Workers' Compensation News

Insurance Commissioner John Garamendi Announces Sentencing of San Diego Couple for Workers’ Comp Fraud, Conspiracy and Grand Theft

The August 29 sentencing was the result of an investigation by the California Department of Insurance’s (CDI) Fraud Division. Investigators found the Rochas conspired to present false information in Mr. Rocha’s continuing workers’ comp claim and while released on her own recognizance, Mrs. Rocha filed a fraudulent workers’ comp claim on her own behalf.

“By cheating the system, the Rochas defrauded not only their employers, but also their insurance carriers and several medical practitioners,” said Insurance Commissioner John Garamendi. “In the end, it’s simply not worth the risk, nor the jail time to commit workers’ compensation fraud.”   

On May 5, 1996, while working for Aircraft Service International, Mr. Rocha was sprayed with jet fuel as he was trying to stop a fuel leak from a truck. On June 3, 1996 a radiator hose ruptured and sprayed him with scalding water. When Mr. Rocha jumped away from the spray, he landed poorly and fractured his ankle. He suffered burns to 10% of his body. Over the next several years, his condition allegedly worsened physically, mentally and emotionally to the point where the Rochas alleged that Mr. Rocha could no longer care for himself. Mrs. Rocha told doctors that her husband was so disabled by his injuries he was unable to be left alone in the house, drive a vehicle, communicate with others, or take care of basic hygiene needs. Mr. Rocha made minimal statements regarding his condition as he portrayed himself in being severely disabled and unable to communicate except at the most infantile level. Mrs. Rocha was eventually hired by the insurance carrier as his caregiver based on recommendations by Mr. Rocha’s doctors. Due to the Rochas manipulative lies, Mr. Rocha was prescribed a motorized wheelchair, wheelchair ramp, and the evaluation of this vehicle for wheelchair access.

The fraud was discovered in 2001 when Liberty Mutual’s Special Investigation Unit contracted a company to obtain subrosa video proving on tape that Mr. Rocha functioned far better than he stated. The video portrayed him walking without aid, taking out the trash, driving his car, taking his children to school, shopping, and even carrying a large TV on his shoulder. 

This investigation uncovered a string of medical professionals who were deceived by the Rochas’ fraud; upon watching the video, many of the medical providers said they felt betrayed and shocked by the level of fraud and deception the Rochas committed.  

Investigators also discovered that Mrs. Rocha submitted her own fraudulent workers’ comp claim after she was arraigned in this case on May 16, 2006. On the morning of June 20, 2003, while working at Victoria Special Care Nursing Home, Mrs. Rocha claimed to have injured her back in a slip and fall. Her supervisor questioned her injury and believed it did not actually occur. A follow-up investigation by the CDI beginning on January 23, 2004, confirmed this was also a fraudulent claim. On February 15, 2005, Mrs. Rocha was charged with insurance fraud.

On January 18, 2006, husband and wife pled guilty to three felony counts each – conspiracy, insurance fraud and grand theft – and stipulated to pay restitution of $37,988.52. Mr. Rocha dismissed his workers’ comp case with prejudice, and Mrs. Rocha was further charged with perjury for lying about her husband’s condition at her deposition. In addition, Mrs. Rocha pled to one felony count of insurance fraud on her separate worker’s comp fraud case and agreed to pay $10,600 in restitution.

On August 29, 2006, Mr. and Mrs. Rocha were both sentenced for their participation in Mr. Rocha’s fraudulent claim and Mrs. Rocha was also sentenced for her separate fraudulent workers’ comp claim. Mr. Rocha was placed on 5 years formal probation and sentenced to 365 days in jail. Mrs. Rocha was placed on 5 years formal probation for both cases and sentenced to 180 days in custody for each case for a total of 360 days in jail. Both were ordered to pay the $37,988.52 in restitution. Mrs. Rocha was also ordered to pay an additional $10,600 in restitution in her case.

The case was prosecuted by the San Diego District Attorney’s office, Insurance Fraud Unit.

If you have suffered personal injuries or emotional distress due to the negligence of workers compensaton laws in West Virginia, contact our Workers Compensation lawyer now and obtain a free case evaluation.

	Did You Know?
	FECA protects three million Federal workers A COST-EFFECTIVE SELF-INSURANCE SYSTEM FECA protects three million Federal workers from economic hardship due to work injury and illness. Included among the executive, legislative and judicial branch employees covered by FECA are civilian Defense workers, medical workers in Veterans' hospitals, and the 800,000 workers of the Postal Service, the country's largest civilian employer.