Frauds find variety of ways to cheat workers' comp system

Workers, employers and even lawyers get accused of workers' compensation fraud, The Oklahoman found from interviews and a review of dozens of court cases. In the past 13 years, Oklahoma judges have ordered restitution payments totaling more than $2.5 million in such fraud cases.
by Nolan Clay and Robby Trammell Published: March 3, 2013

Copyright 2013, The Oklahoman

Told by her doctor she needs surgery on her knee, the young woman gets a job at an Enid ice cream store and on her third day fakes falling.

The newest worker at a Shawnee manufacturing company deliberately slices her finger with a utility knife, bleeding all over the restroom, to make a superficial cut look much worse.

The fired Oklahoma City hotel manager slowly hobbles in on a cane to see a doctor. He tearfully reports being so hurt from a fall months before that he can't walk, get out of bed, bathe or dress without assistance.

Hours later, he is seen without the cane at a pool hall shooting pool.

Those are just three of the more blatant examples found in court records of ways people cheat the state's workers' compensation court system.

In the last three years, prosecutors at the Oklahoma attorney general's office have filed more than 50 workers' compensation fraud cases. And Attorney General Scott Pruitt wants businesses and insurance companies to send him more.

“No fraud is too small,” Pruitt said.

Workers, employers and even lawyers get accused of workers' compensation fraud, The Oklahoman found from interviews and a review of dozens of court cases. In the past 13 years, Oklahoma judges have ordered restitution payments totaling more than $2.5 million in such fraud cases.

“There's a lot of types of fraud,” said Vincent Antonioli, a veteran prosecutor in charge of a special unit at the attorney general's office that files workers' compensation fraud cases.

Antonioli, an assistant attorney general, said the most prevalent kind of worker fraud involves the worker who has a legitimate injury, but later exaggerates or makes false and misleading statements about his medical condition or physical limitations.

Commonly, such fraud occurs a couple of years after the injury when a patient has had medical treatment and should be getting better. Instead, the patient persists in saying the pain is still too debilitating to return to work.

The second most prevalent kind involves a worker who lies about how he was injured, Antonioli said. The worker will report he was hurt in the scope of his employment when he actually was hurt during horseplay, such as racing forklifts, he said. Other times, the worker actually will suffer some injury at home and then claim it was on the job.

Another kind involves a worker who lies about his medical history. In some cases, the worker will report injuring a body part, but not disclose he had hurt the same body part years before.

Employers also commit fraud, the prosecutor said. Some make false or misleading statements to obtain workers' compensation insurance and some operate illegally without it.

How much fraud exists is up for debate.

One workers' compensation judge, Bob Lake Grove, said he believes fraud is minuscule.

“I think most injured workers are honest,” the judge said.

Still, fraud is suspected enough to keep private investigators busy across Oklahoma.

One of the biggest firms, Winston Services in Norman, has nine investigators watching people on workers' compensation disability. Owner Robert Cox estimates the company gets 15 to 20 new cases a week.

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by Nolan Clay
Sr. Reporter
Nolan Clay was born in Oklahoma and has worked as a reporter for The Oklahoman since 1985. He covered the Oklahoma City bombing trials and witnessed bomber Tim McVeigh's execution. His investigative reports have brought down public officials,...
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by Robby Trammell
Assistant Managing Editor
Robby Trammell is news director for The Oklahoman and NewsOK.com. During his 41-year career, he has received numerous reporting awards and civic honors. With The Oklahoman’s investigative team, he won a first-place spot news reporting award for...
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