POUGHKEEPSIE, N.Y., August 3 – Compensation Risk Managers, LLC (CRM), an administrator for workers compensation group self-insurance programs has announced the successful identification and prosecution of a fraudulent workers compensation claim, involving a claimant who purported to be disabled but was instead working as a bartender and bouncer.

The announcement comes in the wake of New York Insurance Department Superintendent Howard Mills criticism regarding fraud-fighting efforts in the workers compensation sector.

According to CRM, the claimant alleged a total disability more than 13 months after the original injury date. The claims adjuster assigned surveillance through Terrier Claim Services to verify the claimants status, and found that he was, in fact, working during this time.

The claims adjuster filed a formal fraud complaint with the Workers Compensation Board, CRM said, leading to the claimants formal testimony before the board, wherein CRM stated that the claimant and his witness (owner of the bar where claimant was found working) perjured themselves and were ultimately found by the law judge to lack credibility. Though the claimant appealed the decision, a panel of senior law judges upheld the original ruling, thus barring the claimant from benefits from February 2004 to present, CRM noted.

While [this case] is a civil violation rather than a criminal violation, it is nonetheless a very successful outcome on a fraudulent claim, said Martin D. Rakoff, co-CEO of CRM. It represents many years of hard work and determination by our claims department on behalf of all our members.