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A thorough investigation on a claim dating back to 1984 helped PMA
expose a Philadelphia workers' compensation attorney and assist in his
recent arrest.
After several years of litigation, an
appellate court ruled to reinstate the claim in 2002 and awarded the
injured worker more than $100,000 in past wage benefits. PMA complied
with the ruling by making past and ongoing indemnity payments. The
payments were made to the injured worker but mailed to his attorney, who
held the funds in escrow on his client's behalf.
In April 2003, the PMA claims team learned
through regular activity checks that the injured worker had passed away.
PMA stopped issuing workers' compensation checks and notified the
attorney of his client's death. Instead of returning the overpayments to
PMA or distributing any insurance benefits to the injured worker's
family, the attorney kept all funds in escrow and eventually expended a
portion of those funds for his personal use.
Once aware that the funds were not returned
or distributed, the PMA claims team also notified our Special
Investigations Unit, a team of PMA specialists who investigate suspected
cases of insurance fraud, and who worked with PMA counsel to prepare and
refer the case to the Pennsylvania Office of the Attorney General.
"At PMA, we are committed to protecting the
assets of our clients and shareholders by actively working with the
National Insurance Crime Bureau and State Fraud Bureaus in the fight
against insurance fraud," says Scott Harrar, Assistant Vice President,
PMA Corporate Claims.
On March 23, 2007, after four years of
extensive investigation, the attorney was arrested and charged with two
felony counts of theft and one count of misapplication of entrusted
property. As a result of these charges, it's likely that the injured
worker's estate will be paid the money it is rightfully owed; PMA will
be reimbursed for any overpayments; and the attorney will lose his
license to practice law in Pennsylvania. This outcome was made possible
by the extensive teamwork between PMA Claims, the PMA Special
Investigations Unit, PMA Corporate and Staff Counsel, and the
Pennsylvania Office of the Attorney General.
And it sends a very resonant message:
Insurance fraud simply doesn't pay.
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