Detention Officer Detained Over Workers’ Compensation Fraud

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Cynthia Wesley, a detention officer in the Los Angeles County Probation department, was arrested for filing a fraudulent insurance claim and for falsifying her workers’ compensation documents. In California  and every other state in this nation, including South Carolina, filing fraudulent documents is a serious offense and may lead to a fine and imprisonment. Even what seems like an insignificant task such as filling out symptoms and injuries incurred while on the job can have grave consequences if made up or magnified, and can constitute fraud.

The Dangers of Filing Fraudulent Documents

Under South Carolina law, an employee who is injured while working may qualify for benefits such as workers’ compensation. The South Carolina Workers’ Compensation Commission recommends that the employee immediately report his or her injuries to the employer and request medical treatment if necessary. If the employee neglects to file a report 90 days after the workplace injury, the employee risks losing the right to workers’ compensation benefits. The employer is also supposed to report the accident; but if the employer does not report or denies that the employee is entitled to workers’ compensation, or if the employee thinks he or she has not received the full benefit that he or she is legally entitled to, the employee can submit Form 50 or Form 52 to the South Carolina Workers’ Compensation Commission. However, the employee filling the form should be aware that a fraudulent misrepresentation might lead to trouble. Even an omission—whether intentional or not—may raise the scrutiny of those reviewing the employee’s claim, similar to what happened in Wesley’s case.

Under South Carolina’s workers’ compensation program, an eligible employee is entitled to all necessary medical treatment that is likely to lessen the disability. An employee may have to visit a doctor approved of by the employer or the insurance company. If a doctor releases a patient with a scar, and if this is non-surgical and visible from at least eight feet away, the insurance company may arrange for an informal conference or viewing to assess the physical damage and determine compensation, if any. It is important that employees keep a truthful and accurate record of all medical notes, visits, prescriptions and the like that are related to the workplace-incurred injury.

An injured employee can request a hearing with the South Carolina Workers’ Compensation Committee by filing Form 50. A hearing is usually granted within 60 days of filing in one of seven hearing districts in the state. An employee who will appear before the South Carolina Workers’ Compensation Committee should consult with an experienced workers’ compensation attorney beforehand. The employee may have misrepresented, magnified or omitted information in the documents that may seem trivial but could be relevant, and may constitute fraud. Filing fraudulent workers’ compensation documents can make a bad situation even worse. It is always wise to consult with an attorney before making a potentially disastrous step.

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