New Jersey Man Pleads Guilty in $74K Insurance Fraud Scheme

December 4, 2018

An Essex County, N.J., man has pleaded guilty in a scheme to obtain $74,000 in disability payments by submitting dozens of forged documents to his insurance provider.

Major Smith, a former teacher in the East Orange school district, pleaded guilty to second degree insurance fraud during a hearing before Superior Court Judge Alfonse J. Cifelli in Essex County on Monday.

Under the terms of the plea agreement, the state will recommend that Smith be sentenced as a third-degree offender and receive a three-year prison term. Smith is scheduled to be sentenced in March 2019.

Smith, who was employed by the East Orange Board of Education until June 2012, admitted filing more than two dozen claims for disability with American Family Life Assurance Company of Columbus (Aflac) that contained forms purportedly filled out by his doctors and/or his employer. Smith filed the allegedly fraudulent claims between February 2012 and October 2015 in connection with injuries he allegedly sustained in several accidents.

“This kind of exploitation of the insurance system is a prime example of why we’re calling on New Jersey residents to report fraud when they see it,” said New Jersey Attorney General Gurbir Grewal in a press release issued by the New Jersey Office of the Insurance Fraud Prosecutor (OIFP). “Insurance fraud drives up the cost of premiums for everyone. By actively working to shut down insurance thieves, honest policy holders can finally stop paying the price for crimes they did not commit.”

The OIFP investigation revealed that Smith impersonated his doctors in claim forms documenting treatments he allegedly received on various dates for injuries he claimed to have sustained in several slip and fall accidents. Smith also pretended to be a representative of the East Orange Board of Education in claim forms verifying his employment in the district, even after he no longer worked there.

“Disability insurance is meant to serve as a financial safety net for individuals who have fallen on hard times, not a source of easy cash for criminals,” said Acting Insurance Fraud Prosecutor Tracy M. Thompson in the release. “The prison term this defendant is facing as a result of his actions is proof that insurance fraud is a serious crime with serious consequences.”

Deputy Attorney General Jennifer L. Menjivar represented the State in the plea hearing. Detectives Wendy Berg and Grace Proetta coordinated the investigation.

Source: New Jersey Office of the Insurance Fraud Prosecutor

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