The Problem

Our client, a workers’ compensation carrier, had information that its wage benefits claimant was working in and managing a business he had formed with his wife and brother just three weeks after his allegedly debilitating injury. The surveillance investigator that our client hired had limited success getting video of the claimant talking with customers and demonstrating product. Nevertheless, counsel for the claimant deflected the video evidence, dismissing it as an isolated instance that required minimal effort at a time when the claimant’s wife and brother were not available to assist the customer. Our client needed irrefutable evidence of the claimant’s work at his new company and how much he made.

Robson, PC’s Approach

A review of the company’s records revealed that it had no employees or contract workers during its first five months of operation.  The claimant asserted that he was too injured to work, spending his days in the store’s back room watching television and playing video games.  Logically, this left only the claimant’s wife and brother to run the business, though they each had other jobs and worked Monday-Friday until at least 4:00 p.m.  By wading into the company’s computerized sales records, Robson, PC’s forensic accountants were able to prove that 64% of the company’s sales during its first five months of operation were generated between 10:00 a.m. and 4:00 p.m. on Mondays through Fridays, hours when the claimant was the only one at the store.

 

The Result:

The Virginia Workers’ Compensation Commission found that the claimant was indeed working while he claimed to be totally disabled.  As a result, the Commission reduced his wage benefit $320 per week averting a $160,000 overpayment, assuming the wage benefits would have been paid for the full 500 weeks potentially allowable under the workers compensation laws.

 

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