Adam Walser of ABC7 News Denver reported last month that Brad Culpepper, former defensive tackle in the NFL, has been accused of workers compensation fraud after appearing on the popular reality show, “Survivor” with his wife.
Culpepper’s career shifted from football player, to personal injury attorney, to reality TV competitor in 2013.
What sparked the accusations? According to ABC7 News Denver, “In 2010, Culpepper filed a workers comp claim in California, where there was no statute of limitations and any player who had ever played a game in the state was eligible to file.” After Culpepper’s claim was filed, California legislators have since changed the law to permit players of teams based in California to file claims.
The NFL Players Association advised former players to file claims, and the NFL and their insurers have paid out hundreds of millions of dollars.
According to Christopher Fusco, an attorney who happens to represent insurance companies while writing a blog featuring legal issues in sports, says “I think that he’s a person they’d like to make an example out of.”
Insurers for the NFL have filed a lawsuit, noting that Culpepper was declared 89% disabled in 2010 and settled his claim for $175,000, a mere 2 years before earning a black belt in mixed martial arts in 2012 and 3 years before appearing on “Survivor” with his wife, Monica in 2013. The suit also highlights that Culpepper claimed he lost quality of life. Culpepper told doctors that “pain interfered with his daily activities, concentration and thinking a lot, or most of the time.”
“He said he can’t do recreational activities,” states Fusco. “He’s limited in what he can do, he has pains every day of the year. And now he’s living on a desert island and he’s swimming and killing fish with his hands and eating bamboo, so that’s going to upset the insurer.”
Culpepper’s attorney, Scott Shutzman, is planning on asking the court to throw out the case, as his client was legitimately injured and he should have been awarded compensation. “There were injuries that were confirmed by no less than 14 or 15 MRI’s, various x-rays, legions of doctors,” states Shutzman. His attorney feels Culpepper had answered all questions honestly.
Shutzman also argues that, “there’s nothing that I’ve seen that says an 89 percent disability rating says you can’t be on a TV show, or do an MMA workout.”
Also worth mentioning, according to ABC7 News Denver, is that “Culpepper was the lead plaintiff in the recent NFL brain jury lawsuit, which was tentatively settled for $765 million.”
Employees, employers, and healthcare providers alike commit workers compensation fraud. Below, a Texas Workers Compensation Blog put together a comprised list of the top 10 workers compensation fraud cases in the year 2012, which cost America $97,446,500 (making it much easier to understand how insurance fraud costs us BILLIONS each year).
1. “Operation Dirty Money” (Florida)
Owner of the Oto Group, Inc. and 10 Shell companies, Hugo Rodriguez, along with seven accomplices, shafted over $70 million in undeclared payroll using several different money services. Rodriguez avoided paying workers’ compensation premiums and coverage using his 10 Shell companies, while scamming legitimate businesses and putting the lives of countless employees at risk.
2. 41,247 Private Employers Failed to Report Payroll Data (Ohio)
41,247 private businesses/companies in Ohio violated state law by failing to report and pay workers’ compensation premiums, which totaled approximately $5.6 million. And the remaining businesses that actually paid their premiums? Their costs were raised.
3. Employee Leasing Companies…too Good to be True? (Texas)
Texas based company, Jackson Brothers Hot Oil Service, decided to hire a staffing agency back in 1999 to funnel in some temporary workers. The staffing agency was required to purchase workers’ compensation for the workers they provided and took out a $4,100 policy. When one of the agency’s workers was severely injured from an explosion, the agency declined to pay the medical bills that ensued. The injured employee and the Jackson Brothers sued the staffing agency for fraud and won $4,466,500 in 2012.
4. Business Owner Under-Reports Payroll by $3.5 Million (California)
Construction business owner, George Osumii, lied to the State Compensation Insurance Fund by under-reporting his employee payroll by $3.5 million from the years 2001 to 2006. Osumii avoided paying $814,000 in premiums.
5. Roofing Company and Owners Sentenced for Labor Violations (Massachusetts)
Newton Contracting Company, Inc and its owners labeled half of their employees as subcontractors (even though they weren’t) and concealed over $3.4 million worth of payroll during annual audits. The Massachusetts Insurance Fraud Bureau discovered the fraud.
6. Like Father, Like Son (California)
Business owner, Steven Morales, hid his payroll to avoid paying workers compensation premiums that totaled approximately $3.1 million. Morales was convicted and sentenced to seven years in prison. Morales’ son Brian was also convicted and sentenced to four years in prison.
7. Construction Company President Accused of Payroll Fraud (Florida)
The president of Navarre Industries, Inc., Randall Seltzer, was charged with workers’ compensation fraud (among several other felony counts) for under-reporting payroll to his insurer according to an investigation conducted by Florida’s Department of Financial Services Division of Insurance Fraud. Seltzer is facing up to 30 years in prison and restitution payments totaling over $2.9 million.
8. Fake Business Owner Fabricated Insurance Certificates (Florida)
Yucet Batista focused his entrepreneurial efforts in creating a bogus company, obtained workers’ compensation benefits, and “rented” the benefits to subcontractors for a fee. Batista helped the uninsured subcontractors avoid paying $2.1 million in premiums by providing more than 250 fraudulent certificates of insurance.
9. 12 Audits Uncovered $1.2 Million in Workers’ Compensation Violations (Massachusetts)
The Boston Marriot renovation project was enormous, and so were the violations of unreported wages.
Between seven companies, there were $584,249.00 in misclassified 1099 wages and $584,287 in unreported W-2 earnings, totaling $1,171,536.00. Six of these companies registered workers as contractors instead of employees.
10. Owners of Historic Inn Face Fraud Charges (California)
Sanjiv and Neelam Kakkar, owners of historic Brookdale Inn and Spa, are facing charges for falsifying wage information to their insurer to lower insurance premiums. Over a several year period, the Kakkar’s paid approximately $800,000 less in premiums than they should have.
According to the acting Attorney General, John Hoffman, 42-year-old Maurice Douglas of East Orange, NJ has been charged with insurance fraud, attempted theft by deception and false reports to law enforcement last month.
NBC Philadelphia reported that Douglas claimed he was carjacked in March of 2014 by two men, one with an assault rifle, who “stole his 2007 Mercedes S-550 as he exited the vehicle at his house.” Douglas also noted that one of the alleged carjackers robbed him of his cell phone, and one other vehicle was used in the escape.
Douglas alerted the East Orange police that same day, along with his insurer in an attempt to collect approximately $38,500.
Police found Douglas’ 2007 Mercedes in an abandoned lot the next day. According to NBC Philadelphia, the car had suffered significant damage with “its headlights and taillights stripped with evident damage to its body and windshield.”
Douglas revealed the alleged carjackers’ escape route in which police retrieved time- and date-stamped surveillance video. The ensuing investigation showed no video evidence of Douglas’ Mercedes or the other getaway car taking the alleged escape route.
If Douglas is convicted on all counts, he could be facing 17 years in prison.
Whether the claim is considered workers compensation or auto liability, the staff at ICU specializes in social media searches to ensure our clients get a clear and true snapshot into the lifestyles and daily activities of each individual subject. Is your subject exaggerating injuries or performing beyond their limitations? The evidence on your subject’s social media accounts can have a major impact on the outcome of a claim, but only if you know it!
Below is a list comprised of sites that the staff at ICU is proficient in searching. The sites include, but are CERTAINLY not limited to:
- Black Planet
Additionally, a good private investigative firm will not only search these sites for your subject (some stay off social media and are actually smarter than they look), but they will search for family, friends, and associates online, as well. If your subject isn’t active on social media, there’s a good chance their family and friends are. We have found countless photos and posts of claimants on their loved one’s accounts!
Shawna Lynn Palmer was arrested last month for workers compensation fraud…all thanks to her public Facebook posts!
The beauty pageant contestant participated in the 2014 Miss Toyota Long Beach Grand Prix Beauty Pageant, according to ABC7 Los Angeles. Palmer is featured in a YouTube video with the other pageant contestants clad in bikinis and high heels, strutting onstage, up and down the catwalk.
Palmer also posted pictures and videos of her and fellow contestants competing in pageants and other events on her personal Facebook page.
However, during these events, Palmer was collecting workers compensation benefits from her previous employer, Stater Brothers, for fracturing her toe on the job and claiming she wasn’t able to work (but she could walk in heels…).
Byron Tucker, deputy commissioner at the California Department of Insurance says, “She went to her doctor (and) told her employers that she couldn’t work. Had multiple visits to her doctor, was referred to a specialist, but all the time claiming she couldn’t wear a shoe, she couldn’t stand for long periods of time. She had a lot of difficulty walking.”
Investigators took to social media to help them make the case.
“You can’t post things to social media while claiming that you’re legitimately injured, taking a check from the state for worker’s compensation benefits and expect not to get caught,” Tucker said.
The beauty queen faces up to a year in jail if convicted. We hope she looks good in orange!
The staff at ICU Investigations is currently working on an almost identical case featuring a woman claiming injuries sustained in a motor vehicle accident, while competing in one of the biggest pageants in the country! We will keep you posted!
According to Jennifer Peltz of Insurance Journal, New York prosecutors have issued just under 400 search warrants to Facebook to pull data including postings, friend lists, photos, and private messages as part of a disabilities benefit fraud investigation geared toward police and fire retirees. The case went public this past June, as Facebook has never received this overwhelming number of search warrants all at once.
Facebook is fighting back, and lawyers for other social media sites such as Foursquare, Kickstarter, Meetup, and Tumblr are allies. Facebook also has support from the New York Civil Liberties Union and the American Civil Liberties Union.
Richard Holwell, attorney representing the additional four tech companies joining alliances with Facebook, says, “With the burgeoning tech industry in New York, the need to protect the privacy of users has never been greater.”
Although some of the users that have been targeted have not yet been charged and may never see that day, prosecutors see it differently. Joan Vollero, spokeswoman for the Manhattan district attorney’s office, says, “Prosecutors have a right and a responsibility to collect evidence in criminal cases, wherever that information is stored.”
Out of the 381 warrants approved by a Manhattan judge in July of 2013, “some 134 people have been charged so far, more than half have pleaded guilty, and prosecutors have said more could be implicated,” according to Insurance Journal. The judge was provided with 93 pages of reasoning and details for all accounts targeted in the investigation.
The retirees were allegedly coached into claiming they were “too psychologically devastated to work. Instead, they led robust lives – some flew helicopters, traveled overseas, did martial arts, went fishing – and sometimes aired the alleged proof of their active lives on Facebook,” according to prosecutors.
Facebook is appealing the court order, even though they have already provided the information, as they feel that the prosecutors are reaching for a case. Insurance Journal says, “Facebook has said prosecutors cast too wide a net. Their campaign amounted to the online equivalent of searching ‘an entire neighborhood of nearly 400 homes.’”