Calif. Man Sentenced Following Plea on Pair of Workers’ Comp Fraud Counts

Ventura County (California) District Attorney Gregory Totten reported that Everardo Ramirez Vega (DOB 11-28-1967) was recently sentenced after his plea on two felony counts of workers’ compensation fraud. The prosecution of Vega followed an investigation conducted by the Criminal Investigations Branch of the California Department of Insurance.

On Sept. 9, 1999, Vega brought a workers’ comp claim against his employers, Vasquez Labor, following an alleged injury to his back, shoulder, and hernia. Vega was treated and his claim was settled for $43,000.

Thereafter, in January 2003, Vega became employed by CRI Concrete Construction, reportedly using the fabricated name of Jose Ortiz and a false social security number.

Only eight days after starting work, Vega (aka Ortiz) alleged he injured his back and filed a workers’ comp claim. Vega was treated by three different doctors. During his treatment, he reportedly denied having had any prior injuries to his back or prior workers’ comp claims. On March 28, 2003, Vega was examined by a “qualified medical examiner” who opined that Vega had not been forthright about his injuries and that they were old in appearance and not work related. The doctor further determined that there was no medical basis upon which to place Vega on disability.

On June 12, 2003, Vega was deposed under oath. During the deposition, Vega reportedly lied by claiming that he did not have any prior workers’ comp claims and that he had never used a different name or social security number.

An investigation uncovered his Sept. 9, 1999, workers’ comp claim, where Vega used a different name and social security number. The 1999 injury involved one of the same body parts (his back) as his most recent claim.

Information relating to a prior injury to the same body part is important in workers’ comp claims because the existence of a prior injury will generally result in reduced compensation. Vega not only lied about existence of his prior injury but also, based upon the opinion of the qualified medical examiner, fabricated the injury upon which his most recent claim was based.

On Sept. 22, 2005, Vega pleaded guilty to two felony counts of workers’ comp fraud. On Thursday, Dec. 1, 2005, Vega was sentenced to 210 days in the county jail. He was placed on probation for five years and ordered to pay restitution in the amount of $18,498.