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CA Comp Claimant Charged With Faking Injury

05 Aug, 2009 WorkersCompensation.com

                               
Sacramento, CA (CompNewsNetwork) - Today Insurance Commissioner Steve Poizner announced the arrest of a Milpitas man for alleged workers' compensation insurance fraud. Antone Costa Rita, Jr., 58, was apprehended on July 31 at his residence as the result of an investigation conducted by the California Department of Insurance (CDI). He was charged with presenting a false or fraudulent insurance claim and making false or fraudulent statements to his employer and to his treating physicians. 

The case is being prosecuted by the San Mateo County District Attorney's Office. If convicted, Rita could face up to five years in prison and/or $10,000 in fines for each count. 

“This case exemplifies the type of fraud that artificially raises costs within the workers' comp system,” stated Commissioner Poizner.  “The fact that it costs taxpayers' additional monies adds insult to injury and simply cannot be tolerated.” 

On November 19, 2002, Rita filed a workers' compensation insurance claim with his employer, the City of Menlo Park, alleging that on October 24, 2002 he "rolled" his left ankle while painting lines at a tennis court in a city-owned park. Over a five-year period ending October 24, 2007, Rita told his treating and evaluating doctors that he was unemployed, that his injury continued to worsen, and that he either could not walk or walked with great difficulty, pain and limping, even after having surgery to repair the injury. Rita also made similar statements while under oath to an attorney representing Menlo Park during a November 16, 2005, deposition. 

However, undercover surveillance videotape taken on various dates throughout 2006 by a private investigation firm for Menlo Park captured Rita walking normally and bearing weight on his left ankle with no indications of pain. The private investigation firm also videoed Rita involved in activities that appeared to be work-related at a San Jose auto repair shop. 

CDI's investigation revealed that Rita made inconsistent statements and material misrepresentations regarding the severity of his industrial injury and his employment status during appointments with physicians treating and/or evaluating him. CDI also found these inconsistencies in Rita's sworn testimony while under oath in a deposition for the purpose of filing a false workers' compensation insurance claim with, and receiving reparation from, Menlo Park via the city's third party administrator (TPA), Innovative Claims Solutions (ICS). 

The alleged fraud cost Menlo Park, via its TPA, nearly $170,000. As a result of Rita's material misrepresentations, ICS paid out more than $38,200 in indemnity benefits, $23,300 in temporary total disability benefits, $14,800 in permanent disability benefits, $38,500 in medical treatment, $3,600 in vocational rehabilitation benefits, and $50,400 in legal expenses, including defense costs and surveillance/investigation. 

Commissioner Poizner oversees sixteen CDI Enforcement Branch regional offices throughout the state. Nearly 1,900 insurance fraud-related arrests have been made by CDI since Commissioner Poizner took office in 2007 – more arrests than have been made during any other two year period, under any previous insurance commissioner. 

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