MJM Assists Everest National in Workers’ Comp Fraud Conviction

Working in conjunction with Everest National Insurance Company, the insurance fraud mitigation and claims investigative service, MJM Inc., successfully aided in the arrest and conviction of a California man for fraudulent workers’ compensation insurance claims.

Odir Fuentes, a 30-year-old construction worker, allegedly suffered injuries while working in July 2001. He was treated and released the same day his injury occurred. Fuentes was under doctor’s orders to wear a back brace and given certain physical restrictions. Additionally, he was to limit the numbers of hours he worked per day.

Fuentes continued to work full time at the construction company, including overtime, using his own name until November 2001 when he began working under the name of Francisco J. Ceja.

Working with Everest National’s SIU, MJM was asked to investigate the claimant. It was found through medical records, employment records, eyewitness statements and prior surveillance that the claimant was working under someone else’s Social Security Number at his workers’ comp employer and two other employers while still receiving workers’ comp benefits. He also filed an additional workers’
compensation claim in 2001.

Upon review of the case findings, MJM prepared a prosecution package and referred the file to the California Department of Insurance for further review.

Fuentes was arrested in November 2007. During his deposition, it was
determined that he presented a number of misrepresentations with regards to his case including his employment under another name, other employment in 2002, prior injuries and the use of a false Social Security Number.

He was charged with insurance fraud, multiple counts of perjury and grand theft. Fuentes entered a plea and was convicted to four years in state prison and ordered to pay $67,406.57 in restitution.

Source: MJM Inc.