APEX Investigation CLAIMANT CONVICTION for Workers' Compensation Insurance Fraud - Mono County, California

Tuesday, March 10, 2026 | 521 | 0

FOR IMMEDIATE RELEASE

Workers’ Compensation Insurance Fraud Conviction – Mono County, California

A workers’ compensation insurance fraud investigation conducted by Apex Investigation Special Investigation Unit (SIU) has resulted in a felony conviction in Mono County, California.

The case involved a 53-year-old female employed as a Small Branch Coordinator with the Mono County Office of Education who reported an alleged workplace injury on October 18, 2024. The claimant stated she tripped on the reading-pit stairs while carrying books at the Bridgeport Library, reportedly sustaining injuries to her left arm, right ankle, and right foot. The claim was submitted through the Self-Insured Schools of California (SISC) workers’ compensation program.

The incident was reported on October 21, 2024, and the claimant first sought medical treatment on October 23, 2024. At that time, she was prescribed a wrist brace and ankle support and placed on work restrictions.

During the course of the investigation, it was discovered that the claimant had been involved in a motor vehicle accident on October 2, 2024—prior to the alleged workplace injury. This accident was not disclosed in the workers’ compensation claim reporting nor to the claimant’s treating medical providers.

Security video obtained from the Bridgeport Library did not depict any visible trip or fall at the time and location reported. The discrepancy between the reported mechanism of injury, subjective complaints, objective medical findings, and the video evidence—combined with the undisclosed motor vehicle accident—ultimately resulted in the denial of the workers’ compensation claim on December 19, 2024.

Recognizing several indicators consistent with potential insurance fraud, the assigned claims examiner referred the matter to Apex Investigation SIU on January 28, 2025, for further analysis. Following completion of the SIU investigation, the evidence established a reasonable belief of suspected fraud, and the case was formally referred to the California Department of Insurance Fraud Division and the Mono County District Attorney’s Office in accordance with California Insurance Code §1871.4 and Penal Code §550(a)(1).

In April 2025, Apex SIU prepared and submitted a comprehensive fraud referral package to the Mono County District Attorney’s Office. On May 15, 2025, the District Attorney filed two felony counts of workers’ compensation insurance fraud against the claimant in Mono County Superior Court.

On February 12, 2026, during a pre-trial hearing, the claimant entered a guilty plea to two felony counts under California Insurance Code §1871.4(a)(1) and California Penal Code §550(a)(1) and paid full criminal restitution of $12,106.90.

The Mono County District Attorney’s Office does not receive dedicated grant funding for the prosecution of workers’ compensation fraud cases. Prosecutors advised that the thorough investigative documentation and evidence package prepared by Apex Investigation SIU significantly supported the criminal filing and successful resolution of this case.

Media Contact

For more information about how Apex Investigation helps insurance carriers, self-insured employers, and public entities strengthen their Special Investigation Unit (SIU) programs and increase successful fraud prosecutions, please contact:

JR Robles
APEX Investigation
Phone: 888-900-2739
Email: jr@apexpi.com
Website: www.apexpi.com