Arrests for April 2011
These arrests were made possible through the cooperation of the Frauds Bureau, law enforcement, the insurance industry and the public.
To report suspected incidents of insurance fraud, call 1-888-FRAUDNY
CAUGHT!
*********************************************
- SENTENCED
Dennis J. Clark Sr., an Oneida County laborer, was sentenced on 4/28/11 to five years’ probation and ordered to pay $42,675 in restitution to the New York Liquidation Bureau. (The Liquidation Bureau had paid workers' compensation benefits on behalf of Legion Insurance Company which is in liquidation.) Following a work-related injury sustained in January 2001, Clark began collecting benefits. During the benefit period, he submitted Work Activity Reports stating that he was unable to perform the duties of his former job as a sanitation engineer at a local garbage collection company. However, he was arrested on 2/12/10 after an investigation by the Frauds Bureau, the Workers’ Compensation Board’s Office of the Fraud Inspector General and the State Police revealed that over a five-year period from 2005 to 2009, he fraudulently collected $43,410 in benefits while fully employed at his previous occupation.
New Hartford, NY, resident William Owens pleaded guilty on 4/15/11 to attempted workers’ compensation fraud. He was sentenced to 100 hours of community service and ordered to pay $83,400 in restitution to the State Insurance Fund and a fine of $15,000. He began collecting workers’ compensation wage-replacement benefits after being classified with a permanent partial disability resulting from a work-related back injury he sustained on 10/5/88. In January 1989, he advised the State Insurance Fund that he had returned to work for a roofing company earning $400 a week. During the benefit period, he submitted 19 documents stating that his salary was $400 a week. During the same period, his employer submitted 16 reports confirming the $400 salary. However, W-2 forms and other documents revealed that he was earning substantially more than $400 a week, thus allowing him to collect $83,400 in benefits to which he was not entitled. The Frauds Bureau, the State Police and the Workers’ Compensation Board’s Office of the Fraud Inspector General pooled resources in the investigation that led to his arrest.
- GUILTY PLEAS
Kelly Woods, an Albany woman who had relocated to Utah, pleaded guilty on 4/28/11 to insurance fraud. She was extradited and arrested on 3/23/11 for faking a work injury in order to collect workers’ compensation benefits. On numerous occasions between 7/08 and 11/10, she reported that she suffered from permanent fixed torticollis, a condition that kept her head at a 90-degree angle at all times. However, she was observed on video moving her head and neck freely. As a result, she fraudulently collected $42,000 in benefits to which she was not entitled. Her arrest was the result of an investigation by the Frauds Bureau, the State Insurance Fund and the Workers’ Compensation Board.
- MATERIAL MISREPRESENTATION
Arrested on 4/29/10
Charged with violation of Section 114.1 of the Workers’ Compensation Law
An investigation by the Frauds Bureau and the State Insurance Fund resulted in the arrest of the operator of a Putnam County construction company for fraudulently attempting to obtain workers’ compensation coverage. He was accused of reversing his first name and surname on an application for coverage so he could mask his identity to conceal the fact that an earlier policy had been cancelled for nonpayment of premiums. Investigators found that the defendant concealed that he was a partner and vice president of the construction company when that company’s policy was cancelled in June 2009 for not paying $41,000 in premiums. He also changed the name of his company and falsely reported that he never had any previous coverage when he applied for a new policy with the Fund.
- PERMISSION GRANTED
Arrested on 4/20/11
Charged with insurance fraud in the 3rd degree and making a false written statement
On 2/8/10, a Utica woman reported to New York Central Mutual Insurance Company that her 2007 Saturn was hit while parked at a local shopping mall and she filed a $4,595 claim for the loss. However, an investigation by the Frauds Bureau uncovered evidence that indicated her son-in-law had been involved in an accident while driving the car with the defendant’s full knowledge and consent.
- NO-FAULT FRAUD
Arrested on 4/19/11
Charged with grand larceny in the 3rd degree, insurance fraud in the 1st and 3rd degrees and falsifying business records in the 2nd degree
The defendant in this case became the 50th suspect to be arrested in this long-term no-fault fraud investigation. He intentionally crashed his vehicle with the complicity of three others who were passengers and have already been arrested. The four then were treated for nonexistent injuries for which Praetorian, Progressive and Liberty Mutual Insurance Companies were fraudulently billed $25,000.
- NOT DISABLED
Arrested on 4/15/11
Charged with insurance fraud in the 4th degree and falsifying business records in the 1st degree
The defendant in this case submitted an allegedly fraudulent claim to MetLife Insurance Company under a long-term care policy stating that because of a disability she needed assistance with the activities of daily living. She was also accused of submitting false invoices for personal care she purportedly received. However, surveillance showed her performing activities inconsistent with her reported disability. As a result of the fraud, she received $1,050 in payments to which she was not entitled. She was arrested following an investigation by the Frauds Bureau and MetLife.
- ALTERED DATE
Arrested on 4/14/11
Charged with insurance fraud in the 3rd degree and falsifying business records in the 1st degree
Following an auto accident on 7/25/09, the suspect in this case filed a claim for no-fault benefits with State Farm Insurance Company. She received medical treatment and was originally diagnosed as “totally incapacitated” and unable to work. She was subsequently cleared by her doctor to return to work on 4/16/10. However, an investigation by the Frauds Bureau found evidence that she had submitted disability notes from 4/16/10 to 12/17/10 claiming she was still incapacitated. She allegedly altered the return-to-work date on the notes in order to continue to receive no-fault benefits even after she returned to work on 6/1/10. As a result of the fraud, she collected $8,701 in benefits to which she was not entitled. After being advised of her Miranda rights, she confessed to committing the fraud.
- ARSON
Arrested on 4/13/11
Charged with arson and insurance fraud
The suspect in this case was charged with attempting to burn his 2008 Chevrolet HHR. He reported to Allstate Insurance Company that the car was stolen from his residence on 5/4/10 and filed a clam for the loss. However, the claim was denied when Allstate learned that he had admitted to the Buffalo Police that he set fire to the car because he could no longer afford the payments. The car was subsequently recovered partially burned and with minimal damage. The Frauds Bureau pooled resources with the Buffalo PD in this investigation.
- SHADY DEALINGS
Arrested on 4/13/11
Charged with grand larceny in the 3rd degree
In a twisted tale of homeowner fraud, an upstate man filed a claim with Nationwide Insurance Company after his home was destroyed by fire and he was reimbursed $300,000 for the loss. He subsequently was contacted by a Nationwide claims representative who informed him that he believed he could get the homeowner an additional settlement with the help of a lawyer friend. The deal was that the unnamed lawyer would get half of whatever additional compensation the homeowner received. The homeowner agreed although he later said that he doubted there would be any additional money. About ten days later, the claims rep informed him that the attorney had been able to arrange an additional settlement of $89,822 and produced the check from Nationwide. As a claims rep, the defendant was authorized to settle claims and write settlement checks on behalf of the company. The claims rep told the homeowner that the attorney in question wanted his name kept out of the transaction. So the homeowner was asked to write a personal check payable to the claims rep for $44.911 – half the amount of the additional settlement. The claims rep advised the homeowner to deny any knowledge of this transaction if Nationwide were to ask. A red flag went up and the homeowner reported his suspicions to Nationwide. The claims rep was fired after Nationwide learned that he had cashed the homeowner’s check and deposited the money into his personal account. He was arrested following an investigation by the Frauds Bureau and Nationwide.
- VIDEOTAPE EVIDENCE
Arrested on 4/13/11
Charged with insurance fraud in the 3rd and 5th degrees, falsifying business records in the 2nd degree and offering a false instrument for filing in the 2nd degree
On 9/24/10, a Bronx man filed an application for no-fault benefits, reporting that he had been involved in an auto accident. He subsequently sought and received medical treatment for purported injuries. However, a review of a videotape of the accident scene showed that the defendant was not involved in the accident and in fact was not in proximity to any of the vehicles involved in the accident. As a result of the fraud, Liberty Mutual Insurance Company was billed more than $20,000 for unnecessary medical treatment. The Frauds Bureau and the NYPD’s Fraudulent Accident Investigation Squad conducted this investigation jointly.
- NONPAYMENT OF PREMIUMS
Arrested on 4/13/11
Charged with insurance fraud in the 4th degree and falsifying business records in the 1st degree
An investigation by the Frauds Bureau based on a referral from Progressive Insurance Company led to the arrest of a Progressive insured whose auto policy was cancelled on 12/10/10 for nonpayment of premium. On 12/16/10, he went to his agent’s office, made a payment and signed a Statement of No Loss, saying that he had not been involved in an auto accident between 12/10 and 12/16. Based on the Statement, Progressive reinstated the policy with no lapse. The insured subsequently filed a $2,946 claim for an accident that occurred on 12/14/10 which the insurer was required to pay based on the Statement of No Loss. Had the insurer been aware of the 12/14 accident, the policy would not have been reinstated without a lapse.
- THEFT OF BENEFITS
Arrested on 4/8/11
Charged with grand larceny and criminal possession of a forged instrument
An investigation by the Frauds Bureau and the State Insurance Fund resulted in the arrest of an upstate woman. She allegedly cashed $3,100 in workers’ compensation benefit checks that were issued to a deceased relative.
- EMPLOYMENT DATES FALSIFIED
Arrested on 4/6/11
Charged with insurance fraud in the 5th degree
Following an auto accident, the suspect in this case filed for lost-wage benefits under the no-fault portion of her auto insurance. During an investigation, Frauds Bureau investigators discovered that the claim contained fictitious dates of employment. She falsely stated that she worked at a local day spa from July 2009 to 5/13/10, the date of her accident. However, the investigation revealed that her last day of work was in fact 4/27/10.
- GUN RECOVERED
Arrested on 4/5/11
Charged with insurance fraud in the 4th degree, grand larceny in the 4th degree and filing a false police report
An investigation by the Frauds Bureau resulted in the arrest of an upstate man for filing a fraudulent homeowners insurance claim. He reported to Adirondack Insurance Company that a .357 Colt revolver and other items were stolen from his home on 3/17/10. The insurer paid out $1,650 on the claim. However, investigators learned that the gun had been recovered by the Buffalo Police Department in a search warrant that was executed on 9/19/09 in connection with a narcotics arrest.
- SAME DAMAGES
Arrested on 4/4/11
Charged with insurance fraud in the 3rd degree
A Suffolk County woman reported to Allstate Insurance Company that her 2003 Mercedes Benz had been involved in an accident on 5/3/10 and filed a claim for the loss. However, an investigation by the Frauds Bureau and the NYPD’s Fraudulent Accident Investigation Squad revealed that she had filed a claim for the exact same damages that resulted from an accident that had occurred on 4/28/10.
- NO SECOND RING
Arrested on 4/1/11
Charged with insurance fraud in the 4th degree and falsifying business records in the 1st degree
The defendant in this case was accused of filing a fraudulent insurance claim after purportedly losing two diamond rings. Frauds Bureau investigators learned that the defendant bought a diamond ring from a Watertown jeweler in November 2009. She lost the ring in July 2010 and was paid $1,199 after filing a claim with USAA Insurance Company. She told investigators that she used the money to buy an identical ring. However, she later filed another claim after purportedly losing the second ring. Evidence indicates that she changed the date on the sales receipt for the original ring so she could submit the claim. She was never paid for the second claim.
- PRIOR SUPPLEMENT
March 2011
- BUILDING FIRE INTENTIONALLY SET
Arrested on 3/13/11
Charged with arson in the 1st degree and assault in the 1st and 2nd degrees
A Brooklyn man was arrested for setting fire to a residential building in which 23 residents were injured, four of them critically. Surveillance videos showed him running away from the building. The fire began in the building entrance and rapidly spread through the stairwells, virtually blocking off the exits. The suspect himself was not a resident of the building and the reason for the arson has yet to be determined.
