San Diego Couple Sentenced for Workers’ Comp Fraud

A San Diego couple has been sentenced to one year in jail after conspiring to deceive medical professionals and employer out of thousands in grand theft and workers’ compensation fraud

According to California Department Insurance Commissioner John Garamendi, Eduardo Ruiz Rocha and Noemi Rocha Quirino were sentenced in San Diego Superior Court to 365 days in jail and 360 days in jail respectively for one felony count each of workers’ compensation fraud, conspiracy and grand theft. They were also ordered to pay a total of $48,588.52 in restitution to Liberty Mutual Insurance and Republic Indemnity Company of America.

The August 29 sentencing was the result of an investigation by the California Department of Insurance’s (CDI) Fraud Division. Investigators found the Rochas conspired to present false information in Mr. Rocha’s continuing workers’ comp claim and while released on her own recognizance, Mrs. Rocha filed a fraudulent workers’ comp claim on her own behalf.

On May 5, 1996, while working for Aircraft Service International, Mr. Rocha was sprayed with jet fuel as he was trying to stop a fuel leak from a truck. On June 3, 1996, a radiator hose ruptured and sprayed him with scalding water. When Mr. Rocha jumped away from the spray, he landed poorly and fractured his ankle. He suffered burns to 10% of his body. Over the next several years, his condition allegedly worsened physically, mentally and emotionally to the point where the Rochas alleged that Mr. Rocha could no longer care for himself. Mrs. Rocha told doctors that her husband was so disabled by his injuries he was unable to be left alone in the house, drive a vehicle, communicate with others, or take care of basic hygiene needs. Mr. Rocha made minimal statements regarding his condition as he portrayed himself in being severely disabled and unable to communicate except at the most infantile level. Mrs. Rocha was eventually hired by the insurance carrier as his caregiver based on recommendations by Mr. Rocha’s doctors. Due to the Rochas manipulative lies, Mr. Rocha was prescribed a motorized wheelchair, wheelchair ramp, and the evaluation of this vehicle for wheelchair access.

The fraud was discovered in 2001 when Liberty Mutual’s Special Investigation Unit contracted a company to obtain subrosa video proving on tape that Mr. Rocha functioned far better than he stated. The video portrayed him walking without aid, taking out the trash, driving his car, taking his children to school, shopping, and even carrying a large TV on his shoulder.

This investigation uncovered a string of medical professionals who were deceived by the Rochas’ fraud; upon watching the video, many of the medical providers said they felt betrayed and shocked by the level of fraud and deception the Rochas committed.

Investigators also discovered that Mrs. Rocha submitted her own fraudulent workers’ comp claim after she was arraigned in this case on May 16, 2006. On the morning of June 20, 2003, while working at Victoria Special Care Nursing Home, Mrs. Rocha claimed to have injured her back in a slip and fall. Her supervisor questioned her injury and believed it did not actually occur. A follow-up investigation by the CDI beginning on Jan. 23, 2004, confirmed this was also a fraudulent claim. On Feb. 15, 2005, Mrs. Rocha was charged with insurance fraud.

On Jan. 18, 2006, husband and wife pled guilty to three felony counts each – conspiracy, insurance fraud and grand theft – and stipulated to pay restitution of $37,988.52. Mr. Rocha dismissed his workers’ comp case with prejudice, and Mrs. Rocha was further charged with perjury for lying about her husband’s condition at her deposition. In addition, Mrs. Rocha pled to one felony count of insurance fraud on her separate worker’s comp fraud case and agreed to pay $10,600 in restitution.

On Aug. 29, 2006, Mr. and Mrs. Rocha were both sentenced for their participation in Mr. Rocha’s fraudulent claim and Mrs. Rocha was also sentenced for her separate fraudulent workers’ comp claim. Mr. Rocha was placed on 5 years formal probation and sentenced to 365 days in jail. Mrs. Rocha was placed on 5 years formal probation for both cases and sentenced to 180 days in custody for each case for a total of 360 days in jail. Both were ordered to pay the $37,988.52 in restitution. Mrs. Rocha was also ordered to pay an additional $10,600 in restitution in her case.

The case was prosecuted by the San Diego District Attorney’s office, Insurance Fraud Unit.

Source: CDI