Evelyn Tolentino, a 37-year-old Medical Assistant, alleged an unwitnessed industrial injury to her left knee, left hip and left ankle after allegedly falling from a ladder while working for Evelyn Jankowski, M.D. Her workers’ compensation claim was accepted, and benefits were being administered. Tolentino presented to her QME with crutches and a limp and explained she must use crutches and could not put her foot down to complete exam. Multiple days of surveillance were obtained which depicted Tolentino utilizing a crutch and having a limp only at her scheduled medical appointments, and all other days of surveillance depicted Tolentino walking with a normal gait, without crutches or a limp. The surveillance film was submitted to the QME who opined that, based on the surveillance film, the injury appeared minimal at best. The QME provided the claimant with a 0% impairment rating, resulting in an attempted theft of permanent disability as the Primary Treating Physician had previously provided a 41% impairment rating.
The contrast between Tolentino’s presentation at a medical appointments and other days of surveillance prompted a referral to VRC Investigations’ Special Investigation Unit for review. VRC’s SIU team submitted a fraud referral to the Los Angeles County District Attorney’s Office and the CA Department of Insurance for suspected Workers’ Compensation fraud, resulting in the opening of a criminal investigation with the Los Angeles County District Attorney. The Los Angeles County District Attorney then filed criminal charges against Tolentino to include 1 Felony count of CA Insurance Code 1871.4(a)(1). On October 6, 2020, Tolentino pled No Contest to felony IC 1871.4(a)(1) and agreed to the restitution order of $32,923.
Insurance fraud is a serious crime and a Coalition Against Insurance Fraud survey found that 3 out of 4 insurance carriers note insurance fraud is increased. Contact Dalene Bartholomew, CFE, CIFI, VP at VRC Investigations to learn more or discuss your fraud abatement program. daleneb@vrcinvestigations.com
Read our recent white paper, “3iD Surveillance Subject Verification” to learn how our 3iD verification system provides assurance that the target we’re looking for is the subject we’re looking at.
Dalene Bartholomew CFE, CIFI
Vice President | VRC Investigations
Phone: 800-654-2185 option 7
Email: daleneb@vrcinvestigations.com
