The claimant suffered a compensable injury. She told the claims representative that the injury resulted in an inability to work. Relying on the statements of the claimant, the respondents began paying temporary total disability (TTD) benefits. Despite claimant’s statements, she was actually working two jobs while also cashing TTD checks. In total, the claimant received an improper amount of $61,560.72 in TTD benefits. Throughout the time period while she was receiving TTD, the claimant repeatedly denied or otherwise ignored inquiries regarding her work activity. Surveillance later confirmed claimant’s employment and receipt of income simultaneous with her receipt of TTD.
Respondents applied for hearing and the ALJ determined the claimant fraudulently obtained TTD. The ALJ ordered the claimant to repay the ill-gotten TTD at a rate of $500 per month for 84 months. Factoring into the ALJ’s decision was the fact that the claims representative continually sent periodic inquiries to the claimant regarding the receipt of wages, which claimant consistently denied.
Claimant appealed, requesting that the repayment be lowered from $500 to $250 per month. The Panel affirmed the ALJ’s order, finding that the ALJ did not abuse his discretion regarding the rate of repayment.
Claims Representation Tip:
For claims where there is extended payment of temporary indemnity, it is advisable to send periodic written inquiries to the claimant to properly document the claimant’s representations regarding receipt of income. The documentation can be key to prove an overpayment, and to support an appropriate rate of restitution.
Jaramillo v. Integrated Healthcare Staffing, LLC, W.C. No. 5-002-486-01 (ICAO Oct. 1, 2018)
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