Grinberg: Hospital Worker Convicted of Fraud

Tuesday, April 10, 2018 | 0

Your humble blogger has been frustrated to the point of shaking his head disapprovingly and judging silently by the relationship between workers’ compensation fraud and actual conviction and restitution. 

Being in the trenches, it is an unfortunate everyday occurrence that some level of fraud, whether from an injured worker, lien claimant or, sometimes, even the applicant attorney, is suspected but doesn’t have enough damage done or sufficient evidence documented to interest the local law enforcement officials.

So it's true schadenfreude when a fraud prosecution finally goes through to a conviction.

Such is the case of Michelle Cordero, now of Nocona, Texas, who was recently sentenced to 60 days in jail for workers’ compensation fraud. Applicant filed a claim alleging injury to the shoulder while employed by a hospital, and denied any prior shoulder injuries. However, investigation revealed that she had told doctors that she actually hurt her shoulder moving boxes at home.

She filed a second claim alleging she contracted meningitis from a patient and denied having been in contact with anyone who had meningitis outside of the hospital, but an investigation revealed that her live-in boyfriend actually had meningitis, and she had concealed this fact from her employer.

Aside from jail time and probation, Ms. Cordero was ordered to pay restitution of $26,089.76 to the third-party administrator.

Your humble blogger, hailing from lands abroad where every silver lining has a cloud, can’t help but temper this victory for justice with some hard facts of life.

Defendants have to front benefits and costs until the fraud is discovered. It’s an open question if restitution will actually be collected by the employer or if this will remain an unpaid bill and defendant will have to spend more dollars chasing the dollars it should have never lost in the first place.

To get to this point in a fraud case, a defendant must pay for the investigation, provide a slam-dunk case and hope that it gets picked out of the flood of fraud referrals prepared by defendants in general.

What would your humble blogger like to see happen in the interest of justice for those cases that don’t make the cut for the district attorney’s limited resources?

There needs to be some consequence for lying or filing false claims other than the possibility of an eventual criminal conviction. Practically, I would like to see the Workers' Compensation Appeals Board give more weight to the impeachment of an injured worker’s credibility when there is documentation of false statements. 

I would like to see zero weight given to subjective complaints from a person who has demonstrated that his or her word cannot be relied upon.

When an injured worker has been shown to lie, the board should adopt a policy to give no weight to the claims or statements made by the injured worker. Unfortunately, at this time, a lot of these situations are treated as, “Well, he may have lied about Fact X, but he seemed credible as to Fact Y.”

Am I being too archaic, dear readers? Applicants' attorneys who read this blog (all three of you), what do you think? If your client has been shown to lie to a doctor or at deposition, do you still trust your client? Do you feel comfortable putting him or her on the stand?

And, one last question for you, dear readers: What happens if Pinocchio says, “My nose grows now?” Does it grow?

Gregory Grinberg is workers' compensation defense attorney at the Law Office of Gregory Grinberg, based in the San Francisco Bay Area. This post is reprinted with permission from Grinberg's WCDefenseCA blog.