A 34-year-old window installer filed a workers’ compensation claim with a client of Argus West after sustaining a lower back injury while loading materials. Though he sought treatment privately, he didn’t report the injury to his employer until months after date of injury. Despite being released to modified duties, the claimant continued to report significant pain and inability to work.

After the claimant submitted a letter to the insured stating he could no longer work, the Argus West surveillance team began an investigation. Over two days, the claimant was seen performing activities inconsistent with his claims of incapacitation—visiting Home Depot, loading supplies, and doing construction work at a private residence. During the claimant’s deposition and Qualified Medical Examination (QME), the claimant denied any work activities, continuing to claim severe pain.

However, the QME reviewed the surveillance footage provided by Argus West and concluded the claimant exaggerated his symptoms, reducing his permanent disability findings and removing work restrictions. The claimant was no longer considered a qualified injured worker, and he lost eligibility for a $6,000 vocational rehabilitation voucher.

The Argus West Special Investigations Unit (SIU) submitted a detailed documented referral to the Los Angeles County District Attorney’s Office. Criminal charges for workers’ compensation fraud were filed and the claimant was convicted and ordered to pay restitution of $2,758.83 to our client, which was paid in full!

This case highlights the importance of diligent investigation and medical review in uncovering fraudulent claims. Through thorough surveillance and expert analysis, our client successfully protected its interests and held the claimant accountable for his actions.