Convicted of WC fraud, man receives jail time, ordered to repay $30K to former Perris employer

PERRIS — A man whose claims of a work-related injury resulted in his eventually being declared permanently disabled was later proven to have grossly exaggerated his claimed injury-related limitations after surveillance video evidence showed “substantial discrepancies” in his claims.

Earlier this month – after a lengthy Workers’ Compensation fraud investigation – Julio Cesar Gomez was arrested on three felony charges related to WC fraud and later pleaded guilty to a single felony count.

As part of his plea arrangement, Gomez was sentenced to three years formal probation, ordered to serve 30 days in a Sheriff’s Work Release Program – with credit for one day served, and ordered to pay reduced restitution fees in the amount of $30,000 to his former employer, Perris-based Silver Creek Industries, Inc.

Gomez initially received medical treatment after reporting he injured his back while bending over and removing nails while on the job. Based on his claims, Gomez was initially given work restrictions that resulted in his being deemed temporarily disabled.

According to Workers’ Compensation fraud investigators, Gomez later “made misrepresentations to medical providers when he presented with limited range of motion and stated he was unable to work due to pain.”

During subsequent medical evaluations, Gomez reportedly denied engaging in any rigorous activities, telling his medical providers he was physically incapable of performing any strenuous tasks as well as many routine, daily activities.

“Based on those misrepresentations, Mr. Gomez was deemed disabled with a permanent disability,” Dalene Bartholomew, Vice President of Probe Information Service, Inc. later explained.

Probe Information Service assisted LWP Claim Solutions during their Workers’ Compensation investigation, after an LWP claim’s adjuster “identified red flags in (Gomez’) claim.”

During LWP’s investigation, Probe Information Service obtained surveillance video footage of Gomez “performing physically demanding activities – including digging holes with a shovel, climbing in and out of the holes, jumping over a fence, installing a roof liner inside a vehicle, carrying a full tool bag, and carrying automotive parts weighing in excess of 15 pounds,” said Bartholomew.

Unaware he had been secretly videotaped performing numerous various tasks and strenuous activities, during a subsequent deposition Gomez “made numerous misrepresentations … including his testimony that he had not performed yard work, worked on any type of automotive repair nor lifted anything exceeding 15 pounds since his date of injury,” Bartholomew explained.

The video evidence was reviewed by a Medical Evaluator who stated there were “substantial discrepancies” between Gomez’ “subjective complaints to medical providers and the surveillance evidence,” according to Bartholomew.

After reviewing the surveillance footage, the Medical Evaluator issued a supplemental report stating that due to the lack of establishing medical necessity and surveillance footage obtained, Gomez fraudulently misrepresented his limitations, thereby allowing him to receive benefits he otherwise would not have been able to.

Based on their investigation and surveillance footage, Probe Information’s Special Investigation Unit later submitted the suspected WC fraud case to the Riverside County District Attorney’s Office for prosecution.

According to the District Attorney’s office, Gomez has already repaid his court ordered $30,000 restitution in full and in advance of pleading guilty, as part of his plea deal for a lowered restitution amount. A Riverside Superior Court record search indicated he has not yet begun paying any of his additional fines or fees totaling $1,536.83, or signed up for his 29 day jail sentence.

 

Contact the writer: [email protected]

Trevor Montgomery, 46, recently moved to Shasta County from Riverside County and runs Riverside County News Source and Shasta County News Source. Additionally, he writes for several other news organizations, including Riverside County based newspapers, Valley News, The Valley Chronicle and Anza Valley Outlook, as well as Bonsall/Fallbrook Village News in San Diego County and The Mountain Echo in Shasta County.

Trevor spent 10 years in the U.S. Army as an Orthopedic Specialist before joining the Riverside County Sheriff’s Department in 1998. He was medically retired after losing his leg, breaking his back and suffering both spinal cord and brain injuries in an off-duty accident. (Click here to see segment of Discovery Channel documentary of Trevor’s accident.)

During his time with the sheriff’s department, Trevor worked at several different stations, including Robert Presley Detention Center, Southwest Station in Temecula, Hemet/Valle Vista Station, Ben Clark Public Safety Training Center and Lake Elsinore Station, along with other locations.