The names of individuals who are subject to indictment or complaint have been deleted in compliance with state law. However, individuals whose cases have reached final disposition and whose names have been publicly disseminated have been identified.

B R E A K I N G N E W S !

On March 18, 1997, two attorneys from a prominent Worcester law firm were indicted on 40 counts of insurance fraud-related charges. Five former clients were also indicted on this date.


IFB Progress Report
(through March 31, 1997)
Convictions 188
Individuals Indicted 158
Complaints Issued 220
Cases Referred for Prosecution 359


A Message from Stuart T. Rossman Chief, Business & Labor Protection Bureau

Only five years ago, Bay State drivers paid among the highest auto insurance rates in the country, and our businesses faced such staggering workers' compensation costs that many closed, downsized or relocated to other states. Fraud became the lightning rod for all that was wrong, or was perceived to be wrong, with the system. Why not when insurance fraud had become so pervasive that it was the nation's second-largest economic crime after tax evasion!

Eventually, significant reform packages emerged in the Massachusetts Legislature in an attempt to put the brakes on rising costs and meet public and corporate demands for a solution. From that debate emerged a model fraud-fighting partnership between law enforcement and the insurance industry that has stopped the spiraling rate increases and returned substantial savings to Massachusetts families and businesses struggling to make ends meet.

The key to this welcome relief is a radical change in the culture of acceptance of insurance fraud and its replacement with a strong zero tolerance message. The Insurance Fraud Bureau of Massachusetts (IFB), created by the Legislature in 1990, is now the primary vehicle, working with traditional federal state law enforcement officials like the Attorney General's Office, for the prevention, detection and investigation of insurance fraud in Massachusetts. The IFB not only faces the daunting task of documenting often complex white collar crimes, but also educating the public about how the cost of fraud drives up the price of everyday living for everyone.

What we know as a fact is that insurers' costs due to fraudulent claims fall as the probability of arrests and convictions rises. Attorney General Scott Harshbarger is committed to vigorously prosecuting insurance fraud violations referred to our office by the IFB. Thus, since 1992, Assistant Attorneys General assigned to the Insurance Fraud Division of the Business and Labor Protection Bureau have initiated criminal actions against more than 350 separate individuals on more than 2,000 fraud counts. To date, more than 350 individuals have been the subject of criminal court actions, and more than 180 of them have been convicted on fraud charges to date. The combined efforts of all

prosecutions has resulted in nearly $500,000 in fines, penalties and court costs and, defendants have been ordered to return more than $6.5 million in restitution to the insurance companies victimized by this supposedly "victimless" crime.

When we launched this partnership five years ago, we knew many obstacles lay ahead. Through education of the general public, insurance industry, law enforcement, the judiciary and the media, we have shown that we can make a difference. Since 1994, there has been more than a ten percent decline in auto insurance rates, returning millions of dollars in disposable income to Massachusetts consumers. Three straight years of double digit decreases in workers' compensation rates have saved businesses hundreds of millions of dollars, improving our overall economic climate and our competitive edge with other states.

Fighting fraud is not a cure for all that drives up the cost of living or the cost of doing business, but it is a key component to bringing those costs under control. The results not only speak volumes about what can be done when we work together in partnership, but also provide an intriguing model for a cooperative and comprehensive public-private initiative to address other issues of economic security in Massachusetts.

Stuart T. Rossman

Chief, Business & Labor Protection Bureau

Massachusetts Attorney General's Office


Property Highlights

"Missing Pearls Never Lost" Case Update

ATTLEBORO- A pearl necklace valued at $600 and reported lost by an Attleboro woman was found to be in the possession of her ex-husband. The subject was in the process of a divorce when she filed the claim with Pawtucket Mutual Insurance Company. The husband, while changing his address for insurance purposes, became aware of the loss report filed by his wife and notified the insurance carrier that he was in possession of the pearl necklace.

An Attleboro woman pled to sufficient facts in Wrentham District Court on January 14, 1997. Her case was continued without a finding for one year. She was ordered to pay $370 in restitution and court costs. Assistant Attorney General Sean J. Kealy prosecuted the case.

Big Fish Story

FALL RIVER- A subject claimed that the salt water pump in his fish tank allegedly malfunctioned resulting in considerable property damage to his home. When attempting to subrogate the claim against the manufacturer of the water pump, Worcester Insurance Company discovered that the manufacturer had already paid the subject for a prior similar property claim through Merchants and Businessmen's Mutual Insurance Company. Receipts submitted in support of the two claims were allegedly falsified.

On October 17, 1996 a complaint was issued against a subject in Fall River District Court on three counts of forgery and two counts each of insurance fraud and larceny. Assistant Attorney General Darlene A. Luccio Jordan is prosecuting the case.


Multi-Lines Highlights

Two Worcester Attorneys and Six Former Clients Indicted on 84 Counts of Alleged Insurance Fraud

WORCESTER- Two Worcester attorneys, partners in one of the largest workers' compensation law firms in the state, are accused of acquiring over $70,000 in legal fees by conspiring in insurance fraud schemes that resulted in more than $310,000 worth of insurance payments for at least six clients. The indictments allege that the attorneys oversaw fraudulent schemes which included the use of false identities and Social Security numbers. The attorneys also allegedly represented clients as totally disabled but yet concurrently employed these clients at the law firm.

The case first made headlines in May 1996 when state police raided three separate locations of the law firm. After being denied entrance by an employee to one of the Worcester offices, state police smashed the front door of the law office in their attempt to serve a search warrant. On March 18, 1997, a Worcester Special Grand Jury returned indictments on two attorneys in the firm and five former clients on a total of 82 counts of insurance fraud-related charges. A sixth former client was indicted on February 27, 1997 on two charges.

The investigation has resulted in:

Insurance companies affected in these cases include Aetna, Wausau, Empire Mutual, Cigna, St. Paul, Minnesota Mutual Life, John Hancock, Sentry, Arbella Mutual and ITT Hartford Insurance Companies.

The indictments are a result of a joint investigation by Attorney General Scott Harshbarger's Office, the Massachusetts State Police and the IFB. Assistant Attorneys General John L. Ciardi, Michael C. Cullen and David R. Marks are handling the prosecution and continuing investigation. Other federal and state agencies assisted during the investigation including the U.S. Department of Justice, the Immigration and Naturalization Service, the Social Security Administration Office of the Inspector General, the Federal Bureau of Investigation, the Massachusetts Board of Bar Overseers, the Massachusetts Department of Revenue, the Medford Police Department and the Office of the New Hampshire Attorney General.

Two Former Insurance Agents Charged in Separate Cases

EAST BOSTON- An East Boston woman, formerly a Lynn insurance agent, allegedly represented herself as a Metropolitan Insurance Company insurance agent and accepted $3,750 in premiums when she was not authorized to write policies or accept money on the carrier's behalf. She also allegedly used a phony Metropolitan stamp and forged the signature of an authorized agent in order to complete applications for motor vehicle registrations.

A complaint was issued in Lynn District Court against a former insurance agent on eight counts of larceny, six counts of forgery and six counts of falsifying a certificate of registration. Assistant Attorney General Sean J. Kealy is prosecuting the case.

Attorney General Scott Harshbarger stated, "These indictments are part of an ongoing investigation and are the first fruits of a five-year probe into allegations of insurance fraud in Worcester County. Systemic fraud of the kind alleged in these indictments is a hidden tax that increases the costs of doing business and the cost of living in Massachusetts. There is no such thing as just bilking the system. We all pay."

BROCKTON- A former insurance agent and joint owner of a Brockton insurance agency accepted more than $15,000 in downpayments for insurance coverage from clients and neglected to forward these payments to the respective carriers. More than two dozen customers thought they had insurance coverage obtained through the agent. Customers believed they were securing automobile insurance from Liberty Mutual or Safety Insurance Companies, medical malpractice insurance from the Joint Underwriting Association or general liability insurance from the U.S. Liability Insurance Company.

Adele Doucette, a former Brockton insurance agent, pled guilty to 25 counts of insurance fraud-related charges in Plymouth Superior Court on March 27, 1997. She was sentenced to two years in the House of Correction, suspended with probation, and ordered to pay $10,000 restitution and to perform 100 hours of community service. Assistant Attorney General David R. Marks prosecuted the case.

Insurance Fraud is Big Business

WORCESTER- In several separate incidents, two Worcester residents allegedly defrauded insurance carriers by reporting fraudulent automobile and workers' compensation insurance claims and submitting false lost wage documentation in support of those claims. Carriers affected include Hanover, Commerce, Liberty Mutual, American Transportation, CNA, Travelers and Safety Insurance Companies.

Complaints were issued against two subjects on a total of 18 counts of insurance fraud-related charges in Worcester District Court on February 19, 1997. One man was charged with two counts of motor vehicle insurance fraud, three counts of larceny, one count of attempted larceny, two counts of conspiracy and one count of forgery. The other subject was charged with two counts of motor vehicle insurance fraud, three counts of larceny, one count of attempted larceny and two counts of conspiracy. Assistant Attorney General Sean J. Kealy is prosecuting the case.


Health Highlights

Phantom Dental Patient

LEOMINSTER- A Leominster woman received dental insurance coverage for her and her family through her employer. She submitted, on three separate occasions, dental forms, allegedly signed by the dentist providing the services, indicating the dental services provided and associated charges. Dental claim forms submitted to State Mutual Life for reimbursement were for payments of $169, $833 and $1,500. The dentists in the three situations deny treating the patient indicated on the form or having a patient by that name.

A subject was arraigned on January 24, 1997 in Leominster District Court on three counts of insurance fraud and two counts of larceny. The case will be prosecuted by Assistant Attorney General Erin K. Olson.


Commercial Highlights

Barn Collapses With a Little Help

WOBURN- The owner/operator of a Somerville tow company alleged that the roof of his barn collapsed and heavily damaged his 1989 Ford F350 tow truck. He received $9,863 for damages to the truck from National Grange Insurance Company. Investigation and witness testimony revealed that the damage to the tow truck was deliberately inflicted when a cross beam section of the barn roof was pulled down with the boom of another tow truck. A consulting engineer inspected the barn structure and determined that the collapse could only have occurred by an intentional act.

A Woburn man, the owner/operator of a tow company, was indicted on charges of insurance fraud, larceny and malicious damage of real property on December 18, 1996 in Middlesex Superior Court. Assistant Attorney General Sarah Hartry is handling the case.

"What's A Businessman to Do?" Case Update

GREENFIELD- The owner of several Greenfield businesses, including a realty office, rental property and a tavern, reported the theft of about $6,000 in bar receipts. The money had been placed in a filing cabinet in his realty office which is located above the tavern. The subject reported the theft of the bar receipts to police. However, when he learned that he had no insurance coverage for this type of loss on his tavern insurance policy, he claimed to St. Paul Marine and Fire Insurance Company the stolen money was receipts from tenants on rental property.

Mark S. Donoghue admitted to sufficient facts on a charge of insurance fraud. He was ordered to pay $9,880 in restitution and placed on one year probation. He was also ordered to speak to a local Chamber of Commerce about the unlawfulness of lying to an insurance company under any circumstance. The case was prosecuted by Assistant Attorney General Brian P. Burke.

Mom Always Said No Playing Basketball in the House!

QUINCY- A subject claimed to Hanover Insurance Company that he sustained an ankle injury when he allegedly slipped and fell in some water on the floor of the laundry room of his apartment building. It is alleged, however, that the actual injury occurred while the subject was playing basketball earlier that evening with two of his cousins. The subject and his wife allegedly staged the slip and fall in the laundry room in order to falsely collect on a claim against the apartment owners.

Complaints were issued against a husband and wife on charges of insurance fraud, attempted larceny and conspiracy in Quincy District Court on December 19, 1996. The prosecutor is Assistant Attorney General Sean J. Kealy.


Automobile Highlights

"Stolen Vehicle Shipped to Nigeria" Case Update

BOSTON- A Boston man shipped his 1987 Volkswagen van to Lagos, Nigeria and then reported the vehicle stolen to Boston police and National Grange Mutual Insurance Company. A Bill of Lading bearing the vehicle's VIN was secured when the National Insurance Crime Bureau (NICB) and Customs shipping records were cross-matched.

Osmor Bello pled guilty to insurance fraud, attempted larceny, concealing a motor vehicle to defraud an insurer and filing a false police report in West Roxbury District Court on January 30, 1997. He was sentenced to one year in the House of Correction, suspended, and ordered to pay a $2,500 fine and to perform 100 hours of community service. Assistant Attorneys General Sean J. Kealy and Brian P. Burke prosecuted the case. The case was investigated by Sergeant Detective Kenneth Lamb of the Boston Police Department's Auto Theft Strike Force and Harry Markle of NICB.

"Stolen Vehicle Located in Virginia" Case Update

REVERE- A Revere man reported to Commercial Union Insurance Company and to police the alleged theft of his vehicle from the Burlington Mall. He was paid $10,650 for his loss. It was discovered, however, that the subject and his sister had been traveling in Virginia when the vehicle caught fire and he had it towed to a local garage. Virginia State Police ran a vehicle check on the vehicle and discovered it had been reported stolen in Massachusetts.

Quinton Williams and Mary Ward pled guilty to motor vehicle insurance fraud, larceny, conspiracy and perjury charges in Chelsea District Court on March 11, 1997. They were each sentenced to three years probation and ordered to pay $12,830 restitution. The case was prosecuted by Assistant Attorney General Sean J. Kealy.

"Oh, No! Not Again!" Case Update

BELMONT- A 1983 Porsche 928 was involved in three separate motor vehicle accidents. In each incident, the subject reported that another vehicle backed into the Porsche causing front end damage. He collected more than $6,800 in damages from the accidents. Photographs and appraisals from the carriers, John Hancock, Metropolitan Property & Casualty and Cigna Property & Casualty, show identical damage inflicted upon the vehicle.

Nicholas Karellas pled guilty to two counts each of motor vehicle insurance fraud, larceny and conspiracy in Middlesex Superior Court on January 2, 1997. He was sentenced to 2 1/2 years in the House of Correction, six months to be served on an electronic bracelet and the balance suspended. He was also ordered to pay $5,000 in court fines, to perform 50 hours of community service and to surrender his passport. Dimitrios Papadogianis previously pled guilty to his involvement in the conspiracy. He was sentenced to six months in the House of Correction, suspended, and fined $3,000. The case was prosecuted by Assistant Attorney General Jennifer Renna Ferreira.

"Insurance Fraud Going to the Dogs" Case Update

LANESBORO- Two men staged several automobile accidents. One subject, the owner of a small gift shop specializing in dog-related items, filed claims for the damages of statues, figurines, prints and other items he had been transporting in his van at the time of each accident. Both subjects filed bodily injury claims and, in total, collected over $100,000 in contents/property and bodily injury payments from John Hancock and MassWest Insurance Companies.

On December 6, 1996 in Berkshire Superior Court, Stephen Parzick pled guilty to four counts of insurance fraud and one count each of larceny, attempted larceny and conspiracy. Parzick admitted that he and his nephew staged the automobile accidents. He was fined $13,700 and ordered to pay $13,704 restitution. The case against his nephew was placed on file. Assistant Attorney General Rosemary Tarantino prosecuted the case.

I Had to Make The Trip Worth My Time

SPRINGFIELD- A Springfield man was involved in a motor vehicle accident and filed a claim with Commerce Insurance Company stating that he had two passengers in his vehicle at the time of the accident. Both passengers collected on personal injury claims allegedly sustained in the accident. The driver and one of the passengers eventually declared in recorded statements that the second reported passenger was never actually in the vehicle but came by afterwards to pick them up. The employer of this "jump-in" passenger also confirmed that he was at work at the time of the accident and left afterwards to pick up the driver at the accident scene.

Ted Ramdass, the driver of the vehicle, admitted to sufficient facts. He was placed on probation and ordered to perform 40 hours of community service. Kendall Richardson was found guilty of insurance fraud and attempted larceny. He was sentenced to one year in the House of Correction, suspended, with probation and ordered to perform 40 hours of community service. AAGs Amy Sharff and John Woodruff prosecuted the case in Springfield District Court on December 16, 1996.

Let's Play Make Believe

NEW BEDFORD- A subject, using an alias name, submitted a claim to Arbella Mutual Insurance Company relating to a staged accident. He claimed to be injured and received medical treatment at a hospital and with various medical professionals. He also submitted a fraudulent employment verification form, using the alias name, which corroborated his employment as a carpenter's helper. The company turned out to be nonexistent. The subject received $2,865 for lost wages and medical bills.

On November 4, 1996 in New Bedford Superior Court, Clinton Pina pled guilty to two counts of larceny, two counts of conspiracy and three counts of motor vehicle insurance fraud. He was sentenced to 18 months in the House of Correction, suspended with probation and ordered to pay restitution of $2,865. Assistant Attorney General Margaret Parks prosecuted the case.

Chicopee Man to Serve 15 Months

CHICOPEE- A Chicopee man had reported the theft of his pick-up truck. That same day the vehicle was involved in an accident, reportedly driven by one of the subject's friends. However, police found both the subject and his friend near the scene of the accident and charged the subject with drunk driving. The subject admitted in an Examination Under Oath that he staged the theft of the automobile and lied to police and Commercial Union Insurance Co. about the theft.

Thomas Stewart was found guilty after trial of insurance fraud in Northampton District Court on February 10, 1997. He was sentenced to serve fifteen months in the House of Correction. The case was prosecuted by Assistant Attorneys General Amy Sharff and John Woodruff.

The Division of Insurance and the Division of Standards revoked the auto body license of Tofani Auto Body. The auto body shop and owner were convicted of defrauding insurance companies by submitting false rental car charges, adding damages to motor vehicles brought to the shop before insurers could appraise the damage and staging accidents for willing customers.

Vehicle Heads South for the Winter

BROCKTON- A subject reported to Boston Police that his mother's vehicle had been stolen from the Brigham and Women's Hospital parking lot. An investigation by Boston police revealed that the subject had actually driven the vehicle to South Carolina and abandoned it in an Amtrack parking lot.

Charges of filing a fraudulent insurance claim, attempted larceny, filing a false police report and conspiracy against a Brockton man were continued without a finding for one year in Roxbury District Court on November 27, 1996. He was ordered to pay a $1,500 fine. The case was investigated by Boston Police Detective Sergeant Kenneth A. Lamb and prosecuted by Assistant Attorney General Sean J. Kealy.

"If It Ain't Broke, Don't Fix It!" Case Update

FRAMINGHAM- A Framingham man admitted to following the orders of his former employer in staging motor vehicle accidents.

Brian Gorgone pled guilty in Framingham District Court on February 10, 1997 to four counts each of motor vehicle insurance fraud and larceny. He was sentenced to 18 months in the House of Correction, 60 days to be served on an electronic bracelet to limit his travel between his home and workplace. Gorgone, who currently owns his own auto body shop, faces the potential loss of his auto body license. His former employer has previously pled guilty to insurance fraud charges. Assistant Attorney General Brian P. Burke prosecuted the case.

Attorney Charged with Embezzlement

STOUGHTON- A Stoughton attorney allegedly embezzled approximately $22,000 of his clients' money. The attorney handles personal injury claims of individuals living in the Greater Lowell area, many of whom are Cambodian immigrants. He allegedly accepted insurance company settlement checks on behalf of his clients and then failed to disburse the monies to them.

A Stoughton attorney was charged with four counts of embezzlement in Lowell District Court on January 23, 1997. Assistant Attorney General Brian P. Burke is prosecuting the case.

Anonymous Phone Call Alerts Carrier to Fraud

NORTH EASTON - A North Easton woman reported an alleged hit-and-run accident in which her Ford F150 pick-up sustained $1,983 worth of damage to the right passenger side. An anonymous phone call alerted the carrier, Commerce Insurance Company, that the vehicle had recently been involved in a claim with another carrier. Investigation revealed that the pick-up, while being driven by a friend of the subject's a month earlier than the reported accident, was involved in a motor vehicle accident. Damage to the right passenger side was appraised at $2,149 by John Hancock Insurance Company. Photographs from the two carriers show identical damage and both damage appraisals list identical damage to the vehicle.

Complaints were issued against two subjects on charges of insurance fraud, larceny and conspiracy in Taunton District Court on March 4, 1997. Assistant Attorney General Sean J. Kealy is prosecuting the case.

"Former Insurance Appraiser Indicted" Case Update

MALDEN- A Malden man reported to Hanover Insurance Company that his automobile had sustained damages from an accident and he received a $3,000 payment for the repairs to the vehicle. Investigation revealed that the subject actually staged the accident with the owner of a Raynham auto body shop by substituting another damaged vehicle for the appraisal.

Christopher Delling pled guilty to insurance fraud and larceny in Lawrence Superior Court on December 17, 1996. He was sentenced to a two year suspended sentence in the House of Correction, ordered to pay $3,000 restitution and to perform 50 hours of community service. Three other subjects in this case received pre-trial probation on January 3, 1997 in Norfolk Superior Court. Between the three subjects, they were ordered to pay more than $22,000 in restitution and court costs. One of the subjects was also ordered to stuff envelopes in a mailing that will be sent to all body shop owners. That letter was reprinted in the December 1996 issue of focusFraud. Other subjects in this case have previously pled guilty. Assistant Attorney General Brian P. Burke prosecuted the case.

Taunton Pair Allegedly Arrange Theft and Torch of Vehicle

TAUNTON- A subject and her boyfriend reported her vehicle stolen to the Taunton Police Department and to Trust Insurance Company. The vehicle was recovered burned in a neighboring town. The pair allegedly arranged for another subject to steal and burn the vehicle to collect the insurance money for the theft.

Complaints were issued against three subjects in Taunton District Court on January 10, 1997 on a total of nine counts of insurance fraud-related charges. A Bristol County Assistant District Attorney will prosecute the case.

Conscientious Passenger Reports Fraud

BROCKTON- A Brockton man reported that he was involved in a two vehicle accident. However, one of the alleged passengers called the insurance carrier, Hanover Insurance Company, and stated that the claim was fraudulent and that she had been approached by the subject to participate in the staged accident.

Two subjects admitted to sufficient facts on charges of insurance fraud and attempted larceny in Brockton District Court on February 24, 1997. Their cases were continued without a finding for six months. Assistant Attorney General Kevin P. Brekka prosecuted the case.

What are Friends For?

NEW BEDFORD- A New Bedford woman and some friends allegedly staged the theft of her Ford Escort from her home. She confided to a friend that she wanted to get rid of the vehicle because she could no longer afford it. Friends allegedly drove the vehicle from the subject's home using a spare key provided by her, inflicted damage to the vehicle and left the vehicle at an industrial park to be discovered. One of the friends admitted to IFB investigators his part in the staged theft. The subject received more than $4,000 from Metropolitan Property & Casualty for her alleged loss.

A complaint was issued in New Bedford District Court on February 3, 1997 against a subject on charges of insurance fraud and larceny. Assistant Attorney General Darlene Luccio Jordan is prosecuting the case.

Color Blind Driver

WEST SPRINGFIELD- A subject reported his Mazda 626 stolen from the Holyoke Mall. He claimed to Commerce Insurance Company that at the time of the theft the vehicle was in perfect condition. Investigation revealed that the subject purchased the vehicle in a damaged state. The previous owners stated that the vehicle had been involved in a rollover accident and that the damage to the vehicle was so severe that they were unable to repair it. The subject substituted a different Mazda 626 for his CARCO inspection, which reflected a vehicle of a different color and with a different transmission and VIN.

A West Springfield man admitted to sufficient facts on charges of insurance fraud and attempted larceny. The case was continued without a finding in Springfield District Court on January 22, 1997. He was placed on probation for one year and ordered to perform 80 hours of community service. The case was prosecuted by Assistant Attorneys General Amy Sharff and John Woodruff.


Helping Hands Highlights

NORTH PROVIDENCE- In a case investigated by IFB investigators and referred to the U.S. Postal Inspection Service in Rhode Island, a North Providence man was arrested and charged with insurance fraud in U.S District Court in Providence on March 24, 1997. The subject was allegedly involved in a motor vehicle accident. He reported his claim to his insurance carrier, General Accident Insurance Company, and received $23,020 for medical and lost wages. The subject allegedly claimed total disability from his work and allegedly inflated his earnings.


Workers' Compensation Highlights

Just Clowning Around

SPENCER- A Spencer school bus driver allegedly claimed to be totally disabled when she strained her right shoulder while opening and closing a school bus door. She collected more than $20,000 in benefits from National Union Fire Insurance Company over a two year period for her alleged disability. However, investigation revealed that the subject worked two part-time jobs, one as a personal care attendant and another as "Boom Boom the Clown". Although a videotape surveillance of the subject performing her clown act shows no apparent physical limitations, the subject declined another position with her employer claiming her shoulder injury prohibited her from driving.

A Spencer woman was indicted in Worcester Superior Court on March 11, 1997 on charges of workers' compensation fraud and larceny. Assistant Attorney General Erin K. Olson is prosecuting the case.

Ex-Wife Turns in Husband

BELCHERTOWN- A subject sustained a work-related injury and received temporary total workers' compensation benefits for more than six years and a lump sum settlement. Subsequent to these payments, the subject's ex-wife notified American Hardware Insurance Company that the subject had been employed for a portion of the time he was collecting the benefits. The subject collected more than $24,000 in benefits during the time he was gainfully employed, however he failed to reveal this employment to the insurance carrier.

Gerald Labonte pled guilty to workers' compensation fraud and larceny in Springfield District Court on March 13, 1997. He was sentenced to two years in the House of Correction, suspended for five years, and ordered to pay $15,000 restitution. Assistant Attorneys General Amy Sharff and John Woodruff prosecuted the case.

"Mere Injury Doesn't Hinder Good Service" Case Update

ARLINGTON- A subject sustained a work-related injury and collected a total of $2,700 in accordance with a long-term disability insurance policy provided by his employer. The subject made several written statements to Universal Underwriters Insurance Company that he had not returned to work. However, he was found to be working full-time as a concierge while continuing to collect long-term disability benefits. He also received $1,160 per month in social security disability payments during the same period he was working full-time as a concierge but claiming the disability.

The case against an Arlington man was continued without a finding for five years in Cambridge District Court on October 10, 1996. He was fined $850 and ordered to pay $6,888 restitution. Assistant Attorney General Sean J. Kealy prosecuted the case.

UPS Employee Pleads Guilty

MILLIS- An employee of United Parcel Service claimed to be totally disabled when she hurt her back while lifting a package. She collected total disability benefits for more than two years from Liberty Mutual Insurance Company despite being employed at Millis Ice Cream Barn and Mini Golf.

Carson Hire pled guilty to charges of workers' compensation fraud, insurance fraud and larceny in Dedham District Court on March 4, 1997. She was sentenced to two years in the House of Correction, suspended, and ordered to pay $9,000 restitution. The case was prosecuted by Assistant Attorney Darlene Luccio Jordan.

Recurring Back Injury

DORCHESTER- A subject allegedly had three separate, but overlapping, workers' compensation claims resulting from three allegedly different accidents in which he incurred back injuries. He received over $30,000 in benefits for his alleged injuries from Reliance and Aetna Insurance Companies. USF&G Insurance Company denied the third claim.

A Dorchester man was indicted on January 22, 1997 in Suffolk Superior Court on two counts of insurance fraud, two counts of larceny, two counts of attempted larceny and one count of workers' compensation fraud. Assistant Attorney General Jennifer Renna Ferreira is prosecuting the case.

Oops! It Happened Again!

ATTLEBORO- An Attleboro man reported that he was reinjured at his home several years after he had sustained a work-related injury. A DIA judge had found the subject totally disabled for a nine month span after the initial injury and then for a full year upon the reoccurrence of the injury and partially disabled thereafter. During the subject's periods of total disability, he allegedly was employed part-time as a janitor at two separate jobs. The subject failed to disclose earned income to Travelers Insurance Company and, in fact, maintained that he had not worked since the re-occurrence of his injury at a DIA hearing and at two IMEs.

In Attleboro District Court a complaint was issued on January 2, 1997 against a subject on charges of workers' compensation fraud and larceny. The case is being prosecuted by Assistant Attorney General Jennifer Renna Ferreira.

Security Guard Placed on Probation

RANDOLPH- A Randolph man claimed post-traumatic stress injury as a result of a shooting incident that occurred in 1991 in the course of his employment as an armed security guard. He stated to his employer and to medical doctors that he was unable to work and feared being in public. His employer subsequently offered him a position as an unarmed guard/gatekeeper or dispatcher but the subject failed to respond to the offers. Investigation revealed that the subject, while receiving workers' compensation benefits, was actually working at a former employer as a security guard. This employer stated that the subject did not appear to be under any stress and did not act any different than when he was previously employed by him.

A Randolph man pled guilty to workers' compensation fraud, insurance fraud and larceny on March 17, 1997 in Norfolk Superior Court. He was placed on probation and ordered to pay restitution. Assistant Attorney General Jennifer Renna Ferreira prosecuted the case.

Arm Wasn't Hurt That Bad

CHELSEA- A subject, while employed with UPS, injured his arm while unloading a trailer. He returned to light duty and lost no time. Three months later he reinjured the arm and was placed on temporary total disability. He stated at an IME that he was not working and signed an earnings report indicating that he had not received any earnings during the period he was receiving workers' compensation benefits from Liberty Mutual Insurance Company. Investigation revealed, however, that the subject allegedly began employment as a delivery truck driver less than a week after he began receiving the benefits.

A subject was arraigned on charges of workers' compensation fraud and larceny in Chelsea District Court on March 6, 1997. Assistant Attorney General Erin K. Olson is the prosecutor.


Premium Avoidance Highlights

"All in the Family" Case Update

CHICOPEE- The owner of an excavating and trucking company repeatedly told his employees to consult their own physicians if they were injured on the job and he would pay their medical expenses. The owner requested that they not file claims if injured because it would increase his workers' compensation rate. During the construction of a housing project for elderly residents, the owner did pay the medical bills for several employees who suffered work-related injuries. In addition, the company submitted false payroll records to the AG's Office and made misrepresentations to Aetna Insurance Company in order to avoid paying the proper workers' compensation premium.

O'Brien Excavating and Trucking, Inc. was found guilty of nine counts of failing to pay prevailing wage rates, one count of failing to provide true and accurate records and one count of insurance premium avoidance in Worcester District Court on December 18, 1996. The company was ordered to pay $34,000 in restitution and was prohibited from bidding or working on public works projects for six months. The day before the trial, the company was awarded a $1 million bid. The judge demanded that they not accept the work. Charges against Victor O'Brien, Jr. and Jeannine O'Brien were continued without a finding for two years. They were placed on two years supervised probation. The case was prosecuted by Assistant Attorney General Bruce Trager.


Attorney General Scott Harshbarger

and the

Insurance Fraud Bureau

of Massachusetts

invite you to attend

Evasion to Incarceration: A Seminar on Workers' Compensation

Premium Avoidance

May 2, 1997; 8:00 a.m. - 4:00 p.m.

$45.00 per person (includes lunch)

Sheraton Needham

REGISTRATION MUST BE RECEIVED BY

APRIL 23, 1997

No walk-ins or late registration payments will be accepted at the door.

For further information, contact Deborah Terry, Telephone (617)439-0439, Fax (617)439-0404

TTY (617)727-4765

Training sessions will be conducted by:

Prosecutors from the U.S. Attorney's

Office

Prosecutors from the Massachusetts

Attorney General's Office

Insurance company personnel/

premium auditors

Insurance Fraud Bureau investigators

SPECIAL FEATURE ! ! !

A training video will feature two premium evasion felons discussing their workers' compensation premium evasion cases including motive and how they perpetrated the crimes. A panel discussion will follow examining the issues surrounding these cases.

If there is anyone in your office that might benefit from this type of training, please pass on the information!

CFEs will be awarded 7 CPE credits