Forum Review - May 22, 2008

To: Return to Work Coordinators

From: Tracy Caldwell, Workers' Compensation Analyst, Benefits Division, (916) 445-9760, FAX (916) 324-3213

Forum Review Notes

Karen Sullivan, Claims Operations Manager ~ South, stopped by to give us all the latest news from State Contract Claims. Among other news items, she announced the new Claims Manager for the Commerce Office: Beverly Harris.

The focus of the morning was Workers' Compensation Fraud. We had three dynamic speakers:

• Linda Willat, Senior Claims Specialist and Fraud Liaison from the Rohnert Park Office, explained the basic elements of workers' compensation fraud and SCIF's obligation to report any suspicious fraudulent activity (per Insurance Code 1877.3(b)(1)). Every SCIF office has a Fraud Liaison, you can find yours on State Fund's Web Site.

• Botond Viragh, Special Investigator from the SCIF Special Investigations Unit, presented the annual training that his unit provides to SCIF adjusters. He represents the next step in the fraud process, because only the Special Investigations Unit (SIU) is authorized to refer a case to law enforcement. They can refer a case with a reasonable suspicion, it is the District Attorney's job to prove the elements of fraud.

• Shelly Moore, Deputy District Attorney from Solano County, then explained that Workers' Compensation fraud is her focus, she does nothing else but investigate and prosecute these cases. Applicant fraud is the most common and the District Attorney will pursue restitution as well as jail time in most cases.

If you have any questions or wish to view any of the power point presentations, please contact me at tracycaldwell@dpa.ca.gov

Updated June 17, 2008 at 3:55 PM.