Successful prosecution of fraudulent workers' compensation claim

Roadside Auto Body, Inc. v. Scott Miller
285 Ill.App.3d 105, 220 Ill.Dec 724

John P. Connolly of Brady, Connolly & Masuda, P.C. successfully prosecutes workers' compensation fraud case.

Facts:

The petitioner reported an unwitnessed accident to his employer 25 days after the alleged incident. A Form 45 was completed and a report was made to the insurance company. The insurer secured a recorded statement from employee and confirmed the accident as reported to the employer. The claim was accepted as compensable and temporary total disability and medical benefits were paid.

• Rumors that while petitioner receiving temporary total disability benefits, that alleged low back problem occurred as a result of military accident;
• Investigation into military history confirmed prior back surgery recommendations;
• No prior Industrial Commission claims;
• Insurer accepted claim as an aggravation of a pre-existing condition;
• Petitioner secured an attorney;
• Petitioner underwent lumbar laminectomy and fusion;
• Petitioner returned to work six months after lumbar laminectomy;
• Petitioner wants to settle workers' compensation action;
• Offer of 30% loss of use of man ($50,000.00) as a whole is accepted;
• Petitioner advised co-worker/best friend of $50,000.00 settlement;
• Co-worker went to employer and suggested that petitioner had filed a fraudulent claim;
• Employer notified insurer;
• By the time the insurer secured a recorded statement from co-worker, the Lump Sum Settlement Contract was approved by the Illinois Industrial Commission;
• Co-worker advised insurer that claimant hurt back in the military, had a longstanding back problem and intended to defraud employer;
• Additional investigation confirmed unwillingness to undergo surgery while in the military;
• Insurer refuses payment of Lump Sum Settlement Contract; and
• Petitioner's attorney successfully secured Order from the Industrial Commission for penalties and attorney's fees in the amount of $28,000.00 for non-payment of Lump Sum Settlement Contract.

Litigation Summary:

John P. Connolly successfully prosecuted a declaratory judgment action in Lake County before Chief Judge alleging civil fraud.

John P. Connolly successfully proceeded to trial before the Chief Judge in Lake County alleging that the defendant/petitioner had engaged in fraudulent activities. The Trial Court found petitioner guilty of fraudulent activity and entered an Order of Restitution on behalf of employer. The Trial Court further set aside the $50,000.00 Lump Sum Settlement Contract, vacated the $28,000.00 penalties and attorney's fees award, and ordered defendant/petitioner to reimburse the respondent insurance carrier in the amount of $50,000.00 regarding prior temporary total disability benefits and medical payments.

John P. Connolly was able to establish by clear and convincing evidence that the petitioner had engaged in fraudulent activities, that the petitioner was not entitled to temporary total disability and medical benefits, and that the respondent did not have to pay the $50,000.00 Lump Sum Settlement Contract.