Workers' Comp Scams That Push the Limits

ByABC News via logo

March 3, 2004 -- Former Pinellas County, Fla., bus driver Bruce Gilbert is a full-grown man who talked like a 5-year-old, a problem his wife blamed on an "on-the-job" accident.

Over 10 years, the Gilberts collected $774,000 in workers' compensation, enough for plenty of Bruce's favorite foods.

When an insurance investigator from the Florida League of Cities asked what his favorite foods were, Bruce Gilbert responded in a childlike voice: "Pizza and spaghetti." Asked about his favorite books, he said he liked books "about animals." His wife claimed he had a regressive mental ailment that effectively gave him the mental capacity of a child of about 5.

But a private eye investigating Bruce Gilbert's disability found that the ex-bus driver, who now lives in Lake City, Fla., could not only still drive, but was also hunting and playing golf. Police in Columbia County, Fla., nabbed him on the golf course in April 2000.

"You're under arrest for workers' compensation fraud and grand theft," the arresting officer said. "Get out of the golf cart, please."

Gilbert kept up his baby talk even after being cuffed.

"They hurt me," he said. "Mommy. My mommy."

Bruce Speaks in Sentences

Thousands of Americans are getting paid for not going to work through workers' compensation scams that even by the smallest estimates cost $1 billion a year. Workers' comp fraud accounts for about 1 percent to 2 percent of all workers' comp payments, according to J. Paul Leigh, a professor of the University of California, Davis. Some of the cases show just how far people will go to collect.

Numbers are very vague for workers' comp fraud. But the Coalition Against Insurance Fraud says all types of insurance fraud cost the average American household about $950 a year.

When Bruce Gilbert was arrested, so was his wife, Alice. While the Gilberts were alone in the police car, they didn't know investigators had left an audiotape recorder running. As the tape turned, Bruce's vocabulary suddenly expanded.

"Workmen's compensation — those bas-----," he said. His wife suggested he try to fake another injury.

"I want you to have a collapse," she said.

Rather than jail time, the Gilberts were each placed on 15 years' probation and ordered to pay back their ill-gotten gains of $774,000.

Money for Nothing

Millions of Americans claim on-the-job injuries every year, but not all are telling the truth.

Timothy Bernard made a deal in Lowell, Mass., after the evidence against him literally fell from the sky. He was caught on videotape while skyboarding during the same period he claimed to have disabling leg and back injuries. He had to give back $3,000 in workers comp benefits and was given two years probation.

Truck driver Crystal Burrill got caught horsing around in California while she supposedly had spine and neck injuries. A videotape of her taking a spill at a rodeo event forced her to admit she'd committed perjury and lied to get benefits. She got probation and paid back $1,500.

Jim Quiggle of the Coalition Against Insurance Fraud says people have offered numerous excuses when it comes to workers' comp.

"The number one reason that people are committing phony workers' comp claims is the economy," Quiggle said.

Mark O'Brien, director of business development at Claims Resource Inc., a Florida-based investigation firm, says some workers don't give it too much thought.

"They can be your average person just thinking that it's an easy way for them to make some money," O'Brien said.

"Do they realize what kind of a crime they're committing? I don't think they think about it," he said.

From Bad Shoulder to a Wrestling Ring

Leroy Howard of St. Petersburg, Fla., hurt his shoulder moving heavy furniture and received about $5,000 in workers' comp.

But private investigator Mike Martof found the 6-foot-2, 250-pound man working in the ring as a professional wrestler known as "The Navy Seal." The Seal was no match for the private eye's video camera, which revealed that Howard's "injury" did not appear to be hindering his performance.

"Not at all," Martof said. "Not whatsoever."

When speaking to an ABCNEWS correspondent, Howard tried to explain himself.

"What I did was wrong, but I didn't see it as being totally wrong," he said.

But when Howard fought the law, the law won.

He made a plea deal after being charged with workers' comp fraud and grand theft in connection with work he was doing without reporting it.

He pleaded guilty, got probation and agreed to make good on the money.

No Money-Back Guarantees

The Coalition Against Insurance Fraud says that when there is no prosecution of workers and no restitution, there's no deterrent for scammers, who end up keeping whatever they can get away with.

Employees aren't the only ones who commit workers' comp fraud. Some employers also do it sometimes by understating the number of workers they have on the payroll in order to get away with paying lower premiums.

According to one national study by CAIF, the state of Florida leads the nation in convictions for insurance fraud. The scammers are usually ordered to pay the money back. But collecting it isn't always that easy.

Officials in Florida say the Gilberts have paid back only about $4,000 of the $774,000 they were ordered to return.

When Good Morning America knocked on the Gilberts' door and asked about the money, Alice Gilbert slammed the door and said, "Go away!"

Meanwhile, Howard, the wrestler, said getting caught actually helped him focus on a new direction. He is in college and looks forward to life outside the ring.