to the judgment to determine whether it discloses substantial evidence-that is, evidence that is reasonable, credible, and of solid value- from which a reasonable trier of fact could find the defendant guilty beyond a reasonable doubt.

An intent to defraud is an intent to deceive another person for the purpose of gaining some material advantage over that person or to induce that person to part with property or to alter that person’s position to its injury or risk, and to accomplish that purpose by some false statement, false representation of fact, wrongful concealment or suppression of truth, or by any other artifice or act designed to deceive.

There was substantial evidence from which a jury could reasonably infer that Jones knew that she was supposed to report her real estate income to the insurance company, that she did not do so, and that she lied about not having real estate income at the deposition.

The Trial Court Did Not Abuse its Discretion in Denying Jones’s Motion for a New Trial

In making the determination, the trial court found that Jones “clearly received income” yet intentionally failed to disclose it. Contrary to Jones’s assertion, the trial court addressed the expense evidence as to the specific intent element and found that Jones knew that she had to report her income even if it was exceeded by her expenses but intentionally failed to do so.

ZALMA OPINION

Ms. Jones lied at deposition about her earnings with a secondary employer while on workers’ compensation which she knew, from her employment with the state prison, that she was required to report to the insurer about her secondary employment. Her appeal was incredible and the court refused to give any credibility to her appeal. She will spend a small time in the prison where she used to work and will go back to making more money selling real estate.