Houston Man Indicted for Comp Fraud

The Texas Mutual Insurance Company reported that a Travis County grand jury recently indicted Sergio Garcia on charges related to workers’ compensation fraud. If convicted, Garcia could face fines, restitution and time in prison.

While working in Houston for Continental Manufacturing, a janitorial and food service products supplier, Garcia allegedly hurt his right shoulder in an on-the-job accident. Texas Mutual began paying Garcia temporary income benefits (TIBs) after his doctor placed him in an off-work status.

The insurer said one of its investigators, Michael Bradley, uncovered evidence suggesting that Garcia was working at a new job while continuing to collect TIBs for his alleged injury at Continental Manufacturing. Investigators call this sort of scam “double-dipping” because the claimant is getting paid by his new employer for working and, in effect, getting paid by his previous employer’s insurance company for being too injured to work.

Double-dipping scams, if allowed to continue, can lead to a higher workers’ comp insurance premium for the first employer when the company renews its coverage.

State law allows injured workers to receive TIBs—up to 75 percent of their weekly salary—only while they are unable to work. The law also requires injured workers to notify the workers’ compensation insurance company when they begin working again.

With every TIBs check, Texas Mutual includes a statement reminding the claimant that he or she must contact the adjuster if he or she returns to full-time or part-time work. Additionally, Texas Mutual adjusters often contact claimants directly to determine their work status.