A workers’ compensation claim was filed by an employee alleging a left ankle and foot injury on July 14, 2025, while stepping down from a forklift. Our investigation revealed that the injury actually occurred during a soccer game and was falsely reported as work-related because the employee lacked health insurance.
The investigation included medical reviews, surveillance, and witness interviews. While medical reports supported the employee’s claim of a work-related injury, witness statements and surveillance contradicted it, confirming the injury happened while playing soccer, and also showing the employee engaging in activities such as dancing at a Mariachi Festival.
The employee made false statements and material misrepresentations regarding the injury and physical limitations.The case was referred to the California Department of Insurance and the Fresno County District Attorney’s Office. Total claim payments to date: $13,415.38.
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