Guilty of Workers' Compensation Fraud

Inflating On-The-Job Injury is Fraud

Post 4841

A jury found Waliullah Nazari guilty of two counts of making false and fraudulent statements for the purpose of obtaining workers' compensation benefits and seven counts of attempted perjury under oath.

In The People v. Waliullah Nazari, D081940, California Court of Appeals, Fourth District, First Division (July 18, 2024) the Court of Appeals affirmed the conviction because surveillance proved Nazari had lied to his physician and insurer.

FACTUAL BACKGROUND

In January 2019, Nazari fell off a ladder at work rendering him unconscious. Hospital records indicated he suffered a broad-based disc herniation between vertebrae 4 and 5, with resulting bilateral/lateral recess stenosis, and sciatica. Nazari submitted a workers' compensation claim to Liberty Mutual Insurance (Liberty Mutual) and received benefits between January 5 and July 19 totaling $99,656.96.

Nazari's treating physician recommended he receive an epidural steroid injection but Nazari's insurance company declined coverage. Nazari saw an orthopedic surgeon for a second opinion about his need for the injection. Among other things, Nazari told the orthopedic surgeon that he needed a walker to stand and could not walk without using a walker. After a physical examination, the orthopedic surgeon recommended that Nazari receive the injection and follow-up with his treating physician.

THE SUB ROSA INVESTIGATION

On April 11, a private investigator working for Liberty Mutual conducted a recorded surveillance session and saw Nazari enter his car and drive away. He saw Nazari return in the car, exit the car, and walk without using a walker and with a normal gait. Later that day, he saw Nazari walk unassisted to a car, remove a folding aluminum walker from the trunk, assemble the walker, and then carry the walker out of view. A few minutes later, he observed Nazari walking slowly with a walker for support to a medical transport van where the driver assisted him into the van. When the van returned to the residence, the investigator watched as Nazari used the walker to slowly ambulate up the driveway and out of view. Nazari was later videotaped carrying a small child in his arms, assisting the child into a vehicle, and driving away.

Liberty Mutual deposed Nazari during the time between the video surveillance sessions and saw conditions different than shown during surveillance. During his second deposition, Nazari claimed, among other things, that he was unable to carry his child and could not drive because he used a walker.

Liberty Mutual closed the investigation and, as required by California statute and regulations, reported the matter to the local District Attorney's Office and California Department of Insurance.

DISCUSSION

The People alleged that Nazari falsely or fraudulently told the orthopedic surgeon on April 1 that he "cannot walk without his walker" (count 1) and "cannot stand without his walker" (count 2).

APPELLATE CLAIMS

To determine the sufficiency of the evidence, courts review the entire record in the light most favorable to the prosecution to determine whether it contains evidence that is reasonable, credible and of solid value, from which a rational trier of fact could find that the elements of the crime were established beyond a reasonable doubt. Nazari contends the sub rosa videos of him walking and standing without the use of a walker after his April 1 visit do not show the falsity of his statements on April 1 because the orthopedic surgeon observed symptoms consistent with a back injury and he presumably received relief from the epidural injection.

There was no evidence in the record to support Nazari's contention he received an epidural injection before he was subject to surveillance. Second, the orthopedic surgeon relied on Nazari being truthful when forming his conclusions.

Surveillance video taken on four subsequent dates showed Nazari walking normally and standing without the assistance of a walker. On two occasions, Nazari walked without the walker and then, minutes later, he required the assistance of a walker when transportation arrived to pick him up.

From the videos, the jury could reasonably conclude Nazari misrepresented his pain level, faked reliance on the walker during his physical examination, and falsely told the orthopedic surgeon that he required a walker to stand or walk.

The Court of Appeals concluded that the jury reasonably concluded that Nazari's statements to the orthopedic surgeon were made for the purposes of obtaining workers' compensation benefits. Accordingly, substantial evidence supported Nazari's two convictions for workers' compensation fraud under section 1871.4, subdivision (a)(1).

ZALMA OPINION

Regardless of the fact that the trial court suspended imposition of sentence and placed Nazari on probation for two years, sentenced him to 365 days in jail as a condition of probation, stayed pending successful completion of probation, and ordered him to pay restitution totaling $53,879.44 at $100 per month he filed this spurious appeal. People who commit fraud, in my experience, are astounded that they did not succeed and have gained enough from their crime to pursue a spurious appeal. The Court of Appeal should have reversed the sentence and made him spend the 365 days in jail.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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