Department of Insurance investigation leads to multiple counts of insurance fraud and perjury
Aug 3, 2021 – LOS ANGELES – Frank Simplicio, 45, of Porter Ranch, has been arraigned on multiple counts of insurance fraud and perjury. Insurance Department investigation revealed Simplicio allegedly claimed to be too injured to work in order to collect over $ 50,000 in disability benefits from an employer’s insurance company while working illegally for other employers.
On May 2, 2017, Simplicio, while working as an environmentalist, filed a claim with his employer’s insurance company alleging cumulative trauma to his neck and back. He also claimed that the work resulted in his diabetes, internal injuries and trouble sleeping. He reported the dates of his cumulative traumatic injuries from July 19, 1996 to May 29, 2015. The claim, however, was filed two years after his alleged injuries.
The investigation revealed that Simplicio received total temporary disability benefits from February 20, 2018 to September 19, 2018, totaling $ 32,051. He also received permanent disability benefits from September 20, 2018 to December 13, 2019, totaling $ 18,610.
In a deposition, Simplicio said he was a landscaper, but had not worked since the date of his injury. However, surveillance footage in October 2018 and February 2019 revealed that Simplicio was actively working as a landscaper. A search warrant was then issued for Simplicio’s bank account statements, which revealed he had collected customer checks from June 2015 to December 2019, totaling over $ 450,000. This does not include possible income from direct deposits through his account.
When told what the investigation found, the qualified medical examiner who handled Simplicio’s claim said Simplicio lied and if they had known about his abilities and concurrent employment, they would not have him. never placed on temporary total disability. Simplicio’s alleged actions resulted in him receiving $ 50,661 in unearned disability benefits. The total loss to the insurance company in this case was over $ 100,000, which includes unnecessary medical, investigative and legal costs.
Simplicio attended the Los Angeles Superior Courthouse and was arraigned on July 29, 2021. The Los Angeles County District Attorney’s Office is pursuing this case.
The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $ 340 billion in premiums each year in California. Since 2011, the California Department of Insurance has received more than 1,000,000 calls from consumers and has helped collect more than $ 469 million in claims and premiums. Please visit the Department of Insurance website at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Helpline at 800-927-4357. Teleprinter (TTY), please dial 800-482-4833.
Source: CA. Insurance Department