KLAS-TV Channel 8 News Las VegasI-Team: Workers' Comp Scammers Caught in the Act
LAS VEGAS -- On a mild February morning a few years ago, Aurelio made a determined, steady climb up a ladder to his roof. He paused, grabbed a long roller and applied new sealant by bending over for hours on end.
The trouble for Aurelio was the camera across the street, silently recording his every move. It caught him defrauding Nevadans with his clearly false workers' compensation claim.
"He starts getting underneath areas, under the air conditioning," says Ranney Pageler, narrating the footage caught by private investigators.
Aurelio said he had back and shoulder problems, none of which appeared on camera.
Pageler's company, Employers, represents companies in 30 states. Their workers' compensation department follows cases that come in from neighbors, employers or hotlines. Pageler says they also data mine to make sure money is going to the right patient.
"We look through medical data to see that people are getting benefits, but they never go to the doctor," he said.
Employers shared multiple adjudicated cases with the I-Team. Aurelio signed a confession after being presented with the evidence of his rooftop ascent and flexible repair job.
Another dealt with a truck driver mechanic. Rodger claimed he had permanent total disability and was due $1,400 every month until he died. As Pageler cued up the video, he pointed out Rodger had an injured back. Yet as the screen flickered to life, Rodger was on his knees, leaning over time and again, twisting and fighting with faulty car brakes in his driveway.
"This is several hours in the heat," Pageler said. "He's doing the same job that we are paying him not to do."
"If you want a criminal history, keep doing what you're doing," warns Brian Kunzi, the director of the Attorney General's Workers' Compensation Fraud Unit.
Kunzi battles these potential scammers in court, pulling out medical files to prove inconsistent statements.
"It's not hard to make the argument that was fraudulent," Kunzi says confidently.
He says the video makes all the difference, however, often forcing confessions on the spot.
"You just see the jury kind of look at the video, look at the defendant, look at the video, look at the defendant, and you can just see," Kunzi says.
Kunzi and Pageler say combating this kind of fraud helps Nevadans pay less nearly everywhere they shop or eat.
"If you're ripping off the system, you're adding to the cost and that's got to come out of somewhere," Pageler says.
More claims lead to higher premiums, and businesses pay extra, passing the costs along to consumers.
Immediately after a conviction or confession, Nevada law stops the lifetime payment on claims. In other states, it takes a separate court hearing and during the meantime, fraudulent patients can continue receiving money.
"When we do get a criminal conviction in the state of Nevada, we're able to remove a lot of that financial impact of that claim from the rate-making system," Pageler says.
Many judges only sentence the scammers to probation, comfortable that the fraud has stopped. Little consolation when the camera lens can end a case without ever going to court.
