SIU Today Summer 2021 - 15

WORKERS' COMPENSATION CASE STUDY
Appealed Fraud Conviction Affirmed, Prison Sentence Upheld
By Dalene Bartholomew, CFE, CIFI
At first glance, it seems like a run-of-the-mill workers'
compensation claim. Latonja Johnson worked for Goodwill
of Southern California as a material handler sorting donated
books. On July 18, 2013, she filed a workers' compensation
claim stating that she had sustained a lower back injury while
lifting books out of a bin. Johnson, 44, claimed the injury had
occurred a week prior, on July 12, 2013. Her claim was accepted
and benefits, including total temporary disability and medical
treatment, were administered. Goodwill of Southern California
is a self-insured entity whose claims were handled by a thirdparty
administrator (TPA), and investigations were conducted
by VRC Investigations.
THE TIP
To the adjuster, nothing on the claim seemed unusual until
a phone call was received on November 1, 2013. A defense
attorney representing another employer called to share that
it was discovered that Johnson had been working two jobs
concurrently when the injury was reported. In addition to her
employment at Goodwill, she also worked for a company called
Advantage Sales and Marketing (ASM). As an events specialist,
her job at ASM was to display food samples at Sam's Club. On
July 31, 2013, two and a half weeks after filing the claim against
Goodwill, Johnson filed a workers' compensation claim against
ASM, reporting an industrial injury to the same body part, with
the same mechanism of injury. She claimed that she had injured
her back lifting a small oven while working for ASM, and stated
that the injury had occurred on July 11, 2013, the day before
the alleged injury at Goodwill. Based on that tip, the adjuster
for Goodwill immediately contacted the Special Investigation
Unit (SIU) team at VRC Investigations.
THE SIU INVESTIGATION
VRC Investigations secured Johnson's recorded statement
and gathered data to verify the credibility and reliability of
her claim against Goodwill. During the recorded statement,
Johnson denied filing other claims. She was questioned about
past medical treatment, prior pain and other previous back
symptoms. She denied any prior pain, prior symptoms or other
medical treatment and refused to sign a medical release.
Since her filings, Johnson had been receiving benefits under
both claims and receiving treatment from two different doctors.
SUMMER 2021 | SIU TODAY 15

SIU Today Summer 2021

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