Nev. Man Found Guilty of Felony Fraud

Attorney General Brian Sandoval announced that Patrick Lee Miller was found guilty of a felony insurance fraud, making false representations to an insurance company. The matter was heard in Humboldt County's 6th Judicial District Court before Judge Iroz. Sentencing is scheduled for Jan. 12. Miller faces one to four years in prison, up to a $5,000.00 fine plus court fees and costs.

"Mr. Miller [allegedly] made a number of false representations to Nationwide Insurance in the context of a claim inquiry,"" said Senior Deputy Attorney General Ronda Clifton, who prosecuted the case. "We investigated along with the Humboldt County Sheriff's Office and the Winnemucca Police Department and found that the claim was composed of items that Mr. Miller's son had been stealing from him, and Mr. Miller had knowledge of that."

Anonymous Tip, Employer Cooperation Solve Pair of Wash. L&I Fraud Cases

Washington has ordered a 62-year-old woman from Okanogan to pay back $117,004 after an investigation reportedly showed that she had collected survivor benefits illegally. And a 52-year-old Olympia man, Richard Sundblad, has been ordered to pay $20,300 in penalties and Department of Labor and Industries benefits he reportedly collected while secretly working.

Carole Edwards, now Carole Herriman, was placed on the pension roles in January 1998 after her husband, Carlos E. Edwards, died while receiving an L&I pension. She had remarried and reportedly not notified L&I. Once she had remarried, she was not entitled to survivor benefits.

Each year, L&I sends a form to survivors to determine if they are still eligible to receive benefits. The form asked Mrs. Edwards if she had remarried. Her response, completed in April 1998, allegedly was "No Way - Ever."

In 2003, the department received a tip that Carole Edwards had remarried. An L&I investigation showed the information to be correct. Three months after assuring the department she'd never remarry, Carole Edwards reportedly did just that. Each year since then, she allegedly has signed an affidavit stating she was still single. During that time, Mrs. Herriman collected more than $78,000 in survivor benefits. State law authorizes L&I to impose a 50 percent penalty on what is owed.

An investigation into Sundblad determined that he had reportedly collected workers' compensation time-loss benefits illegally. While collecting wage-replacement benefits from L&I, the claimant had arranged to have his paychecks deposited in The Sunblad Family Trust in an attempt to allegedly hide his work activities from the department.

Sundblad was injured Aug. 2, 2002, while working for Belmont Enterprises in Centralia. The claimant contended that his injury prevented him from working, and he began receiving time-loss benefits.

Belmont Enterprises notified the department that someone had seen the claimant's truck and felt he was working for a new employer. An L&I fraud investigator located the new employer and, with that employer's cooperation, reportedly videotaped the L&I claimant loading his truck with no sign of a disability.

The new employer also provided payroll information that showed the claimant's paycheck going to the The Sunblad Family Trust. According to investigators, it appears the claimant intentionally dropped the "d" in the trust's name to avoid detection.

The case was turned over to the Thurston County prosecutor, who has charged Sundblad with two counts of perjury, three counts of first-degree theft and one count of forgery.

L.A. Man Pleads No Contest to Fraud

A Los Angeles man pleaded no contest to two felony counts of insurance fraud after CDI Fraud investigators determined that he misrepresented injuries allegedly sustained in his workplace.

Tommie Lee Robinson, 55, claimed he injured himself while moving materials in his position as a Quality Control Inspector at Cherokee International, a manufacturing company in Irvine, Calif. Robinson was sentenced on Sept. 17 in Orange County Superior Court to 90 days in jail and ordered to pay $11,562 in restitution, $200 in fines, and serve three years formal probation.

Investigators found that in April 1998 Robinson reported the injury to his supervisor and was referred to a physician for evaluation and treatment. Robinson returned to modified work duties, but continued to complain of pain, eventually requiring back surgery in 2001. During his deposition on the injury Robinson stated that he always used his cane to walk. However, a two-month hidden videotape investigation in 2001 reportedly revealed that Robinson walked without a cane and without any signs of discomfort.

The treating physician's original diagnosis of a 100 percent disability rating would have provided Robinson a payment of $20,000 per year for the remainder of his life and would have cost the insurance company approximately $250,000. After reviewing the videotape, the physician changed Robinson's disability rating to 24 percent, and Robinson settled his injury claim at a total cost of $14,500.

Calif. Couple Charged with Fraud

Criminal charges of insurance fraud have been filed against Cory and Tiffany Thurlow of Modesto, Calif., by the District Attorney's Office of Stanislaus County. They are charged with two felony counts and a misdemeanor.

These charges arise from an insurance claim the Thurlows made against their insurance carrier, Workmen's Auto Insurance of Los Angeles, for an alleged theft of property from their house on May 27, 2003.

The Thurlows allegedly claimed that approximately $60,000 worth of household items were stolen by burglars. Due to the suspicious nature of the claim, Workmen's Auto referred the case to claims investigation firm David Morse & Associates. Subsequent investigation revealed numerous inconsistencies and misrepresentations, and the matter was referred to the Stanislaus County District Attorney's Office. Further investigation by the District Attorney investigators produced evidence to indicate that the Thurlows had hidden the allegedly stolen belongings in a storage facility.

Martin D. McDermott III, vice president, claims, for Workmen's Auto Insurance, said, "The first step to improve the odds in the battle against fraud is our front line claims professionals. Adjusters can't ignore those 'red flags.' If SIU gets the case for investigation early in the claims process, the odds to uncover insurance fraud are now in our favor. The hopes and dreams of many claims professionals in the fight against fraud have been lost. We need to accept the challenges of fraud in our industry so we can feel the exhilaration of victory and keep the cost of insurance affordable for everyone."

Agent Sentenced for Felony Fraud

John Vernon Liller, 53, of Carson City, Nev., was sentenced after pleading guilty to felony fraud charges.

Liller was the owner and agent at a Farmers Insurance office for more than 22 years. Between March 2000 and March 2001, Liller allegedly took money from clients that was intended for the purchase of insurance and misused the funds.

Liller was sentenced 12 to 48 months in prison but was later placed on probation and ordered to pay $14,000 in restitution.