The Scurry County (Texas) Grand Jury indicted Jake V. Silva on charges of fraudulently obtaining workers’ compensation benefits. According to Texas Mutual Insurance Co., an investigation revealed that Silva continued to work while collecting temporary income benefits (TIBs) for an alleged on-the-job injury.
Silva allegedly suffered an injury to his right arm while working for B&F Well Service in Snyder. The same day, a doctor cleared him to return to work with restrictions. When B&F was unable to meet those restrictions, Texas Mutual Insurance Co. began paying TIBs.
The Texas MutualSM adjustor handling the claim got suspicious because Silva was difficult to contact while off work. The investigation revealed that shortly after leaving B&F, Silva started working for Midwestern Services Company Inc. in Snyder. He later worked for Express Personnel, a staffing service in Midland, where his assignments included operating windmills. After leaving Express Personnel, Silva accepted a job with Teraco, Inc. in Midland. An injured worker who is collecting TIBs must notify the insurance carrier if he or she returns to work in any capacity.
“Our adjustors are trained to recognize the warning signs of fraud,” said Elliott Flood, VP of Special Investigations at Texas Mutual Insurance Company. “When an injured worker is difficult to contact, or is belligerent when contacted, it raises our suspicion. Many of our fraud investigations start when an adjustor feels that too many things about a claim just don’t add up.”
To prove fraud, the Texas MutualSM investigator had to show that Silva knowingly lied in order to receive benefits. The evidence included a recorded conversation between the Texas MutualSM adjustor and Silva, in which the adjustor informed Silva of his obligation to notify Texas Mutual Insurance Co. if he began working while collecting TIBs. Silva had also received written notices with his TIBs checks and with form TWCC-26 (Texas Workers’ Compensation Commission).
The Silva investigation is part of the Texas MutualSM “Zero Tolerance of Fraud” program. Texas Mutual Insurance Co. maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
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