December 16, 2024 | Sacramento, CA — MedLegalNews.com — In a decisive case highlighting the ongoing challenges of workers’ compensation insurance fraud, authorities sentenced Gustavo Cisneros for defrauding his employer and their insurance company out of more than $70,000. The Sacramento County District Attorney’s Office Insurance Fraud Unit announced that Cisneros pled no contest to felony insurance fraud.
Sentencing and Restitution
The Honorable Shauna Franklin handed Cisneros a sentence of 150 days in county jail, two years of formal probation, and restitution payments to the victim in an amount still to be determined. This case underscores the severe consequences individuals face for manipulating the workers’ compensation system.
Fraudulent Claims Exposed
In 2016, Cisneros reported injuries from a fall while working as part of a construction crew. However, investigators determined that Cisneros exaggerated his injuries and their limitations. Multiple doctors treated him, but he frequently changed providers and refused to follow treatment plans.
Broader Impact of Workers’ Compensation Insurance Fraud
Cisneros’ fraudulent activities caused immediate financial harm to his employer and the insurance provider, burdening them with over $70,000 in costs. These fraudulent claims not only drive up insurance premiums for other employers but also congest the workers’ compensation system, delaying medical care and financial support for legitimately injured workers who depend on these resources.
According to the Sacramento County DA’s Office, addressing such cases remains a high priority as these schemes harm both employers and genuinely injured employees.
To read more about ongoing efforts to combat workers’ compensation insurance fraud, visit the Sacramento County District Attorney’s Office.
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FAQs: Workers Compensation Insurance Fraud
What is workers compensation insurance fraud?
Workers compensation insurance fraud occurs when individuals submit false or exaggerated injury claims to receive payments or benefits they are not entitled to.
What penalties can result from workers compensation insurance fraud?
Convictions can include jail time, probation, restitution, and fines, as illustrated by the 150-day sentence and probation given to Gustavo Cisneros.
How does workers compensation insurance fraud affect employers and employees?
Fraud increases costs for employers and insurance providers, raises premiums, and delays benefits and care for legitimately injured workers.
How can employers and insurers prevent workers compensation insurance fraud?
By maintaining thorough documentation, verifying injury claims, monitoring treatment compliance, and reporting suspicious activity to insurance fraud units.